MEDICATION THERAPY MANAGEMENT
Anantha Naik Nagappa, Uday Venkat Mateti and Asim Priyendu
Manipal College of Pharmaceutical Sciences, Manipal University, Manipal-576104, India
What is Medication therapy management?
Medication Therapy Management (MTM) is team effort of healthcare professionals to ensure expected outcomes in a systems approach. The Prescription is an abbreviated communication written by doctors to pharmacists to make the medicines for dispensing to the patients. Although doctors instruct the patients regarding medicines, the final say should come from the pharmacists who have to make a pharmaceutical care plan and explain to the patients in detail regarding disease, drugs and life style. This was further extended when the care plan becomes a process of managed system. The MTM involves the pharmacist's interventions in carrying out the process of therapy under direct supervision.
The MTM aims at giving the optimized outcomes in terms of Pharmacoeconomic, clinical and quality of life in a therapeutic care plan on one to one patient basis.
The MTM Process involves following process which ensures the expected outcomes in a therapeutic situation. System approach comprises of logical proactive cycle of entire treatment process. It begins with medication therapy review followed by documenting personal prescription record. The next step involves making a customized medication action plan and administering to the patients. It also involves periodical review and identifying the gaps which are responsible for poor outcomes. The Pharmacists are supposed to identify and refer the issues of diagnostic and prescribing to the doctors. The issues of drug administration and nursing are to be referred to nursing staff. Any matter related to medication is to be resolved by pharmacists himself. The above process documentation and follow-up is the responsibility of Pharmacist. Figure 1 represents the process and work flow of MTM Services.
Figure 1: Process and work flow of MTM Services
Process and work flow of MTM Services:
The MTR deals with systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems (MRPs), developing a prioritized list of MRPs, and planning and implementing to resolve. The patient or attendant along with pharmacist are involved in MTR, and administered on one to one basis. This results in early detection of MRPs and thus can avoid emergency admissions to hospitals due to ADRs crisis further it can save money and effort of all stakeholders in chain.
B). Personal Prescription Record (PPR):
At the end of a complete medication therapy review, the patient should receive his/her documents containing detailed information about his/her medications (prescription and non prescription medications, herbal products, and other dietary supplements). The PPR is created with a purpose to help patients in self-medication management. The maintenance of the PPR is a collaborative initiative among patients, pharmacist, doctor, and other healthcare professionals. Patients should be supported to maintain and update the PPR. As this would helps in future consultations with precise medication history, which may be difficult if healthcare professionals has to make it afresh on each visit.
The medication action plan (MAP) is a patient-centric document which consists of prioritized list of instructions for the patient to use in tracking progress for self-management and health concerns. The MAP gives a summary of background of the patient which can be indicative of important medication plan for the future. The therapeutic basis of prescribing becomes clear and rational as it contains the analysis and reasoning of medication usage. The MAP is completed by the patient working collaboratively with the pharmacist and other health care provider. In institutional settings the MAP could be established at the time the patient is discharged.
The pharmacist provides consultative services and intervenes to address MRPs. Interventions may include working with the patient to address specific medication problems and/or collaborating with other health care providers to monitor or resolve existing or potential MRPs. Interventions should be made in consultation with doctors if it is a pharmacy related issue otherwise the problem should be referred to the concerned health care professional for resolving. It is not a practical to identify and resolve all the MRPs in a single visit because the MRP may appear any time during the course of treatment and disappears on its own. Hence it becomes essential to provides constant and continuous care process during entire treatment.
Documentation is the important element of the MTM service model. The pharmacist documents all the services and intervention(s) performed in an appropriate manner for evaluating patient progress and aiding the billing process. MTM documentation may be become mandatory as it may be required for the regulation adherence and compliance review of patients specific further record containing the details of services provided. For example the SOAP [S = subjective observations, O = objective observations, A = assessment and P = plan] analysis. Preferably electronic documentation is popular due ease in handling and data mining.
The pharmacists are key persons to administers, coordinate and document the MTM process. The pharmacists should interact with the patients for explaining the details of therapeutic plan. They should communicate with doctors and nurses regarding the outcome and the bottleneck in successful implementation of therapy plan.
The MTM being a system approach brings out the reasons for deviations in therapy process leading to varied outcomes. It studies and administers stepwise instructions leading to clarity of therapeutic plan to the patients and health care professionals. The goals of the therapy are well defined at the beginning of the MTM helps one to make continued corrective process along with the treatment. Further documentation of MTM allows one to conduct a retrospective analysis which can help in further improvement in MTM. The MTM advocates the team work of all the health care professionals focusing on patient centric care. It also examines the rationality of prescription and supports evidence based practice.
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