Essential Questions and Education for Medication Therapy Management (MTM)
Medication therapy management requires a systematic approach that includes comprehensive medication review, patient education, and adherence monitoring to optimize health outcomes and reduce medication-related problems.
Essential Questions for MTM Assessment
Medication Profile Review
- Review and update all medical problems (cardiovascular and non-cardiovascular) 1
- Verify all current medications including:
- Prescription medications
- Over-the-counter medications
- Supplements and herbal products 1
- Ask specific adherence questions:
Medication Use Assessment
- Assess for duplicate therapies across medication classes 2
- Identify medications with high anticholinergic burden that may impair cognition or increase fall risk 2
- Check for medications that may worsen existing conditions (e.g., NSAIDs in heart failure) 2
- Evaluate dosing schedules and identify opportunities for simplification 2
- Ask about medication storage and administration techniques 1
Patient-Specific Factors
- Assess patient's understanding of each medication's purpose 1
- Identify barriers to adherence:
- Evaluate patient's support system and caregiving arrangements 1
- Assess for cognitive impairment that may affect medication management 1
Essential Education Components
Medication-Specific Education
- Provide written educational materials in the patient's preferred language 1
- Review the purpose of each medication and its relationship to the patient's conditions 1
- Explain proper administration techniques:
- Timing relative to meals
- Whether medications can be crushed or split
- Safe handling procedures 1
- Discuss potential side effects, when they might occur, and how to manage them 1
- Explain drug-drug and drug-food interactions 1
Adherence Support
- Provide medication calendars with specific dates for taking medications and refill dates 1
- Discuss use of pill organizers or other adherence tools 1
- Explain the importance of taking all medication doses as prescribed 1
- Discuss how missed doses should be handled 1
- Establish emergency and non-emergency contact points for medication questions 1
Follow-Up and Monitoring
- Explain which clinical parameters the patient should monitor (e.g., blood pressure, blood glucose) 1
- Identify symptoms that warrant contacting the healthcare team 1
- Establish a follow-up plan for monitoring adherence and toxicity 1
- Schedule comprehensive follow-up within 7 days of dispensing new medications 1
Implementation Strategies
Documentation
- Document all MTM interventions in the patient record 1
- Record patient's understanding of the medication regimen 1
- Document adherence assessment findings 1
- Note any identified drug-related problems and interventions 3
Collaborative Approach
- Involve clinical pharmacists and nursing staff in medication reviews 2
- Include patients and caregivers in decision-making 2
- Coordinate with prescribers when medication-related problems are identified 3
- Leverage electronic health records to identify potential drug-drug interactions 1
Common Pitfalls and Caveats
- Avoid medical jargon when explaining MTM services - patients often don't understand the term "medication therapy management" 4
- Don't rely solely on patient self-reporting for adherence assessment - consider using multiple assessment methods 1
- Avoid judgmental attitudes when discussing adherence issues, which can decrease patient honesty 1
- Don't assume patients understand their medications' purposes or importance - verify comprehension 1
- Be aware that provider estimates of adherence are often unreliable 1
- Remember that medication lists from electronic health records are frequently inaccurate 1
By implementing these comprehensive MTM practices, healthcare providers can help optimize medication use, improve patient outcomes, and reduce medication-related problems.