What I learned week 8
What I learned week 8
Courtney Doyle-Campbell
This
week, Miss Doyle-Campbell educated us about MTM, Medication Therapy Management.
MTM is a program that helps you and your doctor make sure that your medications are working
to improve your health. A pharmacist or other health professional will give you
a comprehensive review of all your medications and talk with you about. MTM
also fosters the relationship between physician and pharmacist because their
services are depended upon pharmacists working collaboratively with physicians
and other healthcare professionals to optimize medication use in accordance
with evidence based guidelines. MTM services further demonstrate the push we’ve
been seeing in the healthcare realm towards a “patient-oriented” focus. In
fact, in the 1950’s pharmacists couldn’t even talk to patients, and it took
until the 1960’s engaged in more dispensing as well as patient care. A pharmacist or other health
professional will give you a comprehensive review of all your medications and
talk with you about:
·
How well your medications
are working
·
Whether your medications
have side effects
·
If there might be
interactions between the drugs you're taking
·
Whether your costs can be
lowered
· Other problems you’re having
In
addition, The MTM service model in pharmacy practice includes the following
five core elements:
· Medication
therapy review (MTR)
· Personal
medication record (PMR)
· Medication-related
action plan (MAP)
· Intervention
and/or referral
· Documentation
and follow-up
In
years past, and even currently to his day, there has been this disconnect
between services that a pharmacist is able to provide and compensation.
Pharmacists are strictly paid for getting prescriptions in and out of the
pharmacy, counseling or MTM has been free.
Izabela
Collier
The basis of Izabela Collier’s
presentation was the ever-changing relationship between pharmacist/physician
and patient; from her own personal experience at Baystate hospital. She
emphasized the importance of verbal communication as well as nonverbal communication
between patient and pharmacist. Nonverbal communication is just as important
and may be argued even more important than verbal.
Question 1 : Even Courtney Doyle-Campbell talked about how
important listening was; when writing down questions for her, I was the one to
ask something like, “From your years in pharmacy school, was it most important
thing you’ve learned that you use in your day to day work life?” and her answer
was to listen to your patient because they can provide you the answers you need
to make sure they are taken care of and treated in the right and effective
manner. If pharmacists, and physicians fail to listen, there can be lethal
consequences. Take for example the Josie Sorell story. Josie came to the hospital
with burns, the medical team at the Johns Hopkins Children's Center constantly
monitored Josie's mixture of drugs, watched for signs of infection, performed
skin grafts to repair the damage from her bathtub accident. While she was
recovering, her mother noticed some strange behavior. Every time Josie saw a
drink, she screamed for it... Josie’s mother asked the nurses about this and
was assured it was normal, although it was not something Josie had ever done.
Eighteen-month-old Josie King died in her mother’s arms two days later. She had
a hospital-acquired infection, was severely dehydrated, and had been given
inappropriate narcotics. If only the doctors had stopped and listened to
Josie’s mother and understoof this was not a normal action for Josue, they
could’ve saved her life. There were red flags everywhere, simply checking the
narcotics again to make sure they were administering the right ones, could’ve
saved Josie’s life. As Izabela Collier explained it, “We call it the Swiss
cheese. There are many holes, potential
places for errors to get through. When
all the holes line up, the errors get through the system and patient dies.”
There are in fact many common types of errors and verbal communication with
providers:
· Distractions and interfering noise
· Heavy accents/language difference
· Use of confusing medical terminology
· Speaking too rapidly
· Sound-alike medications
· Sound-alike numbers
· Workload issues
· Third party communications: “whisper down the
alley:
Question 2: Another question I had asked Courtney Doyle
Campbell was “what benchmarks has MTM provided to prove that this system is
working?” She advised that adherence isn’t a big one, that it’s hard to get a
patient to adhere to their medication but its ultimately hard to change
behavior. But, she added MTM has helped regulate blood sugar levels and blood pressure
in hundreds even thousands of people. Heart attacks have also lowered, as well
as quality of life. And lastly, doctor’s visits have lowered, which is almost
an indirect correlation of patient health. The higher the patients’ health, the
lower the number of doctor visits. I considered some more key statistics and
pulled data from the articles to draw some conclusion about the effectiveness
of MTM programs. “137, 870 MTM services helped patients avoid unnecessary
healthcare utilization (doctor appointments, hospitalizations, ER visits and
life-threatening events).”
Question 3: Izabela Collier talked so much about the
importance of listening to your patient and asking appropriate questions, and
working collaboratively with the pharmacist, physician and patient for
effective goals, I wondered if the patient has any reviews of their quality of
care. I asked how often do patients usually get to survey or review their doctors
and staff, and she said mostly everything the hospitals will hand out a survey
and they encourage the patient to fill it out so the hospital can improve in
the long run. Some of the most important factors that make a patient stay
favorable is having a doctor and staff that a. listens, b. treats them nicely
with warm tones and c. improved health. I considered more about what specifically
makes the patient leave a hospital happy. A new study
shows that physicians with mindfulness skills communicate well with patients,
and provide better quality care. The study, held at Mary Catherine Beach of
John Hopkins University gave out questionnaires to HIV patients across the US.
They recorded the physicians interacting with their patients and interviews
them to get their perspective of their clinician’s care. When the researchers
analyzed the audio recordings of the clinician-patient interactions, they found
that clinicians who were higher in mindfulness had more patient-centered
communication—that is, they spent more time building rapport with their patient
and talking about the patient’s experience, rather than focusing solely on the
biomedical aspect of the patient’s illness. They also had a more positive
emotional tone, spent more time in visits with their patients, and had patients
who rated the quality of their communication and care more highly. These
attributes contribute to quality of care, many of which Izabela Collier spoke
about:
· Building rapport
· Emotional tone
· More face to face tome
· Effective communication
· Listening
Question 4: Another thing I was curious about was the
economic future of MTM programs relating to Medicare and the trump administration.
Courtney Doyle-Campbell taught us that Medicare is the bulk of MTM programs. I
was curious as to how MTM programs would change in the future. Courtney advised
MTM programs will still be relevant, and rules and regulations may become
stricter. For example, 66% of the insurance companies say you need to be on 8
medications to receive MTM services. Considering the future, I see there are
some changes regarding the CMS, (Centers for Medicare and Medicaid Services).
They recently released ““Advance Notice of Methodological Changes for Calendar
Year 2018 for Medicare Advantage Capitation Rates, Part C and Part D Payment
Policies and 2018 Call Letter.” These points sum up the article:
· Insurance companies will identify patients who
need some encouragement to improve their medication adherence, or similar star
rating measures. The insurance company will rely on the people who are closest
to these patients - their pharmacists - to provide this encouragement. As a
reward, they will pay the pharmacies a few dollars for each successful
intervention.
· Most of the existing star rating measures will
remain in place. Medication adherence will continue to be measured for diabetes
medications, statins, and certain blood pressure medications.
· Pharmacies will be able to earn money by
encouraging on-time refills, changing to a 90 days’ supply, and making
adherence check-in phone calls to patients.
· CMR’s (Complete Medication Review) will still be
a focus from insurance plans. This is the most lucrative MTM opportunity for
good reason. It takes a lot of time and work to complete.
Notes Page:
Izabela Collier acknowledged from a business perspective
that, “you’re trying to prove that your service is better than others based on
your personal training; rather than generalized information found online,
through friends & family, etc.”
Patient diagnosed with chronic disease, cancer, diabetes,
crones, etc. think of their diagnoses as “losing their old self” and continuing
life with their new self.
We are very poor at non-verbal communication, such as
listening.
Leaving the decision making up to the patient is the best
method of communication. Treat all patients like a mother, father, child,
friend.
The patients should adhere to their medicine for themselves,
not to impress the physician. Many lies about their adherence when they feel
like the healthcare provider will judge them because so.
50% of prescriptions aren’t picked up
400,000 deaths a year
Pharmacists are trying to create a constructive way to deal
with errors, not a punitive.
In an Asian country, doctors don’t get paid until the patient
gets better*
Changes are only made when the patients, “customers” complain
Outside Sources:
NBhttp://www.outcomesmtm.com/documents/2016MTMTrendsReport.pdf
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