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Pharmaceutical Care, Clinical Pharmacy and Medication Therapy Management
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Pharmaceutical Care, Clinical Pharmacy and Medication Therapy Management

Pharmacist Mei-Yu Chen will introduce clinical pharmacy and pharmaceutical care and medication therapy management (MTM) in this video.
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Hello everyone My name is Mei-Yu I’m currently a clinical pharmacist of Taipei Veterans General Hospital. In this following session, I will talk a bit about clinical pharmacy services. In this following hour, I will first introduce the concept of clinical pharmacy, then the Clinical pharmacy related statements in GPP guideline, Essentials of Good Clinical Pharmacy Services, and the challenges and obstacles that we are facing in the development of Clinical pharmacy, and a brief introduction on the current practices in Taiwan.
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And After this Session, you should be able to describe different perspectives on the activities and practice of clinical pharmacy, and Identify the concept of clinical pharmacy services described in GPP guidelines, and identify the common clinical pharmacy services offered in hospitals and health systems.
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In the past century, the pharmacy profession has long been evolving its various roles in delivering care to patients. Throughout history, pharmacists have been associated with the delivery of medications as one of its primary values for patients in need of these therapies. As the preparation of medications moved from individual pharmacists to pharmaceutical industry, and dispensing process became functions that could be handled by technologies, and pharmacists have continually evaluated and discovering their optimal roles in patient care. As early as the 1950s, health-system pharmacy pioneers are advocating that pharmacist go to patient care areas and create a clinical role, including rounding with physicians. And since 1980s, the concept of clinical pharmacy, pharmaceutical care and medication therapy management was developed and introduced over time.
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So first, What is clinical pharmacy? As defined by the American College of Clinical Pharmacy, the ACCP. Clinical pharmacy is the area of pharmacy concerned with the science and practice of rational medication use. It is patient-directed, evidence based and designed to promoted health, wellness, and disease prevention in order to improve the quality of life of patients. And Clinical pharmacy services, or the CPS, refers to the services that pharmacists provide beyond dispensing, aiming at improving health outcomes in the context of the patients’ regular health care team. Using the knowledge of drugs, pharmacists can provide patient education, drug information and consultation services in the clinical care of patients. In the 1990s, pharmacy pioneers begin to advocate the concept of pharmaceutical care.
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Pharmaceutical care is a broader thinking than clinical pharmacy services. The pharmaceutical care is Responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life. So, the pharmacists not only provide clinical services, pharmacists should also be involved in the design and implementation and monitoring of the therapeutic plan, and work with patients and other healthcare professionals to achieve the goal of ensuring optimal outcome. So, the clinical pharmacy and pharmaceutical care have similar goals which is to improve health outcomes, but they emphasize different aspects of practice. Pharmaceutical care is a philosophy about a system for the delivery of patient care. And Clinical pharmacy is an essential component in the delivery of pharmaceutical care.
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Pharmacists should apply their clinical pharmacy services skills to design a pharmaceutical plan and to collaborate with other healthcare professionals in order to reach therapeutic goal. However, for most pharmacists, they still don’t have a clear instruction about how to provide a successful pharmaceutical care in their daily practice even though they routinely provide clinical pharmacy services. Therefore in 2003, pharmacy experts in the united states started to advocate the concept of medication therapy management, the NTM, which can be viewed as a strategy to incorporate the philosophy of pharmaceutical care into everyday pharmacy practice. And the goal is to focus on and create solutions for patient-specific drug therapy problems and collaborate with other health care professionals.
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The core elements of MTM include Medication therapy review, Personal medication record, Medication-related action plan, Intervention and or referral and finally Documentation and follow-up. These core elements provide a mechanism to accomplish the comprehensive evaluation and medication therapy management. In the first step of MTM, the Medication therapy review, it is a systemic process of collecting patient-specific information, assessing medication therapies to identify medication related problems, developing a list of medication related problems, prioritize, and creating a plan to resolve them. Depending on the type or scope of MTM you are conducting, the medication therapy review can either be comprehensive or targeted.
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The information you may need to gather includes patient’s health condition medication use history, vital statistics, recent lab reports, and recent incidences such as ER visits, or hospitalizations et cetera. The collecting of patients’ health-related information and current and past medication lists, which maybe achieved through an patient interview or through accessing the computerized health record system. Then you need to assess, evaluate and identify drug related problems, and then develop a plan to solve these problems. According to American Pharmacist Association, The medication related problem can be categorized into unnecessary medication therapy, need for additional medication therapy, ineffective medication, or dosage too low Adverse drug event, dosage too high, and non-adherence. There can be multiple medication related problems in a single MTM evaluation.
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Therefore, it is important to prioritize the MRPs before moving on to making plans to resolve them. Is the problem new or the patient has had it for while? The severity of the problem, the patient’s feelings and attitude regarding the seriousness and urgency of the problem, and how easily the problem can be solved, and whether the problem is appropriate for a pharmacist to address, these factors all need to be taken into consideration while assessing the priority of medication related problems. Then, the MTM service suggest that, for each patient we are in charge of, we need to document and maintain a personal medication record.
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The personal medication record is a comprehensive record of patients medications, including the prescription and nonprescription medications, vaccines, herbal products and other dietary supplements. For the purpose of evaluation of potential interactions. And, the third element is medication-related action plan. Medication related action plan is a patient centric document containing a list of actions for the patient to use in tracking progress for self-management. And,upon reviewing and identifying medication related problems, pharmacists need to help develop a plan or a strategy to resolve the problem or improve the appropriateness of a patients medication therapy. Which may either be a suggestion on a medication dosage adjustment or medication alterations or substitutions.
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After developing a action plan to solve medication related problems, Pharmacist should provide consultative services and interventions to address medication-related problems, and when necessary, the pharmacists refers the patient to a physician or other healthcare professionals. And, the final steps of a complete MTM is the documentation and follow up. All MTM services should be documented in a consistent and structured manner. This documentation should be compliant with the accepted standards for documentation or billing standards within your health care facility. For example, the form of a traditional SOAP, or SOAP note, which is consists of subjective data, objective data, assessment and plan, may be widely applied as a official documentation format.
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And routine follow up is also crucial for pharmacists to make sure that their suggestions and interventions have truly been taken and making an improvement of a patients medication therapy.

Pharmacist Mei-Yu Chen will introduce clinical pharmacy and pharmaceutical care and medication therapy management (MTM) in this video.

Key concepts:

What is Pharmaceutical Care?

“Pharmaceutical care is the philosophy of patient care delivery systems, including designing, implementing, and monitoring therapeutic plans. The goal is to achieve definite outcomes that improve patient’s quality of life. Clinical pharmacy is an essential component in the delivery of pharmaceutical care.”

What is Clinical Pharmacy?

“Clinical pharmacy is the area of pharmacy concerned with the science and practice of rational medication use. It is patient-directed, evidence-based, and designed to promoted health, wellness, and disease prevention to improve patients’ quality of life.” (Defined by American College of Clinical Pharmacy)

What is Medication Therapy Management?

In 2003, pharmacy experts in the U.S. started to advocate the concept of medication therapy management(MTM), which can be viewed as a strategy to incorporate the philosophy of pharmaceutical care into everyday pharmacy practice.

The goal is to focus on and create solutions for patient-specific drug therapy problems and collaborate with other health care professionals.

The core elements of MTM include medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and finally documentation and follow-up. These core elements provide a mechanism to accomplish comprehensive evaluation and medication therapy management.

Medication Therapy Management (MTM) Steps:

1. Medication Therapy Review

This is a systemic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a list of medication-related problems, prioritize, and creating a plan to resolve them. Ms. Chen will explain in detail how you evaluate medication-related problems (MRP) review.

2. Personal Medication Record

The MTM service suggests documenting and maintaining a personal medication record for each patent. A Personal Medication Record (PMR), is a comprehensive record of patients’ medications, including past prescriptions and non-prescription medications, vaccinations and other dietary supplements.

3. Medication-Related Action Plan

The third element is the medication-related action plan. The Medication-Related Action plan (MAP) is a patient-centric document containing a list of actions for the patient to use in tracking progress for self-management. Pharmacists need to help develop a plan to resolve the problem or improve a patient’s medication therapy appropriateness. The MAP usually takes the form of a suggestion on a medication dosage adjustment, medication alterations, or substitutions.

4. Follow Up

The final step is the documentation and follow-up. All MTM services should be documented in a consistent and structured manner.

Share and learn:

  • Does the hospital you work at/visited provide MTM services?
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Good Pharmacy Practice: Introduction to Clinical Pharmacy Services

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