Medication Therapy Management

What Is It?

What is medication therapy management (MTM)?

MTM (Medication therapy management) refers to describe a broad range of health care services that pharmacists and medical experts on the health care team provide to the patient. Medication therapy management is a group of services that optimize therapeutic outcomes for individual patients.

Medication therapy management services include:

MTM CARE TEAM: The MTM Care Team consists of the Primary Care team, Pharmacists and Pharmacologists, Specialist. The collaboration and interaction of these members provide medication therapy management to help patients get the best benefits from their medications by actively managing drug therapy and by identifying, preventing and resolving medication-related problems.

Why is MTM needed?

Problems related to Medication mismanagement are a massive public health problem in the United States. Experts estimate that 1.5 million preventable adverse events occur each year that result in $177 billion in injury and death.

Do You Face Problems?

Our MTM Tool is there to prevent the following Common Medication Problems:

1. Do you discontinue the medicine before course completion?

Our Medication Alert System remind you when it is time to take medicine, order refills, and get medical consultations.

Online Ordering System The built-in mechanism eases the pain of going to the chemist. It makes online orders for your prescriptions a reality and bring medication to your doorstep. It integrates with your Personal Medical Records.

2. How to consume medicines when you are taking multiple medicines?

We believe and drive the principle of Educate before you medicate. The Care Team and the Virtual Doctor (e-Clinician) educated you:

3. Consume medicine with certain food items with which they should not be taken

Did you know?

1. Alcohol consumed with sleep medicines (for example, Ambien or Ambien CR) or anti-psychotics (for example, Seroquel) can lead to serious complications.
2. Antibiotics reduce the effectiveness of birth control pills.
3. Selective Serotonin Re-uptake Inhibitor (SSRI) Antidepressants (for example, sertraline/Zoloft ®) taken with St. Johns Wort increases the risk of drowsiness and not being able to think clearly.
4. Combining pain relievers, prescriptions or multi-symptom medicines that have the same active pain relief ingredient could result in the taking too much of that ingredient, and too much of any one ingredient can lead to serious health problems

4. Mixing drugs or drugs with certain foods could be dangerous

Grapefruit juice can prevent the body from breaking down some medicines, which means the medicine may stay in your system longer.

5. Consuming medications that need to be avoided in certain health state or diseases

The solution has built in intelligence to give alerts across restrictions around does and precautions during intake medications in certain diseases.

The Solution To These Problems

The Connected Care Platform has a built in Interaction checker that continuously checks and warns of combinations of medicines and food items which should not be consumed together as these chemicals interact either to reduce or increase the medicine efficiency/ impact or have additional unwanted reactions. These checks happen when you manage and maintain your Personal Health Record and are a paid up user.

Key Facts On Medication

• - More than 3.5 billion prescriptions are written annually in the US
• - Four out of five patients who visit a physician leaves with at least one prescription. Similar numbers are reported for Developing Countries.
• - Medications involved in 80% of all treatments and impact every aspect of a patient’s life.
• - 67% of hospitalization for people 65 years and older tied to five medications: Warfarin, Insulin; Antiplatelet, Oral Hypoglycemic, Anti-Hypertensive.
• - 28% of Hospitalization among seniors are due to adverse drug reactions.
• - Elderly account for 12.9% of the US Population but consume approximately 34% of total prescriptions.
• - 2/3 of adverse events post-discharge are related to medication.
• - Polypharmacy mismanagement and hospitalization costs $1.1 billion.

Cost Of Medication Errors

Drug therapy problems are an every-day occurrence and cost money all over the world. In US drug related morbidity and mortality costs this country almost
$200 billion annually, this exceeds the amount of money we spend on the medications themselves.6-8

Impact Of Inappropriate Medication

Outcome Of MTM Therapy

The above gaps in medication are addressed the following objectives are met:

• - Better Control of Disease leading to reduced costly Medical emergencies and Hospitalizations.
• - Reduces Medication that is very common.

How is MTM provided?

A Personal Care Team of the consumer provides integrated MTM in all care settings in which patients take medications.

This includes home therapy and management in different settings may provide different types of medication therapy management services. The MTM team achieve:

• - Make sure that the right medication is given to the patients depending on their health conditions
• - Help achieve the best possible outcomes from treatment.

E-prescription Is Centre Stone Of MTM

What is e-prescribing and why is it safer than a paper prescription?

Many physicians,physician assistants, and nurse practitioners are starting to make the switch from using the standard prescription pad and pen to electronic prescribing?

1. Instead of writing out your prescription on a piece of paper, your Physician can enter it directly into the PHR from their Computer / Laptops/ Mobiles.
2. The prescription is secure and available to you on line.
3. It has a strong audit trail and complies with the legal framework.
4. You can convert your prescription into Drug Buy orders with a Click.

The Beneficial outcome:

1. Helps Avoid Medication errors.
2. Deliver an accurate and legible prescription.
3. Receive Care team medication tips to help you.
4. An integrated part of your Connected Care PHR (medical record).
5. Interaction Check: Check prescription against the diseases, allergies / and other ongoing medications for interactions, contraindications. This prevents costly medication errors.
6. Enable Comprehensive Medication Review.
7. Online receipt of your prescription. You have a head start in getting your medicines filled. The Care Team can effectively and easily monitor your medications and even help lower costs of medications.
8. E-prescribing can improve the safety and convenience of prescribing.
9. Electronic prescribing, or e-prescribing, can help prevent some medication errors and gives pharmacists, doctors and nurses access to immediate, more complete information about your medical and medication history and proactively can alert them to potential problems such as drug allergy.

ACTIVE WELLNESS e-prescribing is an integrated part of the Connected Collaborative Care Platform and storage of records in the PHR that results in safer, more informed prescribing. Thus patients get the care that best fits their needs.

Who Needs It?

Who benefits from MTM?

All who uses drugs can benefit from MTM. This helps evaluate the drugs being taken and reviews interactions and side effects that may be happening around intake:

Maximum benefit is to persons who are

What Problem MTM Solves?

HIGH HEALTHCARE COSTS: World Health Organization, findings show that medical aid for chronic diseases in developed countries averages 50%, and therefore the consequences of poor drug medical aid cause health outcomes and increased health care costs.”

The two most common drug medical care problems experienced by patients receiving comprehensive medication management are that MTM solves:

• - The patient requires additional drug medical aid for prevention, synergistic or palliative care.
• OR
• - The current drug dosages need to be titrated to achieve therapeutic levels that reach the intended goals of therapy.

Patients With Chronic Disease Are At High Risk

Persons with multiple chronic illnesses:

The Institute of Medicine has noted that while only 10% of total healthcare costs are spent on medications, whereas they have ability to control disease and impact overall cost, morbidity, and productivity–when appropriately utilized–is enormous.

“Pharmaceuticals are the most common medical intervention, and their potential for both help and harm is enormous. Ensuring that the American people get the most benefit from advances in pharmacology is a critical component of improving the national health care system.” Institute of Medicine.

Which patients benefit most from comprehensive MTM?

The Connected Collaborative Care Technology is especially helpful if you, your partner, parent or child have a chronic illness or are recovering from surgery and take multiple medicines.

Significant evidence is there to establish (+) ve impact on patient health and achieve improved health, lowers morbidity, longer life & better outcomes through comprehensive medication therapy management.

Patients segments that benefit the most:

Chronic Disease Patient Drives Maximum Benefit:

Chronic Diseases which are costly and are associated with multiple medications to control them are great candidates to drive maximum benefits. They are:

MTM Solution Offering

MTM is an integral part of the Managed Care services offering. The personal care team has Pharmacist/ Pharmacologists along with Care coordinators, Doctors and Specialists. They undertake a review of medications under the guidance of a Pharmacologist periodically.

Patient Enablement: The integrated Drug Database helps provide patients with crisp information from A to Z of the medicine.

The Solution Helps Address The Problems In MTM

Why MTM Is Critical?

DRUGS: We all know that there are now 10,000 prescription drugs and 300,000 over-the-counter medicines in the market. It is not possible for a human being to manage such a huge repository and thus it requires reliance on technology and analytics to manage the drug therapy of a person. A Collaborative Connected Platform of Active Wellness is the answer.

The Lurking Danger:

Eight out of Ten adults self-medicate using over-the-counter (OTC) medicines
50% of people have difficulty in understanding the prescription.

BY LAW when a physician prescribes drugs for a patient, the physician has to make sure that the patient is well informed of the drugs risks, benefits and correct way of consuming drugs.

1. Statistics show that this occurs in less than 20% of the patient population.
2. Either doctors are short of time or patients are not in a position to understand what physician is hurriedly explaining to them.
3. Or to make the matter still worse they don’t know what questions to be asked to ensure correct and effective consumption of medicine.
4. Unfortunately, many people don’t consult their doctor, pharmacist or nurse, or take the time to learn about how to use OTC and prescription medicines safely.

Impact Of Lack Of Knowledge: – 30-50% of prescriptions are not taken as they should be. We are hurt by Preventable medication errors.

MTM Solution Addresses the need of these 30% – 50% of the cases

1. Solves Drug Compliance Issues
   1. We forget to take medicine.
   2. Forget to carry them with us while going out/to work.
   3. Skip for Non-Availability of prescribed medicine in the market
   4. Decide to Discontinue the medicine before course completion
   5. Reduce the dose to avoid perceived side-effects or reduce cost
2. Helps Avoid Medication Interactions
   1. Drug – Drug Interactions: Alerts you when try and combine medicines which should not be taken together
   2. Drug – Food Interactions: Alerts you when you consume medicine with certain food items which should not be taken with a medication.
3. Warns when drugs are Contraindicated based upon health profile
   1. Alerts consumers when Medication are to be avoided in certain health state or disease.

MTM Solution Prevents Common Gaps In Drug Rx

Medication gaps accounts of over 13 % of the medication-related adverse events is listed below. The Smart MTM addresses these and saves not only money but also improves your health and better control of the disease. MTM closes the following medication gaps.

Beneficial Outcome Of MTM Therapy

When the above gaps in medication are addressed the following objectives are met:

• - Better Control of Disease leading to reduced costly Medical emergencies and Hospitalizations.
• - Reduces Medications that are very common.

Sign Up Form MTM Service

The Connected Care Collaborative Ecosystem has built in MTM management Services and helps to reduce / eliminate the medication gaps. This service is available under Paid Service.

Self Managed Package:

Here you can manage your medication through the platform by entering your drugs and receive medication alerts. There is no specific comprehensive review. The platform allows you to request medication review as additional services. Sign in to Know more...

Managed Care Packages:

Here you get to have a “Personal Care Team” that help manage your medications. The Care Team works with you for bettering your health 24x7x365. The team through use of built in intelligence and medical expertise manages the medications and identifies gaps in care. It helps you stay healthy and keep your medical conditions under control. Sign in to Know more...

Home Care Management:

We offer MTM services to patients that have multiple Chronic Conditions and have been discharged from hospital. We offer them care service at home. Please leave a message and we will contact you.

MTM Services

How Does MTM Engage & Deliver?

The Active Wellness Collaborative Care Ecosystem has built in tools that help initiate monitor and manage Medication Therapy.

The Delivery Steps

1. With the experience, a patient is having around his medications.
2. Ongoing proactive identification of medication-related problems and design interventions that are specific and effective.
3. Measure actual outcomes to determine what is and what is not effective for the patient.
4. Personalized need assessment leads to development of problem-focused therapeutic solutions.
5. Escalations to the treating team (Home Care & Clinic Care).

Technology Backed Solution

1. The Connected Care Ecosystem allows Primary Care Teams to deliver better care and improved outcomes, meet patient care goals and reduce health care costs. MTM is an integral part of the solution.

What Happens In Each MTM Encounter?

FOCUS: Each MTM Encounter focus is on the key goals to deliver:

• - Improve patient outcomes
• - Control costs

DELIVERY STEP DETAILS:

STEP 1: A description and review of the patient’s medication experience

1. How the patient makes his/her decisions about the medications, he/she takes in a cultural and holistic context.
2. Provides a complete medication history and current medication record, complete with how the patient is taking the medication(s).
3. A complete medication record is provided to both the patient and the prescribing providers so that everyone is aware of all medications and how they are being taken.

STEP 2: List out medication-related problems which need to be addressed

1. These problems interfere with the achievement of the patient’s goals of therapy.
2. Clearly definite the issues a patient is experiencing or might be at risk to experience, it is not possible to individualize the interventions in a manner that will optimize the desired outcomes.
3. When no medication-related problems are found in the evaluation the medical team can be assured that all of the patient’s medications are appropriate, effective, safe, and being taken as intended.
4. Undertake an ongoing evaluation to evaluate the effectiveness, efficiency, response to therapy and side effects that can inhibit compliance.

STEP 3: Personalize the Care Goals and define Measurable outcome parameters

The measures are determined specifically for each patient so he/she is able to participate in the care plan in a patient-centered approach.

Appropriate parameters for effectiveness and safety are determined:

STEP 4: Personalized Interventions defined for each patient (education/ tools)

Determine reason of why patients are not compliant (after the medication has been determined to be appropriate, effective, and safe). The causes include:

This is overcome by involving the patient while setting up goals.

STEP 5: Track Monitor & Follow-up evaluation of actual outcomes

Achieving health goals for minor and acute care needs are met through routine medication use. But in the cases of Multiple Chronic Disease there is a specific need to titrate dose to achieve therapeutic goal and objective.

Follow-up in chronic disease is necessary for the following reasons:

A. Goals

B. Medication Data

1. Follow-up evaluation adds new data to the use of medications in practice.
2. Support Post-Marketing Surveillance Programs for drugs: The information collected in medication management on new products helps in continued ongoing evaluation of the therapeutic effectiveness of medicines in clinical use.

Why Patients should consider need for additional MTM services?

Providers are becoming specialized and focus on their core specialty. Most physicians and providers have the training and experience to manage medications effectively within their area of general or specialist knowledge.

It is normal practice for multiple Physicians to manage chronic disease. Patients have multiple prescriptions. The Care Teams / Patients need to seek additional consultation as:

1. Managing medications outside of their usual scope of care.
2. When the patients do not reach/ attain clinical goals of therapy.
3. Primary care providers usually refer patients to a specialist for medication adjustments, although the diagnosis is well established.

Common examples of Specialist Referrals

Key Is Coordination Of Medications

The MTM teams help support and coordinate medications:

1. Prescription by multiple specialists
2. Ever increasing use of
   1. herbals
   2. supplements
   3. and nutraceuticals
   4. and foods
3. These compounds interfere with or enhance a drug’s effect in complex patients. This would lead to a more comprehensive medication review.
4. Adverse reactions and interactions are frequently seen with multiple medications and are compounded by the effects of chronic disease on organ systems.
5. A Primary care provider takes guidance from a clinical pharmacist to undertake a comprehensive medication review to determine:
   1. Medication and food interactions and
   2. Adjustments in a patient undergoing chemotherapy for cancer
   3. Adjustments in anti-seizure medications
   4. Review patient on multiple medications to treat a condition such as high blood pressure that is still not at goal.
6. The team approach leads to the Collaborative Coordinated Care evolves, this focus on chronic disease management, as well as an emphasis on preventive therapies with documented evidence of improved outcomes, leads to a more comprehensive medication management and is a cornerstone of quality care.

How is this service requested and delivered?

When a provider identifies a patient in need of comprehensive medication management, a reference is made to the qualified practitioner. The delivery of service is dependent upon the proximity of the practitioner, the specific structure of the medical home as well as the service delivery design of the practitioner providing the service. In many practices, the medication management practitioner is employed by the medical home and resides full time or part time in the clinic or practice. In this scenario the practitioner is available at any time to deliver the service and he/she functions inside the medical home structure.

When medication management needs are established outside the primary clinic (be it a community pharmacy or health plan or a hospital entity) . The patient is referred to a medical practitioner and an appointment is set. The practitioner in community delievers medication management services off premises and the medication management practitioner provides the referring physician with written documentation of the assessment and communicates the need for any changes as well as a record of all of the clinical outcomes achieved. The patient is followed until the goals of therapy are met or until the physician determines the level of care required. This involves the Care teams to collaborate and have the consent of not only the patient but also an agreemeent between the practitioner and physician providing medication management.

The patient can also request the medication management service directly, and also seek an appointment with the practitioner. Even in this situation, communication between the medication management practitioner and the primary care physician occurs after each patient encounter. Care coordination among the treating teams is essential for effective Medication management.

Medication management services can be provided by a virtual care team. The medication management practitioner has to be in direct communication with the patient (in person, telephonically, or telemedicine/virtual clinic) to deliver the services as described. IT systems necessary to support telephonic or telemedicine/virtual clinic arrangements must include accurate and reliable ways to identify medications and dosages currently being taken by the patient as well as a clear means to determine the response of the patient to the medications. When this service is provided by telephone or through a virtual clinic structure, it should be done by medication management practitioners who have had experience (are skilled in interview techniques) with these media and developed standardized methods to ensure a quality service is delivered.

References

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8. Source: Centers for Medicare & Medicaid Services, “National Health Expenditures,” 7 January 2008.
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