MTM has been defined by the pharmacy profession as “a distinct service or group of services that optimize therapeutic outcomes for individual patients [that] are independent of, but can occur in conjunction with, the provision of a drug product.” (11 national pharmacy organizations, 2008)
Medication therapy management is part of the expanding role of the pharmacist. A pharmacist evaluates the medications prescribed and how a patient is feeling to identify and resolve issues. Such as untreated conditions, drug interactions, adverse drug reactions, inappropriate drugs or doses and whether a patient is taking the medications as prescribed.
MTM is offered as an all-encompassing model that incorporates the philosophy of pharmaceutical care, techniques of patient counseling, and disease management in an environment that facilitates the direct collaboration of patients, pharmacists, pharmaceutical technologists and other health professionals.
The pharmacy profession has been integral to the delivery of drug therapy to patients since its inception, yet pharmacists commonly have been dissociated from the use, evaluation, and monitoring of drug therapy.
Kenyans experience an increase in adverse drug reactions and drug costs daily, this has prompts a call for an enhanced role for pharmacists in ensuring effective drug use and patient safety.
Medication therapy management consulting involves regular, direct contact between a MTM service provider pharmacist and the patient. It is a practice-based activity provided by pharmacy professionals. It entails a systematic process of collecting patient and medication-related information which occurs during the pharmacist-patient encounter.
In addition, the MTM service assists in the identification and prioritization of medication-related problems. During the MTM encounter, the pharmacist (MTM provider) gathers all prescription and nonprescription products information such as Prescription drugs, over-the-counter (OTC) medicines, herbal therapies, Cosmetics, dietary supplements and vitamins.
After assessing and identifying medication-related problems, the pharmacist develops a patient-specific medication action plan (MAP)
The MAP is a list of self-management actions necessary to achieve the patient’s specific health goals. The patient and pharmacist/pharmacy technician utilize the MAP to record actions and track progress towards health goals.
During the MTM session, the pharmacist identifies medication-related problem(s) and determines appropriate intervention(s) for resolution. Often, the pharmacist collaborates with other health care professionals to resolve the identified problem(s)
The pharmacist then document his/her encounter and determine appropriate patient follow-up via the patients’ medical doctor/ clinician. MTM focuses on the whole patient, drug therapy use and recognition of a specific patient’s drug therapy needs.
The contribution of pharmacy profession to patient care is beyond the mechanical and technical supply function associated with dispensing, with increase of “expert patient” the profession has to evolve to meet the growing patient needs by embracing MTM practice model.
Currently many of the tasks and functions performed by the pharmacy professionals are being replaced by other personnel or automation, and therefore empowerment of pharmacy professionals will depend more on them “knowing how” as opposed to “knowing what.” This means the pharmacists/ pharmaceutical technologists knowing how to make intervention to the patients in terms medication choice, review, management, documentation and followup.
In Kenya,the impression of patients about pharmacy professionals and their chemists is often that; they offer a type of commercial/business-like service where the doctor prescribes with appropriate dosage, appropriate instructions, and the pharmacist or the pharmacy technician dispense in exchange for money. A clear business, thus, a simple drug dispenser will not be enough in a shared and community-based economy rather a profession which fits in the chain of provision of primary health care. In a Kenyan setup, the pharmacy profession arguably has been “deskilled” and does not have specialist skills. Traditionally, pharmacists and pharmacy technician utilized their scientific knowledge to develop the skills necessary to formulate, compound, and dispense medicines which has been reduced to tell sales and over the counter dispensing.
Future Pharmacy profession clearly should communicate the value of their unique pharmaceutical knowledge because pharmaceutical knowledge is one of the unique key attributes of the pharmacy profession, and without this being more fully utilized; the status of the profession may be called into question. In my view pharmacy graduates should shift their focus away from the distribution of medicines towards providing a broader range of services like Medication Therapy Management services.
At the long run, medication therapy management will enable pharmacists and pharmacy technicians to provide personalized drug-related information and interventions suited to individual patient needs.
MTM saves money for the patient, in the long run patients buy less medication. A patient taking his or her medication correctly is a patient who’s likely to be in good health sooner resulting to reduction of the country’s overall healthcare spending and assures patients real peace of mind. Patients enrolled in MTM consulting clinics and who talk and discuss their medications with the MTM service provider, do result in real peace of mind, assurance of disease improvement and longevity of life knowing that they are taking their prescription drugs, herbal medicines and OTC appropriately. During MTM session, the pharmacy professional by utilizing pharmacoeconomics knowledge and skills can look for ways to help patient on out-of-pocket prescription drug costs by suggesting legal substitutions which may lower patients cost of prescription drugs. E.g from Ksh. 20,000 to Ksh. 15,000 each month.
Another important benefit that comes along with MTM services is development of Personal Medication List (PMR). Most of patients do not have personal medication list either for themselves or to share with their clinicians or care givers, it is during MTM consulting this plan is developed by the MTM consulting pharmacist. It is fulfilling for any patient to have his/her a Personal Medication List to keep and share with his/her doctor and health care providers or to present in a health facility prior to admission.
During MTM consulting also the pharmacists conduct Comprehensive Medication Review (CMR). A CMR is a one-on-one discussion with a pharmacist or a pharmaceutical technologist (under the supervision of a pharmacist) to friendly answer questions and accurately address concerns from the patient about the medications he/she takes. The pharmacist will offer ways to manage patients’ conditions with the drugs they take. If more information is needed, the pharmacist may contact the prescribing doctor. A CMR review takes about 30- 45 minutes and usually offered at every review to scheduled medical clinic appointment. A Targeted Medication Review (TMR) is conducted during MTM consulting to filtered patients. This involves mailing or faxing suggestions to the patients’ doctor/physician/consultant every 3 months about prescription drugs that may be safer, or work better than his/her current drugs.
In developing care plan for the patients, the pharmacist prepares Medication Action Plan (MAP). This plan may include suggestions from the pharmacist for the patient and his/her doctor to discuss during their next doctor visit.
Embracing MTM services means the pharmacy/pharmacist becomes a trusted healthcare partner, creates additional retail opportunities for a pharmacy or drug store, since patients will likely be visiting more frequently to see the pharmacist for MTM consulting and also creates new revenue opportunities for pharmacies and enable the pharmacists to run a health management centre instead of drug distribution.
Currently the practice of retail or whole sale pharmacy doe not enable filtering of patients or even manage medicines for people taking multiple drugs and also not able to help patients with medical conditions manage their treatment or helping patients in interpreting their data. MTM consulting does not only economically empower the pharmacists to take charge of medication use and expected therapeutic outcomes to the patients but also empowers patients to manage their medications well. When accurately implemented, Medication Therapy Management will transform the old-fashioned pharmacies into 21st century health management facilities.
For the pharmacy professionals to be able to evolve the practice, they may have to understand that this is high time to turn retail pharmacies into MTM consultancies Centers instead of simple drug distribution rooms; this will give pharmacists opportunity to provide basic care to patients with simple problems and/or provide health management consultations.
This way pharmacists and pharmacy technologists rise to almost the same level of primary health care intervention and practice with other health care professionals.
Dr. Joseph Murithi Kathare
Dpharm, Bpharm, Cand. Msc. Pharmco, Toxicology
MTM Consulting Services
MTM Limited