The value of MTM

Each one of us has had the experience of completing Med Histories on patients through P.Care Lab, P3 rotations and the OSCE assessment. Many of us complained about having to do this task: it took too long, we couldn’t do things “our way”, or the patients weren’t even real. I know I was among the complainers. I really disliked this “exercise” because either the patients were completely fake or my recommendations never made it back to the patient/physician (which was the case for P3 rotations). But here I am, doing Med Histories in my internship and it’s completely different from past experiences.

What is my role in MTM?

I call members to discuss their medications. I ask about allergies, immunizations, medications, OTCs, and herbals/supplements. I discuss with members any concerns they have regarding their drug therapy, and I question them on symptoms/side effects they’re experiencing from their medications. This MTM service is voluntary and only offered to members who meet the criteria: enrolled in Medicare Part D, at least 2 of 5 disease states (CHF, cholesterol, DM, HTN, COPD), have at least 8 prescriptions, and having the total cost of drugs at $3,000 or more.

Any member who elects this service will be designated an appointment via telephone. Each phone conversation lasts on average 10 minutes and in that time I gain a wealth of knowledge on the member. After the phone call I evaluate my notes and make recommendations for the pharmacist to review before the final letter is mailed to the member. Finally! My work, my recommendations, are actually making it to the patient. Thus far, I have talked with over 30 members and there was only one where I didn’t have a recommendation. Since the criteria for this service is extensive, these members are in need of constant monitoring. I am able to apply the clinical knowledge I’ve learned in therapeutics to make extremely helpful recommendations.

The in-class setting of taking a Med History feels unrealistic and very awkward – the “patient” is a volunteer and trained on how to respond to each one of our questions. But I do have to say, that the skills I learned in class were extremely helpful. Before I started making MTM calls at work, the pharmacist in charge only asked one question, “You do med histories in school, right?” I responded with a yes, and with that he gave me the patient profiles and said “Have at it! Let me know if you have any questions” and walked away. I was just expected to know who to do this. The patient profile I was given only contained a list of medications that were processed at the pharmacy and billed to the insurance – I received no other information. I wasn’t even provided with a Med History form. And to my fellow classmates, does this sound familiar?...the OSCE! All the complaining we did, who would have thought, that the OSCE we took did actually simulate real practice settings.

My bottom line to you: Although the exercises we do in class with the volunteer patients may seem awkward and uncomfortable, it really does help prepare you for the real practice setting. It's very rewarding knowing I was able to help a patient whether it was lowering their medication costs to avoiding a drug interaction.