What to watch for when doing MTM

[Lisochka]

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Could you guys help me out? I need help with MTM...
Obviously we talk about administration techniques, side effects and so on...
Here is what I struggle with:
What kind of drug interactions or drug- disease state interactions to watch for?
For example: pt is Zpack so hold citalopram, no BB post MI, what else?
I am interested in clinical aspects...

 

[trailerpark]

So what about half the Medicaid population that's on both celexa and tramadol...

 

[wagrxm2000]

Patient is on a zpak, hold citalopram. Now that's funny. What they teach you in class doesn't happen in real life.

 

[waiter]

otcs? immunizations?

 

[Deja]

everyone and their mom is on zpak for everything

 

[npage148]

If not a zpack, then 2g stat

 

[Deja]

If not a zpack, then 2g stat

This I can understand, those damn chlamydia is everywhere

 

[Unchained]

Recommend immunizations. They make money for your corporation. They'll also make you feel as though you're part of the healthcare team.

 

[farmadiazepine]

Override..

 

[trailerpark]

I was told Prevnar 13 makes bank.

 

[Deja]

I was told Prevnar 13 makes bank.

well most insurances don't cover prevnar 13 yet... at least from what i have seen, so yeah, if people are paying cash price, then for sure

 

[marscole]

Flu shots...

 

[wagrxm2000]

well most insurances don't cover prevnar 13 yet... at least from what i have seen, so yeah, if people are paying cash price, then for sure

Um the typical person that gets a prevnar shot is over 65 in which case medicare pays for it. Obviously you have those with certain conditions getting it but that's a low percentage, at least here it is.

 

[Deja]

Um the typical person that gets a prevnar shot is over 65 in which case medicare pays for it. Obviously you have those with certain conditions getting it but that's a low percentage, at least here it is.

yeah you are right... I may have remembered wrong? or did medicare just recently started to cover it lol idk anymore

 

[txpharmguy]

How the heck does anybody have time for MTM this time of the year? I'm same serious. Between flu shots and prescriptions, I barely have time to breathe.

 

[farmadiazepine]

MTM is a joke. There are companies whose sole focus is on MTM and nothing else. I work at a pharmacy on Saturdays where the owner has has started doing MTM this past year, and honestly, I don't know how he finds time to do. I am typing, filling, checking, answer phones, and solving problems, and on top of all that, I am supposed to do an MTM session? Take time to answer questions into a website, call a patient, have them come in, etc. All for what, $20-$60 if done correctly? That's why there are companies that only do MTM. It's impractical from a retail store standpoint, unless you can find a good way to do it, like APPE students. If the money is there for pharmacists, it would be worth it, but right now it seems the only people doing well on it are those who have CVS'd the idea, like Outcomes and Mirixa.

 

[BenJammin]

well most insurances don't cover prevnar 13 yet... at least from what i have seen, so yeah, if people are paying cash price, then for sure

Our outpatient pharmacy does a ton of Prevnar immunizations all covered by insurance.

 

[npage148]

Of the immunization allowed in ny, I only have trouble getting Tdap covered

 

[Carboxide]

Could you guys help me out? I need help with MTM...
Obviously we talk about administration techniques, side effects and so on...
Here is what I struggle with:
What kind of drug interactions or drug- disease state interactions to watch for?
For example: pt is Zpack so hold citalopram, no BB post MI, what else?
I am interested in clinical aspects...

You're kind of missing the mark here. The things you aren't considering are the relevance of interactions. For example, a ZPack is a very short duration drug - so QTc is not that big of an issue. In addition, I would be very concerned with holding a psych med. That's bad news for patients. Do you want to be the cause of a relapse? There are MANY drugs that cause QTc prolongation. You can't avoid using them together. You have to rely on the MD to monitor. As for BB post MI, there is no recommended duration of treatment. If the MI was not recent, it is completely reasonable that they are not on it anymore.

I would look for:
Drug timing (levothyroxine, phosphate binders, interacting drugs that should be taken separately)
Simplification of regimens
Duplicate Rxs - including adding a second drug without maximizing the first (e.g. HCTZ 12.5 mg + furosemide 40)
For chronic conditions like CHF: making sure they all have the 3 key drugs on unless BP doesn't support it, same for asthma, COPD
Age-drug issues (tramadol dosing, novel anticoag, etc)

The ideal situation would be to have a SCr available.

 

[Lisochka]

Thank you so much!
I probably need a refresher on all those points...Can you guys recommend a review course or a book that goes over MTM material/content?