Medication questions? Ask a Pharmacist!

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pills-dispenser-966334__180Every year or so I do an “Ask the Pharmacist” show on Healthy Matters.  These are always popular shows with listeners and this week was no exception.  Joining me in studio were two HCMC pharmacists, Laurie Wilhite and Erika Ridl.  We answered questions from listeners about all kinds of medication topics.

To hear the Q&A from our pharmacy show you may want to listen to the podcast here.

I learned a ton on Sunday’s show but two of the take home messages are 1) you are not alone if you have medication questions and 2) your pharmacist is most definitely your friend.

Actually, I hope to educate folks about one thing in this post:  MTM (or Medication Therapy Management).  Ever heard of it?  I didn’t think so.  Read on, read on.

Erika Ridl, PharmD & Laurie Wilhite, PharmD CSPI

I’d like to introduce our two PharmDs from the show, but before I do, what the heck is a PharmD?

PharmD is the term we throw around the hospital pretty much every day in the offices of our doctors.  Here’s a conversation you may hear at any hospital:

Doctor A:  “Hey, this patient is on 27 medications.  Do you know if the statin is compatible with the seizure medication and are they both compatible with the heart drug and do I have to check a blood level for the blood thinner and if the patient eats a grapefruit is it going to matter?”

Doctor B:  “Of course I don’t know.  Why don’t you call the PharmD?

OK, I totally made that conversation up but the point is real – doctors rely on PharmDs (which stands for “Doctor of Pharmacy” ) all the time.

Pharmacists and MTM

Here are my two guests from last week’s radio broadcast.

IMG_1282Laurie is super well-trained.  She’s done specialty fellowships, she is certified in Poison Information, and she has two jobs here at HCMC. She does part of her work in our Conservative Care Clinic which specializes in pain management.  She also has expertise in the Poison Center (I did an earlier post about the Poison Center that you may want to check out).  <–Click on her picture for more about Laurie and her practice.IMG_1283

Erika is a resident pharmacist, having finished Pharmacy School, then finishing one year of residency training, now doing another year of training in Ambulatory Care.  She specializes in helping patients out in with their medications in the clinic (as opposed to when they are in the hospital).  Click on Erika’s picture for more about her –>.

So what is MTM:  Mary Tyler Moore?

Anybody from Minnesota of a certain age will remember Mary Tyler Moore.  Sadly, I guess I am of a certain age since the first thing I think of when I see the initials MTM is our favorite fictitious newswoman.   I can hear the words now . . .

Who can turn the world on with her smile?  Who can take a nothing day . . . and suddenly make it all seem worthwhile . . . well it’s you, girl, and you should know it. . . .”

OK, this is sad that I didn’t even have to look up the words to the MTM theme song.  But I’ve totally gone off the rails here.  Enough Mary Tyler Moore.  What MTM really stands for is Medication Therapy Management.

MTM is perhaps not known to as many people as it should be.  Even many of my doctor colleagues are a bit in the dark on it.  Here’s what MTM is according to the American Pharmacists Association:

“Medication therapy management, also referred to as MTM, is a term used to describe a broad range of health care services provided by pharmacists, the medication experts on the health care team.”

MTM services can occur in any setting where you are a patient but I’m going to focus on the clinic setting.  In a clinic that offers MTM services, the pharmacist is part of your health care team in a very real and integrated way.  Basically this means that you, as a patient, can have a clinic appointment with a pharmacist just like you do with your doctor.  The pharmacist can then work directly with your doctor, PA, or nurse practitioner, as well as the other staff in your clinic to assist you in getting the best health outcomes with your medications.

And MTM services are probably covered under your health plan.  Click here to see what Medicare has to say about it (punch line – it is covered under many Medicare Part D drug plans but be sure to check your own plan first).  Many other health networks automatically include MTM benefits for patients with several medications and/or medical conditions.   Usually the service is billed through the clinic where you see your doctor.

An MTM visit focuses on your medications and is a chunk of dedicated time to discuss issues such as:

  • Review all of your medications, including non-prescription over-the-counter (OTC) medications and herbal supplements
  • Side effects questions
  • Review your medications to look for potential drug-to-drug interactions
  • Correct way to take your medications – time of day, with food or without, etc . . .
  • Helpful tips on how to remember to take your medications
  • Answer any other questions you may have about your medications

Are MTM services right for me?

“I believe the patient can become a better patient when they understand the importance of their medications and how they should be properly used.  It’s one of the best kept secrets in health care.”

That is the sentiment from Gary Schneider who is the Director of the Medication Management Network at the University of Minnesota College of Pharmacy.  He told me that the College of Pharmacy has over 300 credentialed pharmacists in the MTM network across the state of Minnesota.

Here atHCMC logo HCMC (my hospital), our Director of Pharmacy Mike Pitzl told me that he has well over 100 pharmacists on his staff and nearly 20 of them provide MTM services at a wide variety of HCMC-system clinics.  The MTM program at HCMC started back in 2009.  Click the link to see the range of services by pharmacists – cancer, HIV, cardiology, primary care, transplant, senior care, neighborhood clinics, digestive health, diabetes . . .

Going back to the American Pharmacists Association, MTM is  potentially of benefit to “anyone who uses prescription medications, non-prescription medications, herbals, or other dietary supplements.”

Who benefits the MOST from MTM?

Look at the following and if these apply to you, you really ought to consider seeing if your clinic system offers MTM services:

You use several medications

If you take lots of medications it can get confusing.  Do I take this pill with that one?  Do I take them all at once or separately?  At night or in the morning?.  Does this blue one interact with that pink one?  All great questions.

You have several health concerns

If you have diabetes and high blood pressure and depression and who knows what else, how can you keep track of which medication is for which purpose?  How do you know if you are addressing each of your health conditions correctly?  Common conditions that may benefit from MTM are diabetes, heart disease, depression, kidney disease, and lung disease, to name a few.

You have questions or concerns about medications

How many times have you gone into the doctor with questions about your bagful of medications and left still not quite sure of what it all means?  You are not alone.

You take medications that require close monitoring

Maybe you are on blood thinners.  Or seizure medications.  Or something else that requires blood work or frequent visits to a clinic.

You have recently been hospitalized

Getting discharged from a hospital is a vulnerable time for anybody.  Being in the hospital often brings with it changes made by the hospital doctors that are different from what you were taking before you went in.  The names change, or the doses, or some medications are started and others stopped.  It can be really hard to keep track of it all.

You get your medications from more than one pharmacy

Although most of us in the health care world discourage people from going to more than one pharmacy (getting your care at multiple locations is usually not such a good idea as it becomes challenging to keep track of everything), sometimes it is necessary.  But if one pharmacy dispenses some of your meds and another dispenses some others, life can get confusing.

A Medication Therapy Management (MTM) visit can help address ALL these issues.  It is true “team-based care”!

 

 

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4 Responses to Medication questions? Ask a Pharmacist!

  1. Robert Nordin - recently retired from Gillette Pharmacy says:

    I listen quite regularly to Sunday morning on WCCO and am enlighten by experts on Healthy Matters. A few weeks ago I listen to the “Ask the Pharmacist – Medications questions” featuring Laurie Wilhite and Erica Ridi: Pharm D’s. I have worked with Laurie Wilhite in the past and have been one of her admirers for her knowledge and skill. I would like to add a comment to one of the questions asked “Are generics equivalent to the brand name drugs”. I agree with the answer that was given, but there are some exceptions.. which I would like share one of them from Gillette Hospital experience.

    We had a 2 year child with seizures and was on a ketogenic diet. The child was taking Lamictal 25 mg chewable for seizures – 6 tabs x 3 times a day via G tube. Lamictal chewable contains 9.375 mgs of carbs/tab so the child got 56.25 mg/dose or 168.75 mg/day.

    When the generic lamotrigine form by Teva Labs when it first came out the MN State Medical Assistance would only pay for the generic form. Teva’s lamotrigine in each 25 mg chewable tab had 21.1 mg of carb so the child got (21.1 mg x 6 tabs = 126.6 mg/dose x 3 doses/day = 379 mg/day) filled by a community pharmacy.

    I believe it was the first day on the generic form the child had seizures and was readmitted. Once we identified the problem, we appealed to MN State Med Assistance and they agree to pay for the brand product – Lamictal. As we all know the FDA approves the active drug to be equivalent, but in some cases a simple change in the medication filler can make a difference.

    Another case was when I ran the Women’s State Prison Pharmacy, the patients complained about the difference in the generic conjugated estrogen product versus what they had with the brand name Premarin. We also found out that if the woman was started on the generic conjugated estrogens, but had to switch to the brand name Premarin due to product availability or some other reason, the patients complained about this switch on how they felt. This one did baffle the clinic staff.

  2. healthymatters says:

    You bring up good points. In general, I’m a big fan of generics as I’m somewhat cynical about the pharmaceutical practices in our country. If for no other reason, the cost-savings to our system would be substantial if we addressed the price of medications issue. That being said, I do know of some people for whom problems arose with generics and they required a trade-name medication. Thanks for adding your experience to the conversation – it is helpful to hear stories from real life to advance our understanding! -david

  3. I appreciate your explanation of MTM. I’m afraid that I am also of the age that I would know what Mary Tyler Moore is, and I’m not even from Minnesota! It is good to know that I can use this type of visit to discuss my side effect questions, I’ve never known who to go to for these things. Thank you for all of your helpful and applicable pharmacist information!

  4. healthymatters says:

    Hey Brooke. There’s even a statue of the real MTM in downtown Minneapolis. Guess we hang on to old celebrities around here! Anyway, lots of my pharmacist friends are doing great work with patient visits. Thanks for checking in with me on the blog! David

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