MEDICATION REVIEW
RESPONSIBILITIES OF A MEDICATION MANAGEMENT
• comprehensive review of patient’s full
PHARMACIST ON MEDICATION medication regimen to ensure medications
SAFETY work well together & avoid problems
ENSURE ACCESS TO MEDICATION
• evaluate ability to pay for medications
• explore alternative medications/payment
means
• pharmacist can provide options for patients
by offering lower priced medicines (generic
counterparts)
SUPPLY MEDICATION INFORMATION
• educate patients & caregivers on safe &
effective medication use
• reviewing proper dosing w patients/
providers can prevent medication errors &
adverse drug reactions
• the time the drug is administered & the
frequency is crucial to ensure maximal
efficiency
EVALUATE MEDICATION APPROPRIATENESS
• assess medication appropriateness, &
safety for each individual patient
• patient condition, medication list, age,
weight, ethnicity, diet, allergies, & kidney &
liver function
IMPROVE MEDICATION ADHERENCE
• help patients make medication as it is
prescribed
• changes in medication, dosing/additional
therapies that improve patient adherence
• dosing schedule can be modified, so intake
of medicines would be convenient to
patients
PROVIDE HEALTH & WELLNESS SERVICES
• deliver health & wellness service
• blood pressure screenings, blood sugar
testing
• offer advices on proper diet that should be
taken by patients & necessary nutrient
supplementation
• checking for drug interactions
• including OTC drugs & herbal medicines
ASSESS HEALTH STATUS
• determine current patient status &
medication effectiveness;
• provide guidance regarding medication
therapy
• detection of dangerously abnormal
changes in physiologic values
COORDINATING CARE TRANSITIONS
• coordinate medication management across
care transitions;
• assist w care coordination for transitions
• pharmacist-led medication reconciliation
➢ identify potential interactions/
omissions in medication of patients
MEDICATION THERAPY
MANAGEMENT IN PHARMACY
PRACTICE
CORE ELEMENTS
• Medication Therapy Review
• Personal Medication Record
• Medication-Related Action Plan
• Intervention &/or referral
• Documentation & follow-up
MEDICATION THERAPY REVIEW
• systematic process of collecting patient-
specific information, assessing medication
therapies to identify medication-related
problems, developing prioritized list of
medication-related problems, & creating
plan to resolve them
• performed to ensure patient receives best
outcomes from the drug therapy to improve
the quality of life
PERSONAL MEDICATION RECORD
• comprehensive record of patient’s drugs
(prescription & non-prescription, herbal
products, & other dietary supplements)
 MEDICATION REVIEW
MEDICATION-RELATED ACTION PLAN
• patient-centric document containing list of
actions for patient to use in tracking
progress of self-management
• HCPs may not be able to check patient’s
condition every time, so they have to
empower the patient to monitor their own
condition – provide them w red signs if they
need to consult w a physician

INTERVENTION &/OR REFERRAL

• pharmacist provides consultative services
& intervenes to address medication-related
problems;
• when necessary, pharmacist refers patient
to a physician/other healthcare
professional

DOCUMENTATION & FOLLOW-UP

• services are documented in consistent
manner,
• a follow-up MTM visit is scheduled based
on patient’s medication-related needs/
patient is transitioned from one care
setting to another
• phone calls can also be made from time to
time to check on patients
• “if you did not document it, you did not do
it”
• necessary for future references & can save
professionals from lawsuits