PPCP Review Spring Midterm

doing an assessment and prioritizing

What is the key to assessing a patient?

1) identify all the health conditions

2) assess those conditions identified

3) prioritize based on assessment

what are the 3 steps you should take when assessing and prioritizing health conditions?

use of a variety of sources like PMH and new conditions are based on symptoms the patient is complaining about which led to the visit

How do you identify health conditions?

How to do a correct assessment of conditions identified

-list level, stage, classification if applicable

-controlled, asymptomatic, or stable

-> if NOT then why

Indication, Effectiveness, Safety, Adherance

What are the medication related needs?

Indication

-Unnecessary med therapy

-Needs additional med therapy

Effectiveness

-ineffective med

-dosage too low

-needs additional monitoring

Safety

-adverse med event

-dosage too high

-needs additional monitoring

Adherance

-Adherence

-Cost

the middle (Med Therapy Problem Category)

When looking at the MTP chart to classify our problems what section should we look at first?

Unnecessary med therapy

•Medication has no indication

•Duplicate medication or class

Dosing, Administration, or storage issue

•Dose too high or too low

•Incorrect or inappropriate dosing regimen, formulation, route, frequency, duration, titration/taper, etc.

•Incorrect storage

Adverse event or monitoring

•Medication-related or allergy-related adverse effect

•Lack of appropriate monitoring

Drug interactions

•Drug-drug , drug-disease, or drug-food interactions

Compliance or cost issues

•Adherence or administration issues

•Cost concerns

Patient lack of understanding

no think about what matters in this situation

Should you always list every interaction when assessing a patient?

-most pressing/serious issue

-what they are there to treat

What do we usually prioritize problems based on?

plan

Where is rationale found in the PPCP wheel?

Rationale for Recommendations

•What are you basing your recommendations on (DI references, clinical guidelines, primary literature)?

•What information from primary literature and guidelines supports this recommendation?

•Why are you recommending this over other potential therapy options (why this class, why this agent within the class)?

•Are there any patient-specific factors for choosing this?

problem solvimg

depends on critical thinking skills

clinical reasoning

depends on evidence-based knowledge

clinical decision making

depends on argument construction

supports

Rationale ___________ your clinical-decision making.

1) Optimize Care Plan (Therapeutic Monitoring)

2) Identify and resolve med therapy problems (Adverse event monitoring)

What are the goals of Follow up?

therapeutic monitoring

-Relate back to your goals of therapy

-May vary from disease state to disease state

-Often found in disease state guidelines

-Commonly related to lab value or diagnostic test (i.e. blood pressure) BUT can also be the absence of an event (i.e.- prevention of heart attack or stroke)

-Should include what you will measure, HOW you will measure, AND when you will measure it

Monitoring Parameter

This will be the specific item that is evaluated to determine if the intervention is effective

How to Monitor

-How is this item going to be evaluated?

-Ex: drawing a lab, PE, asking about symptoms

When to Monitor

This is timeline for when you will perform the monitoring task

Plan

Should include what your plan would be if the monitoring parameter is not met

FALSE

When adverse event monitoring you should just list side effects. T or F

Implement

•Addressing medication-related problems

•Engaging in preventive care strategies

•Initiating, modifying, discontinuing, or administering therapy

•Providing education and self-management training

•Contributing to coordination of care, including the referral or transition of the patient to another health care professional

•Scheduling follow-up care as needed to achieve goals of therapy

collaboration

The practitioner implements the care plan in ___________ with other health care professionals and the patient or caregiver.

preventative services

help you stay healthy, detect health problems early, determine the most effective treatments, and prevent certain diseases

EX: vaccines, health screenings, educaiton

Part B

What part of Medicare covers preventative services?

Common Health Screenings

-Point of care testing

-health risk assessment

-depression screening

-anxiety screening

-cognitive screening

-fall prevention

-cancer screenings

medicare wellness visit

Preventative health appointments for Medicare beneficiaries with a goal to prevent disease or disability

no they cannot because they are not seen as providers by Medicare part b

Pharmacist can complete annual wellness visits, however, they cannot directly bill for this service?

immunization considerations

-practice site

-qualifications

-protocols

-administration

travel vaccines

-HEP A

-HEP B

-Meningococcal

-Measles

-Rabies

-Typhoid (live or inactivated)

-Yellow fever

-Japanese encephalitis

VAERS

national vaccine safety surveillance program that helps to detect unusual or unexpected reporting patterns of adverse events for vaccines

anyone

VAERS accepts reports from ____________ including patients, family members, healthcare providers and vaccine manufacturers. (reports of vaccination errors)

required by law

Healthcare providers are ____________ to report to VAERS.

Mississippi Immunization Information eXchange (MIIX)

-Mississippi State Department of Health State Immunization Registry

-allows you to search and view patient's vaccination record

-CDC

-Pneumorecs

-Prevention Taskforce

What are the recommended apps about vaccines?

pharmacist implementation

-addresses medication

-initiates, modifies, discontinues, or administers medication therapy as authorized

-provides education and self management training to the patient or caregiver

-contributes to coordination of care, including the referral or transition of the patient to another health care professional

-schedules follow up care prn to achieve goals of therapy

scope of practice

the boundaries within which a health professional may practice

-largely determined by statutes enacted by state legislatures and by rules adopted by the appropriate licensing entity

state boards of pharmacy

For pharmacists, scope of practice is regulated by what?

initiation authorized under CPA in MS

-Hormonal contraception

-Tobacco cessation aids

-"Test and Treat"

-Naloxone

-Glucagon

modify authorized under CPA in MS

•Quantity (30-to-90-day switch)

•Therapeutic substitution

•Dose adjustments based on lab monitoring

Discontinue authorized under CPA in MS

•Antibiotic Stewardship

•Medication Therapy Management

•BEERS Criteria for Geriatric Patients

Administer authorized under CPA in MS

•Vaccinations

•Long-acting Injectables

•Antipsychotics

•Contraception

•Vitamins

•Hormones

continuum of pharmacist prescriptive authority

This authority exists somewhere along a continuum and is either dependent (delegated through a collaborative practice agreement) or independent (authority comes directly from the state, no delegation required) authority

-collaborative prescribing

-autonomous prescribing

-credentialing/privileging

What are the mechanisms to expand pharmacist's scope of practice?

Collaborative Practice Agreements (CPAs)

-create formal practice relationships between pharmacists and prescribers

-Serve to improve the efficiency and effectiveness of collaborative care delivery

-increase access to care

-expand available services

-increase the efficiency and coordination of care

-leverage pharmacists' medication expertise

What are some of the benefits of collaborative practice agreements (CPAs)?

-order laboratory test

-refill authorizations

-management of specific health conditions

What are some examples of services that fall under scope of practice collaborative practice agreements?

nationwide/statewide protocols

are issued by a state board or agency that authorizes pharmacists to prescribe a medication or category of medications under a protocol

statewide standing orders

is an authorization issued by a single prescriber allowing all pharmacists in a state to dispense medication(s) directly to a patient in certain scenarios ​

category-specific prescribing

is when a state authorizes pharmacists to prescribe certain categories of medications without the need for a statewide protocol based on clinical guidelines and professional judgement

credentialing

•a process performed by organizations (e.g., employers, payers, networks) to assess and confirm the qualifications of health care providers

-Ex: board certification, residency certificates

privileging

•grants permission to a pharmacist (or other health care professional) to provide specific services within an organization.

-Ex: Order lab values, pharmacokinetic dosing

-Institution type

-Existing health care culture

-IT infrastructure

-Provider group integration

-State-specific legislation

What is credentialing and privileging limited by?

MTM

-Defined by APhA as a distinct service or group of services that optimize therapeutic outcomes

-Involves identifying, resolving, and preventing medication-related problems

Medication Therapy Review (MTR)

a review of prescription, over-the-counter medications, herbal therapies and dietary supplements

Medication-Related Action Plan (MAP)

A list of action steps for the patient based on identified medication issues ​

Personal Medication Record (PMR)

List of all the patient's medications upon completion

Intervention and/or referral

•Medication-related problem? Contract prescriber

•Expertise of another professional needed? Make referral

Documentation and Follow-up

Documentation, billing

-Medication Therapy Review (MTR)

-Medication-Related Action Plan (MAP)

-Personal Medication Record (PMR)

-Intervention and/or Referral

-Documentation and Follow up

What are the MTM 5 core elements?

monitor the quality of Medicare Part D plans

What is the purpose of Medicare and Medicaid (CMS) star ratings?

value-based care

is evidence-based, outcome driven, and resource appropriate

•Help patients make the best use of their medications

•Earn revenue for professional services

•Demonstrate value to healthcare payers

Quality measure systems present a significant opportunity for pharmacists to do what?

Medication Reconciliation

Reconcile discrepancies and address any issues

Patient Education

Educate patients on proper medication use and adherence

Care Coordination

Communication with other providers to ensure continuity of care

Follow Up

Can reduce serious adverse drug events, use of emergency care, and hospital readmissions