As we discussed in a previous blog, there are many comprehensive medication management benefits. These include an optimized and personalized medication regimen, greater collaborative care, stronger patient engagement, and — most importantly — improved outcomes typically achieved at lower costs.
But how does one achieve these and other benefits associated with delivering comprehensive medication management (CMM)? Follow these seven best practices.
1. Determine who will benefit from CMM most
While every patient can benefit from CMM, pharmacists may find it difficult to deliver CMM to all of them due to the time and effort required to achieve the comprehensive service. If pharmacists find themselves forced to choose which patients should receive CMM, they should base that decision on several factors, primarily who would benefit most.
A report from the Patient-Centered Primary Care Collaborative states that CMM is of the greatest benefit to:
- patients who have failed to reach or not maintain the intended therapy goal;
- patients experiencing adverse effects from their medications;
- patients with difficulty understanding and following their medication regimen;
- patients in need of preventive therapy; and
- patients who are frequently readmitted to a hospital.
Additionally, CMM should target:
- patients with three or more comorbidities;
- patients on ten or more maintenance medications;
- patients receiving prescriptions from five or more prescribers; and
- emergency room frequent flyers.
2. Gain a complete understanding of the patient
To provide a patient with proper CMM, one must first allocate the time necessary to effectively and fully understand the patient's medication needs. This understanding should include the following:
- patient's medication history;
- patient’s medical history;
- experiences with medications;
- experiences with obtaining medications;
- experiences with administration;
- preferences and beliefs that may affect areas including medication selection and filling of prescriptions; and
- other factors that may impact medication decisions.
3. Include all medications
CMM requires pharmacists to consider all of a patient's medications when evaluating usage history. This means examining more than just prescriptions and over-the-counter drugs. It must also include the likes of herbs, supplements, vitamins, and other alternative medications.
4. Perform individual assessment of each medication
A commonly cited definition of CMM speaks to one of the most critical CMM best practices. The definition reads as follows: "The standard of care that ensures each patient's medications are individually assessed to determine the medication is appropriate, effective for the medical condition, safe given the comorbidities and other medications being taken, and the patient is able and willing to take the medicine as intended."
Every step highlighted in this definition is vital to successful CMM. Deviation in any fashion, such as skipping evaluation of a medication or assuming a patient is willing and/or able to take a drug, can derail efforts to achieve the objectives of CMM and lead to patient harm.
5. Identify obstacles to success
To produce the best outcomes, pharmacists will need to determine if any obstacles are likely to stand in the way of achieving optimal CMM. Examples of such barriers include the following:
- medication affordability;
- lack of convenient access to pharmacy;
- limited understanding of instructions (e.g., language barriers, limited health literacy, memory issues);
- administration challenges;
- medication availability;
- side effects that limit activities of importance; and
- travel schedule.
6. Develop patient-specific plan
Once a pharmacist has completed the CMM best practices described above and can paint a detailed picture of a patient, it's time to develop a therapy plan. This plan should cater to the specific medication and care needs of the patient and, hopefully, achieve desired outcomes.
While the pharmacist will likely take the lead on development of the plan, he or she should not work in a silo. Rather, the pharmacist should engage and request insight and feedback from other stakeholders, including other pharmacists, primary care providers, nurses, specialists, and social workers.
Furthermore, the pharmacist should engage the patient in plan creation and assessment. Active engagement can help secure greater patient buy-in for the plan, identify potential obstacles that otherwise may have been missed, and address questions before the plan is started.
7. Perform regular reevaluations
The therapy plan should be treated as a living document, receiving ongoing attention and reevaluation. This will help determine whether the plan is still working as intended and keeping the patient on a path to success or if changes must be made, whether to address shortcomings in the plan or new obstacles that have since presented themselves.
Pharmacists may also need to make plan revisions if desired clinical goals have changed. When changes are made, pharmacists should closely monitor whether the changes are implemented and having their desired effects or if a new approach may be required.