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MTM HOME ASTHMA MTM PILOT RESOURCES PATIENT INFORMATION PHARMACIST EDUCATION/GUIDELINES

 

 
 
Practice Resources
 
 
 
 
 
 
 
 
 
 
 

 

 

 

 

Patient Enrollment Resources


 




Initial Visit Training Video

 

Second Live Visit Training Video

  

 




 

Frequently Asked Questions regarding the Asthma MTM Pilot

Underlined document titles indicate that they are available in the MTM Pilot Guide Packet above. Clicking the title will take you to the document.

 

What should I tell the patient when contacting them about enrolling in the Pilot?

 

  • The patient should be informed of the purpose of the Pilot and the benefit to them.
  • It is important to inform the patient of the time commitment involved with the program, as you do not want to choose patients who are unlikely to follow through.
  • After scheduling the Initial Visit, ask the patient to arrive 10-15 minutes early to fill out the consent forms and other enrollment documents.
  • Remind the patient to bring in ALL medications (pills, insulin, OTCs, herbal supplements, etc.) to the Initial Visit.

 

 

How do I use the personal medication record? When do I give it to the patient?

  • Two versions of the Personal Medication Record are provided in the MTM Pilot Guide Packet, but you may use a version of your own if you wish.
  • It is recommended that you make several copies of the Personal Medication Record so that you can provide the patient with a clean copy of their updated medication record at later meetings.
  • At the Initial Visit, you will review all of the patient's prescription medications, OTC medications, and herbal supplements - these should then be filled out on the Personal Medication Record of your choice with accurate dosing and directions.
  • After the Initial Visit, you should review the patient's medications to identify any drug therapy problems, such as unnecessary drug therapy, wrong drug, wrong dose, etc.
  • Any recommended changes should then be faxed to the physician with the Asthma Action Plan, Prescription Approval Letter, and the Allergen Testing Referral Form (if applicable).
  • After you have received approval or denial from the physician regarding any changes to the patient's drug therapy, you may will out a new Personal Medication Record, which will be given to the patient at the Second Live Visit.
    • The new Personal Medication Record should be reviewed with the patient at this time to improve adherence.

     

  • You should have received four or five Asthma Care Kits at your practice site, each containing a Peak Flow Meter and a Holding Chamber.
  • The Asthma Care Kit should be given to the patient at the Initial Visit.
  • At the Initial Visit, instruct the patient on how to use the Peak Flow Meter and Holding Chamber (if necessary)
  • Give the patient the Peak Flow Meter Patient Log and ask them to record their twice-daily readings until the Second Live Visit.
  • Patient education for the Peak Flow Meter:
    • Make sure that the meter is starting at zero.
    • It is best to stand while using the meter.
    • Take as deep of a breath as possible, then close the mouth tightly around the mouth piece of the meter, making sure that the tongue is not blocking the flow of air.
    • Blow out as hard as possible without making any forward motions with the head or body.
    • Rest for a minute or two, then repeat the process two more times.
    • Record the highest of the three readings on the Peak Flow Meter Patient Log.
    • Repeat this process every morning and evening until the Second Live Visit.
      • There should be two readings per day, for a total of approximately 28 readings by the Second Live Visit.
  • At the Second Live Visit, you will use the patient's highest reading from the Peak Flow Meter Patient Log as a starting point to fill out the peak flow values on the Asthma Action Plan.

 

What do I do with the Asthma Action Plan?

  • After the Initial Visit, the Asthma Action Plan (AAP) should be faxed to the physician for approval.
  • At this point, only the top portion of the AAP containing the patient identifiers and doctor's information will be filled out. You may also add the patient's maintenance regimen in the green zone as a suggestion if you wish. The peak flow values, yellow zone, and red zone will be left blank at this time.
  • The AAP will be faxed to the physician along with the Prescription Approval Letter, Allergen Testing Referral Form (if applicable) and any other recommendations.
  • If/when the Prescription Approval Letter and AAP have been approved by the physician, you may fill in the albuterol and steroid prescription information on the AAP.
  • At the Second Live Visit, you will obtain the patient's best Peak Flow reading from their record sheet. You may then use this number to fill in the Peak Flow values for the green, yellow, and red zones.
  • You will then review the AAP with the patient to ensure that they understand how to use it based on their Peak Flow readings, which they should continue to monitor on a daily basis.
  • A copy of the AAP MUST be given to the patient at the Second Live Visit.

 

What is the Prescription Approval Letter for?

  • The first page of the Prescription Approval Letter is intended to inform the physician of the patient's participation in the MTM Pilot Program and request their cooperation.
  • The second page provides the physician with several options for two prescriptions: albuterol and a steroid.
  • After the Initial Visit, the Prescription Approval Letter should be faxed to the physician along with the Asthma Action Plan, Allergen Testing Referral Form (if applicable), and any other recommendations.
  • If/when the Prescription Approval Letter and AAP have been approved by the physician, you may fill in the albuterol and steroid prescription information on the AAP, which may then be given to the patient.

 

What do I do with the referral forms?

  • A Quitline FAX Referral Form for smoking cessation and an Allergen Testing Referral Form have been provided in the MTM Pilot Guide Packet
  • During the Initial Visit with the patient, you should address both smoking cessation and allergies, as these factors can exacerbate asthma symptoms.
  • If one or both of these factors are identified, ask the patient if they would like to be referred.
    • The Quitline FAX Referral Form for smoking cessation should be sent to Quitline at 1-800-483-3114. Quitline will then contact the patient within the next few days.
    • The Allergen Testing Referral Form should be faxed to the physician along with the Asthma Action Plan and Prescription Approval Letter. The physician may then decide whether or not to refer the patient for testing.
      • A list of Medicaid plans and their preferred lab has been included on page 2 of the Allergen Testing Referral Form - Please review this form to ensure the patient is eligible for testing before sending the form to the physician.
  • If the patient was referred, follow up at the Second Live Visit to see if they have been contacted by the appropriate parties about the next step of the referral.

 

 


 


Recommendations from pharmacists participating in the Pilot

 

Prior to Initial Visit

  • Choose patients that have a reasonable number of medications to reduce visit times.
    • One pharmacist reported seeing a patient with approximately 20 medications. The appointment took about an hour.
  • Look through the patient's profile ahead of time. You may want to fill out part of the Personal Medication Record before the Initial Visit if time allows.
  • Be sure to remind patients to bring all medications, including asthma devices, insulin, oral medications, topical medications, OTCs, herbal supplements, dietary supplements, etc.
  • Overestimate the amount of time you will spend on the interaction.
    • A general estimate is about 20-25 minutes per interaction, but patients with several questions or a large number of medications will take longer. 

     

During the Initial Visit

  • Before recommending allergen testing to the patient, review the second page of the Allergen Testing Referral Form to be sure that their plan covers the testing.

 

After the Initial Visit 

  • Try to minimize the number of times you contact the physician by combining issues into one communication if possible.
  • Fill out as much information as you can on the Prescription Approval Letter and the Asthma Action Plan before sending them to the doctor for approval.
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