Pharmacist (MTM Clinic)

MAIN FUNCTION:

Medication Therapy Management Services

• Conduct comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs)


• Assess medication regimens for:
  
  
  
  • Appropriate medication selection
  
  
  • Appropriate dose
  
  
  • Appropriate route
  
  
  • Appropriate frequency
  
  
  • Appropriate indication
  
  
  • Therapeutic effectiveness
  
  
  • Safety concerns
  
  
  • Patient adherence and barriers
  
  
  
  


• Identify, prevent, and resolve medication-related problems


• Develop individualized medication action plans


• Communicate recommendations to providers and healthcare teams


• Follow up on medication changes and clinical outcomes

Clinical Pharmacist Assessment

Evaluate patient-specific factors including:

• Drug-drug interactions


• Drug-disease interactions


• Allergies and intolerances


• Renal function considerations


• Hepatic function considerations


• Laboratory monitoring needs


• Contraindications and precautions


• Duplicate therapy


• Medication affordability and access barriers

Patient Care & Education

• Provide medication counseling and education to patients and caregivers


• Promote medication adherence and self-management strategies


• Educate patients regarding:
  
  
  
  • Medication purpose
  
  
  • Expected benefits
  
  
  • Potential adverse effects
  
  
  • Monitoring requirements
  
  
  • Lifestyle modifications
  
  
  
  


• Support patients in understanding and managing chronic conditions

Chronic Disease Management Support

Provide pharmacist-led interventions and monitoring for conditions such as:

• Diabetes


• Hypertension


• Hyperlipidemia


• Anticoagulation therapy


• Asthma/COPD


• Heart failure


• Other chronic disease states as identified by clinic needs