Motivational MTM



No matter how old you become, you always remember what it felt like on game day.  In the locker room, all suited up, nervous tension about the game to come and perhaps a little anxiety about the size of the other team.  You hear a couple of the lineman hitting each other's shoulder pads with ferocious intensity.  The team is getting a little rowdy, the sound of hands banging against the metal lockers.  Then, the Coach walks into the locker room.  Quickly the room is as quiet as church at the 6 a.m. service.


The Coach isn't there to talk about the plays we are going to run that day.  He doesn't want to discuss how we did at last week's game, or for that matter, what the plan is for next week's game.  Right now, right here, the Coach is here to talk about today.  What are we doing here?  Why did we take the time to put on our uniforms?  How are we going to reach deep down inside ourselves and draw upon that strength that will allow us to go out there and give the game 110% of our effort!


We are familiar with traditional Medication Therapy Management, its core elements, and all that goes into a complete session.  When talking with patients we use the techniques associated with one of the latest catch phrases in the health care field called Motivational Interviewing.  I have yet to see anyone combine the two into what I would like to call Motivational MTM.


Pharmacists are being called upon to step up, take responsibility, and help bridge the medication-education-gap that exists between patients, and their health care providers.  Medication Therapy Management is one way in which pharmacists are playing a central role in assisting patients understand and manage their mediations. 


Motivational interviewing, on the other hand, is a patient-centered method for identifying an individual’s readiness for change and enhancing motivation by exploring and resolving ambivalence about the new behavior. These techniques, such as open ended questions, reflective listening, and summary statements help promote informed decision-making and encourage patients to participate in their own health care.


One particular arena where pharmacists are being called upon, in a transition of care, medication education capacity, is to help patients who are being discharged from hospitals maintain an appropriate level of adherence to their medication regimen once they return home. 


I would argue that patients are not in their best state of mind while they are hospitalized.  It would be inappropriate to assume that a patient, educated about their medications while in their hospital bed, would be in a position to recall all of the specifics of their education once they got home.


Perhaps this would be an opportunity to implement a Motivational MTM program.  Sure, the patient is excited and ready to go home.  Here comes the pharmacist with a stack of papers and says, "WAIT", I know you are ready to leave; however, before you exit this hospital, it is my intention to discuss each and every one of your medications with you, while also highlighting on these papers all of the important aspects of your medications so when you get home you may read through them again.


Instead, how about if the pharmacist comes into the room and shares a little empathy with the patient and their family.  Understanding that they have just been through this tremendous process and would like nothing more than to leave and get to the comfort of their own home.  Heading home; however, means that they will now be the ones responsible for managing their medications.  Are they ready for this task?


As the Coach said, What are we doing here? Are we ready to take on this task? Are we ready to reach deep down inside and come up with the strength that will allow us to give 110% to adhering to our medication regimen?  


Sure, Motivational MTM can include some open-ended Vince Lombardi one-liner questions; however, it also needs to include some brass tacks of adherence.  Patients need to fully understand the daunting statistics that surround adherence so they realize what they are up against:


      • 75% of adults are not adherent to their prescription medication in one way or another.
      • 125K deaths in United States each year due to non-adherence.
      • Up to 69% of all medication related hospital admissions are due to non-adherence.
      • Non-Adherence costs the country up to 300 billion dollars/year.


Before a patient leaves the hospital, it is imperative that they understand what their specific barriers to adherence are.  Whether it be cost of or access to medications, social or religious, mental or familial, or one of the many other barriers, a discussion needs to take place so these barriers may be addressed.


The pharmacist may also help a patient understand what it means when they hear the term, Health Literacy.  With a little help, a patient should be in a position to describe their diagnosis in one or two sentences while also describing what treatments have been employed to treat the specific diagnosis.  Furthermore, and possibly more importantly, the patient should be in a position to describe the consequences of not treating their diagnosis.


Lastly, patients need to understand that their community pharmacist is a valuable Medication Information and Health Literacy resource. Patients, at all points along their health care continuum, should be encouraged to develop a relationship with a community pharmacist they trust. 


Now it's time for the patient to head out the door, get in their car and head home.  The have completed a 20 minute Motivational MTM session with their pharmacist;


  1. They understand what drug adherence means and the challenges it poses.
  2. They have a much better understanding of their specific barriers to medication adherence.
  3. They are able to voice their diagnosis and clearly identify the specific treatments for each diagnosis.
  4. They know exactly where they will go for follow up questions and concerns about their medication regimen.


OK team, now let's get out there and give it all we got!


Thanks
Steve


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