Medication Therapy Management (MTM) and Medication Therapy Review (MTR)

MTM is a range of services provided by pharmacists to help improve your health.

• An MTM session typically includes sitting down with your pharmacist to discuss your medications in depth.
• These sessions often last 30-60 minutes.

There are five aspects to a full MTM session that are completed by the pharmacist working with the patient and the patient’s doctor(s):

• Conducting a Medication Therapy Review (MTR);
• Creating a personal medication record;
• Creating a medication-related action plan;
• Providing an intervention and/or referring the patient to another practitioner; and
• Documenting the session and following up with the patient and/or their doctor(s).

MTM provides an in-depth assessment of your medication treatments.

• MTM might also assess your nonmedication treatments, as needed.

Pharmacists review all of your medications from all prescribers as well as over-the-counter, supplement and herbal products.

Pharmacists discuss and address medication problems you may be having. Pharmacists determine if there are:

• Medications being used incorrectly,
• Duplication of medication types,
• Unnecessary medications, and
• Additional medications that are needed for untreated or inappropriately treated health conditions.

Pharmacists provide in-depth medication education in addition to providing advice to you, your family or your caregivers.

• MTM empowers you to know the goals of your medication therapy and be in better control of your medication use.
• MTM helps you have a better understanding of your medications.
• MTM helps you get the most benefit from your medications and can detect and prevent medication problems.

Within an MTM session, a pharmacist may do all of the following:

• Recommend that you take your medication at a different time of day to avoid drug interactions that could cause side effects;
• Review your medications and find that one of them is causing you to be sleepy during the day;
• Look through your immunization records to determine if you need any immunizations at this time;
  • If you did need immunizations, the pharmacist might be able to administer them during your visit;
• Address any other medication-related concerns you have and work to solve them to improve your health.

MTR is a service that can be completed alone OR as a PART of an MTM session.

• Similar to MTM, you sit down with your pharmacist to visit during an MTR.
• Unlike MTM, an MTR by itself is shorter and more focused.
  • An MTR alone may only last 5-15 minutes.
• An MTR session often looks at specific medications.
  • For example, only the medication(s) prescribed to treat diabetes.
• MTR does not typically look at nonmedication treatments.

An MTR may be started by you with a concern about a medication.

• Medication may not be working as well as you want.
• Medication might be causing a side effect.

An MTR session could be started as a focused follow-up to an MTM session.

• MTR sessions can occur between longer MTM sessions to address specific points or concerns.

Your pharmacist will work with you or your other health care providers to try and solve any specific concerns.

An MTR session may also be completed to start an MTM session as one of the five steps.

MTR sessions can occur frequently, if needed.

• MTR sessions provide easy access to have an analysis of specific medications by your pharmacists.

If your blood sugar is not controlled, the pharmacist will look at what medications you are using for controlling your blood sugar.

• If you need an alternative medication to control blood sugar, then the pharmacist will work with your doctor to coordinate this specific change.

If you are feeling sleepy at a certain point during the day, the pharmacist will try to determine if a medication might be causing you to be sleepy.

• If the sleepiness is from a medication taken in the morning, then the pharmacist might recommend taking that medication in the evening instead.

• Provides easy access to answer questions to improve your health.
• Works to resolve medication-related issues you are experiencing:
  • MTM works to help identify issues;
  • MTR sessions might be started by you telling your pharmacist about an issue.
• Collaborates with your doctor and other health care professionals.
• Educates you on any needed changes.

• Decreased doctor and hospital visits by reducing medication-specific problems;
• Decreased risks of possible side effects;
• Increased medication effectiveness;
• Increased overall benefit from medications;
• Improved frequency of medication use;
• Improved health through proper medication use; and
• Resolved medication concerns.

A Personal Medication Record (PMR) is the result of a full medication therapy review session. This is completed as part of an MTM session. It is a physical document that is made by your pharmacist with your help. It includes:

• All prescription and nonprescription medications;
  • Including name, dosing, instructions, why it is prescribed and which doctor prescribed it;
• Herbal and supplement products you may be using;
• Your personal information (name, date of birth, telephone number, etc);
• Your allergies; and
• Date the document was updated.

• A PMR can be given to other health care providers, including doctors and nurses you may see in the clinic or hospital.
• This document can help you remember what each medication is for and which doctor prescribed it.

• This is the care plan developed by your pharmacist after discussing your medications in an MTM session or shorter MTR session.
• A MAP includes items that you and the pharmacist can complete without working with a doctor or other health care professional.
• For instance, if the time when you take a medication needs to change, this would be included in a MAP.
• You may receive a copy of a MAP after an annual MTM session or a quarterly MTR session if changes are needed.
• Your pharmacist will educate you on what is written in the MAP to help you understand your medication plan.

In an MTM or shorter MTR session, issues might be found that require the pharmacist to work with your doctor or other health care provider.

• For instance, if a medication is causing a side effect, the pharmacist might reach out to the doctor who prescribed that medication to request a dose decrease or a change in medication.
• If a medication is not working well enough, the pharmacist may reach out to your doctor to request a dose increase or change in medication.

Depending on your pharmacy, this may be the pharmacist calling or faxing the doctor's office with what they think could be changed and why they think it should be changed. Your doctor may allow the pharmacist to make the change, or the doctor may have other ideas that are different from what the pharmacist recommended.

If a change is made, the pharmacist can help in changing any medications and provide further education to you to help you understand the change.

• Documentation happens at several points in the MTM process, including with the personal medication record (PMR) and medication action plan (MAP).
• Your pharmacist will update your pharmacy records based on what you talk about in a full MTM session or in a shortened MTR session.
• Your pharmacist will also document all conversations with your doctor or other health care professionals.
• You may have a scheduled follow-up with your pharmacist as a result of an MTM session, which may include a more pointed MTR session a few months after your full MTM session.

• When MTR and MTM sessions are completed regularly, your pharmacist has ongoing records of changes that have been made and how well those changes worked.
• Having a record on file with your pharmacy helps your pharmacist serve as your medication expert alongside the rest of your care team.