MTM Clinic

Yesterday I had the chance to visit the MTM clinic (called MMS clinic here).  For the most part, MTM clinic is very similar to how I have observed it in the US.  The pharmacist will get a list of the patient's medications on the EMR, check for appropriate indications and dosages, note duplicate therapies and inform the patient of any recommended changes to streamline medication management.  The whole visit takes anywhere from 30 minutes to 1 hour depending on how complicated the patient is.  

The one huge difference is that because the number of MTM pharmacists is very limited here, they typically see only 5 patients a day.  Those 5 patients are selected at random by the intake pharmacist at the outpatient pharmacy based on certain criteria: age > 65, > 5 medications on the list, and a specific disease state that is the "theme of the day".  Monday is renal day, Tuesday is all disease states, Wednesday is DM and so on.  

When the patient comes down to the pharmacy after the clinic visit and brings the prescription list, the intake pharmacist flags the patient and sends the info to the MTM pharmacist whose office is conveniently in the outpatient pharmacy.  What's a little odd and interesting is that the patients here are a captive audience.  They can't really opt out of the MTM consult service before they can pick up their prescriptions if they are selected.  The MTM pharmacist told me that most, if not all patients, warm up to the MTM visits very quickly though so they are never really short of work.  Plus with the amount of time the patients have to wait to get their medications, it's probably a better option to kill their time anyway: 

40-55 minutes is the estimated wait time!

The other way for patients to get into MTM clinic is if their doctor refers them to the pharmacist because they think it would be beneficial.  This is again mandatory, but I find that most patients here listen to what their doctor says anyway.  Like it is in the US, there ends up being more patients than the MTM clinic can handle so they usually end up with about 100 patients a month, squeezing in a few more here and there when they can.