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Leading the way in medication management

The Medical College of Wisconsin (MCW) School of Pharmacy is preparing its student pharmacists to become MTM providers by having students earn WPQC certification as part of their coursework.

Patient medication nonadherence and medication errors in the United States are estimated to be responsible for $290 billion in healthcare costs each year. Medication management can help reduce these costs and improve health outcomes for patients at the same time. Pharmacists who are medication experts can lead the way in Medication Therapy Management (MTM). The Pharmacy Society of Wisconsin (PSW) has issued a challenge to Wisconsin pharmacies to deliver over 10,000 MTM consultations to patients through its Wisconsin Pharmacy Quality Collaborative (WPQC) initiative. The Medical College of Wisconsin (MCW) School of Pharmacy is preparing its student pharmacists to become MTM providers and help PSW meet their goal. All students at the MCW School of Pharmacy earn WPQC certification as part of their coursework and are prepared to begin providing MTM services when they enter the pharmacy on rotation. Students are able to carry over these skills into their pharmacy practice when they graduate and enter the field as practitioners.

The WPQC program aims to expand the role of pharmacists beyond their traditional scope to serve as medication managers, decrease costs associated with medication misuse, and reduce prescription drug costs for participants. The WPQC sets guidelines that pharmacists and pharmacies must meet to receive reimbursement through Medicare and other payers for an MTM service called Comprehensive Medication Review (CMR) in the state of Wisconsin. “It is unique in that pharmacies can bill for services that the pharmacist provided. Normally, you’re only getting paid for the drug you’re dispensing,” says Kari Trapskin, PharmD, Vice President of Health Care Quality Initiatives at PSW. “There aren’t many states that have something similar.” Accredited pharmacies must go through surveys every six months and prove that they are verifying pediatric doses, assessing for medication allergies, and checking for adverse drug effects on a regular basis, among other quality requirements.

In a CMR, pharmacists work with patients to complete a medication checkup that promotes correct medication use and patient safety. “The patients we have worked with and have been impacted the most have been the patients who are older, have low health literacy, have multiple medications and chronic conditions. I think the patients who have multiple doctors are especially benefitted,” says Dimmy Sokhal, PharmD, clinical pharmacist at Hayat Pharmacy and volunteer faculty member at the MCW School of Pharmacy.

Before a CMR, a pharmacist reviews the patient’s medication history. During a typical visit, the pharmacist will meet face-to-face with the patient and assess their prescription and over-the-counter medication usage, talk about adherence to medications, instruct them how to use medical devices, and identify any problems that might exist in their drug therapies, or any medication plans that are more cost-effective. The patient receives a personal medication record which contains information about the name, dosage and frequency of the patient’s medications, and a medication-related action plan which contains items for the patient to work on to increase the therapeutic benefits of their regimen. After the visit, the pharmacist communicates with the patient’s physician to provide a visit summary, recommend changes, update the patient’s medication record, and provide referrals for follow-up care.

“WPQC is opening up doors to be able to provide this service to patients who are more in need,” says Dr. Sokhal. “I think a lot of patients who have coverage through the state also have health literacy barriers. It is definitely more helpful for the underserved population.”

The MCW School of Pharmacy is taking the initiative to train student pharmacists to provide advanced practice services such as CMR. This follows the MCW School of Pharmacy’s aim to address the growing need for expanded access to healthcare in medically underserved communities.

“The MCW School of Pharmacy is preparing pharmacy students for careers at WPQC pharmacies through our innovative curriculum. In Patient Care Lab, our students learn the skills for MTM services such as intervention-based services and CMR. Our students are able to apply the skills they learn in WPQC training to the real-life practice setting in their Experiential Education rotations,” says George MacKinnon III, PhD, MS, RPh, FASHP, founding dean and professor of the MCW School of Pharmacy.

Students at the MCW School of Pharmacy receive training to provide CMR throughout the course of their first two years while in their Patient Care Lab. The students begin to learn MTM skills within their first year. These skills include motivational interviewing, medication counseling, medication adherence, and over-the-counter and complimentary medications. Students gain necessary knowledge about medications and disease states from classes in the didactic curriculum. Students learn additional MTM skills in hands-on settings their second year, including a lab activity where Hayat Pharmacy brings in Rohingya patients for student CMR recommendations.

MCW School of Pharmacy students become WPQC certified in their second year. Students are given a few weeks to go through the home study materials outside of class and take the test for WPQC certification. “The pharmacy students that go through the training are receiving a very similar training to what the pharmacists receive when they’re getting certified,” says Dr. Trapskin.

The WPQC training covers how to run a CMR and an overview of the processes they must complete to receive reimbursement. The training also emphasizes the changing role of the pharmacist in the retail setting and how the culture of retail pharmacy is moving from a product-driven model to a service-centered model. This adds to the MCW School of Pharmacy’s focus on teaching the expanded role of the pharmacist. “Pharmacy is moving beyond where you just fill the medication and dispense it. It’s about the whole experience and population management,” says Rachel Kavanaugh, PharmD, BCACP, Director for Professional Laboratories and Assistant Professor of Clinical Sciences at the MCW School of Pharmacy.

WPQC certified students are more independent during Experiential Education rotations and can provide MTM services at WPQC pharmacies, including Hayat Pharmacy. Over half of MCW School of Pharmacy students reported participating in an MTM activity while out on an Experiential Education rotation at one of the 36 WPQC sites available. WPQC students can help out the pharmacies where they are on rotation by cutting down on the amount of time preceptors must spend training them and being able to provide a wider range of services.

“I do think that the training is helpful for students when they’re on rotations at a WPQC accredited pharmacy because they can essentially take on the role of a pharmacist. They can be more independent,” says Dr. Kavanaugh. “The training is intense. I think that exposure is going to make them more comfortable in their rotation.”

Certified students on rotation at a WPQC pharmacy gain hands-on experience with the entire process of CMR. “Students bring a lot of value to our program making it more efficient. They learn at the same time,” says Dr. Sokhal. Students gather information about medication history, do drug interaction reviews, work on documentation and billing, and even conduct face-to-face CMR visits under the supervision of a pharmacist.

WPQC accredited students can help community pharmacies that are new to WPQC to implement a CMR program. “I think it’s very important that students get WPQC certified during their schooling,” says Dr. Trapskin. “They may be on rotation at a site that is interested in getting WPQC accredited or maybe they are accredited but haven’t been able to implement CMR yet. We have seen students be really instrumental in setting up the services for the pharmacist so that it can be sustainable going forward.”

While WPQC training is especially helpful to students who want to become community pharmacists, it also translates to other areas of pharmacy. “Having that additional training on different ways to talk to patients and elicit change is important,” says Dr. Kavanaugh. The training also makes students going into other fields aware of the services that community pharmacists can offer and ways that they can collaborate with them to provide a higher level of patient care.

“It’s good to know whatever setting that you are in, there is something like WQPC which is a resource for helping patients achieve better outcomes and quality life,” says Dr. Sokhal.