MTM Health Literacy & Patient Counseling 4 — Questions and Answers
Question 1: During an MTM encounter, a patient reports taking their metformin 'when I remember.' What is the pharmacist's BEST initial step?
- Immediately recommend switching to a once-weekly formulation
- Explore the reasons behind inconsistent adherence without judgment (Correct answer)
- Document non-adherence in the chart and alert the prescriber
- Suggest the patient use a pill organizer without further discussion
Correct answer: Explore the reasons behind inconsistent adherence without judgment
Identifying the root cause of non-adherence through motivational interviewing is essential before recommending any solution.
Question 2: Motivational interviewing (MI) in pharmacy practice is BEST characterized by which principle?
- Confronting the patient about the risks of their non-adherent behavior
- Eliciting the patient's own motivation to change by exploring their values and goals (Correct answer)
- Providing detailed education until the patient agrees to follow the treatment plan
- Setting measurable adherence targets and monitoring compliance weekly
Correct answer: Eliciting the patient's own motivation to change by exploring their values and goals
MI is a collaborative, person-centered approach that draws out patients' intrinsic motivation rather than imposing external pressure to change.
Question 3: A patient who reads at a 4th-grade level is given a Medication Action Plan. To best support comprehension, the document should include:
- Detailed pharmacokinetic information about each drug
- Simple sentences, large font, pictures, and white space (Correct answer)
- A full list of FDA-approved indications for each medication
- Medical terminology with a glossary provided as a separate handout
Correct answer: Simple sentences, large font, pictures, and white space
Plain language, visual supports, and uncluttered formatting are evidence-based design elements that improve comprehension for patients with low literacy.
Question 4: Which of the following BEST describes the 'transtheoretical model' (stages of change) as applied to medication adherence?
- A billing framework for MTM services categorized by complexity
- A model describing patient readiness to change behavior across five sequential stages (Correct answer)
- A pharmacokinetic model predicting drug response based on patient genotype
- A quality metric used by CMS to evaluate MTM program outcomes
Correct answer: A model describing patient readiness to change behavior across five sequential stages
The transtheoretical model identifies stages (precontemplation, contemplation, preparation, action, maintenance) that reflect a patient's readiness to adopt healthy behaviors.
Question 5: A patient declines to take a newly prescribed statin because they heard 'statins destroy your liver.' The pharmacist should FIRST:
- Reassure the patient that liver damage is extremely rare and prescribe anyway
- Acknowledge the patient's concern and ask where they heard that information (Correct answer)
- Call the prescriber to discuss switching to a non-statin lipid-lowering agent
- Provide a printed evidence summary refuting the myth immediately
Correct answer: Acknowledge the patient's concern and ask where they heard that information
Acknowledging concerns and exploring their source builds trust and is the foundation of effective motivational dialogue before providing corrective information.
Question 6: Which patient population has the HIGHEST risk for low health literacy according to US public health data?
- Adults aged 25-44 with college education
- Elderly adults, those with lower education levels, and non-English speakers (Correct answer)
- Teenagers using digital health apps for medication reminders
- Middle-income adults with chronic disease diagnoses
Correct answer: Elderly adults, those with lower education levels, and non-English speakers
Low health literacy disproportionately affects older adults, individuals with less formal education, and those whose primary language is not English.
Question 7: A pharmacist adapts their counseling style from directive to collaborative mid-session after sensing patient resistance. This reflects which counseling competency?
- Accurate empathy and active listening
- Rolling with resistance using MI principles (Correct answer)
- Shared decision-making documentation
- Interprofessional communication
Correct answer: Rolling with resistance using MI principles
In motivational interviewing, 'rolling with resistance' means shifting approach rather than confronting or arguing when a patient pushes back.
MTM Health Literacy & Patient Counseling 4
During an MTM encounter, a patient reports taking their metformin 'when I remember.' What is the pharmacist's BEST initial step?