MTM Transitions of Care & Care Coordination 1 — Questions and Answers
Question 1: Which intervention is MOST critical for a pharmacist conducting MTM during a patient's transition from hospital to home?
- Reconciling the discharge medication list against pre-admission medications (Correct answer)
- Scheduling a follow-up appointment with the cardiologist
- Ordering a complete metabolic panel within 48 hours
- Contacting the insurance company to verify new formulary coverage
Correct answer: Reconciling the discharge medication list against pre-admission medications
Medication reconciliation at discharge is the highest-priority MTM activity because discrepancies between discharge and pre-admission medications are a leading cause of post-discharge adverse events.
Question 2: A patient is discharged from the hospital on warfarin. Within the first 30 days post-discharge, which MTM activity best reduces readmission risk?
- Mailing a comprehensive medication list to the patient
- Conducting a targeted medication review with INR monitoring follow-up (Correct answer)
- Referring the patient directly to anticoagulation clinic without pharmacist contact
- Waiting for the next scheduled CMR in 6 months
Correct answer: Conducting a targeted medication review with INR monitoring follow-up
A targeted medication review focused on warfarin therapy, combined with INR monitoring coordination, addresses the high risk of bleeding or thrombosis in the vulnerable post-discharge window.
Question 3: According to CMS guidelines, how soon after hospital discharge should an MTM follow-up contact ideally occur to reduce readmissions?
- Within 7 days (Correct answer)
- Within 30 days
- Within 60 days
- Within 90 days
Correct answer: Within 7 days
CMS and quality improvement initiatives recommend MTM follow-up within 7 days of discharge to catch medication errors, adverse effects, and adherence issues before they lead to readmission.
Question 4: Which tool is MOST commonly used by pharmacists to document medication discrepancies identified during care transitions?
- Medication Therapy Management Action Plan (MAP)
- Personal Medication Record (PMR)
- Best Possible Medication History (BPMH) (Correct answer)
- Medication Error Reporting Program (MERP)
Correct answer: Best Possible Medication History (BPMH)
The Best Possible Medication History (BPMH) is the standard tool used to capture a complete, accurate medication list from multiple sources, serving as the baseline for reconciliation during care transitions.
Question 5: A patient newly prescribed a beta-blocker for heart failure is being transitioned from a hospitalist to a primary care provider. The MTM pharmacist's MOST important coordination action is to:
- Discontinue the beta-blocker until the PCP reviews the case
- Communicate the indication, dose titration schedule, and monitoring parameters to the receiving provider (Correct answer)
- Switch the patient to a different antihypertensive to simplify the regimen
- Defer communication until the patient has a follow-up lab result
Correct answer: Communicate the indication, dose titration schedule, and monitoring parameters to the receiving provider
Communicating indication, titration plan, and monitoring parameters ensures continuity and prevents the receiving provider from inadvertently discontinuing or mismanaging a newly initiated guideline-directed therapy.
Question 6: Which patient characteristic most significantly increases the risk of medication-related problems during care transitions?
- Age under 40 with a single chronic condition
- Polypharmacy (5 or more chronic medications) in a patient with multiple comorbidities (Correct answer)
- Recent vaccination at a retail pharmacy
- Enrollment in a Medicare Advantage plan
Correct answer: Polypharmacy (5 or more chronic medications) in a patient with multiple comorbidities
Polypharmacy combined with multiple comorbidities greatly increases the probability of drug interactions, duplications, omissions, and dosing errors during the transition process.
Question 7: During a post-discharge MTM call, a patient reports not filling two of five new prescriptions due to cost. The pharmacist's BEST initial action is to:
- Advise the patient to skip those medications until their next physician visit
- Assess the clinical priority of each unfilled medication and explore financial assistance options (Correct answer)
- Call the prescriber immediately to discontinue all five medications
- Document the non-adherence and close the case
Correct answer: Assess the clinical priority of each unfilled medication and explore financial assistance options
Assessing clinical priority ensures life-sustaining medications are obtained first, while exploring patient assistance programs, generics, or therapeutic alternatives addresses the cost barrier without compromising safety.
MTM Transitions of Care & Care Coordination 1
Which intervention is MOST critical for a pharmacist conducting MTM during a patient's transition from hospital to home?