MTM Transitions of Care & Care Coordination 2 — Questions and Answers
Question 1: Which communication channel is MOST effective for transmitting a medication reconciliation summary to a primary care physician after a patient is discharged from a skilled nursing facility?
- Verbal telephone report only, documented in the pharmacist's notes
- A written, structured medication list faxed or sent via secure EHR message (Correct answer)
- Instructing the patient to relay the information verbally at their next appointment
- Posting the summary on a public patient portal without provider notification
Correct answer: A written, structured medication list faxed or sent via secure EHR message
A written structured summary sent through a secure channel creates a permanent record, reduces transcription errors, and ensures the receiving provider has the information before the follow-up visit.
Question 2: An MTM pharmacist identifies that a patient's discharge instructions list metformin 1000 mg twice daily, but hospital records show the dose was reduced to 500 mg twice daily due to acute kidney injury. This is an example of:
- A commission error
- A medication reconciliation discrepancy — unintentional dose change (Correct answer)
- A therapeutic substitution
- A formulary exception
Correct answer: A medication reconciliation discrepancy — unintentional dose change
An unintentional dose discrepancy between actual hospital orders and discharge paperwork is a classic medication reconciliation error that can lead to patient harm if not corrected.
Question 3: Which of the following BEST describes the pharmacist's role in an interdisciplinary care transitions team?
- Solely dispensing medications and verifying insurance at discharge
- Providing medication expertise, identifying drug therapy problems, and communicating with the care team to ensure safe handoffs (Correct answer)
- Acting as the primary case manager responsible for all social determinants of health
- Replacing the attending physician's discharge counseling responsibilities
Correct answer: Providing medication expertise, identifying drug therapy problems, and communicating with the care team to ensure safe handoffs
Pharmacists contribute clinical medication expertise to the interdisciplinary team, identifying and resolving drug therapy problems while facilitating communication to ensure medication safety across the continuum of care.
Question 4: A patient with chronic kidney disease is discharged on NSAIDs prescribed by the hospitalist. The MTM pharmacist identifies this as a drug therapy problem. The MOST appropriate next step is to:
- Immediately discontinue the NSAID without consulting the prescriber
- Contact the prescriber with a recommendation to use an alternative analgesic appropriate for renal function (Correct answer)
- Allow the patient to continue the NSAID since the hospitalist prescribed it
- Wait until the patient's GFR drops below 15 mL/min before intervening
Correct answer: Contact the prescriber with a recommendation to use an alternative analgesic appropriate for renal function
NSAIDs can worsen renal function in CKD; the pharmacist should proactively communicate the concern and suggest a safer analgesic alternative, functioning within the collaborative scope of MTM practice.
Question 5: Under Medicare Part D MTM programs, which care transition scenario MOST directly triggers an enhanced eligibility for a Comprehensive Medication Review (CMR)?
- A patient who has been stable on the same medications for 3 years
- A patient recently hospitalized and newly diagnosed with a qualifying chronic condition (Correct answer)
- A patient who switched insurance plans but has no new medications
- A patient who refilled all prescriptions on time last quarter
Correct answer: A patient recently hospitalized and newly diagnosed with a qualifying chronic condition
CMS encourages MTM outreach after hospitalizations and new chronic disease diagnoses because medication regimens change significantly, increasing the risk of drug therapy problems.
Question 6: Which of the following is a validated measure used to assess care transition quality in MTM programs?
- The Morisky Medication Adherence Scale (MMAS)
- The Care Transitions Measure (CTM-3) (Correct answer)
- The Beers Criteria for Potentially Inappropriate Medications
- The Modified Mini-Mental State Examination (3MS)
Correct answer: The Care Transitions Measure (CTM-3)
The Care Transitions Measure (CTM-3) is a validated patient-reported tool that assesses preparation and self-management support during care transitions, directly relevant to MTM program quality.
Question 7: A patient is transferred from an acute care hospital to a long-term care facility. The nursing home's medication administration record lists a different antihypertensive than the discharge summary. The pharmacist's action should be to:
- Use the nursing home's existing medication without investigation since they are both antihypertensives
- Clarify the discrepancy with the prescriber before administering either medication (Correct answer)
- Administer both medications to avoid missed doses
- Defer to the nursing home formulary without notifying the physician
Correct answer: Clarify the discrepancy with the prescriber before administering either medication
Any discrepancy must be clarified with the prescriber to determine which medication is intended, preventing a potential medication error from an unresolved transition-related discrepancy.
MTM Transitions of Care & Care Coordination 2
Which communication channel is MOST effective for transmitting a medication reconciliation summary to a primary care physician after a patient is discharged from a skilled nursing facility?