MTM Transitions of Care & Care Coordination 3

Question 1

Which of the following care transition models is MOST associated with pharmacist-led medication reconciliation and patient self-management coaching?

Accepted Answer

The Coleman Care Transitions Intervention (CTI)

Answer

The Wagner Chronic Care Model

Answer

The Donabedian Quality Framework

Answer

The Patient-Centered Outcomes Research Initiative (PCORI)

Question 2

A patient with type 2 diabetes is transferred to home health after amputation surgery. The MTM pharmacist notes insulin was not included on the home health medication order. This omission is BEST classified as:

Accepted Answer

An error of omission — a critical medication was not carried forward

Answer

A therapeutic duplication

Answer

A prescribing cascade

Answer

An intentional therapeutic substitution by the surgeon

Question 3

Which strategy is MOST effective at ensuring medication adherence in the immediate post-discharge period for patients with low health literacy?

Accepted Answer

Using teach-back with a simplified visual medication schedule

Answer

Providing a 10-page written medication guide in medical terminology

Answer

Recommending the patient memorize the prescribing information inserts

Answer

Relying entirely on the caregiver without involving the patient

Question 4

An MTM pharmacist receives a referral for a patient who was just discharged from a psychiatric inpatient unit. The patient's outpatient psychiatrist was not informed of the medication changes. The pharmacist's PRIMARY coordination task is to:

Accepted Answer

Contact the outpatient psychiatrist to transmit the discharge medication list and identify discrepancies

Answer

Begin titrating the inpatient-initiated medications independently

Answer

Withhold all psychiatric medications until the next scheduled outpatient appointment

Answer

Defer all psychiatric medication review to the social worker

Question 5

Which metric is MOST directly tied to the effectiveness of pharmacist-led MTM during care transitions in reducing hospital readmissions?

Accepted Answer

30-day all-cause hospital readmission rate

Answer

Number of new prescriptions generated per MTM session

Answer

Patient satisfaction score with pharmacy wait times

Answer

Pharmacist continuing education hours completed

Question 6

A patient newly started on a direct oral anticoagulant (DOAC) is being transitioned from hospital to home. Which counseling point is MOST critical for the MTM pharmacist to address?

Accepted Answer

Adherence to dosing schedule, signs of bleeding, and the need to inform all providers of DOAC use

Answer

The importance of taking the medication only when symptoms occur

Answer

The requirement for weekly INR monitoring, the same as warfarin

Answer

Stopping the DOAC if a minor bruise is observed

Question 7

When performing a post-discharge MTM visit, the pharmacist identifies a patient is taking both a brand-name drug dispensed at hospital discharge and its generic equivalent purchased at a retail pharmacy. This represents:

Accepted Answer

Therapeutic duplication — an unintentional doubling of the same medication

Answer

A formulary exception requiring prior authorization

Answer

An appropriate combination therapy approved by the prescriber

Answer

A prescribing cascade triggered by an adverse effect