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 Coleman Care Transitions Intervention uses transition coaches — including pharmacists — to promote medication self-management, follow-up appointments, and personal health record use during post-discharge periods.

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

Failure to carry forward a critical medication like insulin constitutes an error of omission during care transition, which can lead to dangerous hyperglycemia or diabetic ketoacidosis.

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

Teach-back combined with a visual, simplified medication schedule confirms patient understanding and compensates for low health literacy, which is a major driver of non-adherence after discharge.

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

Closing the communication gap between inpatient and outpatient psychiatric providers prevents medication errors, ensures continuity of mental health treatment, and is a core MTM coordination responsibility.

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

The 30-day all-cause readmission rate is the most widely used outcome metric for evaluating transition-of-care programs, including MTM, as it directly measures whether interventions prevented return hospitalizations.

(MTM) Medication Therapy Management Board Certification Practice Test

(MTM) Medication Therapy Management Board Certification Practice Test

MTM Transitions of Care & Care Coordination 3