Outcomes Personal Pharmacist™ Training
Module/Encounter™ MTM Case Examples
Case Example #1

A 45 year old female, presented to a pharmacy with a
prescription for a sulfa antibiotic (Drug A).

The pharmacist reviewed her drug history and found a
notation that she is allergic to sulfas. The previous
reaction was anaphylaxis. The pharmacist contacted
the physician recommending a switch to an alternative
medication (Drug B). The physician was not
aware of the patient’s history and agreed with the
pharmacist’s recommendation.

The pharmacist filled the new prescription for the
alternative medication and properly educated the
patient. Upon follow-up the pharmacist learned that
the patient’s infection had resolved after a full course
of therapy.
Case Example #1: Question 1

How many Encounter claims
should be filed as a result of
Case Example #1?




One
Two
Three
Four
Case Example #1: Question 2

What is the Reason for the first claim?




Needs Therapy
Suboptimal Drug Selection
Adverse Drug Reaction
Other
Case Example #1: Question 3
 What
is the Action for the first
claim?
 Comprehensive Medication
Review (CMR)
 Prescriber Consultation
 Patient Education/Monitoring
 Patient Compliance Consultation
Case Example #1: Question 4
 What
is the Result for the first
claim?
 Therapeutic Success
 Initiated New Therapy
 Changed Drug
 Altered Regimen/Changed Drug
Case Example #1: Question 5

What is the initial prescription
information for the first claim?
 The sulfa the patient took previously which
caused an anaphylactic reaction
 The alternate antibiotic (Drug B)
recommended by the pharmacist
 The antibiotic (Drug A) originally
prescribed by the doctor
 There is no initial prescription information
Case Example #1: Question 6

What is the final prescription
information for the first claim?
 The sulfa the patient took
previously which caused an
anaphylactic reaction
 The antibiotic (Drug B)
recommended by the pharmacist
 The antibiotic (Drug A) originally
prescribed by the doctor
 There is no final prescription
information
Case Example #1: Question 7
 What
is the frequency of
therapy for the first claim?
 Acute
 Intermittent
 Chronic
 You do not need to select a
frequency of therapy
Case Example #1: Question 8
 What
is the ECA for the first
claim?
 Level 1: Improved Quality of
Care
 Level 3: Additional Prescription
Order
 See Previous Claim
 Level 7: Life Threatening
Case Example #1: Question 9

What should be included in the
note of the first claim?
 Description of the education and
monitoring
 Description of the intervention
 Justification for the ECA selected
B&C
Case Example #1: Question 10

What is the Reason for the
second claim?




New/Changed Prescription Therapy
Suboptimal Drug Selection
Adverse Drug Reaction
Other
Case Example #1: Question 11

What is the Action for the
second claim?
 Comprehensive Medication Review
(CMR)
 Prescriber Consultation
 Patient Education/Monitoring
 Patient Compliance Consultation
Case Example #1: Question 12

What is the Result for the
second claim?




Therapeutic Success
Initiated New Therapy
Changed Drug
Altered Regimen/Changed Drug
Case Example #1: Question 13

What is the initial prescription
information for the second claim?
 The sulfa the patient took previously
which caused an anaphylactic reaction
 The alternate antibiotic (Drug B)
recommended by the pharmacist
 The antibiotic (Drug A) originally
prescribed by the doctor
 There is no initial prescription information
Case Example #1: Question 14

What is the final prescription
information for the second claim?
 The sulfa the patient took previously
which caused an anaphylactic reaction
 The antibiotic (Drug B) recommended by
the pharmacist
 The antibiotic (Drug A) originally
prescribed by the doctor
 There is no final prescription information
Case Example #1: Question 15

What is the frequency of therapy
for the second claim?




Acute
Intermittent
Chronic
You do not need to select a
frequency of therapy
Case Example #1: Question 16

What is the ECA for the second
claim?
 Level 1:
 Level 3:
Order
 Level 5:
 Level 7:
Improved Quality of Care
Additional Prescription
Emergency Room Visit
Life Threatening
Case Example #1: Question 17

What should be included in the
note of the second claim?
 Description of the education
and monitoring
 Description of the intervention
 Justification for the ECA selected
 B&C
Case Example #2

A 54 year old male presented to a pharmacy requesting a
refill of his medication (Drug A) to prevent gout attacks. He
stated that he was having an acute gout flare and he did not
feel the medication was helping.

The pharmacist educated the patient that this medication is
used for maintenance therapy to prevent gout attacks and
explained that the physician must be contacted to
recommend a treatment (Drug B) for the current attack.
The pharmacist contacted the doctor and recommended a
treatment. The physician approved the new order.

The pharmacist educated the patient about the new
medication and how to start the refill when the gout flare
resolves. A monitoring call was scheduled for two days later.
During the monitoring call the patient stated that his attack
has resolved and he was doing much better with no
questions, and was now taking the medication daily for
maintenance.
Case Example #2: Question 1
How
many Encounter claims
should be filed as a result of
Case Example #2?
One
Two
Three
Four
Case Example #2: Question 2

What is the Reason for the
first claim?




Other
Overuse
Underuse
Administration/Technique
Case Example #2: Question 3

What is the Action for the first
claim?




Patient Education/Monitoring
Prescriber Consultation
Patient Consultation
Patient Compliance
Consultation
Case Example #2: Question 4
What
is the Result for the first
claim?
Therapeutic Success
Altered Compliance
Initiated New Therapy
Altered Regimen/Changed Drug
Case Example #2: Question 5
 What
is the initial prescription
information for the first claim?
 The medication to prevent gout
attacks (Drug A)
 The medication to treat gout
attacks (Drug B)
 A pain medication
 There is no initial prescription
information
Case Example #2: Question 6

What is the final prescription
information for the first claim?
 The medication to prevent gout
attacks (Drug A)
 The medication to treat gout
attacks (Drug B)
 A pain medication
 There is no final prescription information
Case Example #2: Question 7

What is the frequency of therapy
for the first claim?




Acute
Intermittent
Chronic
You do not need to select a
frequency of therapy
Case Example #2: Question 8

What is the ECA for the first
claim?




Level
Level
Level
Level
1:
2:
3:
5:
Improved Quality of Care
Drug Product Costs
Additional Physician Visit
Emergency Room Visit
Case Example #2: Question 9

What should be included in the
note of the first claim?
 Description of the education and
monitoring
 Description of the intervention
 Justification for the ECA selected
B&C
Case Example #2: Question 10

What is the Reason for the
second claim?




New/Changed Prescription Therapy
OTC Therapy
Needs Therapy
Unnecessary Therapy
Case Example #2: Question 11

What is the Action for the
second claim?
 Comprehensive Medication Review
(CMR)
 Prescriber Consultation
 Patient Education/Monitoring
 Patient Compliance Consultation
Case Example #2: Question 12
What
is the Result for the
second claim?
Therapeutic Success
Initiated New Therapy
Changed Drug
Altered Regimen/Changed Drug
Case Example #2: Question 13

What is the initial prescription
information for the second claim?
 The medication to prevent gout
attacks (Drug A)
 The medication to treat gout
attacks (Drug B)
 A pain medication
 There is no initial prescription information
Case Example #2: Question 14

What is the final prescription
information for the second claim?
 The medication to prevent gout
attacks (Drug A)
 The medication to treat gout
attacks (Drug B)
 A pain medication
 There is no final prescription information
Case Example #2: Question 15

What is the frequency of therapy
for the second claim?




Acute
Intermittent
Chronic
You do not need to select a
frequency of therapy
Case Example #2: Question 16
 What
is the ECA for the second
claim?
 Level 1: Improved Quality of Care
 Level 3: Additional Physician Visit
 Level 5: Emergency Room Visit
 See Previous Claim
Case Example #2: Question 17

What should be included in the
note of the second claim?
 Description of the education and
monitoring
 Description of the intervention
 Justification for the ECA selected
B&C
Case Example #2: Question 18

What is the Reason for the
third claim?




New/Changed Prescription Therapy
Suboptimal Drug Selection
Adverse Drug Reaction
Other
Case Example #2: Question 19

What is the Action for the third
claim?
A. Comprehensive Medication Review
(CMR)
 Prescriber Consultation
 Patient Education & Monitoring
 Patient Compliance Consultation
Case Example #2: Question 20

What is the Result for the
third claim?




Therapeutic Success
Initiated New Therapy
Changed Drug
Altered Regimen/Changed Drug
Case Example #2: Question 21

What is the initial prescription
information for the third claim?
 The medication to prevent gout
attacks (Drug A)
 The medication to treat gout
attacks (Drug B)
 A pain medication
 There is no initial prescription information
Case Example #2: Question 22

What is the final prescription
information for the third claim?
 The medication to prevent gout
attacks (Drug A)
 The medication to treat gout
attacks (Drug B)
 A pain medication
 There is no final prescription information
Case Example #2: Question 23

What is the frequency of therapy
for the third claim?




Acute
Intermittent
Chronic
You do not need to select a
frequency of therapy
Case Example #2: Question 24

What is the ECA for the third
claim?
 Level 1:
 Level 3:
Order
 Level 5:
 Level 7:
Improved Quality of Care
Additional Prescription
Emergency Room Visit
Life Threatening
Case Example #2: Question 25

What should be included in the
note of the third claim?
 Description of the education and
monitoring
 Description of the intervention
 Justification for the ECA selected
 B&C
Congratulations!
This concludes Module/Encounter MTM
Case Examples.
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