Science and Practice
Commentary
A medication therapy management residency rotation adjusts to coronavirus disease 2019 constraints

https://doi.org/10.1016/j.japh.2021.01.024Get rights and content

Abstract

The purpose of this commentary is to describe the Johns Hopkins Home Care Group’s (JHHCG) Community-based Pharmacy Residency Medication Therapy Management (MTM) rotation, summarize adjustments made to the rotation after the onset of the coronavirus disease 2019 (COVID-19) pandemic, describe key learnings from the adjustments, and provide a call to action for other residency programs seeking to improve their rotations amidst pandemic restrictions. MTM clinical pharmacists at JHHCG collaborate with patients to identify barriers to adherence, review medications, and develop plans for improvement. Through improved medication adherence, the goals for this program are to reduce adverse effects, patient cost, and medical visits or hospital admissions. Central to this practice is the belief that strong patient relationships are necessary to uncover the root cause of medication nonadherence. In Postgraduate Year-1 (PGY-1) community-based pharmacy residency training, new pharmacists learn the value of building relationships with patients and working through complex problems during this clinical experience. By assisting patients with complex medical conditions and social situations, new pharmacists gain skills in patient care, pharmacy operations, and medication access challenges. As the COVID-19 pandemic forced the discontinuation of face-to-face interactions in this setting, rotation experiences for residents were adapted with the goal of continuing high-impact patient interactions and keeping everyone involved safe. Although considerable changes were made to the MTM rotation because of the COVID-19 pandemic, residents were still able to provide meaningful clinical care telephonically and continued to learn valuable patient care skills. Most importantly, high quality care was still delivered to the patients despite considerable challenges. The major challenge for the residents’ clinical experiences as a result of the adjustments has been finding an impactful volume of complex patients to enhance their skills. Other residency programs are encouraged to consider three recommendations to improve their rotations moving forward.

Section snippets

Adjusting the rotation in response to COVID-19

By mid-March 2020, it was clear that in-person patient care aspects of the MTM rotation needed to be adjusted to mitigate the unnecessary risks of spreading coronavirus disease 2019 (COVID-19) to the community. Protecting the patients’ safety became a priority as most are in COVID-19 high-risk groups.2 Safety of the residents, preceptors, learners, and other pharmacy staff was also considered. Yet, residents were still expected to achieve the residency goals through quality patient care

In-person home visits shift to telephonic CMRs

HBMM visits are the backbone of the MTM rotation, with each resident performing two to three home visits each month. Because referrals come from within the health system, extensive information about the patient is available in the medical record. Once a referral for a home visit is received, a pharmacy technician calls the patient to schedule a date and time for the appointment. Residents are responsible for independently leading MTM encounters of all types, with preceptor assistance available

In-person Pillbox Teaching Clinic shifts to pillbox delivery

Residents also staff the Pillbox Teaching Clinic for four hours every month. In this clinic, pharmacists work one-on-one with patients to improve medication adherence and develop longitudinal relationships. Each resident class is expected to see 20 patients for at least three encounters throughout the year.

During the clinic visit, the pharmacist reviews the returned pillboxes to assess adherence and discusses reasons for any missed doses with the patient. If the patient sees providers within

Learnings and takeaways

The residents who experienced the transition to the outlined modifications in March 2020 for this rotation quickly adapted. The change from home visits to telephonic MTM was not a difficult transition for them because they had already built strong patient interviewing and counseling skills over the preceding nine months and were able to use those skills in the telephonic environment. Likewise, adjusting to the new pillbox clinic format went well because they had already formed strong

Moving forward

As the COVID-19 pandemic continues for the foreseeable future, it is likely these rotation modifications will stay in place until the end of the 2020-2021 residency year. Although the COVID-19 modifications have continued to provide a meaningful clinical experience, the community residents will return to in-person home visits and pillbox clinic once it is safe to do so. There are several action items the residency program is taking on as a result of the pandemic which other residency programs

Conclusion

Despite several challenges posed to the MTM rotation because of the COVID-19 pandemic, adjustments were quickly made to ensure residents are still able to provide meaningful clinical care, patients are still receiving services, and everyone involved is protected. The shift from home visits to telephonic CMRs has continued to provide meaningful clinical experiences for the residents. Adjusting in-person pillbox clinic to a pillbox delivery service poses logistical challenges for the residents

Danielle Pennock, PharmD, Postgraduate Year 2 Community-based Pharmacy Administration and Leadership Resident, Department of Pharmacy Services, Johns Hopkins Home Care Group, Baltimore, MD

References (2)

  • E. Pherson et al.

    Medication management through pharmacist-provided home-based services

    J Am Coll Clin Pharm

    (2020)

  • People with certain medical conditions. Coronavirus Disease 2019 (COVID-19)

Danielle Pennock, PharmD, Postgraduate Year 2 Community-based Pharmacy Administration and Leadership Resident, Department of Pharmacy Services, Johns Hopkins Home Care Group, Baltimore, MD

Lauren Barbour, PharmD, MPH, Clinical Coordinator, Department of Pharmacy Services, Johns Hopkins Home Care Group, Baltimore, MD

Robert Green, PharmD, BCGP, Clinical Coordinator, Department of Pharmacy Services, Johns Hopkins Home Care Group, Baltimore, MD

Denise Fu, PharmD, BCACP, Clinical Programs Manager, Patient Care Services, Department of Pharmacy Services, Johns Hopkins Home Care Group, Baltimore, MD

Disclosure: The authors declare no relevant conflicts of interest or financial relationships.

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Published by Elsevier Inc. on behalf of the American Pharmacists Association.