PTCB MTM key terms

A patient-centered service in which pharmacists review a person's full medication regimen to find and resolve drug-related problems, improve adherence, and coordinate with other prescribers. It is usually offered to people with multiple chronic conditions and high drug costs.

A structured, interactive review of every medication a patient takes, including prescription, over-the-counter, herbal, and supplement products. It is typically done face-to-face or by phone and ends with a written summary given to the patient.

A focused review, often done quarterly, that uses claims data to spot specific problems such as nonadherence, duplicate therapy, or a missing therapy. Unlike a CMR, it does not always require direct contact with the patient.

A short, patient-facing document prepared after a comprehensive review that lists what the patient should do next, such as a drug to start or stop, monitoring steps, and follow-up appointments. It is provided in writing to the patient.

A written, current list of every medication a patient uses, including dose, frequency, and the reason for use. The patient keeps it and shares it with caregivers, prescribers, and pharmacists, especially during transitions of care.

An adherence measure that divides the number of days a patient had medication on hand by the number of days in a measurement period. It is used in Medicare Part D star ratings and other quality reporting.

An adherence calculation that compares total days' supply dispensed with the number of days in a measurement period. Values above one can occur with early refills, which is a key limitation compared with PDC.

A CMS quality rating system for Medicare Advantage and Part D plans, scored from one to five stars. Higher ratings depend partly on medication adherence and safety measures that pharmacies can directly influence.

The federal agency that runs Medicare, Medicaid, and the Children's Health Insurance Program. It writes the rules that govern Part D MTM programs, eligibility criteria, and quality reporting requirements.

The optional Medicare benefit that covers outpatient prescription drugs through private plans. It requires plans to offer MTM programs to eligible members who have multiple chronic conditions and high drug spending.

A collaborative conversation style that helps patients uncover their own reasons for change, such as improving adherence. It relies on open questions, reflection, and affirmation rather than advice-giving or confrontation.

A written agreement that authorizes a pharmacist to provide defined patient care services, such as adjusting doses or ordering laboratory tests, under specified conditions with a prescriber's approval.

A plan requirement that a prescriber obtain approval before a drug is covered. It is a common access barrier that pharmacists help resolve during MTM by documenting need or suggesting covered alternatives.

Federal regulations that protect the privacy and security of individually identifiable health information. Pharmacists may share MTM information only as permitted, such as for treatment, payment, or with patient authorization.

Any drug therapy issue that interferes with a desired health outcome, such as an untreated indication, an inappropriate drug, a dose that is too high or too low, an adverse effect, or nonadherence.

A harmful or unintended response to a medication given at normal doses. It differs from an adverse drug event, which also includes harm resulting from errors such as a wrong dose or wrong drug.

When a patient takes two or more drugs from the same class or with the same mechanism of action, adding risk of additive side effects without extra benefit. It is a common target for MTM interventions.

A change in the effect of one drug caused by another, ranging from mild to life-threatening. Interactions may alter absorption, metabolism, or clearance, or combine to produce additive toxicity such as excessive sedation.

A situation in which a drug should not be used at all because the risk of harm clearly outweighs any possible benefit, such as a documented severe allergy or a specific disease state named in the labeling.

The strongest safety warning the FDA requires on a prescription drug's labeling, highlighting risks such as serious injury or death. Pharmacists must recognize these warnings when reviewing a patient's therapy.

Describes drugs where small differences between therapeutic and toxic doses can cause serious harm. Dosing and monitoring must be precise, and laboratory levels are often checked routinely.

A family of liver enzymes that metabolize most drugs. Some drugs inhibit these enzymes and raise levels of co-administered drugs, while others induce them and lower those levels.

The time required for the amount of drug in the body to decrease by half. It guides dosing intervals, predicts how long effects last, and helps estimate when steady state is reached.

The use of multiple medications at the same time, often defined as five or more. It increases the risk of interactions, adverse effects, and nonadherence and is a frequent focus of medication review.

The cumulative effect of taking one or more drugs with anticholinergic activity. The total burden can cause confusion, constipation, urinary retention, and falls, particularly in older adults.

An estimate of kidney function used to adjust doses of drugs cleared by the kidneys. It is commonly calculated with the Cockcroft-Gault equation using age, weight, sex, and serum creatinine.

The study of how a person's genes affect response to drugs. Genetic variation in metabolic enzymes or drug targets can make a standard dose ineffective or dangerously toxic for a particular patient.

The formal process of comparing a patient's current medication list with new orders at transitions of care and resolving discrepancies. It aims to prevent omissions, duplications, and dosing errors when patients change settings.

Any preventable event that may cause or lead to inappropriate medication use or patient harm. Errors can occur during prescribing, dispensing, administration, or monitoring, whether or not harm actually results.

A drug that carries a heightened risk of significant harm when used incorrectly. Extra safeguards such as independent double-checks, distinctive labeling, and restricted access are recommended when handling them.

Drug names that look similar in print or sound similar when spoken, leading to wrong-drug errors. Strategies include tall-man lettering, reading back orders, and storing the products apart.

A structured team process used after a serious safety event to identify the underlying system failures that allowed it to happen, rather than blaming an individual. Findings guide changes that prevent recurrence.

A published list of medications that are potentially inappropriate for older adults, maintained by the American Geriatrics Society. It helps clinicians avoid drugs whose risks outweigh benefits in this population.

Screening tools for older adults: STOPP flags potentially inappropriate prescriptions, while START flags commonly needed medicines that are missing. Together they support structured medication review and deprescribing decisions.

The planned, supervised process of reducing or stopping medications that no longer provide benefit or are causing harm. It involves weighing risks and benefits and monitoring the patient after each change.

An ongoing, systematic review of prescribing, dispensing, and medication use to detect problems such as interactions, duplications, and inappropriate doses. It may be performed before dispensing, during use, or retrospectively.

A nonprofit organization that collects medication error reports, publishes safety alerts, and maintains lists of high-alert medications and error-prone abbreviations used by health systems.

The FDA's program for reporting adverse events, product problems, and medication errors. Reports submitted by pharmacists and other clinicians help identify safety signals after a drug reaches the market.

A four-step quality improvement method: plan a change, carry it out on a small scale, study the results, and act on what was learned. Cycles repeat to test and refine improvements before wider adoption.

A communication technique in which the patient explains in their own words how to take a medication, confirming understanding. It reveals gaps that a simple question like 'Do you understand?' would miss.