Pharmacist (MTM Clinic)

• Conduct comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs)
• Assess medication regimens for:
  • Appropriate medication selection
  • Appropriate dose
  • Appropriate route
  • Appropriate frequency
  • Appropriate indication
  • Therapeutic effectiveness
  • Safety concerns
  • Patient adherence and barriers
• Identify, prevent, and resolve medication-related problems
• Develop individualized medication action plans
• Communicate recommendations to providers and healthcare teams
• Follow up on medication changes and clinical outcomes

Evaluate patient-specific factors including:

• Drug-drug interactions
• Drug-disease interactions
• Allergies and intolerances
• Renal function considerations
• Hepatic function considerations
• Laboratory monitoring needs
• Contraindications and precautions
• Duplicate therapy
• Medication affordability and access barriers

• Provide medication counseling and education to patients and caregivers
• Promote medication adherence and self-management strategies
• Educate patients regarding:
  • Medication purpose
  • Expected benefits
  • Potential adverse effects
  • Monitoring requirements
  • Lifestyle modifications
• Support patients in understanding and managing chronic conditions

Provide pharmacist-led interventions and monitoring for conditions such as:

• Diabetes
• Hypertension
• Hyperlipidemia
• Anticoagulation therapy
• Asthma/COPD
• Heart failure
• Other chronic disease states as identified by clinic needs