Best Practices
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      3. Best Practices

      Making the CMR Offer

      Pick the best person for the job 

      • Who at your pharmacy has great rapport with patients? 
      • Use support staff: technicians, students, etc. 
          • Note: Every user (including support staff) should have his/her own unique profile at outcomes.com. 

      Things to remember when offering a CMR 

      • Complete the CMR on-the-spot when possible 
        • If you are connected with the patient in-person or on the phone, do the CMR on-the-spot to eliminate need for scheduling or future coordination 
      • Consider completing the CMR in conjunction with other services. 
        • Who is due for refills? Add a note to the prescription bag to remind you to complete a CMR.
        • When is the patient coming in for an immunization?
      • Always verify you are speaking to the right person before disclosing PHI

      Make them an offer they can’t refuse 

      • Assume acceptance
        • Avoid using a yes/no question; instead, offer a choice of date or time. 
        • Make accepting a matter of fact: “It’s time for your annual medication review – can I transfer you to talk to the pharmacist now? (If no)What day works best?” 
        • Enter the offer with the assumption that the patient will accept. If you don’t question the value of the service or the patient’s acceptance of your offer, it’s less likely the patient will. 
      • Check if the patient has had a CMR before
        • In the Outcomes platform patient queue, check if the patient has the repeat CMR indicator and the date of the last CMR. 
        • If yes, use this in your conversation: “It’s time for your annual medication review. Last year, you did this review with Julie in March.”  
      • Reference the letter from the patient’s health plan
        • Most patients receive a letter from their health plan informing them of their eligibility for this service. “You may have received a letter from your insurance plan telling you about this medication review.” 
      • Keep it simple with a brief overview 
        • “The pharmacist wants to review your whole regimen with you—looking for interactions, unnecessary medications, and making sure you are taking medications at the correct times.” 
      • Avoid language and jargon that might confuse the patient 
        • The patient might not know what CMR or MTM means. 
        • “Insurance requires this” This phrase is off-putting to the patient. Also, the CMR is not required for the patient. 
        • A medication review is a benefit included by the patient’s health plan. 
      • Smile, then speak 
        • Physically smiling (especially when on the phone) makes a difference in how you sound. 
      • Be confident of the value of this service for you and for your patient 
        • People like to help! Inform the patient this review helps you provide better care and advice as well as helps him/her.
      • Use an issue within a TIP as a lead in
        • “I have a concern about one of your medications that I would like to talk with you about. While you’re here, I’d like to review all your medications and over-the-counter products you use to make sure they are working well for you.” 
      • A few key points to have ready for responding to questions 
        • “It doesn’t cost anything extra.” 
        • “You get personal attention with the pharmacist.” 
        • “The pharmacist will work with you and your doctors to resolve any concerns.” 

      Patient Barriers—Change “no” to “yes” 

      We’ve noted a few phrases and points to help you counter common barriers that patients present. Your goal is to inform and convince the patient he/she will benefit from talking with you about his/her medications. 

      "I already do this with my doctor.”

      • First, reinforce this behavior, because it’s good for the patient to review medications with the doctor. 
      • “I’d still like to review medications with you.” 
        • “It’s good to review medications as a whole and will help me understand your regimen.” 
        • “Sometimes it is beneficial to get a second pair of eyes to make sure everything works well together and to look for cost savings.” 
        • “I can review medications that were prescribed by other doctors.” 
        • “Let’s make sure any OTCs or supplements you take are safe to use with other medications.” 

      “I don’t have time.”

      • “I am happy to schedule at a convenient time. When will you be at the pharmacy next?” 
        • “It doesn’t take long. I’ll just make sure my list matches what you’re taking. If I have questions or concerns, we’ll discuss them along with any questions you have.” 
        • What day would work better for you? 
          • Note: Reinforce that it’s not a large time commitment and there is benefit to making the time. 

      “I don’t have questions.”

      • “The pharmacist might have some.” 
        • “He/she can look for cost-saving opportunities and side effects that you may not be aware of.” 
        • “It’s a good time for us to update your records at the pharmacy, so we can better help you.” 

      “I can’t come to the pharmacy.”

      • “The pharmacist can talk to you on the phone.” 
          • Note: Check for a PA requirement before making the offer! Make this check part of your CMR routine. 

      “I don’t handle my medications.”

      • “That’s ok. Who takes care of your medicines for you? We can include them in our conversation.” 
          • Best practice: include caregiver/family member and patient together. Family members often like the extra information to make sure they understand what their loved one takes and how to help them. Having that caregiver involved also might bring up side effects or concerns for you to address. 
            • Note: CMRs must be completed with the patient unless the patient is cognitively impaired 

      You got a “Yes.” Now what? 

      • Add the CMR appointment to the patient’s Outcomes profile (even for on-the-spot CMRs). 
        • Marks the patient “in progress” to let other pharmacists know the patient is being served 
        • Shows on your dashboard for an easy appointment reminder 
      • Review the patients' profile to get the most out of the CMR. 
        • Review any TIPs and Rx history (both in the Outcomes platform and your dispensing system). 
        • Are there medications that commonly have administration concerns (inhalers, insulin, etc.)? 
        • Has the patient been picking up medications on time? 
      • If an appointment is scheduled, set a reminder to contact the patient 24-48 hours in advance of the appointment. 
        • Important to avoid no-shows 
        • Remind the patient to gather medications, OTC products and supplements 
        • Good opportunity to involve your support staff in MTM!