Here is our interview with a retail MTM consultant pharmacist, Alan Tanabe.  He stepped up to take the lead in his pharmacy’s MTM program and helped the Meijer chain of pharmacies be recognized as one of the best MTM programs of any retail chain in the country.  He is active on LinkedIn giving tips and contributing to discussions.  He is very passionate about pharmacy’s opportunity to serve patients through MTM and clinical services.

Alan Tanabe graduated from Ferris State University with a Bachelors in Science for Pharmacy in 1991, and is currently enrolled as a student in the Non-Traditional Pharm D. program at the University of Colorado, Denver (expected to complete in 2016). He has worked at Meijer Pharmacy since 1989.

We are featuring Alan here so that he can share the story of how he found his passion for clinical services in a retail setting.  We appreciate him sharing his story in order to inspire other pharmacists and help them grow in their careers.

How did you begin offering MTM services?

Alan: I believe that our company started with offering Mirixa MTM services in 2006, and shortly after (Meijer pharmacies) contracted with Outcomes.  We didn’t have many assigned cases at that time, and MTM was still a very new concept, at least for me.  I felt like I fumbled my way through it at first, not exactly knowing what was expected of me, but was able to complete cases.  Then around 2010, our Clinical Services Pharmacist approached me and asked me to take on a more active role as an MTM pharmacist.  At the time I didn’t really understand why she chose me as I didn’t exactly feel like I was an expert with MTM, but I agreed to try my best.

A lot of MTM at that time was self-taught, and with practice and experience not only did my MTM skills improve, but I discovered that I really enjoyed working MTM and recognized the potential impact that it could have on patient care and the profession of pharmacy.  Fast forward to today, and it is very clear how important MTM is, and will continue to be, for pharmacy and the patients we serve.

What does your day consist of?

Alan:  I work in a community pharmacy setting, so a lot of my day consists of filling and checking prescriptions, patient counseling, communicating with prescribers, being a preceptor for IPPE and APPE students, and other duties associated with community pharmacy.  I generally have one full day per week to devote to MTM.  However, as I’ve become more experienced with MTM, I’ve found that I can usually work some MTM activity into most days.  I know that some pharmacists feel that they do not have time to do MTM work as we are already so busy.  However, MTM is not solely working up comprehensive medication reviews and conducting them with patients.  MTM also includes activities that many of us are already doing on a daily basis such as recognizing gaps in therapies, recognizing and addressing non-adherence, addressing patient concerns regarding adverse effects, finding cost-effective opportunities for our patients, and many other aspects.  Once you realize this and gain some experience, incorporating MTM into your daily work does not seem so difficult.

What does a normal week look like?

Alan: Focusing on my “MTM day”, I spend the majority of that day assisting some of our other stores with their cases.  I make calls to assigned patients for various reasons, such as performing adherence checks or following up with their medications to assess responses.  If the patient is targeted for a CMR, I first look for reasons to speak with the patient.

For example, if I notice that the patient recently experienced a change in dose or medication, or if the patient is overdue to refill a medication, that gives me a good reason to talk to the patient and creates a nice segue for asking the patient to update their medication profile with us so we can assess their responses to therapy and address any questions or concerns (instead of using the term CMR).

I also spend some time communicating with physician offices, making recommendations if I notice gaps in therapies or the use of potentially inappropriate medications such as BEERs drugs for our older patients.  Other times I have the opportunity to be a trainer for other pharmacists and interns, to show them effective ways of incorporating MTM into their daily work.

What is your favorite part about doing MTM?

Alan:  There are a couple of things I really enjoy.  Of course it is rewarding to see when your efforts result in better outcomes for our patients, and it does help reinforce the relationship between patient and pharmacist.  I also really enjoy showing students/interns just how involved MTM work can be and the impact that it can have. Although the topic of MTM is now discussed in schools, many students seem surprised just how expansive the services can be.

What is your least favorite part about doing MTM?

Alan:  Even though MTM has been around for about 10 years, the concept of pharmacists taking the initiative to address patient therapy is still very foreign to many people.  It can be frustrating when you receive the response “That’s my doctor’s job…I will discuss it with him/her.”  However, don’t get too discouraged.  MTM is becoming more accepted by other health professionals and can become a more regular practice with their patients.

What advice would you give to a person wanting to begin offering clinical services like MTM?

Alan:  If MTM is new to you, it would be advisable to look for opportunities for introduction training, such as through APhA.  After that, communicate with other pharmacists who are active with MTM and ask them to share their advice and experiences with you.  Learn tips about what has worked well for other pharmacists.  Also, make sure that you are familiar with current therapy guidelines (e.g. JNC8, ASCVD, ADA, etc…) which will help you assess patient response to therapy as well as identify opportunities for additional RPh-initiated claims.

Is there an example of a big impact you have made in regards to a single patient’s intervention during an MTM consultation?

Alan:  One example of a pretty big impact an MTM consultation had on a patient was when I conducting a CMR, a patient was already taking trazodone for sleep and depression, but was having suboptimal responses.  Through interviewing, I found out that she was also experiencing symptoms of urinary incontinence and some nerve pain, but wasn’t being treated pharmacologically for those symptoms (except for some occasional NSAID use for the pain).  I told her that I had an idea of an agent that may be able to help her with each of these symptoms & that I would discuss it with her physician.  I suggested to the physician to discontinue to trazodone and try nortriptyline, hoping that it would give her better relief of her insomnia, depression and nerve pain, but also the anticholinergic activity may improve her urinary incontinence.  The physician agreed to try it.  Some months later, that patient came to the pharmacy counter to thank me for the service and my suggestion as it was successful in improving each of her symptoms with minimal adverse effects.

Takeaway points:

• Build clinical skills by reviewing current guidelines
• Addressing workflow issues creates more opportunities for MTM during daily tasks
• Having a great attitude will help make you more adaptable
• Find an “MTM mentor” to bounce ideas off
• Be willing to teach and to learn
• Find a “talking point” with each patient you call to pique their interest in your services

Thanks again to Alan for not only being a great patient advocate, but a great advocate for the profession of pharmacy.