Provide comprehensive medication management following the 10 step process described by the Patient-Centered Primary Care Collaborative (PCPCC), including ongoing care to ensure achievement of desired patient outcomes. For best practice, the 10 step process found on the link below may be used to guide this service: https://www.pcpcc.org/sites/default/files/media/medmanagement.pdf

Actively screen, recommend and administer immunizations listed in the Utah Vaccine Protocol, and potentially others via prescription.

This requires a proactive process of timing a patient’s routine refills with a pharmacist’s clinical disease state management and monitoring for progression toward desired therapeutic goals. The purpose of clinical medication synchronization is to ensure that patients are refilling and taking their medications as prescribed and to ensure that patients are achieving therapeutic goals with safe and effective medications. This process is not to be confused with automatic refill and includes 7 steps:

1. Actively identify and recruit patients who are good candidates for medication synchronization services
2. Develop an accurate list of current medications. Evaluate which medications can be synchronized and develop processes and procedures for identifying anchor medication and short filling medications using short fill override codes when appropriate
3. Syncing/timing the refills. Developing a synchronization schedule that works for the patient
4. Calling the patient each time prior to refilling medications to go through the list and verify refills needed. This includes asking about medication changes (due to prescriber visits/hospitalizations) as well as assessing the reason a patient does not need a medication refilled and addressing issues (such as with the DRAW tool)
5. Refill the medications (this step includes getting new prescriptions when needed and resolving any third party issues such as prior authorizations)
6. Patient appointment—Meet with the patient upon pick-up/delivery of medications. This step should be performed by a pharmacist or a student pharmacist under the supervision of a pharmacist
   • Assess/monitor progression toward desired therapeutic goals of medications. (e.g., is the patient’s blood pressure medication actually reducing their blood pressure to goal?)
   • Determine if patient has achieved therapeutic goals. Assess safety and efficacy of each medication
   • Identify any gaps in therapy (e.g. immunizations needed)
   • Perform necessary clinical services (e.g. CMR, Med Rec, disease-state management, point-of-care testing, etc.) 
   7.  Follow-up with providers regarding non-adherence or failure to reach therapeutic goals. This step should be performed by a pharmacist or a student pharmacist under the supervision of a pharmacist

The process of comparing a patient’s medication orders to all of the medications that the patient has been taking (active, chronic, as needed and OTC including herbal) to avoid medication errors. This process should be done at every transition of care. Pharmacists should assess for discrepancies, communicate with other providers/health-systems, and work closely with the patient to ensure that their current medications are intended and appropriate. Pharmacists will document that they performed the medication reconciliation, identified any discrepancies, and communicated with other providers as necessary. The process includes 6 steps:

1. Develop a list of current medications.
2. Develop a list of medications to be prescribed.
3. Compare the medications on the two lists.
4. Make clinical decisions based on the comparison.
5. Communicate the new list to appropriate caregivers and to the patient.
6. Document medication reconciliation activities.