Implementing Medication Therapy Management services is not without its challenges. Pharmacists often face systemic, financial, and interpersonal hurdles when trying to provide this valuable patient care. For PharmD students, recognizing these barriers and learning effective strategies to overcome them is just as crucial as mastering the clinical aspects of the MTM process. This quiz will test your ability to identify common obstacles and the solutions that pave the way for a successful and sustainable MTM practice.
1. A significant operational barrier to implementing MTM in a busy community pharmacy is often:
- A lack of patients with chronic diseases.
- Insufficient time and an inefficient workflow that prioritizes only dispensing tasks.
- An oversupply of private counseling space.
- Pharmacy software that is too advanced.
Answer: Insufficient time and an inefficient workflow that prioritizes only dispensing tasks.
2. Which of the following is a key strategy to overcome the barrier of insufficient time for MTM services?
- Asking patients to come back another day indefinitely.
- Hiring more dispensing technicians to free up pharmacist time for clinical services.
- Performing MTM consultations at the drive-thru window.
- Only offering MTM services after the pharmacy has closed.
Answer: Hiring more dispensing technicians to free up pharmacist time for clinical services.
3. A patient’s lack of awareness about what MTM is and how it can benefit them is an example of which type of barrier?
- Pharmacist-level barrier
- Systemic barrier
- Patient-level barrier
- Interprofessional barrier
Answer: Patient-level barrier
4. To address patient lack of awareness about MTM, a pharmacy could:
- Assume that eligible patients will automatically know about the service.
- Only discuss the service with physicians.
- Develop marketing materials and have staff proactively identify and inform eligible patients.
- Wait for the insurance company to educate all patients.
Answer: Develop marketing materials and have staff proactively identify and inform eligible patients.
5. A major financial barrier to the widespread adoption of MTM services in pharmacy has been:
- The high cost of drugs reviewed during MTM.
- Lack of pharmacist provider status and inconsistent reimbursement models.
- Patients being unwilling to pay for any healthcare services.
- The high salary demands of all pharmacists.
Answer: Lack of pharmacist provider status and inconsistent reimbursement models.
6. Demonstrating positive economic, clinical, and humanistic outcomes (ECHO model) is a strategy to overcome which barrier?
- Lack of a private counseling area.
- Convincing payers and administrators of the financial return on investment of MTM.
- Poor internet connection in the pharmacy.
- Pharmacist lack of confidence.
Answer: Convincing payers and administrators of the financial return on investment of MTM.
7. A physician is hesitant to respond to a pharmacist’s MTM recommendations, believing it encroaches on their scope of practice. This is best described as an:
- Interprofessional barrier.
- Patient adherence barrier.
- Workflow barrier.
- Economic barrier.
Answer: Interprofessional barrier.
8. What is the most effective initial strategy to gain buy-in from a local physician who is skeptical of MTM?
- Sending a lengthy, detailed monograph of every drug the patient is on.
- Calling the physician’s office repeatedly until they respond.
- Starting with a single, concise, evidence-based recommendation that clearly improves patient safety.
- Reporting the physician to the medical board for not collaborating.
Answer: Starting with a single, concise, evidence-based recommendation that clearly improves patient safety.
9. Lack of access to a patient’s complete medical record, including lab results and physician notes, is what type of barrier?
- A technology and interoperability barrier.
- A patient adherence barrier.
- A pharmacist knowledge barrier.
- A reimbursement barrier.
Answer: A technology and interoperability barrier.
10. How can a pharmacist attempt to overcome the barrier of incomplete patient information?
- Guess the patient’s lab values.
- Perform a thorough patient interview and request the patient’s permission to contact their prescribers for necessary information.
- Assume the missing information is not important.
- Base all decisions only on the prescription fill history.
Answer: Perform a thorough patient interview and request the patient’s permission to contact their prescribers for necessary information.
11. A patient’s low health literacy is a significant barrier to understanding their Medication Action Plan (MAP). A good strategy to tackle this is:
- Using complex medical terminology to ensure accuracy.
- Providing the MAP in written format only, with no verbal discussion.
- Using simple language, visual aids, and the teach-back method to confirm understanding.
- Telling the patient to ask a family member to explain it to them later.
Answer: Using simple language, visual aids, and the teach-back method to confirm understanding.
12. A pharmacy physically lacks a private space for confidential consultations. This is a recognized ________ barrier to MTM.
- Financial
- Workflow/Logistical
- Clinical
- Interprofessional
Answer: Workflow/Logistical
13. A potential solution for a lack of physical consultation space in a pharmacy is to:
- Conduct the MTM review at the main pharmacy counter.
- Utilize a well-designed, semi-private area or schedule consultations during quieter pharmacy hours.
- Cancel all MTM services.
- Ask the patient to discuss their health information loudly.
Answer: Utilize a well-designed, semi-private area or schedule consultations during quieter pharmacy hours.
14. A pharmacist feels they are not confident enough in their clinical skills to provide MTM. This is a(n):
- Pharmacist-level barrier.
- Payer-level barrier.
- Patient-level barrier.
- Unsolvable barrier.
Answer: Pharmacist-level barrier.
15. How can a pharmacist overcome a lack of confidence in providing MTM?
- By avoiding complex patients.
- By pursuing continuing education and MTM certificate programs.
- By deciding MTM is not part of their job.
- By asking the technician to perform the service.
Answer: By pursuing continuing education and MTM certificate programs.
16. A patient’s cultural beliefs about health and medicine may act as a barrier to accepting MTM recommendations. The best approach is to:
- Ignore the patient’s beliefs and insist on following the clinical guidelines.
- Acknowledge and respectfully discuss the patient’s beliefs to create a collaborative and culturally competent care plan.
- Tell the patient their beliefs are wrong.
- Refer the patient to a different pharmacy.
Answer: Acknowledge and respectfully discuss the patient’s beliefs to create a collaborative and culturally competent care plan.
17. The time-consuming nature of documentation is a frequently cited barrier. What is a key strategy to mitigate this?
- Forego documentation altogether to save time.
- Use standardized forms and efficient documentation software.
- Write the documentation on a sticky note.
- Complete all documentation at the end of the month.
Answer: Use standardized forms and efficient documentation software.
18. A patient is eligible for MTM but declines, stating, “I don’t have time for another appointment.” This is a barrier related to:
- Patient engagement and perceived value.
- Pharmacist knowledge.
- Pharmacy workflow.
- Interprofessional relations.
Answer: Patient engagement and perceived value.
19. To overcome patient reluctance due to time constraints, a pharmacist could offer:
- Only one MTM appointment per year.
- A guarantee that the appointment will take less than 5 minutes.
- Flexible scheduling options, including telehealth or phone consultations.
- A free gift for attending the appointment.
Answer: Flexible scheduling options, including telehealth or phone consultations.
20. Difficulty in communicating a patient’s care plan between the hospital and community pharmacy upon discharge is what kind of barrier?
- A systems-level barrier related to continuity of care.
- A patient adherence barrier.
- A medication cost barrier.
- A formulary barrier.
Answer: A systems-level barrier related to continuity of care.
21. A “turf war” or a physician’s perception that a pharmacist is overstepping their role can be minimized by:
- The pharmacist making changes to prescriptions without consulting the physician.
- Fostering a collaborative, rather than competitive, relationship focused on the shared goal of patient safety.
- Avoiding all communication with the physician.
- Reporting the physician for being uncooperative.
Answer: Fostering a collaborative, rather than competitive, relationship focused on the shared goal of patient safety.
22. Social determinants of health, such as a patient’s inability to afford healthy food for a diabetic diet, can be a major barrier. A pharmacist should:
- Recognize this barrier and provide resources or referrals to social services if possible.
- Ignore the issue as it is outside the scope of pharmacy.
- Tell the patient they need to budget better.
- Assume the patient is not motivated to manage their diabetes.
Answer: Recognize this barrier and provide resources or referrals to social services if possible.
23. Which of the following is a proposed solution to the financial barriers of MTM?
- Pharmacists working for free.
- Achieving federal provider status for pharmacists to allow for billing to Medicare Part B.
- Banning insurance companies from pharmacy practice.
- Increasing the cost of prescription drugs.
Answer: Achieving federal provider status for pharmacists to allow for billing to Medicare Part B.
24. The belief within a pharmacy organization that MTM is “extra work” and not a core part of the business model is a(n):
- Administrative or management barrier.
- Patient literacy barrier.
- Clinical knowledge barrier.
- Legal barrier.
Answer: Administrative or management barrier.
25. Overcoming an administrative barrier to MTM requires:
- Ignoring the administration’s concerns.
- The pharmacist to pay for the MTM software themselves.
- Strong leadership and advocacy from pharmacists to demonstrate the value of MTM to the organization.
- Reducing the number of prescriptions dispensed.
Answer: Strong leadership and advocacy from pharmacists to demonstrate the value of MTM to the organization.
26. A patient is skeptical of a pharmacist’s recommendation because they have a strong, long-standing relationship with their doctor. How should the pharmacist address this?
- By criticizing the doctor’s original prescription.
- By acknowledging the patient’s trust in their doctor and framing the recommendation as a collaborative suggestion to enhance safety or efficacy.
- By refusing to provide any more information.
- By telling the patient their trust is misplaced.
Answer: By acknowledging the patient’s trust in their doctor and framing the recommendation as a collaborative suggestion to enhance safety or efficacy.
27. A lack of standardized processes for performing and documenting MTM across different health systems is a ________ barrier.
- Systemic
- Personal
- Educational
- Ethical
Answer: Systemic
28. One way to tackle the problem of a patient’s transportation issues is to:
- Tell the patient they have to find their own ride.
- Utilize telehealth and remote monitoring technologies.
- Cancel the MTM service for that patient.
- Insist on in-person visits only.
Answer: Utilize telehealth and remote monitoring technologies.
29. When a pharmacist identifies a drug therapy problem but the physician does not accept the recommendation, the best immediate next step is to:
- Argue with the physician until they agree.
- Document the recommendation and the physician’s response, and continue to monitor the patient.
- Change the prescription anyway.
- Tell the patient the physician made a mistake.
Answer: Document the recommendation and the physician’s response, and continue to monitor the patient.
30. Presenting a business plan for MTM services to pharmacy management is a strategy for overcoming:
- A patient health literacy barrier.
- A clinical knowledge gap.
- An administrative or financial barrier.
- A drug interaction.
Answer: An administrative or financial barrier.
31. A key to overcoming interprofessional barriers is establishing clear and effective:
- Hierarchies
- Communication channels
- Legal boundaries
- Sales pitches
Answer: Communication channels
32. A patient with memory issues consistently forgets to take their medication. This represents a barrier that could be addressed by:
- Suggesting the use of adherence aids like pillboxes or reminder apps.
- Simply telling the patient to “try harder to remember.”
- Assuming the patient is willfully non-adherent.
- Increasing the dose to account for missed pills.
Answer: Suggesting the use of adherence aids like pillboxes or reminder apps.
33. The MTM core element of “Documentation and Follow-up” is a direct strategy to combat the barrier of:
- Poor patient outcomes due to lack of continuity of care.
- High medication costs.
- Lack of pharmacy staff.
- Poor pharmacy design.
Answer: Poor patient outcomes due to lack of continuity of care.
34. A pharmacist who successfully integrates MTM into their daily practice has likely overcome the barrier of:
- Poor workflow management.
- A lack of eligible patients.
- Having too much free time.
- Low drug prices.
Answer: Poor workflow management.
35. A “difficult conversation” with a prescriber about a potential prescribing error is best handled by:
- Using accusatory language.
- Focusing on facts and patient safety in a professional and non-confrontational manner.
- Having the patient confront the prescriber.
- Ignoring the error.
Answer: Focusing on facts and patient safety in a professional and non-confrontational manner.
36. A significant barrier for MTM in rural areas can be:
- A surplus of pharmacists and healthcare providers.
- Patient access issues due to geography and fewer available resources.
- A lack of chronic disease in rural populations.
- Perfect interoperability between all health systems.
Answer: Patient access issues due to geography and fewer available resources.
37. Developing a “collaborative practice agreement” with a physician is a powerful strategy to overcome:
- Barriers related to a pharmacist’s authority to make medication changes.
- The physical lack of space in a pharmacy.
- Low patient health literacy.
- High medication costs.
Answer: Barriers related to a pharmacist’s authority to make medication changes.
38. When a patient does not see the immediate value in an MTM session, it is often because:
- The session focused only on collecting data without providing a clear, actionable plan.
- The pharmacist provided a free water bottle.
- The session was too short.
- The pharmacist was too friendly.
Answer: The session focused only on collecting data without providing a clear, actionable plan.
39. One of the biggest challenges in demonstrating the economic value of MTM is that:
- The savings, such as from a prevented hospitalization, are often realized by the payer later and are not immediately visible.
- MTM services have no economic value.
- The cost of MTM always outweighs the benefits.
- It is impossible to track clinical outcomes.
Answer: The savings, such as from a prevented hospitalization, are often realized by the payer later and are not immediately visible.
40. A pharmacist can help break down a patient’s feeling of being overwhelmed by:
- Listing every possible side effect for all 15 of their medications.
- Focusing on small, manageable goals and celebrating successes with the patient.
- Providing them with a 100-page book on their disease state.
- Telling them their case is the most complex they have ever seen.
Answer: Focusing on small, manageable goals and celebrating successes with the patient.
41. Resistance from pharmacy staff to adopt new MTM-related duties is a barrier that can be addressed through:
- Clear leadership, training, and explaining the “why” behind the new services.
- Ignoring the resistance and hoping it goes away.
- Threatening to fire any staff member who complains.
- Assigning all MTM duties to a single person.
Answer: Clear leadership, training, and explaining the “why” behind the new services.
42. Which of the following is NOT a typical barrier to MTM implementation?
- Inadequate reimbursement.
- Lack of time.
- A surplus of pharmacists trained and willing to perform MTM.
- Poor interoperability of health records.
Answer: A surplus of pharmacists trained and willing to perform MTM.
43. A SWOT analysis helps a pharmacy recognize barriers by identifying:
- Only the pharmacy’s strengths and opportunities.
- Only the external threats to the business.
- Internal weaknesses and external threats that could impede MTM success.
- A list of services to offer.
Answer: Internal weaknesses and external threats that could impede MTM success.
44. To tackle the barrier of poor communication with a physician’s office, a pharmacist could:
- Send all communications via standard mail.
- Establish a preferred, reliable method of contact, such as a specific secure messaging portal or fax line.
- Leave voicemails on the general office line.
- Stop trying to communicate altogether.
Answer: Establish a preferred, reliable method of contact, such as a specific secure messaging portal or fax line.
45. Patient engagement is a common barrier. Which technique is designed to improve this?
- Didactic lecturing
- Motivational interviewing
- Providing minimal information
- Using closed-ended questions only
Answer: Motivational interviewing
46. The legal and regulatory landscape of pharmacy practice can be a barrier if:
- The state’s scope of practice rules are overly restrictive and do not allow pharmacists to provide advanced services.
- The laws are too simple and easy to understand.
- Pharmacists are granted provider status.
- The state board of pharmacy is supportive of MTM.
Answer: The state’s scope of practice rules are overly restrictive and do not allow pharmacists to provide advanced services.
47. A solution to the complexity of MTM documentation is:
- To not document at all.
- To use specialized MTM software platforms that streamline the process.
- To write notes by hand on paper charts.
- To hire a medical scribe for every pharmacist.
Answer: To use specialized MTM software platforms that streamline the process.
48. Advocacy by professional pharmacy organizations is a key strategy for tackling which type of barrier?
- A single patient’s misunderstanding of their copay.
- System-level issues like provider status and reimbursement policies.
- A pharmacist’s lack of confidence.
- A poorly designed pharmacy workflow.
Answer: System-level issues like provider status and reimbursement policies.
49. If a patient is not adherent due to a complex dosing schedule, a pharmacist can tackle this barrier by:
- Adding another medication to the regimen.
- Working with the prescriber to simplify the regimen (e.g., using once-daily or combination products).
- Blaming the patient for being forgetful.
- Telling the patient the schedule is not that hard.
Answer: Working with the prescriber to simplify the regimen (e.g., using once-daily or combination products).
50. The foundational solution to nearly all barriers in MTM is:
- Better marketing materials.
- Effective communication and demonstrating the value of the service.
- A larger pharmacy building.
- Lowering the cost of all medications to zero.
Answer: Effective communication and demonstrating the value of the service.
I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.
Mail- Sachin@pharmacyfreak.com