MAIN FUNCTION: Medication Therapy Management Services • 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 Clinical Pharmacist Assessment 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 Patient Care & Education • 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 Chronic Disease Management Support 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