2.3 Description of the intervention
MTM was defined as analysis, education and monitoring services provided
by pharmacists to optimize patient outcomes [14]. For this study,
the MTM process included the following five steps: (1) collected
clinical information of patients and recorded a comprehensive list of
patients’ medications, including previous and current medications and
whether there was any adverse drug reactions (ADR) during the
medication; (2) identified DRPs, such as unnecessary, suboptimal or
repeated medications, over- or under-dosing, toxicity or adverse
reaction; (3) identified patient’s understanding of his/her medications
and diseases, and provided appropriate patient education based on the
knowledge deficits discovered; (4) provided treatment advices, including
those related to dosing and drug regimens based on the DRPs identified;
and (5) performed individual follow-up of the achievements of drug
treatment.