JAPhA Home Based MTM 2016

EXPERIENCE
Integrating home-based medication therapy management
(MTM) services in a health system
Shannon Reidt*
, Haley Holtan, Jennifer Stender, Toni Salvatore, Bruce Thompson
a r t i c l e i n f o
Article history:
Accepted 18 January 2016
a b s t r a c t
Objectives: To describe the integration of home-based Medication Therapy Management
(MTM) into the ambulatory care infrastructure of a large urban health system and to discuss
the outcomes of this service.
Setting: Minnesota from September 2012 to December 2013. The health system has more than
50 primary care and specialty clinics. Eighteen credentialed MTM pharmacists are located in
16 different primary care and specialty settings, with the greatest number of pharmacists
providing services in the internal medicine clinic.
Practice innovation: Home-based MTM was promoted throughout the clinics within the health
system. Physicians, advanced practice providers, nurses, and pharmacists could refer patients
to receive MTM in their homes. A home visit had the components of a clinic-based visit and
was documented in the electronic health record (EHR); however, providing the service in the
home allowed for a more direct assessment of environmental factors affecting medication use.
Evaluation: Number of home MTM referrals, reason for referral and type of referring provider,
number and type of medication-related problems (MRPs).
Results: In the first 15 months, 74 home visits were provided to 53 patients. Sixty-six percent
of the patients were referred from the Internal Medicine Clinic. Referrals were also received
from the senior care, coordinated care, and psychiatry clinics. Approximately 50% of referrals
were made by physicians. More referrals (23%) were made by pharmacists compared with
advanced practice providers, who made 21% of referrals. The top 3 reasons for referral were:
nonadherence, transportation barriers, and the need for medication reconciliation with a
home care nurse. Patients had a median of 3 MRPs with the most common (40%) MRP related
to compliance.
Conclusion: Home-based MTM is feasibly delivered within the ambulatory care infrastructure
of a health system with sufficient provider engagement as demonstrated by referrals to the
service.
© 2016 American Pharmacists Association®
. Published by Elsevier Inc. All rights reserved.
Home-based health care has been shown to benefit pa-
tients with a broad range of needs. Post-stroke rehabilitation
delivered by home-health physical therapists has improved
activities of daily living and gait speed.1
Home-based nursing
programs have demonstrated improvements in patients'
clinical outcomes such as fatigue, activities of daily living, and
quality of life in patients with stage two or three chronic
obstructive pulmonary disease.2
These programs have also
improved patient self-efficacy in chronic-condition self-man-
agement, including asthma, chronic obstructive pulmonary
disease, diabetes, coronary artery disease, hypertension, and
congestive heart failure.2,3
Home-based nursing has demon-
strated improvements in clinical outcomes such as blood
pressure, weight, and blood glucose levels.3
Delivery of care in
the home is beneficial for those with limited access to clinics
and those with poor or questionable self-management of their
disease state(s) and medication regimens.4
Home-based care
also provides invaluable information to clinicians about a pa-
tient's living environment.4
Disclosure: This project was supported by the Metropolitan Area Agency on
Aging Title IIID Health Promotion Program.
* Correspondence: Shannon Reidt, PharmD, MPH, BCPS, 308 Harvard St.
SE, WDH 7-103, Minneapolis, MN 55415.
E-mail address: reid0113@umn.edu (S. Reidt).
Contents lists available at ScienceDirect
Journal of the American Pharmacists Association
journal homepage: www.japha.org
http://dx.doi.org/10.1016/j.japh.2016.01.003
1544-3191/© 2016 American Pharmacists Association®
. Published by Elsevier Inc. All rights reserved.
Journal of the American Pharmacists Association 56 (2016) 178e183
SCIENCE AND PRACTICE

Health care providers such as physicians, nurses, and
physical therapists have a history of providing care in patients'
homes; however, home-based pharmacist services are much
less established. Some home-based pharmacist services have
focused on patients who take specific medications, such as
warfarin, or have specific conditions, such as heart failure.4-6
Other services have targeted patients who have recently
been discharged from hospital.7-9
Benefits of pharmacists' in-
terventions in these patients include improvement of patients'
self-management of medications,9
decreased emergency room
visits, and decreased hospitalizations.8
In one study, patients
who received home-based MTM after hospital discharge were
40% less likely to have an emergency room visit or hospitali-
zation than those receiving usual care.8
Similarly, pharmacists
have rated 70% of their home-based interventions as having a
“dramatic” or “substantial” improvement on the patients'
abilities to manage their medications.9
The benefits of pharmacist-provided MTM have been well
documented.10-13
Pharmacists have provided MTM to patients
in clinics and pharmacies; however, these environments may
have barriers. For example, MTM may be difficult to provide in
busy community pharmacies.14
The health system involved in
this article observed that some patients had transportation
barriers preventing them from getting to a clinic or pharmacy
and others did not feel comfortable bringing medications to
these locations for an MTM visit. Some patients with care-
givers who should participate in an MTM encounter were
unable to attend appointments at a clinic or pharmacy. The
health system hypothesized that providing MTM in a patient's
home may overcome these barriers and identified a need for
improved care coordination between primary care providers
(PCPs) and home health care care nurses and increased sup-
port for nonadherent patients. The health system looked to
home-based MTM to meet these needs. Although providing
home-based pharmacy services is not a new idea, the present
article adds to the literature by describing how a health system
with well established MTM services may implement home-
based MTM. Although other home-based pharmacy services
have targeted specific populations, this practice is innovative
by targeting a wider ambulatory patient population.
Objectives
The objective of this article is to describe the integration of
home-based MTM into the ambulatory care infrastructure of a
large urban health system and to discuss the outcomes of this
service.
Practice description
Hennepin County Medical Center (HCMC) has been
providing MTM services since 2006. The health system has
more than 50 primary care and specialty clinics. Eighteen
credentialed MTM pharmacists are located in 16 different
primary care and specialty settings, with the greatest number
of pharmacists providing services in the internal medicine
clinic. Services provided include comprehensive medication
review, targeted disease state management, therapeutic drug
monitoring, patient education, and adherence support. Pri-
mary care clinics are patient-centered medical homes, and
pharmacists are able to use protocols to modify patients'
medication regimens. Annually, pharmacists conduct approx-
imately 10,000 MTM encounters and receive reimbursement
primarily from Minnesota Medicaid. However, all insurers are
billed for services. All MTM pharmacists undergo a cre-
dentialing and privileging process through the HCMC Office of
the Medical Director, and appointment is renewed every 2
years. They are additionally credentialed as MTM Providers
through insurance plans as able. The department is supported
by a full-time MTM support analyst, a former community
pharmacy technician, who assists with patient billing, sched-
uling, data reporting, and quality assurance initiatives.
Practice innovation
HCMC began providing home-based MTM in 2012. One
pharmacist was designated as the home visit pharmacist and
devoted 0.2 full-time equivalent to home-based MTM. Because
the pharmacist had previous experience providing home-
based MTM, no training related to home-based care was pro-
vided. The health system does provide personal safety training
classes that would have been required otherwise because the
pharmacist conducts visits alone. Components of a home-
based MTM visit were designed to be similar to a clinic-based
MTM visit to promote consistency across the health system.
During the home visit, the pharmacist evaluates all medica-
tions and over-the-counter (OTC) products for indication,
effectiveness, safety, and convenience and compliance.
Because the visit occurs in the home, the patient's caregiver can
easily participate in conversations related to medication use,
and the pharmacist can observe the environment in which
medications are taken and stored. The patient and pharmacist
devise a plan for medications that is documented in the elec-
tronic health record (EHR). Updated medication lists are shared
with non-HCMC providers, such as community pharmacies
and home health care nurses, by fax. If more information needs
Key Points
Background:
Many other health professions, including medicine,
nursing, and therapy, have a history of providing
home-based care; however, few descriptions of
home-based MTM exist in the literature.
Home-based MTM programs have been described
that target patients recently discharged from the
hospital where the pharmacist providing care is
associated with a health system or a home care
agency.
Findings:
Patients with a history of nonadherence, trans-
portation barriers getting to a pharmacy or clinic, or
with home health care nurses may be good candi-
dates for home-based MTM. Care coordination and
documentation of services in the health-system EHR
are essential to successful integration of home-based
MTM.
Home-based MTM in a health system
179

to be shared, the pharmacist calls pharmacies and home health
care nurses instead of faxing a visit note. For example, the
pharmacist often calls community pharmacies to discontinue
prescriptions that have been changed or discontinued by pre-
scribers. When registering with the health system, each patient
signs a patient authorization and consent form which allows
health system providers to share information with those
outside of the health system. The pharmacist informs the pa-
tient of any information that will be shared with health care
providers. The pharmacist obtains additional consent if records
from an outside institution are needed. The pharmacist com-
municates recommendations to modify medications to HCMC
providers through the EHR.
Wireless access to the EHR while in a patient's home has
been cost-prohibitive; as a result, the pharmacist reviews the
patient's chart before the home visit. Because organizing
medications occurs during the home visit, the pharmacist
travels with pillboxes, markers, rubber bands, and other or-
ganization tools. The pharmacist brings a blood pressure cuff
to all visits. If the medication list is updated during the home
visit, an updated list is mailed to the patient after the visit.
Because Medicare Part D plans are not billed, a Medication
Action Plan is not given to the patient at the completion of the
visit. Instead, instructions for the patient discussed during the
visit are written down and left in the patient's home.
Recruitment and scheduling
Initially, hospital discharge patients at high risk of read-
mission were targeted, and home visits were scheduled at the
point of hospital discharge. The objective of targeting these
patients was to schedule a home visit within 1 week of hos-
pital discharge. This method was unsuccessful because
scheduling a home visit was logistically difficult when many
other post-discharge appointments were being scheduled.
Feedback from Nurse Clinical Coordinators indicated that the
discharge process was already overwhelmed by numerous
readmission-reduction initiatives, and scheduling home visits
was easily overlooked.
As a result, the focus was changed to patients in ambulatory
care clinics. Providers, including physicians, advanced practice
providers (i.e., nurse practitioners and physician assistants),
registered nurses, and pharmacists were educated about
home-based MTM. Pharmacy leaders attended department
meetings across the health system to give presentations
describing what home-based MTM was, what patients were
candidates, and how to place referrals. Providers were
encouraged to refer a patient for home-based MTM for the
following reasons: transportation barriers getting to the clinic,
patient unwillingness to bring medications to the clinic, and
concerns that environmental factors were affecting medication
use. Providers ordered a referral in the EHR, which alerted the
MTM support analyst to contact the patient to schedule a 60-
minute new patient appointment. No geographic restrictions
were placed on who could receive home-based MTM.
Documentation of services and care coordination
A documentation template was created for home-based
MTM that mirrored the template used for MTM provided in
the clinic. Clinic-based MTM notes include a list of medical
conditions, a medication list, a narrative of patient symptoms
and concerns, laboratory values and vital signs, condition-
specific assessment and plan, including recommended medi-
cation changes and patient education needed, assessment of
medication adherence, a succinct list of medication-related
problems (MRPs), and time spent with the patient. In addi-
tion to these elements, home-based MTM notes include a brief
narrative of the patient's living situation. For example, the
pharmacist documents if the patient lived alone or in an un-
kempt environment. A “home visit” encounter type is created
in the EHR so that when providers and schedulers look at a
patient's appointments, they would recognize when a home-
based MTM visit is scheduled as opposed to a clinic MTM
visit. This prevents patients from having clinic appointments
scheduled right before or right after a home visit.
When home-based MTM was established, the goal was to
use a home visit as a bridge to the clinic. After a home visit, a
patient would receive follow-up MTM in the clinic. To promote
this continuity of care, communication among the home visit
pharmacist and the rest of the care team was essential. Home
visit notes were shared with a patient's PCP, clinic pharmacist,
and any other specialty providers via the EHR. Additionally, the
home visit pharmacist communicated with community-based
providers such as community pharmacies and home health
care nurses.
Billing for services
Charges for services are entered in the EHR and processed
by the billing department. In Minnesota, Medicaid and one
commercial insurance plan cover MTM delivered in the homes
of those patients who take 3 or more prescription medications
to treat or prevent one or more chronic conditions.15
Reim-
bursement rates for home-based MTM are the same for MTM
delivered elsewhere (i.e., clinic or pharmacy) and are based on
the number of medications and conditions reviewed and the
number of MRPs identified. Facility fees are not used for home-
based MTM. The health system bills all insurers for MTM visits
whether they are provided in clinics or in the patient's home. If
coverage for MTM is not provided by the insurance, patients
may incur a bill. The health system has negotiated contracts
with insurers to cover clinic-based and home-based MTM as
MTM services have expanded. In addition to revenue from
insurance payments, the health system had a contract with the
Metropolitan Area Agency for Aging that supported the cost of
home visit for patients 60 years of age and older. The health
system reimburses the pharmacist for mileage expenses
incurred travelling to patients' homes.
Evaluation
Home-based MTM was evaluated by the number of re-
ferrals, the reason for referral, type of referring provider and
the number and type of MRPs. Continuity of care was
measured by whether or not patients received clinic-based
MTM within 120 days after a home-based MTM visit and
whether they received follow-up care from their PCP within
120 days after a home-based MTM visit to address problems
identified during the home visit. The PCP was not necessarily
the referring provider but was defined as the provider
(physician, advanced practice provider) designated in the EHR.
S. Reidt et al. / Journal of the American Pharmacists Association 56 (2016) 178e183
180

Data were collected from the EHR and entered in a Microsoft
Excel spreadsheet. Descriptive statistics were used for age, sex,
race, referral type and referral reason, and follow-up time with
pharmacists and PCPs. Approval was granted by the Institu-
tional Review Board (IRB) of the health system and the Uni-
versity of Minnesota.
Results
From September 2012 to December 2013, 74 home-based
MTM visits were provided to 53 patients. Fifty-five percent
of patients were 65 years of age or older, and approximately
one-half were black (55%) and female (57%). Patients took a
median of 12 prescription and over-the-counter (OTC) medi-
cations and had 7 chronic conditions (Table 1). Most patients
received 1 home visit; however, 8 patients received more than
1 home visit (range 3 to 9). Patients who were unable or un-
willing to see a pharmacist in clinic to follow up on medication
changes or adherence counseling received more than 1 home
visit. A majority of home visits occurred within a 10-mile
radius from the hospital; however, patients living up to 20
miles from the hospital were also seen. The pharmacist spent
approximately 10 minutes reviewing the patient's chart before
the home visit, and the visit lasted from 30 to 60 minutes. The
pharmacist spent approximately 15 minutes documenting
each visit. Sixty-six percent of the patients were referred from
the Downtown Internal Medicine Clinic, and approximately
50% of referrals were made by physicians. The most common
referrals were for patients with nonadherence or trans-
portation barriers preventing them from receiving MTM in the
clinic. Additionally, patients who had home health care nurses
were often referred, so the pharmacist could reconcile the
medications being set up in pillboxes with those on the health
system medication list. Nonadherence, transportation barriers,
and the need for medication reconciliation with a home care
nurse accounted for 51% of all referrals. Referrals for patients
with caregivers who could not attend clinic appointments and
patients who did not want to bring medications to the clinic
were also common (Table 2).
Regarding continuity of care, 54% of patients saw their PCP
within 30 days of the home visit to address problems identi-
fied during the home visit, and 92% followed up with their PCP
within 120 days. Within 30 days of the home-based MTM visit,
11% of patients followed up with a clinic pharmacist, and 17%
followed up within 120 days (Table 3). MRPs were identified at
each home visit and were classified according to type: indi-
cation, effectiveness, safety, and compliance.16
A median of
3 MRPs were identified at each home visit. The most common
problems identified (40%) were associated with compliance
(Table 4). Compliance-related problems were classified for
patients who did not understand how to use their medications
or preferred not to take their medications. Patients were often
using medications, such as inhalers and insulin pens, incor-
rectly. Compliance-related problems also classified those
Table 1
Patient demographics (n ¼ 53)
Patient characteristics No. of patients (%)
Age (y)
18e50 7 (13)
51e64 17 (32)
65 29 (55)
Sex
Male 23 (43)
Female 30 (57)
Race
Black 29 (55)
White 20 (38)
American Indian 2 (4)
Asian 1 (2)
Other 1 (2)
Insurance type
Medicaid 4 (8)
Medicare 29 (55)
Commercial 19 (36)
Uninsured 1 (2)
No. of medications (Rx and OTC) per patient,
median (range)
12 (4e49)
No. of medical conditions per patient,
median (range)
7 (3e17)
No. of medication-related problems per patient,
median (range)
3 (0e6)
Table 2
Home medication therapy management (MTM) patient referrals
Home MTM referral No. of referrals (%)
Clinic
Internal medicine 33 (62)
Senior care 12 (23)
Coordinated care 7 (13)
Psychology 1 (2)
Provider type
Physician 27 (51)
Advanced practice provider (nurse practitioner,
physician assistant)
11 (21)
Pharmacist 12 (23)
Registered nurse 1 (2)
Patient self-referral 2 (4)
Referral reason
Nonadherence 9 (17)
Transportation barriers 9 (17)
Medication reconciliation with public
health nurse
9 (17)
Will not bring medications into clinic 7 (13)
Medication review with caregiver 6 (11)
History of no-show clinic appointments 4 (8)
Medication reconciliation 4 (8)
Hospital discharge follow-up 2 (4)
Medication organization 2 (4)
Polypharmacy 1 (1)
Table 3
Continuity of care after home MTM visit (n ¼ 53)
Measure No. of patients (%)
Days elapsed between MTM visit and clinic visit
1e14 0
15e30 6 (11)
31e60 4 (8)
61e120 5 (9)
No clinic MTM 34 (64)
Days elapsed between home MTM visit and PCP follow-up
1e14 14 (26)
15e30 15 (28)
31e60 10 (19)
61e120 10 (19)
No follow-up 4 (8)
Abbreviations used: MTM, medication therapy management; PCP, primary
care provider.
181

instances when patients were using expired or family mem-
bers' medications.
The pharmacist made interventions during the home visit
that were typical of clinic-based visits. For example, the phar-
macist recommended laboratory monitoring and initiating,
discontinuing, or modifying medications. Having access to all
medications in the home, the pharmacist was also able to make
interventions that may have been difficult to make in a clinic.
For example, the pharmacist eliminated duplicate bottles of
medications or expired medications and identified a safe and
convenient location to store medications. Medication disposal
and organization were typical interventions that occurred
when patients were using more than 1 pharmacy or continued
to receive refills for medications that had been discontinued by
a prescriber. Medications were disposed of in the patient's
home according to Food and Drug Administratione
recommended practices,17
and the pharmacist documented the
names of the disposed medications in the EHR.
Because 40% of identified MRPs related to compliance,
adherence counseling interventions were common. The
pharmacist worked with the patient to develop strategies to
improve compliance. By observing the patient in his or her
home environment, the pharmacist was able to suggest ways
that the patient could incorporate taking medications into his
or her daily routine. The pharmacist's assessment of compli-
ance often uncovered reasons, besides forgetfulness, for
noncompliance, such as not understanding directions, fear of
side effects, belief that medications would not work, or poor
coordination with caregivers and home health care nurses.
When such reasons were uncovered, patients sometimes re-
ported that they would not be willing to have in-depth and
candid conversations about compliance in a clinic or phar-
macy. Once reasons for noncompliance were identified, the
pharmacist and patient agreed on appropriate interventions.
Common interventions included patient education tailored to
the patient's interests and concerns.
Discussion
Home-based MTM met the needs of the health system by
helping patients with a history of nonadherence and bridging
communication gaps between the health system and
community-based providers. Home visits offered an oppor-
tunity for caregivers, such as personal care attendants, to be
involved in the medication assessment, which was important
given their valuable insight in identifying and overcoming
barriers to compliance. Referral reasons observed in this
project may identify patient populations that should be tar-
geted to receive this service. Providers often referred patients
with a history of nonadherence that could not be fully un-
derstood in the clinic. In the patient's home, the pharmacist
could observe environmental factors that might be affecting
adherence and could make appropriate interventions. Patient
complexity and number and type of MRPs observed in this
study are similar to those reported by Reidt et al., who also
found compliance-related problems to be the most prevalent.
The interventions in this paper are similar to those reported in
other studies8,9
that emphasized patient education and care
coordination between health systems, home care nurses, and
community pharmacies.
Patients were referred by providers who were unable to
reconcile medications with home care agencies or caregivers.
In these cases, medication changes had often been made but
were not clearly communicated to the home care agency or
caregiver, and providers were uncertain what medications
were being set up in a patient's pillbox. Home-based MTM
enabled a pharmacist to inspect the pillbox, resolve discrep-
ancies with a home care nurse or caregiver, and collaborate
with the nurse or caregiver to develop a care plan to resolve any
MRPs. In these cases, the pharmacist was the bridge between
the health system and the patient's home support system.
There was a low volume of home visits provided during the
first 15 months that this service was available, and most pa-
tients received only one encounter. The health system ex-
pected a low volume of service because home-based MTM was
viewed as an option for a select group of patients who were
not able to access MTM in the clinic or for whom clinic-based
MTM had not resolved all MRPs. Home-based MTM was
designed to be a consultative service where the pharmacist
would provide a limited number of in-home encounters and
then facilitate follow-up with clinic pharmacists. Follow-up
with PCPs was much more common than follow-up with
clinic pharmacists and this is an area for improvement. The
home visit pharmacist often assisted the patient in setting up a
PCP appointment, which may explain the high rate of PCP
follow-up rate. This same assistance was not provided for
follow-up with clinic pharmacists but will be in the future.
Promotion of this service primarily relied on word of
mouth, which may also explain the low volume of patients
served. Because many of the health system clinics are staffed
by medical residents who are rotating through clinical sites,
communicating information about the service was difficult.
Although not formally tracked, very few patients refused a
home-based MTM visit. Patients were more likely to agree to
the service if the referring provider had discussed the service
with the patient before the MTM support analyst called the
patient to schedule the visit.
Payment for home-based MTM is a limitation to its
implementation. Few reimbursement opportunities exist in
fee-for-service models, although our health system has suc-
cessfully included reimbursement for home-based MTM in
contract negotiations with insurers and has had grant funding
to help cover costs. Currently, the cost of delivering home-
based MTM is greater than revenue from insurance pay-
ments; however, the health system sees value in this service,
because it provides MTM to patients who have a history of
nonadherence and may not otherwise access MTM.
The health system has made changes to improve the ser-
vice since its initiation. Coordinating home-based MTM visits
with home health care nurse visits has made communication
between the pharmacist and nurse more efficient. Reminder
calls to patients one day before the home visit has helped to
decrease the incidence of patients not being home for the visit.
Table 4
Medication-related problems identified
Medication-related problem n (%)
Indication 35 (18)
Effectiveness 44 (22)
Safety 39 (20)
Compliance 80 (40)
Total 198
S. Reidt et al. / Journal of the American Pharmacists Association 56 (2016) 178e183
182

Pharmacy students and residents on clinical rotations have
been incorporated in the visits, but they do not conduct home
visits without direct supervision.
There are a number of limitations to evaluation of home-
based MTM in this article. Continuity of care was considered
only for care that occurred after the home-based MTM visit;
therefore, it is uncertain how often patients were seeing their
PCPs before the home-based MTM visit. Patients receiving
home-based MTM were not compared with those who
received clinic-based MTM, so it is uncertain if the types of
MRPs experienced by both groups are the same and if home-
based MTM contributes to easier identification of some
MRPs. Because a broad ambulatory care population was tar-
geted for home-based MTM, disease-specific clinic outcomes
(e.g., blood pressure, blood glucose) were not evaluated.
Home-based MTM is resource intensive, so demonstrating its
value is essential. Future research should evaluate how iden-
tification of MRPs may differ between home-based and clinic-
based MTM. Other outcomes that may measure the impact of
home-based MTM include patient self-efficacy to manage
medications, patient satisfaction, and adherence. Finally, it is
unclear what patients benefit most from home-based MTM or
if telephone-based MTM may serve the needs of health system
patients who do not access MTM in a clinic.
Conclusion
Home-based MTM is feasibly delivered within the ambu-
latory care infrastructure of a health system with sufficient
provider engagement as demonstrated by referrals to the ser-
vice. The service meets the needs of the health system by
addressing nonadherence and bridging the gap between clinic-
based and community-based providers. The service is resource
intensive, and research is needed to evaluate its impact.
Acknowledgments
The authors thank Don Uden, PharmD, FCCP, for review of
the manuscript and Candace Mealey for assistance in
compiling data.
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in a community pharmacy. Clin Ther. 2005;27:104e111.
15. Minnesota Department of Health and Human Services.
MTM provider manual. Available at. Accessed www.dhs.state.
mn.us/main/idcplg?IdcService¼GET_DYNAMIC_CONVERSION;
RevisionSelectionMethod¼LatestReleaseddDocName¼dhs16_136889;
September 26, 2015.
16. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical care practice: the clini-
cian's guide. 2nd ed. New York: McGraw-Hill; 2004.
17. Food and Drug Administration. Disposal of unused medicines: what you
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Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/
SafeDisposalofMedicines. Accessed July 4, 2015.
Shannon Reidt, PharmD, MPH, BCPS, University of Minnesota College of Phar-
macy, Minneapolis, MN, and Hennepin County Medical Center, Minneapolis, MN
Haley Holtan, PharmD, BCPS, BCACP, Hennepin County Medical Center, Min-
neapolis, MN
Jennifer Stender, PharmD, AE-C, Hennepin County Medical Center, Minneap-
olis, MN
Toni Salvatore, Pharmacy student, University of Minnesota College of Pharmacy,
Minneapolis, MN
Bruce Thompson, RPh, MS, Comprehensive Pharmacy Services, Former Director,
Hennepin County Medical Center, Minneapolis, MN
183

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