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.