I totally agree it’s past time for pharmacists to be given prescribing authority, at least on a limited basis. There are so many instances where a pharmacist could make the decision to appropriately select and prescribe from a limited formulary of medications for a number of common disease states.

Pharmacists receive more intensive training and are more qualified to make decisions regarding appropriate medication therapy than most nurse practitioners or physicians assistants I know, and probably more qualified than many MDs as well.

Prescribing authority is given to MDs, NPs and PAs, in my opinion, after receiving basic training algorithms to assist them in making prescribing decisions based on their diagnosis. They don’t receive near the training or knowledge base in pharmacology, pharmacokinetics, adverse drug reactions and drug interactions that should be used in the drug prescribing process. They are also somewhat dependent on and easily swayed by the influence of pharmaceutical sales and marketing efforts, something which pharmacists are able to sort through by throwing out the hype and making better clinical decisions based on rational therapeutic approaches.

And, from what I have seen, most prescribers are easily swayed by their patients as well. All of the direct to consumer pharma advertising has created a patient population who go the the doctor with their expectations of what should be prescribed… and sometimes get upset when they don’t get what they want!

Pharmacist prescribing would expedite patient care and lower the cost of care by facilitating or streamlining the process of finding the correct medication and dose to reach and maintain therapeutic goals. This would tie in very well with a medication therapy management type of pharmacy practice that monitors new medications and makes changes or adjustments quickly and efficiently based on patient response to therapy.

All this would help to reduce costs associated with patient medication therapy,improve and streamline the process of reaching therapeutic goals, aid in assisting, educating and counseling patients to ensure compliance and adherence to drug therapy and improve patient outcomes.

The PharmD vs. BSPharmacy status for prescribing authority will need to be addressed in some manner. Pharmacists were making decisions regarding appropriate medication selection and use decades ago. It wasn’t until the prescriber and dispenser functions began to change that pharmacists  began to lose the authority to ‘prescribe’ all but those medications given OTC status. Generally speaking, most RPhs have as much knowledge and decision making skills when it comes to prescribing as those who prescribe the prescription orders they fill and dispense. Same with PharmDs.

Yes, it is time for pharmacists to be given prescribing authority, if even on a limited basis. I would expect that this authority would be expanded after a year or two of monitoring said prescribing authority based on the positive outcomes we would see.

” I don’t understand why some pharmacists have been reluctant to get involved with the evolution of their profession and provide effective patient counseling. Perhaps those pharmacists are practicing in a workplace not conducive to patient counseling or maybe they are fearfull of patient interaction. Possibly they are just not interested in getting involved, in which case I would suggest they consider a new profession. Regardless of the specific scenario, I think it is time for another call for action. Pharmacists need to get involved in counseling and educating their patients now!”  (Pharmacy 2.0 and 1/2 March 18th, 2009).

Fast forward to the year 2012.  The pharmacy world continues to watch and wait as we follow the WAG vs. ESI saga amidst reducing third party reimbursement, changing pharmacy regulations and many pharmacy Boards extending a ‘blind eye’ towards idiotic (or insane)  ’15 minutes or it’s free ’ types of corporate policies that are dangerous for the public and demeaning to the practice of pharmacy.

I’ve heard it for years… pharmacists will be providing counseling and cognitive services to patients and GETTING PAID FOR IT in the near future.   I remember first hearing it before I graduated from pharmacy school in the ’70s.  I always believed it and thought OBRA ’90 legislation might be the beginning of it.  But I was disappointed to see this happening only in a few areas of pharmacy like long term care.  Many pharmacists failed to recognize the potential for patient counseling and most members of the pharmacy corporate world continued to place profits before patients, ignoring the need and disregarding the future of the profession.

But I still believed it to be true.  Pharmacists will be providing comprehensive patient counseling and cognitive services and getting paid for it.  This is a valuable service to provide to our patients and customers that will improve their lives.  This is a service that saves health care dollars in the long run.

Early this century, MTM became the new pharmacy buzz word.   According to my ’trusted sources’ at Wikipedia, Medication therapy management (MTM) is a partnership between the pharmacist, the patient and their caregiver, and other health professionals that promotes the safe and effective use of medications and helps patients achieve the targeted outcomes from medication therapy.  (see www.pharmacist.com)

I like that definition of MTM.  Unlike the Medication Modernization Act 2003 it specifically states that MTM is a partnership between THE PHARMACIST, the patient and their caregiver.  Not a nurse, not a physician or any other health care professional.  The pharmacist is THE member of the health care team best qualified to provide medication therapy management services.

So who’s ready to get on board with MTM?  Will pharmacists finally step up to the plate and qualify themselves to be actively involved with MTM?  The future is happening right now!  Pharmacists are being paid for MTM and other cognitive services.  This is becoming reality and will become the norm in pharmacy practice.

There is power in numbers.  It will only be through the power of those involved in providing these types services.  It cannot be achieved any other way.  Not by by associations or organizations;  and certainly not through legislation or pharmacy boards.  It will only come from the strength of those providing the MTM services.  Everyone and everything else is only an appendage and supportive in nature.

Together, as a unified group, MTM pharmacists can make that happen.  You might ask “how are we to do this”?  

The Community Clinical Pharmacists MTM Group on LinkedIn is one of the ways to achieve this.  If you have not started a LinkedIn profile you need to consider it now, especially if you want to start an MTM practice.  The ccpMTMgroup is designed primarily for pharmacists who are interested in providing independent MTM consulting services.  This is the first step in setting up a network of MTM pharmacists committed to promoting and providing pharmacy MTM services.  I invite you to join this group and take part in the discussion and be part of this transition towards independent MTM consulting. As a group we can overcome the obstacles in our path and achieve this goal.

Albert Einstein  defined insanity as “doing the same thing over and over and expecting different results”.  Pharmacists cannot expect to continue with a ‘business as usual’ attitude and expect the necessary changes to take place.  We need to create an environment to accommodate these changes.

Now is the time for a new call to action that stimulates pharmacists to take steps to make this change happen. Pharmacists cannot continue (as @empress_penguin ’s Twitter profile translates) like  ”clumsy penguins swimming in the sea of mothers across health and welfare”  and expect this change to happen.  (Google Translate – Japanese to English).  (Since I don’t speak Japanese I don’t fully understand what that means but it seems to be representative and descriptive of the pharmacy profession at times.)

We need to change that now.  Pharmacists need to stop swimming ‘clumsily’ and erratically with the currents.  We need to set our sites on the goal and fight the currents in the river of Lethe we’ve been in for years.  Pharmacists must learn to swim upstream towards those goals that will maximize our efforts to improve patient care and strengthen our position as a health care professionals.

Decide now to commit to action or get out of the way of progress.  If you stood back with a ‘wait and see’ attitude when OBRA ’90 was put in place, we don’t need you now – unless you are ready to step up and make the necessary changes.  ”It’s time to get down and dirty and practical, so let’s focus on what might really work to make progress on… change at the grassroots level”.  (see ‘How to Create Change’, sustainablebusiness.com)

To be successful in this endeavor MTM Pharmacists need to:

• Decide to ‘DO IT’ and incorporate MTM opportunities into their pharmacy practice
• Commit to a PLAN OF ACTION to facilitate the necessary changes for practicing appropriate MTM principles
• FOLLOW THROUGH with their plan for implementing MTM within their practice setting
• Support and encourage their colleagues who are involved with MTM and educate the public to the benefits of MTM services

My hearing was evaluated by my hearing aid practitioner and it was discovered it wasn’t a faulty hearing aid at all.  It was my left ear that was failing.  I subsequently lost all hearing in my left ear on May 15, 2004 and lost the hearing in my right ear about 2 months later.  I was later told it was sensorineural hearing loss of unknown origin.

After being seen by an ENT/hearing specialist I was set up with an appointment for further evaluation at Oregon Health Sciences University.   This resulted in me being scheduled for cochlear implant surgery on September 2, 2004.    

I persuaded the doctor to activate my cochlear implant about 3 weeks later, two days before my eldest daughter was to be married.  Even though it sounded like a fusion between Mickey Mouse and R2D2, I was able to hear nearly every word at that memorable ceremony after being totally deaf.

Testing after my cochlear implant was activated showed that I had regained 98% speech recognition.   My good speech recognition scores are most likely attributed to only being totally deaf for about 9 weeks.  I guess that I was sort of a ‘poster boy’ in the OHSU Audiology department for awhile.  In less than a month I began to hear normal again.  My wife’s voice began to sound like it used to sound in less than 6 weeks.

It was only a few months later that I became involved with the Cochlear Awareness Network.  I’ve participated in Cochlear outreach activities since that time.  I recently was asked to represent Cochlear Americas at the 2011 Association of Medical Professionals with Hearing Loss conference.   I’ve done a number of presentations over the years at Lion’s and Rotary club meetings, church and civic groups, the School of Occupational Therapy at Pacific University, the Portland Medical Representatives Association and shared my personal story at a continuing education seminar for audiologists.   I just led Team Cochlear at the Walk4Hearing in Portland, Oregon raising money for the Hearing Loss Association of America’s efforts to raise awareness and provide programs and assistance for those suffering from hearing loss.

The challenge of going deaf and receiving my cochlear implant has truly changed my life in a number of ways.  Not only was I able to hear again but I gained a great deal of perspective and maybe even a little wisdom from going through the process.  This has resulted in personal growth in areas that I would not have otherwise experienced.

I now participate as an Ambassador for the Cochlear Awareness Network and believe that having a cochlear implant is a great conversation starter.   I have people ask me about it all the time.  I enjoy sharing my story with others and hope that I can help them learn that there are solutions available to many who are ‘hearing challenged’.

Disaster can strike with little or no warning, giving us little or no time to prepare.  Floods, hurricanes, fire, earthquakes or other natural disasters all pose serious concerns.  How well we prepare ourselves in advance of disaster will be determine the extent of how our needs are met.

As witnessed in recent years, natural disasters or emergency situations can occur anywhere at anytime.

In the wake of Hurrican Katrina in 2005, Americans witnessed just how fragile paper based health record systems really are.  Public health and medical response personnel were faced with the challenge of meeting the health care needs of the victims of Katrina.  Meeting the immediate medical needs of the injured or those with chronic conditions without access to their medical records was one of the greatest challenges.  Trying to care for the thousands who were displaced by the hurricane was hampered by the loss of access to their medical records as well.

Prepare your family for possible emergencies or natural disasters.  To learn more about preparing an emergency personal health record PHR click here or view this prezi  –

Why You Should Start a Personal Health Record

Why You Should Start a Personal Health Record

This is the story of “Earl” and the personal health record (PHR).  Of course the names have been changed to protect the privacy of those involved. 

Subject:   87 y.o. white male Caucasian, hypertension, pacemaker, dementia/Alzheimer’s, history of strokes and multiple hip replacements, multiple medications, etc., etc.

History:   Earl still lives on the farm that he has worked for 60+ years of his life.  His wife passed away several years ago.  Earl lives alone except for the cats in the barn that he feeds twice daily.  His family members live nearby and check on Earl several times daily, bringing dinner to his house each evening. 

One sunny spring afternoon recently Earl decided to take a walk down the lane on the farm.  On his way back to the house Earl got tripped up in some rough grass and fell.  Earl was unable to get himself up and lay face down on the grass, his forehead bleeding from where his head hit the ground.  He tried to use his emergency alert button but he was out of range of the receiver connected to the phone in the house.  His repeated attempts to get himself up were fruitless and exhausting.  Earl lay helpless waiting for someone to find him. 

It was over an hour before one of Earl’s family members brought dinner to the house.  After searching the house and barn for Earl he was finally found down the lane.  After a 911 call was placed the EMS personnel arrived with the ambulance to transport Earl to the hospital.  After getting him in the ambulance the EMTs asked what medications Earl was taking… 

A few months earlier, one of Earl’s family members had prepared an emergency personal health record for him.  It was placed in the Emergi-Tube on the side of the refrigerator.  The information was retrieved from the Emergi-Tube and given to the EMTs and taken with Earl to the hospital.  The information was helpful in the emergency room as it not only contained information about Earl’s medications but also a brief outline of his medical conditions, allergies and other pertinent medical information. 

Earl was released from the hospital the next day, a little sore but happy to be home with his cats again.  The information provided on the emergency PHR was helpful to those medical personnel caring for him.  Having this information readily available ensured that the ER and hospital staff were able to continue Earl’s medications properly during his stay. 

We should be encouraging people to learn about PHRs and how to use them to protect themselves and their loved ones.  The use of a PHR will help protect them in the event of an emergency, help decrease the incidence of medication errors, allergic reactions and improve communications with physicians and clinicians.   More importantly, the use of a PHR will empower patients to better monitor and control their medical conditions and improve their overall level of health. 

If you are interested in learning more about personal health records visit:  

http://www.healthrecordresources.com/index.php

Begin by organizing all of the health information you have at home. Gather all information from:

• Files at home containing information from physician visits or hospital admissions
• Pertinent information that might be contained in billing records from physician or hospital visits
• Identification cards or immunization records prepared by health care providers
• Information provided by your pharmacy or with the prescriptions you receive
• Information contained in insurance billings or other documents
• All other sources or pertinent records containing relevent personal and family health history   

Once you have this information in a single location you are ready to begin building a personal health record (PHR).  You are also entitled to copies of all personal health information maintained by your physician or health care provider. You will want to discuss with them what information they have on file and how to obtain copies for your records as well.

Learn more about obtaining your health information from health care providers by reading Dave deBronkart’s ( @ePatientDave on Twitter  )  blog article entitled      ”Gimme My D*** Data “.    

Managing your health information is like balancing your checkbook….it will become easier if you work on maintaining and updating your information regularly.

Gather information, organize it and share it on a regular basis with your health care providers.

Your personal health record (PHR) should be a collection of important information about your health (or the health of someone you are caring for) which you actively gather, maintain and update.  The information that your PHR should include (but is not limited to):

• Personal identification (name, birth date and demographics) 
• Emergency contacts 
• Names and contact information of your physician, dentist, eye doctor, and any other specialists
• Health insurance information
• Living wills, advance directives, or medical power of attorney
• List and dates of significant illnesses, injuries and surgical procedures
• Current medications and dosages
• Herbal supplements and pertinent dietary information
• Drug allergies or sensitivity and other allergies 
• Pertinent family history information
• Important test results; eye and dental records
• Organ donor authorization

Having access to your personal health information in an emergency can be critical.   Your emergency personal health record (ePHR) can provide lifesaving information necessary for your medical treatment.

Paul (name has been changed) seems to be a responsible young husband and father.  But Paul’s wife was evidently concerned enough to make sure that he had the necessary medical information to handle any unforeseen medical situations that could arise.  The list consisted of some basic information including:

•              name, phone and address of primary care physician
•              name, phone and address of specialist
•              health insurance information including policy number
•              list of medical conditions
•              list of allergies, etc.
•              emergency contact information

The basic information and instructions left for Paul by his wife would have been contained in their personal health records (PHR’s) if they had one.  Creating and maintaining personal health record would have eliminated the need for Paul’s wife to write a list each time she was away from home. 

I was informed by another friend (baby boomer age) that he knew nothing about the medications his wife takes.  His concern was, should something ever happened to her, that he would not know how to advise EMS personnel or emergency room physicians about her medical conditions or her medications.  I suppose that he would end up emptying the medicine cabinet into a brown paper bag and handing it over to them in hopes of helping them make prudent medical decisions.  A personal health record would provide more complete information in a much more usable format.

Both situations are real and most likely represent the actual level of preparedness of most Americans.   Starting a personal health history is a good first step towards a functional personal health record (PHR).  Once the information is gathered it can be used to create a personal health record that will provide basic health information for you and your family. 

Personal health records can easily provide pertinent information in a medical emergency.  PHR’s can also be used to benefit the exchange of this information between you and your health care providers.  PHR’s will help help you to manage your medical conditions better as well.  Consider starting a personal health record for you and your family now.

Many pharmacies are now offering their patients a thirty day supply of generic medications for the low price of $4.  Most think that this is the greatest thing since sliced bread.  I know people who were spending $40 to $200 a month or more on prescriptions that are now saving a great deal of money.  This savings not only makes most of them very happy but boosts their self image by making them feel like saavy shoppers.  On the surface it may seem like a win-win situation.  But is the $4 prescription phenonema really an answer to the need for better, more cost efficient pharmacy services?

Let me share a couple of experiences that may seem unrelated to the $4 prescription.  This past year I was interviewing website developers and given a number of quotes for setting up my website.  Several of them gave me bids and explanations of what they would do for me at very reasonable prices, considerably below others designers I spoke to.  But the little voice kept creeping into my head saying “you get what you pay for”.  I opted to go with a website developer who was willing to go beyond the basics of building the site; one who was willing to provide their services to me to ensure that I would be able to manage and optimize it as well.  I am not only getting a website that I can be proud of but also learning how to use other web based tools to support my business.  By doing this my life has been made simpler and I will benefit long term from their advice and support.

Another example that comes to mind is auto repair.  I had a car that had clutch problems that needed to be taken care of.   I sought out the nearest “shade tree mechanic” type of shop that had the lowest labor charges in town.   He installed a new slave cylinder which solved the clutch problem for about two days.  I made repeated trips to the mechanic’s shop over the next few weeks finding that he had no long term solution for the problem.   I went to another shop and found more knowledgable mechanics who solved the problem the next day.  Had I just taken the vehicle to them in the first place my life would have been simpler and it would have cost less money in the long run.  I wished that the voice would have reminded me that “you get what you pay for”.

Where am I going with this?  Pharmacy services are more than just counting and pouring, licking and sticking the labels that go on the $4 prescription bottles.  Ask yourself some of these questions. How much money are you saving buying ten prescriptions a month at $4 each from a pharmacist who fails to tell you how to take them correctly?  Does the pharmacist take the time to know your medical condition sufficiently and to listen to your questions and provide information needed to treat your condition?  And what of the medications prescribed that are not on the $4 list? Does the pharmacist just charge you the $89.67 price for that prescription or does he take the time to discuss less expensive alternatives with your physician?  Do you even have the opportunity to really talk to him when you need to?

Purchasing pharmacy services is really not any different than your other purchases in life.  You will usually always “get what you pay for”.  Many pharmacies are now understaffed trying to keep businesses profitable selling $4 prescriptions.  Their pharmacists are under a great deal of pressure trying to ensure that your prescriptions are ready when you request them.  Patients are complaining of long wait times for prescriptions as well as the lack of adequate counceling from the pharmacist.   The $4 prescription price provides instant gratification while ignoring the pharmacy services that are truly going to benefit the patient. Remember “you get what you pay for” the next time you are buying your $4 prescription and ask yourself if it’s really worth it in the long run.