Recently I began wondering if the pharmacy profession really learned anything from OBRA ’90. As I looked back to my days in pharmacy school one of the things I remembered most is the emphasis placed on the necessity of patient counseling. Many of the discussion centered on how we needed to start patient counseling/consultations in hopes of someday getting reimbursed for that service. I must confess that I received payment for patient consultation on occassion and actually had a modestly lucrative business on the side as a long term care pharmacy consultant. So what happened in the last twenty-five plus years to change the way pharmacists consult with their patients?

Along came the Omnibus Budget Reconciliation Act of 1990 .

OBRA’90 (http://ows.doleta.gov/dmstree/uipl/uipl91/uipl_1291.htm) mandated that pharmacists expecting to receive Medicaid payment would have to provide specific levels of service to ensure quality care. The following three standards were set forth were expected to be met:

1.Prospective drug use review (ProDUR)
2.Patient counseling
3.Maintaining proper patient records

Since the passing of OBRA’90 effective use of technology has automated both ProDUR and patient record keeping. Pharmacy computers now routinely scan patient records to check for drug/drug interactions, allergies and other conflicts and alert pharmacists for possible intervention. But how many of those potential intervention points are just overriden by the pharmacist without proper review? And what about the patient counseling standard? Most if not all states have passed pharmacy legislation requiring a pharmacist to counsel patients since OBRA’90. Is that because pharmacists have failed to meet the basic OBRA’90 requirements?

It’s pretty obvious that OBRA’90 did not motivate all pharmacists equally on the importance of patient counseling. 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!

Health information technology (HIT) is the great driving force in healthcare today. Healthcare 2.0 is becoming the norm. Even social networking is being used to improve healthcare and patient outcomes. The advent of electronic medical records (EMR’s) and personal health records (PHR’s) gives pharmacists an opportunity to get involved in patient care. Pharmacists are trained patient record keepers as well as trained patient counselors. Pharmacists are capable of educating their patients to the benefits of PHR’s if they choose to do so. The opportunities are here now for those pharmacists who are willing to invest time to educate themselves. Now is the time to get involved. Learn about PHR’s and the other innovations that are changing healthcare today and get involved by counseling and educating your patients. Remember, true motivation can never be legislated, it must come from within.

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