Health Records


For the most part people go to their physician or healthcare provider to get help or treatment for a medical problem. But some people are so stubborn they’ll wait until the last minute, suffering with an ache, pain or other uncontrolled symptom of disease or condition until they have no other recourse but make an appointment to see their doctor. It’s often only when they get to this virtual point of no return are they willing to give in, seek advice and visit their ‘healer’ of choice.

Similarly, due to stubborness, the desire to follow doctor’s orders seems to disappear for many patients as soon as the prescribed treatment or therapy relieves the pain or symptoms they were suffering from. This happens all too often with antibiotic therapy where patients stop taking their medication when symptoms subside, terminating the therapy before the full course of treatment has ended. It’s also evident when a patient is prescribed a maintenance medication to control a disease or chronic condition such as hypertension, cardiovascular disease, COPD or diabetes, often leading to uncontrolled symptoms, progression of disease state or even death.

What can we do to increase patient adherence and compliance with their prescribed medication regimen?

Lack of medication adherence… America’s other drug problem-

MedTime cartoon

medication compliance cards, not clubs…

Adherence and compliance to medication therapy or prescription drug regimen seems to be an ever looming problem, adding over $300 billion in healthcare expense annually in the U.S. alone. Recent statistics posted by Express Scripts indicate 69% of non-adherence to drug therapy is behavioral in nature resulting from forgetfulness or procrastination. So what’s it going to take to get people to take their medications?

No Wooden Clubs or 2 by 4’s –

Pharmacists are continually frustrated with this problem. I’m sure physicians and other prescribers are as well. Because, for the most part, we can’t “make” a patient take their medication if they don’t want to. Even when we spend the extra time to educate patients about their disease state and prescribed medications we can’t compel anybody to be compliant if they’re unwilling to do so.

$331 billion is at stake-

Improving medication adherence and ensuring timely medication use are the greatest opportunites to cutting the nearly one-half trillion dollars of avoidable healthcare costs worldwide. Any measures taken to reduce this expense and advance the responsible use of medicines  will lead to improved health outcomes as well.

What we can do, and should do, is to continue to educate, offer encouragement and provide medication reminder devices and tools to help patients who need to improve their medication compliance.

There are many tools available ranging from simple pill boxes and reminder caps on pill bottles to smart phone apps and automated pill dispensers. Some of the most unique, innovative and easy to use reminders devices are the medication compliance cards from Med Time Compliance. These devices can be designed for specific needs ranging from their iRemindHer once a day oral contraceptive compliance card and multiple daily dosing reminder cards to unique products designed for complex dosing regimens such as growth hormone injections or chemotherapy medication regimens with variable dosing schedules.

A simple thing-

As healthcare providers we should all adopt the slogan, “Remember the Reminders” to help improve medication adherence and compliance. Adding reminders to the patient education process will undoubtedly become one of the simplest, least expensive ways to improve medication adherence and compliance in the future.

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Dag-nabbit! 

Walter Brennan was a familiar character in many of the western movies and television shows, including “The Real McCoys”, we watched growing up as a kids in my parent’s home. I always remember when he was angry or just really emphatic he used the word dag-nabbit often in these shows.

I was recently reminded that Walter Brennan played the role of Murph, a pharmacist, in the 1947 movie “Driftwood”. I don’t remember if he used the word “dag-nabbit” in Driftwood or not. But I can imagine him as a pharmacist using it when frustrated with patients who don’t take their medication as prescribed.

Physicians and pharmacists dedicate their lives to helping patients manage their various disease states with the help of prescription drugs. Whether it is hypertension, diabetes, COPD, Parkinson’s or any other chronic disease a patient may have… if patients don’t take their medication as prescribed their disease will progress and they may find themselves in the emergency room at the local hospital.

$300 billion dollar a year problem: 

And dag-nabbit, we’ve got a medication adherence problem in the U.S. that increased healthcare costs by over $300 billion last year! Failure to take medications correctly decreases the quality of life for these individuals and it’s estimated that failure to take prescription medications as prescribed results in over 125,000 deaths each year.  So why don’t people take their medications as prescribed?

barriers to medication adherence

There are a number of reasons people don’t take their medications correctly. Communication barriers, socio-economical barriers and motivational barriers all contribute to the medication non-adherence problem.

Forgetfulness, poor understanding of disease or illness, concerns about medication costs are all contributing factors to the non-compliance issue. So how do we work towards solving the medication adherence problem?

Solving the medication adherence problem: 

Healthcare professionals need to step up efforts to engage and educate patients to the importance of taking medication correctly. Physicians, nurses and pharmacists should increase efforts to enhance patient’s understanding of their disease and how they will benefit from taking their prescription medications appropriately. Pharmacist medication therapy management MTM has also been shown to increase adherence resulting in improved patient outcomes and reduce healthcare costs.

There are a number of organizations like Script Your Future that provide information and tools to improve medication compliance. Those who care for the elderly can also assist patients with reminders to take their medications as prescribed.

Technology can help with medication reminders and tools that improve medication adherence. Text messaging and reminders via phone are available to give personal medication reminders. There are many ‘pill reminder’ devices and systems available that have audible alarms or visual cues to remind patients it’s time to take their medication.

The LCD Compliance Card is the most accepted and used compliance device in the world. More than 10 million units have been distributed globally in several health care fields including both physician and veterinary practices.

The functions of the Compliance Card are all pre-programmed. There are no user settings. Users start the device at the desired time of day by depressing one button. There are variations of the Compliance Card that adapt to multiple regimens including daily, twice a day, or once a week.

So dag-nabbit – there really shouldn’t be any excuses not to take your medicines as prescribed!

In the aftermath of an emergency situation or natural disaster like Hurricane Sandy we often look back and ask a serious question:

“What could we have done differently to be more prepared?” 

Reflecting on the events that unfolded in 2005 during Hurricane Katrina, we can get a idea of the magnitude of what can happen:

  • approximately 1.5 million people were evacuated.
  • emergency shelters were set up to triage 30,000 to 40,000 people.
  • a 700 bed emergency room was set up to address patient needs.

But in the midst of this effort another crisis was being battled which increased the degree of difficulty for healthcare providers in treating these patients:

Medical records were lost, destroyed or inaccessible for use to treat patients properly.

In the wake of the storm many of these patients could not remember what prescription medications they took.  Doctors could not confirm medications, immunizations, test results or a patient’s medical history.  One can only imagine the problems that arose trying to treat these patients when healthcare providers were lacking important patient personal health information.

Some would say the electronic medical record systems employed at hospitals and doctor’s offices now solve the problems we faced during Katrina.  But recently during Hurricane Sandy, we saw hospitals losing power and cell phone grids being crippled. How are the electronic medical records to be accessed then?  Likewise, records ‘in the cloud’ or ‘silos’ may not be usable.

Taking responsibility:

You, as a patient, need to take responsibility to ensure your personal health information is available in a medical emergency.  You need to maintain a record of this information to share with medical providers, whether it be a routine checkup with your physician or a medical emergency situation.

A simple solution: 

Emergi-Tube and QuickStart ePHR

A personal health record (PHR) can be used to keep track of your personal health information and protect you in an emergency.  A simple PHR would  include medical conditions, allergies, a list of prescription medications along and emergency contact information.

Products like Emergi-Tube and QuickStart ePHR work together, making it easy to keep a record of your health information. With the QuickStart ePHR you can enter your personal health information and print forms to share with your physician. You can edit, update and save information on your computer or USB memory device. As you enter the information into the PHR form it automatically saves your health information and allows you to print a wallet identification card to carry at all times.

Emergi-Tube is a lightweight, water resistant storage device to hold your printed health records and USB memory device.  Designed to be visible in the home, it’s ‘grab and go’ feature allow you to take your records with you if evacuated or just on the go. Additional tubes are ideal for in your car or suitcase when traveling.

For more information on Emergi-Tube and QuickStart personal health records visit www.HealthRecordResources.com or email your contact information to info@HealthRecordResources.com for assistance.

(pharmacist affiliate program available now!)

http://healthrecordresources.com/pharmacists_affiliate.php

“The pharmacist of tomorrow is going to be unrecognizable to most of us. He might not be a vending machine, but he’s not going to be that quiet old white-haired guy up behind the counter, either.”  —  Jim Ammen as quoted on QuoteSea.

W.C. Fields in The Pharmacist, 1933

The profession of pharmacy is rapidly changing in the 21st century. Gone are the days past when there was a pharmacy on nearly every corner in town and the Rexall brand was known in every household. Independent druggists were first line caregivers in the community, often prescribing medications for illness and ailments when patients could not see a physician. Community pharmacists were seen as a pillar of society… independent, highly visible in the community and usually considered well off financially.

Hospital pharmacies, on the other hand, were usually found in the basement, with an existence almost unknown to physicians, nurses and patients alike. The hospital pharmacy existed, in the mind of many people, solely to perform the dispensing and delivery of prescription medications as ordered by the physician. And likewise, the hospital pharmacist often had an image to match. Their salaries even lagged behind those pharmacists in a community setting until fairly recently. But hospital pharmacist stepped up to the challenge.

Times are a changin’…

Hospital pharmacists began performing many clinical functions supporting the delivery of care in addition to the delivery of drugs. An increasing level in the sophistication and number of pharmaceuticals required an increasing level of knowledge and sophistication on the part of pharmacists as well. While the community pharmacist was still counting by fives and ‘lickin and stickin’ labels, hospital pharmacists were taking on greater roles in drug delivery and patient centric clinical functions. Adding to that the increasing numbers of chemotherapeutic agents, radiopharmaceuticals, biopharmaceuticals, nuclear pharmacy and technological advances in drug delivery have made hospital pharmacy a specialty at the very least.

We now see community pharmacists suffering from numerous attacks on their livelihood. Increasing numbers of third party payers, decreasing margins and higher stress and demand in the prescription filling process have fueled the frustration of many pharmacists:

“The word out in the pharmacy community is that the small pharmacist was sold down the river by the drug companies and the PBMs (pharmacy benefit managers)” — Doug Larson

“I’ve been a pharmacist for 40 years now, and Monday morning I didn’t want to come to work because I knew what would await me. Basically, we’ve got a travesty on our hands” — Charles Pace

“It’s every independent pharmacist’s worst nightmare. There isn’t one component that’s working. It’s so extensive that it’s hard to imagine it’s going to get fixed — Todd Brown   (all quoted from QuoteSea/pharmacists)

These and many other unrepeatable quotes and comments are being heard daily from pharmacists who are overworked and under appreciated, being pushed along towards burnout and increasingly locked into the ‘golden handcuffs’ of the chain pharmacy bullies of the industry. Is it any wonder community pharmacists are complaining?

“I’ve tried to maintain an uneasy balance between your friendly unassuming neighborhood pharmacist and Anthony Perkins in ‘Psycho‘ – Roger Bart, (check the date) September 29, 1962!!

Anthony Perkins as 'Norman Bates' - 'Psycho' 1960

Many of the remaining independents are on the verge of financial ruin. Those who work in chain drugstore settings are frustrated, confused and tired of the ongoing abuse they receive. It’s amazing that we don’t have more pharmacists going postal or psycho as a result of the stressful conditions they work in.”

What will it take to bring about the necessary change in the profession? Payment for cognitive services or medication therapy management services is a step in the right direction. Recognition as healthcare providers by healthcare, governmental and third party payers would also help change this environment. But what will be the driving force to secure the future of community pharmacy?

You Are!

We, who want to be the pharmacists of tomorrow, are going to have to step up and take the lead toward securing the profession. We can’t count on professional associations and lobbyists to do it for us. Many of our professional associations are being managed by non-pharmacists (and we complain about non-pharmacists in corporate managerial positions). New pharmacists coming into the ranks must be prepared to recognize the opportunities that exist. And like the rest of us, they also need to stand up for what is morally right for the profession. We all need to take a lead on providing care that is patient oriented and always look out for the patient’s interests, even when it might be contrary to the ‘business as usual’ profit driven policies of corporate pharmacy. Doing so will win their confidence and secure their advocacy for the services you provide them. If your patients are being served appropriately and their needs taken care of you can be sure their voice of support will be heard.

Step up and do the ‘next right thing’ when it comes to taking care of your patients. Look forward to and expect the changes to take place, but only after you have done your part. Our future will be what we make it to be. Each of you in the profession of pharmacy has an obligation to stand for what you believe. After all, if you don’t, who will?

I’ve been in the profession of pharmacy for over half my lifetime. I’ve seen the ins and outs of what happens in independent, hospital, nursing home and chain pharmacies. There are many problems that have plagued pharmacists over the years that have made it difficult at times to practice real, patient oriented pharmacy.  Unfortunately patient care sometimes takes a backseat to all the headaches and stress involved in the prescription filling process.

For most pharmacists the profession has evolved to a hectic paced, overworked environment. Many are filling hundreds of prescriptions each day, dealing with difficult insurance issues and coordinating the prescription filling process understaffed and over-pressured. There are almost always issues and disputes between the overworked support staff. And then there are the interactions with cantankerous customers or the nurse ‘know it all’ that really makes a pharmacist’s day.

All of this can lead to a pharmacy professional that is run ragged by the shear volume of the workload. We often have ‘management’ that thinks they know a better way to fill prescriptions more efficiently to give us time to counsel with our patients. We even have customers that want to weigh in on how to fill prescriptions better. After all, we’re just putting pills in a little bottle that came out of a bigger bottle, right? Oh, and don’t you dare put the blue pills in Mrs. Smith’s bottle that should contain pink pills. We’re still expected to be exacting and perfect in all we do. No wonder so many pharmacists are bald or balding due to the natural phenomenon of pulling one’s hair out.

But even with all this going on, your pharmacist should still be able to satisfy your need for personal pharmacy services. If not, you may need to consider finding a new pharmacist.

Here are three valid reasons why you should consider firing your pharmacist:

1.  Your questions don’t get answered properly. 

Yes the pharmacist is always busy, but they’re still obligated to answer your questions. We’re not talking about questions like “what aisle are the toothpicks on” or “do you know when you will be getting more toothbrushes in stock”. In most states pharmacists are obligated to answer your questions when you pick up a prescription. If your questions can’t be answered at that time, your pharmacist should schedule a time to sit down with you uninterrupted. If you can’t get the answers you need you should fire your pharmacist.

2.  You can’t get a prescription filled in a reasonable amount of time.   

Here again, pharmacies are usually a busy place. But that’s no excuse for a pharmacist to tell you to come back tomorrow for your antibiotic. I’ve witnessed pharmacists telling a mom or dad with a sick child the prescription will be ready in 3 hours… or even longer. A 24 hour pharmacy recently told a young mother with a prescription from the E.R. to come back after 3 a.m. There were no other patrons in the pharmacy when she arrived 4 hours before that. What’s he doing? Taking a 4 hour break or something? Prescription refills are a different story but if you can’t get your new prescription in a reasonable length of time you should fire your pharmacist.

3.  Your pharmacist ignores you or fails to recognize you as a patient. 

There may be more than one pharmacist at a pharmacy location. And every one of them will know by sight some of the customers at that store. We don’t always recognize all of the good customers, but we all seem to know who the bad customers are.  It’s easy to remember Jane Doe because she is the one who never remembers to call in her refill for birth control pills. We all remember John White who repeatedly complains that we shorted him on his Vicodin. But it’s difficult to remember those ‘regulars’ who rarely complain or make a scene.  Regardless, it is unacceptable for a pharmacist to ignore or fail to recognize a customer, good or bad. If you don’t get greeted in a cordial and respectable manner you should fire your pharmacist.

The bottom line: 

If you are still unsatisfied with the service you receive and your pharmacist is as generic as most of the pills on his shelves or breathes negativity with every other word you should find a new pharmacist. One who is willing to go out of his way to ensure you understand your medications. One who will see to it the staff can take care of customers in a reasonable amount of time. And one who will recognize you with a smile on his/her face even though they don’t remember your name.  They’re out there and ready to assist you in transferring your prescriptions to their pharmacy with a promise and commitment to provide the service you deserve.

Twitter’s @ThePharmerGuy recently posted on his blog ‘Another Day Behind the Pharmacy Counter…’ asking the question:  Why Can’t Pharmacists Prescribe?  He details a very good argument as to why pharmacists should have prescription authority.   My thoughts on this topic follow below:

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.

An emergency Personal Health Record (PHR) should be your family’s first priority in your emergency preparedness plan.

Disaster can strike with little or no warning, Wildfires Engulf Homesgiving 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.

Hurricane DamageIn 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