medical care


“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

Part of the team… 

Harnessing the power of a pharmacist’s knowledge and expertise to control healthcare costs and improve patient outcomes has been a difficult process. Those promoting the transformation of the role of the pharmacist from the traditional dispenser of medications to a dispenser of information have always been confronted with the question of “who will pay for these services”. Fortunately, since the implementation of Medicare-D, the value of pharmacists providing cognitive services, including medication therapy management MTM services, has become more widely recognized.

But even with this increased recognition, the profession of pharmacy is still facing a sort of ‘identity crisis’. “Pharmacists see themselves as having nine different identities” according to a recent @ChemistDruggist article, thus suggesting they play a ‘flexible role’ in healthcare but remain uncertain of the future.

It’s been a long time coming…

The decade long push for recognizing pharmacists as healthcare providers is finally seeing results. Recent legislation in California became law when Governor Jerry Brown signed the pharmacist provider status bill (SB 493) recognizing pharmacists as healthcare providers. I’m sure other states will be looking at similar legislation in the near future. But will the new legal recognition as providers get pharmacists a seat at the healthcare team table?

“Pharmacists are working more closely with patients and healthcare colleagues in hospitals, outreach teams, patients’ homes, residential care, team graphichospices, and general practice” reports the Royal Pharmaceutical Society @rpharms in ‘Now or Never: Shaping Pharmacy for the Future’. In the U.S. the team based care approach continues to get a foothold with pharmacists participating in patient centered medical home models, accountable care organizations and in collaborative arrangements with other healthcare providers. But we have a long road ahead until we’ll actually see a majority of pharmacists participating as a member of the healthcare team on this level.

It all makes sense…

There are areas where it’s been shown pharmacists can contribute as a first string member of the healthcare plan team. Take medication non-adherence for example. The cost of non-adherence and compliance to prescribed medication therapy has been reported to be well over $290 billion annually in the United States. This is often a direct reflection of the lack of a patient’s understanding of their particular disease state and how their medication therapy can control or improve their particular condition. This is a great example where having a pharmacist on the care plan team makes a great deal of sense, especially at any point of transitional care.

A major component of the patient care plan consists of properly treating the patient’s disease state with appropriate drug therapy. When there is a breakdown, pause or discontinuation of medication therapy by a patient, i.e. lack of medication adherence or compliance, one can almost always predict a breakdown in overall patient care. This can result in increased hospital re-admissions, lack of disease control, increased complications and of course, increased healthcare costs.

Including a pharmacist in the patient care plan process can improve patient outcomes, especially during transitional care. About 1 in 5 Medicare patients who leave the hospital are readmitted withing 30 days. “We know that people who have medication discrepancies, or are not adhering to what the health care team thought they were adhering to, have at least double the risk of becoming a readmission” reports Jane Brock, MD, of the Colorado Foundation for Medical Care. 

Pharmacists should be given the role of patient care managers and  should be performing services such as medication reconciliation, checking for potential adverse drug reactions, performing patient education and other patient oriented services such such as MTM whenever there is a transition inlogo_white medical care. They should also be directly involved with follow-up services to ensure adherence and compliance to drug therapy and report this back to the patient care plan team. Compliance to drug therapy is critical in chronic diseases such as diabetes, hypertension or heart disease and community pharmacists are in an ideal position to fulfill this role. 

Moving forward…

I’ve written before on the topic of pharmacists “being the healthcare provider”. As PROVIDERS of services (including MTM services) and EDUCATORS to help patients understand their medications and medical conditions, pharmacists will be recognized as a resource to ensure continuity through the transitions of healthcare, thus changing patient’s lives, improving outcomes and saving healthcare dollars.

So again I say “Be the Provider” and take an active roll as part of the patient care planning team.

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.

We have a drug adherence problem in the United States contributing well over $300 billion each year toward the escalation of unnecessary medical expenditures.

And you may be part of the problem!  

“Three out of four Americans don’t take their medication as prescribed while one-third doesn’t even pick up their medication,” says Rebecca Burkholder, vice president of Health Policy at the National Consumers League.

Not taking your medications correctly can contribute to long term UncleSame_takeyourmedshealth problems, especially for patients who have chronic disease such as diabetes, asthma, hypertension, COPD or heart disease.

So how do you know if you’re “part of the problem”?

Do you ever-

  • forget to take your medication on time, every time?
  • have trouble staying “on track” with your medication schedule?
  • skip doses or cut doses in half to save money?
  • forget to refill your prescriptions on time?
  • take the wrong medication?
  • fail to fill new prescriptions your doctor gives you?

If you answered “yes” to any of the above questions you are not being fully compliant with your prescription drug therapy.  Your failure, or non-compliance to taking your medications correctly can lead to:

  • additional physician office visits
  • progression of disease state
  • emergency room visits
  • hospital admissions

As a matter of fact –
If you’re not taking your medication correctly your medical condition will most likely worsen. It will result in increased inconvenience for you, increased healthcare costs and increased chance for a shortened lifespan or premature death.

Steps you can take –

  1. talk to your pharmacist about your medications in depth so you understand what they do and when to take them.
  2. consult with your pharmacist and healthcare provider if you have concerns about side effects from your medications.
  3. find out if there are ways to save money on your medication expenses if you have trouble affording them.
  4. fill your prescriptions in a timely manner, both new prescriptions and refills
  5. Utilize medication management and reminder tools to help you remember to take your medications each and every day.

Pharmacists are considered THE most accessible of any healthcare providers in the U.S. Use the availability of their counsel and expertise to your advantage to improve your health.

I was immediately intrigued when I read @PhilBaumann ‘s thought provoking post titled ‘140 Health Care Uses for Twitter‘.

Twitter evolution via @mashable
(nursing caps added)

I’ve observed many of the 140 uses Phil mentions over the last couple of years while following and tweeting on Twitter.  But some of the ideas he came up with were totally new to me, if not ‘off the wall’ in some respects. Phil comments: “there’s potency in the ability to burst out 140 characters, including a shortened URL”… and he’s right!
Twitter is potent medicine!
He also cautioned about several additional issues health care tweeters face including patient privacy, legal and HIPAA concerns.

But if we focus on what Phil suggests, to “be imaginative, determined and innovative” in our approach to using Twitter (and other social media) as a powerful adjunct ‘healthcare tool’, we’ll find even more possibilities and ways to improve patient lives.

As a pharmacist the gears in my head started turning right away after reading #29 – Prescription management, including pharmacy refill reminders.  I thought I would expand on a few uses for Twitter that pharmacists might employ in their practice in the future.

Phil already mentioned the first one on my list, #29a prescription refill reminders. I would add #29b “your prescription is ready” reminders and #29c “we’re waiting for your doctor to authorize a refill” reminders. There may be others that fall into similar, logistical type categories as these.

Here’s a few more I thought of that expand on and utilize the pharmacists professional expertise:

#29d:  Patient Medication Education-

This is an area any pharmacist on Twitter can leverage, after all, pharmacists are medication experts.  Most of my tweets on any given day will have some component of patient education, although some more than others. One patient education plan could be to target specific disease states or patient populations to help them understand their disease and how to manage it properly. Another plan could be to educate patients on drugs and drug interactions as well.

#29e:  Medication compliance and adherence-

Lack of adherence to prescription medication therapy cost the U.S. $317.4 billion in 2011 and we can expect that figure to continue to rise until we find solutions to the problems surrounding the issues of compliance. Pharmacists who find a way to improve medication reminder programs for their patients will not only save healthcare dollars but improve patient lives. Twitter and/or texting could be leveraged to improve patient compliance.

#29f:  Medication safety and drug interaction alerts and reminders- 

Twitter could be utilized by pharmacists to notify patients of medication safety issues and potential drug/drug or food/drug interactions that could be problematic. There are over 2 million cases of adverse drug interactions annually in the U.S. resulting in over 100,000 deaths. The cost of these adverse drug interactions is also in the billions. It’s even more difficult to measure the cost of human suffering and loss of life.

#29g:  Alerting patients about special pharmacy programs- 

Many pharmacies offer special clinical outreach programs and screenings including blood pressure checks, blood glucose screening, bone density testing and immunizations. These could be promoted via Twitter and other social media sites. Twitter could be used as a patient reporting tool for tracking health data.

#29h:  Drug recall notifications- 

Pharmacists and pharmacy technicians are often involved in drug product recalls, both prescription and over-the-counter medications. It’s important to pass this information on to patients and consumers alike.

#29i:  Pharmacist to Pharmacist interaction-

One of the greatest benefits I’ve discovered (and it took me awhile) on Twitter is the ability of pharmacists to connect with other pharmacists. Of course, many pharmacists on Twitter have ‘secret identities’ making it difficult to connect on a professional level, most of them hiding their identities because they use Twitter to vent or as a release from their daily tasks in the pharmacy. You know who you are! Over the past several years I’ve connected with a number of great Twitter pharmacists on a professional level and I look forward to meeting more of you ‘lurking’ out there.

#29j:  Twitter as an professional educational tool- 

Another benefit I’ve found on Twitter is the magnitude to which a pharmacist (or other medical professional) can learn. Professional education, much of it on par with any accredited continuing education or medical education programs can be found if you look in the right places.

#29k:  Building professional credibility- 

Using Twitter (and other social media) can do one of two things for pharmacists and healthcare professionals:  You can use it to build your credibility and establish yourself as an expert in your field OR you can use it to cripple your identity as a professional. Tweet responsibly.  Enough said.

#29l:  Using Twitter to build patient relationships- 

Probably one of the most important ways pharmacists (and other health care professionals) can utilize Twitter is in building relationships with patients and keeping those lines of communication always open. If you’re using social media properly it will have of some component or level of social interaction. And if you can interact with patients and let them get comfortable with who you are they’ll begin to respond by showing trust and confiding in you.

I’m sure if we put on our thinking caps and throw caution to the wind a bit, we could think of more ideas for pharmacists and other medical providers to improve health care by leveraging social media. More important is the charge to be a leader in utilizing this technology to improve health care and not lag behind other professions.

What do you think?

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

It’s a fact:  People don’t take their medicine correctly.  Poor adherence or lack of compliance to prescription medication therapy costs the U.S. billions of dollars each year!

You may or may not be aware that medication adherence and compliance is a hot topic today. Over $290 billion dollars is spent annually as a result of poor medication adherence.

Poor medication therapy adherence costs over $290 billion each year.

And when you start to look at the costs of adverse drug events, inappropriate or ineffective therapy, you’re looking at somewhere between 1/2 to 1 trillion dollars spent in the U.S. annually over and above the cost of the drugs prescribed to treat U.S. patients.

Pharmacists are able to help control many of these costs through comprehensive medication reviews and medication therapy management MTM.

As we become more conscious of healthcare costs we are seeing how pharmacist MTM services will help control costs within the accountable care organization ACO or continuity of care organization CCO settings that are evolving. Patient centered medical home models have shown that the involvement of a pharmacist, in direct patient care, will help reduce these costs. Utilizing the knowledge base of pharmacists and enlisting them as ‘patient care managers’ would directly improve patient care and save healthcare dollars.

Medication therapy management MTM has been available and covered under Medicare Part D since 2006. Patients who qualify, based on the number of medications prescribed and the number of patient disease states, can receive comprehensive medication reviews at no cost, covered by Medicare Part D.

But pharmacist MTM is also evolving from providing MTM services to only Medicare Part D patients. Many pharmacists are moving forward providing MTM services to patients not covered under Medicare D, including patients who are not covered for MTM services, or those who would be considered private pay patients.

Although patients may not meet the criteria of 3rd party payers for MTM services (# disease states, # meds taken, etc.), these patients can benefit from comprehensive medication reviews. A pharmacist medication review and coaching for patients who are diabetic, hypertensive, COPD, etc., will improve adherence, often saving healthcare expenses and improving patient lives through better medication therapy.

There is a great deal of pharmacist interest in providing independent MTM consultations to these patients who do not fall under the Medicare D category. This is the area of focus Spectrum Health MTM Group is working on to provide comprehensive medication reviews on a much broader scope through a network of individual, independent pharmacist MTM consultants.

Spectrum Health MTM Group is pushing the concept of  pharmacists as patient care managers and helping MTM pharmacists to work with patients and healthcare providers to improve patient lives, improve adherence to medication therapy and reduce healthcare costs.

For more information visit www.ezMTMbiz.com 

“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?

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