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?

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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?

God heals, and the Doctor takes the Fees…
Benjamin Franklin: Poor Richard’s Almanack , 1736. 

Maybe old Ben Franklin even recognized the beginning of a trend in healthcare. It’s not the fault of the doctors per se but healthcare is not always focused on patient care, it’s business… big business. Non-profit hospitals used to be dedicated to giving appropriate healthcare to all, even those who could not pay. Now we see non-profit hospitals, formerly operated by faith based organizations, being turned into for profit corporate systems providing care to a community based on direction from share holders and management teams.

In Ben’s day the physician, more times than not, received payment in kind  from his patients.  A basket of eggs or sack of potatoes from the garden for minor services. Possibly the chicken itself; a goat, pig or cow for more major transactions. If the patient couldn’t pay, or pay in kind, they usually provided service later on to repay the ‘debt’ of receiving treatment and to express their gratitude. I’m sure that most patients were more than happy to repay for appropriate health care services in that day and age, especially when they survived and got better.

Life was probably much easier before health insurance:

Although the concept of being protected through health care insurance is a great idea it’s contributed to a big business mentality. Third party payers and corporate insurance companies are in it to cut costs and make money, or at least not lose money.

Yes, healthcare is big business. We don’t see the family doctor working out of his home doing house calls much any more. They’re usually affiliated with a hospital or group practice of multiple physicians. We don’t see many ‘mom and pop’ pharmacies anymore either. We now have the Walgreens, CVSs, Walmarts and mail order pharmacy. All of them along with pharmacy benefit management groups (PBMs) selling patient information to generate more revenue.  And with this type of change we’ve seen the transition from real patient care focused practices to enterprises designed to ‘drive’ healthcare services and generate profits to satisfy stockholders. Is this truly in the best interest of the patient?

Patient care seems to get lost in the healthcare world today. Even the patient centered medical home model (PCMH), while touting the focus on patient care, is really designed to manage healthcare costs. Accountable care organizations (ACOs) and continuity of care organizations (CCOs) basic premise is to control healthcare costs.  That doesn’t say much about patient care, does it. So when did we lose patient care and how do we get it back?

Having a mission statement does not mean fulfilling the right mission:

I don’t think that patient centered care is totally lost. But patient centered care must come from the individual providers. Now I’m not saying that this doesn’t happen. It just happens less often than it should. Those of us involved in healthcare, whether physicians, nurses, pharmacists or other auxiliary personal all need to be focusing what we do around the idea of what is best for the patient. Sometimes it means taking a stand for what is right for the patient, even if it’s not in the best economic interest of the healthcare machine.

Providers can be the stimulus that changes healthcare to patientcare. Focus on what is best for the patient in the long run. If the system is broken or fails to take care of people by following the usual and customary ground rules, changes need to take place. Decisions based on positive patient outcomes need to be made as opposed to decisions base merely on economic factors. Maybe if providers start doing this, with each patient, the system can be changed from within. One could only hope that by doing so we can change healthcare to patientcare.

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.