MORS and SMORS — more than a sweet treat

I’m going out on a limb here and betting many of you have not heard of MORS and SMORS. For your information, they may be one of the best solutions around to improve medication adherence, compliance and patient safety.

Medication Organizer Reminder Systems MORS and Secure Medication Organizer Reminder Systems SMORS are a group of products designed to organize patient medications and provide audible and/or visual alerts to remind patients to take their medication on time, every time.

My interest in MORS and SMORS, (which always reminds me of a good time around a campfire), began nearly three years agosmores 3 when I first started researching medication adherence and compliance.

Although the causes and proposed solutions to the medication adherence/compliance problem vary widely and are often debated, it seems one thing can be agreed upon by all… it is a very costly healthcare problem in the U.S. today. The cost of non-adherence was estimated to be $290 billion annually by the New England Healthcare Institute NEHI in 2009. It’s now estimated by some to be in the neighborhood of $330 billion or more annually.

When you add in the additional costs of adverse drug reactions, medication misuse, lack of control of diseases like hypertension, diabetes, etc., additional physician, hospital and emergency department visits, this figure approaches nearly a half trillion dollars annually.  And this does not even take into consideration the loss of life from inappropriate medication use estimated to be over 125,000 deaths annually.

MORS and SMORS can help patients improve their medication compliance which in turn will improve control of their particular disease and reduce healthcare costs in the long run.

Opening doors for pharmacists —

I recently presented information on April 17th, 2013, to the Oregon Board of Pharmacy on the topic of medication adherence and compliance, the costs associated with the problem and the patient safety issues that arise when patients don’t take medications as prescribed. Pharmacists need to understand and utilize the available technology, including MORS and SMORS, to improve patient outcomes and help reduce healthcare costs.

But at this time the Oregon BOP does not allow pharmacists to dispense, fill or set up medications for use in medication organizer reminder systems. Pharmacy rules for medication labeling and packaging currently prevent pharmacists from doing so as they are not compliant with Board rules and guidelines. Several other states, including neighboring Washington State, have moved forward and adopted rules to allow pharmacists to utilize this technology to improve patient care and safety.

The Board responded favorably to my request by proposing additions to the customized patient medication packaging rule (Oregon 855-041-1140) to provide a waiver for approved medication organizer reminders systems not meeting regular labeling and packaging guidelines. After the recent rulemaking hearing, the Board will now move forward and vote on the new rule and, hopefully, implement this change in Oregon pharmacy law at their August 2013 meeting.

Patient safety is the issue —

The proposed rule change is based on improving patient safety as well as improving medication adherence. Allowing pharmacists to be involved with filling or dispensing medications for use in medication organizer reminder systems will have a positive impact on medication adherence, compliance and medication safety. Do you see the opportunity for pharmacists here?

The real solution —

The impact of the proposed rule changes are not based solely on the use of medication organizer reminder systems. The real solution to the adherence dilemma is getting pharmacists involved with their patients.

A recent report published by the National Community Pharmacy Association NCPA identified what I believe to be the biggest factor for combating the medication adherence problem:

  • The biggest predictor of medication adherence was patients’ personal connection (or lack thereof) with a pharmacist or pharmacy staff. Patients of independent community pharmacies reported the highest level of personal connection (89 percent agreeing that pharmacist or staff “knows you pretty well”), followed by large chains (67 percent) and mail order (36 percent).

“This predicting factor was followed in order of importance by: affordability of medications; continuity in health care usage; how important patients feel it is to take their medication as prescribed; how well informed they feel about their health; and medication side effects.”

Enter here… The Door is OPEN —

The door is now open for pharmacists to seize this opportunity to get involved with medication organizer reminder systems and assist their patients who may be struggling with medication adherence problems.

It’s the perfect addition to patient counseling or medication therapy management MTM to improve patient medication compliance and patient safety.

If your state Board of Pharmacy rules need to be changed for you to get involved, you need to BE THE CHANGE. Address the topic with your state Board and urge them to move the profession of pharmacy forward.

Feel free to contact me for assistance and advice on how to move forward with this in your state.

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Can you hear me now?

You can call it selective hearing, being preoccupied or just not interested in listening to somebody when they’re trying to tell you something. In my case, it was also losing my hearing in the frequency range of my wife’s voice. never listenShe would often complain that I never listen to her. She returned one evening from a craft fair or bazaar with a painted block of wood, wrapped with a ribbon, and handed it to me. It had the following inscription:

“My wife says I never listen to her… at least I think that’s what she said.” 

Later I discovered our lack of communication was only partially due to my progressive hearing loss. I say “partially” because I now know I was guilty of not giving her my full attention when she spoke to me. I struggled with my hearing (and listening) until a few years later when I suffered profound loss of hearing in both ears.

Though my total loss of hearing was devastating when it happened, regaining my hearing through the process of receiving a cochlear implant has taught me some very important lessons about the difference between hearing and listening.

Hearing is not the same as listening.

The rehabilitation process of regaining my hearing through the miracle of a cochlear implant was hard work. I would struggle to hear at times, knowing I needed to understand the words being said.

But because I was concentrating so much on hearing the words in a conversation, I found myself lacking in the area of listening to the conversation. My brain was so focused on hearing that I didn’t have time to listen at first. Likewise, if our minds and concentration are focused elsewhere, we’re going to miss most of the conversation.

Using more than just your ears.

Listening is not only hearing what is being said, but what is not being said or only partially being said. There are so many nuances to a conversation that one can’t hear unless they truly engage in listening. Body language, facial expression, verbal and non-verbal messages can only be pick up if one is fully engaged, both hearing and listening.

So now you might be asking yourself “what does this have to do with healthcare?”

Time allotted:  8 minutes per patient.

The New York Times recently published an article referencing a study which confirmed “new doctors are spending less time with patients than ever before.” I’m sure this translates over to many of the physicians who’ve been in practice for a number of years as well. Physicians (and pharmacists for that matter) are being bogged down in paperwork and other tasks not directly associated with patient care.

Pharmacists have been under this pressure for years. Even With OBRA mandating patient counseling on all new prescriptions, most pharmacists find it difficult to  get 30 seconds to counsel a patient at times. And I’m sure that physicians and pharmacists are not the only healthcare professionals who are lacking the time to spend listening to patients.

“The opposite of talking isn’t listening. The opposite of talking is waiting…”
~ Fran Lebowitz

So here’s a few tips that would improve the delivery of healthcare from a listening perspective:

  • Stop talking – let your patients tell their story
  • Get ready to listen – remove distractions (including laptops, etc.)
  • Be patient – put them at ease and let them share their concerns
  • Listen for what’s not being said – listen with your eyes as well
  • Be empathetic – try to understand the patient’s point of view

Unless we put forth the effort to prepare ourselves to listen it probably isn’t going to happen.

No time, no time, no time…

One might argue the case of  this new generation of healthcare practitioners being different than past generations due to time constraints. Circumstances may change over time. But the framework for building good relationships with other people hasn’t changed much, if at all, for centuries.

If we want to improve healthcare we must improve the communication and interaction with patients… many who are more informed and engaged in their health and medical conditions than ever before.

So what happened to the sign?

It still sits on our kitchen windowsill, over 15 years later, as a daily reminder to us all.

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.

 

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.