“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.

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?