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 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?

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 

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.