“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.

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.

Remember the Reminders… the medication reminders, that is.

Considering the scope of the medication adherence and compliance problem in the U.S. it just makes good sense to use any means possible to help patients improve their compliance with prescription drug therapy. If you’ve read any of my recent blog posts or follow healthcare news at all you’re well aware of the extentstring-around-finger of the problem, the cost of which is now reported to be over $300 billion annually in the U.S. alone.

I’m now seeing other effects of non-compliance with information suggesting the medication compliance problem may be putting the public at even greater risk. There is evidence showing over 50% of drug clinical trial patients do not report missed doses to the clinical trial study team. This could result in problems experienced later by the public after the FDA has approved the sale of new drug products in the market place.

Finding the right fit –

So how do medication reminders fit into the scheme of things and what reminder tools or devices should be used?

There are many medication reminder tools and devices available ranging from simple pill boxes or organizers and reminder caps on pill bottles to smart phone apps and automated pill dispensers. The choice of medication reminder tools or devices would also depend on the needs of the patient with special considerations given for high risk patients who may be living in environments with little or no supervision by family or outside healthcare services.

Direct or indirect patient contact through text messages, email or telephonic messages will also influence patient compliance. But even with the plethora of medication reminder devices and techniques available we cannot discount the influence of direct patient education and encouragement from healthcare professionals.

Patient education coupled with the right reminder tools or device will produce the greatest dividends towards combating the medication adherence and compliance problem that exists today.

Improving patient outcomes – saving healthcare dollars –

Here are a few examples where medication compliance reminder tools or devices can be easily inserted into the healthcare delivery process:

  • reminder devices provided through hospital discharge planning and follow up of high risk patients to prevent re-admissions
  • reminder devices provided during counseling sessions by pharmacists, home health or home care agencies
  • reminder devices provided before leaving the physician’s office with a new prescription for maintenance medications
  • reminder devices provided in conjuction with special clinical monitoring including anti-coagulation clinic therapy or other similar outpatient services
  • reminder devices provided by pharmaceutical companies marketing products and drug therapies to improve product recognition, acceptance and compliance
  • reminder devices provided as an adjunct to monitoring patients participating in clinical trials
  • reminder devices provided by insurance, 3rd party payers or self insured businesses to reduce expenses related to medication non-compliance in patients taking maintenance medications
  • reminder devices provided to residents of independent living or retirement communities

A liberal dose of medication reminders –

For the most part we can’t control a patient’s healthcare decisions. We can’t make people take their medications if they’ve decided not to. We can, however, help steer them in the right direction with proper education and encouragement. Adding a liberal dose of medication reminder devices to the patient’s drug therapy regimen along with patient education has the greatest chance of improving compliance with prescription medication therapy.

Put on your thinking caps –

I challenge you to think of other ways to incorporate medication reminder devices into the healthcare delivery process. I look forward to your thoughts and ideas and encourage you to comment or contact me directly via email at dave.walker@medtime-compliance.com

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.

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