Maximizing a Patient s Medication Experience Sarah A. Parnapy Jawaid, Pharm.D. Associate Professor of Pharmacy Practice Bernard J. Dunn School of Pharmacy, Shenandoah University sparnapy@su.edu November 3, 2017 S o m e s l i d e s p r e p a r e d b y A l l i L i z e r a n d M i c h a e l W i l s o n, s t u d e n t p h a r m a c i s t s
Outline Describe factors that lead to nonadherence and how these can be prevented Describe how pharmacists are a part of the health care team in a variety of practice settings Discuss the Pharmacists Patient Care Process and how pharmacists use this process in a variety of practice settings to assess proper medication use
Statistics Almost % of people who are prescribed a medication for chronic conditions do not take them correctly. Nearly of Americans are on at least one prescription drug and over 50% of Americans are on at least two prescription drugs. % of Americans take 5-9 medications. % of prescriptions written are not filled Improper use of prescription drugs cost $ billion a year. A.J. Claxton et al. A Systematic Review of the Associations Between Dose Regimens and Medication Compliance. Clinical Therapeutics, August 2001. Zhong, W. et al. (2013). Age and sex patterns of drug prescribing in a defined American population. Mayo Clinic Proceedings, 88(7). www.bu.edu/slone/files/2012/11/slonesurveyreport2006.pdf Tamblyn, Robyn. The Incidence and Determinants of Primary Nonadherence With Prescribed Medication in Primary Care Ann Intern Med. 2014; 160(7). Improper Use of Prescription Drugs Costs $200 Billion a Year, Report Finds - Medscape - Jun 20, 2013.
The Evolving Role of the Pharmacist From primarily a dispenser of medications to a provider of services with a more expanded and team-based clinical role Provision: Medications and medication education Patient-centered care Medication therapy management or comprehensive medication management Health improvement and disease state modification/prevention services Product-centered to Patient-centered
New Pharmacist Roles Comprehensive medication management Medication therapy management Transitions of care Medication reconciliation Direct patient care Collaborative practice Not within a pharmacy BUT as part of a healthcare team Interprofessional practice
NABP Model State Pharmacy Act & Model Rules DEFINES THE PRACTICE OF PHARMACY TO INCLUDE: Order interpretation Medication dispensing Participation in drug & device selection Drug/immunization administration Drug regimen review Telepharmacy Drug-related research Patient counseling Provision of medication-related patient care services Medication therapy management Collaborative Pharmacy Practice Ordering and interpretation of tests Compounding Safe storage Record-keeping and continually optimizing patient safety and quality of services through effective use of emerging technologies and competency-based training Source: NABP. Model State Pharmacy Act and Model Rules 2016. Available at www.nabp.net. Accessed August 20, 2017.
Health Care Team Patient
Polypharmacy/Polymedicine Defined as taking five or more drugs increases the risk of drug interactions, adverse drug events, nonadherence, and reduced functional capacity
Prescription drug use in the past 30 days among adults aged 18 and over, by age and number of drugs taken: United States, 1988 1994 through 2013 2014
Polypharmacy What leads to polypharmacy? Multiple providers Multiple pharmacies Multiple medications for the same disease state Effects of polypharmacy Therapy duplication Increased risk for adverse drug events Increased hospitalizations Increased healthcare costs Drug interactions Functional status Cognitive impairment Maher RL, Hanlon, JT, Hajjar ER. Clinical Consequences of Polypharmacy in Elderly. Expert Opin Drug Saf. January 2014.
Factors Related to Non-Adherence
Hodges Nl, Spiller HA, Casavant MJ, Chounthirath T, Smith GA. Non-health care facility medication errors resulting in serious medical outcomes. Clinical Toxicology. 2017.
Pharmacists Patient Care Process Collect: The pharmacist assures the collection of necessary subjective and objective information about the patient in order to understand the relevant medical/medication history and clinical status of the patient. Information may be gathered and verified from multiple sources. Assess: The pharmacist assesses the information collected and analyzes the clinical effects of the patient s therapy in the context of the patient s overall health goals in order to identify and prioritize problems and achieve optimal care. Joint Commission of Pharmacy Practitioners Plan: The pharmacist develops an individualized patient-centered care plan, in collaboration with other health care professionals and the patient or caregiver that is evidence-based and costeffective.
Pharmacists Patient Care Process Implement: The pharmacist implements the care plan in collaboration with other health care professionals and the patient or caregiver. Follow-up: Monitor and Evaluate: The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan in collaboration with other health care professionals and the patient or caregiver as needed. Joint Commission of Pharmacy Practitioners
Medication Reconciliation
Medication Reconciliation Emergency room, admission, discharge, outpatient pharmacy Allergies Prescriptions medications Over the counter medications Herbals Patient safety is a priority!!
Optimizing Medications Appropriate Assessing if the patient is on the correct medication at the correct dose for a correct indication Effective Determining if the medication is the best option to treat the patient Safety Determining if the patient is experiencing any adverse effects from the medications or interactions with other medications Adherence Determining if the patient is taking the medication as it was prescribed
Medication Reconciliation Pharmacists make an average of 3.3 medication adjustments per patient. Incorrect information, including dose, route, and formulation, was the most common error, accounting for 68% of inaccuracies. Missing medications was the second most common error Other errors included compliance issues, variances and extra medications. On average, the pharmacists took 39 minutes to complete medication reconciliation for each patient. Splawski J, Minger H. Value of the Pharmacist in the Medication Reconciliation Process. Pharmacy and Therapeutics. 2016;41(3):176-178.
Chronic Care Management
Chronic Care Management Saving time for providers by offering follow up appointments, explaining the medications that will be provided to patients What the medications are, how to use them, identify barriers to taking medications, what patients should monitor for Diabetes help to evaluate doses of diabetes medications and insulin doses COPD evaluate COPD classification and appropriate therapy management. Hypertension - blood pressure follow up, dose adjustments Hyperlipidemia Anticoagulation INR, monitoring, medication/lifestyle counseling
Chronic Care Management Health care is shifting from disease-focused care to patientcentered care Need to look at the medical issue from the patient s perspective Understand patient s idea about what is wrong Assess how the problem affects the patient s daily life Discover what expectations the patient has regarding therapy
Chronic Care Management Medications are a cornerstone in the management of many chronic diseases Assuring medication is appropriate and safe is challenging due to various issues Medication discrepancies complicate managing chronic diseases Only 44% of patients bring a current medication list to appointments
Cost Savings
Cost Savings for Systems The Institute of Medicine (IOM) estimates that at least 1.5 million preventable adverse drug events occur within the healthcare system each year. The costs of these preventable adverse drug events has been estimated to exceed $4 billion annually. Institute of Medicine of the National Academies, Preventing Medication Errors, National Academies Press, 2007
Cost Savings for Patient Options for cost savings Patient Assistance Programs Discount Cards Look at formulary Medicare Part D drug coverage If patients are eligible Managing Chronic Diseases More checkpoints between PCP visits increase the likelihood of patient adherence -> less costs
Relationships
Relationships Providers/Healthcare Role as a healthcare professional offering support Drug knowledge resource Member of team who can help counsel patients on medication usage Patients Become comfortable with pharmacy as a resource More likely to advocate for themselves and hear counseling in a community pharmacy setting Nearly 40 percent of patients say they would follow their doctor s orders if they received some sort of reminder between visits either by text message, email or voicemail
Patient Case KM is a 52 year old male who presents to the Emergency room for a COPD exacerbation. Home medications:
Patient Case What are some discrepancies that you identified? How could we work together a a team to resolve this discrepancy? How could these discrepancies have been avoided?
Summary Described factors that lead to nonadherence, polypharmacy and how these can be prevented Described how pharmacists are a part of the health care team in a variety of practice settings Discussed the Pharmacists Patient Care Process and how pharmacists use this process in a variety of practice settings to assess proper medication use
Questions/Comments