TO THE BEST INTEREST OF THE PATIENT PHARMACIST - PRESCRIBER COOPERATION IN COMPOUNDING

TO THE BEST INTEREST OF THE PATIENT PHARMACIST - PRESCRIBER COOPERATION IN COMPOUNDING B6: COMPOUNDING A CORE COMPETENCE OF THE PHARMACIST TO THE BEST INTEREST OF THE PATIENT PHARMACIST - PRESCRIBER COOPERATION IN COMPOUNDING B6: COMPOUNDING A CORE COMPETENCE OF THE PHARMACIST TRIAD RELATIONSHIP PRESCRIBER I PATIENT I PHARMACIST COMPOUNDING STORIES 1

TO THE BEST INTEREST OF THE PATIENT PHARMACIST - PRESCRIBER COOPERATION IN COMPOUNDING B6: COMPOUNDING A CORE COMPETENCE OF THE PHARMACIST TRIAD RELATIONSHIP PRESCRIBER I PATIENT I PHARMACIST COMPOUNDING STORIES TRIAD RELATIONSHIP Traditional relationship Foundation for pharmaceutical compounding Pharmacist: intermediary between patients and their doctors Taking medicines to best effect Allen, L. (2005) Extemporaneous prescription compounding, in Troy, D. (ed.) Remington The Science and Practice of Pharmacy. 21 st edn. Baltimore and Philadelphia: Lippincott Williams & Wilkins, 1903-1912 McElhiney, L. (2006) Introduction to hospital compounding, Int J Pharm Compd, 10, 245-250 2

TRIAD RELATIONSHIP Care about the patients and cultivate your relationships with physicians When the three members of the triad work together, then you succeed Evelyn Timmons Cormier, M. (2015) Bedside manner: not just for doctors anymore, Int J Pharm Compd, 19, 115-118 Davis, J. (2000) Profile of a practice: surviving the competition, Int J Pharm Compd, 4, 203 TRIAD RELATIONSHIP PHARMACIST PRESCRIBER To cooperate To substitute Recognize and respect the professional duties of each member of the healthcare team Each member has a firmly established role and professional obligations All have a critical part in the patient s treatment Frieders, L.J. (2006) PostScription: Patients or Clients?, Int J Pharm Compd, 10, 320 3

TRIAD RELATIONSHIP PHARMACIST PRESCRIBER If a doctor needs to be called for clarifications, even if you feel uncomfortable, you should call - but always in private, never in front of the patient. Doctors should be consulted, there should be no barriers. It is the pharmacist s duty to help and protect the patient. Pylant, P. (2014) Interview with Maria Carvalho, 10 October TRIAD RELATIONSHIP PHARMACIST PRESCRIBER 1. Analyse the medical community: get to know the prescribers in your area 2. Identify potential prescribers: connect and build a relationship 3. Exhibit best practices: provide feedback and follow-up Timmons puts herself on the road, meeting with physicians, continuing to develop contacts. When she feels she s lost contact with a doctor hasn t heard from one in a while she calls to find out what s going on. Cormier, M. (2015) Bedside manner: not just for doctors anymore, Int J Pharm Compd, 19, 115-118 Davis, J. (2000) Profile of a practice: surviving the competition, Int J Pharm Compd, 4, 203 Hudson, S. (1999) Compounding for athletes: tips for making the team, Int J Pharm Compd, 206-208 4

TRIAD RELATIONSHIP PHARMACIST PRESCRIBER Perseverance and passionate commitment You may receive arbitrary treatment from doctors, but you must persist Accessibility and time; willingness to be of service Timmons spends a tremendous amount of time on the phone providing consultations Continuously up-to-date and backed up with scientific literature Cormier, M. (2015) Bedside manner: not just for doctors anymore, Int J Pharm Compd, 19, 115-118 Davis, J. (2000) Profile of a practice: surviving the competition, Int J Pharm Compd, 4, 203 Hudson, S. (1999) Compounding for athletes: tips for making the team, Int J Pharm Compd, 206-208 TRIAD RELATIONSHIP PHARMACIST PATIENT Provide privacy for the patient Listen to the patient Ask the patient pertinent questions Educate the patient: increased understanding comes with increased compliance Cormier, M. (2015) Bedside manner: not just for doctors anymore, Int J Pharm Compd, 19, 115-118 5

TO THE BEST INTEREST OF THE PATIENT PHARMACIST - PRESCRIBER COOPERATION IN COMPOUNDING B6: COMPOUNDING A CORE COMPETENCE OF THE PHARMACIST TRIAD RELATIONSHIP PRESCRIBER I PATIENT I PHARMACIST COMPOUNDING STORIES US COMPOUNDING INTERNATIONAL SEMINAR Houston, TX I October 2014 6

US COMPOUNDING INTERNATIONAL SEMINAR Houston, TX I October 2014 660 participants (USA, Europe, Canada and Australia) Random sample selection of participants Survey questionnaire (10-item), short oral interview Pharmacy practice, qualitative research A. PERSONAL INFORMATION A1. Are you a compounding pharmacist? A2. How many years of experience? A3. Which is your nationality? A. PERSONAL INFORMATION B. PRESCRIBERS INTERACTION C. CASE REPORTS 7

A1. Are you a compounding pharmacist? Compounding Pharmacist 32 Pharmacy Technician 5 Others 3 37 participants: compounding pharmacists and pharmacy technicians 86% compounding pharmacists: pharmacy owners and employees A2. How many years of experience? 37 participants: less than 1 year up to 40 years of experience 21 participants (57%): 5 or more years of experience 13 participants (35%): 10 or more years of experience 8 participants (22%): 20 or more years of experience 8

A3. Which is your nationality? United States 33 Canada 3 Australia 0 Participants from 15 different states 30% from TX and 18% from AL and FL Europe 0 B. PRESCRIBERS INTERACTION B1. How frequently do you interact with prescribers? B2. Which are the main reasons for interacting with prescribers? B3. How comfortable are you to interact with prescribers? B4. Do prescribers call the pharmacy if they have any issues or concerns? B5. How frequently do you visit prescribers? B6. Which are the most frequently contacted medical specialties? A. PERSONAL INFORMATION B. PRESCRIBERS INTERACTION C. CASE REPORTS 9

B1. How frequently do you interact with prescribers? Once a DAY: 14% More than once a day: 53% Once a WEEK: 8% More than once a week: 17% More than once a MONTH: 8% B2. Which are the main reasons for interacting with prescribers? 1. Problems with the prescription / clarifications: 86% Dosage strength, quantity, vehicle / base Route of administration, directions Drug interactions, refills New patient details Help: can t read the prescription 10

B2. Which are the main reasons for interacting with prescribers? 2. Patient s feedback, follow-up and refills: 20% We share the patient s feedback with the doctors e.g. reactions to the compounding treatment If the patient is not doing well we recommend some changes to the compounding treatment B2. Which are the main reasons for interacting with prescribers? 3. Suggestions: 17% Formula suggestions, general recommendations (fax and email) Formula changes, therapeutic alternatives, unique dosage forms I have a patient with this condition, what would you do? Is it possible to prepare this formula? 11

B2. Which are the main reasons for interacting with prescribers? 4. Insurance and pricing: 11% If insurance does not cover the compounded medicine, pricing can be in issue If the compounded medicine is too expensive we call the doctor to discuss the need for an alternative B3. How comfortable are you to interact with prescribers? 3% 35% 62% Very comfortable Comfortable Uncomfortable 12

B4. Do prescribers call the pharmacy if they have any issues or concerns? 3% Once a DAY: 15% More than once a day: 24% Once a WEEK: 12% More than once a week: 24% 97% Once a MONTH: 9% More than once a month: 12% Yes No Rarely 3% B5. How frequently do you visit prescribers? Once a DAY: 3% More than once a day: 11% Once a MONTH: 11% Once every few months: 11% Once a WEEK: 11% At least / more than once a week: 23% NONE: 29% 13

B6. Which are the most frequently contacted medical specialties? HRT Pain Management Veterinary Pediatrics 17% 17% 34% 51% OTHERS Cardiology ENT Geriatrics General Medicine 14% Hospice Care Dermatology Dentistry 14% 9% Orthopedics Podiatry Wound Care 0% 10% 20% 30% 40% 50% 60% C. CASE REPORTS Would you like to share a successful collaboration with a prescriber? A. PERSONAL INFORMATION B. PRESCRIBERS INTERACTION C. CASE REPORTS 14

When doctors call with questions, I take the opportunity to invite them for a visit at the pharmacy Doctors call the pharmacy all the time as we have reputation of providing good information I do presentations to groups of doctors at their clinics and at the pharmacy (we have a seminar room for presentations) Face to face conversations are better than telephone calls I am very comfortable with doctors, I talk to them all day long As long as I know what I am talking about, I am very comfortable talking to doctors I attend health fairs and local events and I approach doctors there to introduce our compounding services 15

We call the patient 5 days after initiating the treatment to check how the patient is feeling We also call the patient 25 days after initiating a monthly treatment to check the need for a refill Then we call the prescriber to provide the patient's feedback and to ask for the refill (when applicable) TO THE BEST INTEREST OF THE PATIENT PHARMACIST - PRESCRIBER COOPERATION IN COMPOUNDING B6: COMPOUNDING A CORE COMPETENCE OF THE PHARMACIST TRIAD RELATIONSHIP PRESCRIBER I PATIENT I PHARMACIST COMPOUNDING STORIES 16

COMPOUNDING STORIES PATIENT PRESCRIBER PHARMACIST COMPOUNDING STORIES I had my pharmacist compound the appropriate type of hormones for her Through compounding I am able to provide balance and restoration to my patients Compounding really allows me to do what I was trained to do https://www.youtube.com/watch?t=22&v=d9pyenr36ci 17

COMPOUNDING STORIES Do you know that we can make this up in a cream form (instead of a suppository)? We got the prescription, we took it to the pharmacy and they quickly made it up https://www.youtube.com/watch?v=a4gboy7b3nk COMPOUNDING STORIES The doctor and I had a long term relationship He phoned me saying ok I ve got a compounding question for you ( ) Can you do anything? https://www.youtube.com/watch?v=bekyzapc-0m 18

TO THE BEST INTEREST OF THE PATIENT PHARMACIST - PRESCRIBER COOPERATION IN COMPOUNDING rx.mariacarvalho@gmail.com 19