Wednesday, July 10, 2013
Back in my community pharmacist days, one of my biggest pet peeves was the lack of coordination of care that occurred when patients were discharged from the hospital and transitioned back to the care of their primary care provider. Many times when a patient would follow-up with their primary care provider, they would have medications ordered that were either duplications in therapy or worse yet, contraindicated to the medications that were ordered upon discharge. It seemed as if nobody at the physician’s office had reviewed what the discharge orders were. Figuring out exactly which medications a patient was supposed to be taking took up a good portion of many days at the corner drugstore.
Now I’m on the other side, at the hospital. When patients are admitted to our floor it can take hours to figure out what medications a patient is actually taking. At my facility, a large portion of our patients are poor historians. They don’t know what medications they are on. They don’t carry an updated medication list. Many don’t even know who their physicians are. It takes hours to figure out what medications they are taking upon admission, potentially delaying care. Heck a couple weeks ago it took 36 hours to get an accurate medication list from the VA for a veteran that was admitted to our facility.
There has to be a better way to reconcile medications to allow for a better level of care for our patients. Is there a role that pharmacists can play in this process?
Some pharmacists would jump in and say MTM is the answer. I’m not so sure about that, at least not with the way that MTM is currently structured. With pharmacists not having provider status, we are not able to bill for our services unless the patient is referred to us by their Medicare-D plan (at least that’s how it is in my state). Second issue with this, not all patients who are in need of our services are Medicare patients. I have had many patients in their 30s and 40s, working full-time jobs who could have benefited from pharmacist-provided care.
But back to the main point, improving communication between physicians, facilities, and pharmacists. I don’t advocate a central database that contains all of a patient’s health care information. In recent times we’ve seen far too many sites get hacked and expose sensitive personal information. I know that I don’t want my information stored in such a manner.
I would like to see patients carry their information with them, say on a flash drive or similar device. At each encounter at the physician’s office, hospital, pharmacy, etc… the device could be accessed to update information. Providers would be able to see what treatment was ordered and check to see if the patient actually followed through with the treatment plan. For example, patient is discharged from hospital with an order for a LABA/steroid inhaler following an admission for a respiratory problem. Five days later they present to the ER for difficulty breathing. The ER staff could access the record and see that the patient did not have their prescription filled, thus the return to the hospital. The hospital would not get dinged for a readmission within 30 days since the patient did not follow the treatment plan. Compliance issues could be identified and referred to the appropriate persons, say a pharmacist who could educate the patient.
The flash drive would also enable providers to see changes in a treatment plan. Let’s say that a primary care provider starts a patient on a medication. Two months later a specialist changes the treatment plan. The specialist could document that the original medication has been discontinued. When the patient presents the flash drive at the pharmacy for updating, the discontinue order would be executed. Too many times I have seen a family member try to help their loved one with medications, only to request refills on a medication that has been stopped for months. A system like this would help prevent such situations.
I know there are many gaps in my plan that would need to be addressed, but this could be a start. What are you thoughts?
Posted by Eric Durbin, RPh at 6:11 AM