Wednesday, June 15, 2011

Here is more from my conversation with a fellow frustrated pharmacist. I find some of his insights very interesting. Again, what are your thoughts? Please share them here for everybody's benefit. I appreciate the emails, but more people see your thoughts when they are in the comments and not my email inbox.

I just read part of your note to Jim. Anybody that says they are an expert in MTM is not being entirely straightforward, in my opinion. If there were such a person and he/she knew how to do it and make it meaningfully profitable, they should be shot if they keep that information to themselves. People may be experts in "MTM" if they have charts available but they are still not managers of drug therapy in the sense Hepler and Strand meant it. We are not given and don't have the right to be responsible to the patient for drug therapy. That still rests with the doctor--we would need an OK from each MD and that's not what Hepler and Strand meant. But what they meant is extremely unlikely to ever occur (my opinion). The Ashville Project was and is such an artificial situation, I'm not surprised they can't give you an exact amount the pharmacists were paid. It was something that evolved over time. At first, the pharmacists spent varying amounts of time and their documentation was very sloppy as to what they actually did. They were also assisted by a diabetes nurse educator who did alot of what we would hope to bill as MTM. They also had a leading community physician running as a front man for them to help get physicians reluctant acceptance and several hospitals, as I recall, were also involved. I'm relying on memory of articles I read about 7 or 8 years ago that I have since thrown out (along with my hope of MTM ever being a working model). I don't know that academia and APhA are actually keeping anything from you so much as they probably really don't have precise figures and the services/types, records, etc varied over the years. Pfizer is now a major sponsor of Ashville and I wouldn't believe anything Pfizer had input on anyway. They back the PBM's and we know what the PBM's think of retail pharmacy. We are fighting against billions of dollars and some of those dollars have been used to compromise APhA. In my opinion, APhA tries to sound like pharmacists is who they represent, but the real money comes from large pharmaceutical corps. that they must feel they can't afford to piss off. Look at the response Tom M. (APhA exec. VP) gave to David Stanley's editorial, "You Talkin' For Me?" in Drug Topics. He barely hid his hostility. He brushed aside David's points and essentially accused him of not knowing how to use technology or technicians. He referred to him as "Stanley" every time he mention David's name except the first time when he called him "David Stanley." I got no sense that he felt he was talking to a colleague but to someone that pissed him off by telling the truth.

1 comment:

Anonymous said...

I'm not really sure.

As I understand it, MTM is something has 'emerged' as a concept from academia to describe a particular MO.

Many of us do whatever we do in the venue we have at hand, and help provide our patients with a pharmacists' perspective of the situation.

Depending on the size of the hospital, when I am requested to perform a specific clinical service, I used skill sets evolved in my career to provide what is needed for the patient. When I do a kinetic monitoring, I'm not only looking at a dose of such and such, but have to take into account other issues, if it's to be an effective therapeutic option. In small rural hospitals, we do it all. In larger hospitals (i.e. during clinical rotations), we performed specific functions because we had a databank already available.