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?
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