Jerry Fahrni

Category: Pharmacy Practice

  • Medication adherence, it should begin and end with a pharmacist

    There’s no question that medication adherence is a problem. How big a problem? Well, according to an article in The American Journal of Medicine, 28% of new prescriptions never get filled, and among patients who do fill their prescriptions, adherence rates are less than 50%. The problem with these numbers is that they represent not only grief for the patient, but for the entire healthcare system.

    According to Dave Walker, a pharmacist that blogs at pharmacy 2.0 and ½, “although the causes and proposed solutions to the medication adherence/compliance problem vary widely and are often debated, it seems one thing can be agreed upon by all… it is a very costly healthcare problem in the U.S. today. The cost of non-adherence was estimated to be $290 billion annually by the New England Healthcare Institute NEHI in 2009. It’s now estimated by some to be in the neighborhood of $330 billion or more annually.” That’s a lot of money.
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  • Fresh application of older healthcare technology

    I came across an interesting article in the July issue of Pharmacy Practice News. The article describes some of the posters presented at the 2013 ASHP Summer Meeting in Minneapolis. The technology covered is relatively old, and a little antiquated when you look at much of the technology floating around the world these days. Nonetheless, this technology still represents opportunity in healthcare.
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  • Purdue University develops tablet-based pharmacy tool for catching medication side effects

    Tablets are changing the way healthcare professionals practice medicine.

    Purdue.edu: “Matthew Murawski, a Purdue University associate professor of pharmacy administration, created a new tool that presents patients with a five-question checklist that catches up to 60 percent of all known medication side effects….”This tool makes the few minutes available for counseling much more rewarding. The checklist results allow the pharmacist to immediately see side effects the patient is experiencing and target their time to solving these problems and improving the patient’s quality of life.” …Murawski’s method, named Pharmaceutical Therapy-Related Quality of Life or PTRQoL, began as paper checklists that took up multiple file folders behind a pharmacist’s desk.”

    Purdue University does some cool stuff around the practice of pharmacy. The only thing that makes me cringe is the line “patent pending” (approx. 1:05 into the video). Nothing that is developed utilizing University resources should ever be allowed to be patented. It should all be open source.

  • Thoughts on the ASHP Summer Meeting (#ashpsm)

    I’ve just returned from the ASHP Summer Meeting in Minneapolis, MN. I was there for work, but managed to squeeze in some sessions; just like a real pharmacist.

    For those of you that don’t know, the ASHP Summer Meeting is small, really small. It pales in comparison to the ASHP Midyear Meeting that’s held each year in December. Being small doesn’t make it bad, it just makes it small. The sessions are smaller and less grand, and the exhibitor area is quite a bit smaller than Midyear as well.

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  • Medication therapy management at TEDxUniversity [video]

    Thanks to Megan Hartranft (@MeganPharmD) and John Poikonen (@poikonen) for tweeting this. It’s nothing earth shattering, but it sums up why pharmacists should be more involved. Tim Ulbrich does a really nice job.

    Pharmacy schools should show this short video to all their pharmacy students before turning them loose on the world. I talked about some of this in my presentation at the HIMSS Southern California Annual Clinical Informatics Summit a couple of weeks ago.

    There was a time when I thought that the best place to engage patients was in the hospital, but I’m starting to rethink that position. If you think about it, engaging patients in the hospital is a bit of a reactive approach. We need to engage patients before they’re hospitalized to get the most bang for our buck.

  • Info packets instead of a pharmacist used in attempt to improve medication adherence

    angry_monkeyI came across an article today in The Baltimore Sun that caught my attention.

    According to the article: “In a test of services geared toward making sure patients took their prescribed medications after leaving the emergency room, none made a difference, a large new study suggests.

    Based on the experiment involving nearly 4,000 ER patients, researchers found that information packets, personal assistance and even access to an on-call medical librarian to answer questions about the drugs did not lead patients to fill more prescriptions or to take them as directed when they left the hospital.”

    The best line from the article has to be that patients were given “access to an on-call medical librarian to answer questions about the drugs [they were prescribed]” This has to get the head-scratcher of the year award. The lunacy of healthcare never ceases to amaze me. Why, oh why would you give patients access to a medical librarian to answer drug questions. I have great respect for medical librarians, but that’s not their domain.

    And as a surprise to no one, “One week after ER discharge, 88 percent of patients had filled their prescription, according to pharmacy records, and in a phone interview 48 percent reported taking the medication as prescribed. Those percentages did not differ between the participating groups.”

    No kidding. Medication adherence is an incredibly complex problem with many different reasons why patients choose not to get their prescriptions filled or fail to take them consistently and accurately.

    Depending on the study you read, medication adherence costs the United States anywhere from $100 billion to $290 billion annually, including increased morbidity, lost time from work, readmissions, etc. Pharmacists have been shown to help. Handing out pamphlets has not.

    Honestly, I’m surprised that the Annals of Emergency Medicine would publish such crap. My cats leave equivalent work in the yard all the time, but at least they try to cover it up.

    The article – Does Providing Prescription Information or Services Improve Medication Adherence Among Patients Discharged From the Emergency Department? A Randomized Controlled Trial – can be found here.

    Morons.

  • Smartphone medication adherence apps [Article]

    JPhA_article_header

    Not sure how I missed this one, but there’s an article in the March-April 2013 issue of the Journal of the American Pharmacist Association that covers smartphone applications for medication adherence.

    Smartphone medication adherence apps: Potential benefits to patients and providers (J Am Pharm Assoc. 2013;53:172-181)

    From the abstract: “160 adherence apps were identified and ranked. These apps were most prevalent for the Android OS. Adherence apps with advanced functionality were more prevalent on the Apple iPhone OS. Among all apps, MyMedSchedule, MyMeds, and RxmindMe rated the highest because of their basic medication reminder features coupled with their enhanced levels of functionality.”

    There’s a lot of good information in the article, especially the bibliography. To top it off, the article is available in its entirety for free so go get it. Actually, the entire March-April issue is worth reading.

  • Evolution of [Pharmacy] Practice in an Age of Information [Presentation]

    Yesterday I was at Children’s Hospital of Orange County in Orange, CA. for the HIMSS Southern California Chapter 5th Annual Clinical Informatics Summit: Adventures in Clinical Informatics. I was there to give a presentation about pharmacy. It’s the first public presentation I’ve given since retiring from the presentation game just over two years ago. Now that it’s over I’m heading back into presenter retirement.

    The presentation in its entirety has been uploaded to Slideshare and is embedded below. Some of the slides didn’t show up at the time of upload. I tried a couple of different things to get them to show up, but at last view they still weren’t there.

  • Clinical Dilemmas and a Review of Strategies to Manage Drug Shortages [article]

    Here’s an interesting article in the Journal of Pharmacy Practice. The article, Clinical Dilemmas and a Review of Strategies to Manage Drug Shortages appears online ahead of print (doi: 10.1177/0897190013482332). Unfortunately you’ll hit a paywall, so if you don’t have a subscription all you’ll get is the abstract.

    That’s unfortunate because according to the article “The expanded phased approach outlined here [in the article] provides a consistent, systematic approach for the management of drug shortages“. You would think they’d want everyone to know about the expanded phased approach due to the “health care crisis” created by drug shortages. Just sayin’.

    Abstract
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    Objective: The objectives of this article are to review the clinical implications of drug shortages highlighting patient safety, sedation, and oncology and introduce an expanded phase approach for the management of drug shortages. Data Sources: Literature retrieval was accessed through a PubMed search of English-language sources from January 1990 through April 2012 using the medical subject heading pharmaceutical preparations/supply and distribution and the general search term drug shortages. Study Selection and Data Extraction: All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, and review articles were evaluated for inclusion. Relevance was determined considering the therapeutic class, focus on drug shortages, and manuscript type. Data Synthesis: The increased number of drug shortages has created significant challenges for health care providers. Two particularly vulnerable populations are critically ill and oncology patients. A lack of therapeutic alternatives in critically ill patients may impact patient safety as well as treatment outcomes. Similarly, a chemotherapy agent in short supply may contribute to adverse outcomes in oncology patients. Conclusions: The mounting number of drug shortages has created a health care crisis, requiring changes in management strategies as well as clinical practice. The expanded phased approach outlined here provides a consistent, systematic approach for the management of drug shortages.

  • Patient collected information and the role of pharmacists

    I had an interesting phone conversation this morning with Kevin Sneed, Pharm.D.(@DeanSneed), Dean at the University of South Florida College of Pharmacy (USF COP). I’ve been trying to connect with Dr. Sneed for a while now, but as you can imagine his schedule is pretty full. Fortunately for me I was able to grab about 30 minutes of his time this morning. And what a great 30 minutes it was. I was so impressed with what he had to say that I’m planning to visit USF COP sometime in the next couple of months to continue the conversation and get a first hand look at what’s going on there.

    While I could expound on our conversation for several pages, one comment that Dr. Sneed made struck me as so profound that I thought I would quickly share it.

    During the conversation we started talking about data, and where it’s coming from. Pharmacy is a data driven science, but never has the data come from so many directions. Dr. Sneed commented that patients are taking control of information these days, and not only are they more informed, but they are generating much of the information that will be used in their care. Patients are becoming connected more and more. This is especially true with the advent of mobile technologies that wirelessly transmit tons of data for everything from exercise regimens, to weight, glucose readings, heart rate measurements, and so on. Dr. Sneed sees a future where patients will present this information not only to physicians, but other healthcare professionals such as pharmacists as well; it will be used as currency to start conversations and facilitate care. I’ve heard people in healthcare refer to data as currency before, but I never really made the connection until now.

    It’s clear that we’re in a new age of heatlchare, and pharmacists need to be prepared to collect this information and utilize it to provide better pharmaceutical care. This may sound superficial on the surface, but it is a very important point. Think of a time, not so far in the future, when pharmacists will have a lot more information about patients at their fingertips. This will likely occur across all pharmacy environments, i.e. outpatient, long term care, acute care, etc. This information will give pharmacists an ever increasing role in direct patient care.

    Something to think about as pharmacists prepare for a future healthcare model that is rich in information provided by their patients. Exciting opportunities lie ahead if we’re prepared to accept them.