Fixing Healthcare Can Be As Close As Your Neighborhood Pharmacy

by John Nosta

The clinical emergency is medicine itself

Demand for primary care services is projected to increase through 2020, due to the increasing aging and population as well as the expanded insurance coverage implemented under the Affordable Care Act (ACA). In other words, the demand for primary care physicians will grow more rapidly than the supply, resulting in a projected shortage of over 20,00 full-time physicians.

The value of your neighborhood pharmacy

Nearly 70% of Americans are on at least one prescription drug and over 50% of Americans are on at least two prescription drugs. Given the shaky assumption that these folks are actually taking their medicines, it’s fair to say that beyond the physician, the pharmacist plays a key role in the health dynamic. Currently pharmacists can provide many services to their patients–from information to specific medicines.  In fact, the pharmacy is often a first source of medical information for many.  Pharmacy services have evolved from strictly dispensing medications to offering services such as medication therapy management, medication education, improving medication adherence, administering immunizations, and health/wellness. In addition, pharmacists can now be found in specialty areas such as oncology, organ transplant and even psychiatry. RxWiki–an on-line patient information service–now extends the pharmacy experience into the digital landscape, offering patients on demand access to medication information, pharmacy transactions, and medication adherence. RxNetwork is another emerging company with a unique methodology to link the pharmacy and patient–providing real-time support from compliance to education.  RxNetwork’s patient relationship management solution bridges the pharmacy-patient communication gap and provides an efficient, non-disruptive solution for the pharmacies with a convenient, rewarding, motivating solution to their connected patients.

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Understanding the role of pharmacists

Pharmacist Amy Schiveley talks with a customer at Lakeview Pharmacy

If your recent flu vaccine was administered at a pharmacy, you have already sampled the expanded role that pharmacists play in our health care today.

A flu shot, though, is just one of many patient-care services pharmacies across the country offer beyond filling prescriptions. From blood pressure tracking to Medication Therapy Management counseling, today’s pharmacists can be a resource for a wide range of information and advice.

In a Medication Therapy Management session, pharmacists can sit down with a customer and go through all of their medications, find out what is working and what’s not, review the purpose of each medication, explain how they work and more, according to Amy Schiveley, managing pharmacist at Lakeview Pharmacy, 516 Monument Square.

Pharmacists already provide some consultation when a customer picks up a prescription, Schiveley said, but MTM sessions take a more in-depth look at the entire medicine profile — including over-the-counter products and supplements — and help the patient better understand what they are taking, why they are taking it and how to take it.

“We go through all of it with a fine-toothed comb,” Shiveley said.

Pharmacists can also help patients understand the risks versus benefits of each medication; explore ways to reduce costs; and work with physicians and insurance companies to figure out what medication options are best for each person, she said.

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Steps you can take to be more informed about your medicines

Safe Medical Treatments: Everyone Has A Role

by Dorothy L. Smith, Pharm.D.

Don’t be afraid to ask questions! 

1. Remember, we are all consumers. The only way a person can make informed decisions and use medicines safely is to know what information is important to obtain from health professionals, how to incorporate the medication into your daily lifestyle, how to manage side effects, when to seek medical help and how to keep track of important information for the doctor and pharmacist.

2. Ask your doctor why YOU need the medicine being prescribed and how it is going to help you. Discuss any concerns you have about taking the medicine so that you have all the information you need to decide whether you want to take it. If you do not want to take the medicine, discuss this with your doctor so that a treatment more acceptable to you can be prescribed.

3. Ask your doctor or pharmacist if there is an FDA-approved Patient Package Insert (PPI) for the medicine you are taking. More and more pharmaceutical companies are developing these informational sheets. They are written in language consumers can understand and are reviewed by FDA for fair balance and clinical accuracy. Many companies are also posting the PPI on their website for consumers to read.

4. Since the average person forgets 50% of what the doctor told them by the time they arrive at the pharmacy, ask the pharmacist to go over all the instructions again.

5. If you would feel more comfortable speaking with the pharmacist in a private area, ask for it. More and more pharmacies have private counseling areas to ensure confidentiality and better learning.

6. Ask the pharmacist to show you the actual medicine so that you know which medicine is used to treat which symptom(s).

· Many people stop taking a medicine because they think they are allergic to it. Actually they may have had a minor side effect. Some allergic reactions can be very serious and require immediate medical treatment. If you have any questions about whether a symptom is an allergy or a side effect, always ask your doctor and pharmacist.

· Be sure you know how to administer the medicine correctly. Some medicines, such as inhalers to treat asthma, require complicated steps. Your doctor and pharmacist can show you the steps to follow when using an inhaler so that the medicine will reach your lungs and not get sprayed on the back of the throat where it will not work. You may want to ask the pharmacist to let you practice using the inhaler in the pharmacy.

7. A prescription label that states “Take 1 tablet three times a day” does not give you enough information. Ask your doctor or pharmacist to help you determine the best times to take the medication so you can easily work the dosage schedule into your daily activities, meal times and work. You will find it easier to remember to take your medicine if it fits in with your normal lifestyle.

8. Try not to adjust your medicine doses or take “drug holidays” without discussing this first with your doctor or pharmacist. Some medicines can have very serious side effects if they are stopped suddenly.

· Many prescription medicines can interact with each other as well as with over-the-counter products and herbal remedies. Your doctor and pharmacist should review your medicines at each visit and make sure that you are not taking two prescription medicines that can interact. It is important that you tell them if you are self-treating with any over-the-counter product or herbal remedies. Even better, ask them before you start self-treating!

· If you receive written instructions that just list side effects that could occur, ask for more information. You need to know how to recognize the early symptoms of common side effects and how to manage side effects that may be annoying but are minor. You also need to know when you should contact your doctor because of a side effect. If you do not understand a medical term, do not be embarrassed to ask what that term means. Keep asking until you understand it!

· If you have a side effect, you need to tell your doctor and pharmacist. You also need to tell them if you did anything to try to treat it–such as skipping a dose, stopping the medicine or taking an over-the-counter or herbal remedy. This information is important for them to include in both your medical record and pharmacy record.

· Some people find it helpful to keep a “medicine diary” they can take with them to their next doctor and pharmacy visit. This diary can help you remember important information to tell your doctor so the doctor can decide if you really had a side effect or if the symptom may have been caused by something else. Your diary can also help remind you of important questions you want to ask.

· Some medicines must be stored away from heat, light or moisture in order to keep their strength. Transdermal patches should not be thrown away where children can find them and put them on like Band-Aids. If you are traveling in a car during hot weather, don’t store your medicines in the glove compartment of the car. The heat can destroy the medicine and it may not work.

· Select your pharmacist with the same care that you select your doctor. You want a pharmacist who will take the time to counsel you at every visit and answer your questions. You should also expect to receive written information that you can take home. However, the written instructions should NEVER take the place of personal counseling. You need your questions answered so you can manage your medicines safely!

· Find out how many days in advance you should order your refills. Ask your pharmacist to develop a program to help remind you to get your refills.

· If you are having trouble remembering to take your medicine, it is important to let your doctor know this. Otherwise, your doctor may think that the medicine is not working and may prescribe another medicine that is less effective or has more side effects. All that really may be needed is to work out a more convenient dosage schedule for you.

· Be sure at each pharmacy visit to tell the pharmacist if you have had any problems with any of your other medicines. Your pharmacist can often provide helpful advice.

13 Things You Should Know About Your Pharmacist

Article from Readers Digest

What to bear in mind the next time you visit the pharmacy counter.

1. Don’t try to get anything past us.
Prescriptions for painkillers or sleeping aids always get extra scrutiny.

2. We’re not serving fries in here.
I’d think twice about using a drive-through pharmacy. Working there distracts us-not a good thing when it comes to pharmaceuticals.

3. We’re human … and we make mistakes
(about two million a year). Ask if we use a bar-code system to help keep us from pulling the wrong drug off the shelf or giving the wrong strength of the right drug.

4. Sometimes we can’t read the doctor’s handwriting either.
E-prescribing can help, but as of 2006, fewer than 20 percent of prescriptions were being electronically transmitted.

5. I hate your insurance company as much as you do.
“Even if something’s working for you, the insurance company may insist you switch to something else,” says pharmacy owner Stuart Feldman.”I’m stuck in the middle trying to explain this to customers.”

6. We can give flu shots in most states.

7. A less-qualified pharmacy technician may have actually filled your prescription. Currently, there is no national standard for their training and responsibilities.

8. Generics are a close match for most brand names. But I’d be careful with blood thinners and thyroid drugs, since small differences can have big effects.

9. I can give you a generic refill that’s different from the one you started with.
When in doubt, ask. Online resources like let you double-check your pill.

10. We’re not mind readers, and there’s not some big computer database that tracks your drugs and flags interactions for pharmacists everywhere. Use one pharmacy. If you start using a new one, make sure we know what you’re taking.

11. Avoid the lines. It gets busy Monday and Tuesday evenings, since many new prescriptions and refills come in after the weekend.

12. Look into the $4 generics offered by chains like Target, Kroger, and Wal-Mart. And it can’t hurt to ask your pharmacy if it will match the price.

13. Yelling at me won’t help.
If I can’t reach your doctor and/or insurance company to approve a refill, there’s nothing I can do about it. “It’s frustrating,” says pharmacist Daniel Zlott, “but I’d be breaking the law in some states if I gave it to you.”

Dr. Daniel Zlott, oncology pharmacist, National Institutes of Health; Cindy Coffey, PharmD; Greg Collins, pharmacy supervisor, CVS/pharmacy, California; Stuart Feldman, owner, Cross River Pharmacy, New York

9 More Things About Your Pharmacist

Article from Readers Digest

More secrets from behind the drug counter.

1. Don’t put up with the silent treatment.
Pharmacists are required by law in most states to counsel patients and answer their questions. If your pharmacist seems too busy to talk with you, take your business someplace else.

2. An over-the-counter version might do the trick.
You may just need to take more pills and forgo insurance reimbursement. But always talk to your pharmacist, and do the math. Half the prescriptions taken in the U.S. each year are used improperly, and most patients nationwide don’t ask how to use their medications.

3. Ask about over-the-counter drugs. “People assume that if it’s over-the-counter, it’s safe,” says Daniel Zlott, a pharmacist at the National Institutes of Health. “I’ve seen serious complications.”

4. Go ahead and call me doctor (I’m just not that kind of doctor). Since mid-2004, pharmacy students must pursue a doctorate in pharmacy (Pharm.D) in order to be licensed. Pharmacists licensed before then must have at least a Bachelor of Pharmacy and pass a series of exams. Either way, your pharmacist has spent more time studying drugs than even your doctor has.

5. Open up a little. “The better I know you as a patient—your health history, your family, and how busy your life is—the better I can tailor medications to fit your lifestyle,” says Zlott. “You may not want to take a drug three times a day, for example, and I’ll know that if I know you.”

6. “People take too many drugs, definitely,” says Stuart Feldman. Two out of every three patients who visit a doctor leave with at least one prescription for medication, according to the Institute for Safe Medication Practices. “Drugs are an easy solution,” says Feldman, “but there are other solutions.”

7. Talk to me—and check my work. Half the prescriptions taken in the U.S. each year are used improperly, and 96 percent of patients nationwide don’t ask questions about how to use their medications. When you pick up your prescription, at a minimum, ask, What is this drug? What does it do? Why am I taking it? What are possible side effects? and How should I take it? Not only does this help you to use the drug correctly; it’s also a good way to double-check that you’re getting the right drug.

8. We’ll save you money if we can
. “A good part of a pharmacist’s time is spent dealing with patients and their incomes,” says pharmacist Cindy Coffey. Part of that is suggesting generic or OTC alternatives. Or if a doctor has prescribed a newer drug with no generic alternative available, says Zlott, “I might call the doctor to suggest an older drug that’s equally effective.”

9. “Some pharmacies are so volume-driven that the pharmacist can’t look up all day,” says pharmacist Cindy Coffey. There were a record 3.8 billion prescriptions filled in the U.S. in 2007—a 13 percent increase from 2003.