Ernest Boyd, R.Ph., MBA Executive Director Ohio Pharmacists Association
CDC s Guide for Pharmacist Partnership for Public Health
Brief overview of Pharmacists All graduate with 6 to 8 year Doctor of Pharmacy degree Best educated in medications, their proper use, interactions, side effects and alternatives Most available professional in community, at low or no cost to patient Now providing wide range of vaccinations
What law currently allows: Administer immunizations for influenza to individuals fourteen years of age or older; (b) Administer immunizations to individuals eighteen years of age or older for any of the following: (i) Pneumonia; (ii) Tetanus; (iii) Hepatitis A; (iv) Hepatitis B; (v) Meningitis; (vi) Diphtheria; (vii) Pertussis. (c) Administer to individuals eighteen years of age or older any other immunization listed in the rule adopted under division (E)(1)(d) of this section.
What other roles for pharmacists in public health? Medication issues directly contribute to 10% of hospital admissions and 20% of nursing home admissions Over 1/3 of prescriptions are never filled. Antibiotic resistance is increasing, partially due to patients not adhering to regimen Pharmacists now paid to improve adherence, and discourage overuse of antibiotics
Medications are primary method of treating/preventing disease, but 50% of patients take medications incorrectly (too often, skipped doses, combinations) Over 60% of hospital readmissions of chronically ill patients within 30 days of discharge are medication related. The pharmacist sees these patients more often than any other professional, and is available nights and weekends.
MTM Medication Therapy Management Pharmacist service that optimize therapeutic outcomes for individual patients. Active management of drug therapy by identifying, preventing and resolving medication-related problems. These services may or may not be provided with the dispensing of the medication or device.
Infant mortality Role of OTC drugs Over-the-Counter Cold Medications Postmortem Findings in Infants and the Relationship to Cause of Death Journal of Analytical Toxicology Laureen Marinetti, primary author, Montgomery County Coroners office, Dayton, Ohio Drugs: The drugs detected were ephedrine, pseudoephedrine, dextromethorphan, diphenhydramine, chlorpheniramine, brompheniramine, ethanol, carbinoxamine, levorphanol, acetaminophen, and the antiemetic metoclopramide.
Call from Jim Davis, Coroner Over 50% of SIDS deaths were actually OTC and some prescription drug deaths He strongly called for action by pharmacists to help prevent misuse/abuse Examples: Diphenhydramine for sleep, acetaminophen overdoses; using cough and cold for children. Major issue that has not been properly addressed
Access to Clinical Data Important Pharmacists need to know the current clinical status of the patient to assess the indication, appropriateness, and effectiveness of medication therapy. Lab values are becoming more important in community practice. Collaborative practice is allowed in Ohio, and pharmacists can adjust doses, order tests, and perform other functions as allowed through the consult agreement with a physician.
Role in transitions Discharge counseling with patient and family Hospital pharmacist at Berger Hospital in Circleville contacts community pharmacist with discharge meds. Community pharmacist then does medication reconciliation, being sure they fill needed meds, and discontinue those no longer used. Community pharmacist has access to patient record as though they were hospital employee. Significant reduction in readmissions.
Role in team-based care Interact with home health providers to assist with medication reconciliation. Coordinate medications prescribed by primary care physician and specialists. Provide drug information at point of prescribing in some settings. Some physician practices hiring pharmacists. The return on investment from pharmacists services is a high as 12:1, and averages 5:1
Patient/caregiver interaction Adherence increases with MTM provision 30% of patients have difficulty interpreting or even reading the prescription label, so verbal information critical. Nearly 30% of Medicare D patients refuse MTM new service, unclear why talking with pharmacist important need reinforcement by other health providers
Ohio Medicaid and Duals Ohio has largest Medicaid MTM program in country, begun September, 2012 Over 100,000 pharmacist MTM services so far Over $3 million in direct cost savings Over $30 million in avoided hospitalizations, ER visits, etc. About 1800 pharmacies participating so far The new dual eligible waiver includes a pharmacist in the patient s care coordination team.
Stroke medications need special care. Blood thinners, antidepressants, statins all need the entire team to be vigilant MTM is especially important due to drug interactions and side effects. Pharmacists are ready to partner for the best outcome for the patient.
Contact info: Ernest Boyd, R.Ph., MBA eboyd@ohiopharmacists.org 614-389-3236