Ms. Heinze is a freelance writer based in Vancouver, British Columbia.
With the continued focus on promoting patient adherence to reduce overall health care costs, pharmacists are under increasing pressure to find ways to deliver health care education at the same time that prescription volumes are on the rise.
The standard answer to this is the distribution of printed materials, delivered when the patient receives the prescription or refill. While this offers value, it is not as effective as it could be if accompanied by a face-to-face counseling session, argues Bill G. Felkey, BA, MS, professor emeritus of healthcare informatics in the Pharmacy Care Systems department at Auburn University in Auburn, Alabama. "We have research to show that the printed information does not create adherence to the same level as a combination of both oral and printed information," he says. "The majority of pharmacists right now also are not very happy with the printed information because it contains, mostly, bad news."
Another issue is the amount of inaccurate information that patients can access. Numerous Web sites, and even respected mainstream news outlets, are guilty of publishing data that is either out of context, too hastily summarized to be of use, or just plain wrong. The upside, Felkey says, is that after a while, patients tend to give up conducting their own research. "The Internet is not too great a threat to the pharmacy because people become overwhelmed when they are trying to navigate through the ocean of information that is out there," he says. "What they need, they quickly realize, is somebody to help sort through which information applies to them, what is the most important thing they should take away, and how they should use the information."
Felkey notes that patients fail in following their treatment recommendations for several reasons: (1) they do not know what to do; (2) how to do it; or worse, (3) they are not motivated to abide by the suggested practices. "The toughest of those 3 is motivation," Felkey says. "What predicts the greatest extent of how a patient will attempt to change their behavior to get the benefits of their prescription medicine, or to do other treatments, or instituting lifestyle changes, is the relationship between the pharmacist and the patient."
Bill Ladwig, vice president of professional services at Lewis Drug in Sioux Falls, South Dakota, labels this relationship as "paramount." He notes, however, that the biggest challenge his practice faces is getting patients to take the time to ask questions. "People are so rushed that they do not oftentimes stop and ask the questions that are so important for their own health," he says. "We are trying to make people realize that they need to take the time to ask the questions and to slow the process down a bit."
At Leesburg Pharmacy in Leesburg, Virginia, pharmacists step up their contact with patients by holding certain prescriptions back so that when the patient comes to pick up the medicine, he or she must speak with the pharmacist first. "During the filling process, if it is identified that there is some need to speak with the patient, we hold it in an area that we call 'special handling' to make sure that we do speak with the patient," explains Cheri Garvin, Leesburg's executive vice president and chief executive officer. "If it is something that we know has a lot of side effects, or if there is a potential for a drug interaction that we want to discuss with the patient, we hold it behind the counter with the pharmacist until the patient comes."
Lewis Drug attempts to change their patients' behavior—and therefore motivate them to interact with the pharmacist— through the media, and recently ran a campaign entitled "Just Ask." The spots featured several different pharmacists delivering a few lines, the overlaying message being, "Just ask—even if you are late. Just ask—even if the kids are crying." Ladwig says, "We are trying to reestablish the thought process. Pharmacists are accessible; we need to make ourselves accessible for this purpose." He adds that pharmacists should seize any opportunity they have to make contact with the patient, be that through counseling sessions or even other activities, such as speaking engagements at local schools.
Ladwig declares that this means more than simply giving patients the opportunity to ask questions. "The 'do you have any questions for the pharmacist?' method is not a very successful model," he says. "You need to actually stop and talk to the person to say, 'this is what this is for.'"
In the past, some pharmacists worried that they would experience reticence from other members of the medical community when they presented themselves as another source of counseling in the bigger picture. This has decreased, largely because doctors are pressed for time. "Because of our managed care stresses, physicians are spending less and less time with their patients," Felkey says. "It's not a turf issue about who should be doing the education. Physicians are increasingly relying on pharmacists to do a greater amount of education—especially about anything related to the drug product."
Pharmacists, too, face time constraints, and will continue to do so as their distribution loads increase. "Because of the decreased reimbursement for the prescription, you have to increase your volume in order to make the same money as you did last year," Felkey says. This competes with the emphasis on the importance of providing health education, which is underlined when aspiring pharmacists enroll in school. "We are trying to make our students realize that pharmacy's future is based on how valuable they are considered in the health care system as professionals who can produce desired outcomes in patients, and that has got to start with their educational role."
Garvin agrees that time is an issue to everyone—physicians, patients, and pharmacists—and she hopes that in the future, a larger number of insurance carriers will recognize the benefits of services like medication therapy management (MTM), opening the door for reimbursement for these counseling sessions. "If you step out from behind the counter to counsel somebody, or maybe they have asked for a recommendation on an OTC medication, it is not like all of the other work goes away," she says. "There is always that pressure; the longer you spend talking to them, the more your pile of work builds up in the pharmacy area. Time constraints are real." So, too, are staffing issues: pharmacies cannot simply have an extra pharmacist on hand in the event that an MTM case may—or may not—walk through the door. "If everyone could see that we will be paid for these services, I think we would have a lot more of the profession on board."
Ladwig says that while robotics and automation have helped with time management, right now the way to provide health care education is by relying on assisting personnel. "The biggest aspect of pharmacy is the contact with the patient," he says. "Successful pharmacists realize the importance of filling prescriptions, but you still have to make that patient contact."
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