Survey results show 40% of health care leaders believe a lack of communication between prescribers and pharmacists is preventing the successful management of patients’ medications.
Current data show that 80% of patients leave their primary care offices with prescriptions, highlighting the critical need for the health care community, and primarily pharmacists and physicians, to rally around the goal of providing quality care while ensuring the medications prescribed are appropriate and up-to-date for each patient.1 In many ways, achieving that goal starts with effective communication.
In fact, a recent survey shows 40% of health care leaders believe a lack of communication between prescribers and pharmacists is preventing the successful management of a patient’s medication, while 25% say medication management is made worse due to mergers and consolidations.2
With this knowledge, the question as to what can be done to address this communication issue between prescribers and pharmacists remains. Specifically, identifying the sources of the communication breakdown is key to effectively address the issue.
Here are a few potential causes:
1. The lack of benefit plan design integration is a key area that can lead to a disconnect between health care clinicians. To address this, pharmacy services should be integrated back into medical benefit and patient care models. This can in turn offer resource allocation insight and provide a business model that is capable of delivering whole-person care with medical and pharmaceutical follow up.
Benefit plan design integration can also open the door to more interprofessional and accountable teams. As the health plan sponsors, medical carriers and employers should focus on high-cost claims and disease states that drive utilization and costs; however, PBMs are continuing to carve out strategies that create further fragmentation and hide insight around the total cost of care, which in turn causes the coordination of care to suffer.
Additionally, this siloed approach to benefits management often disaggregates the delivery of care at the expense of high-quality, comprehensive patient care, with the true attribution of ROI and savings often getting lost along the way.
2. The lack of transparency is another area that needs to be addressed to move toward more comprehensive medication management. All members of the patient care team should have full access to all relevant clinical information at the point of care. Physicians do not always have access to all of a patient's medication list, and pharmacists do not always have a patient’s medical history or a physician’s stated goals for that patient’s treatment, which can limit the pharmacists ability to provide effective medication management support.
3. The lack of a team-based care approach can lead to significant communication difficulty due to the time constraints a prescriber often faces in their day-to-day. Specifically, although medications are involved in 80% of how physicians treat and prevent illness, physicians often have little time to speak to patients about new medications during a typical office visit. With a team-based approach, a medication expert can work in a collaborative practice with a physician, which can significantly impact the total cost of care and the overall quality of care, while still helping patients achieve the clinical goals of therapy.
When pharmacists work with patients directly as a part of a team working alongside the prescriber, they can help to address a few key areas in particular. Specifically, pharmacists can ask patients these 5 patient questions to support a more patient-focused approach to medication management:
1. Is this the right medication for this patient? For many patients, the answer is yes, but this question is the starting point of an important conversation between the patient and their care team. To start the conversation, a care team member can appoint an active participant (patient or caregiver) to be a part of the health care strategy and then give the patient or caregiver an opportunity to invest the time to learn more about the treatment plan and goals.
2. Who can this patient go to with further questions about their medication? The more doctors a patient sees and the more medications the patient is taking, the more complicated the process can be of coordinating all of the moving pieces of their own care. When a medication dose becomes too high or too low, or when a new medication turns out to conflict with the current treatment regimen, it can make a patient sicker rather than healthier.
Pharmacists can help with this issue by making it clear to the patient who exactly they can contact with questions regarding their medication as those questions arise, and which situations should warrant contacting their doctor directly.
3. What is the right dosing for this medication? Pharmacists can help make clear to patients the right dosing and dosing device for their medication, as often the correct use of the dosing device is critically important. Pharmacists can show patients how to properly use the device to extract the exact dose that is required for their treatment, as a milliliter difference can impact the treatment efficacy or safety for some medications.
For the purposes of providing further support around safety protocols, pharmacists can provide patients with the number for the American Association of Poison Control Centers at 1-800-222-1222 for advice and help, as well as immediate support in case of an accidental overdose.
4. When is the right time to change and discontinue medications? There are medications that some people will be taking indefinitely for chronic disease, but that is not the intention of every therapy. Health conditions can change, and new therapies can reach the market that may be better suited to a patient’s needs, so it is critical for patients and caregivers to assess whether their current prescription still meets the prescriber’s goals for treatment.
Additionally, pharmacists can make clear to patients the importance of encouraging transparency around any negative side effects the patient may be experiencing from the medication, as pharmacists can help resolve this issue through dosage changes.
5. How will my patient know if the medication is working? Any effective assessment process is reiterative and ongoing. Goals are personalized and understood by patients, caregivers, and members of the care team, so it is imperative that a patient’s health care team conducts ongoing evaluations and assessments of medication outcomes. Pharmacists can play a critical role in these efforts and encourage caregivers and patients to step in and speak up to make sure these assessments continue to happen throughout the patient’s treatment process.
Comprehensive medication management starts with health care experts. Closing the gap between each process in order to ensure the patient is receiving the best care they need is essential. Patients deserve a coordinated, interprofessional team empowered with information at the point-of-care available to deal with medication therapy problems.
About the Author
Katherine H. Capps, co-founder and executive director of The Get the Medications Right™ (GTMRx) Institute, a coalition of over 1600 members calling for medication management reform brings together critical stakeholders across health care.