The Last Touch...

I read a recent report by the New England Health Care Institute that, while an eye-opener, wasn't a real shocker. The bottom line: Medication non-adherence (patients not taking their medications as prescribed) leads to $290 BILLION in additional health care costs due to treatment failure requiring additional outpatient care or hospital re-admission. This is 13% of our overall US health care expenditure! Patients with complex medication regimens (primarily patients with chronic conditions and multiple co-morbidities), elderly and poor patients made up the bulk of patients.

Pharmacy school teaches us that medication compliance is one of the most important aspects of pharmaceutical care. The pharmacist is the "last touch" in the health care system before the patient is sent into the wild on their own. Every state has counseling requirements. Why? Because it is critical that the patient understands how to take their medications (for the long haul in chronic conditions) and the ramifications of NOT taking them as prescribed.

But my own experience at the local pharmacy has been less than exemplary. I don't usually tell the staff at my local mega-chain that I'm a pharmacist. A harried technician asks me as she hands over the bag covered in patient leaflets if I want to talk to the pharmacist about it. The pharmacist glances over at me with a look of desperation, dishevelment and weary - my "last touch" with the pharmacist left me no better informed and just with a feeling of pity for him. The Pharmacy Chick Blog has a very poignant take on why this may be the case

My former hospital's discharge pharmacy wasn't much better. In the morning, as many patients were being discharged, a line would form outside "the window." A line of angry patients that wanted nothing more than to get out of the hospital and get home to recover. The counseling was rushed, cursory and minimal. Guaranteed, no matter how good the hospital stay had been, no matter how friendly the nursing care, this "last touch" tainted the entire experience in the mind of the patient.

Can pharmacy make a difference here? Clearly, it can.

The NEHI report mentioned above goes on to identify that when proper counseling is done, both at discharge and during a retail pharmacy experience, medication non-adherence improves by 40+%. This is identified on surveys to patients post discharge and could be subject to reporter bias.

A more concrete example of the value of discharge counseling and targeted follow up was presented at the ASHP Summer Meeting this past June. This presentation showed that when pharmacy takes an active role in the discharge process, medication failure related re-admissions fell dramatically. In fact patients in the control group (only cursory required counseling given with no follow up phone counseling) were 2 and 4 times more likely to be re-admitted for ADEs at 30 and 60 days respectively. They targeted the "at risk" patient groups identified above for specific post-discharge follow up calls. Just calling and checking in with patients had a huge impact on re-admissions.

The Obama administration is making it clear that being re admitted for the same medical issue is in the cross hairs for health care reform. The pharmacy profession has a real opportunity to show some value and push for medication therapy management. The evidence is behind us!

What do you think? What would your patients say about their "last touch" with your pharmacy services? Leaving comments is FREE!

~charles