Under DEA regulations that took effect June 1, e-prescribing of controlled substances is now permitted in the United States. All the dust has not yet settled, however; APhA joined with other pharmacy associations to suggest ways that the process could be improved. In addition, software developers may need at least a year  to make the updates to computer systems that will allow prescribers to transmit scheduled medication orders, intermediaries to process the prescriptions, and pharmacies to receive them.

DEA has been moving for years toward allowing e-prescribing of controlled substances. The latest push began in June 2008 when the agency announced its intention to create an alternative to manual prescriptions. After the February 2009 economic stimulus act created incentives for increased use of health information technology by physicians, pressure increased for DEA to offer a structure for e-prescribing.

As pointed out in the article, pharmacists may not have to opportunity review a electronically submitted controlled substance prescription for 6-12 months, until this new process has sufficient time to be implemented. However, this is a long overdue - and welcome - policy change.

For additional information from the DEA, navigate your browser to the following site: http://www.deadiversion.usdoj.gov/ecomm/e_rx/index.html

Abstract 

Background

Patient satisfaction with medication therapy management (MTM), a required component of the Medicare Part D benefit, is an important outcome to consider when evaluating MTM programs.

Objective

To measure patient satisfaction with a pharmacist-provided telephone MTM program.

Methods

The study design was nonexperimental and cross sectional. A survey was mailed to Scott & White Health Plan Medicare Part D beneficiaries (n=60) who received telephone MTM in 2007. The survey was composed of 15 Likert-scaled questions (1=strongly disagree to 5=strongly agree) that assessed satisfaction with MTM. Descriptive statistics were used for quantitative data analysis. A qualitative content analysis of patients' responses to 3 open-ended questions was also conducted.

Results

The response rate for the survey was 80% (47 of 59). Study participants were 70.8 (±7.9) years old, and most were white (84.1%) and female (54.3%). The alpha coefficient for the satisfaction scale was 0.88. Overall mean satisfaction score was 4.0 (±0.6), with items ranging from 3.6 to 4.3. The highest level of agreement (mean=4.3) was with the following statements: (1) I can easily contact my pharmacist when I have questions or concerns; (2) My pharmacist adequately answers my questions; and (3) I am content receiving MTM over the telephone. The patients agreed least (mean=3.6) with the following statements: (1) When necessary, my pharmacist has encouraged me to receive preventive health care services; and (2) When needed, my pharmacist refers me to other health care providers.

Conclusions

Most of the beneficiaries were satisfied with their MTM care. The positive response to telephone MTM is important because Medicare Part D plans are using the telephone as a method of MTM delivery. Education regarding the pharmacist's role in preventive care and pharmacist follow-up with non-pharmacist health care providers may lead to greater satisfaction levels.

The National Institutes of Health (NIH)/National Library of Medicine (NLM) released a BETA version of a tool to help patients and healthcare providers identify medications via its physical properties (e.g., shape, color, imprint) and provide with FDA content consisting of links to medication information and labeling.

Although this tool is not really ready for full-time, clinical use - as evidenced by the disclaimer and the broken URLs - this has the potential to be a very helpful tool, free of subscription fees.

Lastly, I see projects like these as further evidence that the demand for informatics-trained clinicians will far exceed the supply in the marketplace.

Although this is a PhRMA sponsored (sanofi-aventis) iPhone application, it appears to be very helpful and useful for on-the-go tracking of nutritional information. It seems designed specifically for diabetic patients, however, its uses appear to extend to any disease state where managing nutrition is important (e.g., hypertension, hyperlipidemia, metabolic syndrome, etc.).

I would consider this app in the realm of telemedicine - or at least mobile health - and the only suggestion I have for improvement, at first glance, is the ability to export or somehow otherwise share this information with healthcare providers.

Why Pharmacists Belong In The Medical Home

Marie Smith^1,*, David W. Bates², Thomas Bodenheimer³ and Paul D. Cleary⁴

¹ Marie Smith (marie.smith@uconn.edu) is head of the Department of Pharmacy Practice, School of Pharmacy, at the University of Connecticut in Storrs.
² David W. Bates is division chief of general medicine at Brigham and Women’s Hospital in Boston, Massachusetts.
³ Thomas Bodenheimer is an adjunct professor of family and community medicine at the University of California, San Francisco.
⁴ Paul D. Cleary is dean of the School of Public Health, Yale University, in New Haven, Connecticut.

Pharmacists can affect the delivery of primary care by addressing the challenges of medication therapy management. Most office visits involve medications for chronic conditions and require assessment of medication effectiveness, the cost of therapies, and patients’ adherence with medication regimens. Pharmacists are often underused in conducting these activities. They perform comprehensive therapy reviews of prescribed and self-care medications, resolve medication-related problems, optimize complex regimens, design adherence programs, and recommend cost-effective therapies. Pharmacists should play key roles as team members in medical homes, and their potential to serve effectively in this role should be evaluated as part of medical home demonstration projects.

Great article; this is the type of professional advocacy we need.

Follow-up visits conducted via a secure Web site may result in similar clinical outcomes as in-person visits among patients with acne, according to a report in the April issue of Archives of Dermatology, one of the JAMA/Archives journals.

'Ensuring timely access to high-quality care is currently a challenge for the stressed U.S. health care system. Many specialities, including internal medicine, psychiatry and dermatology, are struggling to accommodate a growing demand for appointments owing to a critical shortage of health care providers,' the authors write as background information in the article. Dermatology, in particular, faces challenges such as an increase in skin cancer and a work force that is not equally distributed geographically. 'One potential solution to these issues may be the adoption of innovative, technology-enabled models of care delivery.'

'In this trial, delivering follow-up care to subjects with mild to moderate acne via office and online visits produced equivalent clinical outcomes by several different metrics,' the authors conclude. 'These findings suggest that dermatologists obtain sufficient information from digital images and survey responses to make appropriate management decisions in the treatment of acne. In addition, this model of care delivery was popular with both physicians and patients, likely owing to the convenience and/or time savings associated with e-visits.'

Although this article discusses follow-up care for a fairly benign condition - mild to moderate acne - it highlights the growing need for, and benefits of, telemedicine.

As the study demonstrates, Health Information Technology (HIT) can be delivered in such a way that it helps clinicians achieve optimal outcomes while maintaining high levels of provider and patient satisfaction.

Abstract: [HTML; subscription required]: http://archderm.ama-assn.org/cgi/content/short/146/4/406

In a letter to American Medical Association (AMA) CEO Michael D. Maves, MD, MBA, ASHP CEO Henri R. Manasse, Jr., Ph.D., Sc.D., expressed his extreme disappointment with a recent members-only-access publication by the AMA entitled “AMA Scope of Practice Data Series: Pharmacists.”  The AMA document, which includes a categorical analysis of pharmacists’ scope of practice in each state, contains numerous inaccuracies, false statements, and mischaracterizations about pharmacy practice and pharmacist education.  ASHP calls on the AMA to retract the document, or, at minimum, correct the inaccuracies and mischaracterizations.

 

Of particular concern, is the repeated characterization of pharmacists as having inadequate education and training, suggesting that their patient care roles should be limited.

Proud that ASHP is aggressively pursuing these type of issues!

Letter to AMA [PDF]: http://www.ashp.org/DocLibrary/News/NewsCapASHPlettertoAMAreScopeofPractice03...

Health information technology: A new world for pharmacy

AUTHORS: Lisa Webster, BPharm, MS, and Rachelle F. Spiro, BPharm, FASCP

Activity Preview

This article provides a primer on Health Information Technology (HIT) for pharmacists, including the current state of HIT, future expectations, and strategies to ensure success.

Learning Objectives After participating in this activity, the pharmacist will be able: List at least five ways in which health information technology (HIT) is predicted to improve patient care. Provide at least five ways in which patient care might be at risk as a result of the adoption of HIT. Discuss six actions that pharmacists can take to help prevent patient harm related to the implementation and use of converging technologies. List four reasons for physician resistance to HIT implementation. Name six organizations involved in the development of HIT standards. State seven ways in which HIT is expected to benefit U.S. patients.

[note: free subscription required to access CPE activities]

A nice, straightforward Continuing Pharmacy Education (CPE) activity from The American Pharmacists Association directed towards educating practicing pharmacists about the importance of HIT.

Objective: To examine whether physicians' use of information technology (IT) was associated with better knowledge of drug costs.

 

Study Design/Methods: A 2007 statewide survey of 247 primary care physicians in Hawaii regarding IT use and self-reported knowledge of formularies, copayments, and retail prices.

 

Results: Approximately 8 in 10 physicians regularly used IT in clinical care: 60% Internet, 54% e-prescribing, 43% electronic health records (EHRs), and 37% personal digital assistants (PDAs). However, fewer than 1 in 5 often knew drug costs when prescribing, and more than 90% said lack of knowledge of formularies and copayments remained a barrier to considering drug costs for patients. In multivariate analyses adjusting for sex, practice size, years in practice, number of formularies, and use of clinical resources (eg, pharmacists), use of the Internet—but not e-prescribing, EHRs, or PDAs—was associated with physicians reporting slightly better knowledge of copayments (adjusted predicted percentage of 23% vs 11%; P = .04). No type of IT was associated with better knowledge of formularies or retail prices.

 

Conclusions: Despite high rates of IT use, there was only a modest association between physicians’ use of IT and better knowledge of drug costs. Future investments in health IT should consider how IT design can be improved to make it easier for physicians to access cost information at the point of care.

Interesting article; tools such as those offered by SureScripts (http://www.surescripts.com/) will help increase provider sensitivity to pharmacoeconomic forces (both for private pay patients and patients with third-party benefits).

Nice high-level slideshow from Medscape [Registration required (free)]