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)]

Clinical Pharmacy Services

Specific to clinical pharmacy services, the law provides for:

MTM Grant Programs. The new law establishes a stand-alone grant program to ensure pharmacist-provided MTM services as defined by the pharmacy profession’s consensus definition on the Core Elements of an MTM program. The program ensures the testing of practice and care delivery models, such as patient-centered self-management programs, that improve patient outcomes through team-based collaborations between prescribers and pharmacists.

Integrated Care Models. The law also includes provisions to ensure that providers with expertise in pharmacotherapy, including pharmacists, are fully engaged in integrated, collaborative, team-based approaches to delivering care, including medical homes, accountable care organizations, community health teams, and home-based chronic care programs.

Transitional Care Activities. The law recognizes the gaps in care coordination and communication that often occur when patients are transferred from one care setting to another. Problems arising from inappropriate medication use are a primary reason for hospital readmissions. Pharmacists—by helping manage pharmacotherapy as part of a transitional care team—will be able to play major roles in preventing these events. Transitional care activities might include medication reconciliation, improved use of personal medication records, and discharge planning that may include MTM services.

Medicare Advantage Plan Incentives. The law provides bonus payments to Medicare Advantage plans that conduct care coordination and management activities. In particular, it acknowledges the need for MTM programs to address medication use issues such as poly-pharmacy through medication reconciliation, periodic reviews of drug regimens, and integration of medical and pharmacy care for chronically ill, high-cost beneficiaries.

Workforce. The law establishes a National Health Care Workforce Commission that will study health care workforce supply issues and make recommendations to Congress.

A nice summary from the American College of Clinical Pharmacy (ACCP) regarding the clinical pharmacist provisions in the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872).

The National Institute of Mental Health (NIMH), which funded some of the accused individuals, has initiated an internal review system to detect potential problems with the management of financial conflicts of interest and has implemented changes to minimize possible bias in its funded studies. More broadly, the NIH is substantively revising its regulations on financial conflict of interest, which were originally adopted in 1995. The proposed new regulations are slated to be available for public comment in early spring 2010. But one of the largest effects of this scandal has been to raise a difficult and still unanswered question about the integrity of psychiatrists. Is the financial conflict of interest problem worse for psychiatrists or are psychiatrists just an easy target? A review of evidence is in order

Thoughtful editorial that suggestions caution regarding some of the current relationships that exist today. More transparency is the rule of the day.

Full text [HTML; subscription required]: http://jama.ama-assn.org/cgi/content/full/303/12/1192

FDA is recommending that healthcare professionals temporarily suspend the use of Rotarix, a vaccine used to prevent rotavirus disease. FDA’s recommendation is a precaution taken while the agency learns more about the situation.

FDA has learned that DNA from porcine circovirus type 1 (PCV1) is present in Rotarix. PCV1 is not known to cause disease in humans. There is no evidence at this time that this finding poses a safety risk. Because available evidence supports the safety of Rotarix, no medical follow-up is needed for patients who have been vaccinated with Rotarix.

There are two licensed vaccines for rotavirus in the United States: RotaTeq and Rotarix. For children who have received one dose of Rotarix, CDC advises that clinicians can complete the series with RotaTeq for the next two doses.

Additional information, including information for healthcare professionals and parents, is provided in the document below.

[03/22/2010 - Update on Rotarix Vaccine¹ - FDA]

    

Important information from the FDA; please disseminate!

While we work to refine the Google Health product, we also continue to pursue integration agreements with providers to make it even easier for people to access their own medical information. We've learned over these past two years that getting a current and past medication history assembled and ready in case of emergencies is one of the strongest value propositions for using an online Personal Health Record (PHR). So today at HIMSS, we're announcing an integration with Surescripts, the leading electronic prescribing network in the United States, to help accelerate the availability of prescription drug history to our users. The Surescripts network connects doctors who prescribe medication to all of the nation’s major pharmacy chains, leading health insurance plans and pharmacy benefits managers (PBMs), as well as more than 10,000 independent pharmacies nationwide. Surescripts provides access to prescription benefit and history information on behalf of health insurance plans representing 65 percent of patients in the U.S.

I am glad to see this announcement as we need more integration and development of PHRs.

Keep Pharmacy-Related Provisions in the Final Version of Health Care Reform Legislation

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Act now to make sure that the interests of our patients, and profession, are protected in this historical legislation.

Senate Bill 1046 RSS feed for this bill

Relating to prescriptive authority for licensed psychologists; declaring an emergency.

Authorizes Oregon Medical Board to issue certificate of prescriptive authority to certain licensed psychologists and sets forth requirements and procedure for issuance of certificate.

This bill has passed the House and the Senate. Please contact Oregon Governor Kulongoski to express your concerns with this bill: http://governor.oregon.gov/Gov/contact_us.shtml

Under pressure from out-of-state interests, our Legislature is about to consider passage of Senate Bill 1046, enabling psychologists to prescribe medication. This bill would jeopardize the safety of our citizens while creating unnecessary costs. The work group proposing the bill held only five sessions, without public testimony. Remarkably, one member of the work group was from California (and required a temporary Oregon license to participate) and heads a distance-learning post-doctoral psychology training program in clinical psychopharmacology that stands to benefit from the bill's passage. I hope that the Legislature will defer judgment on such an important issue to a regular session during which full and open testimony can be offered.

I am not in favor of this kind of legislation, which I think sets a dangerous precedent. I agree with the author of this editorial that it would be interesting to see if this actually expands care into rural and undeserved populations.

Instead of increasing the scope-of-practice for this profession, I feel a better option would be to encourage the expansion of professionals already credentialed to provide medication therapy.