evolving patient care: the pharmacists’ role
DESCRIPTION
Evolving Patient Care: The Pharmacists’ Role. Jessica Haskins-Cummings, PharmD Pharmacy Manager, Walgreens. Objectives. Describe current trends in the pharmacy profession Explain the development of pharmacists and their evolving role in a multi-disciplinary patient care team - PowerPoint PPT PresentationTRANSCRIPT
Evolving Patient Care: The Pharmacists’ Role
Jessica Haskins-Cummings, PharmD
Pharmacy Manager, Walgreens
Describe current trends in the pharmacy profession
Explain the development of pharmacists and their evolving role in a multi-disciplinary patient care team
Describe community pharmacy consultations and what pharmacists are discussing with your patients
Discuss new medications and regulations
Objectives
Pharmacy Past
Pharmacy Present
‘Well Experience’ model
Pharmacy Future
More multidisciplinary team approach to patient care
Reimbursement based on outcomes and readmission rates
Clinical services outside of traditional pharmacy practice
Personalize and optimize therapy
Pharmacy Future
All PharmD graduates now Basics still there: medicinal chemistry,
pharmacokinetics, pharmaceutics, pharmacodynamics 2 years pre-pharm, 4 years pharmacy school Residency and fellowships are more common
Multidisciplinary professional development throughout school (longitudinal assessment) AACP and ACPE accreditation standards
Extern-type rotations throughout school More direct patient contact More interaction with different facets of the healthcare
system
Path to PharmD
Path to PharmD
Graduates expect more from the workplace in clinical, retail,
hospital, and specialty pharmacy
Private consultation/ immunization rooms Clinical decision making
in rounds Clinical services:
health testing Medication Therapy
Management immunizations specialty drug therapy
More involvement in patient care
Bedside consultations before discharge Reassurance and
integrating new therapy to current lifestyle
Retail ‘window’ consults Balance of optimal
therapy, lifestyle changes, insurance limitations, and customer service
Comprehensive Medication Therapy Management (MTM, ‘brown bag’ consult) Thorough sit-down
therapy optimization
Pre-op
meds
Disease state specifi
c
Surgery
meds
Maintenance meds
Counseling your patients
$100 billion per year in hospital admissions due to poor medication adherence.
Percentage of patients with chronic illness that DO NOT take medications as prescribed: 40-50% 22% take less than the amount prescribed 2/3 do not take any of their medication, but fill
them 12% do not even fill their prescriptions
Adherence
Diabetes Mellitus: Severe hyperglycemia with insulin resistance,
ketoacidosis Increased risk for gum disease and tooth decay
Blood disorders: Leukemia, sickle-cell anemia Increased risk of gingivitis
Immunocompromised patients: Sjorgen’s syndrome, viral infections Increased risk for oral disease
Pulmonary conditions: TB, purulent infections, tonsillitis, rhinitis Increased risk for halitosis
Renal or hepatic failure Increased risk for gum disease and tooth decay
Disease state specific counseling
Pre-op Regimen
Antibiotic prophylaxis Controversial in
recommendations Case-by-case situations Pharmacist role
Proper timing of therapy Side effects and how to
minimize Monitoring for interactions
and allergic reaction history
Oral Antithrombotics Anticoagulants
Coumadin, Jantoven (warfarin)
Eliquis (apixaban) Pradaxa (dabigatran) Xarelto (rivaroxaban)
Antiplatelets Aspirin Effient (prasugrel) Brilanta (ticagrelor) Plavix (clopidogrel)
Surgery Meds Anesthesia/ Sedation Anti-anxiety Anti-inflammatories Pain relievers
Mepergan Fortis: no longer available
FDA & DEA request to have hydrocodone reclassified to a scheduled 2 controlled substance
Hydrocodone
Vicodin Lortab Norco
5mg 5mg/500mg 5mg/500mg 5mg/325mg5mg/300mg
7.5mg 7.5mg/500mg 7.5mg/500mg 7.5mg/325mg7.5mg/300mg
10mg 10mg/500mg 10mg/500mg 10mg/325mg10mg/300mg
Hydrocodone/APAP combo
Hydrocodone
Vicodin Lortab Norco
5mg 5mg/500mg 5mg/500mg 5mg/325mg5mg/300mg
7.5mg 7.5mg/500mg 7.5mg/500mg 7.5mg/325mg7.5mg/300mg
10mg 10mg/500mg 10mg/500mg 10mg/325mg10mg/300mg
Hydrocodone/APAP combo
Muscle relaxers & anti-inflammatories Rx Only fluoride supplements
>1500 ppm total fluorine OTC prevention:
Stannous fluoride: inhibits bacterial growth Triclosan: inhibits prostaglandins
Artificial saliva products (Salivart)
Maintenance Products
Chemotherapeutics, immune modulators, head / neck radiation therapy Oral mucosal symptoms delayed after therapy Preventative therapy warranted: chlorhexadine
rinse, sucralfate suspension, allopurinol mouthwash, strict adherence to oral care regimen
Amifostine (Ethyol) concomitant therapy – scavenger of free radicals
Oral pilocarpine – stimulates salivary secretions
Meds that affect oral health
Meds that affect oral health
Anticholinergics oxybutinin,
diphenhydramine, dicyclomine, atropine
Antidepressants amitriptyline, doxepin,
desipramine Diuretics
hctz, furosemide Stimulants
pseudoephedrine Antipsychotics
chlorpromazine, thioridizine, clozapine
Decreased saliva flow
Increased risk for gingivitis & halitosis
Typically dose related
Procardia, Nifedical (nifedipine) Overgrowth of gums onto teeth
Sandimmune (cyclosporine) Swollen, painful, red gums
Dilantin (phenytoin) Swelling, bleeding of gums
Inhaled corticosteroids (Advair, Qvar, Flovent) Increased risk for thrush
Bisphosphonates Osteonecrosis (IV 94% vs oral 6%)
Meds that affect oral health
OTC medications – what are your patients finding at their drugstore?
Fluoride products Topical anesthetics Peroxide & pain-relief washes Dry mouth products Nightguard Filling repair kits Whiteners Floss Sensitivity products Denture products Dental wax
Myrbetriq: overactive bladder Sores, ulcers, or white spots in the mouth or on
the lips Dry mouth
Tudorza Pressair: bronchodilator Dry mouth Fruit-like breath odor
Zetonna: allergic rhinitis White patches inside nose or throat
New Developments in medicine
Improve adherence Improve outcomes Improve quality of life
Multidisciplinary approach to patient care
Thank [email protected]