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THE FUTURE OF PHARMACY

VOL 28, NO.1 - JUNE 2012

a n d p a r t i c ip at e in commit t e e s for nur sing hom e ser v i c e s . Phar ma c is t s ’ role in the c a r e of old e r adult s in the ho sp it a l , sub - a cut e c a r e unit s , a nd a s sis t e d li v ing env ir o nm e nt s a re incr e a sing . Phar ma c y ser v i ce s a re ren d e r e d a s a pa r t of an int e r dis c ip lin a r y t e a m . Whe n p at i e nt s a re tr a ns fe r r e d bet we e n dif fe r e nt lo c at i o n s , pha r m a c is t s play an int e gr a l role in co o r din at ing dr ug ma na ge m e nt s . B et t e r communi c a - t i o n s y s t e m s that allow sha r ing of info r m at i o n sho ul d b e de v e l o p e d to enha n ce opt im a l us e and s afet y of dr ug s acro s s p at i e nt c a r e set t ing s . 9

Effective education to improve compliance T h e comp l e x nat ur e of me dic at i o n comp li a n c e is su e s sug ge s t s that the r e is not like l y to b e any quic k or simp l e rem e di e s for the non - c o mp li a n c e . 1 0 A numb e r of sug ge s t i o n s hav e b e e n of fe r e d by va r io us re s e a r c h e r s . Hayne s ha s point e d out that any ef fo r t s to imp r o v e comp li a n c e sho ul d t a r ge t onl y tre at - m e nt for whic h the r e is re a s o n a b l e e v id e n c e of the r a p e ut i c ef fic a c y. 1 1

E d u c a t in g Pat i e nt s a n d He a lt h C a r e Pr o v i d e r s Pharma c is t Le v e l: Patient e du c at i o n ha s b e e n sug ge s t e d a s a pr im a r y me a ns of imp r o v ing p at i e nt comp lia n c e , a nd ha s b e e n show n to b e succe s s f ul in ma ny c a s e s . Howe ve r, a s Flavo ha s de s c r ib e d p at i e nt e du c at i o n is not simp l y rep e at ing dir e c t i o n s or ha n ding out pr int e d mat e r i a ls . It is a pro ce s s invo l v ing sk ills in dat a gat h e r ing ; indi v i du a li z at i o n of ins t r u c t i o n s ; pro mpt ing a nd sup p o r t a nd e v a lu at i o n a nd foll o w - up of the p at i e nt ’s suc - c e s s in imp l e m e nt ing the tre at m e nt regim e n . 1 2 T he p at i e nt s a re enco ur a ge d to e x p r e s s their p oint s of vie w so that he a lt h c a r e pro v i d e r s may b e s t de ci d e what st r at e gi e s will b e mo s t app r o p r i at e to imp r o v e comp li a n c e .

T he pro ce s s of p at i e nt e du c at i o n c a n b e mor e ef fe c t i v e , if inco r p o r at e d int o the da il y int e r a c t i o n s of each p at i e nt enco unt e r a nd c a n ac t ua ll y s av e tim e by incr e a sing p at i e nt comp li a n c e . Fewer c a lls or visit s to the phy si c i a n or pha r m a - c is t , a s well a s ot h e r b en efit s of comp lia n c e such a s avoi ding ho sp it a li z at i o n , may re sult if pro p e r e du c at i o n a l te chni qu e s a re emp l oy e d ea r l y in the the r a p y. 13

P ub li c Edu c a t i o n Pr o g r a m s : T h e r e a re ma ny opt io n s av a ila b l e to pro m ot e progr a mm e s for info r ming a nd e du c at ing eld e r l y p at i e nt s a b o ut me dic at i o n is su e s . One such progr a mm e is “Elder-Ed and Elder he a lt h progr a m s ” con du c t e d by Univer sit y of Mar yla n d ’s sch o o l of pha r m a c y in 19 8 3 , in whic h ret ir e d pha r m a c is t s a re te a m e d wit h pha r m a c y stu d e nt s in pro v i ding couns e ling to senio r cit i ze n s in gro up set t ing s . In this progr a m , pha r m a c y stu d e nt s a re re quir e d to for m relat i o n ship s wit h the eld e r l y p at i e nt s by visit ing the m per io di c a ll y to help e du c at e the m ab o ut their me dic at i o n s . In this way, the stu d e nt le a r n s the b e s t fro m senio r pha r m a c is t s a nd is in tur n able to ha n dl e som e of the pro b l e m s eld e r l y p e o p l e fa ce wit h me dic at i o n regim e n s . Other simila r progr a mm e s e x is t , init i at e d by T he Nationa l Council on Patient Info r m at i o n a nd Educ at io n (NCPIE) in whic h

the Council emp l oy s pub li c ser v i c e a nn o un c e m e nt s , e du c a - t i o n c a mp a ign s , a nd sp e c i a l e ve nt s such a s the “ Ta lk a b o ut pre s c r ipt i o n mont h ” to ra is e pub li c awa r e n e s s a b o ut pro b - l e m s a s s o c i at e d wit h pre s c r ipt i o n me dic at i o n . 1 4

Us in g Co mp li a n c e A i d s T h e r e is a wide ra nge of comp li a n c e a ids av a ila b l e via ele c- t r o ni c a nd me ch a ni c a l de v ic e s that hav e the pot e nt i a l to help to imp r o v e adh e r e n c e a nd comp li a n c e . 15 T he s e r a nge fro m simp l e cha r t s a nd re co r ds of me dic at i o n us e to sop his t i c at e d Glow - e l e c t r o ni c b ot t l e c a p s that hav e ala r m s a nd fla shing indic at o r s to ale r t a pat ie nt whe n a do s e is due . Complia n ce a ids c a n ra nge in pr ice fro m a fe w cent s to 3 0 0 dolla r s for a Glowc a p . 1 6 Such aids may b e us ef ul for p at i e nt s wit h mem o r y imp a ir m e nt or p at i e nt s on a comp l e x me dic at i o n regim e n .

Other st r at e gi e s a nd pro p o s a ls that c a n imp r o v e p at i e nt comp li a n c e inclu d e : t 1SPWJEJOHSFNJOEFSDBSETGPSSFmMMJOH t 1SPWJEJOHXSJUUFOPSQSJOUFEJOGPSNBUJPOUIBUJTFBTZUP

rea d (Poster s) ; t ,FFQJOHNFEJDBUJPOIJTUPSJFT t 3FHVMBSDPOTVMUJOHUIFQBUJFOUT t 4JNQMJGZJOHUIFSFHJNFOBTNVDIBTQPTTJCMF t *OWPMWJOHGBNJMZNFNCFSTJOTVQQPSUBOETVQFSWJTJPOSVMFT t %FNPOTUSBUJOHUIFQSPQFSUFDIOJRVFTGPSFGGFDUJWFVTBHF

of app li c at i o n a pp a r at us a nd t 6TJOHQJDUPHSBNTGPSFGGFDUJWFDPVOTFMJOH

In the old e r p op ulat i o n , it is als o imp o r t a nt to a s s e s s p at i e nt s for cognit i v e defic it s whic h may imp a ir their a bilit y to re c a ll do s e s a nd the tim e s at whic h the y sho ul d b e t a ke n . Under the s e cir cum s t a n c e s , enlis t ing the a s sis t a n ce of fa mil y, c a r e t a ke r s or ot h e r so cia l sup p o r t may b e ne ce s s a r y. In the ab s e n c e of a c a r e r, us e of c a le n d a r p a ck s or ala r m clo c k s to ser v e a s remin d e r s may b e emp l oy e d . 1 7

Howe ve r, st r at e gi e s emp l oy e d to imp r o v e p at i e nt comp li a n c e hav e b e e n show n to b e ef fe c t i v e onl y ins of a r a s the y are mat c h e d to indi v i du a l p at i e nt ne e ds .

Reducing expenditures and cost 1 8 Pha r m a c i s t ’s may co o r din a t e a n d opt im i s e dr ug t h e r a p y to imp r o v e out c o m e s by re du c in g t h e co s t s a n d e x p e n di t ur e by : t 5BSHFUJOHQBUJFOUTUBLJOHVOOFDFTTBSZNVMUJQMFQSFTDSJQ -

t i o n s t h at c a n c a u s e s e r i o u s ha r m a n d wa s t e v a lu a b l e re s o ur c e s . t 3FEVDJOHUIFOVNCFSPGUIPTFBUTFSJPVTSJTLPGTJEFFGGFDUT

f r o m me di c in e s co n si d e r e d in a p p r o p r i a t e fo r us e in el d e r l y p at i e nt s . t $PMMBCPSBUJOHXJUIQIZTJDJBOTJOPSEFSUPPQUJNJTFESVH

t h e r a p i e s by in c r e a s in g t h e us e of me di c a t i o n s co n si d e r e d to b e b e s t fo r in di v i d u a l pr a c t i c e s . t 1SPWJEJOHUIFSBQFVUJDJOUFSDIBOHFGPSDFSUBJONFEJDJOFTUP

p r o v i d e e qu a l or b et t e r clini c a l out c o m e s .