There are memories that deserve resurfacing, especially those which compel a Community Pharmacist to seek purpose in alleviating patient concern and unease. At the heart of ePharmacistNow is a story experienced by every patient who has ever had to interact extensively with a healthcare professional. While working in a national drug store chain, I was drawn to an elderly patient carrying a small paper bag filled with prescription medications. The woman sought my help, desperate to make sense of what she considered an unusual circumstance. Yet, managing ones own collection of medications and the frustrations that often accompany them are not as isolated as many people think. More than 3.5 billion prescriptions are written annually in the United States (Sommers 2005) and four out of five patients who visit a physician leave with at least one prescription.
One after another, each prescription placed in front of me revealed the patient’s growing concern. She had medications prescribed by several physicians which were filled by different pharmacies, some looked different but overlapped in purpose. Medications at different dosage strengths with varying instructions, including medicines that should not be taken together because of drug interactions as well as expired ones were there to overwhelm her. In addition to her medication concerns, her guilt for monopolizing my attention away from other pharmacy-related functions provoked a feeling of remorse. As a Pharmacist, it was disturbing to witness a patient so desperate that she felt the need to apologize for a service that should be necessary in her circumstance.
The true nature of a community pharmacy often leaves its Pharmacists constrained with time and even an extensive consultation would leave them vulnerable to a backlogging of responsibilities. It is not uncommon for a patient to decline a consultation for this reason, believing that they can save time by managing their own prescriptions. However, the complexity of handling these issues increases for an individual who has various disease states with multiple medications from their physicians. As a result, physicians may become overwhelmed, believing that their prescribed medications might not be optimally used for their patient’s well being. Each year, 290 billion dollars are spent on avoidable medical cost due to medication non- adherence: hospitalization (33-69%), preventable adverse drug events (21%), and deaths (125,000 per year) (Gurwitz et.al. 2003, McCarthy 1998).
These statistics gave way to Medication Therapy Management (MTM), a pharmaceutical care service using targeted medication counseling in congruence with a comprehensive medication review system. Pharmacists engaging in Medication Therapy Management can exclusively focus on this type of effort, involving detailed care elements that a typical Community Pharmacist would not be able to adequately provide given their time constraints. The desired outcome helps patients optimize their drug therapy by allowing them to understand how their medications work best.
A study in American Society of Health-System Pharmacist (2009) shows that Pharmacists who are working with primary care providers, saved an estimated $1,123 per patient in medication claims and $472 in medical, hospital, and emergency visit costs per year. Other studies show that the delivery of this service demonstrated a return of investment (ROI) as high as $12 for every dollar spent on Medication Therapy Management (Isetts, Schondelmeyer et.al. 2008) and an average of $5 for every dollar spent. This is a conservative estimate. The ROI is likely to be much higher because practitioners routinely underestimate the impact on a patient’s life and it is difficult to put a number on high patient satisfaction.
Had I had the opportunity to sit down and talk to her without concern for time, I know I could have impacted the patient’s life in a meaningful way. Medication Therapy Management (MTM) will take Pharmacist-patient interaction to a whole new level in order to achieve positive, measurable health outcomes in a cost effective manner, allowing them to live happier, healthier and ultimately fuller lives.