Consultant Pharmacist - ASCP
Download
Report
Transcript Consultant Pharmacist - ASCP
Meeting Minutes
October 14, 2013
I. Congrats to our new liaisons
Vivian Hong and Nhu Nguyen!
II. Upcoming events
a. Speaker event with Dr. Alan Bell
i. Oct 24
ii. 6:00 – 7:30 PM
b. Omnicare Tour
i. Nov 6
ii. 1:00 – 3:00 PM
Consultant Pharmacy Practice
Mark Sey
October 14, 2013
Definition - Who is a Consultant
Pharmacist?
A pharmacist who is compensated to provide
expert advice on the use of medications by
individuals or within institutions, or on the
provision of pharmacy services to institutions.
Originated in the nursing home environment
ASCP focus - defined by their common
commitment to enhance the quality of care for
all older persons through the appropriate use
of medication and promotion of healthy aging.
The Right Answer
YOU !
Today’s Discussion
Evolution of Consultant Pharmacy
American Society of Consultant
Pharmacists
Senior care environments
Key long-term care professionals
Senior care pharmacy practice
Evolution of Consultant Pharmacy
1965- Medicare/Medicaid
– Drug regimen review required by charge nurse
and prescribing MD working together
– Consultant Pharmacist responsibilities for drug
distribution
1969 – ASCP Established
1974 – DRR required by pharmacists in NF!
Evolution of Consultant Pharmacy
1982 - Indicators developed to help
surveyors assess DRR
1980’s – Consultant pharmacists showed
their stuff!
– Practice roles more clearly defined
– Consultant’s effectiveness documented
Decreased inappropriate drug use
Fewer ADR’s
MD’s accepted CP recommendations
Evolution of Consultant Pharmacy
“Success Breeds Success” Increased mandate for
consultant’s services
1987 - Pharmacist review mandated in ICF
1988 - Pharmacist quarterly review mandated in
ICF-MR
Pharmacists published their work in Consultant
Pharmacist
People took increasing awareness of consultant
pharmacists
American Society of Consultant
Pharmacists (ASCP)
8,000 members
Numerous State chapters
National meetings – May and November
Well-respected and informative web site
Website:www.ASCP.com
Website:www.seniorcarepharmacist.com
Embraces interdisciplinary initiatives
Supported development of Commission for
Certification in Geriatric Pharmacy (CCGP)
The Continuum of Care
Caregiver Skills
High
Low
High
High
Hospital
Nursing
Facility
Assisted
Living
Low
Acuity
Cost
Subacute
Home
Health
Care
Low
The Senior Market
34.3 million individuals 65 years old and older
Nursing homes
1.8 million residents Assisted living
1.8 million residents
Other elderly
10.2 million
residents
Home care
3.5 million beneficiaries
Community-based LTC
8.5 million individuals
NORCs
8.5 million residents
Nursing Facilities
The traditional LTC environment in the U.S.
Provide care using a “medical model” that is
somewhat analogous to hospitals
Approximately 2/3 of NFs are operated for-profit
~1/2 are operated by chains –
9% bed growth compared in 2010 compared to
2009
–
–
–
–
HCR ManorCare, 38,000+ beds; 283 facilities
Golden Living, 33,000+ beds; 332 facilities
Life Care Centers of America, 31,000+ beds; 221 facilities
Kindred Healthcare, 29,000+ beds; 231 facilities
Nursing Facilities
Total number of beds 1,725,326
–
–
–
–
Medicare 77,023
Medicare/Medicaid 1,413,951
Medicaid 186,086
Noncertified 48,266
Resident payer sources
– Medicaid 65%
– Private/other 22%
– Medicare 13%
Nursing Facilities
200 beds or more
8%
100 to 199 beds
41.8%
Fewer than 50 beds
12%
50 to 99 beds
38.7%
Typical NF Patient Flow
Hospital
• Patient seen in ER for work-up
• Patient may be admitted to qualify for Medicare
Part A
• Patient worked up based on hospital criteria
• Treated and stabilized
• Set for discharge
• To nursing facility after
initial admission or
• Return to nursing facility
after brief hospitalization
Discharge
to home or
assisted living
Rehab
Short
Stay
• Return to
hospital for
acute event,
eg, fracture,
symptomatic
A-fib, etc
Long
Stay
• If needed, NF residents
will usually need to visit the
specialists
• NF attending physicians and selected
geriatric specialists see residents in
the facility
Nursing Facility
Focused View of NF Resident
• Nurses continually
monitor resident’s
health status
through the plan of
care
• Nurse
Practitioners
may see
patients for the
physician group
Nurse
Nurse
Practitioner
Rehab
Short
Stay
Rehab
Long
Stay
• Medical Directors
need to make the
best medication
choices for their
patients
Medical
Director
• LPNs need to know
how to manage NF
residents
• Consultant
Pharmacists
regularly review
medications
Nursing Facility
Consultant
Pharmacist
LPN
Assisted Living Facility Models
Hospitality
Model
Personal Care
Model
NF Alternative/
Replacement Model
Assisted Living Target Market
75-85 years of age
mostly female
$25,000 income (supports $1,6001,750/month using 75-85% of resident’s
income)
2+ ADL support
Typical AL Patient Flow
• Residents may come
from the community
or move back to the
community for
various reasons
• Resident may visit
Attending Physician,
or Attending Physician
may visit facility
Community
Attending
Physician
• If resident
becomes less
independent
or needs
short-term rehab
Nursing
Facility
Hospital
•
•
•
•
•
Assisted
Living Facility
Patient seen in ER for work-up
Patient may be admitted
Patient worked up based on hospital criteria
Treated and stabilized
Set for discharge
• Resident usually visits
specialist. Specialists
rarely visit assisted living
facility. Resident would
see specialist for
monitoring of medications
Specialist and therapies
“The goal of assisted living is
to keep them in assisted living.”
Nursing Director National
Assisted Living Provider
Assisted Living vs.
Nursing Facilities
Nursing
–
–
–
–
–
–
Facilities
Elderly population
Multiple medical dx
Multiple medications
Federal regulations
Skilled staff
Mandated DRR
Assisted
–
–
–
–
–
–
Living
Elderly population
Multiple medical dx
Multiple medications
Regulated by State
Less skilled staff
DRR mandate varies
Key LTC Professionals
Administrator
Medical Director
Attending Physician
Consulting Physician
Nurse Practitioner/ Physician’s Asst.
Nursing Staff
–
–
–
–
–
–
Director of Nursing (DON)
Charge Nurse, Head Nurse
Nursing Supervisor
MDS Nurse
Staff Nurse
Nurse Aides
Key LTC Professionals
Pharmacists – consultant and dispensing
Therapy Staff (physical and occupational
therapy)
Dietitian
Activity Directory
Social Services
Geriatric Case/Care Managers
Staff development coordinator
Family members
LTC Pharmacy Landscape
OmniCare 1,400,000 NF/ALF beds
PharMerica Corp. 360,000 NF beds
Regional pharmacy providers
– Green Tree, South Central Illinois
Smaller pharmacy providers
New, evolving provider and consultant
companies, some specializing in AL
Independent consultant pharmacists
LTC Pharmacy Services
Drug Distribution
Services
Consultant Pharmacy
Services
Pharmacy Providers Services
Efficient and accurate distribution
– Emergency kits
– medication administration record
Standardized services between facilities
Improve pharmaceutical care
– formulary
Pharmacy providers influence market share
–
–
–
–
Consultant pharmacists recommendations
Formulary preferred products
Disease management initiatives
Educational initiatives
What is a Consultant
Pharmacist?
A patient advocate for best clinical care
Licensed by state to practice pharmacy
No degree requirement
No specific credentials required by most
States
Typically involved in many activities
LTC Pharmacists
Employment Model
LTC Pharmacists
Practice Involvement
Consultant Pharmacist’s
Domain
Pharmaceutical care
Medication-related problems
Appropriate use
Medication Regimen Review “MRR”
Anything drug-related
– Side effects, dosage, switch to alternative
products, monitoring, add drug for untreated
indication, etc.
Pharmacists
Practice Activities
Medication Regimen Review
Resident-specific
Pharmacist-conducted
Required in all NFs as a Medicare/Medicaid
Condition of Participation and by OBRA ‘87
Performed at least monthly
Retrospective or prospective
Encourage appropriate medication use
Provide optimal Pharmaceutical Care
Components of Effective
Medication Regimen Review
Interdisciplinary
Concise
Accurate
Neat
Non judgmental
Well documented
Evidence-based
Referenced when
necessary
Follow up included
MRR Challenges for
Pharmacists
Adequate training
Clinical skills and experience
Exploding knowledge base
Recognition/Cooperation
Adequate reimbursement
Work load
Thank-you!