Transcript - The Oregon Hospice Association

Hospice Pharmaceutical Care
2015 and Beyond
Mary Mihalyo, PharmD, CGP, BCPS, CDE
Oregon-Washington Spring Intensive
Vancouver, Washington
23 March 2015
Pharmaceutical Care
The direct, responsible provision of medicationrelated care for the purpose of achieving
definite outcomes that improve a patients
quality of life.
Medication related + Care related + Outcome related
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ASHP Statement on Pharmaceutical Care
Am J Hosp Pharm 1993;50,1720-3
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Medication related
Includes decision to or not to use medications as
well as judgements regarding medication
selection, dose, route, frequency and method
of administration plus patient education.
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ASHP Statement on Pharmaceutical Care
Am J Hosp Pharm 1993;50,1720-3
3
Care related
The pharmacist providing direct personal
concern (i.e. care) for the well-being of another
person just as nursing and medicine does.
Integrated, collaborative and cooperative
domains of care including medical care, nursing
care and pharmaceutical care.
ASHP Statement on Pharmaceutical Care
Am J Hosp Pharm 1993;50,1720-3
Outcome related
• Identifying potential and actual medicationrelated problems
• Resolving actual medication-related problems
• Preventing potential medication-related
problems
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ASHP Statement on Pharmaceutical Care
Am J Hosp Pharm 1993;50,1720-3
5
Medication-related problems
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Untreated indication
Improper medication selection
Subtherapeutic dosage
Failure to receive medication
Overdosage
Adverse drug reaction
Drug–Drug and Drug-Food Interaction
Medication use without an indication
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ASHP Statement on Pharmaceutical Care
Am J Hosp Pharm 1993;50,1720-3
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Hospice CoPs 2008
• Defined the role of the pharmacist for
Hospice.
• As an industry, have we met the CoPs ?
• Let’s take a look at select sections…
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Medicare Part D & Hospice
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Was reform necessary?
Has continuity improved?
Have outcomes improved?
Medicare Part D reform affirmed the right of
hospices to use a formulary and resulted in
approximately 25% increase in the cost of
medications for the hospice industry.
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Medication Cost
What is cost?
Cost is defined by the buyer!
Pharmacy
Hospice
Cost is NOT average wholesale price !
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Are Medication Costs Rising?
Yes, at rates never seen before….
Brand name medications:
Generic medications:
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Why Medication Prices Are Rising
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Industry consolidation
Drug shortages
Raw material shortages
Unanticipated demand
Manufacturing difficulties
Regulation
Business and economic issues
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Medication Price Increases
Medication
Approximate Hospice Cost
2013
Approxiate Hospice Cost
2014
Amitriptyline 100mg Tablet $4.00
$91.00
Atropine Opth. Soln 1%-5
$21.00
$9.00
Erythromycin Estolate Susp $25.00
400 mg/5ml; 240 ml
$350.00
Morphine 60 mg ER; #100
$75.00
$125.00
Morphine 20 mg/ml; 30ml
$9.00
$18.00
Nystatin Susp 100,000 U
240 ml
$25.00
$42.00
Oxycodone 20 mg/ml;30ml $57.00
$284.00
Tetracycline 250 mg cap
#100
$236.00
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$3.50
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Necessary Hospice Infrastructure
Pharmacotherapeutic Support System
3 Essential Components:
a. Pharm D
b. Preferred Drug List
c. Pharmacy & Therapeutics Committee
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PharmD
“My Hospice can’t afford to hire a pharmacist!”
Really?
“Your Hospice can’t afford not to hire a
pharmacist!”
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Hospice PDL
Composed by symptom and by medication.
Must be a dynamic document
Patient specific!
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P & T Committee
Multidisciplinary hospice stakeholders meet on a scheduled
basis to oversee all issues relative to hospice medication use.
• Adding or deleting medications from PDL
• Adverse drug reaction reporting
• e-Prescribing protocol
• Medication diversion and error review
• Medication cost per patient day
• Patient education tools
• Pharmacy QA
• Symptom management algorhythms
• Therapeutic interchange
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Hospice Preferred Drug List
Please see sample provided
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Adverse Drug Reaction Reporting
Required by JCAHO!
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e-Prescribing Protocol
e-Prescribing of controlled substances, including
CII is now legal is 48 states.
Regulations may vary, state by state.
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Medication Diversion & Error Review
• Individual states are now imposing new
regulations aimed at preventing diversion of
opioids from the home of hospice patients.
– Example: State of Virginia now requires hospice to
report patient death to the distributing pharmacy
of record.
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Benchmark Medication Costs
• National PPD goal = $8.00
– Post Medicare Part D reform = $10.00 ?
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Patient Education Tools
• Hospice patient population medication
specific written material left in the home for
patient and care giver education.
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Pharmacy QA
• Pharmacy dispensing error reporting
• Patient satisfaction
• Nurse satisfaction
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Therapeutic Interchange
Defined as the dispensing of a drug that is
therapeutically equivalent to but chemically different
from the drug originally prescribed by a physician or
other authorized prescriber.
Example: Substitution of ipratropium bromide
inhalation solution(Atrovent)® for Spiriva® or Tudorza®
Example: Substitution of oral prednisone 10 mg per day
for Pulmicort® nebulization solution.
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ACCP Position Statement: Guideline for
Therapeutic Interchange 2004
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Therapeutic Interchange
• Although usually of the same pharmacologic
class, drugs appropriate for therapeutic
interchange may differ in chemistry or
pharmacokinetic properties, and may possess
different mechanism of action, adversereaction, toxicity, and drug interaction
profiles.
• In most cases, the interchanged drugs have
close similarity in efficacy and safety profiles.
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ACCP Position Statement: Guideline for
Therapeutic Interchange 2004
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Symptom Management
Algorhythms
Please see sample provided
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Remember:
“It is neither immoral nor
unethical to think about the cost
of therapy!”
-Methadone Mary, 1998
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Questions?
[email protected]
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