Transcript Evolving Patient Care: The Pharmacist`s Role

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
 Describe community pharmacy consultations and
what pharmacists are discussing with your patients
 Discuss new medications and regulations
Pharmacy Past
Pharmacy Present
‘Well Experience’ model
Pharmacy Future
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
Path to PharmD
 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
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
Counseling your patients
Disease
state
specific
Maintenance
meds
Surgery
meds
Pre-op
meds
OTC
Adherence
 $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
Disease state specific counseling
 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
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/APAP combo
Hydrocodone
Vicodin
Lortab
Norco
5mg
5mg/500mg
5mg/500mg
5mg/325mg
7.5mg/500mg
7.5mg/325mg
10mg/500mg
10mg/325mg
5mg/300mg
7.5mg
7.5mg/500mg
7.5mg/300mg
10mg
10mg/500mg
10mg/300mg
Hydrocodone/APAP combo
Hydrocodone
Vicodin
Lortab
Norco
5mg
5mg/500mg
5mg/500mg
5mg/325mg
7.5mg/500mg
7.5mg/325mg
10mg/500mg
10mg/325mg
5mg/300mg
7.5mg
7.5mg/500mg
7.5mg/300mg
10mg
10mg/500mg
10mg/300mg
Maintenance Products
 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)
Meds that affect oral health
 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
 Anticholinergics
 oxybutinin,
diphenhydramine,
dicyclomine, atropine
Decreased saliva flow
 amitriptyline, doxepin,
desipramine
Increased risk for gingivitis
& halitosis
 Antidepressants
 Diuretics
 hctz, furosemide
 Stimulants
 pseudoephedrine
 Antipsychotics
 chlorpromazine,
thioridizine, clozapine
Typically dose related
Meds that affect oral health
 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%)
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
New Developments in medicine
 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
Multidisciplinary approach
to patient care
 Improve adherence
 Improve outcomes
 Improve quality of life
[email protected]
Thank you!!!