Pharmacies - both hospital and independent retail - are becoming a more integral part of the health care delivery chain as the industry shifts to value-based care models. No other link in that chain comes in more contact with patients than do pharmacies. These eight recent need-to-know developments provide hospital and independent pharmacies with insights on how they can contribute to industry transformation as well as take advantage of those opportunities to improve their own financial health.

Medication Adherence

Poor adherence major contributor to inability of diabetic patients to control blood sugar levels

A comprehensive review of scientific and medical literature concluded that poor medication adherence in patients with type 2 diabetes is a major contributor to their inability to control their own blood sugar levels. Researchers from the Behavioral Diabetes Institute published their review in the journal Patient Preference and Adherence. The researchers said two “modifiable factors” influence medication adherence by type 2 diabetic patients: treatment burden and treatment-related beliefs. Treatment burden includes complexity, convenience, out-of-pocket costs and hypoglycemia risk. Treatment-related beliefs include perceived treatment efficacy, medication beliefs and trust in providers. They said most interventions to date have focused on the former --treatment burden --and more need to be focused on the latter - treatment-related beliefs - to turn the situation around. They advocated for effectively communicating the benefits and risks of treatment with patients, addressing their treatment concerns, engaging in shared medical decision-making and providing self-management training and counseling. “It is apparent that addressing problematic medication adherence in the T2D population offers the potential for dramatically reducing costs and improving care and outcomes for patients,” the researchers concluded.

54% of diagnostic laboratory tests detected “inconsistent” use of prescribed medications

That's according to the Prescription Drug Monitoring Report 2016 by Quest Diagnostics. Quest looked at more than 3 million de-identified patient lab test results over a five-year period from 2011 through 2015, and determined whether the medications detected in patients were consistent with patients' diagnoses. In 54 percent of the cases, the prescription medications detected were inconsistent with the patients' diagnoses. Of those inconsistent cases, 45 percent involved finding of one or more additional medications, 32 percent involved finding no medications at all and 23 percent involved finding different medications than the ones prescribed. Among the possible causes of lack of adherence were patients not taking their prescribed medications because of undesirable side effects, their symptoms subsided or they couldn't afford the medications.

61% of patients say their conversations with their cardiologists over heart meds lacking

A survey of 21 cardiologists at four practices and 66 of the physicians' patients found that the two sides rarely are on the same page regarding medication adherence. Results of the survey, conducted by researchers from Northwestern University's medical school, appeared in JAMA Cardiology. Some 61 percent of the patients said they rarely or never discuss adherence to heart failure medications with their physicians. Of those, 13 percent had poor adherence and 55 percent had moderate adherence. 67 percent of the doctors disagreed or strongly disagreed with the statement: “I am aware of how often my patient misses a dose of medication.” Among the reasons cited by the cardiologists for not discussing medication adherence with patients were lack of time and the need to discuss other clinical issues with patients.

Medication Reconciliation

Nearly 50% drop in hospital readmission rate from pharmacist-led medication reconciliation program

A medication reconciliation program initiated by a health plan and executed by pharmacists reduced the hospital readmission rates of health plan enrollees who participated in the program. That's according to a study in the journal Health Affairs. The health plan identified newly discharged enrollees at high or moderate risk of being readmitted to the hospital within 30 days based on their medical conditions and number of prescription medications. The pharmacists conducted medication reconciliation consultations at home visits with enrollees at high risk and by phone with enrollees at moderate risk. Among the medication problems identified and corrected during the consultations were medications omitted from discharge instructions, medications that should have been prescribed based on clinical guidelines and potentially harmful drug interactions. Some 12.2 percent of the 131 enrollees in the program in 2013 were readmitted to the hospital for any reason within 30 days of initial discharge compared with 22.1 percent of a comparable group of enrollees not participating in the medication reconciliation program.

Nine steps to minimize polypharmacy and improve drug safety for heart failure patients

The American Heart Association published in its journal Circulation a comprehensive list of prescription, over-the-counter and complementary and alternative medications that can cause or exacerbate health failure in patients already suffering from heart disease. Polypharmacy, which the 39-page report defined as the long-term use of five or more medications, is a “significant concern” in heart failure patients because it's common for them to be suffering from other multiple chronic medical conditions. Topping the report's list of steps to reduce the risk is a call for providers to conduct “comprehensive medication reconciliation at each clinical visit and with each admission.” Further, “Patients should be specifically asked about drug, dose and frequency of all their medications, including OTC medications and CAMs. If possible these should be verified with the pharmacy or prescriber,” the report said.

Antibiotic Stewardship

39% of hospitals have antibiotic stewardship programs that meet best practice standards

A study in the journal Clinical Infectious Diseases found that only 39 percent of the nearly 4,200 U.S. hospitals looked at for the study had antibiotic stewardship programs that met all seven core elements of an effective program as defined by the CDC. Among the seven core elements are drug expertise (appointing a single pharmacist leader who is responsible for working to improve antibiotic use) and tracking (monitoring antibiotic prescribing and resistance patterns), according to the CDC. The researchers said their findings reveal that hospital antibiotic stewardship program implementation “varies” across the U.S. but that “comprehensive ASPs can be established in facilities of any size, and hospital leadership support for antibiotic stewardship appears to drive the establishment of ASPs.”

Eight performance measures included in new Joint Commission antimicrobial stewardship standard

The Joint Commission has published a new antimicrobial stewardship accreditation standard for hospitals and long-term care facilities. The new standard, which takes effect on Jan. 1, 2017, features eight “elements of performance” that hospitals and long-term care facilities must meet to pass the standard. Among the elements are the creation of an antimicrobial stewardship multidisciplinary team that includes an infectious disease physician, infection preventionist, pharmacist and practitioners and a program to educate patients and their families on the appropriate use of antibiotics. As quoted by the American Society of Health-System Pharmacists, Margaret VanAmringe, the Joint Commission's executive vice president, said the new standard was created “to ensure that healthcare organizations have an identifiable antimicrobial stewardship program.”

Pharmacy Technology

$887.8 million global e-prescribing market in three years

The worldwide market for e-prescribing systems that operate on computers or mobile devices like smartphones and tablets is projected to will reach $887.8 million by 2019, according to the Global Market Study on E-Prescribing: North America to Witness Highest Growth by 2019 report released by Persistence Market Research. That's up from $250.3 million in 2013, with the market enjoying an average annual growth rate of 23.5 percent. Like the growth in the CPOE market, the primary drivers of the growth in the e-prescribing market are the need to improve the efficiency of care delivery and at the same time reduce medication errors, the report said.

Unable to cast object of type 'System.DBNull' to type 'System.String'.   at McKesson.ImageHelper.getImageDesc(String URL)

About the author

McKesson editorial staff is committed to sharing innovative approaches and insights so our customers can get the most out of their business solutions and identify areas for operational improvement and revenue growth.