EMERGING TREND


ACHIEVING THERAPEUTIC OUTCOMES WITH SAFE AND EFFECTIVE MEDICATIONS


PHARMACISTS AS


INTERVENTIONISTS By: Randy McDonough, PharmD, M.S., CGP, BCPS, FAPhA, Chief Executive Offi cer, Towncrest Pharmacy Corp., Iowa City, IA


I


remember reading, for the fi rst time, about pharmaceutical care in my early career and the importance of pharmacists taking responsibility as the drug therapy expert.1


Reviewing the statistics on drug-related morbidity and mortality


caught my attention that there is a problem in our country with drug misadventures.2-3 T is was further highlighted in 2016 when I read that the US spent $329 billion on prescription drugs and yet another $528.4 billion was spent on non-optimized medication therapy.4-5


T is means that for


every dollar spent on prescription drugs, our country spends another $1.61 on the problems associated with those medications. Reading and studying about drug-related morbidity and mortality, pharmaceutical care, and practice transformation motivated me to change my own practice to focus on helping my patients achieve their therapeutic outcomes with safe and eff ective medications. I emphasized the need to become a “pharmacist interventionist” which means that, as pharmacists, we need to focus our attention on identifying and resolving medication-related problems (MRPs) that our patients are experiencing. What does it mean to be a pharmacist


interventionist? First and foremost, we must free up pharmacists to have the time to provide this level of patient care. We did this in our practice by optimizing medication synchronization, the appointment- based model, utilizing our technicians optimally, integrating technology to improve effi ciencies, staffi ng appropriately,


and developing collaborative working relationships (CWR) with prescribers and other health care providers.6


T is also meant


that we had to change how we worked with our patients. Each patient encounter is an opportunity to collect and assess clinical information, determine if the patient is experiencing an MRP, and intervene (act) to resolve the MRP. In fact, we emphasized to our pharmacists that with every patient encounter you should expect to fi nd an MRP. If we maximize our time with our patients, asked the right questions, and assess their medication regimen; it becomes more apparent that an MRP exists. By utilizing an electronic patient clinical documentation system, we were able to monitor and follow- up with our patients over time to ensure that their medications are optimized. If an MRP is identifi ed, then it is time to intervene. T e intervention can be at the patient level (e.g. adherence to therapy), at the prescriber level (change in drug or dose), but most times it is with both the patient and prescriber. Practice transformation creates the


capacity for pharmacist to be freed up to provide medication management services. To optimize our care of our patients, we utilized the pharmacist work-up of drug therapy (PWDT) to guide our eff orts.7


develop an interventional plan including follow-up and monitoring. T e information collected from patients and/or their caregivers during the PWDT include the following:7


• Patient specifi c information • Medical problem list/diagnosis • History of Present Illness (HPI) • Past Medical History (PMH) • Current medications • Medication history • Allergies • Smoking/alcohol/recreational drug use history


• Compliance • Systems review • Pertinent laboratory values


commonly categorized the MRPs into the following classifi cations:8


Once this information is collected, we (see chart, pg. 15)


Once we have identifi ed and categorized T e


PWDT is similar to the medical work up performed by physicians except it is focused on the patients’ drug therapies. It utilizes a standardized strategy to collect patient information and pertinent laboratory values to create a medication problem list. Once the MRPs are identifi ed, then pharmacists


the MRP, we determine our action needed to resolve the MRP. We have successfully utilized SOAP notes to communicate our interventions to prescribers. It standardizes our patient workups, the communication to other providers is in a consistent format, and we always include an updated medication list (prescription, non-prescription, and supplements). If our clinical intervention is to recommend a change in drug or dose, it is usually stated in a format that is answered by “yes” or “no” by the prescriber and that by signing the SOAP note, that this becomes a new physician order for the patient.


14 Missouri PHARMACIST | Volume 98, Issue II | Summer 2024


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