Evolving Patient Care: The Pharmacists’ Role

Evolving Patient Care: The Pharmacists’ Role

Jessica Haskins-Cummings, PharmD

Pharmacy Manager, Walgreens

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

Objectives

Pharmacy Past

Pharmacy Present

‘Well Experience’ model

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

Pharmacy Future

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

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

Pre-op

meds

Disease state specifi

c

Surgery

meds

Maintenance meds

Counseling your patients

$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

Adherence

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

Disease state specific counseling

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

Vicodin Lortab Norco

5mg 5mg/500mg 5mg/500mg 5mg/325mg5mg/300mg

7.5mg 7.5mg/500mg 7.5mg/500mg 7.5mg/325mg7.5mg/300mg

10mg 10mg/500mg 10mg/500mg 10mg/325mg10mg/300mg

Hydrocodone/APAP combo

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)

Maintenance Products

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

Antidepressants amitriptyline, doxepin,

desipramine Diuretics

hctz, furosemide Stimulants

pseudoephedrine Antipsychotics

chlorpromazine, thioridizine, clozapine

Decreased saliva flow

Increased risk for gingivitis & halitosis

Typically dose related

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

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

New Developments in medicine

Improve adherence Improve outcomes Improve quality of life

Multidisciplinary approach to patient care

Thank [email protected]

Evolving Patient Care: The Pharmacists’ Role

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