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4 posts from March 2011

03/16/2011

Both Patients and Health Care Have a Great Need for a Personal Touch!

By Daniel A. Hussar is the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

Hardly a week goes by when I don't see a published paper or other commentary about the lack of patient adherence with instructions for using medications. I have had a strong interest in this topic since the time that I first published a paper in 1975 on patient compliance (a term that I still consider preferable to patient adherence). I wish I could report that the pharmacists and others who read that paper or have heard me speak on this topic were so impressed and motivated by what they learned that we have made great advances in improving patient adherence. But we haven't. Indeed, most of what I wrote in 1975 could be reprinted verbatim today and be just as valid and current.

Why have we not made substantial progress in improving patient adherence and markedly reducing the occurrence of other drug-related problems? We certainly recognize the extent of these problems and have even identified some strategies that have been effective in the limited patient populations in whom they have been evaluated. However, in many respects, our health care system and health professionals have failed to come close to our potential to provide optimum health care for our patients. An explanation that insurance companies, government programs, and others are responsible for the shortcomings of our health care system has considerable validity but must not preclude a challenge to the health professions as to why we have not been more effective. This challenge should begin with a very fundamental but essential question - Do health professionals demonstrate the interest, caring, and commitment (i.e., the "personal touch") that I would contend are essential for the relationship of health professionals and their patients to be effective and result in positive outcomes. In my opinion, it is this personal touch that is necessary (but is too often missing) for much greater effectiveness in addressing challenges such as improving patient adherence.

The personal touch of pharmacists

In considering the settings in which most pharmacists practice, it is quickly apparent that there is wide variation in the extent of the opportunities to provide a personal touch:

Community pharmacies - This is the setting in which there is the greatest opportunity for pharmacists to provide a personal touch for the largest number of patients. However, the extent to which this is done is highly dependent on the level of staffing of pharmacists, student pharmacists, and pharmacy technicians, the stress in the work environment, and the degree to which the owner/management encourages this communication with patients. In many community pharmacies there is no interaction between the pharmacist and the patient in a process in which patients are instructed by a technician to "sign here" and are then sent on their way. Although some community pharmacies have established adherence programs featuring automatic refills and/or telephone calls from the pharmacy to patients, the motivation is often based on the anticipated economic return with an emphasis on the number of calls and the time in which they are completed.

Hospital pharmacies - In certain hospitals pharmacists have excellent opportunities to provide a personal touch to selected inpatients, patients with special needs in certain clinics, and in meetings with patients who are being discharged. However, in many hospitals, the responsibilities of the pharmacists are primarily distributive in nature, there is little or no interaction with inpatients, and the provision of medications to clinic patients often involves minimal communication.

Mail-order pharmacies - There is no personal touch provided by pharmacists for the patients for whom they prepare prescriptions. Even the pharmacists who speak with patients by phone often have incentives to keep such discussions brief (e.g., part of their evaluation is based on the number of calls during a designated time period).

The inescapable conclusion of these observations is that pharmacy as a profession is falling far short of our potential in providing a personal touch for patients that will contribute to better drug therapy and health care.

A great communicator

The pharmacist who was the best communicator and motivational speaker whom I have known was the late Robert Henry. I know that just the mention of his name will prompt a positive memory and smile for every pharmacist who ever heard him speak. I considered the content, eloquence, and style of his message to be so effective that I invited him to speak in many of my classes at the Philadelphia College of Pharmacy. I was blessed and motivated by my friendship with him.

Robert Henry was an advocate for the personal touch and the responsibility that he insisted that pharmacists had in providing this touch for the patients they served. He would conclude many of his presentations by sharing the following poem, "The Touch of the Master's Hand," that was written by Myra Brooks Welch in 1921.

It was battered and scarred, and the auctioneer
Thought it scarcely worth his while
To waste much time on the old violin
But he held it up with a smile.

"What am I bid, good folks," he cried,
"Who will start the bidding for me?"
"One dollar, one dollar, do I hear two?"
"Two dollars, who makes it three?"
"Three dollars once, three dollars twice, going for three,"

But no,
From the room far back a gray bearded man
Came forward and picked up the bow,
Then wiping the dust from the old violin
And tightening up the strings,
He played a melody, pure and sweet
As sweet as the angel sings.

The music ceased and the auctioneer
With a voice that was quiet and low,
Said "What now am I bid for this old violin?"
As he held it aloft with its' bow.

"One thousand, one thousand, do I hear two?"
"Two thousand, who makes it three?"
"Three thousand once, three thousand twice,
Going and gone," said he.

The audience cheered,
But some of them cried,
"We just don't understand."
"What changed its worth?"
Swift came the reply.
"The touch of a master's hand."

And many a man with life out of tune,
And battered and scarred with sin,
Is auctioned cheap to the thoughtless crowd,
Much like the old violin.

A mess of pottage, a glass of wine,
A game, and he travels on,
He is "going" once, and "going" twice,
He is "going" and almost "gone."

But the Master comes and the foolish crowd
Never can quite understand
The worth of a soul and the change that is wrought
By the touch of the Master's hand.

A spiritual dimension

The latter part of this poem reflects a spiritual dimension - something that is not often considered as health professionals interact with their patients. However, with increasing frequency there have been suggestions that knowledge of a patient's spiritual "history" is of value in communications, decisions, and plans regarding a patient's health care.

My son, Eric, is a pharmacist-physician. When he concludes an office visit or a visit with a hospitalized patient, he will often ask the patient if he would like him to pray for him. Of the hundreds of times that he has offered to do this, less than ten patients have declined. Following the prayer, many patients have voiced their heartfelt appreciation. I have to think that this personal touch will also contribute to these individuals giving careful attention to the medical and drug therapy advice he has provided them.

03/08/2011

Priorities for our Profession - Pharmacy

By Daniel A. Hussar is the Remington Professor of Pharmacy at University of the Sciences' Philadelphia College of Pharmacy. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

Choosing the topic for this month's issue of The Pharmacist Activist was more of a challenge than usual. Not because there are not enough important issues to address, but rather because there are so many. Indeed, pharmacy faces so many challenges that identifying the degree of priority with which they should be addressed is an important decision in and of itself. Therefore, the purpose of this editorial is to identify the issues that, in my opinion, require our profession's highest priority attention.

  1. Commitment, passion, and activism
  2. Many pharmacists are apathetic or even negative about pharmacy and their individual responsibilities, and it is no consolation that this situation exists in every profession and area of employment. Tens of thousands of pharmacists are not members of even one professional association. Some would contend that the wide availability of employment opportunities (at least until recently) and high salaries have contributed to the apathy and complacency that is so widespread. Pharmacy has provided a good livelihood for the vast majority of pharmacists and every pharmacist should recognize a responsibility to give something back to our profession. This should be motivated by our enthusiasm for and pride in our profession, and demonstrated through a commitment to and passion for what we represent and can do individually and collectively for our patients and profession. We need thousands more activists within pharmacy. The colleges of pharmacy have an extremely important responsibility in encouraging these attitudes, qualities, and involvement among student pharmacists that will be continued through their professional careers. Our professional organizations must be more innovative and effective in increasing membership and active participation in professional initiatives.

  3. More effective professional organizations
  4. Our profession needs an organizational structure at the national, state/regional, and local levels that will serve and advance the interests of pharmacy in a more effective manner than is being accomplished through our current system (please see the editorial in the January 2011 issue [www.pharmacistactivist.com] for possible national organizational structure options). Leaders of the national pharmacy organizations should meet to actively consider these options in the context of what is best for the profession, and not just what is best for individual organizations. Many state/regional pharmacy organizations are struggling financially and have limited effectiveness. In my opinion, the profession is best served by having one organization of pharmacists in each state, and the leaders of the multiple pharmacy organizations within a state should be encouraged to develop and approve such a structure.

  5. Independent pharmacies must thrive
  6. Notwithstanding the importance of the roles and accomplishments of pharmacists in all areas of professional responsibility, it is the independent pharmacists who are the "face" of our profession with the public and who have the most prominent identity that is responsible for the reputation for trust and integrity that our profession enjoys. It is also the independent pharmacists who are the most likely to have the personal interaction with the largest number of patients who receive the medications and services around which the expanding roles of pharmacists are based. As the number of chain/corporate and mail-order pharmacies has increased in recent years and the number of independent pharmacies has declined, some have predicted the disappearance of independent pharmacies. However, we must not let that happen! A number of years ago I voiced the opinion that the future roles and success of the profession of pharmacy are inextricably linked to the extent that independent pharmacists can be successful in their professional responsibilities. My conviction regarding the validity and importance of this opinion is even stronger today. Our entire profession must be strongly supportive of efforts that will enable independent pharmacies to not only survive, but thrive.

  7. Tightening of the job market
  8. The economic challenges of the last several years coupled with the large increase in the numbers of colleges of pharmacy and pharmacy graduates have resulted in a significant tightening of the employment opportunities for pharmacists and student pharmacists. This situation has many extremely important implications that are as positive as a much larger number of opportunities in which the abilities and skills of pharmacists can be utilized in providing optimal drug therapy for many more patients, and as negative as widespread pharmacist unemployment. We must not be content to sit back and watch how this situation evolves. Our profession must be actively engaged in developing plans and strategies that will result in the assimilation of a much larger number of pharmacists in the provision of more comprehensive services of documented value to an increasingly elderly patient population with greater needs for optimal drug therapy. The alternative would be the worst possible contradiction - a country with millions of people who have a great need for the expertise possessed by pharmacists who can not provide it because of the failure of a healthcare system that does not recognize and pay for that expertise.

  9. "Walking the talk"
  10. As much as many of us extol the expertise of pharmacists and the value of our advice and services, optimal services are not the norm and, indeed, for many, are not evident at all. We must provide to a much greater extent what we claim as the value of our role and responsibilities. We must do much better in providing even the most basic information and services, and develop programs that will provide pharmacists with the information and confidence necessary to extend their services. As a profession we have the potential to assume "ownership" of important challenges such as the prevention of medication/dispensing errors and increasing patient compliance with the instructions for using medications. If pharmacists do not respond to these opportunities that can be viewed as such a natural part of our domain of responsibilities, it will only be a matter of time before other health professionals will.

  11. Prescription benefit programs
  12. The inequitable compensation and conditions of most prescription benefit programs are continuing important concerns for pharmacists. Pharmacists must document the value of their services and the cost of dispensing a prescription so that they are well positioned to demonstrate inequities in programs in which they are asked to participate. Pharmacists should not reduce the scope and quality of their services to try to adjust for the inadequacies of the program but rather should decline to participate in programs in which the compensation or other conditions are not equitable. Notwithstanding the need to avoid specifics of compensation issues because of antitrust implications, the profession should develop a model prescription benefit program that would effectively address the drug therapy needs of patients, and encourage and recognize the value of the information and services provided by pharmacists.

  13. Legislative influence
  14. Pharmacists and our professional associations must have much more extensive and effective communication with our legislators. The geographical distribution of pharmacists provides an excellent opportunity for legislative influence. However, we are not even close to reaching our potential in this regard. In addition to having pharmacy's interests and services considered in new and revised national health insurance legislation (e.g., Obamacare), other issues require the attention of the profession. Examples include legislative changes that would permit pharmacists and our organizations to collectively negotiate for equitable compensation for the services we provide, and changes that would prevent mandated participation of patients in mail-order pharmacy programs.

  15. Taking a stand
  16. The profession of pharmacy, primarily through its professional organizations, must demonstrate the courage to address situations that place patients at risk and/or are potentially damaging to the profession, even if they may be controversial or sensitive. For example, excessively busy and stressful working conditions that increase the risk of dispensing errors must not be tolerated. Employers who persist with policies that place patient safety in jeopardy must be challenged. Likewise, prescription benefit programs that require or provide financial incentives for patients to obtain medications from a mail-order pharmacy and decrease personal communication between patients and pharmacists must be challenged. The continuing establishment of new colleges of pharmacy in the face of a saturated marketplace for pharmacists is another situation that must be questioned.

  17. Developing leaders
  18. The urgent attention that is needed to address the numerous current issues can easily obscure the importance of developing the future leaders for the profession. The identification and development of new leaders is a critical component of plans to position pharmacy for success in the future.
     
  19. Expanded and new opportunities
  20. At the same time that current challenges demand priority attention, there must be a vision for expanding some existing opportunities and developing new ones. The manner in which some pharmacists have developed practices that focus on compounding prescriptions to meet individualized needs of patients is one such example. Other examples include expanded roles in medication therapy management (MTM) programs, immunization programs, the self-care of patients with nonprescription products, the provision of durable medical equipment products and services, and the provision of specialty pharmaceuticals.

03/06/2011

Interview with astronomer Clyde Tombaugh, discoverer of Pluto

Although Pluto has been demoted from an ordinary planet to a "dwarf planet," Americans are rightly proud of its extraordinary discovery in 1930 by astronomer Clyde Tombaugh at the Lowell Observatory near Flagstaff, Arizona.  Fifteen years ago, shortly after his 90th birthday, I had the opportunity to interview Tombaugh by phone.  I've posted the interview on the Philadelphia Area Center for the History of Science (PACHS) site (where I am now one of the contributing bloggers):

Interview with Clyde Tombaugh

 

03/04/2011

Cosmological Milestones

Here's a new video I did for the AT&T Science and Technology Author Series. In the program, I discuss cosmological milestones in recent history, as well as the ongoing search for dark matter and dark energy.


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