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6 posts from January 2014

01/30/2014

What can Obamacare do for you?

               Over the past several months, we’ve delved into two separate yet very important aspects of healthcare and pharmacy practice. We have followed the birthing pains of President Obama’s signature legislation some weeks while discussing the importance of medication adherence other weeks. We will now discuss how these two seemingly isolated realms of healthcare are indeed intertwined.

               The goal of the Affordable Care Act (ACA) is to improve the well-being of American citizens, rein in costs associated with healthcare in our country, and provide health insurance to those that could otherwise not afford it. As a future pharmacist, I will focus on the goal I perceive to be most important to my chosen profession: improving the well-being of my fellow Americans.

As we’ve discussed in previous posts, medication adherence is paramount in the constant battle to improve patient care. In the past, topics such as technology and techniques to monitor patients were assessed in Mission Impossible: How to tell if your patients are taking their medications; as well as why patients don’t take their medications in Why Don’t You Take Your Medication? in Part I and Part II installments. While it is the responsibility and duty of us as pharmacists to make sure that patients are taking their medications as directed, Uncle Sam has taken matters into his own hands by passing legislation to encourage health care professionals to improve outcomes.

Why has Washington taken such an interest in medication adherence? The reality is that medication non-adherence is estimated to cost $290 billion per year in additional healthcare costs. With almost 13% of the total yearly expenditure in healthcare being spent on preventable diseases and procedures, law makers and healthcare professionals alike see an opportunity to make medicine more affordable to the American patient.

The ACA has multiple provisions aimed at improving patient outcomes. Under the ACA and Medicaid expansion, hospital re-admission for certain conditions will result in penalties to the institution. With the real threat of not being compensated for services provided to re-admitted patients, hospitals across the country are revising procedures and doing their best to increase medication adherence and lower re-admission rates. As pharmacists, we will have a pivotal role in this revision of policy.

Along the same lines as re-admission rates, hospitals will now be subjected to quality assurance measures to hold them accountable. The Pharmacy Quality Alliance (PQA) is a non-profit organization that has developed measures related to medication use; PQA has adopted ten such measures that will cover a range of services, including medication adherence.  In addition to such assurance measures, there is something known as Medicare Advantage “Star” ratings that will provide financial incentives to plans in the Medication Advantage (MA) program. In the Star Ratings system, medication adherence is weighted HEAVILY because of its importance (medication adherence accounts for 11% of the total star score). This “Star” rating system has the opportunity to influence the care of over 12 million Medicare beneficiaries.

Three models being experimented with now are patient-centered medical homes, accountable care organizations (ACOs), and episode-based payments. These models are intended to lower health care costs and improve the overall quality of care being distributed to patients. And as is the case with hospitals, they will be evaluated on measures established by the ACA. ACOs for example will be assessed by the same kind of quality assurance measures as previously discussed. And as discussed before, medication adherence is a number one priority in those measures with 20 of the 33 measures relating directly to medication adherence.

When we discussed in previous posts why patients don’t take their medications, cost was a major factor. An important aspect of the ACA is to lower costs that would deter a patient from seeking care or filling a potentially life-saving prescription at a pharmacy counter. A portion of the ACA that doesn’t get much publicity is that it has a provision that impacts Medicare and Medicaid benefits. Under the new healthcare law, the threatening “doughnut hole” has been closed. This effort to close the gap in Medicare coverage is estimated to save beneficiaries $3.4 billion in prescription drug costs which comes out to $837 per person, per year. This is no small amount of money and could indeed encourage people to get that necessary prescription filled. When the decision for a retired individual on a fixed income to choose between their groceries or medicine is no longer necessary, everybody wins.

While this is an exciting time for healthcare, we as pharmacists are entering a brave new world. As I’ve discussed, the ACA calls for many changes in the way healthcare will be administered with an emphasis on medication adherence; and with pharmacists being the medication experts, we will be expected to lead the charge in making many of these changes a reality. This presents our profession of choice with an opportunity to not only create value as health care professionals, but also put our foot in the door and establish ourselves as vital cogs in the 21st century healthcare machine. At this time the ACA does not establish a system by which we as pharmacists will be compensated for our increased duties and responsibilities which is obviously not a desirable situation. But don’t be discouraged. We as pharmacists should take this opportunity to not only elevate the prestige of our profession, but also establish value that will positively impact the way we are compensated in the future. Pharmacists are no longer ‘pill counters.’ We are well respected experts in a vital facet of medicine and it is time we are recognized as such. As Horace so eloquently put it: Carpe diem!

Mackenzie F. Blair, PharmD '15

01/24/2014

What Happens to Philly's Homeless Community During Frigid Weather?

MetrauxStephen Metraux, PhD, associate professor of health policy and public health, has done extensive research on homelessness and housing,as well as other aspects of urban health. He is also working with the U.S. Department of Veterans Affairs as part of their commitment to ending homelessness among veterans by 2015.

With the recent streak of bone-chilling weather, Dr. Metraux weighed in on how this weather impacts Philadelphia's homeless community. Here's what he had to say:

If you were fortunate enough to be somewhere warm during this recent cold snap, you may have been wondering what happens to those who do not have access to warm shelter.  In particular, how do people who are homeless and subsisting on the streets go about surviving in this cold?

Data on how many homeless are stuck out in the cold are difficult to come by. The homeless population is notoriously challenging to count, as they usually strive to stay inconspicuous amidst the public spaces to which they are relegated. The best available number comes from the City of Philadelphia’s annual “Point in Time” count, when teams of volunteers canvass the shelters and the streets and count the homeless people and families that they encounter.  Of the 5,625 homeless persons counted on a January night in 2012, 526 (9%) were unsheltered.

So how do these 526 persons survive the elements on nights like those we have recently had? The first line of defense is provided by the City of Philadelphia, who implement a “Code Blue” on any night when “real feel” temperatures fall under or around 20 degrees. On Code Blue nights, outreach workers and police can bring any homeless person in to stay in a shelter or other public facility temporarily designated for overnight accommodations. No one gets turned away and, if necessary, a Court Ordered Transportation to Shelter (COTS) can be quickly obtained to bring resistant persons indoors on occasions when leaving a person outdoors may subject him or her to danger from the elements.

Code Blue’s success is best indicated by the rarity of hypothermia deaths among homeless persons in the past few years.  But Code Blue is at best a stopgap solution.  The best solution for protecting the homeless from the elements is through renewed efforts to reduce homelessness. The number of street homeless in Philadelphia have been declining over the previous few years, due largely to innovative programs to engage the most recalcitrant homeless persons and provide them with housing and services.  The more this continues, the less we need to worry about homeless persons on nights like these.

01/21/2014

Snow Shoveling Techniques Can Help Keep Individuals Injury Free, Says USciences PT Prof

Hoglund_0As temperatures continue to plunge and snowfall levels increase across the tri-state region, a physical therapy professor at University of the Sciences in Philadelphia reminds individuals the exertion, cold weather, and slippery surfaces snow shovelers face in these conditions are a dangerous combination. 

“Contrary to what many people believe, snow shoveling is no different than any other type of vigorous physical activity,” said Lisa Hoglund, PT, PhD. “That’s why it’s important for people to ease into the workout, practice proper technique, and rest when needed.”

She said although shoveling snow can provide good exercise, it can also be dangerous for optimistic shovelers who take on more than they can handle. According to a national study in the American Journal of Emergency Medicine, U.S. hospitals treat on average about 11,500 injuries and medical emergencies a year related to shoveling snow.

 Here’s a list of tips Dr. Hoglund said can help prevent injuries while shoveling snow:

  • Warm up. Before heading outdoors, take 10 minutes to jog in place or run up stairs, and stretch to get your muscles warmed up.
  • Use an ergonomic shovel. Ergonomically correct shovels are typically much lighter than normal shovels and have a contoured handle designed to reduce or eliminate bending and decrease lifting.
  • Proper technique is key. Stand with your feet about hip width for balance, and keep the shovel close to your body. Be sure to push the snow instead of lifting it. If you have to lift, bend your knees and lift with your legs, and avoid twisting or throwing snow over your shoulder.
  • Take light loads. Because each large shovelful of snow can weigh up to 30 pounds, smaller loads are recommended to help prevent injuries.
  • Listen to your body. Take breaks every 15 minutes, and be sure to pay attention to your body's signals, such as pains, shortness of breath, or chest discomfort.

“Snow removal is more than just another necessary household chore because all the bending and heavy lifting can put an individual at serious risk for injury and even a heart attack,” Dr. Hoglund said.

 Dr. Hoglund is an American Board of Physical Therapy Specialties-certified orthopedic clinical specialist who has spoken extensively on the topics of injury prevention, pain management, and physical therapy.

01/20/2014

We Will Try Resolutions Again but Pharmacy May Need a Revolution!

By Dr. Daniel A. Hussar, 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.

For many individuals and organizations, the arrival of a new year is the time to determine resolutions to be accomplished. Although I have not designated them specifically as "resolutions," some of my editorials in the Pharmacist Activist have addressed what I consider to be the priorities for our profession of pharmacy (please see "The 'Tyranny of the Urgent' Must Not Compromise our Commitment to our Priorities," [May 2012 issue] and "Priorities for our Profession" [February 2011 issue] of the Pharmacist Activist).

Most of the priorities/resolutions I have identified in earlier editorials have been recognized as challenges for decades and could be recited on an annual basis. As I again read the two editorials mentioned above, my assessment is that there has been very little progress made in addressing important issues. I accept my share of the responsibility for this limited progress—I need to do more!

I recognize that pharmacists and the leaders of our profession do not have any obligation to read or agree with anything I write or recommend. And often they don't. There can very well be concerns and priorities that are more important than the ones that I identify, and/or I may not be clear enough, persuasive enough, or bold enough in communicating my recommendations. However, I continue to contend that there are challenges that pharmacy must effectively and urgently address. This time I will call them "Resolutions" and many of my comments that follow will be very familiar. I have limited this commentary to five areas. There are many more that are also deserving of our attention. They are provided for the purpose of generating discussion, action, and better ideas and recommendations.

Resolutions for pharmacy

  1. Individual pharmacists must demonstrate more commitment, passion, and activism on behalf of our profession. It starts with me/us! What have we done as individuals to advance our profession and to address the problems that exist? If we have done nothing, we forfeit our right to complain about or criticize what others are doing or not doing. We must start by being members and, optimally, active participants in our professional associations. In my opinion, every pharmacist and pharmacy student should be a member of the American Pharmacists Association, the one national pharmacy organization that is positioned to represent the entire profession. We also have a responsibility to be members of the state and local associations of pharmacists that represent the entire profession. In addition, there are many other associations with focused/specialized programs and services in which membership and participation will be of great value for pharmacists with specific practice interests and responsibilities.

    I strongly encourage not only involvement but activism of pharmacists as individuals in programs and initiatives that will promote and advance our profession. However, as active as we may be as individuals, our sphere of influence is limited, and the resources and strength of associations with a large membership is essential.

  2. Our national pharmacy associations must be more effective and more accountable. Our profession needs an organizational structure that will serve and advance the interests of pharmacy in a much more effective manner than is being accomplished through our current system. Our national associations give primary or exclusive attention to self-preservation and growth of their individual membership, programs, and finances. As important as these things are, not enough attention is being given to identifying and taking action on the issues that are of the greatest importance for the profession as a whole. Indeed, it often appears as if the national associations are competing with each other more than they are collaborating with each other.

    Our national associations and our leaders need to be more accountable by responding to concerns experienced by tens of thousands of practicing pharmacists such as understaffed and stressful workplace environments that increase the risk of errors and harm to patients. Issues such as the abuse and overdose deaths from prescription products containing hydrocodone or oxycodone cry out for leadership and initiatives that will greatly reduce these tragedies. But how does pharmacy respond? With conflicting opinions from the national organizations as to whether hydrocodone combination products should be transferred from Schedule III to Schedule II. Our profession and the public deserve better!

    The importance of building the strength and effectiveness of pharmacy at the national level can't be overstated, as this will also be essential for success with respect to the following resolutions.

  3. The Vision for 2015 must be implemented. In late 2004 the Joint Commission of Pharmacy Practitioners (JCPP), comprised of the leaders of the national pharmacy associations, developed the following vision statement that was endorsed by all of the major national pharmacy practitioner organizations:

    "Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes."

    This vision statement is followed by a discussion titled, "Pharmacy Practice in 2015," that embraces the patient-centered role of the pharmacist, and pharmacists doing in practice what we have long been saying we are capable of doing. This is a bold initiative from which patients and the profession of pharmacy can greatly benefit, and which demonstrates a positive outcome when our national associations work with each other.

    The year 2015 is a goal and not a rigid deadline. However, we are only one year away from 2015, and it is appropriate to assess what progress has been made over the last 10 years. There are patient-centered practice accomplishments of individual pharmacists and individual associations. However, these accomplishments are for the most part isolated and few in number compared with what needs to be done to implement the vision. What happened to the progressive vision for which there was such agreement in 2004? It would appear that the national associations that developed the vision statement did not continue to collaborate, but went their separate ways. They should be accountable in explaining why there has not been substantive progress in working together and attaining this vision. Instead, the priority of the JCPP appears to be to revise the vision statement. The new statement is reported to be:

    "Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based health care."

    Will JCPP be accountable to pharmacists in describing its lack of involvement/progress in attaining the vision for 2015? Will the national associations be as accountable with respect to their responsibility in attaining the revised vision as they are in expecting their members to be accountable in providing the health care described?

  4. The profession of pharmacy must establish a model prescription benefits and services program. The vast majority of prescription benefit programs administered by pharmacy benefit managers, insurance companies, and government agencies are seriously flawed. They fall far short in using the knowledge and skills of pharmacists and in assuring optimal effectiveness and safety of drug therapy for patients. Numerous efforts to improve these programs have failed, and many programs are getting worse. We can't depend on others to design a program that will assure the quality of medications and the services of pharmacists that will also be cost-effective. We must do it ourselves!

    Many of our national pharmacy associations do not presently provide a prescription benefit program for their own employees that includes the services and other quality measures that they expect their pharmacist members to provide to patients. This situation should be given immediate attention. The national associations should work together to identify the resources and expertise needed to establish a model prescription benefit program and network of participating pharmacists in the Washington, D. C. area. This program would first be made available to employees of the national pharmacy associations. As soon as possible, it should be made available to legislators and government officials and their staffs. There would be a considerable cost to establish such a program but I can't think of a more important investment for our national associations. I have full confidence that the quality and value of such a program would be quickly recognized and publicized to the extent that others would also adopt it.

  5. The profession of pharmacy must do much more to provide fulfilling employment opportunities. Several factors (e.g., national economic challenges, many new colleges of pharmacy) have converged to create a situation in which many pharmacists are having difficulty in obtaining employment. Colleges of pharmacy and the pharmacy associations must do much more to assist pharmacists in obtaining positions. Some contend that when the Vision for 2015 is implemented there will be a shortage of pharmacists. However, that is not the reality now and will not be soon. But it does provide all the more reason to move as quickly as possible to implement the Vision.

    Additional strategies must be developed to assist pharmacists and students who will be graduating soon to have fulfilling employment responsibilities. For example, two independent pharmacies might each fund one-half of a full-time position. Also important is the recognition that some employers of pharmacists will reduce the staffing of pharmacies with the expectation that pharmacists will not leave because employment may not be available elsewhere. It is very difficult for employee pharmacists to challenge management regarding understaffing or a stressful workplace environment because they might be placing their job at risk. The pharmacy associations and colleges of pharmacy have a responsibility to do more to assist pharmacists in obtaining employment in which they can provide the expertise and services that patients need.

The list goes on but these five resolutions will suffice for now. Not only are they important but there is an urgent need to be effective in addressing them. Changes in health care are occurring at an unprecedented pace. If we are not successful in responding to these challenges soon, a revolution in our profession will be needed!

01/08/2014

USciences Wellness Expert Says ‘Cold Weather Shouldn’t Derail Exercise Goals’

While the cold weather can discourage even the most motivated athletes, exercise science professor Heidi Freeman, PhD, at University of the Sciences in Philadelphia has compiled seasonal fitness tips to keep individuals fit, inspired, and warm during the winter months.
 
“Once chilly weather arrives, the temptation to skip your outdoor exercise routine can often be very strong,” said Dr. Freeman, program director of exercise science and wellness management at USciences. “However, the cold weather does not have to mean an end to outdoor exercise, and it certainly shouldn’t intimidate exercisers.”
 
In fact, Dr. Freeman said using commonsense and preparing well for the chilly weather allows individuals to exercise safely and enjoyably all winter long:
  • Dress the part. Dress in layers that you can remove as soon as you start to sweat, then put back on as needed. First, put on a thin layer of synthetic material, such as polypropylene, which draws sweat away from your body; and avoid cotton, which stays wet next to your skin. Next, add a layer of fleece or wool for insulation. Top this with a waterproof, breathable outer layer. 
  • Protect your hands, feet, and ears. Protect your extremities from frostbite by wearing a thin pair of gloves under a pair of heavier gloves or mittens lined with wool or fleece. Also, wear a thermal hat or headband to protect your ears.
  • Hydrate. Even if it’s not as obvious as in the summer, you’re still sweating during cold-weather workouts and pushing yourself, so drink plenty of water.
  • Pay attention to weather. Exercising when it is cold and raining can make you more vulnerable to the cold. Similarly, wind chill extremes can make exercising outdoors unsafe even if you dress warmly. Consider taking your workout indoors if the weather is exceptionally cold and wet.
  • Stay accountable. Because the daylight hours are limited during the winter months, stay safe by letting someone know your exercise plan and when you expect to be back.

The winter months are also a great time for outdoor exercisers to try different types of indoor fitness routines, said Dr. Freeman. For example, she suggests Zumba, rock climbing, and cycling classes offered at local fitness and recreation centers.

Exercising While Sick Can Do More Harm than Good, Says USciences Prof

With the flu and cold season in full swing, kinesiology professor Karin Richards, at University of the Sciences in Philadelphia, said many people tend to ignore their symptoms to keep on track with their fitness resolutions for the New Year. In fact, Richards said working out while under the weather can actually do more harm than good for individuals looking to shed a few pounds and adopt healthier lifestyles.

 “Depending on where a person experiences symptoms of illness can make or break his or her workout and recovery,” said Richards, acting chair of the Department of Kinesiology . “For instance, those who experience above the neck symptoms such as stuffy noses and sneezing are generally fine to continue their exercise routine. However, those with symptoms below the neck such as a fever, nausea, and muscle aches are urged to stay in bed and recover.”

  KarinTo date, the flu has claimed the lives of three Philadelphians as the number of infections have begun to climb in the city. So far this flu season – which runs from Sept. 20 to May 18 – 66 cases of the influenza virus have been confirmed in Philadelphia. That’s why Richards said it is vital for sick people to resist the urge to exercise, and stay home from fitness centers as the flu is easily spread in these types of environments.

 However, in an effort to keep individuals experiencing minor cold symptoms in line with their fitness goals, Richards compiled a list of exercise tips to help them stay healthy and active:

  • Take it easy. Lower the intensity of a regular workout.  For instance, if an individual is used to running, he or she is encouraged to walk.
  • Stretch out. Sometimes yoga and gentle stretches can make an individual feel better and relieve congestion and pressure. Yoga Journal suggests positions such as supported bridge, legs up the wall, and standing forward bend aid congestion. When battling sinus pressure, Richards said she places her fists over each other and rests her forehead on them when practicing the downward dog position.
  • Be courteous.  While the sniffles should not be an excuse to not exercise, Richards said to use common courtesy and avoid sneezing and coughing all over the gym equipment. She urges individuals to work out at home or outdoors until they are free of their symptoms.
  • Stay active year round. One of the best preventative measures to avoid sickness is regular physical activity.

 While halting an exercise regime while sick might seem like a giant setback, Richards said most individuals can get back into their routines fairly quickly once they have fully recovered.

 “There is a fine line between a minor cold and the flu, and it’s important for individuals to stay in tune with their bodies,” said Richards. “A person’s body is stressed when fighting the infection, so placing additional stress through intense exercise only suppresses the immune system even more.”

 “Of course, individuals are encouraged to seek the advice of their primary care physician or a healthcare professional if they have any questions regarding continuation or resumption of their exercise routine if they are sick,” she added.

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