What I learned week 7
What I learned week 7
Dr. Housman
began with an introduction of a historical article from 1909 describing the
relationship between physician and pharmacist. In the past, physicians would
diagnose the patient and the pharmacist would simply just count the pills and
give them to the patient. The physician diagnosed the patient, the pharmacist
dispensed the pills, there was no relationship between the two to work in
conjunction with the patient. Moving forward, Dr. Housman advised that there is
now this relationship between the pharmacists and physicians to work together
for the greater good of the patient; especially in a hospital setting where his
background is from. Pharmacists are now getting face to face time with the
patients, and it is highly encouraged. Yes, a physician is the one to diagnose
the patient, but the pharmacist needs to know and understand the patient’s
status, condition and other health conditions or factors that could potentially
alter the prescribed dose the physician originally recommended. In addition,
all pharmacists must approve the medication. The two of them now work together
to form 1. The right medicine and 2. The right dosage/regime. Dr. Housman told
us a story I found very interesting; he said that back 10 years ago when he was
in pharmacy school working in the hospital, his class was about 20 students and
at any time of day all 20 students could be found in the hospital pharmacy.
Nowadays, classes that size only require 1 maybe 2 pharmacists in the pharmacy
and the rest of the students are on the patient floors going door to door
visiting the patients and understanding their needs and specs; forming a
relationship with the patient. This face to face communication with the patient
is extremely beneficial. It is just as important for the pharmacist to visit
the patient as it is for the doctor. Dr. Housman acknowledged though that it is
still the nurses who see the patients the most, then physicians, then pharmacists.
It’s also important to know that nurses are the most trusted, following are the
pharmacists. Dr. Housman than transitioned into formularies…who creates them,
how are they created, what factors decide which drugs are on the list, etc. I
learned that there is a group called The
Pharmacy and Therapeutics (P & T) Committee who decide the formulary. This group consists of 15-20
people, ranging from the pharmacy director, physicians, administers, and even
some head nurses. I think the most important thing to understand about the
P&T committee is that when the P&T committee gets together to decide
what drugs to put on the formulary, cost is the last factor they take into
consideration. The main factor that decides if a drug is added to a formulary
is the outcome. “The selection of pharmaceuticals to be included is based on
the objective evaluation of the relative
therapeutic merits, clinical outcomes, safety and costs to Baystate Health (CO
13.330 – Formulary System).” This line alone demonstrates that cost is last,
there are more important factors such as safety and efficacy. We only talked
briefly about drug utilization within the last 15 minutes. Drug utilization is defined
as an authorized, structured, ongoing review of prescribing, dispensing and use
of medication. Drug utilization encompasses
a drug review against
predetermined criteria that results in changes to drug therapy when these criteria are not met. What I recall is that Dr. Housman and
Baystate are steadily decreasing their utilization of antibiotics; which is
great news. “In 2015 alone, approximately 269 million antibiotic prescriptions were dispensed from
outpatient pharmacies in the United States, enough for give out of every six
people to receive one antibiotic prescription each year. At least 30 percent of
these antibiotic prescriptions were unnecessary.”
1. One of the questions I asked Dr. Housman
when we were discussing the relationship between pharmacist and physician was,
“Do pharmacists have to pay mal practice insurance just like the physicians,
and if so, what’s the different in amount.” Dr. Housman advised yes,
pharmacists do indeed invest in mal practice insurance and he advises all his
students to invest into mal practice insurance. This is because when an issue
does occur, the patient usually goes after the healthcare provider with the
most amount of money. In most cases the patient seeking money back from
malpractice will go after the physician because in turn they have the highest
amount of pay and education, and usually right under the physician are the
pharmacists, with usually the second highest salary and years of education. The
more you make, the more people want to sue you—is basically how he put it. But
no, pharmacists do not pay as much in mal practice insurance as physicians do.
The more years of education and the riskier the job, the higher amount of
coverage paid. I researched some current articles relating back to pharmacist
malpractice insurance and the cost of malpractice insurance for pharmacists is
on the rise. This is due to pharmacists doing more in 2017; they are doing more
than just counting of pills. This is what Dr. Housman was explaining to us,
that pharmacists now have more responsibility. “Pharmacists are
now recognized as prescribers to some degree in almost all states. Legislation
in most states reflects the provider role, and in some cases even allows
pharmacists to bill for services. In some regions, pharmacists may initiate or
modify therapy for common conditions such as diabetes, asthma, COPD, or
conditions requiring anticoagulant or cardiac drugs.” And with greater responsibilities,
there is a higher risk of liability, but in many cases health institutions often
misunderstand the expand of a role of a pharmacist, so the pharmacist may be
misrepresented under a healthcare systems malpractice coverage. Most common
mistakes for pharmacists include dispensing errors, issues that arise as
pharmacists initiate or modify therapy are “more difficult to quantify and are
therefore more protected.” This new relationship of a pharmacist in the hospital
setting should be fully understood by the whole institution, and pharmacists in
my opinion should not be afraid to intervene drug therapy where they see need,
if at the end of the day it benefits the patient.
2. Another question that I asked Dr. Housman was
“In your opinion, with personal experience from Baystate, do you think with
that the push for electronic health care records as well as the drive for more
healthcare IT, do you see this impacting the quality of care? Dr. Housman
acknowledged that yes indeed it’s a very real problem they could potentially
face but with such improvements at Baystate even within the last 10 years, he
hopes that face to face consultations and quality of care will remain high. He
acknowledged though that the east coast is 10 years behind hospitals in the
west coast, and even down south, so they do have time to monitor these changes and
make sure there is a balance between quality of care and technological advances.
I learned from the readings from August 31st that “The health
industry lags behind other industries, such as retail and telecommunications,
in the deployment of emerging technologies such as artificial intelligence,
drones and virtual reality. Yet these technological innovations loom on the
health industry’s horizon with great potential to disrupt. 2017 is the year to
prepare for the eventual arrival of these technologies and their impacts on
business models, operations, workforce needs and cybersecurity risks.” There has
to be a balance.
Sites Used:
· https://www.pwc.com/us/en/health-industries/top-health-industry-issues.html
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