Take as directed: clinical pharmacy services provides one-on-one advice pharmacist

How many times have you received a prescription at your local pharmacy or through your health plan's mail-order service, only to be confused about how to take your new drug? Most usually come with simple directions on a label and pages of drug information and daunting interaction warnings.

And occasionally the short instructions on a bottle can be confusing. That's one reason that about half of all adults don't take their prescription drugs as directed. Here are some common reasons why people give:

* ‘‘I felt better so I stopped taking it.”

* ‘‘I didn’t understand how to take it.”

* ‘‘I didn’t like the side effects.”

* ‘‘I couldn’t afford the medicine.”

* ‘‘I didn’t feel better. I thought it wasn’t working so I stopped taking it.”

* ‘‘I cut the pill in half to save money.”

If you pick it up at a retail pharmacy, the pharmacist, who may routinely fill or supervise the filling of up to 400 prescriptions a day, has only a few minutes to go over how and when to take your prescription and explain any side effects you could experience. Your doctor, who may see up to 20 patients a day, has just a few minutes to talk about your prescriptions.

What if those prescriptions came with access to a pharmacist to help you understand how and when to take them, and whether taking them with or without food is best for you? As a health system transformation initiative, PacificSource Community Solutions recently concluded a highly successful pilot program that brought together Oregon Health Plan patients and pharmacists. PacificSource, headquartered in Bend, is the coordinated care organization serving OHP members in the Central Oregon and Columbia Gorge regions. The CCO partnered with MTMCare, based in Hood River, on a clinical pharmacy services program to reduce medication-related health problems among OHP members.

“People don’t know what they don’t know,” says Nicole Schrankel, MTMCare co-founder and schief clinical officer. “Many patients don’t think to ask what symptoms their medications are treating or what to do if they suffer side effects. We can prevent hospital visits by addressing people’s fears or questions around taking medications.”

Although medication therapy management is a proven health system transformation innovation and preventive service, most primary care providers can’t afford to hire a full-time pharmacist. That’s where MTMCare comes in. It has a nationwide network of pharmacists who provide patients with one-on-one counseling and targeted interventions, over the phone or face-to-face.

One of the things MTMCare can do is look at information from both physicians and insurers to see if a patient has actually been picking up their prescribed medications. “It’s rare for a provider to have both of those pieces of information on a single patient, but it provides a much fuller picture,” Schrankel says.

“By having this access I found a patient who had not picked up a prescribed inhaler," Schrankel says. "I called the patient at home and found the cost for a name brand inhaler was three times the usual copay and they couldn’t afford that. I was able to consult with the doctor and suggest an alternative dosing regimen where they would be billed only one copay."

MTMCare’s pharmacists serve an estimated 10,000 Medicare, commercial and OHP patients annually. Schrankel, a graduate of Oregon State University with a pharmacy doctorate from Idaho State University, says she is pleased that MTMCare is improving the lives of patients and cutting health care costs for the people and organizations it serves.

“I’m proud to be at the forefront of the movement to incorporate pharmacists as part of the patient-centered, team-based approach to primary care," she says. "Health plans are recognizing medication therapy management and clinical pharmacy services as a cost-effective way to help ensure that patients live longer, healthier lives."

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