Monday, March 9, 2015

Iowa’s community pharmacists aren’t required by law to ask patients about their medications each time one is refilled, but many recognize the opportunity to spot problems and help patients get the most benefit from their medicines.

Two College of Pharmacy faculty members – Matthew Witry, PhD, and William Doucette, PhD – drew upon 12 interviews and 254 surveys with the state’s community pharmacists to find out which factors help community pharmacies engage patients during refills. Study results are published in a recent issue of the Journal of American Pharmacists Association (JAPhA), and in a forthcoming Research in Social & Administrative Pharmacy article.

Roughly 4.5 million ambulatory care visits and 100,000 deaths are attributed to medication problems each year. Most of these issues are not from errors in prescribing, but from patients experiencing a known side effect, or taking their medicine too much or not enough.

“When people use medications on a long-term basis, the pharmacist often ends up meeting with these patients more frequently than prescribers do,” Witry said. “Therefore, the pharmacists are well-positioned to uncover potential drug problems before they become severe. Only the patient knows if they are having side effects, their reasons for missing doses, and if the drug is doing its job. The only way to uncover this kind of information is to talk to the patient and ask the right questions.”

The pharmacists interviewed and surveyed valued the idea of using refills as an opportunity to identify and resolve clients’ potential drug problems, but many said environmental, time, and workload issues got in the way.

Pharmacists said they are more likely to discuss drug therapy with patrons when another pharmacist is on duty, and when they personally hand off the prescription. Witry said “Both the interviews and the surveys reported that pharmacists tend to start more discussions with patients they are familiar with, so I think it’s to a patients’ advantage to get to know their pharmacist.”

Upcoming changes may help pharmacists target patients for drug therapy discussions during refills. Instead of patients refilling prescriptions several times throughout the month, pharmacies are starting to merge prescription refill dates so that patients are coming in once a month to get their medications. Doing so helps the pharmacist prepare, by gathering patient information to jump-start important conversations. Some Iowa pharmacies are increasing technicians’ roles to free up pharmacists to personally hand off medications. In some cases, insurance companies are beginning to pay pharmacists to touch base frequently with patients with certain health issues or who are taking certain medications.

Witry said further research could help pharmacists routinely use technology to flag people to talk to at refill time – such as those late filling prescriptions.

Witry joined the faculty of the Health Services Research (HSR) Division of the Department of Pharmacy Practice and Science (PPS) in 2014. He received his PharmD (2008) and PhD (2013) in Pharmaceutical Socioeconomics from the college, and Doucette was his faculty advisor for his dissertation on this topic.