Make an impact on the public’s health
Pharmacists can treat patients collectively, too
Pharmacists are experts at dispensing the correct drug in the correct dosage to the correct patient. Two pharmacists, however, suggest that the profession can do a better job of considering the public, collectively, as a patient.
The profession can make a "gigantic impact on the public’s health if pharmacists simply unite to focus their efforts on tackling problems," say RADM John Babb, RPh, MPA, and Victoria J. Babb, PharmD, in the article "Filling a prescription for the public’s health," which was published in the January/February 2003 issue of the Journal of the American Pharmaceutical Association (available at www.aphanet.org/JAPhA/janfeb03pdfs/Babb(56-60).pdf).
RADM John Babb is director of the Commissioned Corps Readiness Force, Office of Emergency Response, Office of the Assistant Secretary for Public Health Emergency Preparedness, Rockville, MD. Victoria J. Babb is special assistant for counterterrorism, Office of Compliance and Biologics Quality, Center for Biologics Evaluation and Research, U.S. Food and Drug Administration, Rockville, MD.
In their article, the authors give several examples of ways pharmacists can treat the public’s health. For example, many pharmacists didn’t advise patients of the risks of troglitazone (Rezulin) after warnings were issued that the drug was hepatotoxic; patients continued to receive refills without additional information about the drug. Pharmacists also can play a primary role in reporting adverse drug events (ADEs) and combating drug resistance, the authors say.
A talk with RADM Babb
Drug Utilization Review recently spoke with RADM Babb about his motivation to write the article. Here is what he said:
Q: What prompted you to write the article?
A: A variety of things:
- my own observations that many pharmacists spend too little time talking to patients about their medication;
- too much of a tendency [of pharmacists] to retreat behind the sign on the counter that reads, "If you have questions about your medication, please ask to speak to the pharmacist"
- too much focus on the mechanics of pharmacy vs. the art of pharmacy;
- a hesitancy to call physicians about prescriptions;
- too little information about the patient (such as labs, indication for the prescription, medical history, concomitant conditions, and other medications);
- a reliance on the physician to know what’s best.
Q: Is this issue more urgent with community pharmacies than with health system pharmacies?
A: When you reflect on the huge amount of money spent on medication misadventures in this country . . . much of that money is related to what happens in hospitals and nursing homes.
Progressive hospitals put pharmacists on the floors with patients, talking to them, reviewing labs, and reading medical charts. Some recent studies have proven that pharmacists assigned to intensive care units actually decrease medication errors and costs. Other hospitals certainly have experienced their own share of ADEs — extended hospital stays due to drug problems, damaged patients, and deaths. So the problem is not confined to one group of organizations. In fact, since hospitalized patients usually are receiving more intensive medication regimens than other patients, the chance of drug problems occurring is significantly higher.
However, the most significant opportunities to talk to patients are in community pharmacies. [Per the article], that’s where the majority of all those troglitazone prescriptions were being filled and refilled. That’s where patients needed to speak to a pharmacist, and perhaps needed the intervention of a pharmacist. That’s where millions of prescriptions are refilled every day; yet in many pharmacies, no one asks the patient, "What problems are you having with your medication?" Prescriptions continue to be refilled, and problems (which may seem unrelated to their medication as far as the patient can tell) are not addressed and can be exacerbated.
Q: What do you think takes away the opportunity for pharmacists to spend more time educating their patients?
A: Again, a long list:
- insufficient staffing;
- too little time to perform the necessary mechanics, let alone the art;
- hesitancy to question the prescriber;
- hesitancy to get into a potentially long, drawn-out discussion with a patient;
- patient unwillingness to spend any extra time in the pharmacy to thoroughly discuss their medication management;
- patient unwillingness to discuss what may be a "personal" situation outside the physician’s office (i.e., exacerbation of benign prostatic hyperplasia while taking a decongestant, blood in the stool while taking nonsteroidal anti-inflammatory drugs, etc.);
- worst of all, some pharmacists do not feel comfortable with their knowledge about many drugs;
- and of course, some employers focus on quantity rather than quality, thus putting pressure on pharmacists to spend less time with patients.
Q: You mention the importance of paying attention to the Dear Healthcare Professional letters and Public Health Advisories. Why do pharmacists not always take these communications as seriously as they should?
A: I’m not sure why these letters and advisories are not taken more seriously. Perhaps there is the feeling that the physician will address the situation. Perhaps pharmacists are numbed by the numbers of warnings they see every day on their pharmacy computer system. At what point are warnings to be taken to heart and emphasized to the patient — or worse, to the physician? Pharmacists are inundated with warnings, so perhaps we miss the ones that are potentially life-changing or deadly. I’m not sure why we don’t simply say to the patient, "Did your doctor have an opportunity to discuss this letter with you regarding drug XYZ?" Perhaps the prospect of a lengthy conversation or phone call with the physician is perceived as not productive.
Q: Do you recommend some kind of alert system in the pharmacy computer?
A: It certainly would be helpful to have a new or refilled prescription flagged automatically so that you can click on a recent letter or advisory, and then share the information with the patient if necessary. That way you would not have to rely on your memory for every warning letter, and you would have documentation at hand if questioned by the prescriber. One of the initiatives of the Department of Health and Human Services is to find ways for innovations in information technology to improve patient care and patient outcomes. This sounds like an opportunity to make improvements.
Q: How do most pharmacists get information about ADEs?
A: While many patients are now sophisticated enough to read and understand the drug information sheets handed to them or access information on the Internet about their drug therapy, many more lack that level of understanding. How do joggers figure out by themselves that the ankle pain they are experiencing is a strong warning sign that they should see their doctor immediately if they are taking ciprofloxacin for an upper respiratory infection? What patients would expect that last night’s fainting spell might be related to the clarithromycin medication they recently added to their ongoing Hismanal therapy — or that it could be symptomatic of a life-threatening side effect?
I submit that pharmacists have a role to play in 1) preventing ADEs from happening in the first place, 2) giving patients information about potential, significant ADEs, and 3) talking to patients about new problems they are experiencing.
Pharmacists are experts at dispensing the correct drug in the correct dosage to the correct patient. Two pharmacists, however, suggest that the profession can do a better job of considering the public, collectively, as a patient.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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