Healthcare, Pharmacy, and Provider Status – We Can Do Better

“Health care harms patients too frequently and routinely fails to deliver its potential benefits. Indeed, between the health care that we now have and the health care that we could have lies not just a gap, but a chasm.” – “Crossing the Quality Chasm” A New Health System For the 21st Century – IOM Report, 2001

A decade later, we have improved, but is it enough to treat the 100 million people staring at us over the next 2 decades?

Scenario: A patient has been in the hospital for (1 day; 1 week; 1 month), and has been discharged.  While in the hospital the patient receives multiple I.V. medications, and several of their oral medications were changed.  Upon discharge, they are told that there are four new medications to take. Medication Reconciliation procedures are implemented, the patient and their (careprovider/spouse/adult son/daughter) are counseled about the medications, and provided instructions about the medications. The patient opts to have the medications electronically delivered to their neighborhood retail pharmacy. The pharmacy has received the prescriptions, which are reviewed by the pharmacist, and filled.  The (patient/careprovider/spouse/adult son/daughter) arrives at the pharmacy within 12 hours of discharge to pick up the medications. They are counseled about the medications, and leave.  The pharmacist, who has advanced clinical training, has no idea of why the patient was in the hospital, no clue of the medications administered by IV in the hospital, and has no knowledge of the laboratory values of the patient in the hospital, or upon discharge.  The (patient/careprovider/spouse/adult son/daughter) is tired, and is a poor historian.  No additional information is available.

No matter how we look at it, that pharmacist is blind to the recent health status of that patient.

This is a significant gap in care provided to the patient. We can do better.

It is not the pharmacist’s fault, or the hospital, or the physician in the hospital.  However, it is the fault of the current healthcare system. We can do better.

This is a serious chasm in care. This must stop. We can do better.

This is just one of countless scenarios that exists.  Many of you have your own stories. I know many will say that this does not happen in their system.  Problem is, there are far more that cannot say that it does not happen in their region, city, town, or system. We can do better.

I have witnessed this scenario on the back end as a primary care clinical pharmacist in a Department of Family Medicine for many years.  And I know for a fact that there are current technologies that could prevent this scenario altogether. I have seen the technology. I know it exists.  The healthcare system is too slow to change, as various interests put their needs in front of the patient’s needs. Scope of practice skirmishes (or fights) over “territory” prevent us from providing the best available care to patients. Entire health systems rely upon claims data to see if a medication was filled, but ignore if the medication made it into the patient’s body. Silos prevent the sharing of needed information. We can do better.

I know many will challenge these thoughts.  But I talk to my colleagues across America, and I read the national reports. I listen to my current patients. I watch how health systems and third parties direct their money to their priorities. I know better.  And I know we can all do better.

I am proud that USF Health and the USF College of Pharmacy are having these conversations internally, and sincerely want to fix these problems, and countless others.  And there are answers; but USF Health cannot do it alone.  Nobody can.  Integrated healthcare must occur, and soon.  75 million Baby Boomers are either here, or on the way. They want better.  They Deserve better.

It is time to include pharmacists as recognized health providers in the Social Security Act. (AMCP link). Nationally. Not just at the state level. To not do this is the same as penalizing patients. We can do better!  Not the total answer, but a big part of the answer.  It provides a pathway so that we will ALL do better.

Patients are Waiting!