Roger Paganelli, owner of the Mt. Carmel Pharmacy, remembers the difficulties he faced juggling the six prescriptions he took following knee replacement surgery.
“I’m only 52, this (being a pharmacist) is the only job I’ve ever had, and I found myself saying, ‘Did I take that one?’” says the third-generation pharmacist. “I can certainly empathize with patients who are elderly and take 20 to 25 prescriptions, two-thirds of which are in tablet form.”
Patients on multiple medications comprise a significant percentage of the clientele seen by Paganelli and other community pharmacists in the Bronx. To support these patients in managing their medications and their overall health, the Bronx Partners for Healthy Communities (BPHC), the SBH-led Performance Provider System, introduced a Community Pharmacy Workgroup in February 2016. This collaboration has led to several patient-centered projects –the latest being the evaluation of the use of antidepressants and its effect on patients’ hemoglobin A1C levels (which is indicative of a three-month average of their blood glucose level).
Additionally, this past May, a panel discussion was held at SBH Health System between members of BPHC’s Program Advisory Committee (PAC) and Bronx community practice pharmacists. The focus was on how these pharmacists can help improve medication adherence.
“Patients often return to the hospital or come to the Emergency Department due to undesirable events linked to medication non-adherence, or their inability to fill prescriptions at the pharmacy,” says Ruth Cassidy, senior vice president and chief pharmacy officer at SBH. “Community pharmacists can play a key role in helping to manage these patients and need to be a component of the provider equation.”
It was highlighted during the panel discussion that there are myriad reasons why many patients are not compliant with their medications. These include a lack of understanding why they need a particular medication, confusion over how to take it, an inability to pay for it, a concern over side effects, or simply a failure to get refills from the pharmacy.
Tony Sementilli, owner of Total Care Pharmacy and a member of the workgroup, says that patients can also be afraid to ask their doctors questions, not understand the answers, or only think of questions once they leave their doctor’ s office. This is a role the community practice pharmacist can play. “After all, we are the last ones they see before they go home and take their medications,”Sementilli says.
Prior to this relationship with BPCH, SBH and select community practice pharmacies have been collaborating on the “Meds to Beds” program. This is where contracted pharmacies fill medications to patients at the time of hospital discharge. The program started with a few nursing units in the hospital and has been expanding due to its success.
“When patients get discharged and are handed a bunch of prescriptions, the fill rate is about 50 percent, and the chances they will be readmitted are great,” says Sementilli. “There is a lot of potential for error. With Meds to Beds, they get 100 percent of what the physician wants them to take once they leave the hospital.”
Community pharmacists also help simplify the process for the patient and health care worker in various ways, such as by creating blister packs and synchronizing medications (neither of which they are reimbursed for). They conduct medication reviews,don’ t require appointments and are available virtually every day. “Those patients who understand this, take advantage of it,” says Paganelli.
Part of the transformation in health care, say the community practice pharmacists, will hopefully change the long-standing perception of patients and providers who view them merely as medication dispensers. Not giving community practice pharmacists access to patients’ electronic medical records –hospital pharmacists have access to this information –only furthers that perception. To fully understand what’s going on with the patient, having such access is imperative, say the community pharmacists.
“When you go to a pharmacy, your question is often, ‘Why does it take so long to fill 30 pills?’ or ‘Why am I spending so much money for an inhaler?” says Cassidy. “In New York and other states, patients, providers and insurers have to look at community practice pharmacists as part of the medical team.”