Drug Topics Voices 07-10-2014

PPAs and CPPs

Re: Robert L. Mabee's “The Pharmacy Physician Assistant” [June 4]:

PPAs already exist. They are called Clinical Pharmacy Practitioners (CPPs) and work under a collaborative practice agreement with their physicians. Their role is not exactly as described in the article about PPAs, but it could easily be expanded.

North Carolina is one state that recognizes CPPs.

Comment posted at www.DrugTopics.com

E-Rxs - Oh, yeah

At www.DrugTopics.com, articles by the Cynical Pharmacist (“Electronic prescriptions: Return to sender,” June 10) and reader Tom Hanson (“E-prescribing: The end of prescription errors? Hardly,” June 11) set off a round of cheers and catcalls. The following are some of the comments you’ll find posted.

Got their number?

This is a hideous problem. Are we by law expected to find and solve physicians’ mistakes?

My biggest problem is the physician phone number listed on the script! I call to correct the prescription and the secretary says, “I’m sorry, this is the billing office. We didn’t send you any electronic scripts.” Totally ABSURD.

It should work both ways

Since the evolution of e-scripts, I have been so frustrated that I do not have a “Return to Sender” option. The doctors and their agents are so hard to get hold of by phone or fax. I consistently leave messages that are not returned.

I’m not a programmer, but it seems to me that if the e-script communication can go in one direction, it should be easy to open the channel to communicate in reverse.

The other thought I have had about decreasing errors in e-scripts is that doctors’ offices should start employing experienced pharmacy technicians to either enter or review the orders before sending them to the pharmacy.

Back to the future

I understand your frustration. I’ve worked in both hospital and retail settings for the government for almost 40 years. We had problems with “physician order entry” in the institutional area back in the 1970s and went back to hand-written orders.

The software providers must use simple directions and provide matching entry fields.

Start with NDC

I highly doubt that any of the software providers that write this defective code are willing to hire the team of pharmacists needed to correct and maintain their software. Pharmacists are just too expensive when compared to offshore coding mills.

Further, even if an e-script vendor were willing to invest in the necessary resources, the data is coming from a third-party “drug database” solution that often contains numerous errors.

One thing that might help is if the FDA would correct their useless NDC system. Every vendor has to “translate” data fields because the FDA allows manufacturers to enter strength, size, quantity every which way, then cry about the cost of relabeling if anyone brings up the concept of a real national standard.

Adding injury to insult

I just get steamed when I receive and fill an Rx, only to be told that it was also sent somewhere else and I need to back it out. Another 30 cents wasted on transmission charges plus a couple of bucks for labor - oh, and that was more than I would have made on the prescription to begin with.

New question

Errors have not been eliminated, but the question has changed. We used to  ask, “What does that say?” Now we ask, “What did he/she mean?”

Does your doctor like you?

“Lantus Insulin; dispense 12 teaspoonfuls (60ml) qHS,” sent not once, not twice, but three times . . .

Excuse me, Mr. Jones, but does your doctor like you?

Living the dream

JP’s June column, “The dream of pharmacy ownership,” drew the following comment:

“Independent pharmacy. There has never been a better time” is right!

I am so happy to read this article. It should be shouted from the rooftops of  every pharmacy school in the land.

If only I could find a young pharmacist who wants to learn my business model (cash only, compounding, nutrition/lifestyle/MTM consults, and functional pharmacy front end) I could  semi-retire into consults-only while they earn sweat equity and, eventually, buy my pharmacy.

Pharmacists foam at the mouth over getting “permission” to stick a needle into their patients. Why?

Pharmacists yearn to do MTM counseling for $45. Why?

Pharmacists yearn to prescribe medications that patients don’t want to take and which do nothing to treat the core cause of their illness (a.k.a., functional medicine).

Why would we want to practice more ”band-aids-over-bullet-holes medicine/pharmacy”? Patients KNOW that the current paradigm doesn’t work/heal. That’s why we take in tons and tons of unused medications for proper disposal: It doesn’t work. Or they find the side-effects/quality of life-after-drugs too debilitating for them to be able to continue on them.

Give me the power to discontinue medications - that’s all I need to make a difference in my patients’ lives.

Clarification: In the June issue, the article “Pharmacists: Where do you want to practice?” listed Tennessee in Table 2 as one of the least expensive states in which to maintain a pharmacist’s license ($96/2 years). Although this is technically accurate, Tennessee also requires a pharmacist to pay a $400 “professional tax” each year to the state.