What’s blocking healthcare delivery in the pharmacy?

“But my doctor wants me to be on this for the rest of my life, why aren't there any refills?” It's a question all of us have heard, and if I were accepting nominations for the most cringe-inducing questions from patients, I'm sure that one would be in the top three.

You know what happens next. Often it’s another recital of how prescriptions expire after a year, followed by a fax, an e-refill request, or a phone call to a doctor's office for an authorization that is sure to be approved; “spotting” the patient a few pills to get by on until we hear an answer; and all too often, seeing the patient return before that answer comes, because we’re dealing with that doctor who claims never to get our faxes, no matter how many times the fax machine says they went through just fine.

First question

I'm not running a cringe-inducing-question contest with this article, though. I'm actually asking a question. In a world where insurance plans now fight for Star Ratings and Medicare now watches like a hawk for patients readmitted to hospitals for preventable reasons, why do we have a system that puts up barriers to patients trying to obtain their routine maintenance medications? Anyone reading this article also knows that some of those patients “spotted” five days’ worth of meds won't return for seven or eight days.

The most common answer you'll probably hear to this question cites the necessity for the patient to make periodic physician appointments, many times for an annual physical. In a world of evidence-based medicine, though, it should be pointed out that there is no strong evidence that an annual physical leads to better healthcare outcomes, an opinion shared by Allan Goroll, a professor of medicine at Harvard Medical School, in an online article in the January, 2010, issue of the American College of Physicians publication for internists. He does go on to say, “However, there is substantial evidence that checking for and treating cardiovascular risk factors, preventable or curable cancers, STDs, depression and substance abuse are all evidence-based, high-value activities.”

Second question

Which brings us to my second question. Is there any pharmacist here who thinks that instead of being the point person for overcoming needless barriers to care, we couldn’t better spend our time being the initial contact for these “high-value” activities?

Instead of “No, we still haven't heard from Dr. Nofaxback,” imagine if your patients heard this: “I see it's been a few months since we've done a blood pressure reading for you, Mr. Smith. Why don't you sit down here and we’ll get your numbers while you're waiting for your Norvasc fill. How did those nicotine patches work out for you? If they're not doing the job, there are a couple different options we could go with. I also see that you're due for your first colonoscopy; did you know that our computers link directly with your gastroenterologist now? When we're done here, my technician can make an appointment with her for you, if you'd like.”

Throw in a little conversation about the general state of the patient's health and the fact that no one is in a better position to know about a propensity for substance abuse than a person's pharmacist, and you have now replaced a significant barrier to medication adherence with something valuable to the patient's health, opened the way for the doctor to spend more of her ever-more-limited time concentrating on diagnosing and solving problems, and found an actual opportunity for the pharmacist to sit down in the course of a 12-hour day.

What’s blocking the win-win-win

And that brings us to the main reason this scenario is not taking place. The technology to accomplish this exists, and the pharmacists’ skill set of is there, but the chances of the “Big Three” pharmacy chains setting up an environment where you have the time to pull this off are about zero.

The reason you don't sit down now for 12 hours is because your company isn't running a healthcare facility, it's running a prescription mill.

In other words, if you’re looking for the biggest barrier to necessary reforms in daily pharmacy practice, you don’t have to look any further than to the corporations that run the pharmacies.

That thought should make you cringe more than any question you'll hear from a customer today.