IPC Patient advocacy & IPE role

Question 1

How would you rate your ability to be a patient advocate?

Answer 1

good

Question 2

Patient Advocacy

Answer 2

Advocate (verb): to support or argue for (a cause, policy, etc.); to plead in favor of

single patient

group of patients (patients with diabetes)

community

state

nation

Question 3

Advocate for: coverage for and access to medications

Answer 3

Contact insurance companies
- Determine preferred formulary options.

Fax PA requests
- Follow-up on coverage

Obtain coupons: GoodRx etc.

Pharmacy deals
- Walmart $4 List
- ShopRite Free DM Meter with affordable strips

Manufacturer Patient Assistance Programs

MCPHS Outreach Program

Question 3

Examples of Advocacy

Answer 3

Coverage for and access to medications

Coverage and access to immunization services

Culturally competent care for diverse populations

Protecting patient’s privacy

Evidence-based care

Patient safety and elimination of medical errors

Appropriate materials to improve health literacy and patient education

The elimination of healthcare disparities

Question 4

Advocate for: coverage and access to immunization services

Answer 4

Assess patient for immunization status and needed vaccines

Utilize immunization state-wide standing orders
- Obtain an immunization certificate
- Keep CPR certification up-to-date
- Complete vaccine CE programs

Utilize state-wide vaccine reporting systems

Understand how to use CDC/ACIP immunization schedules

See the previous slide- coverage of vaccines

Question 5

Advocate for: culturally competent care to diverse populations

Answer 5

Appropriate translation services

Role of a Community Health Worker

Understand your patient’s culture
- Drug-Food interactions: Foods they eat, when they eat, etc
- Cultural “illnesses” or treatments
- Role of religion in health

Resources available within the community
- What is currently available?
- Can you be a resource?

Question 6

Advocate for: culturally competent care to diverse populations

Answer 6

Not culturally competent:
“You have high blood pressure. We recommend a low salt diet”
Patient: I don’t eat salt

Culturally sensitive:
What seasonings do you use when cooking or eating?
Adobo
Do you know that contains >300 mg of salt per serving.

Question 7

Advocate for: culturally competent care to diverse populations

Answer 7

How do patients of that culture describe illnesses, react with illness, etc.

PR patients with asthma often describe SOBas “fatigue”

PR patients will often say in English that they “drink” their medicine due to the translation of “tomar”

What is customary for patients to use in their culture:

Question 8

Advocate for: protecting patients privacy

Answer 8

Private counseling area
Private area for vaccinations
Training of staff
Organization of pharmacy workflow, drop off areas, pickup areas

Question 9

Advocate for: evidence-based care

Answer 9

Stay up-to-date on the latest information

Utilize the Pharmacist Patient Care Process

Effectively research clinical questions utilizing appropriate resources

Communicate information effectively to patients and/or providers

Develop trusting relationships with patients and providers

HHC Example:
- DM Patient-started on glyburide

Question 10

Advocate for: appropriate materials to improve health literacy and patient education

Answer 10

Counsel patients whenever possible

Assess material for appropriate health literacy level
- Free CDC online training
- Assess using objective scales (PEMAT, FOG/SMOG)

Evaluate the health literacy level of your patient
- Validated tools

Verify understanding with teach-back or similar techniques

Utilize patient action plans

Utilize medication adherence packaging

double-check

Question 11

Advocate for: the elimination of healthcare disparities

Answer 11

Serve the underserved

Identify factors that lead to health disparities and address them

Examples:
- HHC
- Highest Teen Pregnancy Rate
- Highest Elementary Absence Rate
- High rate of IVDU, overdose, and transmission of blood-borne infectious diseases

Black and African Americans increased risk of HTN, CVD
- BP counseling at barber shops

Question 12

One voicecan make an impact.Manycan change history.

Answer 12

Participate in organizations whose mission (or at least in part) is to advocate for patients and the profession
- Be an ACTIVE member

Even students can have a voice!
- No experience necessary- only passion

Question 13

True or False:
Pharmacists can prescribe medications

A
True

B
False

Answer 13

A
True

most cannot prescribe meds but they can if you have CPA

Question 14

CPA

Answer 14

Collaborative Practice Agreements (CPA) or Collaborative Drug Therapy Management (CDTM)

Formal relationship between pharmacist and prescriber

Defines the scope of practice
- Mutually agreed upon drug therapy protocols
- Transfers prescriptive authority to pharmacist

Referral System

CPA
- establish a formal relationship
- delegate patient care functions
- contain negotiated conditions

Question 15

CPA

Answer 15

Increases patient access to care:
- 86% of the US population lives within 5 miles of a community pharmacy

Improves patient health outcomes

Provides prescribers with an additional resource to help manage their workload

NOT REQUIRED to have a collaborative relationship with the provider
- Always within the pharmacist’s role to provide recommendations

to prescribe: need CDTM
to make a recommendation: you do not need CDTM

Question 16

Examples of CPA

Answer 16

Refill Authorization

Therapeutic Interchange

Chronic Disease Management

Ordering Laboratory Testing

Question 17

Refill Authorization

Answer 17

No CPA:
No refills
- Fax or call the provider to get refills
- causes Delay in care because the provider usually gets back to you in 48 hours

With CPA:
Pharmacist assesses patient
- Determine if a refill is appropriate

Initiate refill extension

The patient immediately receives medication

Question 18

Therapeutic Interchange

Answer 18

No CPA:
- Prescribed medication not covered by insurance/hospital formulary

• Pharmacist contacts prescriber for alternate medication
• Delay in care

With CPA:
- Pharmacist assesses patient

• Determines appropriate substitution

Initiates substitution
- Notifies prescriber

• The patient immediately receives medication

Question 19

Chronic Disease Management

Answer 19

No CPA:
- The patient sees the provider for Q6-12 months

• Disease states remain out of control for longer period
• Difficulty with adverse events

With CPA:
- The pharmacist is an additional healthcare provider

• May initiate, adjust, or discontinue medication for specific disease state
• Healthcare outcomes are achieved quicker
• Adverse events are addressed quicker

Question 20

Ordering Laboratory Testing

Answer 20

No CPA:
- Providers are overwhelmed
- Important labs are overlooked

With CPA:
- Pharmacist can order laboratory tests
- Especially if prescribing medications that require laboratory monitoring

Question 21

CPA Establish a Formal Relationship

Answer 21

Written Agreement
- Varies by state what documentation is required

Individual or Group agreements
- MA: must be individualized
- NH: may be individualized or between a group

Practice Settings varies
- Inpatient vs. ambulatory care vs. community pharmacy
MA:
- Inpatient/ambulatory care: any CPA
Community restricted to: Asthma, COPD, DM, HTN, hyperlipidemia, CHF, HIV/AIDS, Osteoporosis

NH:
- Previously restricted to only inpatient- now expanded

Question 22

Delegate Patient Care Functions

Answer 22

Scope of Practice
Disease States that are eligible vary by state
Protocol agreed upon by provider and pharmacist
Initiate, modify, or discontinue therapy within that disease state
Several states restrict initiation (can only adjust doses, not start new medications)

Question 23

CPA Requirements (Varies)

Answer 23

Referral Process, CPA duration, communication requirements
Providers, Pharmacists, and Patients covered within the agreement
Scope of Practice and Protocols
Disease states, medications, etc.
May include labs or physical assessments
Documentation
Reported to prescriber
Reported to state
Training
Board certified?
Residency trained?
Years of experience?
Continuing education requirements?
Certifications (CPR, disease state specific?)
Liability/malpractice insurance

Question 24

How to obtain a CPA

Answer 24

Step 0: Professional awareness
- Working largely independently, but may interact for discrete episodes of care

Step 1: Professional recognition
- Attend face-to-face meetings, discuss program, request feedback

Step 2: Exploration and Trial
- Start with 1-2 patients, create recommendations for prescriber to consider, test out workflow

Step 3: Professional Relationship Expansion
- Optimize workflow, increase number of patients in pharmacists care

Step 4: Full Collaborative Working Relationship
- Bilateral communication and trusting relationship achieved. CPA terms agreed upon and implemented.

Question 25

for the CPA agreement who is the prescriber

Answer 25

RPh is the prescriber so the RPh signs the script

You’re the prescriber!

RPH with CPA can sign the Rx

the physician does not need to sign the script

Question 26

CPA vs. Standing Orders

Answer 26

CPA
- Often requires a referral
- Clinical judgment is utilized
- Few pharmacists/institutions have
- Pharmacist is prescriber
- Examples:
Diabetes management
HTN management
Pharmacist prescribed birth control

Standing Order
- Typically does NOT require a referral
- Protocol already available; strict step-by-step – if/then
- Almost all pharmacists/institutions utilize
- The provider who signed the order is the prescriber
- Examples:
Immunizations
Naloxone
Emergency Contraception

Question 27

HHC Example: Naloxone Standing Order

Answer 27

Any person who is at risk for an opioid overdose or is willing to assist a person at risk of an opioid overdose

A 68-year-old patient presents to the pharmacy requesting naloxone. Is prescribed oxycodone for cancer pain.

Question 28

Just because you CAN doesn’t mean you CAN…

Answer 28

Takes time to develop relationships with providers

Advocate for yourself to work at the top of your license
- Barriers to implementing CPA agreements
- Not always financially stable
Unless considering cost of care, improved patient outcomes, etc.

Patients can’t utilize it if pharmacists AND patients are not aware it exists
- Recent study found most community pharmacists were unaware of the CPA regulations in their states
- Even fewer patients are educated about pharmacists’ ability to prescribe within a CPA agreement

Encourage the provider to help establish this relationship during the referral process

Question 29

Which one of the following applies to acupuncturists?

Reconcile home and hospital medications

Administer immunizations

Able to make recommendations for a patient’s plan of care for a patient with bladder dysfunction.

Administer oral local anesthesia.

Answer 29

Able to make recommendations for a patient’s plan of care for a patient with bladder dysfunction.

Question 30

Which of the following health care professionals are able to make recommendations for a patient’s plan of care for a patient with bladder dysfunction? Select ALL that apply, no partial credit.
Show answer choices

Acupuncturist

Occupational therapist

Physical therapist

Diagnostic medical sonographer

Answer 30

Acupuncturist

Occupational therapist

Physical therapist

Question 31

Which health care professionals require a doctorate degree for entry level practice within the United States? Select ALL that apply; no partial credit.
Show answer choices

Optometrist

Acupuncturist

Physician assistant

Physical therapist

Answer 31

Optometrist

Physical therapist

Question 32

Which one of the following require an associates’ degree for entry level practice within the United States?
Show answer choices

Acupuncturist

Dental hygienist

Occupational therapist

Optometrist

Answer 32

Dental hygienist

Question 33

Which one of the following does NOT apply to physicians?
Show answer choices

Can perform wound debridement.

Change field of practice/ specialties within the profession without returning to school or residency training.

Reconcile home and hospital medications

Administer oral local anesthesia

Answer 33

Change field of practice/ specialties within the profession without returning to school or residency training.