IPC Patient advocacy & IPE role Flashcards
How would you rate your ability to be a patient advocate?
good
Patient Advocacy
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
Advocate for: coverage for and access to medications
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
Examples of Advocacy
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
Advocate for: coverage and access to immunization services
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
Advocate for: culturally competent care to diverse populations
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?
Advocate for: culturally competent care to diverse populations
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.
Advocate for: culturally competent care to diverse populations
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:
Advocate for: protecting patients privacy
Private counseling area
Private area for vaccinations
Training of staff
Organization of pharmacy workflow, drop off areas, pickup areas
Advocate for: evidence-based care
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
Advocate for: appropriate materials to improve health literacy and patient education
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
Advocate for: the elimination of healthcare disparities
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
One voicecan make an impact.Manycan change history.
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
True or False:
Pharmacists can prescribe medications
A
True
B
False
A
True
most cannot prescribe meds but they can if you have CPA
CPA
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
CPA
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
Examples of CPA
Refill Authorization
Therapeutic Interchange
Chronic Disease Management
Ordering Laboratory Testing
Refill Authorization
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
Therapeutic Interchange
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
Chronic Disease Management
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
Ordering Laboratory Testing
No CPA:
- Providers are overwhelmed
- Important labs are overlooked
With CPA:
- Pharmacist can order laboratory tests
- Especially if prescribing medications that require laboratory monitoring
CPA Establish a Formal Relationship
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
Delegate Patient Care Functions
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)
CPA Requirements (Varies)
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
How to obtain a CPA
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.
for the CPA agreement who is the prescriber
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
CPA vs. Standing Orders
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
HHC Example: Naloxone Standing Order
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.
Just because you CAN doesn’t mean you CAN…
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
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.
Able to make recommendations for a patient’s plan of care for a patient with bladder dysfunction.
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
Acupuncturist
Occupational therapist
Physical therapist
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
Optometrist
Physical therapist
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
Dental hygienist
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
Change field of practice/ specialties within the profession without returning to school or residency training.
