OBRA 90 (exam 1) Flashcards
patient counseling is done to
avoid medication errors
promote safe and effective mediation use
promote medication adherence
who can perform counseling?
pharmacist or pharmacy intern
patient counseling requirements
new patient
new prescription for existing patient
every time a dose, strength, ROA or directions has changed
counseling must be offered
everyone a patient has a prescription refilled or refill authorization
3 prime questions of counseling
what did your doctor tell you this medication is for?
how did your doctor tell you to take the medication?
what did your doctor tell you to expect?
if counseling is refused, can the rx still be dispensed?
yes
barriers to effective counseling
language
hard of hearing
blind
education
how questions are asked
patient attitude
lack of importance
environment
lack of sufficient time
OBRA ‘90
Pharmacists have a duty to warn patients of risks associated with prescription drugs
according to OBRA90, the pharmacy must make reasonable effort to
obtain, record and maintain patient information
Federal Level of OBRA
Pharmacists must counsel patients when dispensing Medicaid prescriptions
which type of patient information should be continuously updated?
allergies
drug reactions
comprehensive list of medications and devices
State level of OBRA
Can require patient counseling for ALL prescriptions
OBRA90 led to improvements in
quality of care
adherence to medications
outcomes
3 Major Components of OBRA ‘90
- Prospective DUR
- Patient Counseling Standards
- Maintaining Patient Records
OBRA90 requires
drug utilization review patient counseling
maintaining patient records
Drug Utilization Reviews (DUR)
Comprehensive review of patient’s medications and health history before, during, and after dispensing
how do mail/delivery service pharmacies provide counseling?
written offer to counsel
counsel via telephone
Goals of DUR
Improve drug therapy
Identify trends in prescribing
Cost savings
Prospective DUR
Evaluating patient’s therapy BEFORE medication is dispensed
Concurrent DUR
ONGOING monitoring of drug therapy during treatment
Retrospective DUR
Review of therapy AFTER patient has received medication
Prospective DUR to identify
drug-drug interactions
contraindications
allergies
incorrect dosing/duration
therapeutic duplications
Concurrent DUR to identify
adverse effects
appropriate dosing
drug-drug interaction
drug-disease interaction
