REACHING OUT
by JUDY CHI
To reduce the likelihood of drug errors, the American Pharmaceutical Association is working with the Institute for Safe Medication Practices to develop a self-assessment tool that community pharmacists can use to measure the safety of their practices. This tool would be similar to the checklist ISMP prepared recently for the American Hospital Association so hospitals could shore up their patient safety.
This was one development APhA president Robert Gibson and senior v.p. of professional and public affairs Lucinda Maine revealed when they visited Drug Topics offices as part of a media outreach program last month.
For Maine, the challenge involving drug errors isn't deciding whether to go with a mandatory or voluntary reporting system. It is, rather, how can we expect health professionals to report drug errors when many consumers still believe that errant pharmacists should be fired?
If a tool to assess a pharmacy's safety is one way to cut drug errors, how about mandating breaks for pharmacists who work long hours? Why hasn't APhA come out in support of such a proposal? Maine explained that the association doesn't have enough information to endorse a specific policy, such as requiring a break after x number of hours worked or x number of Rxs dispensed. Gibson put it more bluntly. He said it is "ludicrous" that pharmacists have allowed themselves to be dictated to regarding when they can take a "potty break." Had he been practicing at a pharmacy with such a policy, he would have gone to work someplace else.
The APhA officials acknowledged that pharmacists' workload is a big problem today and one that is not helped by the current pharmacist shortage, which affects all regions and practice settings. Still, the association has no regrets about supporting the all-Pharm.D. system. Maine said she anticipated the chains would say, "I told you so," regarding the existing manpower bind. But the conversion to the all-Pharm.D. system is only a contributing factor to the R.Ph. shortage, she noted. With more sophisticated drug technology being approved every day and the need to help patients manage their therapies, it's absolutely necessary for pharmacists to have that level of training, she asserted. Backing her up was Gibson, who said that, coming from California, he was one of the first pharmacists in the country to receive the Pharm.D. degree.
If the volume of prescriptions is high now, it's going to be worse when a Medicare outpatient drug benefit passes.
Maine thinks there's still a 50-50 chance that a Medicare drug benefit will pass this year, since so many constituents are clamoring for it. She considers the House bill that was passed "undercooked" and looks more favorably on the Senate version, although she said that, at the time, not enough details had emerged about the proposal. A better alternative, she said, is SenioRx Gold. Under this proposal, the federal government would offer funding to the states for providing drugs to vulnerable seniors. Not only is reimbursement for pharmacy services part of the proposal, but also it does not require a change in the Social Security Act to recognize pharmacists as providers before reimbursement can start flowing, since it is a state-based approach.
Elaborating on reimbursement, Maine said pharmacists want a fair one for the product, any special packaging they provide, and pharmacist services. That's why the association is opposed to leaving it up to pharmacy benefit managers to decide what the reimbursement should be. There has been a deep imbalance in the relationship between pharmacists and PBMs, with the former being unable to leverage the latter for fair reimbursement, she maintained. Now that several major PBMs have announced they're merging, they may gain even more power over providers, she lamented.
Even now, APhA thinks SenioRx Gold could be the "eleventh-hour solution," if the House and Senate cannot come to a compromise, which President Clinton might support. She added that the President is motivated to "sign almost anything" because he wants better health care to be part of his legacy.
In other news, Maine disclosed that APhA would be coming out with two other products for members. One is a practical text called 101 Ways to Improve Your Pharmacy Worklife. Due out in October, this document will provide pharmacists with simple ideas on how to defuse stress and improve professionalism. The other product is a guide APhA is developing with the American Dietetic Association that will help members of both groups handle consumer queries about dietary supplements. This guide should be published in the next couple of months.
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