Today, there are many forces encouraging patients to use more than one pharmacy. Physicians are directing patients to chain pharmacies with $4 prescription options. Grocery store chains are offering discounts on gasoline for each prescription transfer. Some patients that simply shop around for convenience, price or both. When a patient elects to use multiple pharmacies, commonly referred to as polypharmacy, there are several significant implications, including a few less obvious possibilities, to be considered. Today’s edition of Tales from the Counter describes a few of these gotcha’s.
Like many of our Tales From the Counter, our adventure begins with a clinical intervention. In our case, our workflow identified a patient that was a candidate for an additional drug therapy. Current guidelines suggest patient would benefit from initiation of a statin to lower cardiovascular risks. Our pharmacist took the time to initiate a discussion with the patient about the possibility of adding a statin during their next encounter.
Like a lot of our recommendations, we always make sure that the patient is aware of any possible suggestions we would like to make to the prescriber. This helps the patient maintain a modicum of control over their own healthcare. The success of any therapy change is inherently dependent on the patient’s willingness to participate.
In this case, the patient wanted to discuss the recommendation with their doctor at their next appointment. Our pharmacist indicated that she would send a note to the patient’s physician outlining the discussion that they shared, the recommendation, and the patient’s desire to discuss the possible new therapy with the physician.
The physician reviewed the note our pharmacist sent and their response included a notation indicating that they were sending a new prescription. Because our pharmacist knew that the patient wanted to speak with the doctor about this before initiating any change in therapy, our pharmacist put a hard-stop on the filling of any new prescription for a statin on the patient. She also took time to call the patient to alert that a prescription was expected and to let her know that we would not fill it until she spoke with her doctor and gave us the green light.
This is where polypharmacy unexpectedly creeps into our story. We did not receive a new prescription for a statin on the patient. Another pharmacy, the one the patient chooses to use for one of their medications based on out of pocket costs, received, filled and called the patient to pick up their new prescription.
The unexpected call about a new medication upset the patient. Our attempt to leave the patient in control of their healthcare failed. We did not anticipate that the prescriber would write the prescription. Nor did we anticipate, or even consider, that the prescription being sent would go elsewhere. We failed our patient on multiple levels despite our best efforts.
The TV commercial character Mayhem, played by Dean Winters, is associated with unexpected and sometimes even catastrophic events. This portrayal also works well for the healthcare clinician. It behooves us to always be on the lookout for the unexpected. Recognize that often we will miss something that later will seem obvious. Our job is to mitigate these challenges. Remember that everything we do should be in the best interest of the patient, but also with their knowledge and permission as well. Our miscommunication could have been prevented. And even our attempt to intervene was thwarted by an unexpected twist.
As you work to make Every Encounter Count, be sure you also stay on the lookout for mayhem lurking around the corner.
