General Comments: (Record here comments regarding patient health status; courses of action you take, physician instructions, etc.) Please check here if you want information about the interactions of alcohol and some drugs. Do you have a special diet? Yes No If so, what? 67-680 0-80--6 800315 The CHAIRMAN. Thank you very much, Dr. Penna. You have made an excellent statement. I suggest Mr. Abrams be our next witness. STATEMENT OF MARK ABRAMS, PRESIDENT, AMERICAN SOCI- The American Society of Consultant Pharmacists is the national professional society of pharmacists who specialize in serving the unique needs of residents of long-term care facilities and providing nondispensing pharmacist services to these and other health care settings. Society membership numbers of 1,500 and includes the leading practitioners in the field who are responsible for pharmacy and pharmacist services to more than 700,000 or greater than half of the Nation's nursing home patients. I work full-time as a consultant pharmacist. I see an average facility, a hundred-bed facility, with over 20,000 doses of medication being given to patients with a medical director who might be in the facility once a week who sees anywhere from 20 to 60 percent of the patients. All the others are being seen by outside physicians. There is no resident or intern as you find in an acute care setting, so the primary responsibility of the patient right now is in the hands of the nurse, and that is a lot of responsibility to give the nurse. Unfortunately, the knowledge pharmacists have of adverse drug reactions, drug interactions pharmacokinetics, and appropriate therapy is not being utilized to its full potential. There have been areas of noncompliance as have been stated today. The widespread lack of understanding or misunderstanding of exactly what constitutes drug regimen review contributes significantly to the problem. All too many nursing home administrators, nurse, physicians, nursing home surveyors and, yes, pharmacists, have little knowledge of what the drug regimen review requirement means. Pharmacists doing good drug regimen reviews, however, will tell you that the entire contents of the patient's medical record, including physicians and nurses' progress notes, occupational and physical therapist notes, dietary and laboratory records, past medical and drug history, as well as medication orders and administration records must be thoroughly reviewed and the information integrated to reach a sound conclusion as to the appropriateness of a drug regimen. As the chairman was saying earlier today about using the nurse, not only do we do that but we find a great source is the physical therapist who has to work with the patient early in the morning and has a greater feel for the subtle changes in the patient. To foster a better understanding of the meaning of drug regimen review, the society is pursuing a number of avenues. First, the society is developing practice guidelines for consultant pharmacists in long-term care facilities which will elaborate on the drug regimen review process. These guidelines are currently in draft stage but should be finalized and adopted by the association in the near future. The society has also endorsed and participated in the department's initial efforts to develop guidelines that nursing home surveyors can use to determine facility compliance with the drug regimen review requirement. Although we have some fear that these "drug regimen review indicators" may be misapplied by inadequately trained surveyors, we view adoption of these guidelines as a positive step by Government to increase emphasis and understanding of the patient care opportunities presented by effective drug regimen review. Unfortunately, other elements of the Government have yet to understand drug regimen review, particularly the economic and patient care value of the activity. Many State medicaid programs still do not recognize the cost for pharmacists of providing this professional service. Consequently, payment to pharmacists continues to be inadequate. In the final analysis, inadequate payment for the drug regimen review and other nondispensing services of the consultant pharmacist remains as the primary roadblock to universal and effective drug therapy assessment in nursing homes. A recent Survey of Long Term Care Operations conducted by the society indicates that pharmacists spend an average of 3 hours per 100 patients per week performing drug regimen review and other clinical and administrative consultant services in nursing homes. This same survey reports that the pharmacist's cost of providing these consultant services is from $12 to $14.21 per hour. In a 100patient facility, the monthly cost to the consultant pharmacist is over $180 in time alone. Yet, if you look at what is going on in the country, particularly in the Maine medicaid program policy limiting reimbursement for consulting pharmacists to 75 cents per patient per month-it is costing you $180 to do it and you are only getting $75 back. You can't stay in business very long and you cannot perform the kind of services that should be performed with this kind of reimbursement. Amazingly, the situation in Maine is not unique. Most States have yet to publicly acknowledge in their reimbursement manuals the fact that the charges of consultant pharmacists are a reimbursable cost under their cost-related reimbursement formulas for nursing homes. Another factor contributing to consultant pharmacists' difficulty in effectively performing drug regimen reviews is their current minimal level of authority to take action to gather information necessary to the review or to correct an "irregularity" in the drug regimen when one is observed. For example, determining whether or not a potassium supplement should be recommended for a patient taking a potassium depleting diuretic is impossible if a recent laboratory test report indicating the patient's body potassium level is not available. Right now we don't have the right to order lab work. It is difficult to tell a physician you don't think this is correct when you don't have the stats. |