Discharge Medication Education

The following words from the Center for Medicare and Medicaid Services (CMS) state clearly that if a patient is to be discharged from a hospital, the hospital is responsible for providing medication education to that patient in a format that is tailored to their individual learning requirements and that they may refer back to. 

There are a variety of tools and techniques that have focused on improving the support provided to patients who are discharged back to their homes. A comprehensive approach employing combinations of these techniques has been found to improve patient outcomes and reduce hospital readmission rates, including, but not limited to the following. 

·         Improved education to patients and support persons regarding disease processes, medications, treatments, diet and nutrition, expected symptoms, and when and how to seek additional help. Teaching methods must be based on recognized methodologies. CMS does not prescribe any specific methodologies, but examples include the teach-back, repeat-back approach and simulation laboratories.

The education and training provided to the patient or the patient’s caregiver(s) by the hospital must be tailored to the patient’s identified needs related to medications, treatment modalities, physical and occupational therapies, psychosocial needs, appointments, and other follow-up activities, etc. Repeated review of instructions with return demonstrations and/or repeat-backs by the patient, and their support persons will improve their ability to deliver care properly. This includes providing instructions in writing as well as verbally reinforcing the education and training.

Please take a moment and read the discussion recently posted at RxEconsult regarding this important issue:


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AudibleRx, that's exactly what I've been looking for!

Group Subscriptions available:
  • Transitional care patients, listen to medication counseling sessions while resting in your hospital bed prior to discharge.
  • New prescriptions, listen to medication counseling sessions while waiting for your prescription at the pharmacy.
  • Insurance companies, provide access to your members to assure provision of consistent and accurate medication counseling information.
Individual Subscriptions:
  • Patients, take the time to understand your medication therapy.
  • Caregivers, understand what you need to know about the medications your are providing.
Understand what you do and don't know about your medications so you may take educated questions back to your own health care provider.  Start listening today at www.AudibleRx.com.


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Pneumonia Warning Siren

During the late 80’s and early 90’s, my wife, young family and I lived and worked in the mountains of Northern California.  Even though an interstate highway went directly through town, we were still considered a relatively small community that looked out for and cared for one another.  At times, winter weather could be quite heavy and the town had a warning system in place to alert the community when we were on the crest of a heavy winter storm. 

Infrequently, the snow would be falling at such a rate that the town’s snow plow system could not keep up with the storm.  This snow fall would create a dangerous environment on the roads due to significant accumulation and, unless you had a snowmobile or a four-wheel-drive with snow tires and chains on all four wheels, you would be stuck. 

This little mountain town had a crude, yet effective, warning system to alert the town that the storm was heavy, the roads were closed to all but emergency vehicles, and stay at home until further notice.  From town central a piercing siren would scream from the top of a building.  I can only imagine that it sounded like an air-raid siren from WWII.  The sound could be heard for miles.  The siren would ring clear for about 60 seconds, and then again, hours later, when the immediate danger was clear.

Pneumonia is an infection of one or both of the lungs caused by either a bacterial, viral or fungal infection.  The infection will inflame the alveoli (the sacs that transfer oxygen to the blood) in your lungs and may cause the alveoli to fill up with fluid causing severe symptoms such as a severe cough, chills, fever and difficulty breathing.

Patients at high risk for developing pneumonia include:

·         Children 2 years of age or younger because their immune systems are not fully developed.
·         Adults 65 years of age or older.
·         Patients with co-existing disease states such as asthma, COPD, heart disease, diabetes, cancer or some other immuno-compromising disease state.

If not treated soon enough or appropriately, pneumonia may lead to severe complications including:

·         Pleural effusion; this occurs with a fluid buildup in the space between the lining of the lungs and chest cavity.  If the fluid becomes infected it may need to be drained through a chest tube or removed.
·         Bacteremia; this may occur when bacteria enter the bloodstream from the lungs.  This may carry the bacteria and spread infection to other organs in the body.
·         Breathing Difficulty; severe pneumonia, coupled with other existing lung disease, may make it difficult to breath in enough oxygen to oxygenate the tissues.
·         Lung abscess; this may occur if pus forms in a cavity of the lung.  This may then need to be drained with a long needle in order to clear the fluid.

Fortunately, we have an internal warning system that lets us know we may be in danger of developing pneumonia.  Initially, a pneumonia patient may experience some chills, fever and a little difficulty breathing.  As the air-raid siren begins to increase in volume, the individual will be experiencing chest pain when coughing, a cough with phlegm, shortness of breath, and possibly some nausea, vomiting and diarrhea.

Learn the warning signs and listen to them carefully, especially if you are at “high-risk” for developing pneumonia.  Listening to the warning signs and seeking medical attention as soon as possible will help decrease the chance a pneumonia infection will develop into a more complicated situation.

You may also be interested in reviewing the following information:


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Community Involvement

Community involvement is the process of engaging in communication and collaboration with members of your community.  Not only is community involvement valuable to the recipients of whatever services are being provided; the simple process of being involved provides a sense of meaning and fulfillment to those offering the services.

This past weekend, my wife and daughter joined me in presenting AudibleRx at the local community hospital health fair.  I know it seems like a small thing; however, many useful, mostly unexpected, consequences arose from the planning of and presenting at this community event.  Time will reveal what consequences will present as a result of us presenting at this fair.

·         The preparation time required me to prepare and organize exactly what it is I wanted to share with the community.

·         I was given the opportunity of sharing AudibleRx in much greater detail with my wife and daughter so they would be prepared to answer questions at the fair.

·         Through the process of preparation, I designed and put together two poster boards that describe what AudibleRx is and how it works.

·         The time that I spent at the fair with my wife and daughter was Really Fun!

·         Visiting with the 200+ individuals that worked their way through the fair allowed me the opportunity to fine tune my AudibleRx pitch.  This process really helped me refine how I can describe what AudibleRx is and how it works in a short, interesting pitch.

·         I had the opportunity to meet a number of care givers and other health fair presenters that were quite interested in AudibleRx which may lead to further collaboration.

·         The feeling of being involved in our community, communicating with individuals and collaborating with other health care workers is priceless.

At AudibleRx, we are all about medication information.  Take the time to increase your Health Literacy by understanding what you do and don't know about your medications.  After you have developed a few educated questions about your medications and health condition, contact your pharmacist, doctor or other health care provider and engage them in a conversation.

The country is in a state of health care transition.  No one really has a clear idea of how the Affordable Care Act will change our access to health care coverage over the next one, five or even ten years.  One point we can be sure of; as individuals, we all need to take more responsibility for our own health.  

Sometimes it really is brain surgery; however, more often, it comes down to simple questions:   

·         Will this food affect my heath?

·         When do I fit exercise into the day?

·         How much sleep do I need?

·         Do I understand my diagnosis?

·         Do I understand why I am taking my medications and the consequences of not taking them?

·         Where do I get my health care questions answered?

AudibleRx, educating and motivating individuals to participate in their pharmaceutical care.

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After the Heart Attack

I have a friend whose heart stopped beating due to a massive heart attack over ten years ago.  His wife found him unresponsive, called 911 and performed CPR on him until the paramedics arrived.  He was taken to the hospital for an extended stay in the intensive care unit where doctors and nurses performed multiple procedures, infused him with many different medications and monitored him constantly in an effort to stabilize his now beating heart.  When discharged from the hospital, my grateful friend did one important thing; he followed his doctor's directions. 

·         First of all, he quit smoking.  He had smoked daily and regularly for many years.  This gentleman has not smoked a cigarette since he left the hospital.

·         He signed up with a health club, and began a regular course of aerobic and resistance training.

·         He followed his doctor's orders about taking his new medications.

Here we are, more than ten years later, and my friend leads a happy and healthy life.  He is somewhere over 70 years old; however, he still exercises daily, travels, hunts, fishes, and is alive to be present for his wife, children and grandchildren.

A study that was just published in the October, 2013 issue of the American Heart Journal reviewed the importance of medication adherence for patients post Myocardial Infarction (heart attack-MI). Unlike most adherence studies, which attempt to answer the question as to why a patient is not taking their medications, this study focused specifically on the clinical outcome of post-heart attack patients compared to how often they took their prescribed medications.

"The results indicated that patients who achieved adherence of 80% or greater to each of their prescribed medications were significantly less likely to experience a major vascular event or undergo revascularization when compared with controls, while non-adherent and partially adherent patients had event rates similar to control patients. Adherent patients were 24% less likely to experience an event compared with control patients."

"The researchers conclude that all recommended therapies are necessary in patients after heart attack and that improved adherence to each drug reduces the risk of subsequent major cardiovascular events. The results of the study highlight the importance of adherence and the need for more interventions to improve adherence among these patients."

After a heart attack patients are sent home with a handful of new medications that they have never taken before.  Many heart attack survivors have never needed to take medications on a daily basis.  Here they are, faced with the task arranging their schedule so they remember to take four or more new medications on a daily basis, sometimes up to three times daily.

Many tools are available to help patients remember to take their medications on a scheduled basis.  Walk into your local community pharmacy and ask them to show you their pill box section, most likely you will see a rack that has over 10-15 different choices of daily or weekly pill containers.  These help patients keep their medications organized in a nice manner.

How do people remember to take their doses?  Like the article we reviewed said, even if you obtain at least 80% adherence to your heart medication you will be increasing your chance for the most favorable outcome of therapy.  I recently reviewed a smart phone app called Medisafe that provides a great dosing reminder tool.  If you have difficulty remembering to take your medications, this is a worthwhile tool.

Lastly, I feel that one area that may be overlooked at times with regards to adherence is medication education.  When a patient receives upwards of four new prescriptions, they need some level of current and ongoing education to help them understand their medications.  Quite often, just the doctor, nurse and pharmacist telling them they need to take their medications is not enough.

This is the section I like to call Motivational Adherence.  Educating a patient about their medications may help a patient to become motivated to participate in their own pharmaceutical care.  When a patient understands what the medication is doing and what effects to look out for, they are then becoming an active participant in their own care, rather than just following directions. 
·         Medication education you LISTEN to
·         Where do you get your Medication Education
·         What is Health Literacy
·         Blood Pressure Medication Treatment Options
·         Acute Coronary Syndrome

Please comment and let us know what tools you use to remember to take your medications.


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Medication Information you LISTEN to

"Pharmacy based, Medication Specific Counseling SessionsTM, provided in audio format, with the intent of educating individuals to better understand their pharmaceutical care, increase adherence and decrease adverse events.  AudibleRxTM objectively bridges the medication-education-gap between the patient, their pharmacist and their doctor."

Daily, patients receive prescriptions in the mail or pick up prescriptions from busy pharmacy counters.  Current barriers to effective medication counseling do not regularly allow time for the pharmacist to sit with the patient and discuss their medications for 10-15 minutes at the counter.
Pharmacists are under tremendous pressure to meet their performance metrics and will regularly cover the counseling points of three or four medications in fewer than two minutes. Furthermore, the patient may be in a hurry to get their medication and leave and may not fully pay attention to what the pharmacist does say.  The patient is sent home with stacks of pamphlets that may be difficult to read.

Patient medication education is only one aspect of medication adherence; however, as stated in a recent report from the Agency for Healthcare Research and Quality, “Our findings suggest that educational interventions and case management approaches offer the most consistent and voluminous evidence of improvements in medication adherence across varied clinical conditions.”

“The pharmacy profession has accepted responsibility for providing patient education and counseling in the context of pharmaceutical care to improve patient adherence and reduce medication related problems.”

Patients log on to the AudibleRx website, navigate to the medication they want to learn about, click on the link, then listen to a 6-8 minute Medication Specific Counseling SessionTM describing all the important counseling information for that specific medication.  After listening to a session a patient or caregiver will have a clear idea of what they know and don’t know about their medication and will be able to take educated questions back to their own health care provider.
It is important to understand that the digital recordings provided through AudibleRxTM are meant to supplement a patient’s education and understanding of their medication and are not a legal replacement for a face-to-face counseling session with their own pharmacist; however, patients may appreciate the simple manner in which they may access and listen to a medication education session.

AudibleRxTM is free for individual users; however, a licensee agreement is necessary when a provider wants to promote its use as a patient education tool such as may be used by an institution, hospital, pharmacy, clinic, insurance company, or any other group, are available.

AudibleRxTM has also released a smart phone and tablet application complete with all the 200+ Medication Specific Counseling SessionsTM currently available.  These apps are being offered for free to individual users and are for personal use only. They are not to be used for institutional education purposes without the institution first obtaining a licensing agreement from AudibleRxTM for such use.

For more information please contact:
Steve Leuck, Pharm.D.
Owner/President, AudibleRx
or visit

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Top 10 Reasons for Medication Non-Adherence

1.  Forgetfulness

2.  Motivation*

3.  Cost

4.  Lifestyle*

5.  Communication*

6.  Patient-Practitioner relationship

7.  Beliefs*

8.  Side effects

9.  Patient experiences

10.    Access

* = related to Health Literacy

Health Literacy

"The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions."

When you get a chance, visit www.adherence360.com and read about all they are doing to advance the process of medication adherence. 


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A Taste of U.S. Pharmacy in Tucson (an exchange student's perspective)

This past summer my wife and I had the good fortune of hosting three foreign pharmacy students for a couple days.  Eventually, they made their way to Tucson, AZ for a two month training program.  One of the students, Luka Tehovnik, took some time to document his trip and graciously shared it with us in this blog.  Please feel free to comment at the bottom to support Luka and his colleagues in this fantastic adventure.

After being interested in International Pharmaceutical Students’ Federation’s Student Exchange Program (IPSF SEP) for quite sometime, I finally did it! I can confidently say that this past summer was the best one I have had so far! It’s difficult to describe the feeling when your dream of travelling to the United States of America finally comes true!

It’s unbelievable how time flies! Not so long ago I can recall myself and the student from Barcelona, Helena, sitting in a cozy Gentle Ben’s on E. University Blvd. in Tucson, Arizona, It was the first brewery in Tucson when it started operating back in 1991. Having their iconic “Tucson Blonde” beer I enjoyed conversation with two Local Exchange Officers (LEO), Douglas Lee-Chan and Wendy Wong and other students from the University of Arizona. We discussed topics from US and Slovenian pharmacy differences to the plans I had for this special experience. That was one of my first social evenings of my genuine American experience.

University of Arizona Medical Center

The University of Arizona Medical Center (UAMC) was the site where I spent most of my time. The morning of my first day at work I got to know my preceptor, pharmacy professor, Dr. Michael Katz with whom I had a fascinating conversation about the upcoming controversial Affordable Care Act (ACA) or so called “ObamaCare”. We also discussed the US and Slovenian health care system and pharmacy education differences, and the role of a pharmacist in both countries. Dr. Katz provided me with several articles about ACA; at the end, I had a clear idea of what ACA is all about and I was able to describe the Medicare Part D prescription drug program coverage gap, a.k.a. the “Doughnut Hole” phenomenon. The beginning of my shadowing experience was very educational, impressing me even more than I already was… I was hungry for more!

Later that day, I attended some lectures, presented by pharmacy residents. Residents are pharmacists who pursue a pharmacy education beyond the Doctor of Pharmacy degree (PharmD), which is required for licensing as a pharmacist in the US. I got to know the pharmacy residents and interns with whom I worked with during my shadowing experience at UAMC. Everyone was so delightful and I honestly couldn’t wait for my practice to begin.

On August 6th at 8 a.m. the real work started. I was assigned to a team at the Internal Medicine Department, which consisted of an attending physician, pharmacy and medicine residents and students. There were approximately 10 people in our group; imagine 10 people entering the patient’s room!

Since UAMC is a teaching hospital, I had an opportunity to meet and know a large number of pharmacy student interns. One of the responsibilities of pharmacy interns was to get to know the patients who would be visited on a specific day. They gathered relevant information from the hospital’s database, focusing on drug related information as well as other pertinent information. Their goals were to recognize potentially harmful drug interactions; stopping the medicine if it was no longer needed; starting the new medication; ordering therapeutic drug monitoring (TDM); recognizing possible noncompliance; and, in general optimizing existing drug therapy.

Presenting the patient’s medical history to the team was the same every day; it was the same routine on every ward I worked on. One from the team, usually a medicine resident or a student presented the patient in depth consisting of: their chief complaint, past medical history, comorbidities, blood tests, past and present treatments and other essential information regarding treatment. A discussion took place in front of each patient’s room, which we were to enter; after all information was clarified, we entered the patient’s room to acquire additional information from each specific patient. I should stress that pharmacy interns were actively included in conversations about the future treatment plan for patients, and doctors appreciated every concern that pharmacist (either a licensed one or a student) addressed to them whether it was a drug interaction, an inappropriate drug or just a drug which was no longer needed. An important aspect we always discussed was whether or not a patient had health insurance. Insurance is essential for reducing healthcare costs for the patient since a national health service does not exist in the US.

While in each patient’s room, attending physician asked the patient a series of questions about their health condition, feeling, possible improvements/deteriorations and drugs. The patient was presented with findings about a specific disease or syndrome and they were presented with a potential diagnostic and treatment plan.

During the ward rounds I completed my patients’ records with additional information, which I had gathered. If needed, at the end of rounds I would accompany a pharmacy intern to visit a patient or consult with a pharmacist with the goal of obtaining additional information.

I had the opportunity to observe the work of a pharmacist in 4 areas: Internal Medicine, Oncology, Intensive Care Unit (ICU) and Pediatrics Intensive Care Unit (PICU). I met different pharmacist on every floor who instantly assisted me with my questions and shared as much knowledge as possible in the time allotted. I especially loved the time I spent in the Oncology unit because in addition to rounds, I also had the opportunity to do additional tasks such as: witnessing lumbar puncture, high-dose methotrexate (HD-MTX) intrathecal application through the Ommaya reservoir (intraventricular catheter system) directly into cerebrospinal fluid, bone marrow biopsy and an IV cytostatic drug preparation. I am very grateful because I would never have been afforded the chance to do these things in Slovenia! I extend a special thanks to the doctors and pharmacists who made those things possible!

Every afternoon a group discussion was led by our preceptor, Dr. Katz. Each one of us presented a case which we found the most interesting and educational from different aspects such as disease complexity, other comorbidities and most importantly, pharmacotherapy. We discussed whether the drugs that were stopped or started were suitable or not; was a patient handled properly; and, what could be changed and or improved. I was included in each patient presentation and conversation afterwards and I tried to participate as much as I could. These meetings were very beneficial in terms of acquiring new knowledge about different drugs and their optimization, how to handle patients properly, promote a quick patient recovery and discharge from the hospital.

During my visit at UAMC I attended a myriad of seminars, prepared by physicians, pharmacy residents and students. These seminars included topics like poisoning and antidotes, a more detailed look at chronic diseases and pharmacotherapy, new drugs on the market and those drugs that are still a part of clinical trials. Following the presentations there was a topic discussion where all participants were encouraged to ask questions, which was another great way for acquiring new knowledge!

Main Differences

I participated in the team discussions about patient treatment plans; however, because of the significant difference between the educational programs in the U.S. and Slovenia, it was sometimes difficult. U.S. pharmacy is more clinical and focused on the patient, whereas in Slovenia, it is more chemistry/laboratory based. In Slovenia, studies are more concentrated into the discovery of new active substances and, consequently, new drugs rather than focusing on the patient. The Slovenian students have more lab exercises than the U.S. students. In my opinion, patient focus is not emphasized enough in my country. The U.S. pharmacist has a very important role in the hospital setting and their opinions and suggestions are taken seriously and usually accepted.

I like the U.S. system better; for example, in the state of Arizona, a pharmacy student is required to have 1500 hours of practice completed before they can apply for North American Pharmacist Licensure Examination (NAPLEX). Of course this number varies from one state to another but it is not all that different. When the U.S. students graduate, they have a clear idea where they want to practice their profession.

During my stay in the U.S., I was surprised to learn that customers can purchase alcohol and cigarettes in a pharmacy; no such pharmacies are found in Slovenia. Convenient stores like Walmart, CVS/Pharmacy, Costco and Sam’s Club have pharmacies located within their stores. Therefore, patrons can shop for food, clothing and Over the Counter (OTC) medicines while waiting for their prescription to be filled; you would never see this practice in Slovenia. In my opinion, the pharmacy should be located by the exit door in order to provide the customer with more opportunities for specific counseling regarding drug usage and contraindications in order to prevent poisoning or overdose. For example should a customer purchase Tylenol for a headache and another pain medicine for ankle that contains acetaminophen there would be a possibility for an overdose. Additionally, in the U.S. there are TV commercials where OTC and prescription drugs are frequently advertised; the advertisement of prescription only drugs is illegal in Slovenia.

While at UAMC I had an opportunity to attend a lecture presented by my preceptor dr. Katz regarding pharmacotherapy of asthma and chronic obstructive pulmonary disease. It was interesting to note that almost every student had a laptop, which is not common at my faculty.

An Authentic American Experience

During the month I spent in Tucson, AZ, I had a variety of experiences ranging from hiking in Sabino Canyon to a live gunfight show in the city of Tombstone, eating delicious food in typical American restaurants and attending house parties. Social activities were well organized and I was able to see a large part of a very spread out big city of Tucson!

I spent two marvelous months in the States and I must say in spite of a lot of misconceptions about the American people, they were amazing! Maybe it was that I hung out with the best people or maybe it was just my positive attitude. Either way, before being judgmental, I suggest you pack your things and go there. I think you will be pleasantly surprised!

While in Arizona, I had a chance to observe health care professionals performing their job and I tried to absorb as much information as I could. It became clear to me how important pharmacists really are! I learned and saw a lot and had high expectations; my experience ended up being more than I had hoped for! The exchange enriched me professionally, culturally and personally. My confidence has been boosted, pharmacy knowledge and various skills improved, including the ones regarding proper patient interaction. I was so impressed by the work of clinical pharmacists, my area of interest, and by amazing people who surrounded me that I really wanted to stay there! I am working hard towards that goal.

I would recommend SEP to everyone; it’s an opportunity of a lifetime, which should not be missed! It’s a perfect way to establish a professional and social network, which can enhance success. If you want to experience pharmacy on another level in other countries, then this is exactly for you!

In summary, I would like to thank the LEOs, Douglas and Wendy, for locating a place to stay, and also to Katrina, Lisa, Matthew and other students who helped with organizing different activities. Furthermore, I would like to extend a big thanks to my preceptor Dr. Katz who did his best to make my experience as great as possible, and also to the pharmacy residents, floor pharmacists and other healthcare professionals who accepted me in their midst for a short period of time. I felt like part of the team!

Lastly, I give a whole-hearted thank you to my dear host family, Dr. William Jones, his wife Anita and their children Amanda, Scott and Helen for making my time great, unforgettable and providing me with everything I needed. Thank you for lending us your car, for delicious margaritas, meals and the quality time I spent with you! I didn’t feel alone not even for a second and I didn’t feel homesick! Thank you again for making me feel like part of your family... I will never forget what you did for me!

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Medication Information Destination

The other day a patient came into the store complaining of white patches on her tongue and a dry, chalky taste in her mouth.  My partner was working with her and he said, after a discussion with her, that she had been using her new steroid inhaler now for over three weeks without rinsing her mouth with water after use.  Furthermore, because of this, she had recently stopped using her long acting steroid inhaler and had gone back to just using her short acting rescue inhaler.  

Upon further discussion, my partner understood that the patient had not received any counseling about her new prescription when she had picked it up at a big box pharmacy a few weeks ago.  No one had counseled her about how to use the inhaler, what side effect or monitoring parameters to look out for, how to use it in relation to her other medications, or any of the other many important aspects of the medication that should be covered in a face-to-face counseling session with your pharmacist. 

This patient was having severe shortness of breath and wheezing from asthma induced by a respiratory infection and her doctor had prescribed a steroid inhaler to help reduce the swelling and inflammation in the airways of her lungs.  There are many important topics to discuss when counseling a patient about their new steroid inhaler; however, at a minimum, a patient should never leave the store without understanding the importance of rinsing their mouth out with water following the administration of a steroid inhaler dose.  

Community pharmacies are much more than just places you go to pick up your prescriptions.  Among other things, I like to consider the community pharmacy a Medication Information Destination.   Yes, while you are at the pharmacy you will pick up your prescription; however, equally as important, you will pick up your medication information.

When you walk into your big box pharmacy, stand in line for 10 minutes and then pick up your prescription, do you also leave with your appropriate medication information.  Does your pharmacist take the time to meet you in the counseling area and discuss all of the important counseling aspects of each medication with you?  If the is medication is a refill, will your pharmacist ask you how you are doing with it and if you have come up with any questions since you last came into the store?

Quite often, the answer is yes, the pharmacist is allowed appropriate time for medication counseling.  If the answer is no, then take some time on a free afternoon, visit four or five local pharmacies, interview the pharmacist for a couple minutes, and choose a pharmacy you feel comfortable with.

I understand that many insurance companies require patients to fill their prescriptions through mail-order pharmacies in order to get the best pricing; however, does your mail-order pharmacist call you each time they send you a new prescription in order to discuss all of the OBRA 90 mandated pharmacist counseling information?  If you have questions, do you need to call the mail-order pharmacy and wait for a pharmacist to come to the phone in order to ask your questions?

I encourage patients with mail-order plans to call their insurance company and request the option to use their own community pharmacy.   Quite often, just a simple phone call is all it takes for an insurance company to allow a patient to pick up their prescriptions at a local community pharmacy.

Remember, each and every prescription has its own set of monitoring parameters, side effects, interactions and unique counseling information associated with it.  Your community pharmacy is your own personal Medication Information Destination.  Not only do you pick up your prescriptions from your community pharmacy, you also take home with you, from your counseling session with the pharmacist, all of the important information necessary in order to optimize your therapy with that particular medication.


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Opiate Pain Therapy, Tolerance and Strategies

What prompted the increase in opiate prescribing over the past 50 years, why do we develop a tolerance to opiates, and what are some solutions to the situation?
·       1991 to 2009, prescriptions for opiate pain medications increased almost threefold, to over 200 million per year.

·       Prescriptions for opiate pain medications nearly doubled, from 11% of all prescriptions in 2000 to 19% of all prescriptions prescribed in 2010.

·       The United States makes up only 4.6 percent of the world's population; however, consumes 80 percent of its opiates.

·       Prescription opiate medications were involved in 14,800 overdose deaths in 2008, more than cocaine and heroin combined.

·       Deaths from unintentional drug overdoses have risen fivefold since 1990.

Read the article at RxEconsult:


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Community Pharmacy and the Donut Hole

The other day one of our patients of many years was picking up a prescription.  "$599", she exclaimed at the pharmacy counter.  "I didn't pay that much last time", she continued.  After a short bit of pharmacy computer forensics, we concluded that all year long she had been paying $90 for a two month supply, last time she picked the prescription up she had paid $197 and yes, this time the total was in fact $599. 

The historical review of the computer records disclosed to us that our young lady had in fact moved 100% into the Medicare D coverage gap, sometimes referred to as the donut hole.  The previous prescription for $197 was her partial entrance into the coverage gap, and this prescription was 100% attributable to crossing part of the broad stretch of the donut hole.

So now what do we do?  During this time of year, late summer too early fall, we come across this particular situation quite often.  Seniors have been paying their co-payments all year long and then all of a sudden they enter into the Medicare D coverage gap.  This is the portion of the Medicare D program where they are responsible for the majority of the cost of their medications.  Over the next few years the coverage gap is being faded out; however, for now, it is still a significant "chunk of change" for quite a few people.

I have come to realize that most seniors do not think about or plan for the coverage gap.  When they show up at the pharmacy and see that their prescription is five times what they paid last time, they are always very surprised and need an explanation of what is going on.  At this point, we take the time to explain the Medicare D coverage gap process.  There is always an "Oh, now I remember" moment in the discussion where the customer remembers the "donut hole" and we proceed to work through the transaction.

With this particular transaction, our young lady was very pleasant; however, the cost of $599 was definitely throwing up a road block.  She was very well aware of the importance of this particular anti-arrhythmic medication.  She understands her care and is quite knowledgeable about how important it is to continue therapy without missing any doses.  We decided to re-process the prescription for only one month, rather than two and then take it from there.

Well, one month of the medication processed out to $300, and this was still a bit ominous for the young lady after she began to think that she would need to do this for two more months, at which point the Medicare D program will reset and start over at the first of the year. 

After a bit more consultation, we discussed the option of contacting the physician about changing from the sustained release form of this medication to the immediate release form.  She explained that the physician had discussed this with her in the past; however, she stated it had been much more convenient for her taking a pill twice daily rather than needing to fit a dose in every 8 hours.  It is interesting that with this particular medication, the sustained release form of the medication costs upwards of 10 times more than the immediate release form.   She agreed that, for the difference in cost, she would be more than happy to adjust her schedule to accommodate an every 8 hour dosing regimen.

Being after five on a Friday afternoon, the physician was not available for immediate consultation, so I explained the situation in writing and sent a fax off to the physician.  The customer agreed she would call the physician Monday morning and discuss the situation with him also.  If the physician agrees and authorizes an order, we will process a prescription for her next week for the immediate release form of the medication.   We then reprocessed the current prescription for seven days of the medication which came to an acceptable $70.

At this point, with three or four pharmacy customers standing behind her at the counter, she exclaims, "I'd like to see someone try and go through this process down at XYZ Big Box Pharmacy, this is why I come to My Community Pharmacy".   Immediately after, the customer standing next to her stated, "These guys are great, I love this pharmacy".   

Yes, working in community pharmacy definitely has its challenges; however, it is moments like these that help make it all worthwhile!


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Adherence, Health Literacy & Medication Education

A study I just reviewed from the September, 2013 edition of the New England Journal of Internal Medicine shows that nearly 72% of patients picking up prescriptions have some sort of Health Literacy limitation.  (If you are unsure of what Health Literacy is, please review this article.)  Of those 72%, approximately half of the patients were not adherent to their medication regimen.   

Perhaps, just maybe, we need to take a closer look at how patients and caregivers receive their medication education. 

There are many venues in which patients receive medication education.  Some are better than others.  When receiving medication information we need to consider a few different items:

1.       What is the source of this information?
2.       Is the information being presented to me in a format that I can understand?
3.       Will I be able to refer back to this information whenever I need?
4.       How do I get my questions answered after reviewing the information is presented to me?

 Some of the methods that patients receive medication information are as follows:

·         Medication information is presented to the patient by the prescriber when the prescription is written.
o   Pros:  Patient is attentive and captive in the office.
o   Cons:  Patients usually forget what prescriber says soon after leaving the office.

·         Prescription counseling info presented to patient at pharmacy counter when picking up prescription:
o   Pros:  Pharmacist does the counseling and hopefully discusses all of the important information necessary.  Pharmacist also hands a drug information handout for follow up. 
o   Cons:  Sometimes pharmacist is busy and hurry’s through session.  Again, patient will regularly forget most of what the pharmacist says by time they get home. 

·         Drug Information Handout:
o   Pros:  These informational handouts are very complete.  Now and again I come across a patient who takes the time to read them front to back and they always call with questions.  This is ideal.
o   Cons:  These handouts are long, boring and cumbersome; rarely will a patient read them front to back and call with questions.

·         Drug information from an internet search:
o   Pros:  Information is right there, ready for your review.  Information is abundant and 1000’s of sources available.  Studies, evaluations, monographs, institutional sites as well as a never ending supply of personal testimonials.
o   Cons:  How in the world do you discern what is credible information.  You need to know and trust your source and you need to take the time to do appropriate research.

·         Friends telling you what to do:
o   Pros:  What could be better than following the advice of a friend?
o   Cons:  Really?  We are talking about your prescription medications here!

·         AudibleRx Web Membership or Android/IPhone  App:
o   Pros:  After having a consultation with your pharmacist at your community pharmacy, you then listen to a 6-8 Medication Specific Counseling Session.  After listening, you will have a clear idea of what you do and don’t know about your medication and be in a position to take educated questions back to your own pharmacist or doctor.
o   Cons:  You need to invest 6 minutes of your time to listen to the counseling session.

Regardless of your method of medication information, please take the time to follow through and do it.  Health Literacy is the concept that patients will understand their own basic health care knowledge.  Understanding your own medications; why you are taking them, what are the consequences of not treating, and where to go for more information are all important aspects of your own Health Literacy.

If you ever have a question about your medication, pick up the phone and call your community pharmacist.  If you don’t have a community pharmacist to contact, get one!  Mail-order prescriptions have done quite a bit to deter patients from having their consults with their own community pharmacist.  I encourage everyone to take a look at their program and see if it is possible to once again begin picking up their prescriptions from their local pharmacy.  When your community pharmacist is filling your prescriptions, the pharmacist is in a much better position to answer your medication related questions.

The above examples of how to receive medication information may all have a place in your education process; however, every patient needs a specific process for verifying and validating their information when they have questions.  Know your source, and know where you are going to call to get your questions answered.


Please take a moment to comment and tell us what your source for medication information is.

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