DURHAM — For 15 years, pharmacists at a Durham nonprofit have helped older, low-income people take the right prescription drugs, in the right amounts at the right times.
But the job of Senior PharmAssist doesn't end there. The agency also works to keep clients from taking prescription drugs in ways that can actually harm or kill them -- through bad interactions with other drugs, food or medical conditions.
Sounds pretty basic, but such precautions on a national scale could save more than $20 billion annually in unnecessary hospitalizations and emergency care, according to one estimate. That's the reason some advocates and health professionals say national health-care reform should include approaches like that of Senior PharmAssist, which coordinates clients' care with doctors and social workers.
This approach got a recent boost from officers of the state's Health and Wellness Trust Fund, who voted to spend $2 million of tobacco-settlement money on two prescription drug-related services: NCRx, which helps seniors pay Medicare prescription drug premiums, and CheckMedsNC, a statewide effort to support outfits such as Senior PharmAssist.
At Senior PharmAssist's offices two weeks ago, community services director Dyana Morgan and pharmacist Marilyn Disco spent more than an hour checking in with Durham retiree Geneva Boykin, 78, about her health and her multiple prescriptions.
"It'll help you live longer if you know what you're taking and what you're taking it for," said Boykin, who had brought in more than a dozen prescription drugs and over-the-counter products in a large tote.
The agency can check the dosages and frequencies of Boykin's prescriptions as well as assisting with problems such as finding a ride to a doctor's office. The goal is to boost drugs' benefits while reducing their bad effects.
Senior PharmAssist can cite academic research showing that its clients are far less likely to require emergency-department treatment and hospitalization.
"We believe it should be in every corner of North Carolina," said Gina Upchurch, the agency's executive director. "We believe strongly we can improve care."
As the national debate on health-care reform heats up, pharmacists and other professionals are looking to take significant roles in the team approach known as the medical-home model. Both better treatment and lower cost, they say, result from better coordination among the members of a patient's treatment team -- from doctors to pharmacists.
"The model focuses on the patient and staying healthy," said Scott Smith, a former UNC-Chapel Hill professor of pharmacy and public health who's now an official in Maryland of the federal Agency for Healthcare Research and Quality. "In my opinion, approaches like Senior PharmAssist should be examined as part of national health-care reform initiatives."
Figures from the Health and Wellness Trust Fund indicate that pharmacists trained to work with CheckMedsNC clients have consulted with 20,000 older people, saving an estimated $10 million in unnecessary care and other avoided costs. In another North Carolina innovation, known as the Asheville Project, city employees who got personal consultations with pharmacists showed improved health in chronic diseases such as diabetes, as well as reduced cost of care.
Sorting out needs
Staff at Senior PharmAssist see clients twice a year for intensive interviews like Boykin's. Questions range from medical matters to quality of life.
Boykin told Morgan that her faith is very important to her; that she doesn't exercise much because she has no one to exercise with; and that she's getting around a little better than she did last year, even though she's had a stroke since then. In addition, she had gone without needed eye surgery because she was unable to pay for it.
"I didn't have any money to pay him, and he turned it over to collection," she said of her eye doctor.
Disco, the pharmacist, said Senior PharmAssist would try to find a way to get Boykin's eye surgery paid for. Then she went carefully over Boykin's insulin regime, especially after learning that Boykin had changed her own dose of insulin after a recent hospital stay. The prescribed dose seemed to her to be too much, Boykin said.
"When they discharged me, they told me to go back to the original dosage," she said. "That I did not obey."
Disco said she would call Boykin's primary-care doctor to let him know about the change.
Morgan and Disco also found that Boykin was treating an abrasion with a tube of cream she had been given in the hospital.
"It says, 'Do not apply over puncture wounds.' I wouldn't put that on it," Disco said, examining the cream.
Dr. Conrad Flick, a past president of the North Carolina Academy of Family Physicians, said pharmacists have an important role in the medical-home approach to caring for patients.
"When we look at medical-homes and how they are set up, we think of it as a team approach," Flick said. "From our standpoint, the pharmacist is an important part of that."
But a doctor should be the driver of any team, he said, because patients who are in a medical-home practice are supposed to have a personal relationship with a professional who is looking at all aspects of care.
"It's hard for anyone other than a primary-care physician to do all of those things at once," Flick said. "Who's responsible if there's an emergency?"
That's fine with Fred Eckel, a pharmacy professor at UNC-Chapel Hill. Pharmacists don't want to be the captain of the ship, but they do bring valuable skills to the table, he said, especially since a doctoral degree is required of North Carolina pharmacy graduates.
"I don't think any really thinking professional today feels like they've got the ability to do all that needs to be done well for a patient," said Eckel, who is also executive director of the N.C. Association of Pharmacists.
Even Boykin, who works to keep up with all her medications, fairly often forgets to put on the nitroglycerin patch she's supposed to wear daily for heart problems. As many as half of people on medication for chronic disease don't take them correctly, Eckel said.
"Pharmacists want to be part of a team that helps improve drug-therapy outcomes," he said. "And right now we don't have good outcomes for many of our patients."
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