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Meeting Minutes October 14, 2013 I. Congrats to our new liaisons Vivian Hong and Nhu Nguyen! II. Upcoming events a. Speaker event with Dr. Alan Bell i. Oct 24 ii. 6:00 – 7:30 PM b. Omnicare Tour i. Nov 6 ii. 1:00 – 3:00 PM Consultant Pharmacy Practice Mark Sey October 14, 2013 Definition - Who is a Consultant Pharmacist? A pharmacist who is compensated to provide expert advice on the use of medications by individuals or within institutions, or on the provision of pharmacy services to institutions. Originated in the nursing home environment ASCP focus - defined by their common commitment to enhance the quality of care for all older persons through the appropriate use of medication and promotion of healthy aging. The Right Answer YOU ! Today’s Discussion Evolution of Consultant Pharmacy American Society of Consultant Pharmacists Senior care environments Key long-term care professionals Senior care pharmacy practice Evolution of Consultant Pharmacy 1965- Medicare/Medicaid – Drug regimen review required by charge nurse and prescribing MD working together – Consultant Pharmacist responsibilities for drug distribution 1969 – ASCP Established 1974 – DRR required by pharmacists in NF! Evolution of Consultant Pharmacy 1982 - Indicators developed to help surveyors assess DRR 1980’s – Consultant pharmacists showed their stuff! – Practice roles more clearly defined – Consultant’s effectiveness documented Decreased inappropriate drug use Fewer ADR’s MD’s accepted CP recommendations Evolution of Consultant Pharmacy “Success Breeds Success” Increased mandate for consultant’s services 1987 - Pharmacist review mandated in ICF 1988 - Pharmacist quarterly review mandated in ICF-MR Pharmacists published their work in Consultant Pharmacist People took increasing awareness of consultant pharmacists American Society of Consultant Pharmacists (ASCP) 8,000 members Numerous State chapters National meetings – May and November Well-respected and informative web site Website:www.ASCP.com Website:www.seniorcarepharmacist.com Embraces interdisciplinary initiatives Supported development of Commission for Certification in Geriatric Pharmacy (CCGP) The Continuum of Care Caregiver Skills High Low High High Hospital Nursing Facility Assisted Living Low Acuity Cost Subacute Home Health Care Low The Senior Market 34.3 million individuals 65 years old and older Nursing homes 1.8 million residents Assisted living 1.8 million residents Other elderly 10.2 million residents Home care 3.5 million beneficiaries Community-based LTC 8.5 million individuals NORCs 8.5 million residents Nursing Facilities The traditional LTC environment in the U.S. Provide care using a “medical model” that is somewhat analogous to hospitals Approximately 2/3 of NFs are operated for-profit ~1/2 are operated by chains – 9% bed growth compared in 2010 compared to 2009 – – – – HCR ManorCare, 38,000+ beds; 283 facilities Golden Living, 33,000+ beds; 332 facilities Life Care Centers of America, 31,000+ beds; 221 facilities Kindred Healthcare, 29,000+ beds; 231 facilities Nursing Facilities Total number of beds 1,725,326 – – – – Medicare 77,023 Medicare/Medicaid 1,413,951 Medicaid 186,086 Noncertified 48,266 Resident payer sources – Medicaid 65% – Private/other 22% – Medicare 13% Nursing Facilities 200 beds or more 8% 100 to 199 beds 41.8% Fewer than 50 beds 12% 50 to 99 beds 38.7% Typical NF Patient Flow Hospital • Patient seen in ER for work-up • Patient may be admitted to qualify for Medicare Part A • Patient worked up based on hospital criteria • Treated and stabilized • Set for discharge • To nursing facility after initial admission or • Return to nursing facility after brief hospitalization Discharge to home or assisted living Rehab Short Stay • Return to hospital for acute event, eg, fracture, symptomatic A-fib, etc Long Stay • If needed, NF residents will usually need to visit the specialists • NF attending physicians and selected geriatric specialists see residents in the facility Nursing Facility Focused View of NF Resident • Nurses continually monitor resident’s health status through the plan of care • Nurse Practitioners may see patients for the physician group Nurse Nurse Practitioner Rehab Short Stay Rehab Long Stay • Medical Directors need to make the best medication choices for their patients Medical Director • LPNs need to know how to manage NF residents • Consultant Pharmacists regularly review medications Nursing Facility Consultant Pharmacist LPN Assisted Living Facility Models Hospitality Model Personal Care Model NF Alternative/ Replacement Model Assisted Living Target Market 75-85 years of age mostly female $25,000 income (supports $1,6001,750/month using 75-85% of resident’s income) 2+ ADL support Typical AL Patient Flow • Residents may come from the community or move back to the community for various reasons • Resident may visit Attending Physician, or Attending Physician may visit facility Community Attending Physician • If resident becomes less independent or needs short-term rehab Nursing Facility Hospital • • • • • Assisted Living Facility Patient seen in ER for work-up Patient may be admitted Patient worked up based on hospital criteria Treated and stabilized Set for discharge • Resident usually visits specialist. Specialists rarely visit assisted living facility. Resident would see specialist for monitoring of medications Specialist and therapies “The goal of assisted living is to keep them in assisted living.” Nursing Director National Assisted Living Provider Assisted Living vs. Nursing Facilities Nursing – – – – – – Facilities Elderly population Multiple medical dx Multiple medications Federal regulations Skilled staff Mandated DRR Assisted – – – – – – Living Elderly population Multiple medical dx Multiple medications Regulated by State Less skilled staff DRR mandate varies Key LTC Professionals Administrator Medical Director Attending Physician Consulting Physician Nurse Practitioner/ Physician’s Asst. Nursing Staff – – – – – – Director of Nursing (DON) Charge Nurse, Head Nurse Nursing Supervisor MDS Nurse Staff Nurse Nurse Aides Key LTC Professionals Pharmacists – consultant and dispensing Therapy Staff (physical and occupational therapy) Dietitian Activity Directory Social Services Geriatric Case/Care Managers Staff development coordinator Family members LTC Pharmacy Landscape OmniCare 1,400,000 NF/ALF beds PharMerica Corp. 360,000 NF beds Regional pharmacy providers – Green Tree, South Central Illinois Smaller pharmacy providers New, evolving provider and consultant companies, some specializing in AL Independent consultant pharmacists LTC Pharmacy Services Drug Distribution Services Consultant Pharmacy Services Pharmacy Providers Services Efficient and accurate distribution – Emergency kits – medication administration record Standardized services between facilities Improve pharmaceutical care – formulary Pharmacy providers influence market share – – – – Consultant pharmacists recommendations Formulary preferred products Disease management initiatives Educational initiatives What is a Consultant Pharmacist? A patient advocate for best clinical care Licensed by state to practice pharmacy No degree requirement No specific credentials required by most States Typically involved in many activities LTC Pharmacists Employment Model LTC Pharmacists Practice Involvement Consultant Pharmacist’s Domain Pharmaceutical care Medication-related problems Appropriate use Medication Regimen Review “MRR” Anything drug-related – Side effects, dosage, switch to alternative products, monitoring, add drug for untreated indication, etc. Pharmacists Practice Activities Medication Regimen Review Resident-specific Pharmacist-conducted Required in all NFs as a Medicare/Medicaid Condition of Participation and by OBRA ‘87 Performed at least monthly Retrospective or prospective Encourage appropriate medication use Provide optimal Pharmaceutical Care Components of Effective Medication Regimen Review Interdisciplinary Concise Accurate Neat Non judgmental Well documented Evidence-based Referenced when necessary Follow up included MRR Challenges for Pharmacists Adequate training Clinical skills and experience Exploding knowledge base Recognition/Cooperation Adequate reimbursement Work load Thank-you!
