If this column captures your imagination, we suggest that you acquire the book, Information Therapy: Prescribed Information as a Reimbursable Medical Service, by Donald Kemper and Molly Mettler, that was published by Healthwise in 2002. Fourteen years later, this may sound like a very dated reference. The authors, however, were looking ahead and actually imagined that one day we would have the information technology we have in our possession in 2016. Some things are timeless, such as getting the right information to the right person at the right time. We are all pretty familiar with the abbreviations for symptoms (Sx), diagnosis (Dx), treatment (Tx), and of course medication (Rx). We would like you to add information therapy (Ix) to your repertoire.
Imagine the possibilities for getting the right information to the right patient at the right time by incorporating the use of information technology into the dispensing process. Patients fail their medication regimens, as well as their self-care disease management, for three reasons: (1) They don’t know what to do; (2) they don’t know how to do it; or (3) they are not motivated to do it. In your current pharmacy practice, we assume that your dispensing process assures that you are presenting individual patients with the right drug in the right strength in the right dosage form with the right regimen. If you do all of these verifications and staple a drug information leaflet for each medication to a paper bag, what is your confidence level that the medication will have the intended effect that you, the prescriber, and the patient desire? If your patients are relying on the printed drug information for guidance or help, research suggests they are not getting what they need.
Like the knowledge resources, all you need to do is search for the resources and screen them using your own professional judgment, along with your knowledge of what your patient is seeking for assistance.
If you are old enough to remember the TV series, “The Six Million Dollar Man,” at the beginning of every episode an announcer would proclaim, “We can rebuild him. We have the technology.” Ladies and gentlemen, in 2016, we too have the technology to rebuild and enhance the dispensing of medications in such a way that people know what to do and know how to do it, and are motivated for self-care management of their medication regimens. Do any of us believe that patients routinely save and refer to the printed information they are given when their medication is dispensed? Do they take this information with them when they go out to dinner or on vacation or to an out-of-town business meeting?
Seeing Is Believing
When there are special dosing considerations such as asthma inhalers or even eye drops or eye ointments, are patients fully aware how to quickly and correctly use their medicines? A quick check shows that there are 12,000 videos on YouTube demonstrating metered dose inhaler use, 19,000 eye drop videos, and 10,700 videos for eye ointment use. Should you let patients pick which drug information site on which to rely, or select which video is most appropriate to teach them or their nonprofessional caregivers how to administer the medication? We believe that you can screen available drug information resources and dispense knowledge that is accessible from your patients’ portable information device wherever they are, whenever they need it. Many of these resources can even be stored locally on their devices when they find themselves off the grid.
|Pictured are two “best in class” cell phones representing 2002 and 2016.|
We know that most of our readers use a professional tertiary drug reference on their smartphones. We wonder how many of you have built a set of links on your device for point-of-care teaching that can be performed using your own smartphone or tablet when you interact with patients. We know from research that 82% of your patients prefer to learn by visual means, and when the behavior to be learned requires action, the video resources needed to demonstrate these behaviors can either be accessed or made locally available on your own information technology. We know you value your decision support resources. Are you aware that a similar level of patientfocused mobile apps exist to assist your patients with both knowledge and motivation tools that allow them to cope with their diseases and need for lifestyle changes?
Does your responsibility for patient care stop once the medication is dispensed? Have you also realized the huge problem patients face with incorporating medication regimen adherence, coping with complex regimen dosing times, and remembering to get chronic medication refills in a timely manner? What about complementary lifestyle changes that should occur surrounding new prescriptions or adjusted dosages on existing prescriptions? Consider the two of us. Brent is a younger man who likes to run around his neighborhood on a regular basis. Bill, on the other hand, is showing considerably more wear and tear and had some concerning lab results at the end of last year after enjoying too many holiday celebrations.
In order to get control and turn around his lifestyle choices, Bill adopted an app called Lark. It fills in the motivation requirement for assuring health success. Lark records activity data, meals (which are rated healthy, neutral, or unhealthy), keeps track of weight gain or loss trending, and most of all, provides health education and encouragement. In 90 days, Bill lost 26 pounds and turned his lab report numbers into something his physician responded to with, “These results are breathtaking!”
In the same way that knowledge can be dispensed along with medications, mobile apps are available to address every needed lifestyle change and suggest coping behaviors for every disease being treated in your practice. Like the knowledge resources, all you need to do is search for the resources and screen them using your own professional judgment, along with your knowledge of what your patient is seeking for assistance. Don’t expect 100% acceptance from your patient population, but you will find that many will make an honest effort to change their behaviors when they see a caring pharmacist expressing interest in their chief concerns regarding their health. As always, we are open to your comments and questions. CT
Bill G. Felkey, M.S., is professor emeritus, and Brent I. Fox, Pharm.D., Ph.D., is an associate professor, in the Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University. They can be reached at felkebg@ auburn.edu and firstname.lastname@example.org.