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Saturday, January 12, 2013


The process: get unwell, make appointment with doctor, visit doctor, get prescription, visit pharmacy, get prescription filled, take prescription. When prescription is empty, go back to the beginning. Do not skip steps.
We all know this isn't true anymore. Now the onus is on pharmacies to do every damn thing for the patient except be sick for them and take the meds for them. We call doctors, we hunt down refills, we predictively fill refills, we call patients to come pick up these refills. We relay messages to them from their doctors. And here is where I make today's point. I am fine with giving these messages. We often see many patients on a daily or weekly basis whereas the doctors may see them only a handful of times a year, often once or twice.
If you are trying to get someone to do something, you have to give them reason to want/need to do it. Doctors will often send messages that "patient must make office visit" or "no more refills until seen". Fantastic. Except when they are attached to prescriptions for a 90 day supply with 3 refills. How is this expected to work? Here's a year supply. Since you haven't been seen in some time, we expect you to pop by for a visit in the next year or so? How about we try this? Give them a 30 day supply. Period. If we fax another request in a month, deny it for this reason. Better yet, give them a 2-week supply. That'll get them in the office right quick. We need to train them.
Don't give me the "it's not convenient for the patient" excuse. It works for all the pain clinics, right? They schedule patients for 28 day supplies of medications with appointments every 28 days. (No. I am not saying all appointments should be q28d. Just more regularity with accountability sprinkled in too.) Pain clinics may do drug tests. Other prescribers should be so vigilant with their testing. Patients often forget, as do some doctors, that routine testing is a necessary part of patient care. Blood pressure monitoring, LFTs for many drugs, especially statins, other blood work, eye checks, breathing checks, etc. If patients are not seen and are not checked, how do we know the medication is correct? Is the correct dose? Frequency? Still appropriate for her? How many events have affected her health since the last visit? Multiple doctors since the heart attack or panic attack? Multiple pharmacies due to free drugs versus mandatory mail order? These routine visits to the offices with regularly scheduled visits to one pharmacy make our jobs easier. It also makes the management of one's healthcare their own. Skipping steps in the process and not holding people accountable can only be bad. I say we force the issue. Maybe I'll schedule an appointment with the doctor. Sometime in the next year or so...

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