Can’t Even See the “E”?

By R. Crady Adams, Past President of

the Virginia Pharmacists Association

Remember the chart used to test your eyesight? The first letter is usually a huge “E” that all but the optmetrically impaired can read. This letter is chosen because it’s design permits a sharp contrast, allowing the eye to easily focus. Workplace problems are often like the “E”. We employees are closer to problems than the boss ¾ it’s clear to us. But from time to time we are faced with such a dilemma that action is in order. Yep, it’s real tough working for a boss who can’t focus on obvious problems in the workplace. 

We must remember that our bosses usually have yet another boss they must report to. Sometimes the boss’s boss is demanding, insistent, unforgiving and perhaps even bi-polar. We should also realize that the boss’s boss could be not a person but the bank that holds the mortgage on the pharmacy, or perhaps the boss’s boss is a spouse who holds something else.

In any event, we conclude that our boss is clearly not seeing the problems we employees face. We might need more help, or a better computer, or an improved benefit package, or our need might be something as simple as a brighter light bulb at our work station. Why can’t our boss see our problem? 

Before we plunge ahead, perhaps a bit of analysis would help. We need to ask a few basis questions. Maybe the boss is myopic and looks at the world hampered with blinders seeing only his or her own problems. Maybe the boss is clueless and presumes that hearing no problems from the staff means there are no problems. Maybe the boss is apathetic (versus pathetic, but that’s another storey …) to our plight. This reminds us of the classic boss’s malady of ignorance and apathy, or an “I don’t know and I don’t care” attitude. We need to understand why our problem persists and why our boss is clueless. 

Next, we should thoughtfully consider how we might inform the boss of the problem. Tact and respect are always good approaches. We should state the problem objectively, how it’s negatively affecting our work, what remedy is needed and the positive effects resulting after a fix. This will obviously take some thought, time and, perhaps, involving co-workers. 

In all things we should be respectful, tactful, polite, courteous, civil and considerate. After all, our goal is to improve our work situation and not to gain the title of “former employee.” Most bosses, when approached formally in this manner, will, at the least, listen and, at best, ask if we have a solution. We should have at least two solutions, both of which we can live with. We should know the cost of our options, the impact, if any, on others and how quickly our suggestion will fix the problem. 

When the boss can’t even see the “E” on the vision chart, our job is to move his or her nose a little bit closer to the chart. Making a boss aware of an issue is often not enough. We must also let them know of the negative cost of doing nothing and the positive impact of fixing it. 

Or, as a last resort, just leave a copy of this article in an obvious place. 

(Editor’s note: this article first appeared in the Mar/Apr 2010 issue of Virginia Pharmacist, official publication of the Virginia Pharmacists Association. It is reprinted here with written permission of the publication and the author.

07/17/10

The More, The More Forgetful

Twenty Five percent of U.S. adults 65 and older take 10-19 medication each day, according to a national survey of more than 1,000 people for Medco Health Solutions, but 57 percent of them admit they forget to take their medications. 

The more they are supposed to take, according to the survey, the more likely they are to forget doses. Among those taking five or more medications, 63 percent say they forget doses.

07/17/10

NCPA Backs Bill to Preserve Seniors’ Access

to Diabetes Supplies at Community Pharmacies  

The National Community Pharmacists Association (NCPA) praised Representatives Peter Welch (D-VT) and Mike Rogers (R-MI) for introducing the Medicare Access to Diabetes Supplies Act. The bill removes diabetes supplies (i.e., test strips, monitors, lancets, glucose control solutions) furnished by small community pharmacies from the Centers for Medicare and Medicaid Services’ (CMS) final competitive bidding program for Medicare Part B DMEPOS (durable medical equipment, prosthetics, orthotics and supplies). Small community pharmacies are currently classified by the Small Business Administration’s definition as having annual sales of $7 million dollars or less. 

“This legislation allows seniors to continue obtaining essential medical supplies like diabetes testing strips from their local community pharmacy,” said Bruce T. Roberts, RPh, NCPA executive vice president and CEO. “The current competitive bidding program favors larger health care providers at the expense of smaller ones like community pharmacies. As a result many seniors who get these supplies from community pharmacies could be forced to travel many miles or go through mail order without the face-to-face consultation that helps maximize health outcomes.” 

“Representatives Welch and Rogers offer a common-sense legislative solution by exempting pharmacies of a certain size from this requirement, which is why we call on Congress to roll up its sleeves and pass it as soon as possible,” added Roberts. 

Competitive bidding requires DMEPOS suppliers to submit a bid to be awarded a contract, explained NCPA. Medicare uses the bids to determine payments. Previous rounds of competitive bidding were problematic enough that Congress intervened to halt, reshape and restart the process again. One of the primary concerns was that small suppliers like community pharmacies, particularly those in underserved rural and urban areas, would be underbid, and ultimately forced out of the program by larger suppliers that have no local presence but could always offer Medicare a better price, even if the quality was questionable. Consequently, community pharmacies and other comparably sized providers have problems winning contracts.  

While 73 percent of community pharmacies sell DMEPOS, it constitutes only a small fraction of their total sales. As a consequence, many community pharmacies will either limit the amount of or stop offering DMEPOS, rather than completing the time-consuming and expensive competitive bidding process. This undercuts the relationship pharmacists develop with seniors. For example, seniors with diabetes get valuable advice for taking prescription drugs and properly monitoring their blood glucose levels. For seniors no longer able to purchase DMEPOS, especially in underserved rural or urban areas without many other health care options, the ramifications of this are not only inconvenience, but  potentially health compromising. 

In addition, competitive bidding is supposed to reduce fraud and lower costs, but the available evidence suggests that the inclusion of diabetes supplies sold by small community pharmacies will not achieve that objective. Not only are all pharmacies regulated and licensed at the state level, but the operators responsible for fraudulent DMEPOS-related crimes are not known to be pharmacies, concluded NCPA.

07/17/10

USP Recommends Standardizing Prescription

Container Labeling to Improve Patient

Understanding of Medication Instructions

To promote the establishment of universal standards for prescription medication labels — and to address the widespread problem of patient misinterpretation of medication instructions — an advisory panel formed by the U.S. Pharmacopeial Convention (USP) recently issued a set of recommendations to bring consistency to labeling on dispensed prescription packaging. The recommendations are patient centered, and were developed following a call for such standards by the Institute of Medicine (IOM) on the issue of health literacy. The recommendations were presented to the IOM Health Literacy Roundtable. 

Limited health literacy has been cited as a major problem by IOM, which states that 90 million adults are affected. Those with limited health literacy cannot fully benefit from much that the health and health care system have to offer, according to IOM. One critical component to health literacy is the ability to properly understand medication instructions and important supplemental information (such as drug interactions). Poor health literacy can lead to non-adherence and medication errors, which may pose significant health risks to patients. Medication misuse results in over one million adverse drug events per year. 

USP, a nonprofit scientific organization that sets legally enforceable standards for the identity, as well as the strength, quality and purity of medicines in the United States, formed a health literacy and prescription container labeling advisory panel in 2007 to examine ways to improve prescription drug container labeling. USP recently released the panel’s recommendations, which cover format, appearance, content and language of prescription labels — all of which contribute to optimal patient understanding, which leads to safe and effective use of medications. 

“Patients have the right to understand health information that is necessary to safely care for themselves and their families,” said Joanne G. Schwartzberg, MD, co-chair of the USP health literacy and prescription container labeling advisory panel. “Confusing medication labels is one area that can be improved considerably. As most of us who have ever received a prescription drug know, the content and appearance of medication labels can vary widely. Sometimes, there is so much information included that it can be difficult to find the most essential information — the directions for use.

By standardizing labels of medications so that they provide reliable, simple and concise information, I think we can significantly advance patient health and safety.” 

Recommendations by the advisory panel include: 

· Organize the Prescription Label in a Patient-Centered Manner. Information must be organized in a way that best reflects how most patients seek out and understand medication instructions. Prescription container labeling should feature only the most critical patient information needed for safe and effective understanding and use.

· Simplify Language. To improve patient understanding and safe and effective prescription medication use, language on the label should be clear, simplified, concise and standardized. Only common terms and sentences should be used. Use of unfamiliar words (including Latin terms) and unclear medical jargon should be avoided. Ambiguous directions such as “take as directed” should be avoided unless clear and unambiguous supplemental instructions and counseling are provided. 

· Use Explicit Text to Describe Dosage/Interval Instructions. Dosage, usage and administration instructions must clearly separate dose from interval and must provide the explicit frequency of drug administration (e.g., “Take 4 tablets each day. Take 2 tablets in the morning and 2 tablets in the evening” is better than “Take two tablets by mouth twice daily”). Use numeric rather than alphabetic characters for numbers. 

· Include Purpose for Use. Confidentiality and FDA approval for intended use (e.g., labeled versus off-label use) may limit inclusion of indications on drug product labels. Current evidence supports inclusion of purpose-for-use language in clear, simple terms. Therefore, the prescriber’s intended purpose of use/indication should be included on the prescription whenever possible and should be stated in clear, simple language (e.g., for high blood pressure, for rash or for stomach cramps). 

· Improve Readability. Critical information for patients must appear on the prescription label in an uncondensed, simple, familiar, minimum 12-point, sans serif font (e.g., Arial) that is in sentence case (i.e., punctuated like a normal sentence in English: initial capital followed by lower-case letters except for proper nouns, acronyms, etc.). Field size (examples of “fields” include patient name and directions for use) and font size may be increased in the best interest of patient care. Critical information should never be truncated. 

· Provide Labeling in Patient’s Preferred Language. Whenever possible, prescription container labeling should be provided in a patient’s preferred language. Translations of labels should be produced using a high-quality translation process.

· Include Supplemental Information. Auxiliary information on the prescription container should be minimized and should be limited to evidence-based critical information. The information should be presented in a standardized manner and should be necessary for patient understanding. This is important because of the extensive variability in the content and application of supplemental information, the lack of scientific evidence for these labels, and the potential ambiguity and failure to address specific patient needs. 

· Standardize Directions to Patients. In recognition of the nation’s move toward eprescribing, standards should be developed for prescribing directions to patients. This would lead to consistency of language and use across all health care professionals and systems. An important element is the elimination of Latin abbreviations, which are often misunderstood and susceptible to variation in translation. 

The USP panel, which is co-chaired by Dr. Schwartzberg and Gerald McEvoy, PharmD., is composed of a group of experts in the fields of health literacy, health policy and medication safety. Their recommendations will form the basis for consideration of a new USP general chapter on prescription container labeling, which is being developed by USP’s safe medication use expert committee. A proposed general chapter, Prescription Container Labeling, is expected to be completed within the next few months. USP then will seek input from the public, including consumer and health care organizations, on its content. 

Full recommendations can be found at www.usp.org/USPNF/compendialNotices/recommendContainerLabeling.html. 

USP is a scientific, nonprofit, standards-setting organization that advances public health through public standards and related programs that help ensure the quality, safety, and benefit of medicines and foods. USP's standards are recognized and used worldwide. For more information about USP visit http://www.usp.org.

07/17/10