Chapter 11 Managed Care, Home Care & Long-term Care Pharmacy PDF

MANAGED CARE PHARMACY MANAGED CARE PHARMACY MANAGED CARE PHARMACY  MANAGED CARE Definition: “Managed Care is fundamentally a health care delivery that attempts to control cost of health care services and delivery, as well as the quality, access and availability of that care. “...

MANAGED CARE PHARMACY MANAGED CARE PHARMACY MANAGED CARE PHARMACY  MANAGED CARE Definition: “Managed Care is fundamentally a health care delivery that attempts to control cost of health care services and delivery, as well as the quality, access and availability of that care. “ In practical terms managed care means care and cost managed by those who pay for it, chiefly the employer, but it is also paid by Insurers, Health plans and the government. IMPACT OF MANAGED CARE ON PHARMACY The initial impact of managed care on Pharmacy practice was to reduce pharmacy cost.  EXPECTATIONS OF A PHARMACIST IN MANAGED There are three expectations CAREof the Pharmacist in managed care. 1. The Pharmacists must shift their emphasis away from their drug products and towards the patient. 2. Delivery of high quality care which is responsive to patient’s need and be attentive to the cost as well. 3. Develop new skills, competencies, and attitudes towards their work. To prosper in managed care, Pharmacists must be good managers and have strong clinical skills for evaluating and counselling various patients of all HOME HEALTH CARE  HOME HEALTH CARE PHARMACY Home Health Care Pharmacy: Patients often receive care & treatment at home rather than in an organized health care setting. Home health care means providing health care services to individuals and families in their place of residence. PURPOSE: Purpose of home health care: 1- Promoting health 2- Maintaining health 3- Restoring health 4- Maximizing level of independence while minimizing illness  ADVANTAGES 1. Patient’s records are more easily available to all health care providers. 2. There is less duplication of the services provided. 3. Better continuity of care. 4. More efficient care (and) 5. Less time consuming for the patient.  HOME HEALTH CARE PHARMACY SERVICES Home Health Care Pharmacy Services: Pharmacists plays a vital role for these patients, as most patients need complex Intravenous medicines that must be carefully compounded. The services provided by Home Health Care Pharmacy include: 1. Total Parenteral and Enteral nutrition. 2. Providing Pharmaceutical care (Identifying and resolving drug related problems) 3. Pain management (Pain control for cancer patients) 4. Home medical equipment (Walkers, Wheel chairs, self monitoring equipment) 5. Total Quality management (TQM) (Provide highest quality of care at all times) HOME HEALTH CARE PHARMACY SERVICES HOME HEALTH CARE PHARMACY SERVICES FUNCTIONS OF PHARMACISTS IN HOME HEALTH CARE Functions of Pharmacists in Health Care include: 1. Preparing infusion products. 2. Providing medication and home medical equipment. 3. Providing Pharmaceutical Care. 4. Maintain medication profiles, written care plans, communication notes. 5. Document patient’s goal of therapy and the progress towards those goals. 6. Identify, resolve and prevent medication LONG TERM CARE PHARMACY  LONG TERM CARE PHARMACY Long Term Care Pharmacy: Long term care covers “a diverse array of services provided over a sustained period of time to people of all ages with chronic conditions and functional limitations” The patients who need long term care include: 1. Patients experiencing the disabling effects of chronic diseases. 2. Those experiencing the long term disabling effects of accidents. 3. Most long term care patients are elderly (> 65 years). GOALS OF LONG-TERM CARE Restoration or maintenance of health and LONG TERM CARE PHARMACY  LONG TERM CARE FACILITIES Long term care facilities include: 1. Nursing homes. 2. Assisted living Independent living (Allows the residents to do as much as possible for themselves, yet provide support and backup. [E.g. Assistance in taking medication, house keeping, eating & doing laundry]. Intermediate care: This level of care is less intense than nursing home care but more intense than assisted living. 3. Continuing Care Retirement Community LONG TERM CARE FACILITIES  CONSULTANT PHARMACY PRACTICE Consultant Pharmacy Practice: A Pharmacists with a special interest in caring for long term care patients has the title ‘Consultant Pharmacist’. Settings: 1. Independent (or) a chain store pharmacy that provides limited long term services. 2. Stand – alone long term care pharmacies. 3. Pharmacies that provide no drugs but consult on the proper procedures and therapies in the facility. 4. Pharmacies located in Nursing home.  SERVICES PROVIDED BY PHARMACIST Consultant services: DRUG REGIMEN REVIEW  Medication use evaluation (MUE) is a performance improvement tool that can be used when there is uncertainty regarding whether a medication will be beneficial. It is particularly useful when limited evidence is available on how best to choose between two or more medications (Fanikos et al., 2014).  Drug Utilization Review (DUR) (Authorized, structured, ongoing review of prescribing, dispensing and use of medications (AMCP. ORG). DUR is an invaluable tool when prescribing drugs, and it can also be helpful in preventing any harm to patients from medication errors (Erwin, 1991). DRUG SAFETY  Improve medication safety.