USPHS Deployment and Pharmacy Forms

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USPHS Deployment and Pharmacy Forms

• LCDR Binh T. Nguyen, Pharm.D., M.S.
• LCDR Connie T. Jung, RPh, Ph.D.
• Food and Drug Administration
• PharmPAC 04/04/07

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Objectives

• How can Medication Therapy Management (MTM) be
  applied towards emergency health
  response/preparedness (USPHS deployment)?
• Purpose of implementing USPHS Pharmacy MTM forms
• Other pharmacy deployment forms

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USNS COMFORT Mission to Latin America and the
Caribbean

• 1 ER/FP Physician
• 1 Preventive Medicine Physician
• 1 Infectious Disease Physician
• 1 Internal Medicine Physician
• 2 Dentists
• 4 Dental Hygienists
• 2 Medical-Surgical Nurses (comfortable with
  patients of all ages, in both in-patient and
  out-patient environments)
• 1 Environmental Engineer
• 1 Environmental Health Officer
• 1 Veterinarian (primarily large animal focus)

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Medicare Prescription Drug, Improvement, and
Modernization Act of 2003

• MMA 2003, Congress stipulated that Part D
  sponsors (i.e. plans) must establish an MTM
  program that is designed to optimize therapeutic
  outcomes (for targeted beneficiaries) through
  improved medication use, and to reduce the risks
  of ADE and drug interactions. MMA 2003 also said
  MTM program elements should promote these goals
• Counsel patients for appropriate use of
  medications and risk of ADE
• Increase adherence to prescription drug regimens
  through medication refill reminders, special
  packaging, and other means
• Detection of ADE and pattern of drug overuse and
  under-use

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MMA 2003

• If properly implemented in community pharmacy,
  the provision of MTM services will lead to
• Improved care for patients
• Higher patient and customer satisfaction
• Lower overall health care expenditures
• New profit centers in community pharmacies
• Greater professional fulfillment for pharmacists
• Unprecedented national recognition of
  pharmacists value

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What is Medication Therapy Management?

• MTM includes services not limited to
• Performing patient health status assessments
• Formulating prescription drug treatment plans
• Managing high-cost specialty medications
• Evaluating and monitoring patient response to
  drug therapy
• Providing education and training
• Coordinating MTM with other care management
  services
• Participating in state-permitted drug therapy
  management

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How will MTM be developed?

• The final rule states that MTM must be
  developed in cooperation with licensed and
  practicing pharmacists and physicians.

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Medication Therapy Management Components

• Medication therapy review (MTR)
• Monitor ongoing therapy
• Review of all meds Rx, OTC, herbal, DS at least
  annually
• Outcome to optimize drug therapies
• Personal medication record
• List of patients own meds, strength, dosing
  directions, and other info
• RPh encourages patients to share this list with
  all of their health care providers
• Medication Action Plan (MAP)
• A MAP contains info to help patient improve their
  medication management
• Intervention on medication therapy problems
  and/or referral
• RPh intervenes to address med related problems
• RPh refers patients to other health care
  providers
• Documentation of services and follow-up

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Applicability to USPHS Emergency Health Response

• Standardized forms for screening
• Standardized flyers for different types of
  services Immunization (influenza, hepatitis),
  Diabetes, Cholesterol, Hypertension,
  Osteoporosis, Hepatitis B, Food Pyramid,
  Exercise, Heartburn, Asthma, Depression,
  Generalized Anxiety Disorder
• Consent forms
• Electronic prescribing and dispensing
• PharmPAC health work group
• Use MTM model to support USPHS pharmacy response
  to public health emergencies

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Patient services pharmacists may provide

• Disease management
• Hypertension (26)
• Arthritis (20)
• Respiratory disease (19)
• Cholesterol disorders (13)
• Chronic Mental conditions (13)
• Heart disease (11) Cardiac risk / CHF
• Eye disorders (10)
• Asthma (10) - COPD
• Diabetes (10)
• Oncology
• Anticoagulant therapy
• Womens health
• Nephrology
• AIDS
• Osteoporosis
• Pediatric services
• Hormone replacement therapy (bioidentical
  therapies)
• Depression

• Lab Testing/Screening
• Blood lipids
• Bone density
• A1C
• Blood glucose
• Blood pressure
• Streptococci
• Helicobacter pylori
• Pulse oximetry
• Prothrombin time test
• Peak flow monitoring / education
• Wellness Program
• Diet/nutrition
• Smoking cessation
• Health status assessment
• Immunizations
• Travel health clinics
• Emergency contraception
• Weight loss management

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Qualitys indicators for pharmacists services

• Diabetes
• Adherence with healthy eating and physical
  activity
• Adherence with drug therapy (i.e. insulin, oral
  antidiabetes medications)
• Percentage of patients with A1C lt 7
• Percentage of patients with blood pressure of lt
  130/80 mm Hg
• Percentage of patients who
• Self-monitor blood glucose
• Receive annual eye exam, lipid panel, flu shot,
  and comprehensive foot exam

• Hypertension
• Adherence with healthy eating and physical
  activity
• Adherence with antihypertensive drugs
• Percentage of patients who reach target blood
  pressure goals. For example
• lt140/90 mmHg in those with hypertension
• lt130/80 mmHg in those with hypertension and
  diabetes or renal disease

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SG Health Priorities Healthy People 2010 Guide
to Public Health Research Needs, 2006

• key scientific based references
• 1) lifestyle modifications with regard to
  obesity, exercise, healthy eating and smoking.
• http//www.medscape.com/viewarticle/438855
• 2) reducing health disparity, specifically as it
  relates to the very young and the very old.
• http//www.uspharmacist.com/index.asp?showarticle
  pagehhc_award/hhcAward5/FifthAnnualhhcAwardArtic
  le2.htm
• 3) emergency preparedness and response readiness
  to chemical, biological, and other terrorist
  threats
• http//www.hhs.gov/pharmacy/ccrf.html
• 4) reduction and prevention of medication errors
• http//cdernet/ods/Error20Resource20Page/resourc
  e.html
• 5) misuse and abuse of drugs (Rx, OTC, herbal,
  alcohol, tobacco)
• http//www.drugabuse.gov/ResearchReports/Prescript
  ion/prescription6.html
• http//arthritis.about.com/od/prescriptionabuse/a/
  abuseofdrugs.htm

• pharmacist involvement and intervention
• 1) pharmacist role as Medication Therapy
  Management specialists, in terms of providing the
  public with important clinical drug and health
  information relating to different disease states
  
• http//www.medscape.com/viewarticle/406783
• 2) pharmacists as immunization specialists -
  being able to give vaccinations
• 3) pharmacist's role in providing good IT
  support/communication technology to make sure
  drug and health information for patients are
  known and can be addressed during disaster
  relief
• http//www.uspharmacist.com/index.asp?showarticle
  page8_1217.htm
• 4) pharmacy response at the community and local
  level, during any emergency, including
  distribution of drugs where they are most needed,
  including the National Stockpile
• http//www.hhs.gov/pharmacy/ccrf/html
• 5) pharmacists as pharmacogenomic specialists, in
  terms of knowledge of pharmacokinetics and
  factors affecting drug metabolism.

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MTM forms, VAPSA and Hospital Practice

• MTM forms
• Patient OTC Medication, Usage, and Family History
  form
• Pharmaceutical Care Drug Assessment Diagnosis
  form
• Patients Question / Concern and Pharmacists
  Assessment / Response form
• Patient Proper Medication Use form
• Pharmacist Communication to Physician form

• Health Clinic
• Health passport
• Screening
• Diabetes
• Cholesterol
• Hypertension
• Others
• Diet and Exercise
• Depression
• Hospital Practice
• Immunization form
• http//www.psc.gov/forms/IHS/ihs.html

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Other deployment forms

• Narcotic inventory CII and CIII-V log
• Controlled substance dispensing log
• Immunization log
• Pharmacists record
• Temperature log form (Freezer/Refrigerator)
• Prescription form
• Important contacts

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Thank you

• PharmPAC
• All officers who provided comments and feedbacks
• Pharmacy Work Group members
• RDF Pharmacy Team Leadership