Calls/Faxes from Pharmacists

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ChasingMyDreams

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I decided to post this here because I mostly reach out to PCPs during my typical day.

What is your perspective on communications from pharmacists? Not just the run of the mill prior authorization and refill requests but actual clinical questions/suggestions about treatment?

Example:

Patient has been on Toprol QD for years, get a new eRx for Metoprolol Tartrate QD. I assume this is a mistake (probably made by an MA), ask the patient if his MD said anything about changing his med patient replies 'no'.

I call and only get an MA who tells me "its what the MD wanted, just fill it" or puts me on hold for 5 minutes and then tell me they will call back and never do.

Or...Patient has been on Losartan 100 QD, we get new eRx for Lisinopril/HCTZ from Cardiologist, call both MDs to determine if Losartan should be DC'ed. Patient insists on taking both.

Same outcome with MA.

These are relatively minor but you get the point. Do you guys see calls from us as annoying and pointless?
I think tons of patients would benefit from what we call Medication Therapy Management (MTM); specifically Comprehensive Medication Reviews (CMRs).

http://www.pharmacytimes.com/news/mtm-advisory-board-updates-definition-of-key-pharmacist-service

Do you all view this as intrusive or would you be open to receiving communications from pharmacists with issues identified? Furthermore, would you ever be open to actually speaking to a pharmacist to go over a patient (discuss adherence barriers, cost barriers, alternative treatment approaches, treatment rationale, etc.)?

It seems that a lot of providers (especially older ones) seem to think we just make sure the right pills are in the right bottle. There are many value add services we can provide that do not (in my opinion) consist of practicing medicine but rather ensuring success with drug therapies. 4 years of pharmacy school taught me a ton but I am a little tired of having therapeutics discussions with MAs.

Thoughts?

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If there's any ambiguity about a prescription, a significant drug-drug-interaction, or a concern about duplication from multiple prescribers, you should call. I have no problem with pharmacists calling in the situations you mentioned. It certainly isn't intrusive. If necessary, I'll speak to pharmacists myself. However, most of the more routine questions can usually be answered by relaying a message through staff. The answer will come from me, however.

I honestly haven't run into any pharmacists who really wanted to get into a conversation about therapeutics.

The calls I find annoying are those that are simply responding to some computer-generated DDI that's merely a caution, not a contraindication (e.g., statin+fibrate, SSRI/SNRI+tramadol, warfarin+pretty much anything, etc.) In nearly every case, I'm already aware of it (my computer does the same thing), and am monitoring appropriately.
 
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I decided to post this here because I mostly reach out to PCPs during my typical day.

What is your perspective on communications from pharmacists? Not just the run of the mill prior authorization and refill requests but actual clinical questions/suggestions about treatment?

Example:

Patient has been on Toprol QD for years, get a new eRx for Metoprolol Tartrate QD. I assume this is a mistake (probably made by an MA), ask the patient if his MD said anything about changing his med patient replies 'no'.

I call and only get an MA who tells me "its what the MD wanted, just fill it" or puts me on hold for 5 minutes and then tell me they will call back and never do.

Or...Patient has been on Losartan 100 QD, we get new eRx for Lisinopril/HCTZ from Cardiologist, call both MDs to determine if Losartan should be DC'ed. Patient insists on taking both.

Same outcome with MA.

These are relatively minor but you get the point. Do you guys see calls from us as annoying and pointless?
I think tons of patients would benefit from what we call Medication Therapy Management (MTM); specifically Comprehensive Medication Reviews (CMRs).

http://www.pharmacytimes.com/news/mtm-advisory-board-updates-definition-of-key-pharmacist-service

Do you all view this as intrusive or would you be open to receiving communications from pharmacists with issues identified? Furthermore, would you ever be open to actually speaking to a pharmacist to go over a patient (discuss adherence barriers, cost barriers, alternative treatment approaches, treatment rationale, etc.)?

It seems that a lot of providers (especially older ones) seem to think we just make sure the right pills are in the right bottle. There are many value add services we can provide that do not (in my opinion) consist of practicing medicine but rather ensuring success with drug therapies. 4 years of pharmacy school taught me a ton but I am a little tired of having therapeutics discussions with MAs.

Thoughts?

Pharmacist are our colleagues and friends. Your welcome to call. If a doctor is defensive against you it's on them. There is nothing wrong with asking for clarification or suggesting a possible correction. We are all on the patients side.
 
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Calls/messages are welcomed. I talk with pharmacists via phone pretty frequently, but more often get a message via staff from the pharmacy and have staff relay a reply for these types of situations. If it was easy to get in touch it would be preferred; I don't like being on hold either when calling the pharmacy. On the inpatient side it's exceedingly helpful when the pharmacist calls with various recommendations, but they have a direct line to us.
 
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I like talking to pharmacists they often teach me things in the hospital. I cannot wait on hold for 10 minutes to return a phone call though. I have had pharmacists fill meds from three different providers on a patient with a stroke who was very confused and only needed to be taking 1 of the 3 medications. It took me over an hour to rectify they situation and what you're describing sounds like it would be very nice in that situation. If we got the direct extension to the pharmacist I think it would be much easier to call back, but usually I can't return phone calls on busy days and have to have the staff help. If someone says the pharmacist has a specific question for the doctor and needs to speak to them that is very different to me than the pharmacy wants to talk about a medication.
 
I would love to stop receiving requests for topical compounded medications from out of state pharmacies for Medicare patients that were never requested by patient or provider. Other than those, if anyone has questions about my prescribed care then I want to hear them. It serves no one well for a provider to have attitude or create hostile relationships towards suggestions towards improvement in care.
 
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