Change Identification and Ethics 8/13

Olson

Evidence-based interventions should

• improve quality

• control costs

• maximize value

Implementation Science

• the scientific study and application of strategies to promote the systematic uptake of research findings and other evidence-based practices into routine use, thereby improving the quality and effectiveness of health services

• focus on the “what, how, when, and who” of implementation rather than with discovering the why or creating an innovation

Before implementation…

• identify a need for change

• how can we do this differently to improve safety, maximize efficiency, and be more cost effective

Functional Fixedness

• the inability to realize that something known to have a particular use may also be used to perform other functions

• cognitive bias that makes you less creative

• ex. diastat, penicillin

Process Change Triangle (PCT)

• Success: the definition of success for your change

• leadership/sponsorship: direction and guidance for a project

• project management: technical side of a change; design, develop, and deliver solution

• change management: people side of the change; enable people to engage, adopt, and use solution

ADKAR Methodology

• Awareness

• Desire

• knowledge

• ability

• reinforcement

• No matter what model, NEED awareness and desire first

Deloitte Future of Health Vision

• greater emphasis placed on preventative care over treatment

• transition to more care being delivered in home or community vs acute care

• professions is at crossroads from product-focused role to more of clinical role

• traditional education and practice models vs opportunities

Opportunities for pharmacists to contribute to public and population health abound

• primary care

• specialty care

• digital health

• population health analytics

Primary care

• supplement or extend services of primary care providers

• help patients better self-manage health conditions before they require acute or complex care

• community pharmacists are well positions for this

• chronic condition management

• prevention and wellness

• minor acute illnesses

• behavioral and mental health

• aging in place

• addressing drivers of health and connecting people with resources

Specialty care

• area of evolution of clinical Pharmacist

• builds upon best practices of health systems

• physicians make diagnosis and pharmacists take it from there

Digital health

• combine meds with digital companions

• assist with finding most appropriate digital health product, assist with setup, and educate on usage, self management, result interpretation, troubleshoot, and submission into EHR

• expanded DME opportunity with onsite use or rental for digital health products that may be more cost prohibitive

• remote patient monitoring

Population Health Analytics

• imbed pharmacist in payer orgs and integrated delivery systems

• pharmacists have innate ability to evaluate clinical evidence and think in terms of numbers needed to treat or level of penetration that would bring improvement at population level

• analyze health outcome data, identify trends, design and test population health interventions that may involve care/case management, updating clinical pathways to incorporate latest evidence base

Structural barriers to shifting the paradigm in pharmacy

• payment models assign > value to product dispensed than to clinical services and improved pt outcomes

• segregation of medical and pharmacy benefits creates disincentives for payers and providers to consider pharmacy as a component of care

• retail and mail-order pharmacies owned by PBMs directly compete with non-PBM owned pharmacies

• product related revenue opportunities are more tempting than service-related opportunities

Regulatory barriers

• pharmacists not recognized as providers at federal level

• pharmacy profession does not speak with one voice

  • differing agendas and priorities

Morals

personal principles regarding right and wrong

Ethics

systematic rules provided by an external source (professional codes)

APhA Code of Ethics for Pharmacists

• established to guide pharmacists in relationships with patients, health professionals, and society

• key points:

  • respect for pt autonomy and dignity

  • commitment to the pts well-being

  • honesty and integrity in professional relationships

  • professional competence and lifelong learning

  • respect for colleagues and other healthcare professionals

Autonomy

honoring patient’s rights to make informed decisions

Beneficence

acting in the patient’s best interest

Non-maleficence

do no harm

Justice

fair and equal treatment

Fidelity

maintaining trust and confidentiality

Conflicts of interest

• financial incentives for recommending specific meds or products

• dispensing from a pharmacy the pharmacist owns or has a stake in

• relationships with pharmaceutical reps

• dual employment or consulting roles

• family or friends as patients

• influence on therapeutic interchange decisions

• ownership of related health business

Frameworks for ethical decision making

• identify the issue and examine the facts

• apply guidelines and standards

• evaluate possible resolutions

• implement and document your decision-making

• review and reflect