Intro to Healthcare Quiz 1

Home Health Care

Provisions of medically related professional services and equipment to individuals and their families in their place of residence

What is the purpose of home health care?

promoting, maintaining or restoring health or minimizing the effects of illness and disability

What is home health care generally initiated?

when a person is unable to provide self-care due to illness

Skilled Nursing Services

Care that can only be performed by a licensed nurse (ex: IV-line maintenance, infection/wound care); typically done in hospital, assisted living communities, nursing homes, etc

What is the pharmacist’s role in skilled nursing services?

Can provide home health products and equipment

Hospice Services

Manage end-of-life process for terminally ill patients and their families (maintain quality of life (ex:pain, nutrition) but no performance of life saving procedures)

What is the pharmacist’s role in hospice services?

Pharmacist employed for medication management

Social Services

Help facilitate transition from hospital or long-term care facility to home and coordinate home care services

Give an example of speech therapy

Help patient regain speech after stroke

Give an example of physical therapy

Help patient regain strength post procedure

Examples of home care industries

• skilled nursing services

• hospice services

• speech and physical therapy

• social services

• homemaker services

• home infusion therapy

Homemaker Service

Assists with daily living (cooking, cleaning, bathing)

Home infusion Therapy

• Provided by pharmacists and nurses;

• includes:

  • parenteral nutrition

    IV

  • antibiotics

  • pain management (IV morphine, hydromorphine, fentanyl)

  • chemotherapy

  • biologic infusions

Examples of durable medical equipment

• wheelchairs

• bathroom safety supplies

• hospital beds

• ambulatory aids

• infusion pumps

• respiratory therapy and supplies

Home health pharmacist

Compassionate individual committed to providing personalized one-on-one care

Considerations one should have as a home health pharmacist

patient’s cultural, spiritual, and family dyanamics

Role of the Pharmacist

• developing a care plan

• selection of therapy or DME

• compounding

• IV infusion

• Monitoring drug therapy

• Communication with physicians, nurses, patients and others

• drug information

• ASHP home care standards

What factors are considered when determining what type and specific facility to send patient to?

• joint decision of pharmacy and nursing in conjunction with patient’s physician

• patient’s own choice

• insurance (is patient’s insurance able to cover costs of that facility?)social factors (does patient have supporting family members who can 1. fund the costs of home health care and 2. take care of patient whenever home health care professional not present)physical condition of home (stairs)

Types of home health patients

post surgical careCVS/ strokeneurological conditionsfall riskdementiachronic paincancerincontinenceprogressive chronic disease - COPD, heart failure

Reimbursement Issues

Medicare and Medicaid - government funded third party payer insurancelimits to what they’ll be covered due to being government fundedLow reimbursement rates - most home healthcare providers will not acceptManaged Care Organizationswill try to navigate patient to facility that is covered by their insurancePrivate SectorPatient pays out of pocket

Patient Centered Medical Homes (PCMH)

ideal model for health systemcomprehensive care for the whole patient, from preventative to chronic careaddress patient values and preferencesteam-based care, led by a clinician (physician or nurse practitioner)coordinated to avoid transitions of care issuespharmacists can perform medication-related services to improve quality and safetyTLDR: more communication between health care team to provide more optimal care

Transitions of Care

The movement of a patient from one setting of care to another

What are the types of transitions between healthcare settings?

changes in service or level of care (example: going from ER to ICU because need higher level of care)Change in setting (ex: patient is discharged from hospital and sent home)Change in provider (ex: physician diagnoses patient, patient sees pharmacist to receive medication)

Consequences of Poor Transitions of Care

ineffective or duplicative caremedication errors and adverse eventsinadequate follow upincreased health care costincreased hospital length of stayExcessive ED visits and avoidable readmissionsPatient dissatisfaction

Among medicare patients, almost 20% who are discharged from a hospital are ____ within 30 days

readmitted

Unplanned readmissions, at a ___ of USD $17.4B, accounted for 17% of total hospital payments from Medicare in 2004

cost

67% of patients face unintended medication ____ in the hospital

discrepancies

40% of medication reconciliation ____ result from miscommunication during patient handoffs

errors

Hospital Readmission Reduction Program (HRRP)

Program managed by the center of medicare and medicaid services (CMS) which penalizes hospitals for excessive readmissions30 day readmission results in repayment of up to 3%

What are exceptions to the Hospital readmission reduction program?

planned admissionobservational stays

Why do poor healthcare transitions happen?

lack of standardized processes between health care systemsUse of different electronic medical records (most hospitals use EPIC while pharmacist do no )Poor communication between providersNo continuity of care

Goals of Transition of Care

Improve collaboration between healthcare providers (treatment plans, medication changes, follow up, patient specific needs)Reduce medication error and adverse events (duplicate medication, drug interactions, drug omissions, incorrect or inappropriate medications)Reduce hospital length of stay, excessive readmissions, and ER visits (improve patient satisfactory and quality of life; reduce cost of burden from healthcare system)

Opportunities for Pharmacist to get involved in transitions of care

medication reconciliation (checks if medication is necessary)medication managementpatient and caregiver education (explains how to take new medication and discusses which to discontinue)care coordinationprescription servicescomprehensive discharge planning

What is BPMH?

Best patient medical history

How do you optimize a patient’s medication therapy?

collect the best possible medication history medication reconciliation provide patient education assess adherence and patient barriers provide follow up and monitoring

How to optimize BPMH?

collect info on medications drug name, dose, route, and frequencyhow patient is actually taking medication vs. how it is prescribednewly prescribed medications collect other info:which unchanged medications need to be continued and which ones need to be heldwhich medications need to be adjusted what new medications did patient start upon dischargepatient’s medication adherence

What is important when collecting BPMH?

Must verify medication information with more than one source (other than patient)

Medication Reconciliation

A formal process for ensuring a complete and accurate medication list at each interface of care

What is important at each step of a transition?

patient education Review medication list thoroughly

Tech back method

patient counseling technique verify patient understands most of the information by..having patient tell you with their own wordsusing open ended questions

How can a pharmacist intervene to address barriers in patient access?

help patients secure access to medicationsprovide patients with instructions for follow-up and monitoringhelp patients with access to durable medical equipmenthelp patients address financial barriers

What are some challenges in regards to patient access? What are some things that can be done?

Patients with no insurance or unable to pay co-payment coordinate with case manager or social workerconsider cheaper alternativeHomeless patients coordinate medication delivery to besideMobility or transportation barrierscoordinate with pharmacy to deliver to beside or homeDifficulty securing stock of medication consider compounded medication REMs Drugs (Risk mitigating programs for high risk meds, may require labs or special education before dispensing)

Hands-Off Communication Considerations

mode of communicationtiming of communication healthcare providers involved in transmitting informationinformation provided standardized workflow or template

Which patient care outcomes can be impacted by a pharmacist?

readmission ratesmedication adherencemedication error reduction patient satisfactioncore measure compliance

What is the payment model of the US Health system?

Mix of public, private, and individual funding

What is the basic makeup (combination) of the US health system?

Combination of Public, Private, and Voluntary-sector

What are the 4 primary sectors of the US Health System?

Public Health, Ambulatory Care, Acute Care/Hospital, Transitions of Care

What is Public Health?

Educate and promote general health information & disease prevention

What is Ambulatory Care?

Provides the first contact with a healthcare provider and continuous care + ambulatory support for chronic conditions patients

What is Acute Care/Hospital?

Provide healthcare services to address unforeseen injury or illness or exacerbated chronic care

What is Transitions of Care?

Coordination and care continuity from one healthcare setting to another, or to home

What are the 5 Steps of the Medication Use Process?

Prescribing, Transcribing, Dispensing, Administering, Monitoring

Which areas of practice do we see more errors in pharmacy practice reported to Board of Pharmacy (+ percentages)?

Prescribing (40%), Transcribing (12%), and Dispensing (11%)

What are errors made during Prescribing?

Error in dosageUnapproved abbreviationsPRN orders without indicationDuplicate/confusion with home medsDocumented allergyIllegible ordersRange ordersVerbal orders

What are errors made during Transcribing?

Written or verbal orders are unclear

What are errors made during Dispensing?

Medications will tend to look or sound alike

What are errors made during Administering?

Time of dose/Missing dose

What are errors made during Monitoring?

Patients don’t continue/start medication

What are the advantages of e-prescribing?

Instant notification of allergies, drug interactions, and duplicate therapiesPrevent prescription drug errorsEasily prescribe controlled substancesMonitor controlled substance prescriptionsReconcile medication history effectivelyImprove medication adherence and increase patient safety Reduce lost prescriptions

What are the disadvantages of e-prescribing?

Improper patient selection App alert fatigue (?)Improper or difficult product selectionPoor technology design featuresSecurity and privacy concerns

What is the focus of Root Cause Analysis?

Examines cause of error due to the process rather than the individual (why NOT who)

Why are medications not being administered on time?

Nurses are busyPharmacist doesn’t complete the order on time Nurses cannot find medication on floor

What is Behavioral Health?

Includes the emotions and behaviors that affect your overall well-beingOften used interchangeably with mental health but includes substance use

What is Mental Health?

a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community

What is Mental Illness?

Health conditions involving changes in emotion, thinking or behavior (or a combination of these). Associated with distress and/or problems functioning in social, work or family activities

What are the 3 Measures of Global Disease Burden?

Disability-adjusted life years (DALYs)Years of life lost to premature mortality (YLLs)Years lived with disability (YLDs)

What is the most common health condition in the US?

Mental Health Disorders - 1 in 5 Adults live with a Mental Illness

What are the most common mental health disorders in the U.S.?

Anxiety disorders and Major depressive disorder

What is the most illicit drug used in the US?

Cannabis or Marijuana

Describe the drivers of increased cannabis use in the U.S.

Belief that cannabis use is not harmfulPerceived benefits of cannabisLegalization of cannabis in some states

Who has a higher risk of dependence to marijuana?

Start using marijuana during youth or adolescenceUse marijuana more frequently

What is providing complex high quality behavioral health care in individuals with co-occurring disorders dependent on?

Lifestyle issues, At-risk behaviors, Service utilization, Barriers to care

What is the percentage of adults that experienced a co-occuring substance use disorder and mental illness in 2021?

7.6%

What are the 3 parts of the biopsychosocial model?

Biological, Psychological, Social & environmental

Outpatient behavior health services provided by the private sector

• private practices

  • psychologists, psychiatrists, counselors, therapists (~50% of psychiatrists maintain private practices)

• substance use treatment centers

  • ex: rehab or detoxification centers and support groups

  • private facilities make up most of the treatment centers

• telehealth and online counseling

  • ex: betterhelp

• employee assistance programs (EAP)

  • behavioral health services as part of employee benefits

Outpatient behavior health services provided by government led CCBHCs

• crisis services

• treatment planning

• screening, assessment, diagnosis, & risk assessment

• outpatient mental health & substance use services

• peer, family support & counseling services

• targeted case management

• outpatient primary care screening & monitoring

• community-based mental health care for veterans

• psychiatric rehabilitation services

When are inpatient behavioral health services appropriate?

• acute crisis

• danger to self or others

• psychotic episodes

• failed outpatient treatment

Types of inpatient behavioral health services

• psychiatric units

• detoxification units

• crisis stabilization units

What is a 5150 hold?

72 hour involuntary hold

What is the criteria for a 5150 hold?

• danger to self

• danger to others

• grave disability

What is Indian Health Services?

federal health program for American Indians and Alaska Natives

What is the purpose of Indian Health Services?

• mission to raise health status for AI/AN people to the highest level possible

• provide behavioral health and alcohol and substance abuse programs

• provide both outpatient and inpatient behavioral services

What is the impact of untreated mental health disorders?

Unnecessary disabilityUnemploymentSubstance abuseHomelessnessInappropriate incarcerationPoor quality of lifeSuicide

What are most common health screening tools?

Patient Health Questionnaire-9 (PHQ-9)Mental Status Examination (MSE)

What are the structural funding behavioral health services in the U.S?

Private insurance, Medicaid & Medicare, Federal block grants, Out of pocket costs

What are the vulnerable populations of behavioral health?

Racial/ethnic minoritiesLGBTQ+IncarceratedHomelessChildrenElderly

What are the challenges to accessing behavioral health services?

Discrimination and racial disparitiesProvider shortagesLack of available/affordable services

What are the drivers of behavioral health inequity?

Social determinants of healthRacial and ethnic disparitiesService access barriersLanguage access barriers

What are the harmful effects of stigma and discrimination on an individual with mental health disorders?

Reduced hopeLower self-esteemIncreased psychiatric symptomsDifficulties with social relationshipsReduced likelihood of staying with treatmentMore difficulties at work

Who are the key players in behavioral health and who can prescribe?

PsychologistsCounselors and therapistsSocial workersPsychiatrists*Nurse practitioners*Primary care physicians*Pharmacists*

What are the common places of practice for psychiatric pharmacists?

Government hospitals or clinicsPublic, private, and academic hospitalsOutpatient mental health clinicsOutpatient primary care clinicsPrisons and correctional facilities

What are the roles of psychiatric pharmacists in behavioral health?

Prescribe or recommend appropriate treatmentEvaluate response and modify treatmentManage medication adverse reactionsResolve drug interactionsSupport medication adherenceProvide medication education

What is the significance of the role of psychiatric pharmacists in behavioral health?

Lack of psychiatric providersRole of psychiatric pharmacists is expanding into underserved areas of the populationPsychiatric pharmacists often function as the psychiatric provider for outpatient clinics

What is the role of community pharmacists in behavioral health?

Counsel on medication adherenceIdentify and manage medication side effectsPerform mental health screeningsConduct medication therapy managementProvide patient educationShare behavioral health resources

What is the significance of community pharmacy?

community pharmacist are the most seen and trusted health care professional

Why are community pharmacists important in the modern age?

expected physician shortage and population aging will make a bigger demand for more community pharmacists to fill in the primary care gaps

What are the goals and tasks of retail pharmacists?

reimbursed for furnishing medicationsincentivizing individual patient carereimbursement for cognitive services

What is the role of the staff pharmacist/floater pharmacist?

oversight of day-to-day operations in the pharmacy related to medication dispensing and clinical services

What is the role of the pharmacy manager/pharmacist-in-charge (PIC)?

record-keeping and maintenancestaffing/schedulingdriving business growthhiring, promotion, terminationoperational structureoversight and responsibility for ALL of pharmacy operations

What is the difference between a PIC and a pharmacy owner?

the owner may not be the PIC or even a pharmacist