What's Wrong With the Health Care System, Part 2
What's Wrong With the Health Care System, Part 2
When estimates that medical mistakes claim the lives of as many as 98,000 hospitalized patients each year make only a small chink in health care's armor, there is reason for concern. In presenting this and other findings, To Err Is Human, the 1999 report of the Institute of Medicine's (IOM) Committee on the Quality of Health Care in America, created a flurry of activity in the area of patient safety. Phase 2 of the committee's strategy calls for much broader improvement. In Crossing the Quality Chasm: A New Health System for the 21st Century, which was released last month, the committee revealed that the solution is not a matter of banging out a few dents. The suit of armor needs major repairs.
"Americans should be able to count on receiving care that uses the best scientific knowledge to meet their needs, but there is strong evidence that this frequently is not the case," said William C. Richardson, chair of the committee. "The system is failing because it is poorly designed. For even the most common conditions, such as breast cancer and diabetes, there are very few programs that use multidisciplinary teams to provide comprehensive services to patients. For too many patients, the health care system is a maze, and many do not receive the services from which they would likely benefit."
Overhauling the system over the next decade will take significant numbers of dollars and multidisciplinary cooperation. The agenda proposed to help the system cross the chasm includes 13 recommendations for change and 10 rules for reform (see sidebar) that call on health care providers to refocus on the needs of patients. Where does pharmacy factor into this mix?
"Front and center, right along with every other health care provider," committee member Mary Wakefield, PhD, told Pharmacy Today. "Overcoming this barrier is not going to be an easy task, but it is essential. An 'all hands on deck' [mentality is needed] to ensure high quality care to offset the fragmented approaches of the past. Depending on the project, any one member of the team responsible for care may take the leadership role, but no one owns the helm except the patient."
The report does not specifically single out the pharmacy profession, but pharmacists are already excelling in two of the priority areas -- teamwork and technology use -- and are well positioned to be important players in the proposed changes.
How Pharmacists Can Help
Pharmacists need to look no further than the second recommendation to realize that they may be ahead of the curve.
The proposal calls for the health care system to be safe, effective, patient-centered, timely, efficient, and equitable. This is the path pharmacists have always taken, and it has been brought to a higher level with the advent of pharmaceutical care. Two recent case studies prove that pharmacy is prepared to take on the responsibilities outlined in the report. Both the APhA Foundation's Project ImPACT: Hyperlipidemia and the Asheville Project employed collaborative practices, improved patient care outcomes, displayed enhanced communication among providers, and changed the financial structure for the delivery of patient care services by pharmacists.
Project ImPACT: Hyperlipidemia was a groundbreaking demonstration project in health care. Pharmacists, physicians, and patients worked in concert to lower patients' serum cholesterol levels. Of the 397 participating patients, 62.5% achieved and maintained their National Cholesterol Education Program lipid goals during the 2-year study. Patients' medication adherence and persistence rates rose significantly.
"The practice model in the Foundation's project addresses many of the recommendations in the IOM report. Specifically, recognition of patients as a source of control over their care, shared knowledge of the free-flow of information, evidence-based decision making, and the cooperation of clinicians," said APhA Foundation Executive Director William M. Ellis. "I believe that Project ImPACT: Hyperlipidemia is transferable to other disease states and the general management of drug therapy. It shows how pharmacists can work collaboratively with patients and their physicians to improve the quality of care."
In Asheville, N.C., employees of the city and Mission St. Joseph's Health System are being offered disease state management programs in diabetes, asthma, hypertension, and lipid management. A total of 365 patients are being seen by 32 pharmacists in the community. Substantial improvements in quality of life and patient satisfaction have been reported, physician acceptance of pharmacists' expanded roles is widespread, and health care cost savings per patient continue to rise. Pharmacists in Asheville are compensated for their services.
"After 4 years of experience with the pharmaceutical care model, [I can report that] we have never done anything in our health care plan that has yielded better clinical or financial results than the Asheville Project," said John Miall, the city's director of risk management and the official who gave the project the green light in March 1997. "We are committed to the model to keep control of our costs. The project is a winner all the way around."
Barry Bunting, clinical manager at Mission St. Joseph's, said that the pharmacists have stepped up to monitor adherence and patient outcomes, coach patients, and make sure therapeutic plans are working.
"The IOM reports says we have a disjointed health care system. In this community, we have been able to link the pieces to help coordinate care. We did not invent new players; we connected pharmacists, physicians, patients, payers, and educators already in place," Bunting said. "All the players do what they are best at. We have shown that it is possible to connect the pieces, not step on turf, and work together to improve patients' health."
Widespread adoption of similar programs, particularly for the chronic diseases listed in the report (e.g., asthma, diabetes, and heart disease) could help meet the call for improved quality and safety. "These ailments typically require care involving a variety of clinicians and health care settings over extended periods of time. But physician groups, hospitals, and health care organizations work so independently from one another that they frequently provide care without the benefit of complete information about patients' conditions, medical histories, or treatment received in other settings," the committee stated.
Use of Technology Comes Naturally
Technology has endless potential to benefit the health care system. The report recommends that Congress, the executive branch, health care organization leaders, and health informatics associations and vendors should "make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education." New advances could eliminate the need for most handwritten clinical data by the end of the decade.
But pharmacists may differ with committee members who asserted that "health care organizations are only beginning to apply available technological advances." Bill G. Felkey, associate professor of pharmacy care systems at the Auburn University School of Pharmacy, presented the profession's case.
Felkey said the many opportunities that patients have to "click-in" for information could be a huge boon for the profession's patient care role. Felkey cited results from a research project he conducted with WebMD that show interest in health care communications over the Internet is growing. The National Quantitative Analysis of Pharmacists' Need for Internet-Based Applications revealed that pharmacists' Internet use is currently at 60% and will increase to 80% in 12 months. Of the pharmacists online, 22% communicate with other health care providers (40% of them do so at least once a week) and 10% communicate with patients (48% at least once a week).
The keys for continued progress toward bringing pharmacy practice into the 21st century include the profession's getting rid of the "last vestiges of computer-illiteracy in our practitioners," Felkey said, and increasing use of point-of-care devices such as desktop and wireless handheld computers that provide information wherever pharmacists interact with patients and physicians. Such devices can be used to reduce uncertainty in the medical decision-making process.
"Pharmacists today are using computers for more clinical decision support than their counterparts in other disciplines. It is therefore only natural for pharmacists to be leaders in this area, but it is so complementary to their therapeutic knowledge base that they should be number one," Felkey said. "It would be a crime for pharmacists not to further establish themselves in this point-of-care information niche."
Other Report Highlights
The report also asks Congress to create a $1 billion "innovation fund" for use during the next 3 to 5 years to subsidize promising projects and communicate the need for health care reorganization. It also calls on the Agency for Healthcare Research and Quality to identify 15 to 25 common, mostly chronic health conditions so that health care entities can develop action plans to improve care for these priority conditions over a 5-year period.
For further information, go to www.iom.edu and click on Recent Reports.
When estimates that medical mistakes claim the lives of as many as 98,000 hospitalized patients each year make only a small chink in health care's armor, there is reason for concern. In presenting this and other findings, To Err Is Human, the 1999 report of the Institute of Medicine's (IOM) Committee on the Quality of Health Care in America, created a flurry of activity in the area of patient safety. Phase 2 of the committee's strategy calls for much broader improvement. In Crossing the Quality Chasm: A New Health System for the 21st Century, which was released last month, the committee revealed that the solution is not a matter of banging out a few dents. The suit of armor needs major repairs.
"Americans should be able to count on receiving care that uses the best scientific knowledge to meet their needs, but there is strong evidence that this frequently is not the case," said William C. Richardson, chair of the committee. "The system is failing because it is poorly designed. For even the most common conditions, such as breast cancer and diabetes, there are very few programs that use multidisciplinary teams to provide comprehensive services to patients. For too many patients, the health care system is a maze, and many do not receive the services from which they would likely benefit."
Overhauling the system over the next decade will take significant numbers of dollars and multidisciplinary cooperation. The agenda proposed to help the system cross the chasm includes 13 recommendations for change and 10 rules for reform (see sidebar) that call on health care providers to refocus on the needs of patients. Where does pharmacy factor into this mix?
"Front and center, right along with every other health care provider," committee member Mary Wakefield, PhD, told Pharmacy Today. "Overcoming this barrier is not going to be an easy task, but it is essential. An 'all hands on deck' [mentality is needed] to ensure high quality care to offset the fragmented approaches of the past. Depending on the project, any one member of the team responsible for care may take the leadership role, but no one owns the helm except the patient."
The report does not specifically single out the pharmacy profession, but pharmacists are already excelling in two of the priority areas -- teamwork and technology use -- and are well positioned to be important players in the proposed changes.
How Pharmacists Can Help
Pharmacists need to look no further than the second recommendation to realize that they may be ahead of the curve.
The proposal calls for the health care system to be safe, effective, patient-centered, timely, efficient, and equitable. This is the path pharmacists have always taken, and it has been brought to a higher level with the advent of pharmaceutical care. Two recent case studies prove that pharmacy is prepared to take on the responsibilities outlined in the report. Both the APhA Foundation's Project ImPACT: Hyperlipidemia and the Asheville Project employed collaborative practices, improved patient care outcomes, displayed enhanced communication among providers, and changed the financial structure for the delivery of patient care services by pharmacists.
Project ImPACT: Hyperlipidemia was a groundbreaking demonstration project in health care. Pharmacists, physicians, and patients worked in concert to lower patients' serum cholesterol levels. Of the 397 participating patients, 62.5% achieved and maintained their National Cholesterol Education Program lipid goals during the 2-year study. Patients' medication adherence and persistence rates rose significantly.
"The practice model in the Foundation's project addresses many of the recommendations in the IOM report. Specifically, recognition of patients as a source of control over their care, shared knowledge of the free-flow of information, evidence-based decision making, and the cooperation of clinicians," said APhA Foundation Executive Director William M. Ellis. "I believe that Project ImPACT: Hyperlipidemia is transferable to other disease states and the general management of drug therapy. It shows how pharmacists can work collaboratively with patients and their physicians to improve the quality of care."
In Asheville, N.C., employees of the city and Mission St. Joseph's Health System are being offered disease state management programs in diabetes, asthma, hypertension, and lipid management. A total of 365 patients are being seen by 32 pharmacists in the community. Substantial improvements in quality of life and patient satisfaction have been reported, physician acceptance of pharmacists' expanded roles is widespread, and health care cost savings per patient continue to rise. Pharmacists in Asheville are compensated for their services.
"After 4 years of experience with the pharmaceutical care model, [I can report that] we have never done anything in our health care plan that has yielded better clinical or financial results than the Asheville Project," said John Miall, the city's director of risk management and the official who gave the project the green light in March 1997. "We are committed to the model to keep control of our costs. The project is a winner all the way around."
Barry Bunting, clinical manager at Mission St. Joseph's, said that the pharmacists have stepped up to monitor adherence and patient outcomes, coach patients, and make sure therapeutic plans are working.
"The IOM reports says we have a disjointed health care system. In this community, we have been able to link the pieces to help coordinate care. We did not invent new players; we connected pharmacists, physicians, patients, payers, and educators already in place," Bunting said. "All the players do what they are best at. We have shown that it is possible to connect the pieces, not step on turf, and work together to improve patients' health."
Widespread adoption of similar programs, particularly for the chronic diseases listed in the report (e.g., asthma, diabetes, and heart disease) could help meet the call for improved quality and safety. "These ailments typically require care involving a variety of clinicians and health care settings over extended periods of time. But physician groups, hospitals, and health care organizations work so independently from one another that they frequently provide care without the benefit of complete information about patients' conditions, medical histories, or treatment received in other settings," the committee stated.
Use of Technology Comes Naturally
Technology has endless potential to benefit the health care system. The report recommends that Congress, the executive branch, health care organization leaders, and health informatics associations and vendors should "make a renewed national commitment to building an information infrastructure to support health care delivery, consumer health, quality measurement and improvement, public accountability, clinical and health services research, and clinical education." New advances could eliminate the need for most handwritten clinical data by the end of the decade.
But pharmacists may differ with committee members who asserted that "health care organizations are only beginning to apply available technological advances." Bill G. Felkey, associate professor of pharmacy care systems at the Auburn University School of Pharmacy, presented the profession's case.
Felkey said the many opportunities that patients have to "click-in" for information could be a huge boon for the profession's patient care role. Felkey cited results from a research project he conducted with WebMD that show interest in health care communications over the Internet is growing. The National Quantitative Analysis of Pharmacists' Need for Internet-Based Applications revealed that pharmacists' Internet use is currently at 60% and will increase to 80% in 12 months. Of the pharmacists online, 22% communicate with other health care providers (40% of them do so at least once a week) and 10% communicate with patients (48% at least once a week).
The keys for continued progress toward bringing pharmacy practice into the 21st century include the profession's getting rid of the "last vestiges of computer-illiteracy in our practitioners," Felkey said, and increasing use of point-of-care devices such as desktop and wireless handheld computers that provide information wherever pharmacists interact with patients and physicians. Such devices can be used to reduce uncertainty in the medical decision-making process.
"Pharmacists today are using computers for more clinical decision support than their counterparts in other disciplines. It is therefore only natural for pharmacists to be leaders in this area, but it is so complementary to their therapeutic knowledge base that they should be number one," Felkey said. "It would be a crime for pharmacists not to further establish themselves in this point-of-care information niche."
Other Report Highlights
The report also asks Congress to create a $1 billion "innovation fund" for use during the next 3 to 5 years to subsidize promising projects and communicate the need for health care reorganization. It also calls on the Agency for Healthcare Research and Quality to identify 15 to 25 common, mostly chronic health conditions so that health care entities can develop action plans to improve care for these priority conditions over a 5-year period.
For further information, go to www.iom.edu and click on Recent Reports.
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