Community pharmacist helps keep patients with chronic illnesses out of the hospital

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Hub on Provider Status

Javier Jiménez

“Pedro” brought 40 prescription bottles into Farmacia San José in Lares, Puerto Rico. He had gotten the prescriptions filled at several different pharmacies, including some on the U.S. mainland and some in Puerto Rico. Among the bottles were prescriptions for congestive heart failure, schizophrenia, and other chronic medical and mental health conditions for which he had been hospitalized multiple times.

But Pedro wasn’t taking any of the medications. He didn’t understand the purpose of the drugs or how and when to take them. And he didn’t see why he should take medicine at all when he didn’t feel bad, so Javier Jiménez, PharmD, CDE, BCPS, helped him.

“If he didn’t take his medications properly, and eliminate the duplicate medications, he would have most definitely been hospitalized again within the next few weeks or month,” Jiménez said.

From 40 bottles to 12

The patient was taking three antipsychotics when he should have been taking one. He had more than one bottle of simvastatin and several benzodiazepines. Jiménez eliminated duplicate medications. He separated medications that had been consolidated into one bottle. And he explained to Pedro that he had to take his medications every day whether he could feel the symptoms of his conditions or not. He left the patient with a list of his medications and instructions for each.

In the end, Jiménez had cut the patient’s prescription load down from 40 bottles to about 12. The whole process took about an hour and a half. Jiménez cut the patient’s drug costs and most likely helped keep him out of the hospital, but he won’t be reimbursed for any of this.

Pharmacists, unlike virtually any other health care provider, cannot bill insurance for the patient care services they provide. As the other stories in this series illustrate, pharmacists do not have provider status, a designation that CMS makes that allows health care providers to bill payers for their services.

Small town in Puerto Rico

In the small mountain town of Lares, about 65 miles west of San Juan, Jiménez often meets patients who struggle to understand prescription instructions. “We have many patients taking 8, 10, 12 medications, who have low literacy skills and can’t read the labels,” Jiménez said.

In Puerto Rico, just as on the U.S. mainland, the burden of chronic disease, including heart disease and diabetes, is great and among the leading causes of death. Many people in Lares and on the island at large would benefit from the service Jiménez provided for Pedro. But without reimbursement, Jiménez can’t spend an hour with every patient who takes multiple chronic medications. Pharmacists have to focus on the dispensing process that pays the salary.

“I can’t take a lot of time to sit with a patient and educate the patient, organize their medication, contact the discharge physician, and [contact] the primary care physician without generating an income,” Jiménez said. “If I were a provider, I could actually provide that service.”

Bridge between acute, routine care

Jiménez notes that patients who have just been discharged from the hospital are particularly in need of a provider who can reconcile their medications for them.

“After many hospitalizations for poor management of their chronic conditions, they have multiple medications, they combine them all into just one or two bottles, then they don’t understand what’s on the label,” he said.
Jiménez believes pharmacists are ideally situated to serve as a bridge between acute and routine care to help keep patients adherent and provide preventive care.

“Pharmacists are in a position, with their knowledge, skills, and location in the community, to be the intermediary between the patient’s discharge physician and the family physician,” Jiménez said. “The problem is that the pharmacists can’t generate any income for this direct patient care service.”


Provider status stories

Pharmacists are health care providers. In a series of profiles appearing in Pharmacy Today and on pharmacist.com, pharmacists explain how their patients would benefit from provider status. And as part of our campaign for provider status, APhA has asked pharmacists to share their story of how they provide care to their patients and how provider status will improve health care. These stories are collected on the APhA YouTube channel. If you would like to share your story, please visit PharmacistsProvideCare.com.

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