thank you guys this has been a great opportunity for me I’m actually really
opportunity for me I’m actually really
opportunity for me I’m actually really very honored to be here to talk to you
very honored to be here to talk to you
very honored to be here to talk to you guys a lot of what I’m going to talk
guys a lot of what I’m going to talk
guys a lot of what I’m going to talk about today is a passion that I’ve
about today is a passion that I’ve
about today is a passion that I’ve pursued for forever since I’ve been a
pursued for forever since I’ve been a
pursued for forever since I’ve been a pharmacist and have worked in the
pharmacist and have worked in the
pharmacist and have worked in the healthcare field one of the things that
healthcare field one of the things that
healthcare field one of the things that really drives a lot of what I do is
really drives a lot of what I do is
really drives a lot of what I do is patient care and how can we actually
patient care and how can we actually
patient care and how can we actually create programs to improve patient care
create programs to improve patient care
create programs to improve patient care so for the first half of my talk today
so for the first half of my talk today
so for the first half of my talk today I’m really going to talk about the
I’m really going to talk about the
I’m really going to talk about the problem that we face in health care
problem that we face in health care
problem that we face in health care which is medication non-adherence and
which is medication non-adherence and
which is medication non-adherence and then the latter half of my presentation
then the latter half of my presentation
then the latter half of my presentation I’m going to talk about a solution that
I’m going to talk about a solution that
I’m going to talk about a solution that we created right here in Toledo Ohio
we created right here in Toledo Ohio
we created right here in Toledo Ohio that really has changed the landscape
that really has changed the landscape
that really has changed the landscape completely we have actually the Toledo
completely we have actually the Toledo
completely we have actually the Toledo leading the nation right now in terms of
leading the nation right now in terms of
leading the nation right now in terms of overcoming the problem that we call
overcoming the problem that we call
overcoming the problem that we call medication non-adherence so could we get
medication non-adherence so could we get
medication non-adherence so could we get a to treat the slide show there we go
a to treat the slide show there we go
a to treat the slide show there we go thank you
thank you
thank you so as healthcare providers we often are
so as healthcare providers we often are
so as healthcare providers we often are working under the auspices of
working under the auspices of
working under the auspices of Hippocrates which says first do no harm
Hippocrates which says first do no harm
Hippocrates which says first do no harm and so everything that we do as
and so everything that we do as
and so everything that we do as healthcare providers we really are
healthcare providers we really are
healthcare providers we really are working towards making sure that our
working towards making sure that our
working towards making sure that our patients are not harmed in any which way
patients are not harmed in any which way
patients are not harmed in any which way yet when it comes to patients what
yet when it comes to patients what
yet when it comes to patients what really fascinates me is we actually make
really fascinates me is we actually make
really fascinates me is we actually make sure that our patients go through a
sure that our patients go through a
sure that our patients go through a large number of Hoops and challenges
large number of Hoops and challenges
large number of Hoops and challenges before they can jump over the hump and
before they can jump over the hump and
before they can jump over the hump and really get to start getting better and
really get to start getting better and
really get to start getting better and improving the quality of life and so a
improving the quality of life and so a
improving the quality of life and so a lot of times when I’m asked to compare
lot of times when I’m asked to compare
lot of times when I’m asked to compare what our patients have to go through I
what our patients have to go through I
what our patients have to go through I compare it to the American Ninja Warrior
compare it to the American Ninja Warrior
compare it to the American Ninja Warrior so for those of you that are fans of the
so for those of you that are fans of the
so for those of you that are fans of the show or ever watch the show you know how
show or ever watch the show you know how
show or ever watch the show you know how crazy things can get and it’s really
crazy things can get and it’s really
crazy things can get and it’s really really challenging but our system our
really challenging but our system our
really challenging but our system our healthcare system really is structured
healthcare system really is structured
healthcare system really is structured in a way in which our patients
in a way in which our patients
in a way in which our patients essentially have to go through a large
essentially have to go through a large
essentially have to go through a large number of Hoops while they’re sick while
number of Hoops while they’re sick while
number of Hoops while they’re sick while they’re trying to get better in order
they’re trying to get better in order
they’re trying to get better in order for them to live happy productive lives
for them to live happy productive lives
for them to live happy productive lives while also keeping the cost of for
while also keeping the cost of for
while also keeping the cost of for themselves and also the healthcare
themselves and also the healthcare
themselves and also the healthcare system at a minimum
system at a minimum
system at a minimum and so will we actually really find is
and so will we actually really find is
and so will we actually really find is how can we make a change to improve
how can we make a change to improve
how can we make a change to improve patient care and the answer to that is
patient care and the answer to that is
patient care and the answer to that is by targeting problems such as medication
by targeting problems such as medication
by targeting problems such as medication non-adherence but before we talk about
non-adherence but before we talk about
non-adherence but before we talk about medication non-adherence it’s important
medication non-adherence it’s important
medication non-adherence it’s important to sort of take a step back and think
to sort of take a step back and think
to sort of take a step back and think about what the patient’s journey might
about what the patient’s journey might
about what the patient’s journey might essentially be so if you want to imagine
essentially be so if you want to imagine
essentially be so if you want to imagine you know a patient who falls sick and
you know a patient who falls sick and
you know a patient who falls sick and now they’ve come down with the flu it’s
now they’ve come down with the flu it’s
now they’ve come down with the flu it’s flu season coming around the corner here
flu season coming around the corner here
flu season coming around the corner here and so they’re really sick they’re the
and so they’re really sick they’re the
and so they’re really sick they’re the congested we are not living in the world
congested we are not living in the world
congested we are not living in the world anymore when the doctors used to make
anymore when the doctors used to make
anymore when the doctors used to make house calls now we are asking this
house calls now we are asking this
house calls now we are asking this patient who is sick and really wants to
patient who is sick and really wants to
patient who is sick and really wants to do nothing better but cuddle up in bed
do nothing better but cuddle up in bed
do nothing better but cuddle up in bed to pick up the phone call the doctor’s
to pick up the phone call the doctor’s
to pick up the phone call the doctor’s office and try to get an appointment
office and try to get an appointment
office and try to get an appointment right and so if you’re lucky after
right and so if you’re lucky after
right and so if you’re lucky after waiting for 20 minutes on hold they
waiting for 20 minutes on hold they
waiting for 20 minutes on hold they probably get to speak to someone that
probably get to speak to someone that
probably get to speak to someone that then sets up an appointment for them and
then sets up an appointment for them and
then sets up an appointment for them and then this patient will now have to make
then this patient will now have to make
then this patient will now have to make that trip to the doctor’s office and I
that trip to the doctor’s office and I
that trip to the doctor’s office and I have been waiting for maybe like an hour
have been waiting for maybe like an hour
have been waiting for maybe like an hour if they’re lucky maybe half an hour they
if they’re lucky maybe half an hour they
if they’re lucky maybe half an hour they meet somebody like this maybe he’s a
meet somebody like this maybe he’s a
meet somebody like this maybe he’s a really good doctor takes the time to
really good doctor takes the time to
really good doctor takes the time to actually find out what problems this
actually find out what problems this
actually find out what problems this patient faces or if they really aren’t
patient faces or if they really aren’t
patient faces or if they really aren’t lucky enough they may find this guy or
lucky enough they may find this guy or
lucky enough they may find this guy or maybe not they may not find this guy but
maybe not they may not find this guy but
maybe not they may not find this guy but somehow there’s a diagnosis what baffles
somehow there’s a diagnosis what baffles
somehow there’s a diagnosis what baffles me every single time is the tall order
me every single time is the tall order
me every single time is the tall order we have our physicians go through if you
we have our physicians go through if you
we have our physicians go through if you really think about it each physician
really think about it each physician
really think about it each physician encounter with a patient ranges roughly
encounter with a patient ranges roughly
encounter with a patient ranges roughly about 12 to 15 minutes and so in 12 to
about 12 to 15 minutes and so in 12 to
about 12 to 15 minutes and so in 12 to 15 minutes the doctor has to come in
15 minutes the doctor has to come in
15 minutes the doctor has to come in empathize with the patient be able to
empathize with the patient be able to
empathize with the patient be able to listen to their symptoms do any sort of
listen to their symptoms do any sort of
listen to their symptoms do any sort of assessment that they need to come up
assessment that they need to come up
assessment that they need to come up with a diagnosis diagnose the patient
with a diagnosis diagnose the patient
with a diagnosis diagnose the patient write a prescription and complete all
write a prescription and complete all
write a prescription and complete all the paperwork all in that 12 to 15
the paperwork all in that 12 to 15
the paperwork all in that 12 to 15 minute time frame and for the most part
minute time frame and for the most part
minute time frame and for the most part our doctors do a wonderful job trying to
our doctors do a wonderful job trying to
our doctors do a wonderful job trying to accomplish this huge challenge we have
accomplish this huge challenge we have
accomplish this huge challenge we have for them but the patient journey doesn’t
for them but the patient journey doesn’t
for them but the patient journey doesn’t end there the next step for the patient
end there the next step for the patient
end there the next step for the patient is to go to the pharmacy to pick up
is to go to the pharmacy to pick up
is to go to the pharmacy to pick up their medication they’re lucky they go
their medication they’re lucky they go
their medication they’re lucky they go through a drive-thru because the
through a drive-thru because the
through a drive-thru because the pharmacy already has the script ready
pharmacy already has the script ready
pharmacy already has the script ready for them the medication ready for them
for them the medication ready for them
for them the medication ready for them or if they have questions they may
or if they have questions they may
or if they have questions they may actually wait in line and usually lines
actually wait in line and usually lines
actually wait in line and usually lines of the pharmacies are really really
of the pharmacies are really really
of the pharmacies are really really Leslie and so we see a lot of patients
Leslie and so we see a lot of patients
Leslie and so we see a lot of patients not spending the time to talk to the
not spending the time to talk to the
not spending the time to talk to the pharmacist because they are not feeling
pharmacist because they are not feeling
pharmacist because they are not feeling well they want to go back home and
well they want to go back home and
well they want to go back home and really start taking the medication to
really start taking the medication to
really start taking the medication to get better well for the most part this
get better well for the most part this
get better well for the most part this is what we see with patients if they are
is what we see with patients if they are
is what we see with patients if they are living good healthy productive lives and
living good healthy productive lives and
living good healthy productive lives and acute condition or an acute problem they
acute condition or an acute problem they
acute condition or an acute problem they may encounter continues on maybe a
may encounter continues on maybe a
may encounter continues on maybe a couple times during the course of the
couple times during the course of the
couple times during the course of the year however a large majority of the
year however a large majority of the
year however a large majority of the patients that we treat are not patients
patients that we treat are not patients
patients that we treat are not patients that have acute conditions we are
that have acute conditions we are
that have acute conditions we are treating patients that have chronic
treating patients that have chronic
treating patients that have chronic conditions like diabetes hypertension
conditions like diabetes hypertension
conditions like diabetes hypertension asthma cancer and so when we look at
asthma cancer and so when we look at
asthma cancer and so when we look at patients for the vast majority of the
patients for the vast majority of the
patients for the vast majority of the journey of a patient who has a chronic
journey of a patient who has a chronic
journey of a patient who has a chronic condition we’re asking them to go
condition we’re asking them to go
condition we’re asking them to go through the cycle over and over and over
through the cycle over and over and over
through the cycle over and over and over again and so another interesting trend
again and so another interesting trend
again and so another interesting trend that we have noticed apart from making
that we have noticed apart from making
that we have noticed apart from making sure that our patients are getting
sure that our patients are getting
sure that our patients are getting better we have noticed that patients are
better we have noticed that patients are
better we have noticed that patients are changing our diagnoses are changing back
changing our diagnoses are changing back
changing our diagnoses are changing back in the 1980s the typical patient looked
in the 1980s the typical patient looked
in the 1980s the typical patient looked like somebody like this where you have
like somebody like this where you have
like somebody like this where you have this individual who was probably about
this individual who was probably about
this individual who was probably about in his 60s or 70s a lot of times they
in his 60s or 70s a lot of times they
in his 60s or 70s a lot of times they were in assisted living facilities or
were in assisted living facilities or
were in assisted living facilities or they actually had a caregiver or crate
they actually had a caregiver or crate
they actually had a caregiver or crate provider mainly a nurse or a nurse
provider mainly a nurse or a nurse
provider mainly a nurse or a nurse practitioner that was with them 24/7 so
practitioner that was with them 24/7 so
practitioner that was with them 24/7 so they really knew what was going on with
they really knew what was going on with
they really knew what was going on with the patient what we saw happening right
the patient what we saw happening right
the patient what we saw happening right in the 90s was we ended up with patients
in the 90s was we ended up with patients
in the 90s was we ended up with patients that were in their 50s that was starting
that were in their 50s that was starting
that were in their 50s that was starting to get diagnosed with chronic conditions
to get diagnosed with chronic conditions
to get diagnosed with chronic conditions now so these are patients that are not
now so these are patients that are not
now so these are patients that are not yet retired they’re still working that
yet retired they’re still working that
yet retired they’re still working that was the tail end of their employment
was the tail end of their employment
was the tail end of their employment well the past couple decades we noticed
well the past couple decades we noticed
well the past couple decades we noticed an very interesting trend we had a lot
an very interesting trend we had a lot
an very interesting trend we had a lot of patients that were yet a lot younger
of patients that were yet a lot younger
of patients that were yet a lot younger that were diagnosed with chronic
that were diagnosed with chronic
that were diagnosed with chronic conditions so much so that a few years
conditions so much so that a few years
conditions so much so that a few years ago I was in Tennessee and working with
ago I was in Tennessee and working with
ago I was in Tennessee and working with a large employer group and it surprised
a large employer group and it surprised
a large employer group and it surprised me there were a large number of
me there were a large number of
me there were a large number of employees the
employees the
employees the age for this employer group was 35 to 45
age for this employer group was 35 to 45
age for this employer group was 35 to 45 years of age and it was very interesting
years of age and it was very interesting
years of age and it was very interesting these people that formed the employer
these people that formed the employer
these people that formed the employer group essentially were taking anywhere
group essentially were taking anywhere
group essentially were taking anywhere from five to seven medications per year
from five to seven medications per year
from five to seven medications per year for chronic conditions that’s a large
for chronic conditions that’s a large
for chronic conditions that’s a large number of medications for people that
number of medications for people that
number of medications for people that are actually working so think about your
are actually working so think about your
are actually working so think about your dad your mom somebody at that age range
dad your mom somebody at that age range
dad your mom somebody at that age range that’s taking a large number of those
that’s taking a large number of those
that’s taking a large number of those medications and their to do that on a
medications and their to do that on a
medications and their to do that on a yearly basis what we end up seeing is
yearly basis what we end up seeing is
yearly basis what we end up seeing is 50% of the world’s population is
50% of the world’s population is
50% of the world’s population is diagnosed with a chronic condition and
diagnosed with a chronic condition and
diagnosed with a chronic condition and right here in the US in the next four
right here in the US in the next four
right here in the US in the next four years the diagnosis for chronic diseases
years the diagnosis for chronic diseases
years the diagnosis for chronic diseases is going to increase by 57% that’s a
is going to increase by 57% that’s a
is going to increase by 57% that’s a huge problem for us and it’s already
huge problem for us and it’s already
huge problem for us and it’s already starting to have its effect one of the
starting to have its effect one of the
starting to have its effect one of the other statistics that we need to really
other statistics that we need to really
other statistics that we need to really be familiar with is if you think back to
be familiar with is if you think back to
be familiar with is if you think back to 1989 we dispensed in America about 700
1989 we dispensed in America about 700
1989 we dispensed in America about 700 million prescriptions the last couple
million prescriptions the last couple
million prescriptions the last couple years the number of prescriptions we
years the number of prescriptions we
years the number of prescriptions we have dispensed is four billion that’s
have dispensed is four billion that’s
have dispensed is four billion that’s six times the number that we actually
six times the number that we actually
six times the number that we actually dispensed in 1989 and so it makes sense
dispensed in 1989 and so it makes sense
dispensed in 1989 and so it makes sense a lot more people are getting diagnosed
a lot more people are getting diagnosed
a lot more people are getting diagnosed with chronic conditions there’s a lot of
with chronic conditions there’s a lot of
with chronic conditions there’s a lot of prescription medications that are being
prescription medications that are being
prescription medications that are being dispensed and you would think that
dispensed and you would think that
dispensed and you would think that patients are actually going to take
patients are actually going to take
patients are actually going to take their medications so that they get
their medications so that they get
their medications so that they get better and lead much more productive
better and lead much more productive
better and lead much more productive lives but that’s not all we see what we
lives but that’s not all we see what we
lives but that’s not all we see what we end up seeing is a number like this we
end up seeing is a number like this we
end up seeing is a number like this we have three out of four Americans that
have three out of four Americans that
have three out of four Americans that are not taking their prescription
are not taking their prescription
are not taking their prescription medications like they have been
medications like they have been
medications like they have been prescribed by the doctor and so we do
prescribed by the doctor and so we do
prescribed by the doctor and so we do have some serious consequences as a
have some serious consequences as a
have some serious consequences as a result of this a lot of these patients
result of this a lot of these patients
result of this a lot of these patients essentially hospitalized they meet
essentially hospitalized they meet
essentially hospitalized they meet untimely deaths or if you look at the
untimely deaths or if you look at the
untimely deaths or if you look at the economics associated with medication
economics associated with medication
economics associated with medication non-adherence this cost us here in the
non-adherence this cost us here in the
non-adherence this cost us here in the United States close to 300 billion
United States close to 300 billion
United States close to 300 billion dollars just because our patients are
dollars just because our patients are
dollars just because our patients are not adherent with their medications it’s
not adherent with their medications it’s
not adherent with their medications it’s a problem that we really need to address
a problem that we really need to address
a problem that we really need to address but in order to look at why this problem
but in order to look at why this problem
but in order to look at why this problem exists or what are some of the barriers
exists or what are some of the barriers
exists or what are some of the barriers associated with the problem we want to
associated with the problem we want to
associated with the problem we want to sort of look at the various aspects of a
sort of look at the various aspects of a
sort of look at the various aspects of a patient taking a medication and what
patient taking a medication and what
patient taking a medication and what essentially poses a barrier
essentially poses a barrier
essentially poses a barrier to them in the interest of time I’ve
to them in the interest of time I’ve
to them in the interest of time I’ve really shortened the number of barriers
really shortened the number of barriers
really shortened the number of barriers and synthesized it into just a few
and synthesized it into just a few
and synthesized it into just a few targeted barriers so if you look at a
targeted barriers so if you look at a
targeted barriers so if you look at a condition related barrier this is when a
condition related barrier this is when a
condition related barrier this is when a patient is essentially diagnosed with
patient is essentially diagnosed with
patient is essentially diagnosed with let’s say high blood pressure it’s the
let’s say high blood pressure it’s the
let’s say high blood pressure it’s the patient gets a medication they go back
patient gets a medication they go back
patient gets a medication they go back home they start taking the medication
home they start taking the medication
home they start taking the medication high blood pressure is one of those
high blood pressure is one of those
high blood pressure is one of those disease states where you don’t really
disease states where you don’t really
disease states where you don’t really know how the medication is doing whether
know how the medication is doing whether
know how the medication is doing whether you’re feeling good you’re not feeling
you’re feeling good you’re not feeling
you’re feeling good you’re not feeling good unless you actually go and measure
good unless you actually go and measure
good unless you actually go and measure your blood pressure what ends up
your blood pressure what ends up
your blood pressure what ends up happening is we’ve noticed patients a
happening is we’ve noticed patients a
happening is we’ve noticed patients a number of times we’ll go back home and
number of times we’ll go back home and
number of times we’ll go back home and for some reason they start feeling
for some reason they start feeling
for some reason they start feeling better maybe it’s the placebo effect or
better maybe it’s the placebo effect or
better maybe it’s the placebo effect or they truly do start feeling better and
they truly do start feeling better and
they truly do start feeling better and without letting their physician now they
without letting their physician now they
without letting their physician now they decide to stop taking the pill I call it
decide to stop taking the pill I call it
decide to stop taking the pill I call it that I don’t feel ill so I don’t want to
that I don’t feel ill so I don’t want to
that I don’t feel ill so I don’t want to take the pill syndrome and a large
take the pill syndrome and a large
take the pill syndrome and a large number of our patients do that and
number of our patients do that and
number of our patients do that and therefore they become non-adherent
therefore they become non-adherent
therefore they become non-adherent we also noticed that in general we send
we also noticed that in general we send
we also noticed that in general we send our patients home with a bottle that
our patients home with a bottle that
our patients home with a bottle that looks like this which has a large number
looks like this which has a large number
looks like this which has a large number of side effects listed on it it
of side effects listed on it it
of side effects listed on it it surprises me every single time
surprises me every single time
surprises me every single time despite sending our patients back home
despite sending our patients back home
despite sending our patients back home with these the side-effects listed our
with these the side-effects listed our
with these the side-effects listed our patients actually end up taking the
patients actually end up taking the
patients actually end up taking the medications but we do encounter patients
medications but we do encounter patients
medications but we do encounter patients that end up with side effects and that’s
that end up with side effects and that’s
that end up with side effects and that’s just normal and natural because they are
just normal and natural because they are
just normal and natural because they are taking medications that have a large
taking medications that have a large
taking medications that have a large number of side effects well if a patient
number of side effects well if a patient
number of side effects well if a patient was informed ahead of time what they
was informed ahead of time what they
was informed ahead of time what they could do to combat this side effect we
could do to combat this side effect we
could do to combat this side effect we would see adherence rates increase
would see adherence rates increase
would see adherence rates increase however what essentially happens is a
however what essentially happens is a
however what essentially happens is a large number of these patients don’t
large number of these patients don’t
large number of these patients don’t know how to overcome the side effects
know how to overcome the side effects
know how to overcome the side effects and so they do not like the side effects
and so they do not like the side effects
and so they do not like the side effects they don’t want to experience them and
they don’t want to experience them and
they don’t want to experience them and so they stop taking you know that
so they stop taking you know that
so they stop taking you know that medication or a much more serious
medication or a much more serious
medication or a much more serious consequence they stop taking all the
consequence they stop taking all the
consequence they stop taking all the medications that they have put on
medications that they have put on
medications that they have put on because they don’t know which medication
because they don’t know which medication
because they don’t know which medication is causing the problem we also noticed
is causing the problem we also noticed
is causing the problem we also noticed that over the years since our population
that over the years since our population
that over the years since our population has essentially started getting younger
has essentially started getting younger
has essentially started getting younger we have in a way not change our way of
we have in a way not change our way of
we have in a way not change our way of dealing with patients in as health care
dealing with patients in as health care
dealing with patients in as health care providers so what we notice is we get
providers so what we notice is we get
providers so what we notice is we get patients that are now very empowered
patients that are now very empowered
patients that are now very empowered with their lives these are your parents
with their lives these are your parents
with their lives these are your parents age these are people that
age these are people that
age these are people that their forties thirties that live very
their forties thirties that live very
their forties thirties that live very productive lies they’re very busy yet
productive lies they’re very busy yet
productive lies they’re very busy yet when it comes to medication taking
when it comes to medication taking
when it comes to medication taking behaviors they don’t know a lot about
behaviors they don’t know a lot about
behaviors they don’t know a lot about their medications themselves because
their medications themselves because
their medications themselves because we’ve not really educated or informed
we’ve not really educated or informed
we’ve not really educated or informed them about the medications we also
them about the medications we also
them about the medications we also notice a large number of patients when
notice a large number of patients when
notice a large number of patients when they actually are dispensed these
they actually are dispensed these
they actually are dispensed these medications they have bottles that look
medications they have bottles that look
medications they have bottles that look very much like this and unfortunately
very much like this and unfortunately
very much like this and unfortunately it’s not a good memory aid for them or
it’s not a good memory aid for them or
it’s not a good memory aid for them or it doesn’t tell them how many times
it doesn’t tell them how many times
it doesn’t tell them how many times they’ve actually taken their medication
they’ve actually taken their medication
they’ve actually taken their medication during the course of the day and so what
during the course of the day and so what
during the course of the day and so what we see a lot of times is patients
we see a lot of times is patients
we see a lot of times is patients essentially will overdose because they
essentially will overdose because they
essentially will overdose because they think that they haven’t taken their
think that they haven’t taken their
think that they haven’t taken their medication so they go back to the
medication so they go back to the
medication so they go back to the medicine cabinet and take the same pill
medicine cabinet and take the same pill
medicine cabinet and take the same pill twice a thrice during the course of the
twice a thrice during the course of the
twice a thrice during the course of the day or they may under dose because they
day or they may under dose because they
day or they may under dose because they just think they’ve taken the medication
just think they’ve taken the medication
just think they’ve taken the medication and they don’t take it for the rest of
and they don’t take it for the rest of
and they don’t take it for the rest of the day when indeed they had not taken
the day when indeed they had not taken
the day when indeed they had not taken the medication to start out with we
the medication to start out with we
the medication to start out with we notice that access is another problem we
notice that access is another problem we
notice that access is another problem we notice the patients who on average of
notice the patients who on average of
notice the patients who on average of taking anywhere from five to twelve
taking anywhere from five to twelve
taking anywhere from five to twelve medications for chronic conditions have
medications for chronic conditions have
medications for chronic conditions have to make about five trips to the pharmacy
to make about five trips to the pharmacy
to make about five trips to the pharmacy if they take five trips to the pharmacy
if they take five trips to the pharmacy
if they take five trips to the pharmacy a lot of times these patients don’t want
a lot of times these patients don’t want
a lot of times these patients don’t want to do that because they don’t have the
to do that because they don’t have the
to do that because they don’t have the time or they don’t want to waste money
time or they don’t want to waste money
time or they don’t want to waste money on gas or a that separate trip so a lot
on gas or a that separate trip so a lot
on gas or a that separate trip so a lot of them will piggyback on trips and so
of them will piggyback on trips and so
of them will piggyback on trips and so what it ends up happening is a patient
what it ends up happening is a patient
what it ends up happening is a patient will essentially take your first
will essentially take your first
will essentially take your first medication they run out of the second
medication they run out of the second
medication they run out of the second and the third medication they wait till
and the third medication they wait till
and the third medication they wait till they are running out of the third or the
they are running out of the third or the
they are running out of the third or the fourth medication and then make the trip
fourth medication and then make the trip
fourth medication and then make the trip to the pharmacy and by that time they’ve
to the pharmacy and by that time they’ve
to the pharmacy and by that time they’ve already been out of two of their
already been out of two of their
already been out of two of their medications for about a week or so and
medications for about a week or so and
medications for about a week or so and so we against the intermittent adherence
so we against the intermittent adherence
so we against the intermittent adherence with their medications we notice that
with their medications we notice that
with their medications we notice that money is a big problem
money is a big problem
money is a big problem health insurance gaps also provide or
health insurance gaps also provide or
health insurance gaps also provide or prevent patients from getting
prevent patients from getting
prevent patients from getting medications that they can take on a
medications that they can take on a
medications that they can take on a timely basis and lastly we see patients
timely basis and lastly we see patients
timely basis and lastly we see patients that just say we don’t have enough time
that just say we don’t have enough time
that just say we don’t have enough time to go to the pharmacy we leave busy
to go to the pharmacy we leave busy
to go to the pharmacy we leave busy active lives and we just cannot make it
active lives and we just cannot make it
active lives and we just cannot make it the time to go to the pharmacy so if you
the time to go to the pharmacy so if you
the time to go to the pharmacy so if you have to funnel it down to three
have to funnel it down to three
have to funnel it down to three for barriers it comes down to complexity
for barriers it comes down to complexity
for barriers it comes down to complexity of the regiment lack of knowledge about
of the regiment lack of knowledge about
of the regiment lack of knowledge about the disease states or the medication
the disease states or the medication
the disease states or the medication that the patients are taking and the
that the patients are taking and the
that the patients are taking and the last barrier which is in accessibility
last barrier which is in accessibility
last barrier which is in accessibility of these medications to the patients we
of these medications to the patients we
of these medications to the patients we looked around the country while we were
looked around the country while we were
looked around the country while we were trying to address this these problems
trying to address this these problems
trying to address this these problems and one of the things that I have worked
and one of the things that I have worked
and one of the things that I have worked the past decade on is to identify
the past decade on is to identify
the past decade on is to identify various providers so we worked with
various providers so we worked with
various providers so we worked with national organizations we worked with
national organizations we worked with
national organizations we worked with physician groups pharmacy groups nurse
physician groups pharmacy groups nurse
physician groups pharmacy groups nurse practitioner groups to identify systems
practitioner groups to identify systems
practitioner groups to identify systems in which we would be able to overcome
in which we would be able to overcome
in which we would be able to overcome these barriers and we ended up finding
these barriers and we ended up finding
these barriers and we ended up finding the solution to these barriers in the
the solution to these barriers in the
the solution to these barriers in the pharmacy and the pharmacist being the
pharmacy and the pharmacist being the
pharmacy and the pharmacist being the solution to the barriers so if you think
solution to the barriers so if you think
solution to the barriers so if you think about it if a patient actually has to
about it if a patient actually has to
about it if a patient actually has to make five trips to the pharmacy each
make five trips to the pharmacy each
make five trips to the pharmacy each month that means they’re more likely to
month that means they’re more likely to
month that means they’re more likely to see the pharmacist a lot more times than
see the pharmacist a lot more times than
see the pharmacist a lot more times than they’re seeing a physician most patients
they’re seeing a physician most patients
they’re seeing a physician most patients will see the pharmacist an average of
will see the pharmacist an average of
will see the pharmacist an average of twelve times during the course of the
twelve times during the course of the
twelve times during the course of the year whereas they see their physician
year whereas they see their physician
year whereas they see their physician probably about a couple of times during
probably about a couple of times during
probably about a couple of times during the course of the year we also notice
the course of the year we also notice
the course of the year we also notice that the pharmacist is very often
that the pharmacist is very often
that the pharmacist is very often referred to as the doctor on the bench
referred to as the doctor on the bench
referred to as the doctor on the bench because they go to pharmacy school for
because they go to pharmacy school for
because they go to pharmacy school for six years on a doctoral degree and they
six years on a doctoral degree and they
six years on a doctoral degree and they learn everything about medications yet a
learn everything about medications yet a
learn everything about medications yet a lot of times they’re very underutilized
lot of times they’re very underutilized
lot of times they’re very underutilized and they don’t really get a chance to
and they don’t really get a chance to
and they don’t really get a chance to talk to patients about their medications
talk to patients about their medications
talk to patients about their medications so we came up with this we came up with
so we came up with this we came up with
so we came up with this we came up with a sea of solutions we decided that we
a sea of solutions we decided that we
a sea of solutions we decided that we would use the pharmacy and the
would use the pharmacy and the
would use the pharmacy and the pharmacist team to essentially simplify
pharmacist team to essentially simplify
pharmacist team to essentially simplify the medication regimen for the patients
the medication regimen for the patients
the medication regimen for the patients educate the patient provide them
educate the patient provide them
educate the patient provide them knowledge and make the medications more
knowledge and make the medications more
knowledge and make the medications more accessible how were we going to do this
accessible how were we going to do this
accessible how were we going to do this well we had services in place we put
well we had services in place we put
well we had services in place we put together an adherence packaging system
together an adherence packaging system
together an adherence packaging system where there is a machine that packages
where there is a machine that packages
where there is a machine that packages all the patient’s medications so that
all the patient’s medications so that
all the patient’s medications so that they can take it for the whole week or
they can take it for the whole week or
they can take it for the whole week or the whole month they actually are
the whole month they actually are
the whole month they actually are organized the pharmacist checks these
organized the pharmacist checks these
organized the pharmacist checks these and they are able to be provided to the
and they are able to be provided to the
and they are able to be provided to the patient so that the patient when they
patient so that the patient when they
patient so that the patient when they need to take the medication during the
need to take the medication during the
need to take the medication during the course of the day can get into this
course of the day can get into this
course of the day can get into this blister take the medications now knows
blister take the medications now knows
blister take the medications now knows that they have already taken their
that they have already taken their
that they have already taken their medication so they’re not overall under
medication so they’re not overall under
medication so they’re not overall under dosing
dosing
dosing we also noticed that when we look at
we also noticed that when we look at
we also noticed that when we look at providing knowledge to patients
providing knowledge to patients
providing knowledge to patients medication therapy management services
medication therapy management services
medication therapy management services where the patient is sitting down with
where the patient is sitting down with
where the patient is sitting down with the pharmacist and the pharmacist talks
the pharmacist and the pharmacist talks
the pharmacist and the pharmacist talks about all the patient’s medications is a
about all the patient’s medications is a
about all the patient’s medications is a very powerful tool to help improve the
very powerful tool to help improve the
very powerful tool to help improve the outcomes of patients in fact medication
outcomes of patients in fact medication
outcomes of patients in fact medication adherence has been found to give us a
adherence has been found to give us a
adherence has been found to give us a one mr. 12 return on investment meaning
one mr. 12 return on investment meaning
one mr. 12 return on investment meaning for every one dollar that we invest in
for every one dollar that we invest in
for every one dollar that we invest in medication therapy management we can
medication therapy management we can
medication therapy management we can save twelve dollars from the healthcare
save twelve dollars from the healthcare
save twelve dollars from the healthcare system and also from the patient that is
system and also from the patient that is
system and also from the patient that is participating these services we also
participating these services we also
participating these services we also noticed that a system called refill
noticed that a system called refill
noticed that a system called refill synchronization is very very powerful
synchronization is very very powerful
synchronization is very very powerful because we can actually get the
because we can actually get the
because we can actually get the patient’s medications synchronized so
patient’s medications synchronized so
patient’s medications synchronized so that they are picking up the medications
that they are picking up the medications
that they are picking up the medications only once during the course of the month
only once during the course of the month
only once during the course of the month as opposed to five separate trips to the
as opposed to five separate trips to the
as opposed to five separate trips to the pharmacy and we also noticed that in all
pharmacy and we also noticed that in all
pharmacy and we also noticed that in all if a patient definitely doesn’t want to
if a patient definitely doesn’t want to
if a patient definitely doesn’t want to get up and doesn’t feel like they want
get up and doesn’t feel like they want
get up and doesn’t feel like they want to make a trip to the pharmacy we can
to make a trip to the pharmacy we can
to make a trip to the pharmacy we can have medications delivered to their
have medications delivered to their
have medications delivered to their doorstep and so when we look at this
doorstep and so when we look at this
doorstep and so when we look at this system in these services various parts
system in these services various parts
system in these services various parts of the country were offering an aspect
of the country were offering an aspect
of the country were offering an aspect of these services however they were not
of these services however they were not
of these services however they were not all under one roof and they were not all
all under one roof and they were not all
all under one roof and they were not all provided to patients and so what we
provided to patients and so what we
provided to patients and so what we decided we were going to do is right
decided we were going to do is right
decided we were going to do is right here in Toledo we work with various
here in Toledo we work with various
here in Toledo we work with various members of the community and we created
members of the community and we created
members of the community and we created the very first adherence pharmacy right
the very first adherence pharmacy right
the very first adherence pharmacy right here in Toledo the severan pharmacy
here in Toledo the severan pharmacy
here in Toledo the severan pharmacy helps patients coming to the pharmacy by
helps patients coming to the pharmacy by
helps patients coming to the pharmacy by helping them sit down with a patient who
helping them sit down with a patient who
helping them sit down with a patient who has a condition will probably come and
has a condition will probably come and
has a condition will probably come and work with the caregiver work with the
work with the caregiver work with the
work with the caregiver work with the pharmacist and be able to talk to the
pharmacist and be able to talk to the
pharmacist and be able to talk to the pharmacist and the staff about their
pharmacist and the staff about their
pharmacist and the staff about their medications about the therapy they’ll be
medications about the therapy they’ll be
medications about the therapy they’ll be able to get their medications in those
able to get their medications in those
able to get their medications in those blister packs and they will also be able
blister packs and they will also be able
blister packs and they will also be able to seek the services of delivery and
to seek the services of delivery and
to seek the services of delivery and they did not really want to spend time
they did not really want to spend time
they did not really want to spend time coming to the pharmacy and picking up
coming to the pharmacy and picking up
coming to the pharmacy and picking up the medications what we saw was very
the medications what we saw was very
the medications what we saw was very very fascinating to us we ended up with
very fascinating to us we ended up with
very fascinating to us we ended up with a high success rate we saw 97% adherence
a high success rate we saw 97% adherence
a high success rate we saw 97% adherence rates which are very very unusual
rates which are very very unusual
rates which are very very unusual there is no literature that’s currently
there is no literature that’s currently
there is no literature that’s currently published that has that high level of
published that has that high level of
published that has that high level of adherence rates we also saw every
adherence rates we also saw every
adherence rates we also saw every patient that came to the pharmacy that
patient that came to the pharmacy that
patient that came to the pharmacy that went through the adherence pharmacy
went through the adherence pharmacy
went through the adherence pharmacy state that they actually were able to
state that they actually were able to
state that they actually were able to reach their clinical goals and they were
reach their clinical goals and they were
reach their clinical goals and they were also able to get to a certain point
also able to get to a certain point
also able to get to a certain point where they were staying out of the
where they were staying out of the
where they were staying out of the hospital staying out of the ER those are
hospital staying out of the ER those are
hospital staying out of the ER those are things that are very very important for
things that are very very important for
things that are very very important for from the healthcare standpoint it
from the healthcare standpoint it
from the healthcare standpoint it minimizes costs while improving patients
minimizes costs while improving patients
minimizes costs while improving patients outcomes so as we move to the next step
outcomes so as we move to the next step
outcomes so as we move to the next step right here in Toledo as we leave the
right here in Toledo as we leave the
right here in Toledo as we leave the nation towards changing and improving
nation towards changing and improving
nation towards changing and improving care by tackling medication
care by tackling medication
care by tackling medication non-adherence I want you to leave you
non-adherence I want you to leave you
non-adherence I want you to leave you with this saying by Helen Keller along
with this saying by Helen Keller along
with this saying by Helen Keller along we can do so little together we can do
we can do so little together we can do
we can do so little together we can do so much please join me in this mission
so much please join me in this mission
so much please join me in this mission to stomp out medication non-adherence
to stomp out medication non-adherence
to stomp out medication non-adherence maybe you a member of your family or the
maybe you a member of your family or the
maybe you a member of your family or the member of your community might really
member of your community might really
member of your community might really benefit from knowing about the existence
benefit from knowing about the existence
benefit from knowing about the existence of a Doran’s pharmacy and being able to
of a Doran’s pharmacy and being able to
of a Doran’s pharmacy and being able to essentially use the services thank you
essentially use the services thank you
essentially use the services thank you again so much for your time I appreciate
again so much for your time I appreciate
again so much for your time I appreciate it
it
it [Applause]
”
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