Issue 9: The Collaborative Practice®

Celebrating AmCare clinical pharmacy innovations and pharmacists across the country

Patient access remains one of the hottest topics in pharmacy. Whether that’s due to care deserts, lack of reliable transportation, or cost, the result is millions of patients across the US losing out on life-altering care.

Fortunately home infusion therapy, telehealth platforms, and other remote-friendly solutions can help. By letting patients receive care where they’re most comfortable – their homes – the most progressive pharmacy leaders are redefining where and how pharmacy is practiced all while minimizing healthcare costs and improving the patient experience .

In this month’s Collaborative Practice, we dig into how the growing trend of “hospital at home” is being applied in pharmacy.

All the best –
The Team @ RxLive

How home pharmacy keeps patients where they belong (at home)

This month we spoke with Marianne Ivey, Professor Emerita of the James L. Winkle College of Pharmacy at the University of Cincinnati and former leader of Pharmacy Services at institutions such as the University of Cincinnati and University of Washington. Dr. Ivey’s educational expertise didn’t just serve her students; it also benefited healthcare leaders and their patients.

In our conversation, we discuss Dr. Ivey’s consultative approach to healthcare management and how the field of pharmacy is changing – and must change – to fit the needs of patients today.

RxLive’s webinar series

We’re building a catalog of webinars that highlight pharmacy leaders’ expertise and help reposition how we view value-based care in the United States. Dig into the Value Expansion archives here.

And if you’d like to take part in any conversation, please feel free to get in touch.

The case for pharmacist intervention

In each edition of The Collaborative Practice, we highlight one anonymized patient case from a pharmacist in our network. The goal? Illustrate the value of pharmacist intervention and its benefit to the healthcare ecosystem. Here’s our case for this month…

Patient Case: How a reduced dose of furosemide helps treat hypotension

Our pharmacist recently met with a 77-year-old patient with HF with reduced ejection fraction(HFrEF) who’d developed hypotension. The patient’s home BP readings included 96/50 mmHG and 86/50 mmHG with symptoms of lightheadedness, dizziness, and a fall one week prior. Upon questioning, she also reported dry mouth.

Her medications included furosemide 80 mg daily, spironolactone 25 mg daily, metoprolol ER 100 mg daily, Entresto 97/103 mg twice daily, aspirin 81 mg daily and atorvastatin 40 mg daily. 

According to the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure in patients with HF who have fluid retention, diuretics are recommended to relieve congestion, improve symptoms, and prevent worsening HF (Class of recommendation 1, Level of evidence  B-NR). Meanwhile, the treatment goal of diuretic use is to eliminate clinical evidence of fluid retention, using the lowest dose possible to maintain euvolemia.

Given the patient’s apparent hypovolemia and HFrEF our pharmacist sent a consult note to the PCP recommending to hold the furosemide and possibly the spironolactone too, monitor for improvement and then reinitiate the medications with a reduced dose of the furosemide. The patient was provided education on how to monitor for hypovolemia and the pharmacist ensured she had a follow-up appointment booked with her PCP the next day given the need for continued close monitoring. No other medication changes were recommended given her other medications have higher levels of evidence for management of HFrEF than loop diuretics and should be maintained at their highest tolerated doses per the guideline recommendations.

Stories we’re following

From the benefits of 340B to the power of patient data, here are five stories that have our attention:

America’s shaky pharmaceutical supply chain is a prescription for disaster

Medication shortages during the pandemic were just the tip of the iceberg. As the FDA grapples with its strained supply chain, another issue has arisen: ineffective drug inspections.

Cyberattacks on hospitals ‘should be considered a regional disaster,’ researchers find

A recent study highlights adverse health effects stemming from ransomware attacks on hospital databases. Metrics studied included “canceled or delayed surgeries and cancer treatments, lack of COVID testing center availability, and loss of communication between hospitals.”

Innovation is necessary to preserve independent, community pharmacy

Recent innovations in community pharmacy (test-to-treat services, new payment models, and remote patient monitoring) are beneficial. But they’re not enough. To improve, pharmacists must adopt broader trends in healthcare – and consider leveraging implementation science to do it.

Opioids are overrated for some common back pain, a study suggests

In a recent study of more than 300 patients suffering from back or neck pain, Australian researchers discovered there was “no difference in pain severity after six weeks between those who received opioids versus a placebo sugar pill.”

Struggling with a drug crisis, San Francisco wants Narcan available at every pharmacy

San Francisco’s District 6 Supervisor, Matt Dorsey, has a haunting message to share: the city’s rise in fentanyl overdoses is a “public health crisis that San Francisco has not experienced since the days of the AIDS crisis.”

Pickle-fall: how a paddle sport is driving higher healthcare costs

At a recent conference, UnitedHealth Group Inc. warned of increasing healthcare utilization rates and reported seeing an abnormally high pace of hip replacements, knee surgeries, and other elective procedures.

According to UBS Group, one culprit is pickleball. 

Our two cents: talk with your healthcare provider about any strenuous physical activity and, if you want to commit to the pickleball lifestyle, focus on developing your backhand.

Kristen Engelen, PharmD
Kristen Engelen, PharmD, is the chief pharmacy officer of RxLive and a certified consultant pharmacist; she has over a decade of experience in retail pharmacy settings. Kristen became an RxLive co-founder because of her passion for geriatric pharmacy, with a focus on the intersection of pharmacy and aging.