I talk to a lot of pharmacists who work inside the pharmacy departments at managed care organizations and health systems. Everyday. Pretty much all day. What I’ve learned is that once you’ve seen one pharmacy department, you have seen… well… one pharmacy department. Every department seems to be structured differently and everybody has different ways of working towards the same goals of improving patient outcomes and lowering costs.
Besides having the same goals, there are two “pain points” that come up time and time again.
The first is establishing ROI for the pharmacy department. In theory everyone knows that it is important and that improved outcomes will lead to lower costs, etc… etc… etc… but when it comes time to meet with the CMO and CFO to demonstrate the department’s contribution, theory is not enough. We’ve written about ROI several times in the past and will most likely do so again, so today I’d like to focus on the second “pain” that is repeatedly mentioned—communication with prescribers.
Again, in theory communication shouldn't be an issue right? I mean, with email, texts, and even (gasp!) the phone, a pharmacist, a trusted member of the care team, should be able to effectively work with providers to drive the safest prescription decisions possible. Right?
Right. But from the majority of those that I’m speaking with it is not happening to anyone’s satisfaction. Emails are ignored. Texts get lost in spellcheck limbo (ever try and text a drug name? Maybe one day I’ll come up with a fun post with just the auto-corrections!). Phone calls go unanswered. Other alerts and tools that get integrated into EHRs fall victim to alert fatigue, or as we mentioned in a previous post, the MYTH of alert fatigue.
Enough of what you AREN’T doing. The purpose of this post is to focus on what you ARE doing to improve communication, and highlight the best practices that we are hearing from our customers. The hope is that you can take what others are doing and institutionalize it in your own department. Whether you are a VP of Pharmacy at a national health plan or a clinical pharmacist working with patients in a community hospital, the following steps can be put in place with very little effort, and I’m confident that they will pay dividends.
1. Keep Current on Drug Safety
Being a data and information guy, I like knowing what is going on. To do so, I consume large amounts of information, mostly by skimming news headlines and using tools like Twitter. I may not have the in-depth details on everything that is happening, but more often than not, I can get the “gist” of it and choose whether or not to go into more depth. The reason why this is possible for me is context. The internet is great at quickly putting things into context, or in other words quickly telling me why I should pay attention. Now, granted, the context you get from, say the Drudge Report is different from the context you’d get from the Huffington Post, but regardless I have the information that I need to decide whether or not to look into it further.
The world of drug safety lacks context. Medwatch alerts are issued by the FDA multiple times a day. News-flow on the thousands of approved medications is non-stop. Studies are published in increasingly numerous journals at an unprecedented rate. No one can possibly keep up with it all.
There is a great quote that helps to elaborate on this point from Donald Lindberg, director of the National Library of Medicine. He stated, “If I read and memorized two medical journal articles every night, by the end of a year I’d be 400 years behind.”
For pharmacists to better communicate with providers they need to be able to first keep up with the most important drug safety news and filter out the noise. Find a source that filters out the noise for you. Better yet, find a source that filters out the noise and puts news into context. This way you can save yourself time and be able to quickly provide your prescribers the information in a way that allows them to take action.
2. Stay Ahead of the FDA
It takes the FDA a long time to act on the post-approval data they receive on drugs. How long? Contact me directly and I’ll share some of our research with you. Without getting into the contributing factors, there is no longer a reason to solely rely on FDA communications when making decisions about drugs. Big data for the masses is here, making publicly available information on reported post-approval side effects accessible. This allows smart people to make smart decisions with all available data.
Utilize internal resources, outsource, or make a small software purchase to create analytics that can make sense of this information. For example, our RxSignal analytic that we’ve developed within the AdverseEvents Explorer software-as-a-service platform can predict what drugs the FDA will take action on, allowing you to take preemptive action.
Having the right data and the right analytics allows you to bring recommendations to a prescriber with the evidence to back it up. Not only will this immediately help the provider to understand your recommendation, but it will set the stage of fact-based-recommendations for all other conversations.
3. Provide Alternatives
Imagine that you go to the same deli for lunch every day, and every day you order their special sandwich. One day you order and then are told by the guy at the counter that the bread they use for the special was shown to cause cancer. Disappointed you ask what else the deli suggests. The guy behind the counter says, “Nothing”. Most likely you will just leave hungry, or worse eat the cancer causing sandwich.
I admit, this is a pretty ridiculous scenario. The deli would almost certainly have alternative choices for you that would satisfy your hunger, not give you cancer, and keep you as a customer.
Why is this not the norm in the pharmacist-prescriber conversation? By pushing alerts from pharmacy to provider without context and without alternatives that are equally efficacious yet safer, is akin to being the guy at the deli counter. Don’t be the guy at the deli counter. Having a simple to use comparative reference to be able to evaluate post-approval safety of drugs by class, indication, and line of treatment allows you to easily bring alternatives to the prescriber, helping them to make the best prescription decision possible.
4. Operationalize the Information aka- put it in their workflow
True or false: prescribers love having to go to a lot of different software applications to do their job?
FALSE! I have a habit of asking all of my doctors about the software and tools that they use throughout their day. The list is long (EHR platform, e-prescribing platform, information platform, etc…) and they always tell me they’d wish everything was just in one place. This is easier said than done, but what pharmacists can do is NOT give the prescriber yet another tool.
Once your department’s protocol is established for keeping up to date with drug safety, staying ahead of the FDA, and providing alternatives, work with your software and data vendors to integrate the data in a way that makes sense. With current technology, it is a lot easier than you may think and I know for fact that firms like ours are more than willing to work to make valuable information accessible to the entire organization.
5. Identify Your Connectors, Mavens and Salespeople Prescribers
If you haven’t read Malcom Gladwell’s The Tipping Point, I highly recommend doing so. (or read the Wikisummary) The ideas and themes of how things catch on, go way beyond traditional marketing, sales and business and can be applied everywhere. Even pharmacy!
One of the more important concepts in the book revolves around the idea of what Gladwell calls, “The Law of the Few” and connectors, mavens and salespeople. Connectors are individuals who have ties in many different realms and act as conduits between them, helping to engender connections, relationships, and “cross-fertilization” that otherwise might not have ever occurred. Mavens are people who have a strong compulsion to help other consumers by helping them make informed decisions. Salesmen are people whose unusual charisma allows them to be extremely persuasive in inducing others’ buying decisions and behaviors.
To help communicate actionable ideas around drug safety identify these types of individuals in your prescribing network and use them. Provide them with the knowledge and power to drive safer drug decisions.
Something as important as communicating drug safety from pharmacy to prescriber, should be a priority in your organization. If it’s not currently, make it one. As outlined here, there are simple ways that you can make improvements today, and there are many resources available to do so.
Download our white paper, Post FDA-approval drug safety data: why they are vital and how they can be made accessible, actionable, and predictable.
Download the white paper, Long-term medical expenses triggered by adverse drug events: Focus on improving patient outcomes, lowering costs, and optimizing formularies.
Our AdverseEvents Explorer application, powered by the RxSuite of analytics is an all-in-one drug safety platform that can help make difference in how your team receives information and communicates it throughout your organization. Register for a complimentary trial of the application now.
Did I miss any best practices around communication? Let us know in the comments.
Executive Vice President