Evolution of practice in an age of information
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Contrary to popular beliefs, pharmacy practice has undergone significant change over the past decade. Pharmacists have been empowered to engage patients like never before through the advent of new automation as well as innovative mobile technologies. The medication distribution process has been streamlined allowing pharmacists more time to engage in cognitive services and patient care. Innovative mobile technologies have given rise to a new generation of well-connected patients that are interested in their own care like never before. This has resulted in an unprecedented amount of information available to healthcare professionals from which a host of services may be provided. This presentation outlines key changes to pharmacy practice, along with examples of new automation and mobile technologies that illustrate these developments and implications for the future of pharmacy practice.
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Evolution of practice in an age of information
- 1. Pharmacy: Past, Present, Future THE EVOLUTION OF PRACTICE IN AN AGE OF INFORMATION Jerry Fahrni, Pharm.D.
- 2. History
- 3. Current Practice Photo credit: Susan Merrell/UCSF
- 4. Medication Errors Medication Errors That Adversely Affect Patient Care Outcomes Net No. of Favorable Outcomes Associated with Each Variable Pharmacist location Decentralized ↓ ↓ 5 Centralized with ward visits ↑ ↑ -2 Centralized ↑ ↑ -2 Adopted from Table 4 - Clinical Pharmacy Services in U.S. Hospitals in 2020 Bond et al, Pharmacotherapy 2004
- 5. “...Develop and disseminate a futuristic practice model that efficiently utilizes pharmacists as direct patient care providers ...” www.ashp.org/PPMI
- 6. How do we make this happen? What do we do when we do?
- 7. 2 QUESTIONS 1. How do we get there? 2. What do we do when we do?
- 9. Telepharmacy
- 10. 1 0 Image courtesy of InstyMeds. Used with permission. Dispensing Technology
- 11. 2 QUESTIONS 1. How do we get there? 2. What do we do when we do? “…utilize pharmacists as direct patient care providers…”
- 12. 81% of U.S. adults use the internet 72% of internet users looked online for health information within the past year 77% of online health seekers say they began their last session at a search engine such as Google, Bing, or Yahoo.
- 13. 85% of U.S. adults own a cell phone - half of those own smartphones 31% of cellphone owners have used their phone to look for healthcare information online 90% of surveyed patients would prefer to use the internet, mobile devices and e-mail to self-manage own healthcare info Pew Internet & Accenture survey results
- 14. Medication Non-adherence $100-$290 Billion Dollar Problem
- 17. “Mango Health… believes that by combining game mechanics with an intuitive, fun design and useful features, they can keep patients on track.“ Drug-drug interaction checking Timed medication reminders Rewards system Gamification Mango Health
- 18. • Lights up and plays music to remind users to take medications • Sends signal to secondary light • System calls user when dose is missed • Automated refill system via cellular connectivity Vitality GlowCaps
- 19. AdhereTech • Battery-powered smart • Senses amount of medication (liquid or solid) in bottle using capacitance • Cellular connectivity built into bottle for connectivity • Data may be shared with friends, family and/or physician • Offers an API for potential integration with portals or gamification platforms
- 23. “It's like drinking from a fire hose” 23
- 25. BY THE NUMBERS 90 Million Active Users 40 Million photos uploaded each day 1 billion unique visits each month 4 billion hours of video watched each month 72 hours of video uploaded every minute 25% of global views come from mobile devices Second largest social network only to Facebook 343 million active users Communities As of January 2013
- 26. Photo credit: http://www.flickr.com/photos/malteahrens/ Security and Privacy
- 27. 27 "I never think of the future - it comes soon enough." ~ Albert Einstein
- 31. Nanotechnology
- 32. Pharmacogenomics The influence of genetic variation on drug response by co-relating gene expression or polymorphism with a drugs’ efficacy or toxicity
- 33. So what’s it all mean?
- 34. Jerry Fahrni, Pharm.D. | twitter: @Jfahrni
Editor's Notes
- 5 core services: drug information, adverse drug reaction management, drug protocol management, medical rounds, and admission drug histories. Services were evaluated for affect on mortality rate, drug costs, total cost of care, length of hospital stay, and medication errorsBond CA, Raehl CL, Patry R. Evidence-Based Core Clinical Pharmacy Services in United States Hospitals in 2020: Services and Staffing, Pharmacotherapy 2004; 24(4):427-440
- Make use of all the automation and technology that’s currently at our fingertips.
- Depending on the study you read, Americans waste between $100 and $290 Billion dollars per year by not taking their medications. In addition it is estimated that as many as 28% of patients never have their prescriptions filled, and that as much as 50% of those that do have their prescriptions filled fail to adhere to the regimen. Express Scripts study - $258 billion a year by not taking prescribed medications because the missed doses lead to emergency room visits, doctors' visits and in-patient hospitalizationsSecond study conducted by CVS Caremark, Harvard University and Brigham and Women's Hospital cited $290 billion in waste. Both studies looked at data from their own customers, insurance payouts, previous research and survey data. The CVS study also included productivity losses. (USA Today article)
- Lester, R., Ritvo., Mills, E., et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomized trial. The Lancet. 376:1838-1845.Strandbygaard,U., Francis, ST., Backer, V. A daily SMS reminder increases adherence to asthma treatment: A three-month follow-up study. Respiratory Medicine. 2009; 104:166-171.Hanauer DA, Wentzell K, Laffel N, Laffel LM. Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes. Diabetes Technology & Therapeutics. 2009; 11:99-106.Miloh T, Annuziato R, Arnon R, et al. Improved adherence and outcomes for pediatric liver transplant recipients by using text messaging. Pediatrics. 2009; 124:e844-e580. Hou MY, Hurwitz S, Kavanagh E. Using daily text-message reminders to improve adherence with oral contraceptives: A randomized controlled trial. Obstetrics & Gynecology. 2010; 116:633-640.
- Recent study by a group of students at the Georgia Institute of Technology replicated a study on the use of SMS intervention for pediatric asthma that was presented at the 2012 International Health Informatics Symposium. In the Georgia Institute of Technology version, researchers randomly assigned 30 asthmatic children ranging in age from 10 to 17 to one of 3 groups - a control group that did not receive any SMS messages; a group that received text messages on alternate days; and a group that received texts every day.
- “It's like drinking from a fire hose.” - Alfred Huger
- Instagram data – As of January 2013 (todaysiphone.com - http://www.todaysiphone.com/2013/01/40-million-photos-uploaded-to-instagram-each-day-90-million-active-users/)YouTube data - http://www.youtube.com/yt/press/statistics.htmlGoogle+ data – As of January 2013 http://www.forbes.com/sites/anthonykosner/2013/01/26/watch-out-facebook-with-google-at-2-and-youtube-at-3-google-inc-could-catch-up/
- Photo analytics and virtual reality ….Medsnap
- “Smart Glass” (Google Glass)Great potential for both practitioners and patients…
- Sensor developed by a team of scientists in Switzerland. The sensor only a few cubic millimeters in volume, but packs 5 sensors, a radio transmitter and a power delivery system. A small patch goes outside the body to power it. The surface of each sensor is covered with an enzyme specifically designed to monitor something specific, and could potentially be used to monitor anything; cholesterol, blood sugar levels, chemotherapy, drug levels (seizure, digoxin, etc). The sensor transmit data continuously via bluetooth.
- Target antibiotic to attack specific bacterial antigensGold coated nano shells heated up with light to destroy cancer cells (Nanobullet)Smart Insulin – “Glucose Sensitive Insulin” Weiss and his research team have engineered a kind of injectable insulin that can detect when levels of glucose in the body are too high or too low, and release itself into the bloodstream accordingly.Read more: http://medcitynews.com/2013/03/smart-insulin-could-someday-help-type-1-diabetes-patients-avoid-hypoglycemic-episodes/#ixzz2RdpGv5TRNano-artificial pancreasBiodegradable nanoparticles that release growth factors and angiogenic factors to improve bioengineering of heart or lung tissue http://www.authorstream.com/Presentation/bhavik943-1549630-nanotechnology-bhavik-khatiwala/