Medication risk mitigation matrix: A pharmaceutical care opportunity for precision medication.

Editorial | 4 Minute Read

Knowlton CH

Published: 7/1/2015

Abstract

Just over 60 years ago, two pharmacists in Washington, DC, Senator Hubert Humphrey and Representative Carl Durham, sponsored legislation that amended the Federal Food, Drug and Cosmetic Act to establish the class of drugs known as prescription or legend medications. While the underlying purpose was to protect the public from self-medicating harm, we were the first country, and are still one of the few, to handcuff pharmacists with this restrictive legislation. Pharmacists moved from the front seat of the primary care car to the curb. We were booted out of the car. We moved to the back of pharmacies, or, in hospitals, to the basement, relegated in these venues just to “fill prescriptions.”


Two decades later, just over 40 years ago, when I was licensed to practice pharmacy, pharmacists had emerged a bit from the shadows and were permitted, once again, to talk with patients about the medications they were taking. Not only had we been precluded from even placing the name of the medication on the prescription label for the previous 20 years, we had been muzzled.


Fast forward two more decades, just over 20 years ago, the late Dr. Dick Penna (then Executive Vice President of the American Association of Colleges of Pharmacy) and I met in his office in Alexandria, VA, to begin planning for our first edition of the textbook, Pharmaceutical Care.1. The pharmacy profession was in the middle of a titanic shift in pharmacy education (i.e., to the all-PharmD, as the requirement for licensure, which was fully adopted for all graduating pharmacists by 2003). The profession was poised to transform and really re-establish a patient-centered practice of pharmacy. The shift embodied a philosophical vision that focused less on the vial of pills and much more on the patient who was using the medication. It was a back to the future, maybe.


The purpose of the Pharmaceutical Care textbook was to delineate a systematic approach for student pharmacists and practicing pharmacists on how to pivot to a patient-centric practice. It was an attempt at supporting the re-engineering of the profession with its fresh and straightforward mission: Helping people make the best use of medications.
It was an attempt to transliterate a then-contemporary phrase from Peter Drucker: It is not, How can I achieve, but What can I contribute that really counts.2. Helping people make the best use of medications was the key, the emerging fresh purpose, for the profession.


Understanding the transition to a patient-centric approach made sense, but implementation was impeded. There was a strong appetite among pharmacists, but externalities like existing payment structures for medications and corporate ownership of pharmacies trumped professional prerogatives. Compensation and corporatization got in the way of pharmacists “helping people make the best use of medications.”
While incremental progress is evident over these past two decades, a professionwide transformational change has been an elusive, arduous, and disappointing process.


Yet, this decade seems to have ushered in a different context. The difference in context is the externalities of policy change in the health care system and the advancement in technology. Drucker again instructs us: “Change happens every day. Problems can be opportunities.” He asks: “How can we exploit this change as an opportunity for our enterprise [profession]?”3.
A new payment system that focuses on outcomes rather than process forces all providers to have a real interest in the results caused by the foremost medical intervention in society: medications. The previous siloing of Part D (i.e., medications) is now of concern to all stakeholders, not just the patient, thanks to the economic incentives and sanctions heaped upon facilities and providers that encourage an outcome focus.


In addition to health care policy moving from fee-for-service to fee-for-value (or, to value-based payments), the propitious timing for the profession’s impact also relates to information technology enablers who provide medication-related data analytics the ability to scale a systematic, uniform approach to medication risk mitigation for pharmacists—in other words, technology to help us apply science individually, technology to really invoke our pharmaceutical care quest.

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