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USPHS Deployment and Pharmacy Forms


RPh encourages patients to share this list with all of their health care providers ... Travel health clinics. Emergency contraception. Weight loss management ... – PowerPoint PPT presentation

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Title: USPHS Deployment and Pharmacy Forms

USPHS Deployment and Pharmacy Forms
  • LCDR Binh T. Nguyen, Pharm.D., M.S.
  • LCDR Connie T. Jung, RPh, Ph.D.
  • Food and Drug Administration
  • PharmPAC 04/04/07

  • How can Medication Therapy Management (MTM) be
    applied towards emergency health
    response/preparedness (USPHS deployment)?
  • Purpose of implementing USPHS Pharmacy MTM forms
  • Other pharmacy deployment forms

USNS COMFORT Mission to Latin America and the
  • 1 ER/FP Physician
  • 1 Preventive Medicine Physician
  • 1 Infectious Disease Physician
  • 1 Internal Medicine Physician
  • 2 Dentists
  • 4 Dental Hygienists
  • 2 Medical-Surgical Nurses (comfortable with
    patients of all ages, in both in-patient and
    out-patient environments)
  • 1 Environmental Engineer
  • 1 Environmental Health Officer
  • 1 Veterinarian (primarily large animal focus)

Medicare Prescription Drug, Improvement, and
Modernization Act of 2003
  • MMA 2003, Congress stipulated that Part D
    sponsors (i.e. plans) must establish an MTM
    program that is designed to optimize therapeutic
    outcomes (for targeted beneficiaries) through
    improved medication use, and to reduce the risks
    of ADE and drug interactions. MMA 2003 also said
    MTM program elements should promote these goals
  • Counsel patients for appropriate use of
    medications and risk of ADE
  • Increase adherence to prescription drug regimens
    through medication refill reminders, special
    packaging, and other means
  • Detection of ADE and pattern of drug overuse and

MMA 2003
  • If properly implemented in community pharmacy,
    the provision of MTM services will lead to
  • Improved care for patients
  • Higher patient and customer satisfaction
  • Lower overall health care expenditures
  • New profit centers in community pharmacies
  • Greater professional fulfillment for pharmacists
  • Unprecedented national recognition of
    pharmacists value

What is Medication Therapy Management?
  • MTM includes services not limited to
  • Performing patient health status assessments
  • Formulating prescription drug treatment plans
  • Managing high-cost specialty medications
  • Evaluating and monitoring patient response to
    drug therapy
  • Providing education and training
  • Coordinating MTM with other care management
  • Participating in state-permitted drug therapy

How will MTM be developed?
  • The final rule states that MTM must be
    developed in cooperation with licensed and
    practicing pharmacists and physicians.

Medication Therapy Management Components
  • Medication therapy review (MTR)
  • Monitor ongoing therapy
  • Review of all meds Rx, OTC, herbal, DS at least
  • Outcome to optimize drug therapies
  • Personal medication record
  • List of patients own meds, strength, dosing
    directions, and other info
  • RPh encourages patients to share this list with
    all of their health care providers
  • Medication Action Plan (MAP)
  • A MAP contains info to help patient improve their
    medication management
  • Intervention on medication therapy problems
    and/or referral
  • RPh intervenes to address med related problems
  • RPh refers patients to other health care
  • Documentation of services and follow-up

Applicability to USPHS Emergency Health Response
  • Standardized forms for screening
  • Standardized flyers for different types of
    services Immunization (influenza, hepatitis…),
    Diabetes, Cholesterol, Hypertension,
    Osteoporosis, Hepatitis B, Food Pyramid,
    Exercise, Heartburn, Asthma, Depression,
    Generalized Anxiety Disorder
  • Consent forms
  • Electronic prescribing and dispensing
  • PharmPAC health work group
  • Use MTM model to support USPHS pharmacy response
    to public health emergencies

Patient services pharmacists may provide
  • Disease management
  • Hypertension (26)
  • Arthritis (20)
  • Respiratory disease (19)
  • Cholesterol disorders (13)
  • Chronic Mental conditions (13)
  • Heart disease (11) Cardiac risk / CHF
  • Eye disorders (10)
  • Asthma (10) - COPD
  • Diabetes (10)
  • Oncology
  • Anticoagulant therapy
  • Womens health
  • Nephrology
  • AIDS
  • Osteoporosis
  • Pediatric services
  • Hormone replacement therapy (bioidentical
  • Depression
  • Lab Testing/Screening
  • Blood lipids
  • Bone density
  • A1C
  • Blood glucose
  • Blood pressure
  • Streptococci
  • Helicobacter pylori
  • Pulse oximetry
  • Prothrombin time test
  • Peak flow monitoring / education
  • Wellness Program
  • Diet/nutrition
  • Smoking cessation
  • Health status assessment
  • Immunizations
  • Travel health clinics
  • Emergency contraception
  • Weight loss management

Qualitys indicators for pharmacists services
  • Diabetes
  • Adherence with healthy eating and physical
  • Adherence with drug therapy (i.e. insulin, oral
    antidiabetes medications)
  • Percentage of patients with A1C lt 7
  • Percentage of patients with blood pressure of lt
    130/80 mm Hg
  • Percentage of patients who
  • Self-monitor blood glucose
  • Receive annual eye exam, lipid panel, flu shot,
    and comprehensive foot exam
  • Hypertension
  • Adherence with healthy eating and physical
  • Adherence with antihypertensive drugs
  • Percentage of patients who reach target blood
    pressure goals. For example
  • lt140/90 mmHg in those with hypertension
  • lt130/80 mmHg in those with hypertension and
    diabetes or renal disease

SG Health Priorities Healthy People 2010 Guide
to Public Health Research Needs, 2006
  • key scientific based references
  • 1) lifestyle modifications with regard to
    obesity, exercise, healthy eating and smoking.
  • http//
  • 2) reducing health disparity, specifically as it
    relates to the very young and the very old.
  • http//
  • 3) emergency preparedness and response readiness
    to chemical, biological, and other terrorist
  • http//
  • 4) reduction and prevention of medication errors
  • http//cdernet/ods/Error20Resource20Page/resourc
  • 5) misuse and abuse of drugs (Rx, OTC, herbal,
    alcohol, tobacco)
  • http//
  • http//
  • pharmacist involvement and intervention
  • 1) pharmacist role as Medication Therapy
    Management specialists, in terms of providing the
    public with important clinical drug and health
    information relating to different disease states
  • http//
  • 2) pharmacists as immunization specialists -
    being able to give vaccinations
  • 3) pharmacist's role in providing good IT
    support/communication technology to make sure
    drug and health information for patients are
    known and can be addressed during disaster
  • http//
  • 4) pharmacy response at the community and local
    level, during any emergency, including
    distribution of drugs where they are most needed,
    including the National Stockpile
  • http//
  • 5) pharmacists as pharmacogenomic specialists, in
    terms of knowledge of pharmacokinetics and
    factors affecting drug metabolism.

MTM forms, VAPSA and Hospital Practice
  • MTM forms
  • Patient OTC Medication, Usage, and Family History
  • Pharmaceutical Care Drug Assessment Diagnosis
  • Patients Question / Concern and Pharmacists
    Assessment / Response form
  • Patient Proper Medication Use form
  • Pharmacist Communication to Physician form
  • Health Clinic
  • Health passport
  • Screening
  • Diabetes
  • Cholesterol
  • Hypertension
  • Others
  • Diet and Exercise
  • Depression
  • Hospital Practice
  • Immunization form
  • http//

Other deployment forms
  • Narcotic inventory CII and CIII-V log
  • Controlled substance dispensing log
  • Immunization log
  • Pharmacists record
  • Temperature log form (Freezer/Refrigerator)
  • Prescription form
  • Important contacts

Thank you
  • PharmPAC
  • All officers who provided comments and feedbacks
  • Pharmacy Work Group members
  • RDF Pharmacy Team Leadership