Pharmacy & Therapeutics Society

In: Health

16 May 2010


The Value of Therapy: The Role of the P&T Society
Speaker: J. Lyle Bootman, PhD, President, P&T Society.

Drug-related morbidity and mortality represent a “silent disease in America.” The value of the quality of health care depends on the accessibility of medicine to patients and on the cost of medicine. The Institute of Medicine (IOM) is attempting to identify some of the reasons for the health care crisis in the U.S. and to challenge the health care community to eliminate the barriers to quality of care.

To Err Is Human: Building a Safer Health System, one of the landmark IOM reports, was released in 1999. This report articulated the economic and clinical consequences of medication errors and the misuse of medications. The report’s recommendation is to exert sufficient pressure to make errors costly to health care organizations and providers so that they will be compelled to improve safety. At the same time, there is a need to enhance their knowledge and provide the tools needed to improve safety and to break down legal and cultural barriers that impede improvements to safety. Given the current awareness about the magnitude of the problem, the IOM believes that it would be irresponsible to expect anything less than a 50% reduction in errors over five years.
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In 2001, the IOM issued another report, Crossing the Quality Chasm: A New Health System for the 21st Century. This report stressed the need to improve quality, to develop strategies for fostering greater accountability for quality, and to identify areas of research to be pursued to facilitate improved quality. The report focused on the personal health care delivery system, specifically by providing preventive, acute, chronic, and end-of-life health care.

Safety flaws are unacceptably common, but the effective remedy is not to browbeat health care workers by asking them to try harder to give safe care. Members of the health care work force are already striving to do their jobs well. In fact, the courage and commitment of doctors, nurses, and others today are the only true means of stemming the flood of errors that are latent in the health care systems. Health care is faced with safety and quality problems because it relies on outmoded systems of work.

Crossing the quality chasm involves:

  • providing services based on scientific knowledge to all who might benefit and refraining from offering services to those not likely to benefit.
  • ensuring care that is respectful of, and responsive to, patient preferences and needs and guarantees that patient values guide all clinical decisions.
  • reducing waiting times and harmful delays for those who receive and those who give care.
  • avoiding waste (of equipment, supplies, ideas, energy).
  • offering equitable care that does not vary because of patients’ sex, ethnicity, geographic location, or socioeconomic status.

Payers should examine their methods of payment to remove barriers to quality improvement. Their methods should provide incentives for adhering to best practices, improving patient outcomes, and encouraging the sharing of information. Academic medical centers should train their personnel to work more effectively and to create health care delivery organizations. These centers must also provide leadership and be prepared to make radical changes in medicine and pharmacy. canadian pharmacy support net

In 2003, Health Professions Education: A Bridge to Quality emphasized that education for health professionals was in need of a major overhaul. The problems were identified as follows:

  • their lack of education for working in teams to treat chronic disease
  • a lack of training in using and applying evidence-based data
  • an inability to address diverse populations (e.g., because of language barriers)
  • their inability to analyze primary causes of errors and problems relating to quality
  • a lack of training in the adequate use of informatics in caring for patients

Planning for the future needs to take into account the drivers of health care, namely employers, business coalitions, consumer interest groups, and patients. Areas that will need particular attention are self-management and health literacy, screenings for cancer and major depression, hypertension, immunizations, pregnancy and childbirth, tobacco dependency, obesity, pain control, stroke, asthma, diabetes, ischemic heart disease, and medication management—the key to success in all areas.

The misuse of antibiotics continues to be a problem, and more than 50% of such episodes are preventable. Programs on medication use and misuse have tremendous appeal and potential support, and leadership from the health professions is essential to rectify the problem.

The agenda of the P&T Society (PTS) for 2004-2005 should include a response to the IOM’s most recent report. Goals should be to track the IOM’s agenda, sponsor a P&T “best practices” compendium and P&T training programs, and provide guidance for medication therapy management services in response to changes resulting from the 2003 Medicare Modernization Act. The immediate goal of the PTS should be to maximize the value of drug therapy, with the ultimate aim of achieving enhanced quality of life.

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