As Baby boomers {people born between 1943 and 1960} age and exit the work force, we are seeing more of them use pharmacy facilities around the country on a regular basis. In fairness to them, the vast majority are rather healthy, and have well managed chronic medical conditions such as diabetes, hypertension, etc. when compared to the generations before them due to access to better modern healthcare system.
Occasionally these demographic might be admitted into the hospital secondary to an acute medical condition or a complication of a hitherto controlled chronic condition. When this happens, the hospital staff usually gains insight into their prior medication history by contacting their pharmacy or PCP alike when known. The requisition placed to the pharmacy is often to provide a listing of medications {complete with dosage regimen and strengths} the patient is currently taking. This initiative is laudable but may not provide a holistic view of the patient’s history, as this effort is only as successful as the patient’s memory permits, if they are alert and oriented. When patient cannot provide thus information, I believe the hospital will triage and commence treatment as per protocol based on the chief clinical complaint of the patient.
Assumptions../.
1 First, it is assumed the patient only uses one pharmacy, when in actual fact the patient could well be a splitter {A splitter is a pharmacy patron that uses multiple pharmacies for reasons ranging from price differential, specific preferred generic manufacturer, to availability of ethnic products}. As a result, the pharmacy contacted will only have a partial view of the patient’s prescription history. Some of the pharmacy facilities may have limited operating hours and may not be open at the time the information is requested, in which case, treatment will commence without this information, as opposed to the chain pharmacies that have a shared central database between locations giving full visibility.
2 The patient is always assumed to be adherent. As the information often requested is limited to what medications the patient is currently taking. This usually means the medications that were dispensed in the last 1 month +/- 15 days.
The Gap../..
The Gap develops when this patient has been stabilized by the admitting hospital and then discharged home with medications or new prescriptions with the advice to follow up with their PCP. The hospital staff often goes a step further by providing the PCP with a comprehensive list of medications the patient was discharged with alongside the usual medical records. The patient presents same to the pharmacy where the gap, and / or in some cases redundancies, are discovered. At this point the patient will need to get the go - ahead from their PCP to either continue the hospital regimen, or the prescription medications pre admission. Oftentimes when this decision is made the pharmacy is not always contacted to inactivate the discontinued medications. The pharmacy staff is now faced with the discrepancy when the patients are seeking refills on “all their medication” as they often say. The patient is now torn between two seemingly out of synch health systems.
Secondly, the gap may arise from the hospital having a closed formulary whereby a medication listed by the patient may be substituted for a formulary equivalent without the patient’s knowledge. When they get home they may end up taking both unknowingly.
The relevance of this piece is only to bubble up the issue and bring to the forefront for consideration as obviously there is a disconnect somewhere within the continuum of care for our seniors
The Current State.
Currently in situations like this, the pharmacy contacts the PCP to reconcile the medications in an attempt to ensure the there are no duplications or inappropriate therapy in light of the recent hospital admission. And sometimes, you hear, “this & that were discontinued when the patient came into the office last month”
Bridging The Gap..…



There are several recommendations that if implemented will drastically reduce this wasteful use of healthcare resources and ensure our seniors are getting the best care intended.
1) There was a proposal a while ago to host an online database such as “Google Health” in collaboration with the NCPDP, National Council for Prescription Drug Programs.This will be an online repository accessible by registered practitioners using the VPN {Virtual Private Network} technology. The online portal will be populated with relevant information gathered from the pharmacy community. This can be accessed upon arrival at the hospital in real time.
2) The State could host a similar database as described above that handles such information. A lot of States now have a similar program to monitor the use of controlled substances anyway. This could piggyback on the existing infrastructure. And in the rare case a patient is admitted in an out of state hospital, they will only have to look up one database to get this pertinent information. I believe the subscription to this service should be voluntary and local pharmacies should be encouraged to download information on a monthly basis or other time frame agreed upon within the project charter, and the information only kept for 6 month after which it ishould be purged to alleviate concerns of storage.
3) Pharmacies may be mandated to provide patients with a monthly statement itemizing all their current medications. I know this approach has its inherent flaws as the medication information may fall into the wrong hands. If handy, the emergency responder may retrieve from patient during an emergency evacuation.
4) Third party payers will have the prescription information and perhaps encouraged to share this when contacted by the hospital to notify of the hospital admission. One of the flaws here is that this option will not cater to cash paying patients
Whatever approach we decide to use to fill this gap, I believe it will go a long way in helping our senior citizens better reap the fruits of their labor and help them on their paths to leading a youthful and productive life.../.