We have a regular customer, elderly, always nice, who cares for his elderly wife and seems somewhat overwhelmed most of the time. Shells out big money for a variety of prescriptions. The other day a prescription for nystatin powder was called in for his wife. We ran through the quantity that was prescribed and it was ridiculously expensive (yeah, nystatin powder -- WTF?) He shows up to get it, and we jointly decide on a lesser quantity to start with, so it's not so expensive.
I asked him how large an area he was using it on. He said he had a couple of other creams he was using for his wife's pressure sores, and he had been instructed to 'mix' the nystatin powder with those creams. He seemed a little hazy on the details, and as I say, overwhelmed. Why would someone instruct this 80-something couple to be mixing creams and powders? Do we really need to complicate their lives like that? There are other things they could use --- heck, tell me the proportions and I'll mix it for them (unfortunately not an option today, a Friday afternoon at 5pm, much to my frustration.)
I shake my head at the impracticality of prescriptions sometimes. I think part of 'treating' someone is stopping to think whether they are capable of carrying out the instructions. Everybody's got good intentions but it is wasted time and MONEY to send people out the door with instructions that are difficult for them to perform or a course of treatment that's unlikely to be completed. I admire the prescribers who think outside the box and who can come up with something simple as an alternative, even if it's not by-the-book treatment.
Speaking of practicality, I had an encounter with a bunch of prescriptions the other day for a patient who was fresh from an MTM session. Good intentions all around, but practicality --- zero. All sorts of medications were added -- vitamins, combinations, other items meant to address some perceived need.
No thought was given to how much they cost, whether they were covered, or how much more complex they made this patient's life. The meds have never been picked up. Don't get me wrong, I understand the philosophy behind Medication Therapy Management and I'm not trying to sound grumpy about it. But this is a total failure unless somebody takes into account whether it's practical. There's more to it than what looks 'good on paper. '
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6 comments:
Most, not all, doctors give the patient two to four prescriptions every visit even if they just have a cough. I have seen this at my pharmacy, too. I thought MTMs were supposed to evaluate their conditions and medications and try to decrease the complexity and confusion about their medications.
I thought MTMs were about my major drug chain finding another revenue stream while adding another thing to do to us already burdened pharmacists.
Just sayin'.
When I did MTM's in school, I did my best to find ways to get rid of medication. MTM's done with that in mind are great, now find me the time and patients that are cooperative.
We have several elderly couples in which the husband is the caretaker. For one of these couples, my favorite one, the husband has insurance coverage but his wife does not. (I don't know the circumstances). The wife has an array of very expensive meds. We gave her the standard store discount, and searched for some coupons online from the manufacturers. Even doubly-discounted, the total is around 300 bucks per month.
I felt horrible ringing this dear man up for his wife's meds, and explained how we tried to bring the costs down. He grasped my hand and gave me the most genuine thank you. I tear up every time I think about that.
Wow!!! MTM seems self-defeating in this scenario. I thought it was about effective use of medication, not adding on 'alternative' crap. This is like the old physician dispensing routine. Totally inappropriate if trying to avoid the professional impropriety of self-interest advisement.
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