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2012 CARE Awards: Honoring ‘Unsung Heroes’ in retail-based health care

BY Antoinette Alexander

As the nation works to iron out the ultimate impact of healthcare reform, thousands of nurse practitioners and physician assistants in retail health clinics across the country are already on the front lines working to improve patient lives and expand access to high-quality, affordable healthcare. To recognize the best of the best, DSN Collaborative Care/Retail Clinician magazine — in partnership with the Convenient Care Association — each year hosts the annual Clinician Awards for Retail Excellence (CARE). This year’s winners were selected from more than 60 nominees.

 

Erica Souders, Target Clinic
The patient experience that Erica Souders provides has brought patient loyalty to the Target Clinic in Warrenville, Ill., and, in fact, several patients have said they wish they could come to the clinic every day. That’s truly a positive patient visit.

Her active listening, ability to emphasize and true concern for each patient does not go unnoticed. Aside from her knowledge and impressive patient care skills, Souders is always volunteering and taking on extra tasks to improve Target Clinic and its surrounding community.  Souders has helped to develop advertising in the community, promoted use of clinics among Target employees and developed high patient return rates to drive the clinic business. She also has taken on the responsibility as the Warrenville Target store Wellness Captain. This position helps to keep all Target team members informed of monthly wellness topics and promotes engagement in one’s own health. She also mentors new graduates, training the new Target Clinic practitioners.

 

Christine Yoemans, Aurora QuickCare
When a woman came to Christine Yoemans at Aurora QuickCare in Greendale, Wis., complaining of a sore throat, Christine took no chances. It’s a good thing because it is likely that she saved her patient’s life. Concerned that the patient had a throat abscess, Yoemans insisted that she go to the emergency room. The woman had no health insurance, so after talking with her lead, Yoemans referred the patient to an ER within Aurora QuickCare’s large integrated health system. The woman took Yoemans’ advice and went to the ER, where they did a CT scan. Doctors ruled out an abscess, but they coincidentally discovered an aneurysm on the left side of her brain. She was referred to a neurosurgeon, who performed a six-hour surgery to remove the aneurysm, which was about the size of a quarter. Doctors told her that because of the size of the aneurysm, had it bled, it most likely would have been fatal.

 

Lori Phinney, MinuteClinic
Lori Phinney is clinically excellent and exceptionally caring, as demonstrated by the fact that — within a six-week window — she assessed and triaged two separate cases of emergent pulmonary embolisms, saving two young lives. As one of the patients said in a thank you letter, “Lori is awesome at what she does, the epitome of an employee and someone that CVS should be so proud of.” It was 8:30 a.m. when that patient stopped at the MinuteClinic in Medway, Mass., as he was having difficulty breathing. He had childhood asthma, and figured he would be prescribed an oral steroid to open up his lungs and would be back home shortly with his wife and two young children. Upon examination, Phinney determined that he needed to go to the hospital, and she dialed 911. The ER doctor found two clots in his left lung, and he was hospitalized for three days. “Lori’s actions are commendable!!! I am speechless, as 1-in-4 do not survive a pulmonary embolism. I have since visited Lori at the clinic to tears of joy and happiness. I am so grateful, appreciative and proud of her actions,” he wrote.

 

Renee Corradetti, Take Care Clinic
Renee Corradetti was performing a routine sport and camp physical when she saw a mass on the young patient’s neck. Concerned about the mass, Corradetti encouraged the family to immediately follow up with their physician to have the growth further examined. Taking Corradetti’s advice, the girl was taken to the doctor and diagnosed with an aggressive form of cancer. The early diagnosis allowed for rapid treatment, and she is currently finishing up successful chemo treatment.

The family wanted to thank Corradetti and surprised her at the Deptford, N.J. clinic one day with the CBS Philadelphia station news to show their appreciation for Corradetti and for retail clinics being available for patients.

 

Melissa Ann Herrington, MinuteClinic
Melissa Ann Herrington, who works at the MinuteClinic in Charlotte, N.C., has been in the same clinic for the past five years — a clear indication that she loves what she does. And while her love of what she does certainly rubs off on her patients, managers and colleagues, it was her astute clinical judgment and years of experience that earned her a CARE Award.

As the story goes, in February, a 28-year-old male patient came to MinuteClinic with complaints of nasal congestion and itchy, watery eyes over the course of about two days. He had no chronic medical conditions and said he had been taking no medications.

While many providers simply may have discounted his symptoms as an uncomplicated upper respiratory infection or seasonal allergies, something jumped out at Herrington — something in the way that he complained about feeling “hot.” Asking him for more details, Herrington learned that he was actually thirsty — all of the time — and had been urinating more frequently than usual. He had a family history of diabetes, but had never been diagnosed himself. She checked his glucose levels — it was over 500. The next stop: The ER across the street from the clinic, where he spent a week as doctors worked to get his blood sugar under control.

 

Shea Adkisson, The Little Clinic
Going above and beyond for a patient, helping the medical “homeless” navigate back to a healthcare provider and triaging those in greater need is something Shea Adkisson clearly understands and adheres to.

A prime example of her dedication is the day when a patient showed up at The Little Clinic in Hermitage, Tenn., just before closing. He was holding his stomach and appeared to be in a lot of pain. He also did not have insurance. Upon signing in, he explained that he had never felt pain like this before. He was sweating and shaking so much that he was having trouble just entering his information into the computer. Certain that it was something quite serious, Adkisson immediately sent him to the emergency room at the Summit Medical Center. He was immediately admitted and taken straight to surgery. His appendix had ruptured. It is very likely that if Adkisson had been a stickler about clinic hours or if the patient had arrived just a few minutes later and had not had the presence of mind to go to the ER himself, he would have died a few hours later.

 

Kelly Longenberger, RediClinic
In addition to a heavy clinic schedule of patients coming in for routine acute conditions, Kelly Longenberger with RediClinic in Atascocita, Texas, is helping to make a big difference in the lives of patients who are participating in RediClinic’s Weigh Forward weight-loss program. In fact, one patient describes Longenberger as something between a coach, cheerleader and a friend.  That patient was 5 ft. 3 in. tall, 230 lbs., on blood pressure medicine and diagnosed with chronic kidney disease when she met Longenberger. The patient knew she needed to make a change. Longenberger encouraged her, and all of her Weigh Forward visits were scheduled for when Longenberger was working at the clinic. After nine weeks, she had made significant progress. She decreased her blood pressure meds, her cholesterol dropped 40 points and her doctor said her kidneys were doing much better. “I owe it all to a person who went above and beyond for me. She made the difference between a life filled with doctors and medicines, and my current life that is full of energy and hope,” the patient said.

 

Susan Matschner, Target
Consumers routinely rank the community pharmacist among the most trusted professionals in the country. But Susan Matschner marks the first-ever pharmacist CARE Award winner. One occasion that stands out and demonstrates the important work pharmacists do every day in terms of patient advocacy was the time a patient complained to the pharmacist about a problem she had been having. The patient had been bouncing back and forth between two different physicians, each deferring to the other on her therapy and unable to make a decision. Susan, who is a Target pharmacist, stayed on the case for days, making countless phone calls until the matter was resolved.

“I have witnessed her sponsoring a charity event almost by herself, helping out needy families and running to the rescue of both a woman having a pulmonary embolism and a choking child,” her nomination stated. “She volunteers for all the difficult tasks without hesitation. She is a great motivator, entertainer, counselor and a role model. She truly is an amazing pharmacist and human being.”

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Collaborative Care 2012 Loretta Ford CARE Lifetime Achievement Award

BY Antoinette Alexander

Shirley Chater, Ph.D., is a visionary and courageous healthcare leader, whose nursing journey started when she was just a little girl hearing the inspirational words of her father assuring her that she could be anything she wanted to be as long as she helped people.

She began working in a doctor’s office as a teenager, and over the years, her career led her to head up one of the most complex and challenging agencies in the federal government — the U.S. Social Security Administration.

Today, she serves as chair of the National Advisory Committee for the Robert Wood Johnson Foundation Executive Nurse Fellows program, a position she has held for the past 14 years. The Executive Nurse Fellows program is an advanced leadership program for nurses in senior executive roles in health services, public health and nursing education who aspire to help lead and shape the U.S. healthcare system of the future. So Chater plays an important role in ensuring there are nursing leaders and healthcare leaders for the future.

“Dr. Shirley Chater is a caring, visionary healthcare leader, a woman who has been a true pioneer in nursing and healthcare for our country. Shirley is a leader who is not afraid of challenges and uncertainty, and continues to look for solutions and ways to ensure we have healthcare leaders prepared for the future,” said Sandy Ryan, chief nurse practitioner officer at Take Care Health Systems.

A brief review of Chater’s career, and it’s clear to see why Chater, a true visionary healthcare leader, is this year’s recipient of the Loretta Ford CARE Lifetime Achievement Award.

In addition to her role as chair of the National Advisory Committee, Chater has an expansive career in education, nursing and healthcare policy. Her ability to organize people, ideas and goals led to her appointment as the commissioner of the U.S. Social Security Administration during the Clinton administration, where she was responsible for 65,000 employees and a budget of more than $480 billion.

During her time at the U.S. Social Security Administration, she led strategy and redesign of business processes for more efficient services and, based on her changes, the agency received the highest ranking of success for customer service.

From 1986 to 1993, she was president of Texas Woman’s University, after serving as vice chancellor of Academic Affairs at University of California, San Francisco, from 1977 to 1982 and associate vice chancellor for the preceding four years.

During her time as president of Texas Woman’s University, she responded to the special needs of single mothers at Texas Woman’s University and established a program for housing, day care, counseling and academic support.

In 2000, she was honored by the American Academy of Nursing as a Living Legend. She is the recipient of 12 honorary doctoral degrees and the University of California, San Francisco Medal — the highest honor awarded by the university.

Today, Chater is an independent lecturer and consultant to colleges, universities and other organizations on management and leadership development issues. She holds the position of adjunct professor at the Institute for Health and Aging, School of Nursing, University of California, San Francisco.

“It was an honor to present Dr. Shirley Chater with the Loretta Ford CARE Lifetime Achievement Award. Like Loretta, she is a pioneer in nursing. She is known for her leadership in reshaping the Social Security Administration, but has also shown the world that it takes nursing leadership at the decision-making table to create positive change, and to persuade and motivate others to take action and achieve common goals that make a difference,” said Tine Hansen-Turton, executive director of the Convenient Care Association.

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Pharmacy techs play front-line role in campaign to boost adherence rates

BY Jim Frederick

“Drugs don’t work in patients who don’t take them.”

Sounds simple enough. But that obvious truism, voiced by former U.S. surgeon general C. Everett Koop, fails to convince tens of millions of patients that they should take their prescription medicines through the full dosage regimen. And in too many cases, patients aren’t even filling the script to begin with.

The battle to improve adherence has been joined. Chain and independent pharmacies — along with hospitals, health plans and public and private health plan payers — are engaged in a massive effort to educate patients about the critical importance of initiating and sticking with their drug therapies, and pharmacy technicians are on the front lines of
that effort.

The toll taken by medication nonadherence is well-known. The New England Health Institute estimates that approximately half of Americans take their medications incorrectly, resulting in approximately $290 billion in avoidable costs every year. More than half of all Americans “live with at least one chronic condition,” noted the National Community Pharmacists Association, but many of their prescriptions don’t even get filled. Citing one study, the National Association of Chain Drug Stores Foundation reported that “nearly 1-in-4 newly prescribed prescription medications was not collected by patients,” especially among patients with chronic diseases like hypertension and diabetes.

The result is predictable: more lapses into serious illness and more hospitalizations. More than 1-of-every-3 medication-related hospital readmissions is linked to poor adherence, according to Ateb, a pharmacy technology provider.

“You can see why medication adherence has become so prominent, when you consider the fact that pharmaceuticals are the No. 1 intervention,” said Kathleen Jaeger, SVP pharmacy care and patient advocacy for NACDS and president of the NACDS Foundation. “The vast majority of older Americans are taking five or more meds. We need to look at what we can do to keep these folks on their medicine.”

A tech’s leverage ability to influence patients directly on adherence is limited. But changes in both the pharmacy workplace and in health care are expanding techs’ direct contact with patients and pushing them into more and more duties formerly held by pharmacists — including discussing adherence with patients and, increasingly, monitoring it via dashboard technology that opens a real-time view into the patient’s record for refilled prescriptions and drug utilization.

“You have a situation where, for the first time, you have the big insurers, the plans, the employers, all focusing on medication adherence and what can be done to improve patient outcomes and move the needle in terms of care and costs,” Jaeger asserted. “Everyone is looking at adherence as an opportunity to make a difference.”

“The stars are aligning,” she added. “It’s a huge win for patients because for the first time everyone is focusing on them. And all the parties have to come together — the primary care doc, the specialists, the nurses, the pharmacists and techs — all have to work together for the first time to improve the outcome for the patient.”

Mark Conklin, director of quality innovations for the Pharmacy Quality Alliance, said technicians would be called on to play a front-line role in the effort to reach patients and improve their medication adherence rates.

“From a process standpoint, pharmacy technicians become very important in helping to target [patients] who are at risk,” Conklin said. “Patient screenings can be done by technicians, and they can alert pharmacists to those at risk for being adherent. That’s where technicians become crucial, either by supporting [adherence] or by taking on more of the dispensing process so pharmacists can be freed up for things like
adherence programs.”

“It requires a change at the pharmacy level, and that includes all staff,” said Conklin. “I see techs as being critical with this shift going on, because pharmacists are strapped for time as it is, and they’re going to need to do more. I think it’s the technician that allows this to get done at the end of the day.”

Chris DuPaul, director of strategic development for CVS Caremark, breaks the nonadherence problem into three leaky buckets where patients can drift away from prescribed drug regimens:

  • Nonfulfillment, when a patient “elects to not pick up a new prescription initiated by a prescriber;”

  • Poor compliance, when a patient takes less of his or her prescribed medication; and

  • Nonpersistence, “when a patient elects to stop taking prescription medication without consulting his/her prescriber.”

David Nau, PQA’s senior director of quality strategies, said primary medication nonadherence or prescription “abandonment,” in which patients don’t obtain their prescribed medications or a prescription is filled by a pharmacy but never claimed by the patient, can lead to “billions of dollars of waste or untapped revenue.” He cites research estimates showing that “each prescription that is returned to stock will cost the pharmacy about $10.”

Pharmacy techs should be aware of some “factors predictive of primary nonadherence,” DuPaul said. Among them, the cost factor. “Compared to preferred medications, nonformulary medications were 17% less likely to be filled and noncovered medications were 86% less likely to be filled, as those medications translated into higher out-of-pocket costs for patients,”  he noted.

Thus, it’s no surprise that “patients who live in higher-income areas [are] more likely to fill prescriptions for new medications,” DuPaul added.
Also tied to adherence rates is the type of medicines being prescribed, noted the CVS strategist. For instance, he said, “prescriptions written for infants are almost always filled, and antibiotics are filled at a rate of 90%,” while “medications for hypertension or diabetes saw primary nonadherence rates in excess of 25%.”

Another critical adherence challenge is that drug regimens can be extremely hard to follow. In a presentation to chain pharmacy leaders in August, DuPaul cited a 90-day study of adherence rates among statin users that “showed massive complexity,” both in the number of drugs required for their therapy, and in the number of times patients visited multiple pharmacies for their meds.

“The average statin user takes 11 medications … and makes five pharmacy visits” to have them filled each month, DuPaul said. And 1-in-10 of those patients, he added, “take 23 or more medications” prescribed by four or more doctors, and “make 11 or more pharmacy visits to two or more pharmacies” every 90 days.

“Simplifying therapy can improve adherence,” he asserted. “Adherence is greater when patients synchronize refills and fill all their prescriptions at a single pharmacy.”

Indeed, one of the most promising developments in driving higher adherence rates is the move by some pharmacies to give patients the option of refilling all their maintenance medications on the same day each month. The process, called medication synchronization, simplifies prescription refills for patients and makes it easier for them to adhere to their drug therapy by merging all their prescriptions to a single fill each month.

Among the drawbacks, synchronization can reduce monthly pharmacy visits, potentially impacting sales. Synchronizing refills also takes time, since pharmacists have to coordinate with prescribing physicians in order to cycle through a patient’s monthly medication schedule and sync up the refill schedule for all chronic medications. It also requires “identifying and focusing on patients that require intervention,” according to Frank Sheppard, CEO of Ateb, as well as a process for monitoring and managing changes within the patient’s monthly drug regimen.

Pharmacy techs can play a big role in that process, both by alerting patients about the program and in monitoring its progress via dashboard automation and other technology making its way into more
pharmacy workplaces.

Among the drug chains offering synchronized refills are Rite Aid, which reportedly is testing in several markets, and Minnesota-based Thrifty White. The 83-store operator has emerged as a leader in medication adherence with innovations like an electronic timer cap on prescription vials and Ready Refill, an opt-in system that manages patients’ refills automatically.

With Ready Refill, said Dave Rueter, EVP personnel for Thrifty White, “when the patient comes in to pick up the script, our technician can review it with them, and the patient can choose those meds they’d like to have in the program. Then our system manages those refills, and we go ahead and refill each one for them and have it ready and waiting for them. They won’t have to call to have it refilled. So the tech does a lot of the explanation of that program to the patient.” Medication synchronization “is really just the next step beyond Ready Refill,” Rueter told DSN Collaborative Care.

“That program is all about adherence,” he explained. “We synch those scripts up so that instead of making five trips to the pharmacy over the month, patients can come in and have them all filled on the same day. The technicians do a lot of the education about what that program is, answer questions and explain its value to patients. They’re involved firsthand in educating patients about it.”

Technicians now also staff Thrifty White’s centralized patient care and pharmacy support center. “They’re doing a lot of the synchronization there, manning the phones and talking with patients,” he said.

Since its launch early this year, synchronization is showing a “very promising” and even “dramatic” impact on patient adherence, Rueter noted.

Other pharmacies are looking at offering the option. On behalf of its independent pharmacy members, the NCPA launched Simplify My Meds, its own version of medication synchronization. NCPA calls it “a personalized coordinated refill program that facilitates improved adherence by aligning a patient’s prescriptions to be filled on the same day each month.”

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