Guest Columns

Consultant pharmacists can improve the health of seniors

Frank Grosso
Frank Grosso

With the growth in the senior population projected to double by 2050, pharmacists — the most accessible healthcare professionals — will become increasingly important. Experienced senior care and consultant pharmacists, who specialize in caring for the medication needs of older adults, will have more opportunities than ever before to provide care in a wide variety of settings, including the community.

What does this mean? The American Society of Consultant Pharmacists was formed 46 years ago to provide support for the emerging role of federally mandated consultant pharmacists. Initially, ASCP was an organization primarily comprising pharmacists providing both dispensing and consulting services to patients residing in nursing facilities.

As healthcare evolved, so has the role of a consultant pharmacist. Though consultant pharmacists have long been thought of as working exclusively in nursing facilities, they are in the process of redefining themselves as they begin to follow seniors through various transitions of care provided in multiple settings. At ASCP's 2015 Annual Meeting in Las Vegas, attendees reported working in a wide variety of settings: 30% provide services mainly for nursing facilities and assisted living facilities while 70% indicated they provide medication consultations and medication management services to elders in other practice settings, including the community.



Nursing Facility

17.20%

Assisted Living Facility

12.80%

Community Pharmacy

8.40%

Administrative Responsibilities

8.20%

University

6.70%

Hospitals

6.50%

Subacute Care

5.40%

Hospice

5.30%

Residential Care/Boarding Home

4.50%

Mental Health Facility

4.10%

Adult Care Center

3.50%

Hospital-Based Long-Term Care Facility

3.50%

Consulting to Noninstitutionalized Patients

3.00%

Home Care

2.40%

Correctional Facility

1.50%

Other

7.10%

Total

100%

Source: ASCP Annual Meeting, October 2015


Consultant pharmacists are in a position to leverage their long-term care experience to meet the growing demands for medication therapy management for post-acute care patients regardless of practice setting. Based on current Medicare requirements for skilled nursing facilities, consultant pharmacists annually complete an estimated 15.6 million patient-specific drug regimen reviews. They assure that their patients' medications are safe, effective, free of side effects, and clinically appropriate based on the patient diagnosis and industry standards of practices. With 46 years of hands-on drug regimen review experience, consultant pharmacists are ready and willing to help identify, prevent, and resolve the medication problems experienced by seniors, regardless of where they live. Current Medicare incentives to improve patient satisfaction, reduce cost, and improve care (the Triple Aim) have led to a decline in nursing-facility census to its lowest point in 10 years


However, the Centers for Medicare & Medicaid Services reported in July 2015 the following statistic:

  • The number of Medicare patients who receive “some” skilled nursing care annually increased by nearly 3 times from 636,000 in 1989 to 1,839,000 in 20101

What does this mean? While the census for nursing facilities is at an all-time low, patients are using skilled nursing facilities for short-term rehabilitation in even greater numbers than ever before.

These patients, 65 years of age or older who are moving through post-acute transitions of care, have multiple comorbidities and complex medication needs. Pharmacists delivering medication therapy management services to patients intersecting the various care transition points can have a positive impact on the significant number of “medication mishaps,” reduce rehospitalizations, and improve patient quality of life. By consulting with a patient prior to leaving the hospital, consultant pharmacists can dramatically reduce post-acute care adverse drug events and resultant costs. According to the Henry J. Kaiser Family Foundation, in 2014, the average cost of a one-day hospital stay was $2,212 (ranging from a low of $1,331 in Wyoming to $3,344 in Oregon).

The community wants and needs medication management services. Just ask an adult child of an elderly parent if he or she wants to have a pharmacist sort out Mom or Dad's medications. You will see the face of the son or daughter light up with relief and gratitude. To that person, when an elderly relative no longer is in a fog or blood pressure is suddenly under control after a medication adjustment, the medication management process seems magical.

Consultant pharmacists, because of their experience and lengthy education with specific focus on the effects of medications for acute and chronic conditions of the elderly, are well positioned to:

  • Observe and properly assess the health of seniors

  • Advocate healthy living practices and disease prevention for seniors

  • Recognize and understand diseases and conditions common in the senior population

  • Identify medication-related problems that can cause, aggravate, or contribute to common geriatric problems

  • Make it easier for seniors to take their medications properly by labeling, packaging, and organizing prescription drugs

  • Understand the role of the caregiver, the financial challenges that seniors can face, and the importance of choosing appropriate care

There's a tendency for physicians to prescribe and pharmacists to dispense medications for an elder. Pharmacists working collaboratively with physicians can do more to evaluate the overall picture of how medications are affecting a patient. This kind of collaboration can make a significant difference in a senior's quality of life.

Frank L. Grosso, RPh, is the CEO and executive director at the American Society of Consultant Pharmacists.

1Federal Register July 16, 2015.

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