It takes too long to get effective new treatments to patients.
OUR SOLUTION: Start incrementally and locally — then apply the best solutions broadly.
How can we keep patients from being readmitted to the hospital because of medication problems?
Not paying strict attention to your medications can have serious, even deadly, consequences. It’s estimated that one million emergency department visits and 125,000 hospital admissions are caused each year by medication issues (called adverse drug events) in outpatient settings. Marilyn Stebbins, PharmD ’88, is determined to change those statistics, beginning with patients who are transitioning from the hospital to home.
In collaboration with UCSF Medical Center and Walgreens at UCSF, Stebbins recently launched what’s known as a meds-to-beds program — a voluntary research pilot program that delivers medications to a patient’s hospital bedside as part of the discharge process, then follows up with patients about their medications, post-discharge, via an automated phone call. Any answer by the patient to the automated call triggers a personal follow-up call by a nurse, or by a pharmacist if the call involves a medication problem.
While all discharged patients receive the phone call, the meds-to-beds patients also leave the hospital with their prescribed medications in hand. The results to date? All meds-to-beds patients studied transitioned to home with their medications and were taking their medications, as prescribed, once they were home. Stebbins plans next to look at readmission rates for these patients and determine whether the program has an impact on medication-related readmissions.
Can pharmacists expand how they serve patients’ medication needs?
Since 2013, state laws have begun empowering specially trained, licensed California pharmacists to practice as legally recognized health care providers. They can now order tests to monitor the safety and effectiveness of medications, and they can prescribe hormonal contraception, nicotine replacement therapy, travel medicines, and naloxone (which can reverse the effects of an opioid overdose). A subset of pharmacists, known as advanced practice pharmacists, can now also initiate, adjust, or discontinue medication therapy for patients, joining their pharmacist peers who’ve been practicing at this level for years under special physician practice agreements in health care facilities.
Lisa Kroon, PharmD and resident alumna, was instrumental in implementing these laws, and she has now turned to researching their impact on patient care. Preliminary results of a recent study, which she led in partnership with the national Albertsons pharmacy chain, indicate that community pharmacists can serve as convenient access points for patients seeking hormonal contraception. The next step? Research to explore whether such access can help lower the incidence of unintended pregnancies. Her findings are shedding light on the impact of expanding pharmacist practice authority across the nation.
How can we make sure we have the medications patients need in our hospitals and clinics?
If you’re admitted to a hospital, the idea that the institution might run short of a medication you need — an antibiotic, a painkiller, an anesthetic — would probably not cross your mind. But since 2005, the number of drug shortages in the U.S. has quadrupled — in many cases impacting patient care, health outcomes, and costs. It’s a national issue that’s generally addressed with a short-term approach, by reacting to shortages rather than anticipating them.
As director of the Medication Outcomes Center, Rosa Rodriguez-Monguio, PhD, is leading a collaborative research agenda — involving experts in pharmacy, medicine, health economics, informatics, policy, and precision medicine — to ensure safe, cost-effective, equitable, evidence-based medication use at UCSF Health. Her current study aims to unearth the root causes and effects of drug shortages. With these findings in hand, she then plans to develop a forecasting model for anticipating and preventing potential drug shortages long before they arise, a model she hopes could ultimately be applied across all UC health care settings.
How can we protect the public against poisonings?
Poisons are everywhere, from chemicals under the kitchen sink to toxic smoke in the air. Two million children, most of them under age 6, will swallow a poison this year in the U.S.
The statewide California Poison Control System (CPCS), administered by the School of Pharmacy, keeps busy responding to calls from the public and health care providers about exposures to poisons and actual poisonings. CPCS poisoning specialists provide free, expert treatment advice and referrals 24/7, every day, at (800) 222–1222 — handling 250,000 calls each year. Fifty-one percent of these calls concern children.
CPCS Executive Director Stuart Heard, PharmD ’72, and his team are currently fielding an uptick in calls related to unintentional pediatric marijuana exposure due to legalization increasing the availability of marijuana edibles, such as cookies and candies. A recent exposure at a child’s birthday party in San Francisco brought 12 children and 9 adults to emergency departments, all with central nervous system effects and many with cardiovascular effects from inadvertently eating gummy candies laced with THC, the psychoactive ingredient in cannabis. Follow-up research by the CPCS concluded that health care providers should consider exposure to THC in children who show altered mental states and should test for it when there is probable cause.
As the CPCS continues to provide Californians with around-the-clock treatment advice in cases of exposure to poisons, the results of CPCS studies like this are also keeping health care procedures and policies in synch with emerging sources of potential poisonings.
Continue the journey to better medicines:
Contributors: Grant Burningham; Levi Gadye, PhD; Paula Joyce; and Susan Levings
