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Pharmacists Raise Concerns for Patient Access to Generic Drugs

Posted on Mon, Apr 13, 2015
Pharmacists Raise Concerns for Patient Access to Generic Drugs

Survey shows it takes one month or longer for PBMs to fix maximum allowed costs underpayments

THURSDAY, April 9, 2015 (HealthDay News) -- Nearly all pharmacists have experienced upswings in the acquisition costs of generic drugs, with price spikes reported to be worse since 2013, according to a report published by the National Community Pharmacists Association (NCPA).

In a survey of 700 community pharmacists, almost all pharmacists reported experiencing a large upswing in the acquisition cost of a generic drug over the past six months. Most pharmacists (93.4 percent) reported that the situation had gotten worse since 2013.

Most pharmacists report that it takes third-party payers one month or more to update pharmacy reimbursement rates accordingly (one to two months, 24.7 percent; three months or more, 62.3 percent). Most (92.8 percent) pharmacists report that the situation has gotten worse with respect to absorbing financial losses on these prescriptions. The typical response on appeal to pharmacy benefit management is rejection of appeal (56.9 percent), with no response in 25.9 percent of cases.

"This survey finds that this problem has only grown more severe over the past two years and requires urgent attention from federal and state policymakers," B. Douglas Hoey, R.Ph., M.B.A., chief executive officer of the NCPA, said in a statement. "Some patients are already skipping medication due to higher prices and copays or are forced into the Medicare coverage gap or 'donut hole' sooner."

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Veterans Listing Non-Nuclear Family Member As Next of Kin

Posted on Sat, Apr 11, 2015
 Veterans Listing Non-Nuclear Family Member As Next of Kin

Overall, 7 percent of veterans in Connecticut have people listed who are not nuclear family members

TUESDAY, April 7, 2015 (HealthDay News) -- A considerable number of veterans list an individual as next of kin who is not a nuclear family member, according to a research letter published in the April 7 issue of the Journal of the American Medical Association.

Andrew B. Cohen, M.D., D.Phil., from the Yale University School of Medicine in New Haven, Conn., and colleagues asked patients receiving care at Veterans Health Administration facilities about their next of kin. Next-of-kin relationships were reviewed for 109,803 veterans who received care from 2003 to 2013.

The researchers found that for 92.9 percent of patients the next of kin was a nuclear family member. For 7.1 percent of patients, the next of kin listed was a person outside the patient's nuclear family; 2.9 percent of patients listed a more distant relative and 4.2 percent listed an individual who was not a blood or legal relative. This was most frequently a friend or intimate relationship outside marriage. For less than 1 percent of patients, the relationship involved another social tie, including landlady, priest, roommate, or sponsor.

"A substantial number of veterans in our sample had a next-of-kin relationship outside the nuclear family," the authors write. "If this finding is confirmed in other populations, states should consider adopting uniform default consent statutes, and these statutes should be broad and inclusive to reflect the evolving social ties in the United States."

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Patients May Be Modifying Meds Due to Trouble Swallowing

Posted on Mon, Apr 06, 2015
Patients May Be Modifying Meds Due to Trouble Swallowing

Some consumers do not consult health professionals if they experience problems, before modifying meds

THURSDAY, April 2, 2015 (HealthDay News) -- Some patients experience difficulties swallowing and modify medication dosage forms, without necessarily consulting health professionals, according to research published in the March issue of the Journal of Pharmacy Practice and Research.

Esther T.L. Lau, Ph.D., from the Queensland University of Technology in Brisbane, Australia, and colleagues estimated the prevalence of swallowing difficulties and medication dosage form modification among community pharmacy consumers. Three hundred sixty-nine consumers were recruited from five community pharmacies and invited to participate in a structured interview.

The researchers found that 16.5 percent of participants reported experiencing difficulties in swallowing, and 10.6 percent reported modifying medication dosage forms. About half of those surveyed (44.2 percent) thought there would be no issues with medication dosage form modification. Regardless of their thoughts about issues associated with these practices, some consumers reported that they would not seek advice from health professionals on experiencing swallowing problems and/or before modifying their medication dosage forms.

"Some consumers appeared to be accustomed to modifying medication dosage forms, even when there was no apparent or obvious need. People were also reluctant to seek advice from health professionals regarding swallowing difficulties, or modifying medication dosage forms," the authors write. "Health professionals must be assertive in educating consumers about swallowing problems, and medication dosage form modification."

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Smell Test Helps Identify Brain Injury in Soldiers

Posted on Thu, Apr 02, 2015
Smell Test Helps Identify Brain Injury in Soldiers

Findings suggest new avenue for identifying hidden injuries

TUESDAY, March 31, 2015 (HealthDay News) -- Testing soldiers' sense of smell can help diagnose those with traumatic brain injury, according to new research published online March 18 inNeurology.

"Although it may seem far-fetched that the sense of smell can be used to identify a concealed brain injury, olfactory impairment was commonly used by neurosurgeons in attempts to localize certain brain tumors prior to the use of advanced neuroimaging in the 1980s," study leader Michael Xydakis, M.D., of the Uniformed Services University of the Health Sciences in Bethesda, Md., said in a university news release.

The study included 231 members of the U.S. military with combat injuries who were patients at the Walter Reed National Military Medical Center. They were evaluated for traumatic brain injury and had their sense of smell tested. All of those with irregular results on the smell test had abnormalities on brain scans. The brain interprets smells by linking them to past memories. This process doesn't work properly if a person is experiencing memory problems, the researchers explained.

"Getting a computed tomography scan in a combat zone is often the equivalent distance of placing a soldier on a helicopter in Washington, D.C., and sending them to Boston. It requires a significant investment in personnel and aviation resources; not to mention flying troops over hostile terrain," Xydakis said in the news release. "Using abnormalities with the sensory systems has opened up an entirely new avenue of investigation for diagnosing brain injuries."

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Documentation Tip of the Week: Present on Admission (POA)

Posted on Wed, Apr 01, 2015
Documentation Tip of the Week: Present on Admission (POA)

Good documentation is important for new physicians as well as veteran caregivers. While documenting can seem like a very straightforward skill, there are often “best practices” that can be utilized. As a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, FL I write a “weekly documentation tip” email to help physicians improve their clinical documentation. I also share these documentation strategies with the residents I teach.

A diagnosis cannot be the main reason for admission, the Principal Diagnosis, unless it is present on admission. Please document if there is a “Possible” diagnosis (eg possible sepsis) at the time of admission.

Did You Know? Hospital Acquired Conditions (HACs) – Hospitals are not paid additional monies for certain medical conditions that occurred during the hospitalization. Please document these conditions in the H&P so there is clear documentation that the condition was PRESENT ON ADMISSION

Examples of HACs:

  • Cath associated UTI
  • Manifestation of poor glycemic control eg DKA
  • Vascular cath infection
  • Ttrauma
  • Blood Incompatibility
  • Foreign object retained after surgery
  • Stage 3/4 pressure ulcer
  • DVT & PE after ortho procedure
  • Fractures


ABOUT THE AUTHOR


Dr. Timothy Brundage is a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, FL. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his M.D. at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips, or ask him about specific documentation issues, by emailing him at DrBrundage@gmail.com.

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