Ease the Healthcare Bottleneck, Save Lives

Jun 20, 2013
Pharmacists and nurses who specialize in specific diseases work with doctors to help provide better patient care and reduce waste.
  • Diabetes

We recently highlighted the health decision bottleneck and the growing importance of clinical specialization in healthcare. Pharmacists and nurses who specialize in specific diseases can partner with physicians to provide better patient care, help fill critical gaps in care and reduce waste.

As a diabetes specialist for the last four years in the Express Scripts Diabetes Therapeutic Resource CenterSM and a Board Certified Diabetes Educator for the past year, I have had the opportunity to be part of a team of experts who collaborate with physicians to help improve patient outcomes and play a role in relieving the health decision bottleneck.

Disease-Specific Risks and Challenges

Recently, I noticed that one diabetes patient, an elderly man, was taking more than twice the recommended maximum daily dose of a common diabetes medication in the class called sulfonylureas. The patient had also recently been diagnosed with coronary artery disease (a specific type of heart disease). This medication can cause hypoglycemia – dangerously low blood sugar – among older patients. In some cases medications such as this can increase the risk of death from heart attacks by up to 30% in older patients.

The patient had been on progressively higher doses of the medication over the past six months. Controlling blood glucose levels is critical in diabetes patients to prevent disease progression and lower the risk of future complications, but the way you go about it is just as important to ensure the patient’s safety. I decided to share my concerns with the physician’s office.

Specialist Pharmacists Supporting Specialist Physicians

Through our discussions, I found that the patient was new to the physician. The doctor had tried to convince the patient to try a different medication, to no avail. I offered to help. With my focus on diabetes and specialized training, the doctor trusted my expertise.

In my conversation with the patient, I found that he was comfortable with the treatment regimen he was on and was uncertain about trying another medication. Unfortunately, he was also unaware of the risks that stem from the medication combined with his coronary artery disease. I explained the risks and suggested safer medication alternatives, and he agreed to give it a try.

Ultimately, the patient received better, safer treatment and we cut down on waste. If he had stayed on the medication he was on, at that high dosage it would have put him at a significantly higher risk of a heart attack, hospitalization or death. In addition, although it’s not intuitive, a higher dose would have provided no further reduction in blood sugar. As a specialist diabetes pharmacist, I see and fix bad decisions like this all the time.

Two weeks later, I received a call back from the physician’s office, seeking input on blood glucose testing meters, supplies and their coverage for the same patient. I was, of course, happy to help.

The Value of Specialization Across All Healthcare Professionals

To me, this single story is indicative of so much of what we all do every day at Express Scripts. By taking our specialized knowledge, consulting with patients and physicians, and focusing on doing what’s best to make the use of prescription drugs safer and more affordable, we make a big difference.

Our healthcare system can be much more successful when those involved in patient care have specialized training and can work together as a team.

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