Patients with complicated illness – those with severe or multiple chronic conditions and taking multiple medications or complicated regimens – are often the patients least engaged in managing their health. This puts them at greater risk for gaps in care, including omissions of essential therapies and medication nonadherence, which could land them in the hospital. For those also challenged with a physical limitation or language barrier, making the best possible health choices can be even more difficult.
Where Others Fall Short
Disease management and case management programs are expensive and don’t offer the medication expertise that patients with complicated illness need to understand and optimize their medications. Retail pharmacies are challenged to provide the expertise and time needed to counsel these patients, leaving them without the personalized, one-on-one pharmacy support they truly need to make the best possible healthcare decisions and improve their quality of life.
For health plans with patients who have complicated illnesses, Express Scripts Personal Medication Coach offers proactive, one-on-one counseling by pharmacists who can provide support and education for patients who need to optimize their medications, reduce gaps in care and, ultimately, improve their quality of life. Often, these consultations identify critical gaps in care leading to a healthier outcome.
Patient identification flow
Identifying Critical Gaps in Care
Recently, one of our Personal Medication Coach pharmacists talked to an elderly, Spanish-speaking woman with asthma and heart disease. The pharmacist quickly identified that the she had limited mobility and recently lost access to her home health aide. As a result, she was unable to get to the pharmacy to refill her asthma and blood pressure medications. Nonadherence to these medications put her at high risk for worsening health.
During the conversation, the pharmacist identified another, more critical concern – a potential misdiagnosis. The patient spoke limited English and said she was unable to clearly explain to her doctor that her symptoms of fatigue and breathlessness happened primarily at night. Based upon the patient’s symptoms, the pharmacist realized that the patient was exhibiting signs of heart failure, not asthma, which if left untreated, could result in hospitalization and worse – death.
Because he provided the consultation in Spanish, the patient was able to explain her needs and symptoms in detail. The pharmacist arranged for her medication to be delivered to her from the retail pharmacy, along with a free blood pressure cuff. He also followed up with her doctor to explain her nightly symptoms and suggested a follow-up visit and a possible change in medication therapy.
The Personal Medication Coach Difference
Cases like this are what differentiates Personal Medication Coach. It was designed and is delivered by pharmacists who specialize in medication therapy management for complex patients. Personal Medication Coach identifies opportunities to help these patients drive the best possible health decisions and outcomes through a multifaceted approach to care that includes:
Personal medication assessments
- Individual prescription reviews
- One-on-one consultations
- Bilingual services
- Provider care coordination
Empowering Best Health Choices
Personal Medication Coach pharmacists empower patients to make the best possible health choices by getting them to take an active role in managing their medications and their health. They also collaborate with prescribers to discuss potential areas of concern and opportunities to optimize therapy. Using a combination of specialized counseling, evidence-based treatment guidelines, and tools to help patients to take charge of their own health decisions, Personal Medication Coach ensures healthier outcomes for those with complex, chronic conditions, while reducing waste for plan sponsors.
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