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8080 North Delaware Drive Bangor, Pennsylvania
| By Charles D Hepler PhD and Richard Segal PhD. Published by CRC Press, Boca
Raton, FL, 2003. ISBN 0-8493-1576-X. Clothbound, 434 pp. (24 x 16 cm),
$149.95.
www.crcpress.com
|
Published Online, October 15, 2003. www.theannals.com, DOI 10.1345/aph.1D274
Now that the problem is out in the open, what to do? The authors suggest that cooperative efforts should be made in systematically managing outcomes. When safe and effective medications are injected into unsafe and ineffective use systems, tragedy results. During my own hospitalization experiences, I have frequently encountered drug treatment errors that were preventable, not because of a faulty system of use and delivery, but from errors due to a lack of knowledge about drug dosage forms and delivery methods. However, these authors maintain that these types of "professional errors" are rare, which seems somewhat dubious. Nonetheless, the bottom line for this book is that real improvement can come only after changes have been made in how drug therapy delivery is organized, provided, regulated, and financed. Thrown in on top of this solution is the authors' recommendation that changes must be made in individual behaviors, which means changing beliefs and values about clinical outcomes and improving decision rules. Put more simply, some needed changes in behaviors involve increasing personal convictions about the problem and its existence and improving the number of people who believe that reducing medication errors will result in a better system. The authors caution that improving or correcting isolated parts of the medications use process may not prevent drug-related morbidity or improve patient outcomes.
Chapters 1–3, as well as the Preface, lay out the problem of frequent patient injury due to preventable medication errors.1 Chapter 4 discusses the objectives and personnel involved in medication use (including pts.) and their differences in perspectives (e.g., values, beliefs, reasoning). Health-related quality of life is defined, and there is a discussion of what comprises an effective therapeutic relationship (i.e., negotiation, active cooperation). Chapter 5 examines healthcare access, cost, and quality, with the aim of providing overall improved quality medication use outcomes and lowered average total costs of care per person. This chapter also outlines the regulatory framework of new drug approvals and drug safety and efficacy in the US.
Chapter 6 introduces the notion that prescribing practices can improve patient outcomes. Of course, this comes as no surprise to most people. Performance indicators are described in Chapter 7, with the proposal that providers and payers should have to collect safety and efficacy data as their part of the medications use systems. This means that pharmaceutical care is provided to individual patients by people, processes, and procedures within a medications management system that evaluates, maintains, and improves the quality of medications use in a patient group (e.g., all pts. in a single practice office).
Simple solutions do not work and have not worked, so what will? The answer is presented in Chapter 8. As usual, effective communication at all levels, and well-placed evaluations and feedback within medications use processes by appropriate persons, including pharmacists and patients, can geometrically reduce error rates that affect a patient. Chapter 9 develops and explores a pharmaceutical care system model. Simulations using this model showed that reducing drug-related morbidity risks depends on detection and resolution of drug therapy problems, of which some are recognizable and correctable, and others are random and/or occur for unknowable reasons.
Chapter 10 explains that a consistent and predictable pharmaceutical care system for individual patients is an essential part of a medications use system. This means that supervision of drug therapy, especially by pharmacists, is necessary. This is the role most pharmacists are trained to assume; however, many are relegated to a role of mechanical medications dispenser in their careers. The reason for this is a huge problem itself (and a book is needed for this subject). However, a pharmaceutical care system cannot exist without "medications" management system, which is described in Chapter 11. Briefly, a medications management system evaluates the quality of medications use in a patient group, identifies system weaknesses or failures causing low quality in the patient group, devises improvements, implements improvements, and evaluates their effects.
Chapters 12 and 13 examine the role of managed care and its influence on the medications use process. Chapter 14 presents a market perspective (i.e., present-day market influences on pharmaceutical care and medications management systems). In the end, this chapter reveals that managed-care organizations should evaluate the quality of medication use among their members. A medications management system should be used to follow up on serious and recurring problems. Evaluations, maintenance, and improvements should be performed on the quality of medications use in a patient group (e.g., all pts. in an insurance program).
The book concludes by stating that thought leaders should push for better medications use standards to protect the public and to lower the "quality tax" on superior producers; the improvements would then force "marginal operators" to improve or leave the industry. After all, the authors state, "...a rising tide lifts all boats." Thus, an initiation of change is hardest to achieve, but, in the end, changes in the right direction are the only things that will improve the current system.
The book makes good use of the flow charts, tables, figures, summaries, examples, cross-referencing, and a glossary of terms, providing a well laid-out cure for current pharmaceutical distribution and use systems in the industrialized world that have a very poor prognosis.
References
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