This month my rotation is at an ambulatory care site, Mission Hospitals Medication Assistance Program (MAP). Ambulatory care is best described as a clinic that is a step between retail pharmacy (CVS, Walgreens, your local independent, etc.) and the hospital. One of the best examples is the VA system. Amb care clinics usually have doctors, pharmacists, nurses, educators, and social workers in various combinations and can either be general care or specialize in a few disease states (ie. diabetes, high blood pressure, anticoagulation) or specialize in a particular patient populations (veterans, geriatrics, low income).
MAP sees patients from three different groups: medication assistance, wellness, or Medicare Part D doughnut hole patients. Wellness patients are enrolled in an employers Wellness Program and come to meet with a pharmacist at least once every 6 months to discuss their diseases and medications and what they can do to live a healthier life. Their meetings are covered by their insurance and the goal is to prevent health problems, doctor and hospital visits, and thus spend less overall on their health care.
The Medicare Part D patients that come to the doughnut hole are actually being enrolled in a study that the pharmacy residents are doing about when patients are falling into the doughnut hole, what kind of help they need when they are there, and when they will fall into the doughnut hole next year. The doughnut hole is a coverage gap in Medicare where patients after reaching some amount of dollars spent on medications by Medicare are now responsible for paying 100% of their drug cost out of pocket. Its incredibly expensive for some folks and can mean the difference between food and medications for the month in some cases.
Doughnut hole patients and medication assistance patients are enrolled in MAP's medication assistance program if they qualify financially. For most programs that means people make less than 200% of the federal poverty level; for one person that is less that $21,660 a year and for a family of two that is less than $29,140 a year. Since these folks can't afford their medications, we apply to drug companies on their behalf to get their medications for them. There's a great website, here, to find out which meds have assistance programs. As part of the assistance program, they have to meet with a pharmacist every 1 - 6 months, depending on how well controlled their diseases are. So that's where I come in....
For the past week or so I have been sitting in with the pharmacists as they meet with patients about their diseases. I look over their charts first and ask questions about why this drug or that drug and then I tell the pharmacist what I think we should ask the patient about since the last visit. Then we meet with the patient. We talk about how they've been doing, if they're going to have enough money for the light bill or food this month, or if they have been checking their blood sugar as often as they should be, etc. If they are a new patient, then we can talk about all the community resources there are in Asheville like Ladies Night Out where they can get free mammograms and pap smears and other women's health things or the dental clinic that offers cleanings for $10 and such. After the patient leaves, the pharmacist and I chart our encounter and talk about why a particular medication or lifestyle change would be most appropriate for this patient.
So far I've done a lot of watching and a lot of learning about resources for those without health insurance. It makes me really wonder what is available in other cities. I've had to teach one patient how to use a new blood glucose (blood sugar) meter, which he thought was fantastic. Despite having diabetes for years, no one had really taught him how to use a new meter and make sure he was doing it properly. He really appreciated me talking with him which definately put my nerves at ease. This coming week I'll start taking every patient's blood pressure at our meetings and I'll give a talk to a geriatric nurse group about food and drug interactions. This Saturday I'll be at a local health fair educating people on ways to manage their high blood pressure and high cholesterol. I'm still trying to decide between this and nuclear as a career, I like them both, but I'm looking forward to getting more involved with amb care this month.
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