T2 - Final Objectives Flashcards
1
Q
What is OBRA 90?
A
- Enacted by the federal govt to improve understanding of medications by Medicaid beneficiaries
- Allows states to create drug utilization review (DUR) to manage purchasing and formulary decisions for state programs
2
Q
What responsibilities were placed on the pharmacist after OBRA 90?
A
- Perform prospective DUR
- Provide patient counseling
- Maintain proper patient records
3
Q
What are the components of OBRA?
A
- Prospective DUR
- Patient counseling
- Maintaining records
4
Q
What is prospective DUR?
A
Is the prescription necessary and appropriate
5
Q
What is the importance of patient counseling?
A
Making sure a patient is administering the drug correctly or having any side effects
6
Q
Why is it important to maintain records?
A
Records but remain accurate and up-to-date
7
Q
What are the factors of OBRA counseling?
A
- Patient counseling should be in person
- No cost to patient
- Written information may supplement patient counseling, but cannot substitute
8
Q
What are the tips for patient counseling?
A
- Collect and update complete medical history
- Perform DUR
- warnunacceptable, recognized, and medically significant risk of serious harm or death to the patient
- Think patient first
- Take the time to councel
9
Q
What are the patient counseling process steps?
A
- Prepare
- Assess
- Counsel
- Document
10
Q
What is prepare in patient counseling?
A
- Prescription
- Patient profile
- Personal knowledge
- Prepare mentally
11
Q
What do we asses for patient counseling?
A
- Physical, sensory, cognitive impairments
- Ability and willingness to use medication
- Knowledge about his/her health problems
- Disease and medication management
- Cultural barriers
- Literacy issues
- Emotional or functional barriers
- Non-verbal ques
12
Q
How do we counsel a patient?
A
- open-ended questions
- Probing
- Reflective listening
- Summarization
- Empathy
13
Q
What do we document during a counseling session?
A
- all documentarian that should be safeguarded to respect patient confidentiality
14
Q
What should a pharmacist record in a counseling session?
A
- Offers to counsel and if accepted and provided or refused
- Counseling points provided
- Perceived level of patient understanding
15
Q
What are questions of Indian health counseling?
A
- What did your provider tell you the medication is for?
- How did your provider tell you to use the medication?
- What did your provider tell you to expect?
16
Q
What are we assessing when we ask “What did your provider tell you the medication is for?”
A
- Disease state knowledge
- Openness about disease state
17
Q
What are we assessing when we ask “How did your provider tell you to use the medication?”
A
- Knowledge of directions/administration
- Morning or evening doses
- Importance of compliance
18
Q
What are we assessing when we ask “What did your provider tell you to expect?”
A
- Medication onset
- Duration of therapy
- Common sider effects and how to manage
19
Q
What is HIPAA?
A
Enhance data exchange: more effective and efficient for administrative & financial transactions
Improve healthcare information security and privacy
Gave patients rights to access their information, the right to seek details of the disclosure of information, and the right to view the pharmacy’s policies and procedures regarding confidential information.
20
Q
What are the 3 major parts of HIPAA?
A
- Transactions: standard on what data to submit
- Security: allow practitioners access to internal and external info
- Privacy: protect patient’s health info
21
Q
What is transactions?
A
electronic information exchange for financial or administrative healthcare activities
22
Q
What is the purpose for transaction?
A
- Increase efficiency
- Improve info quality and accuracy
- Reduce costs
23
Q
What is the security rule of HIPAA?
A
- Established national standards to protect personal health information
- Requires safeguards to ensure confidentiality, integrity, and security of electronic PHI
- Requires identification and protection against security or integrity threats
- Requires compliance of workforce
24
Q
What are the privacy rules for HIPAA?
A
- National standards to protect medical records and other PHI
- Sets limits on use and disclosure of information without patient authorization
- Gives patients the right to access their health records
- No restrictions on disclosure of de-identified health information
25
What are the basic principles of HIPAA?
1. Health info belongs to patient
2. Patients should be informed about all the uses and disclosures of their health info
26
What is a CV?
Curriculum vitae
Written record of your professional experiences, academic training, service experience, research experience, teaching experience, awards, and notable accomplishments
27
What is the purpose for a CV?
highlight reel” for all of your accomplishments with the pharmacy profession and other relevant healthcare-related areas
28
What is a letter of intent?
1. Describes your specific areas of interest to a specific employer, residency program, or fellowship program
2. Opportunity to demonstrate your passion for the pharmacy profession
29
What is the purpose of interviewing?
1. To get to know candidates on a more personal level
2. Assess how they will fit into the program
3. Assess how they will get along with the current staff
4. Determine how to rank each candidate amongst all applicants
30
How should we budget for interviews?
1. Business cards and cv
2. ASHP mid-year clinical meeting
3. Registration fees
4. Residency interviews
5. Business attire
6. Thank you and postage
31
What are the general tips on professional attire for interviewing?
1. Avoid strong colognes or perfumes.
2. Remove any facial and oral cavity piercings.
3. Wear well-fitting, appropriate attire. (i.e., business suits)
4. Avoid clashing colors in your attire.
5. Wear appropriate shoes.
32
How can we be prepared of interviews?
1. Research the potential employer or residency/fellowship programs.
2. Think about potential interview questions.
3. Reflect on your answers prior to the interview.
4. Practice your communication skills.
33
What is professionalism?
Set of attitudes and behaviors believed to be appropriate to a particular occupation
34
Why is professionalism important?
1. You
2. Profession of pharmacy
3. Members of the health care team
4. Patient
5. Society
35
What are the different professional dress events?
1. Formal (white, black, black tie optional)
2. Semi-formal
3. Business formal
4. Business casual
36
How should we make introductions?
1. Host should make the introductions
2. Lower ranking person is introduced to the higher ranking person
3. Take the initiative to introduce yourself
37
How do we make an introduction?
State the name of the person being introduced to (‘higher-ranking’ person).
Say “I would like to introduce” or “this is,” etc.
State the name of the person being introduced (‘lower-ranking’ person).
Offer some information to assist with starting the conversation
38
What are forms of address for men?
Mr
39
What are forms of address for women?
1. Ms (default)
2. Mrs
3. Miss
40
What are the parts of an email?
1. Salutation
2. Honorific
3. Professor's last name
4. Nicety
5. Reminder of your connection
6. Reason for your email
7. Show that you have tried to resolve the issue before you ask
8. Polite clear restatement of what you want the professor to do
9. Sign off
10. Signature
11. Follow up
41
What are the parts of a thank you note?
1. Date
2, Greeting
3. Opening
4. Body
5. Closing
6. Signature
42
What is compliance?
1. Original term
2. Considered to be politically incorrect by some because it implies following the provider’s orders
43
What is persistence?
Amount and frequency of medication refills
Only an estimate due to stockpiling
44
What is adherence?
Current popular term in US
More politically correct than compliance
45
What is concordance?
patient’s partnership with their provider
46
What are the types of non adherence?
1. Intentional
2. Unintentional
47
What is intentional nonadherence?
1. Resistance
2. Does not meet reasons patients take medication
3. Cost
4. Adverse effects
48
What is unintentional nonadherence?
1. Lack of routine
2. Cofusion
3. Trouble with device
4. Lack of understanding of necessity
49
What is the reality of For chronic disease therapy, an 80% adherence rate has been hailed as the amount needed to get benefit?
There has been no evidence to definitively support an 80% adherence rate for benefit.
The original VA study that initially demonstrated efficacy of antihypertensive therapy did not measure adherence and still showed considerable benefit.
50
What is the reality of Providers “manage” a patient’s chronic disease?
The only time a healthcare provider manages a chronic disease is the 15-30 minutes during periodic follow-up visits.
The remainder of the time the patient manages their chronic disease.
51
What is the reality of Providers believe that they can motivate patients to adhere with their therapeutic regimen?
Behavioral sciences have shown that all motivation is self-motivation.
52
What is the reality of providers clearly explain the risk of suboptimal adherence, patients will automatically be motivated to take their medication as prescribed?
A threatening, chastising approach has limited utility and may lead to results that are opposite of what they are trying to accomplish.
53
What is the reality of Elderly patients have lower medication adherence rates than younger populations?
the elderly generally take more medications and have more barriers to adherence, their actual adherence rates are better than younger populations.
54
What is the reality of Educating the patient should be enough to ensure optimal adherence?
Studies repeatedly show that traditional educational programs have little/no effect on medication adherence in asymptomatic chronic diseases.
55
What are the requirements for medication adherence?
1. Sufficient understanding of the disease and medications
2. Motivation to take the medications
3. Implementation of necessary behavior changes
56
How do we measure mediation adherence?
1. Subjective measure
2. Objective measures
57
What is subjective measure?
1. Patient interviews (open ended or probing questions)
58
What is objective measures?
1. Refill records (eyeball method and medication possession ratio)
2. Pill counts
3. Control of the chronic disease
4. Serum medication levels
59
What are the limitation of subjective measures?
1. Lack of accuracy with patient interviews (Forgetfulness)
2. Poor provider-patient rapport and communication (Embarrassment)
3. Telling the provider what they want to hear (Desire to avoid punishment)
60
What are the limitation of objective measures?
1. Time consuming and impractical
2. Limited access to refill records
3. Filling at multiple pharmacies
4. Variations in drug levels
5. Masking nonadherence
61
What is the best method of measuring adherence?
Set the stage and use patient interview, plus one or more objective measures of adherence
62
What are the levels of literacy?
Below basic, basic, intermediate, proficient
63
What is health literacy?
The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.”
64
What is the impact of limited health literacy?
1. Decreased knowledge of understanding
2. Decreased ability for med management
3. Uncertain effect on med adherence
4. Worse health outcomes
5. Increased healthcare costs
65
What is the relevance to pharmacy with health literacy?
Patient information leaflets
Medication labels
Patient counseling
Medication names
66
What are the groups at risk for limited health literacy?
1. Age 65 or older
2. Minorities
3. Spoke another language prior to formal education
4. Have less than a high school diploma
5. Live at or below the poverty line
6. Rate their overall health as poor
7. Have Medicaid, Medicare, or no insurance
8. Have limited English proficiency
67
What are informal assessments for health literacy?
Look for common signs
Conduct a medication review (Refill history, Medication list, Memorized instructions)
68
What are formal assessments for health literacy?
1. REALM-SF
2. S-TOFHLA
3. NVS
4. Chew Questionaire
69
What are examples of preforming informal health literacy assessments?
1. Hand written material upside down
2. Hand material and watch how they look at it
3. Do they make excuses?
70
Signs of limited health literacy?
1. Reads slowly
2. Has difficulty telling a coherent story
3. Fills out forms incorrectly or incompletely
4. Has difficulty following instructions
5. Does not ask questions for clarification
6. Fails to show up for appointments
7. Unable to verbalize a list of medications
8.Reads slowly
9. Has difficulty telling a coherent story
10.Fills out forms incorrectly or incompletely
11. Has difficulty following instructions
12. Does not ask questions for clarification
13. Fails to show up for appointments
14. Unable to verbalize a list of medications
15. Uses excuses
71
What is REALM-SF?
Word recognition test
Full form asks patients to read aloud 66 medical words
Short form asks for 7 medical words
Does not test comprehension
Only available in English
Time needed: 2-3 minutes
72
What is S-TOFHLA?
Available in English and Spanish
Often used in research
4 numeracy items and 2 prose passages about medical issues
Time needed: 7 minutes
73
What is NVS?
Available in English and Spanish
Patients given nutrition label and asked 6 questions about the label
Time needed: 3 minutes
74
What are questions associated with Chew Questionaire?
1. How often do you have someone help you read hospital materials?
2. how confident are you filling out hospital forms by yourself?
3. How often do you have problems learning about your medical conditions because of difficulty understanding written information?
75
What are answers that suggest low health literacy?
1. Somewhat
2. A little bit
3. Not at all
76
What are the techniques for clear health communication?
1.Slow down – take time to counsel
2. Create a relaxed, non-threatening environment
3. Use plain language
Show/demonstrate medications
4. Focus on 1-3 key points and repeat them frequently
5. Use the teach-back method
6. Encourage questions
7. Provide patient-friendly material
8. Use pictures or illustrated medication schedules
9.Review complete regimen and consolidate into daily schedule
