Value Added Services and Opportunities in Pharmacy Practice
Anantha Naik Nagappa and Uday Venkat Mateti
Manipal College of Pharmaceutical Sciences, Manipal University, Manipal-576104
What are Value Added Services?
Value Added Services (VAS) in healthcare has become essential due to competition and fragmented services leads to increase in cost. A VAS in healthcare is an integrated approach promising the total healthcare in a cost effective manner. The reimbursement by third party payer or out of the pocket payment is locking for cheap affordable quality VAS in healthcare.
Give examples of Value Added Services in Pharmacy Practice?
The pharmacists are responsible for all the matters related to drugs in therapy for patients. Pharmacists are supposed to voluntarily and understand the necessity of their professional knowledge practice and protect the patients being injured by the drugs. On the other hand they are supposed to take interest to check the correctness of medicines and their dosages prescribed by the doctors to dispense. They should exhibit the professional zeal to inform the mistake in the prescription directly with the prescriber without giving any clue to the patients. The doctors shall acknowledge the mistakes and correct the prescriptions.
What are integrated VAS in Community Pharmacy?
The patient who approaches the community pharmacy for filling the prescription shall also expect the pharmacist at the counter to advise him regarding any special instructions for the patients. The VAS shall include the management of prescription history, any special drug interaction of the particular patient, generic medicine price information and dosage alert along with online patient counseling. All these services by pharmacists enforce a sense of gratitude among patients and shall soon be earning the patient loyalty as customers
How VAS does helps in improving the Business of Community Pharmacy?
The customers who are satisfied with the services of the pharmacists shall spread the message and recommend other customers to fill the prescriptions. The VAS can act as trigger to develop the business
What are the special advantages for the patients by VAS?
The VAS is based on the principle of individualization of therapy. The patient centric approach takes consideration of current patient condition and makes change in the strategy of treatment. The patient is allowed to interact and give feedback on the outcome of treatment to the clinical pharmacists.
What is the role of inter-professional communication in developing VAS platforms?
The VAS platform is a dynamic integrated system which receives inputs from different stakeholders on an online basis and responds to all stakeholders informing them in the development of patient condition. Hence there is a need for developing an Information Technology based support system in which different stakeholders are able to give inputs and receive the outcomes in order to improve the value of services.
How the quality of the services can be improved by VAS?
The quality of services can be improved by timely evaluation and measurements given by patients as feedback. The quality of life studies, patient reported outcomes using validated psychometric instruments like SF-36 and EQ-5D. The VAS of a particular disease or conditions quality can be measured by disease specific instruments like KDQOL for patients with chronic kidney disease and Audit of Diabetes-Dependent Quality of Life (ADD-QoL) for diabetes patients.
How the new technology is creating Opportunities in delivering VAS?
The major constraints for delivering VAS are the patients are remotely placed, lack of adequate healthcare professionals and lack of tools for delivering the VAS at the patient's doorstep. The innovations in communication technologies are able to address the above deficiencies effectively for example Tele-medicine, mobile health and e-health. In Tele-medicine it is possible to consult an expert and get their decisions online by adopting the platform of Tele-medicine. The motivation of the patients by timely cautions and alerts can improve the patient's compliance and improve their health. The technology has significant role as a game change in health delivery systems. The VAS are playing a major role in creating an informed patient who practices appropriate health styles rather than rushing for a hospital in order to get treated for a critical condition.
How the patient counseling can be delivered as VAS?
The patient counseling is a two way communication in which the pharmacists have to make an assessment what to counsel for a patient. The customized approach for patient needs can be assessed after a dialogue in which patient express his condition and suffering. These can be the initial clues for the pharmacists to beginning with what and how to counsel. The value of counseling can be highlighted when the patient appreciate the concern and empathy of the pharmacists.
Enumerate the established VAS for patients?
The established VAS for the patients is summarized in the figure 1.
Describe the VAS in the area of oncology Pharmacy?
The patients suffering from cancer are having serve pain due to drug and diseases. The complaint of their inability to eat due to nausea and damage to oral mucosal layers. They need to have refilled from above problem and pain. The problem of nausea can be addressed by antiemetic agents and sometimes with zinger. The mucosal irritation can be minimized by use of glycerin or some other smoothening agents. The other complication involves anemia and frequent infections due to diminished immunity caused by bone marrow suppression. The calculation of dose of adjuvant medicines apart from anticancer agents offers an opportunity of VAS for pharmacist.
Describe the VAS in the area of ambulatory pharmacy care?
Ambulatory Pharmacy care (APC) can be delivered in a community or home based for the patients who are not so serious to be admitted in a hospital. The pharmacist on call visits the patients who are having a prescription. The patient may call a pharmacist for various situations and conditions for wellness advice, professional counseling and health promotion, triage and referral, and patient education and self-management.
Describe the VAS in the area of Nutrition Support Pharmacy?
It is observed that myth and miss information affects the health consumers in the matter of nutrition, life style and health for example many of the patients start using nutritional product by advertisements in mass media and newspapers. Although there is not an immediate danger in using nutritional products but however the patients get into functional foods which may carry the herbs and food grade chemicals for example the use of aspartame can act as a cumulative neurotoxic if regularly consumed for the management of obesity under the zero calorie sweeteners. It is true that aspartame gives rise to methanol which is highly neurotoxic. Hence a proper supervision of nutrition support can protect the patient.
Describe the VAS in the area of Pediatric Pharmacy?
The childrens are averse to bitter taste of drugs and refuse to comply with the treatment regimen. The taste and flavor are the important aspects of formulations where in a pharmacist can play a significant role. The children's are likely to be attracted by medicine and end-up with drug accidents. Hence it is very necessary to pack the medicines in child resistant packages for the patients who have children's in the home. Some drugs are very safe and some are very harmful for children's for example Paracetamol does not cause liver injury in usual therapeutic doses whereas Aspirin is likely cause Gray baby syndrome and should be avoided. The pharmacist should be on high alert while dispensing pediatric prescriptions.
Describe the VAS in the area of Psychiatric Pharmacy?
In the treatment of Psychiatric illness the patients are mentally deficient to take self-care. Hence need the assistance of nursing and pharmacy during illness. Depending on the condition on average the treatment ranges from one month to one year. The dispensing of Methadone in de- addiction program of Narcotic addiction. Pharmacist should be careful and alert. Any laxity while dispensing can result in lapse of duty. The pharmacist should address the need of pharmaceutical services through a designated care giver identified by the family. The caregiver of the patient should be enquired regarding patient condition.
Describe the VAS in the area of Nuclear Pharmacy?
The Nuclear Pharmacy containing radiation medication which can cause occupational hazards to pharmacists and patients if due diligence is not practiced in handling the medicines. The Nuclear medicines are usually treated in wards and there is a need for making standard handling procedures posters and exhibiting in the wards where ever possible. The Nuclear pharmacy applications are mostly in the area of cancer and thyroid conditions. There should be a systematic counseling module should be administered for all the discharged patients. There can be a helpline being established in the pharmacy to answer the patients enquiries regarding the problems raised due to treatment by nuclear medicines
Describe the VAS in the area of Critical Care Pharmacy?
The value of pharmacy practice is appreciated by fellow healthcare professionals and patients who are resources for information regarding dosage, Adverse Drug Reactions, Therapeutic Drug Monitoring, Drug-Drug Interactions, etc., in the Intensive Care Units the clinical pharmacists are indispensable team members who are easily accessible to doctors and nurses in day to day treatments of patients.
Describe the VAS in the area of customized dispensing services Pharmacy?
The available formulations may contain a fixed dose which is considered as one hat fits all. This may not be suitable for all patients all the times. Sometimes doctors may feel to reduce or increase the dose of a drug for a particular patient. At that time the doctor may demand the pharmacists to compound a special formulation in such circumstances pharmacists should be able to prepare the dosage of medication as per the prescriptions.
Describe the VAS in the area of anticoagulation services?
The dosage of Warfarin and administration of dosage should be determined by INR (International normalized ration). There is a need for the pharmacist to measure INR and report the value for the doctor to decide a part when and how much of Warfarin should be administered to patient. It has been observed several times the patient condition worsen when INR values are not referred while using the Warfarin. The low or high dose of Warfarin can be dangerous it also very important to causation patients regarding Warfarin toxicity manifesting due to consumption of NSAIDS painkillers by the patients.