Health Outcomes- The Role of the Patient

In a recent editorial published in the May/June edition of the Journal of the Advanced Practitioner in Oncology (JADPRO), Drs. Ramirez and Campen exposed systemic failures in detecting drug-drug interactions (DDIs) in the oncology setting. Their article was an extrapolation of a Chicago Tribune exposé that addressed the same issue albeit in the community pharmacy setting. Ramirez and Campen basing their editorial on the “Swiss cheese model” identified 4 gaps: (1) prescriber knowledge, (2) computer screening, (3) pharmacist knowledge, (4) patient education. The authors concluded that “The system is failing, and the problem only seems to be growing”.

Where do we go from here? how do we fix such a problem? in previous posts, I mentioned the shift toward a new healthcare paradigm of patient outcomes data collections. Perhaps one of the most important contributors to the gaps exposed by Ramirez and Campen is the use of multiple pharmacies as a provider of pharmaceuticals. For instance, patients may receive his chronic illness therapies from a mail order supplier, his acute medications from his local drug-store and his oncology or immunological therapy from a specialty pharmacy. Not to mention that all these medications may be prescribed by various specialists and general practitioners. In addition, the availability of apps and websites that provide cost comparison and coupons promoting patients to shop for medications from various sources compound the multi-pharmacy use problem. There is enough evidence in the literature that indicates that this issue reduces adherence to medication, and increase the risk of unchecked DDIs.

Historically, pharmacists enjoyed the highest level of trust to provide drug information to patients, improved adherence by reminding patients of due refill, promoting medication therapy management (MTM), avoid dispensing medication causing potential DDIs without discussion with prescribers.

However today, in the multi-pharmacy use model that centralized one pharmacist is removed and the patient’s safety is therefore compromised.

As we move into this new paradigm change in healthcare where costs trump all, there seem to be two options to keeping a centralized data on the patient’s medication therapy.

1) Health insurance agency (governmental or non-governmental): data is maintained and reviewed in real-time, screened for the potential drug-drug interaction, duplication of therapy, dosage appropriateness…etc (not to mention these services are currently sporadically available). In addition, there must be some routine review conducted by health insurance agency in the like of case management. However, inherent in such a model, are ethical concerns and conflicts of interests that need to be addressed. For instance, how would cost influence choice of therapy? or how would the agency use patient’s data?

2) Patient portal data gathered from various healthcare providers is stored in a secured patient portal with ease of use. The patient is then educated on its use and it is ultimately the patient that grant access to the healthcare providers. Furthermore, built-in application to enhance health literacy and engaging the patients in a meaningful way to take charge of their health. This seems to be the best model, relying on a universal electronic health record (EHR) as opposed to multiple provider-dependent variations of electronic medical record (EMR). However, this model is not without shortcomings, mainly patient literacy. Yet this can be overcome with patient education and user-friendly customization according to the patient’s health literacy level. Ultimately, the onus is therefore on the patient to take charge of his/her records and disseminate this information to his/her clinicians.

Improving patient’s health outcomes is not simply the burden of the “system” as if the “system” is some extrinsic entity. Improving patient’s health outcomes relies significantly on education the patient and improving their health literacy so that the patients take charge of their health.

The CORE Reference

 

CORE Reference
Image: amwa.org

An experienced pharmacist who holds a doctor of pharmacy from Shenandoah University, Joseph Chebli currently serves as the executive director and managing member of JC Rx Consulting in Belle Mead, New Jersey. Joseph Chebli also belongs to multiple professional organizations, including the American Medical Writers Association.

An important resource for professional medical communicators, the American Medical Writers Association provides both educational and professional reference material. One of its major professional resources is the CORE Reference.

Short for “clarity and openness in reporting–E3-based,” the CORE Reference is an open-access resource designed to help medical writers prepare clinical reports for interventional studies. It is currently available online at http://www.core-reference.org.

The American Medical Writers Association partnered with the European Medical Writers Association in an organization called the Budapest Working Group to develop the CORE Reference over a period of two years. Published in 2016, it augments previous International Conference on Harmonisation (ICH) E3 guidelines from 1995.

Quality by Design

JC Rx Consulting
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Joseph Chebli is an accomplished pharmacist who currently advises multiple independent medical education providers as the managing member and executive director of JC Rx Consulting. Over the course of his career, Joseph Chebli has developed considerable expertise in the development and support of industry Quality by Design (QbD) techniques and strategies.

Experts created pharmaceutical QbD to streamline factory operations in an industry that often lags behind others in terms of manufacturing technology and cost. This lack of manufacturing emphasis is indicative of an industry that concentrates the bulk of its finances on research and development.

A methodical system of improvement that takes a scientific approach to quality risk management, QbD begins with a set of predefined goals and stresses the importance of understanding the product and process and process control. In general terms, it strives to improve manufacturing quality and performance while enhancing the supply of safe and effective consumer drugs. Key aspects of the QbD process include reducing product rejections, streamlining regulatory procedures, and conducting more focused inspections.

The American Society of Consultant Pharmacists’ 2016 Annual Meeting

American Society of Consultant Pharmacists
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A graduate of the Shenandoah University Bernard J. Dunn School of Pharmacy, Joseph Chebli is a pharmacist who serves as VP of Clinical Operations at JC Rx Consulting. Active in his professional community, Joseph Chebli maintains membership with the American Society of Consultant Pharmacists.

Founded in 1969, the American Society of Consultant Pharmacists is the only international professional organization committed to ensuring optimal medication management and better outcomes for seniors. To improve the knowledge and skills of its members, the society hosts several events, including its annual meeting, which was held on November 4-6, 2016, at the Hilton Anatole in Dallas, Texas.

Members had the opportunity to earn continuing professional education (CPE) credits by attending a variety of educational sessions, including Natural Medicines & Dietary Supplements: Interactions and Reactions, Opioid Misuse and Addiction Treatment in Older Adults, Pharmacologic Treatment of Diabetic Peripheral Neuropathy, Psychiatric Complications of Idiopathic Parkinson’s Disease, Beyond Metformin I: Drug Selection in Older Patients with Type 2 Diabetes, and Beyond Metformin II: Newer Antidiabetic Agents in Management of Type 2 Diabetes.

The 2016 Annual Meeting closed with a session titled New Drug Update 2016, in which Daniel A. Hussar, PhD, discussed recently released medications and those that will be released shortly, with emphasis on the main features of these drugs and their use in the context of existing therapies.

ASHP Recognized by The Washington Post as a Top Workplace

American Society of Health-System Pharmacists
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Since 2014, Joseph Chebli has been serving as the director of medical and scientific services at Med Learning Group in New York City. A licensed pharmacist who received his doctor of pharmacy degree from the Bernard J. Dunn School of Pharmacy at Shenandoah University, Joseph Chebli is a member of the American Society of Health-System Pharmacists (ASHP).

For the past seven decades, the ASHP has been representing thousands of pharmacists who act as patient care providers in acute and ambulatory settings. Currently 43,000 members strong, the organization is committed to its mission of improving medication use and enhancing patient safety.

The ASHP not only strives to be excellent in its mission, the organization also works to provide a great environment for its employees. Company CEO Paul Abramowitz recently announced that the ASHP was named a top workplace by The Washington Post.

The prestigious distinction was a result of a confidential employee survey done by the newspaper in 2015. Apart from 90-percent participation by ASHP employees, which The Washington Post noted was an exceptionally high number, the survey revealed that the ASHP staff had a high level of employee satisfaction. Factors affecting employee satisfaction included participation in decision-making, respect for leadership, and meaningful teamwork.

The Importance of Medication Regimen and Administration Reviews

JC Rx Consulting
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A managing member with JC Rx Consulting, Joseph Chebli, PharmD, provides comprehensive health care consulting solutions that span the creation of continuing medical education and effective nurse training programs. Dr. Joseph Chebli also provides medication regimen reviews (MRR) as part of his clinical consultancy offerings.

Of vital importance in ensuring the proper monitoring and management of the patient’s condition, MRR starts with admission to a care facility. In continues throughout the time of hospital residency and finishes when discharge, death, or transfer occurs. Through MRR, the consultant pharmacist closely coordinates with nursing staff and doctors in ensuring the safety and efficacy of the prescribed medicine for specific conditions.

Documentation that the correct drug was administered is provided through a quality assurance review and medication administration record. The level of detail extends to checking the storage unit for proper storage of the medications and a checking expiration dates. In addition, the skills of the administering nurse is evaluated, with HIPAA-compliant findings transmitted electronically. Recommendations are provided and trend analysis that allows gaps to be identified and resolved is undertaken on a quarterly basis.

Who Are Consulting Pharmacists?

JC Rx Consulting
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A certified consultant pharmacist, Joseph Chebli serves as managing member and executive director of JC Rx Consulting, LLC, based in Belle Mead, New Jersey. In addition, Joseph Chebli is an adjunct assistant professor at Felician College in Lodi, New Jersey, where he teaches courses on the moral and spiritual dimensions of health care.

Most people deal with a pharmacist in a retail setting when they pick up their prescriptions. While this is perhaps the largest segment of professionals, there are other pharmacists who lend their expertise to patient groups and other organizations. These professionals are known as consulting pharmacists.

Often in the geriatric care setting, consulting pharmacists help senior adults make informed decisions about the medications they are using. They do this through a one-on-one relationship in which the consulting pharmacists tailor their expert advice based on the patient’s health conditions, diet, and other relevant factors.

Consulting pharmacists also provide advice to healthcare professionals who prescribe medications, as well as those who oversee the dispensing of drugs.

Felician College’s Healthcare Administration Degree

Felician College
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With degrees in pharmacy from Shenandoah University and St. John’s University as well as a master’s degree in systematic theology from the Immaculate Conception Seminary at Seton Hall University in New Jersey, consultant pharmacist Dr. Joseph Chebli is a managing member and the executive director for JC Rx Consulting in Belle Mead, New Jersey. In addition to his consulting work, Joseph Chebli, PharmD, teaches a course called The Moral and Spiritual Dimension of Health Care at Felician College in Lodi, New Jersey.

The course is a component of Felician College’s healthcare administration and nursing degree. Healthcare administrators do not generally work directly with patients but rather shape the policies and systems that affect those patients on a day-to-day basis. These are the professionals who will need to be able to make effective, ethical decisions about how healthcare systems run.

Felician College’s program in healthcare administration includes a range of courses in healthcare as well as core business courses that will provide students with the ability to think critically, communicate effectively, stay accountable to their decisions, and make those decisions as ethically as possible. The program is centered on the case study approach, which gives students a chance to look at real-world situations both in teams and on their own.

The healthcare industry is growing, especially in New Jersey, and completing a degree in healthcare administration may open up a range of possible career options, including health information technology, biotechnology, consulting, and government positions.

Medical Communication Services Spanning Continuing Education Programs

Medical Communications
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Joseph Chebli, PharmD, is the owner and managing member of JC RX Consulting in New Jersey, a firm that provides healthcare facilities with patient-centric advisory services. Also the director of Med Learning Group in New York, Dr. Joseph Chebli offers a full range of support solutions, from medication management and chart review to implementation of benchmarking and trend analysis.

JC RX Consulting also offers strategic medical communication and medical education development solutions with a scientific basis. Undertaking in-depth gap analysis, the JC RX team creates needs assessments and assists in generating continuing medical education (CME) grants that achieve positive results.

As grant givers, pharmaceutical companies seek out independent medical education programs that offer distinct disease management benefits to patients and providers. JC RX Consulting has longstanding relationships with CME providers who offer objective, unbiased educational materials that reflect the latest clinical guidelines and regulations. The firm provides education solutions geared toward entire health systems as well as to specific staff, such as physicians, nurses, and administrators.

Medical Communication Services at JC Rx Consulting

JC Rx Consulting
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Joseph Chebli is the VP of clinical operation at JC Rx Consulting. A doctor of pharmacy with more than 25 years of experience, Joseph Chebli is also a consultant director of scientific and medical services for the Med Learnign Group in New York City.

At JC Rx Consulting, Mr. Chebli and his team provide clients–healthcare industries and facilities–with a wide variety of services.

In the area of clinical pharmacy, JC Rx Consulting offers an interdisciplinary approach to patients’ care that incorporates monthly trend and quality assurance reports, as well as analyses that highlight clinical areas where improvement is required. These “gap analysis” reports study the clinicians’ practices, such as gradual dose reduction, drug-induced behavioral adverse effects, and health economic outcomes.

The consultant is available to help the client work through the generated reports and to recommend and instigate any necessary policies to ensure improvement in the future. The medical communication division is also responsible for the development of nurse training programs.

JC Rx Consulting services help clients create and maintain open lines of communication among all professionals involved in a patient’s care: the health system, nurses, doctors, and pharmacists.