Magazine article Drug Topics

Counseling '93: What the Pharmacist Should Know

Magazine article Drug Topics

Counseling '93: What the Pharmacist Should Know

Article excerpt

The purpose of this article is to summarize and discuss the most important aspects of the new federal legislation that mandates expanded standards of practice in patient counseling, to suggest how that new federal legislation is consistent with the trend in practice known as pharmaceutical care, and to examine its impact on community pharmacy practice.

The Omnibus Budget Reconciliation Act of 1990 (OBRA '90) expands the role of patient counseling by the pharmacist, effective Jan. 1, 1993. Some aspects of OBRA '90 relevant to our discussion include:


"The State plan shall provide for a review of drug therapy before each prescription is filled or delivered to an individual receiving benefits under this title, typically at the point-of-sale or point of distribution. The review should include screening for potential drug therapy problems due to therapeutic duplication, drug-disease contraindications, drugdrug interactions (including serious interactions with nonprescription or over-the-counter drugs), incorrect drug dosage or duration of drug treatment, drug-allergy interactions, and clinical abuse/misuse....

"As part of the State's prospective drug use review program under this subparagraph, applicable State law shall establish standards for counseling of individuals receiving benefits under this title by pharmacists which includes at least the following:

The pharmacist must offer to discuss with each individual receiving benefits under this title or caregiver of such individual (in person, whenever practicable, or through access to a telephone service which is toll-free for long-distance calls) who presents a prescription, matters which in the exercise of the pharmacist's professional judgment (consistent with State law respecting the provision of such information), the Pharmacist deems significant including the following:

(aa) The name and description of the medication.

(bb) The route, dosage form, dosage, route of administration, and duration of drug therapy.

(cc) Special directions and precautions for preparation, administration, and use by the patient.

(dd) Common severe side or adverse effects or interactions and therapeutic contraindications that may be encountered, including their avoidance, and the action required if they occur.

(ee) Techniques for self-monitoring drug therapy.

(ff) Proper storage.

(gg) Prescription refill information.

(hh) Action to be taken in the event of a missed dose.

"A reasonable effort must be made by the pharmacist to obtain, record, and maintain at least the following information regarding individuals receiving benefits under this title:

(aa) Name, address, telephone number, date of birth (or age), and gender.

(bb) Individual history where significant, including disease state or states, known allergies and drug reactions, and a comprehensive list of medications and relevant devices.

(cc) Pharmacist comments relevant to the individual's drug therapy.

"Nothing in this clause shall be construed as requiring a pharmacist to provide consultation when an individual receiving benefits under this title or caregiver of such individual refuses such consultation."


What does this all mean to the community pharmacist? The wording of OBRA is not as exact as it should be. Parts are unclear and subject to interpretation. What is clear is that the intent of the Congress is to expand pharmacy practice. It involves doing something more for patients. It is not new, but this time Congress means it. The health-care crisis in terms of escalation of costs mandates that action be taken.

What is clear is that the Congress expects the community pharmacist to play a major role in the drug use process. Pharmacists asked, "Doctor, is it OK if I counsel?" Congress has now said, "Yes, it is OK. Not only is it OK, Mr. …

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