Health care reform and the 2012 Election

Since I am at home visiting family for the week, I took the opportunity to vote early here in my local precinct rather than mailing in my ballot as I have in previous years. With the presidential election only days away, lines at the booth were encouragingly long, even in this small rural town.

Although the US economy has largely been the centerpiece of debate between Barack Obama and Mitt Romney, health care reform is a close second, with the fate of the Affordable Care Act (ACA) hanging in the balance. As the individual largely responsible for its creation -- not to mention the namesake for "Obamacare", by which the ACA is more commonly (and often derisively) known -- Obama supports extension of the act as part of his second presidential term, while Romney has pledged to repeal it as early as his first day in office. And the fate of the ACA is only the tip of the iceberg -- the candidates also differ on their views regarding the future of Medicare and Medicaid, the roles and responsibilities of state and federal governments, preventative health, women's health, and more. As Blendon, et al write in their editorial on the role of health care reform in this election, "rarely [have] two major candidates' views about health care been so diametrically opposed" [1] -- despite the fact that much of the ACA is based on the state health care program that Romney helped create as governor of Massachusetts.

As is the case with any political issue subject to significant controversy, the conversations surrounding health care reform have largely been monopolized -- and arguably paralyzed -- by the opinions of politicians and pundits of the popular news media, leaving little opportunity for health care professionals to educate themselves on the stark differences between the candidates' platforms. Although more is at stake for health care professionals in this election than perhaps ever before, few resources are available to help compare and contrast the two candidates' views -- at least in a way that is comprehensive and non-partisan. Of note, I did find this resource developed by WebMD, which compares several of the most important issues surrounding health care reform (e.g., addressing the rising costs of care, Medicare and Medicaid, women's health, etc.) head-to-head.

My point is this: without regard to political affiliation, every individual participating in this election -- especially health care professionals -- should assume responsibility for educating themselves on the issue of health care reform, not simply based on the opinions that dominate the airwaves, but based on the details of the two platforms themselves. And even if you vehemently disagree with the views of the opposition, educating yourself on the issue only elevates the level of discussion, which -- no matter the result of the election -- is a win-win for everyone.

Note: For the purposes of this entry, information was presented in a non-partisan fashion; if you continued reading to see if I would describe my views on the issue (or endorse a particular candidate's position), I would be happy to discuss further by email. Additionally, if anyone is aware of other helpful resources, please send them my way, or leave them as comments below.

References

1. Blendon, et al. Understanding health care in the 2012 election. N Engl J Med 2012; 367:1658-1661.

Clinical pharmacy services: but what shall we call it?

The opening session of this past week's 2012 Annual Meeting of the American College of Clinical Pharmacy (ACCP) focused on advancing a comprehensive and consistent practice for clinical pharmacy, a topic that often generates significant -- if not heated -- debate among practitioners and professional organizations alike.  In her opening remarks, Dr. Linda Strand, one of four panel members selected to share their perspectives on the topic, laid out what she considers the five "rules" necessary for the success of clinical pharmacy services.

In order to be successful, these services must be:

1. Described simply, in terms of what they can do for the patient;
2. Based on standards of care so that they can be delivered consistently from one practitioner to the next, and from one patient to the next;
3. Integrated within the rest of the health care team in terms of consistent terminology, philosophy, care process, and standards of practice;
4. Able to generate measurable results that are reproducible;
5. Paid for in the same way that other patient care is reimbursed.

While the latter four rules are all concepts that the whole profession is likely to support, the first, or what shall we call it? is one that we have struggled with for decades. I couldn't help but get the sense that even the four members of the panel did not agree entirely on what we should call it.

I thought -- perhaps mistakenly -- that we had largely laid this issue to rest with the coining of the term medication therapy management, which was meant to describe clinical pharmacy services in a way that pharmacists, patients, providers, and payers could intuitively understand.  This feature gave it several advantages over pharmaceutical care, a term favored by many individuals across the profession of pharmacy, but one that never seemed to catch on outside of it.  Unfortunately, medication therapy management coincided with the development of the Medicare Part D benefit (of which it is an integral part), so it has been viewed by many as being only a component of what pharmacists can do rather than the comprehensive services described by the Core Elements document, or the consensus definition of medication therapy management, which is already supported by nine national professional pharmacy organizations (including ACCP):

A distinct service or group of services that optimizes drug therapy with the intent of improved therapeutic outcomes for individual patients.

So rather than moving us forward, I am concerned that reverting back to arguing over what we should call it will only distract us from the most important issues at-hand -- the last four of those five rules necessary for our collective success. While we still have a long way to go, the momentum generated by the medication therapy management movement arguably took us farther in a few years than previous efforts did over the course of decades, largely because it took an idea mostly relegated to members of the pharmacy profession and put it in the minds of the people responsible for consuming it, legislating it, and paying for it.

And we can't afford to go back now.

Is medication therapy management the right term? I don't know -- that is for the profession to decide. But we need to decide quickly, because the latter four of Strand's rules may slip through our fingertips while we waste time arguing over what to call it.

Just a little heart attack: supporting the Go Red for Women campaign

During her review of the initial management of acute coronary syndromes in my Advanced Cardiac Life Support (ACLS) course this afternoon, Paula Miller shared with us the video posted below, produced by the American Heart Association as part of its Go Red for Women campaign.  The goal of Go Red for Women is to raise awareness of cardiovascular disease as the number one cause of death among women -- more deaths than all types of cancer combined. As part of the campaign, women are encouraged to understand their risk of cardiovascular disease and recognize the signs and symptoms of heart attack and stroke, which often present differently in women than in men.

Although chest pain or pressure remains the most common symptom of heart attack, women are more likely to experience other symptoms, including:

• Lightheadedness
• Shoulder or jaw pain
• Nausea or vomiting
• Shortness of breath
• Breaking out in a cold sweat

The signs and symptoms of stroke are generally similar in men and women and include:

• Confusion
• Dizziness
• Loss of balance
• Changes in speech
• Numbness or tingling in the face, arms, or legs, especially on one side of the body

You can read more about the signs and symptoms of heart attack and stroke here.

Entitled "Just a Little Heart Attack", the video stars Elizabeth Banks as a multitasking mother of two who is busy juggling her career and household while virtually ignoring an ongoing heart attack -- a perfect illustration for why the Go Red for Women campaign is so important.  I found it well-done and entertaining and thought I would share: