Letters to the editor: June 18, 2007

June 18, 2007

Pharmacist takes issue with APhA recommendations on how to dispose of unwanted drugs

Evidence needed for drug disposal

In your April 16 issue, you reported on APhA recommendations against "crushing and flushing" because of possible effects on the ecosystem.

As pharmacists, we have a good understanding of the dose/response relationship, which is at the center of this discussion. We know that there are concentrations below which no effects can be measured regardless of the "toxicity" of the substance-diluted botulinum toxin (Botox) is a good example. We also know that no matter what the substance, a sufficiently high quantity can be toxic-and this includes "nontoxic" substances such as oxygen, saline, and water.

Let's not be too quick to jump on a bandwagon that may be supported by nothing more than junk science.

John G. Fisher III, Pharm.D.
Director, Alabama Poison Center
jfisher@alapoisoncenter.org

Rx for success in home telehealth

Response to my Viewpoint in Drug Topics, Dec. 10, 2006, indicates that many pharmacists are interested in home telehealth. If you make a decision that you want to be a participant in such a program, the home telehealth manufacturer will train your staff and demonstrate how easy it is to set up a system.

Most available systems are similar, as they all collect a patient's vital signs and forward them almost instantly to the physician or nurse.

The VNAs (visiting nurse associations) and HHAs (home health agencies) have found that the cost per patient when using home telehealth will save them money. Several HHA and VNA principals have told me that, via home telehealth, they have been able to show a better profit. The VNA and HHA associations can prove to be your most valuable customer when you are offering to either sell or rent them a home telehealth program. Then you can also set up a maintenance and service component. All of this is cash business!

The VNA, HHA, physician, or patient has to pay for the specific equipment (for vital signs they want to monitor). In many cases, the patient or the family caregiver will gladly underwrite the cost. Home telehealth is not expensive, and a great many patients (particularly senior citizens) have the discretionary dollars and can afford this cost. This will come about when you discuss the program with the practitioner.

Physicians (especially cardiologists and respiratory specialists) have been very involved, and they will often be your customers. A little research into your archives, mostly stored in your computer, will help you identify those patients who will benefit from using this equipment. Seek out the practitioners and nursing services that will need home telehealth, and certainly include the family caregivers. Your computer will identify the patients, their physicians, their health conditions, and often the family caregivers.

Long-term care facilities, nursing homes, and senior citizen complexes can arrange for you to set up a kiosk where their population can forward vital signs to the practitioner or other recipient. A fee is usually charged, but it is income for them (and you), and a very important service.

The pharmacy has to be in the center of activity to make it work. If you feel comfortable with this discipline and wish to learn more, please feel free to contact me at (877) 553-5127.

Sheldon Prial, B.S., R.Ph.Shelly.prial@att.net