RESUMEN
The increased use of central nervous system depressants (CNSD) and psychotropics are one of the many factors that contribute to suicidal behavior in soldiers. U.S. Army policy requires medication screening for any soldier prescribed 4 or more medications when at least 1 of the medications is a CNSD or psychotropic. Constant deployments challenged health care provider ability to comply with required screenings, and senior leaders sought proactive intervention to reduce medication risks upon return of the 101 st Airborne Division (Air Assault) from deployment in 2011. A pharmacy-led team established the Polypharmacy Clinic (PC) at Blanchfield Army Community Hospital. Of the 3,999 soldiers assigned, 540 (13.5%) met the initial screening criteria. Success of the pilot program led to the mandatory screening of all other Fort Campbell, Kentucky, brigades. During the first 12 months, 895 soldiers were seen by a clinical pharmacist, and 1,574 interventions were documented. Significant interventions included medication added (121), medication changed (258), medication stopped (164), lab monitoring recommended (172), adverse reaction mitigated (41), therapeutic duplication prevented (61), and drug-drug interaction identified (93). Additionally, 55 soldiers were recommended for temporary duty profiles based on their adverse drug effects. Ten soldiers were recommended for enhanced controlled substance monitoring. Placing soldiers on clinically appropriate medications and removing potentially harmful medications from their possession are examples of how the PC positively impacted the Commanding General's ability to deploy a fully medically ready force. Soldiers consistently remarked favorably on the thorough medication counseling provided at their PC appointments. Innovative notes within the electronic health record summarized relevant findings regarding soldiers' medications, which allowed providers to quickly pinpoint and adjust medication regimens. With each identified high-risk soldier, we decreased the potential for postdeployment medication issues. Additionally, the PC generated over $70,000 in relative value units for the hospital.
Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Hospitales Militares/organización & administración , Polifarmacia , Adulto , Femenino , Humanos , Kentucky/epidemiología , Masculino , Errores de Medicación/estadística & datos numéricos , Persona de Mediana Edad , Desarrollo de Programa , Adulto JovenRESUMEN
Prescription drug prices are frequently both politically and personally salient issues. The Department of Defense (DoD) offers a robust prescription benefit to 8.8 million beneficiaries. This benefit has evolved to meet changes in technology and patient requirements. The PharmacoEconomic Center (PEC) was established as the first pharmacy benefit manager entity in 1992, primarily in response to rapidly rising DoD pharmacy program expenditures. In its short history, the PEC has dramatically improved patient safety and decreased costs. To accelerate the efficiency and effectiveness the enterprise-wide pharmacy benefit manager has already achieved, DoD should increase the funding, staff, and authority of the PEC.