NCPIE Spurs Medication Communications: An Interview
NCPIE Spurs Medication Communications: An Interview
The National Council on Patient Information and Education (NCPIE), organized in 1982, is a multidisciplinary nonprofit coalition of member organizations committed to improving communication of information on the appropriate use of medications to consumers and healthcare professionals. NCPIE member organizations represent the healthcare professions, consumers and patient groups, managed care service providers, voluntary health agencies, and the pharmaceutical industry. The US Food and Drug Administration (FDA) and the US Pharmacopeia are founding NCPIE members with nonvoting, liaison status on NCPIE's board of directors.
Ray Bullman has served as Executive Vice President of NCPIE since January 1995. Mr. Bullman joined the staff of NCPIE in 1985, assuming staff leadership in 1995. Under his guidance, in 1995, NCPIE produced 2 authoritative resources on prescription medication adherence: Prescription Medicine Adherence: A Review of the Baseline of Knowledge and Topical Bibliography on Prescription Medicine Adherence. The Council also developed a series of provider- and setting-specific Recommendations for Action to Advance Prescription Medicine Adherence. In 1996, the Council collaborated with the American Medical Association (AMA) on development of AMA's Guidelines for Physicians for Counseling Patients About Prescription Medications in the Ambulatory Setting. In 2000, Mr. Bullman, representing NCPIE, collaborated with the FDA's Center for Drug Evaluation and Research on the organization and implementation of the Cyber-Smart Safety Coalition. Mr. Bullman also coordinated the development of NCPIE's "Talk About Prescriptions" Month (annually in October), and managed the annual national awareness campaign from 1986 to 1995.
Prior to joining NCPIE, Mr. Bullman served from 1979 to 1984 as Community Program Development Specialist with the National High Blood Pressure Education Program, under a contract to Kappa Systems, Inc, from the Heart, Lung, and Blood Institute of the National Institutes of Health. He also served, from 1972 to 1978, as Administrator for the Rockville Community Clinic in Rockville, Maryland.
Mr. Bullman received a bachelor's degree from the University of Maryland in College Park, and a Masters in Association Management (MAM) from George Washington University in Washington, DC.
Bernstein: How well is the pharmacy profession represented among the NCPIE membership?
Bullman: Pharmacists and the pharmacy profession are well represented in NCPIE. Currently serving on NCPIE's board are representatives from the American Pharmaceutical Association, American Society of Health-System Pharmacists, National Association of Chain Drug Stores, and the National Community Pharmacists Association. Our general membership includes the Academy of Managed Care Pharmacy, American Association of Colleges of Pharmacy (plus 25 schools/colleges of pharmacy), the National Association of Boards of Pharmacy, and the American Society of Consultant Pharmacists.
Bernstein: How does a multidisciplinary coalition like NCPIE relate to pharmacy practice?
Bullman: Since our beginning, and because the pharmacy profession is so involved in NCPIE, our messages and materials are a win-win for pharmacists. They encourage consumers to speak with pharmacists and support the pharmacists' role as the medication expert. For example, NCPIE always encourages consumers to "talk with your pharmacist," and to "ask your pharmacist" about side effects, precautions, and instructions for use whenever a new medication is prescribed or recommended as part of the treatment regimen.
Additionally, NCPIE conducts public affairs campaigns related to improving appropriate medication use that have key messages for pharmacists and consumers. Individual pharmacists and their corporate or institutional employers can adapt these messages and offer customized (with their logo) resources to patients. All of NCPIE's messages are designed for year-round use, to promote and enhance pharmacist-patient dialogue. Also, pharmacists who are involved in the NCPIE coalition have unique opportunities to network with key consumer and patient groups, to exchange information about "tried and true" and emerging medication education strategies, and to learn about cutting-edge medication information research. Individual pharmacists are eligible for the Paul Rogers/NCPIE Medication Communicator Award.
Bernstein: What actions/activities can NCPIE recommend for pharmacists to promote a more informed patient?
Bullman: Pharmacists are doing a good job under a great deal of pressure and scrutiny. There's tremendous focus now on medication safety and reduction of medication-related errors. This puts the spotlight on the pharmacy profession and individual pharmacists more than ever before. NCPIE encourages pharmacists and prescribers to routinely counsel patients about instructions for use, precautions, recognition/management of side effects, and avoidance of drug-drug and drug-food interactions. Equally important is the provision of useful, easy-to-read, written information about the medication for use at home by patients and their family or caregivers. NCPIE would also recommend that pharmacists continue to provide outreach in their local community by speaking with community groups about appropriate medication use. "Talk About Prescriptions" Month, which NCPIE sponsors annually in October, and National Pharmacy Week, also in October, are great times for this valuable public service outreach.
Bernstein: What is unique about NCPIE that continues to attract participation in and support by national and state pharmacy organizations for nearly 20 years?
Bullman: As organized pharmacy's focus has shifted toward pharmaceutical care and as the mission of many pharmacist organizations has become even more patient-focused, the parallel to NCPIE's mission is readily apparent. For nearly 20 years, NCPIE's mission has been to stimulate consumer-healthcare professional communication about medications. Consider how complementary this is to the mission of national and state pharmacy organizations and the practicing pharmacist. With the recent focus on reducing medication-related errors and improving patient safety, the leadership of NCPIE and its long-standing, coalition-based messages become all the more timely.
Bernstein: Explain how NCPIE views collaboration. What impact can collaboration by pharmacy organizations, consumer and patient groups, the pharmaceutical industry, and other stakeholders have on reduction of medication errors and patient safety?
Bullman: NCPIE often refers to the "medicine education team." This team includes healthcare professional(s) and the patient and his/her caregiver. Decisions about treatment, whether or not they involve pharmaceuticals, should be arrived at in consultation with the patient and his/her caregiver. This helps create "buy-in" right from the start; which, in turn, can promote improved medication adherence while fostering better 2-way communication as the treatment plan progresses. In addition, such communication is key at every point along the medication-use continuum to reduce medication errors.
Starting at the point of prescribing and continuing when the patient fills the prescription at the pharmacy and uses the medication at home, school, or work, the patient must feel like he/she plays a key role on the medicine education team. Ideally, this message will be conveyed through collaborative outreach programs of pharmacist organizations, consumer/patient groups, and the pharmaceutical industry.
Bernstein: In today's age of technology, aren't traditional awareness campaigns such as NCPIE's annual "Talk About Prescriptions" Month passé?
Bullman: Today, there is an ever-growing need for such campaigns as NCPIE's "Talk About Prescriptions" Month, especially due to the increase in broadcast and print direct-to-consumer (DTC) pharmaceutical advertising of drug- and condition-specific content. As patients are being bombarded with these messages, regardless of whether they have the medical condition being addressed, they may suffer from information overload about new pharmacologic treatments. It is essential that patients, prescribers, and pharmacists reconsider the answers to very basic but important questions put forth by NCPIE, such as: "Is this medication the most appropriate for my condition, and, if so, how do I take it correctly?"
Further, with increasing reliance on self-care, particularly self-administration of many herbal supplements, there is an increasing need to talk about prescriptions. Given the increasing chance for drug-drug interactions as consumers add to their personal armamentarium, NCPIE's basic "Talk About Prescriptions" campaign is all the more important.
Bernstein: From NCPIE's perspective, what are some of the major issues that pharmacists face in patient education over the next 3 to 5 years?
Bullman: As patients turn more to self-care, and often purchase self-care items at nontraditional distribution sites (eg, Internet, dietary supplement specialty stores, mail-order), keeping track at the retail pharmacy level of what traditional and nontraditional prescription and over-the-counter (OTC) medications patients are taking becomes increasingly challenging. Vigilance is needed by the pharmacist and pharmacy technician to ensure that all new patients complete a patient profile form and that returning customers keep the form updated. Important patient education areas include:
Bernstein:
A recently released study
estimates that medication misuse costs the US economy more than $177 billion each year. The estimated number of patient deaths has increased from 198,000 in 1995 to 218,000 in 2000. How can an individual pharmacist have an impact on a national problem of such staggering dimensions?
Bullman: For the practicing pharmacist, this requires a commitment from his/her supervisor and corporate leaders to prioritize and publicize provision of pharmaceutical care. This can begin with the 2 points noted in response to the previous question (see the last 2 bullet points, directly above). Second, and again with the help of one's supervisor, an individual pharmacist can develop a special monitoring project. For example, pharmacists can monitor their patients over a specific age who are taking a specific number of different prescription medications within a 3-month period. In addition, they can involve all patients of a certain age who are on a medication that requires regular lab tests (eg, assessment of liver or kidney function). Pharmacists can, in collaboration with the prescriber, send postcards or make telephone calls to remind/encourage the patient to keep lab appointments.
While such small projects may be unscientific due to self-selection bias (among other confounding factors), undertaking them and sharing results with local, state, and national pharmacy and prescriber organizations is one way that an individual pharmacist can personally have an impact on significant public health problems.
Bernstein: There's been a great deal of debate about the provision of a prescription drug benefit to Medicare enrollees. What is NCPIE's position on this issue?
Bullman: The proposed Medicare outpatient prescription drug benefit poses an opportunity to enhance Medicare's wellness messages and to promote the value of appropriately used pharmaceutical therapy. Over two thirds of all doctor's visits end with a prescription being written, and Medicare beneficiaries account for over one third of all prescriptions despite representing only one eighth of the US population. About 98% of Medicare beneficiaries use a prescription medication in any given year, thus making prescription drug use the leading medical intervention. Such use can also, as shown by the recent Institute of Medicine report, be a leading cause of hospitalizations and deaths.
Currently, Medicare offers extensive wellness information on their Web site on specific medical conditions whose screening tests are covered by Medicare. Unfortunately, Medicare provides virtually no easily accessible information that highlights simple steps beneficiaries can take to promote safe, effective use of their medications. With the exception of the FDA's "Take Time to Care" campaign geared to women, which was modeled in large part on NCPIE "Talk About Prescriptions" campaigns, the federal government has not prioritized education about safe medication use as an issue for the more than 35 million Medicare beneficiaries, almost all of whom regularly use prescription medications. However, several objectives in the federal government's public health blueprint for the nation, "Healthy People 2010," do include targets for promoting safe medication use in elderly patients.
Regardless of the financing/reimbursement strategies to be implemented as part of a Medicare drug benefit package, sufficient funding must be included for a national medication awareness program for older Americans.
Bernstein: Looking forward, what do you envision the medication information and education landscape looking like in 10 to 15 years?
Bullman: With continuous advances in information technology and exchange, major changes can occur in 10 to 15 years. In that time frame, real-time medication information will be available to everyone, including consumers, patients, prescribers, and pharmacists. Today, there's a considerable lag time between when new and revised information about pharmaceuticals is available and accessible. In the future, I think that such information will be instantaneously available via centralized, electronic sources.
Manufacturers, health professionals, and consumers will have access to this information anywhere and at any time. I also think that health and medication information will be routinely and universally available in a variety of formats, including audio, video (which will be menu-driven for selection of appropriate language and level of understanding, and will incorporate lifestyle and disease-specific information), along with user-friendly access to research databases, including relevant clinical trial information.
The National Council on Patient Information and Education (NCPIE), organized in 1982, is a multidisciplinary nonprofit coalition of member organizations committed to improving communication of information on the appropriate use of medications to consumers and healthcare professionals. NCPIE member organizations represent the healthcare professions, consumers and patient groups, managed care service providers, voluntary health agencies, and the pharmaceutical industry. The US Food and Drug Administration (FDA) and the US Pharmacopeia are founding NCPIE members with nonvoting, liaison status on NCPIE's board of directors.
Ray Bullman has served as Executive Vice President of NCPIE since January 1995. Mr. Bullman joined the staff of NCPIE in 1985, assuming staff leadership in 1995. Under his guidance, in 1995, NCPIE produced 2 authoritative resources on prescription medication adherence: Prescription Medicine Adherence: A Review of the Baseline of Knowledge and Topical Bibliography on Prescription Medicine Adherence. The Council also developed a series of provider- and setting-specific Recommendations for Action to Advance Prescription Medicine Adherence. In 1996, the Council collaborated with the American Medical Association (AMA) on development of AMA's Guidelines for Physicians for Counseling Patients About Prescription Medications in the Ambulatory Setting. In 2000, Mr. Bullman, representing NCPIE, collaborated with the FDA's Center for Drug Evaluation and Research on the organization and implementation of the Cyber-Smart Safety Coalition. Mr. Bullman also coordinated the development of NCPIE's "Talk About Prescriptions" Month (annually in October), and managed the annual national awareness campaign from 1986 to 1995.
Prior to joining NCPIE, Mr. Bullman served from 1979 to 1984 as Community Program Development Specialist with the National High Blood Pressure Education Program, under a contract to Kappa Systems, Inc, from the Heart, Lung, and Blood Institute of the National Institutes of Health. He also served, from 1972 to 1978, as Administrator for the Rockville Community Clinic in Rockville, Maryland.
Mr. Bullman received a bachelor's degree from the University of Maryland in College Park, and a Masters in Association Management (MAM) from George Washington University in Washington, DC.
Bernstein: How well is the pharmacy profession represented among the NCPIE membership?
Bullman: Pharmacists and the pharmacy profession are well represented in NCPIE. Currently serving on NCPIE's board are representatives from the American Pharmaceutical Association, American Society of Health-System Pharmacists, National Association of Chain Drug Stores, and the National Community Pharmacists Association. Our general membership includes the Academy of Managed Care Pharmacy, American Association of Colleges of Pharmacy (plus 25 schools/colleges of pharmacy), the National Association of Boards of Pharmacy, and the American Society of Consultant Pharmacists.
Bernstein: How does a multidisciplinary coalition like NCPIE relate to pharmacy practice?
Bullman: Since our beginning, and because the pharmacy profession is so involved in NCPIE, our messages and materials are a win-win for pharmacists. They encourage consumers to speak with pharmacists and support the pharmacists' role as the medication expert. For example, NCPIE always encourages consumers to "talk with your pharmacist," and to "ask your pharmacist" about side effects, precautions, and instructions for use whenever a new medication is prescribed or recommended as part of the treatment regimen.
Additionally, NCPIE conducts public affairs campaigns related to improving appropriate medication use that have key messages for pharmacists and consumers. Individual pharmacists and their corporate or institutional employers can adapt these messages and offer customized (with their logo) resources to patients. All of NCPIE's messages are designed for year-round use, to promote and enhance pharmacist-patient dialogue. Also, pharmacists who are involved in the NCPIE coalition have unique opportunities to network with key consumer and patient groups, to exchange information about "tried and true" and emerging medication education strategies, and to learn about cutting-edge medication information research. Individual pharmacists are eligible for the Paul Rogers/NCPIE Medication Communicator Award.
Bernstein: What actions/activities can NCPIE recommend for pharmacists to promote a more informed patient?
Bullman: Pharmacists are doing a good job under a great deal of pressure and scrutiny. There's tremendous focus now on medication safety and reduction of medication-related errors. This puts the spotlight on the pharmacy profession and individual pharmacists more than ever before. NCPIE encourages pharmacists and prescribers to routinely counsel patients about instructions for use, precautions, recognition/management of side effects, and avoidance of drug-drug and drug-food interactions. Equally important is the provision of useful, easy-to-read, written information about the medication for use at home by patients and their family or caregivers. NCPIE would also recommend that pharmacists continue to provide outreach in their local community by speaking with community groups about appropriate medication use. "Talk About Prescriptions" Month, which NCPIE sponsors annually in October, and National Pharmacy Week, also in October, are great times for this valuable public service outreach.
Bernstein: What is unique about NCPIE that continues to attract participation in and support by national and state pharmacy organizations for nearly 20 years?
Bullman: As organized pharmacy's focus has shifted toward pharmaceutical care and as the mission of many pharmacist organizations has become even more patient-focused, the parallel to NCPIE's mission is readily apparent. For nearly 20 years, NCPIE's mission has been to stimulate consumer-healthcare professional communication about medications. Consider how complementary this is to the mission of national and state pharmacy organizations and the practicing pharmacist. With the recent focus on reducing medication-related errors and improving patient safety, the leadership of NCPIE and its long-standing, coalition-based messages become all the more timely.
Bernstein: Explain how NCPIE views collaboration. What impact can collaboration by pharmacy organizations, consumer and patient groups, the pharmaceutical industry, and other stakeholders have on reduction of medication errors and patient safety?
Bullman: NCPIE often refers to the "medicine education team." This team includes healthcare professional(s) and the patient and his/her caregiver. Decisions about treatment, whether or not they involve pharmaceuticals, should be arrived at in consultation with the patient and his/her caregiver. This helps create "buy-in" right from the start; which, in turn, can promote improved medication adherence while fostering better 2-way communication as the treatment plan progresses. In addition, such communication is key at every point along the medication-use continuum to reduce medication errors.
Starting at the point of prescribing and continuing when the patient fills the prescription at the pharmacy and uses the medication at home, school, or work, the patient must feel like he/she plays a key role on the medicine education team. Ideally, this message will be conveyed through collaborative outreach programs of pharmacist organizations, consumer/patient groups, and the pharmaceutical industry.
Bernstein: In today's age of technology, aren't traditional awareness campaigns such as NCPIE's annual "Talk About Prescriptions" Month passé?
Bullman: Today, there is an ever-growing need for such campaigns as NCPIE's "Talk About Prescriptions" Month, especially due to the increase in broadcast and print direct-to-consumer (DTC) pharmaceutical advertising of drug- and condition-specific content. As patients are being bombarded with these messages, regardless of whether they have the medical condition being addressed, they may suffer from information overload about new pharmacologic treatments. It is essential that patients, prescribers, and pharmacists reconsider the answers to very basic but important questions put forth by NCPIE, such as: "Is this medication the most appropriate for my condition, and, if so, how do I take it correctly?"
Further, with increasing reliance on self-care, particularly self-administration of many herbal supplements, there is an increasing need to talk about prescriptions. Given the increasing chance for drug-drug interactions as consumers add to their personal armamentarium, NCPIE's basic "Talk About Prescriptions" campaign is all the more important.
Bernstein: From NCPIE's perspective, what are some of the major issues that pharmacists face in patient education over the next 3 to 5 years?
Bullman: As patients turn more to self-care, and often purchase self-care items at nontraditional distribution sites (eg, Internet, dietary supplement specialty stores, mail-order), keeping track at the retail pharmacy level of what traditional and nontraditional prescription and over-the-counter (OTC) medications patients are taking becomes increasingly challenging. Vigilance is needed by the pharmacist and pharmacy technician to ensure that all new patients complete a patient profile form and that returning customers keep the form updated. Important patient education areas include:
Staying abreast of the latest clinical news regarding interactions between pharmaceuticals, common OTC preparations, and herbal supplements
Taking full advantage of existing technologic advances to promote improved patient understanding about their medications; for example, offering large-print medication leaflets to older patients, Braille leaflets and/or audiotaped information to visually impaired patients, and Spanish-language leaflets or those using pictograms as language/literacy preferences warrant
Embracing and implementing the OBRA '90 offer-to-counsel law, whose applicability to almost all states is extended to non-Medicaid patients as well.
Bernstein:
A recently released study
estimates that medication misuse costs the US economy more than $177 billion each year. The estimated number of patient deaths has increased from 198,000 in 1995 to 218,000 in 2000. How can an individual pharmacist have an impact on a national problem of such staggering dimensions?
Bullman: For the practicing pharmacist, this requires a commitment from his/her supervisor and corporate leaders to prioritize and publicize provision of pharmaceutical care. This can begin with the 2 points noted in response to the previous question (see the last 2 bullet points, directly above). Second, and again with the help of one's supervisor, an individual pharmacist can develop a special monitoring project. For example, pharmacists can monitor their patients over a specific age who are taking a specific number of different prescription medications within a 3-month period. In addition, they can involve all patients of a certain age who are on a medication that requires regular lab tests (eg, assessment of liver or kidney function). Pharmacists can, in collaboration with the prescriber, send postcards or make telephone calls to remind/encourage the patient to keep lab appointments.
While such small projects may be unscientific due to self-selection bias (among other confounding factors), undertaking them and sharing results with local, state, and national pharmacy and prescriber organizations is one way that an individual pharmacist can personally have an impact on significant public health problems.
Bernstein: There's been a great deal of debate about the provision of a prescription drug benefit to Medicare enrollees. What is NCPIE's position on this issue?
Bullman: The proposed Medicare outpatient prescription drug benefit poses an opportunity to enhance Medicare's wellness messages and to promote the value of appropriately used pharmaceutical therapy. Over two thirds of all doctor's visits end with a prescription being written, and Medicare beneficiaries account for over one third of all prescriptions despite representing only one eighth of the US population. About 98% of Medicare beneficiaries use a prescription medication in any given year, thus making prescription drug use the leading medical intervention. Such use can also, as shown by the recent Institute of Medicine report, be a leading cause of hospitalizations and deaths.
Currently, Medicare offers extensive wellness information on their Web site on specific medical conditions whose screening tests are covered by Medicare. Unfortunately, Medicare provides virtually no easily accessible information that highlights simple steps beneficiaries can take to promote safe, effective use of their medications. With the exception of the FDA's "Take Time to Care" campaign geared to women, which was modeled in large part on NCPIE "Talk About Prescriptions" campaigns, the federal government has not prioritized education about safe medication use as an issue for the more than 35 million Medicare beneficiaries, almost all of whom regularly use prescription medications. However, several objectives in the federal government's public health blueprint for the nation, "Healthy People 2010," do include targets for promoting safe medication use in elderly patients.
Regardless of the financing/reimbursement strategies to be implemented as part of a Medicare drug benefit package, sufficient funding must be included for a national medication awareness program for older Americans.
Bernstein: Looking forward, what do you envision the medication information and education landscape looking like in 10 to 15 years?
Bullman: With continuous advances in information technology and exchange, major changes can occur in 10 to 15 years. In that time frame, real-time medication information will be available to everyone, including consumers, patients, prescribers, and pharmacists. Today, there's a considerable lag time between when new and revised information about pharmaceuticals is available and accessible. In the future, I think that such information will be instantaneously available via centralized, electronic sources.
Manufacturers, health professionals, and consumers will have access to this information anywhere and at any time. I also think that health and medication information will be routinely and universally available in a variety of formats, including audio, video (which will be menu-driven for selection of appropriate language and level of understanding, and will incorporate lifestyle and disease-specific information), along with user-friendly access to research databases, including relevant clinical trial information.
