SOS Rx

Senior Outpatient Medication Safety

Full Coalition Meeting, January 7, 2004

Meeting Report

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The third full coalition meeting of Senior Outpatient Safety (SOS Rx), held January 7, 2004, included 50 participants and observers representing 45 organizations. The meeting was held in the George Meany Conference Room at the AFL-CIO Building in Washington, DC. All meeting documents, including the agenda and list of attendees, are available at www.nclnet.org/sosrx under the January 7 meeting documents.

The meeting began with introductory remarks from convening organization National Consumers League and a brief introduction of new participants.

Presentation

The presenter at the January meeting was Dr. Lucian Leape, Harvard School of Public Health. Dr. Leape’s presentation on outpatient medication safety is available at www.nclnet.org/sosrx. Highlights from his presentation include:

Approval of the approach SOS Rx is taking via the Action Agenda
The three big issues today regarding medications: drugs are too expensive, pharmaceutical companies have too much influence in Congress, misuse of medications is a major problem
Importance of consumers knowing what medications they are taking and why, asking when in doubt, keeping a list of all medications, and assuming a new symptom is due to medication
Advocates one name per pill, per drug – importance of having one name, whether generic or brand name, regardless of manufacturer; and one pill with same color and shape, regardless of manufacturer, for each medication.
Improve pill bottle labeling – increase font size, include only essential information, include bar code
Expand counseling role of the pharmacist: patients need more help (especially seniors taking multiple medications), doctors rarely take the time to explain, pharmacists are qualified, counseling is a better use of their time than putting pills in bottles

An extensive question and answer session followed Dr. Leape’s presentation.

Discussion of Action Agenda

Linda Golodner, National Consumers League, started the discussion by giving a short report on the SOS Rx consensus retreat at Wye River in November. An Action Agenda was developed at the retreat and further refined in work groups during December. The Action Agenda consists of four projects. For each project, a point person has been designated as the leader. The point person for each project gave a description of the project. After each presentation there were questions and discussion. Set forth below is a summary of each action agenda project and the group consensus for moving forward on the project.

1. Consumer Actions – Targeting high-risk situations – Mariana Serrani, National Alliance for Hispanic Health

Summary – Educate consumers on the avoidable risks of interactions with certain high-risk medications, such as warfarin. A public education campaign will target consumers taking high risk medications and inform them that other non-prescription medications they may be taking (OTCs, dietary supplements, herbals) as well as food, could interact with prescribed medications. The resulting campaign will be a template that could be customized and used for any high-risk medication.

Suggestions for Moving Forward:

1) Make sure the right persons are at the table as we move forward (don’t duplicate what is already out there, or will be). Obtain input of a cardiologist.

2) Develop a critical path or framework - what are the objectives, what is the delivery vehicle for the messages, identify target audience, etc.

3) Agreement to focus on warfarin (focus on a high-risk drug as opposed to high-risk population), but keep in mind all drugs.

4) Emphasize importance of clear bottle labeling

5) Stress role of the pharmacist in the campaign

6) Focus on simple message

2. System Changes – Clearinghouse of Best Practices on High-Risk Situations – Lou Diamond, Medstat

Summary – Develop a clearinghouse of best practices for high-risk situations in the outpatient medication area. Such a clearinghouse would include past practices currently housed in different places. To initiate this project, SOS Rx will convene a one-day meeting of experts to frame the scope of the project.

Suggestions for Moving Forward:

1) Define scope of the clearinghouse – identify best practices, or the criteria for including a best practice; determine how much of clearinghouse will be passive or active; opportunity to provide a consumer translation of guidelines.

2) Evaluate best options for an operational model of the clearinghouse – private, public or both.

3) Consider governance – who or what organization will oversee clearinghouse

4) Coordinate and integrate this effort with any other similar efforts in the patient safety arena

5) Develop a budget for this project

3. Personal Health Record (renamed Personal Medication List) – Andy Barbash, Mobile Health Program

Summary – While there are various initiatives regarding personal health records, including the personal medication record, standards and uniformity are needed to ensure such records are consumer friendly and useful. The focus of this project will be on the personal medication list or record, particularly on developing appropriate standards and encouraging consumers to use the lists. This project will involve an initial meeting of experts and stakeholders to define the roles and responsibilities of the different players and the messages that are needed to ensure standardization and use of the personal medication list.

Suggestions for Moving Forward -

1) Immediate action to explore the possibility of promoting the personal medication list in conjunction with CMS’s education to seniors about the new Medicare drug discount cards

2) Plan for expert meeting in the next 90 days with focus on the personal medication record. Need to be clear on objectives for the meeting.

4. Promoting Electronic Prescribing - Will Lang, American Association of Colleges of Pharmacy

Summary – This project will review initiatives under way to achieve acceptance and use of E-prescribing for all interested parties (including consumers) and also review standards development. After developing a status report, a small conference will be convened with the different players to discuss what more needs to be done to gain acceptance and use of E-prescribing. After the conference, a media campaign will be conducted to publicize the results of the conference, including educating consumers about E-prescribing.

Suggestions for Moving Forward:

1) Focus on acceleration the acceptance of E-prescribing

2) E-prescribing - governed by state boards of pharmacy so it varies from state to state. Project may want to concentrate on a certain region.

3) Need to identify the business case for E-prescribing

Moving Forward:

· The group ratified the Action Agenda, on the condition that the suggestions made today are incorporated into the project agendas.

· NCL will revise the Action Agenda items as suggested by the group discussion at this January 7^th meeting, and will work to create clear objectives for each project.

· NCL will work with the point persons for each of the four Action Agenda projects to help convene sub-group meetings to move forward on implementing the project agendas.

· The next full meeting of the coalition will occur on April 7, 2004 from 10 am – 2 pm (EST). All meetings will be held in Washington, DC, and accessible via telephone conference call.