(This post is part of a series of posts. To read from the begining of the series go here.)
My thoughts on this subject have changed quite a bit since I first wrote this series in March of 2005. Then I was not a fan of hospices that use the large "mail order" hospice pharmacies, now I believe that those pharmacies may be the best option for some hospices.
Your hospice is in charge of providing all medications that are needed to control the symptoms associated with your hospice diagnosis. With that charge comes a lot of responsibility. Your goal is to have your pain controlled. The hospices goal is to control your pain in a cost effective manner. I used to think that a hospice that was willing to hire an out of state pharmacy was a sign that the hospice was more focused on the cost control side than the pain control side. While that instinct may not be 100% wrong, I am sure it is also not 100% right. What I have learned in the past few years is that there is one thing that is much more important than where your hospice purchases the drugs.
The important thing is how good the pharmacist is. The national mail order hospice pharmacies pride themselves on having pharmacists who specialize in hospice type drugs. They spend time and money studying the types of problems hospices face and the drugs that can best solve the problems. It is this type of drug knowledge that you want from the hospice you choose. Hospices use medications in a way that few understand. We use pain medications at levels that make many doctors uneasy. Hospice also uses many drugs for "off label" purposes. If your doctor (like many we work with) is not comfortable with using high level pain meds and doesn't know the "off label" uses of drugs, then you have one strike against you. If your hospice's pharmacist agrees with the doctor, then you have strike two and three.
No, this does not mean that you should choose a hospice just because it uses a mail order pharmacy. (I'm still not convinced that they are a great option for hospices.) What it does mean is that a great hospice is going to have a real relationship with its pharmacist. You are looking for a pharmacy/hospice relationship that entails much more than just filling prescriptions. No matter how good a hospice's nursing staff may be, there are times when they are going to need some serious research help. Being able to call your pharmacist, whether he is around the corner or in another state, and get well educated answers to serious questions is a key to good hospice care. Not every patient is going to need that kind of research or knowledge, but some patients require all the brainpower a hospice can find. Having real access to a pharmacist with some serious brainpower is one thing that really allows a hospice to care for its patients.
The other pharmacy consideration goes back to location. Even hospices that have mail order pharmacies must have a local pharmacy to do emergency quick fills. Find out which pharmacy that is. The further that pharmacy is from your house the longer you will have to wait for your emergency pain medications. Some hospices provide their patients with "emergency packs" to help solve this problem. This pack has one or two doses of the most commonly used emergency drugs, so that you have these drugs in your home just in case. This is a great idea, but there is always the chance that you will need an emergency drug that isn't in the pack. There is little substitute for a good 24/7 relationship between a hospice and its local pharmacy.
There are four more parts to this series. Next, find out why size matters
1 comments:
What if the hospice has a pharmacist on staff? Would you see that as a good thing or a conflict of interest? Just curious.
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