tag:blogger.com,1999:blog-9143719926358099859.post6353921125939458227..comments2023-10-26T08:08:43.486-07:00Comments on Dr. Mintz' Blog: How the Government Plans to Lower Cost by Eliminating Doctors and Shifting Costs to PatientsDr. Matthew Mintzhttp://www.blogger.com/profile/01058182168282244996noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-9143719926358099859.post-1486499948161282222012-08-27T05:37:24.639-07:002012-08-27T05:37:24.639-07:00@smart janitor,
You are correct that there are ce...@smart janitor, <br />You are correct that there are certain medications that probably can be prescribed without a doctor's office visit as long as pharmacy counselling is assured. You brought up in my mind the two perfect candidates: inhaled nasal steroids (which are under-utlized and probably safer than OTC decongestants) and epipens (which are also under-utilized and potentially life saving). <br />The problem is that if you read the actual document from the FDA they are talking about 1) cost savings and 2)management of chronic diseases. I firmly believe that things like asthma, hypertension, diabetes and high cholesterol ought to be mangaged by clinicians. It is true that in other countries, medications can be dispensed without a physicians visit. The difference is that most other countries have universal health care where getting an appointment with a physician and paying for that appointment are not a problem. My concern is that rather than try to actually solve our health care concerns, the government (via the FDA) appears to be looking for a cheap, cost-cutting measure. <br />(Also, my disclosures are made available at the disclosures link which is at the top of the blog, under the more about Dr. Mintz link). Dr. Matthew Mintzhttps://www.blogger.com/profile/01058182168282244996noreply@blogger.comtag:blogger.com,1999:blog-9143719926358099859.post-65983006341945225032012-08-26T23:11:46.687-07:002012-08-26T23:11:46.687-07:00I'm sorry, but I think you're wrong, or pe...I'm sorry, but I think you're wrong, or perhaps just undertraveled. When I lived in Spain and Italy, it was common to be able to go to a pharmacist--highly trained, competent people, in those countries--and after a brief interview get a drug for a condition. I'm not talking about getting chemotherapy drugs from a pharmacist. I'm talking about getting, for example, the very safe nasal corticosteroids that you, Dr. Mintz, complain are so underutilized in this country. Or a supply of two Imitrex tablets for a migraine. Or a three-day supply of triamcinolone for a small contact dermatitis. Et cetera. There are a number of very minor clinical issues that fall into a grey area, in the American drugs dispensing system, of needing more counseling than is provided for an OTC drug and less medical system involvement than is needed to obtain a prescription. Thus, the proposal to make certain drugs for certain therapies available after pharmacist counseling. I think you're hugely overreacting by saying, "Where is the outcry?" [But then again, I think some of your writing is irrational. Why do you not disclose your faculty appointment at George Washington University School of Medicine? Some ethics rule there?] In any case, I think you'll agree with me that there are certain drugs available OTC in this country that probably should only be sold with a little more counseling--drugs such as diphenhydramine (Benadryl) for sleep, or pseudoephedrine (Sudafed) for nasal congestion. It might well save lives, however, if Epi-Pens were available after pharmacist counseling, given the extremely dangerous nature of anaphylaxis, and the fact that poor and/or uneducated people don't have the medical access to doctors that would enable them to get prescriptions for Epi-Pens. I think the issue is more subtle than your writings indicate.The English Avocadohttps://www.blogger.com/profile/03408541726062962885noreply@blogger.comtag:blogger.com,1999:blog-9143719926358099859.post-51672765367441311402012-05-23T19:38:29.027-07:002012-05-23T19:38:29.027-07:00As a professor who regularly teaches pharmacy stud...As a professor who regularly teaches pharmacy students, I find this troubling at best. I have long thought pharmacists are overeducated for what most pharmacists actually do in any given day. However, in no way do I think pharmacy schools provide the clinical knowledge necessary to diagnose and treat patients. I wonder if the whole Pharm,D paradigm shift helped pave the way for this course of action. I do know that many states are graduating more pharmacists than needed. Is this really the way to provide access to care ? Can it really be called that? I have to admit that I am a PA, so I do value the role of physician extenders. Trying to fill his particular square hole with a round peg, however, is dangerous.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-9143719926358099859.post-82648584969471006722012-04-17T05:45:16.197-07:002012-04-17T05:45:16.197-07:00Thanks Jasmin. First and foremost, regardless of w...Thanks Jasmin. First and foremost, regardless of what the FDA decides, pharmacists should be paid for their work. One of the reasons the current retail pharmacist spends most of their time behind the counter and not talking to patients, thus not ulitizing the skills for which they were trained, is because they don't get paid to counsel patients. This is major problem, because as per my post, I think the pharmacist can be a key player in the health care team. The good news is that Medicare is now starting to pay a tiny bit of money to pharmacists who review Medicare patients' meds. Already, this has increased pharmacist-patient interaction, which is a good thing. Unfortunately, the payments are currently not enough and commerical insurances haven't followed the government lead. I have no problem with this model (paying pharmacist to counsel patients) or an Accountable Care Organization model where the pharmacists are part of the team and the whole team gets paid partially based on the quality of care delivered. The problem with the FDA proposal is that it leaves the doctor out of the loop. And yes, to your point, you would have to pay the pharmacist more. What the FDA/government is saying, if you read between the lines, is that paying a pharmacist is a lot cheaper than paying a physician.Dr. Matthew Mintzhttps://www.blogger.com/profile/01058182168282244996noreply@blogger.comtag:blogger.com,1999:blog-9143719926358099859.post-11120399945182406352012-04-16T19:10:45.467-07:002012-04-16T19:10:45.467-07:00By "eliminating" the physician and givin...By "eliminating" the physician and giving additional responsibilities to the pharmacist, won't there be some sort of additional payment necessary for the pharmacists performing these duties? I don't really see how the government/insurance companies/patients will be cutting costs in that regard (they're still paying a health professional). I appreciate their efforts to reduce the effects of the physician shortage, but this does not seem like the greatest idea.Anonymoushttps://www.blogger.com/profile/00551525508641413507noreply@blogger.com