This past weekend, I went door to door around a lower socioeconomic neighborhood with a few individuals from my church, inviting the community to a free health fair that my church is sponsoring in the next few weeks. It was quite the eye-opening experience- I had never seen this part of Cleveland, where individuals don’t have doors or windows to their houses, their yard filled with broken glass and trash- a community crying out in need.
As we went to door to door, one of the individuals from my church (who happens to be a medical resident), developed a survey to ask the community what type of health consultations that they would prefer at the fair, and what type of programs would help improve their health. The community asked for the typical health screenings- blood pressure, glucose monitoring, etc, but one of the type of programs they all felt (literally, all) they needed was a type of exercise program. After talking to individuals around the area, I did find out that the high school gym was open every now and then, as well as a local boxing gym, but why did these individuals not know about the options in their area to keep them healthy?
My real heartbreak came when we visited a house of a middle aged woman, living by herself. We talked to her for a little while- about the health fair, about who we were, and so on, and she seemed quite receptive. She then talked about how her health was deteriorating, how her whole family was in California and she was alone, and how she was on seventeen different medications for who knows what. I tried to talk to her about maybe managing the medications and told her to go to the fair to speak with some physicians who may be able to decrease the number of her medications, and her whole face scrunched up as she began to shake and cry. She seemed grateful that we were talking to her- but I felt that she just did not have the healthcare help that she so desperately needed. She quickly then just shooed us away and closed the door; and off we went to the next house.
So, that got me thinking- what are we doing, as inpatient pharmacists, to encourage and educate patients in discharge counseling? If we meet with patients before they leave the inpatient area, we have the opportunity to really teach them about their medications (where they might forget to ask important questions when they pick up their medications from retail), as well as educate them on healthy ways of living. The hospital that I work at, does indeed, do some discharge counseling-but what if we did this for every single patient?
Don’t get me wrong- the whole healthcare system is working on it. As part of the Healthy People 2010 (and now it’s 2020) Initiative, ASHP followed the suit that the US Department of Health and Human Services implemented to reduce disparities among individuals and communities. Thus, we have the 2015 ASHP Initiative, where one of the objective (objective 1.4, to be exact) is that pharmacists, by 2015, will be providing counseling for high risk patients. And certain medications will be emphasized (beta-blockers for those in hospital for acute MI, and so on) for certain conditions, but nonetheless, we will be furthering counseling the patients on an inpatient basis on what they’re taking- assuming the role of an inpatient/community pharmacist.
What steps can we take to convert a whole health system to get used to this? Do we have enough pharmacists? Will staff/nursing/families be accepting of pharmacists in this role? But we can’t just depend on community pharmacists to do all this counseling as well. Do we use the help of pharmacy residents and students to help with our effort to provide discharge counseling for every patient? Nonetheless, after what I saw on Sunday, I do, highly believe there needs to be a better, more efficient job being done on discharge counseling and it’s up to us, as inpatient pharmacists and as a whole, to ensure the safety of the patient as they leave the hospital.