18 July 2013

Some Patients May Not Need Doctors As Often

Would this even be possible? Would the medical profession even allow this? I am talking about patients not needing to see a doctor just to receive a prescription and needing to see a doctor far less often than presently needed. Trisha Torrey is the first to bring this to my attention in her discussion here. Now the internet is picking up on this and more blogs may appear on this topic. The humorous part is that Ms Torrey's blog was written over a year ago and it is just now starting to gain some traction among empowered and participatory patients.

I personally feel this has merit with some legal safeguards. Not mentioned in any blog or article I have seen yet, is a requirement that the pharmacist be known, and report to the primary care physician. Understand that I am only writing this from the diabetes point of view and only for those that have type 2 diabetes (both those on oral medications and those on insulin).

I am talking about responsible empowered patients that are very knowledgeable about their diabetes being able to prescribe their own medications rather than see a doctor for every renewal or on a regular basis. Insurance would still be required to cover these medications and testing supplies. These approved (yes, you would need to be approved) patients could request lab tests at specified intervals and have the results sent to the doctor and yourself. Doctor could specify an approved list of tests or could add to the list if desired.

Ideas for rules:
#1. Patients would need approval from their doctor and their pharmacist.

#2. Patients would then have a prescription pad available at the pharmacy in a specific color to denote patient prescribed. Lime green has been suggested.

#3. Pharmacists would have a list of approved medications for the patient and dosage range (if any) that would be allowed. Doctor could update this because of evidence indicating medication under review or being pulled by FDA.

#4. Controlled drugs would not be eligible for this and doctor appointments would still be required.

#5. The patient could only write for himself or herself and any other use would end this privilege, permanently.

#6. Because the pharmacist can review records, a special request for additional medications for vacation could be evaluated and determined to be reasonable. Example: Patient has medication for 20 days before new prescription, will be going on vacation in 10 days for 30 days. Patient wants prescription to cover vacation plus 5 to 10 days. Under most circumstances, patient could get ninety day supply, but feels it is safer to carry smaller amount. Pharmacist can see that the request is reasonable and would fill the prescription. Now if the patient had just received a 90 day refill and wanted an additional 30 days for a 10 day vacation, the pharmacist would be justified in not filling the prescription as the patient already has about 90 days and won't specify when the vacation will happen.

#7. Self-prescribing cannot be moved to another pharmacy without the doctor's and new pharmacy's approval.

#8. Home A1c tests could be done quarterly and cost reimbursed by insurance, but legislation may be necessary at the state and federal level to force Medicare to reimburse and insurance to cover. Medicare and insurance could not stand in the way of approved self-prescribing.

#9. It may be necessary to have a meter that can connect to a computer to upload meter information to a doctor's office on a quarterly basis. This may require physician training or at least nurse training to read the reports and talk to the patient if necessary. Also, it may be required to have insurance reimburse physician or nurse for the time spent.

#10. If a new medication comes on the market, then a telephone conference may be required or an appointment to determine if the new medication can be substituted for an existing medication.

These are suggestions and there may be more rules needed. I am open for discussion and suggestions on this topic as it may become very interesting.

With the projected physician shortages predicted under the Affordable Care Act, this may well be a possibility. This could free up doctors that have patients that are microexperts in diabetes and allow empowered and participatory patients to be more in charge of their diabetes.

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