Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk episode 69 I'm your co host, Dr. Kane. I'm Dr. Schuman. I'm Dr. Patel, and the title of today's episode is the pharmacist must see you now a new rule requiring pharmacist counseling in Illinois, we actually have a very special guest today. His name is Dr. Dylan Moe. He's a PharmD graduate of the College of Pharmacy here at our own Rosalind Franklin University, class of 2015 he's a retail pharmacist in the local area. Here in the Chicagoland area, he's actually been a pharmacy manager for just over a year now, and he also is a preceptor for the College of Pharmacy here. So Dr. Moe, thank you very much for joining us today. You're welcome. Thank you for the invite. So today we're talking about a new rule that went into effect in August and then began being enforced in September, related to an Illinois rule requiring that all new prescriptions must be counseled by a pharmacist when a patient picks up that new prescription. Speaker 1 01:28 And in particular, we are talking about the Illinois rule 68 IAC 1330.700, which is the Pharmacy Practice Act's patient counseling rule. Speaker 2 01:38 And this was enacted in response, in particular, to the Chicago Tribune story that a number of our listeners may have heard about, discussing dangerous drug interactions and concerns about picking them up in a clinical practice setting. Dr. Sean Kane 01:48 And we're not going to get too much into kind of the background of the Chicago Tribune article and things like that. Suffice it to say that it's a very controversial piece, and there's been a lot of discussion about the findings of that article. And for now, we're just going to kind of leave that where it is, and we're going to focus on what the impact of that has been, which is this new Illinois rule. Speaker 2 02:11 So the first piece of it is that the pharmacist or the student pharmacist must, and again, must being the key word here verbally counsel patients or the patient's agent with every new prescription. Dr. Sean Kane 02:21 And I just want to emphasize there, it's not just the pharmacist. It's actually the pharmacy student that can also be involved, which I think is a great addition to that rule, right? Speaker 1 02:29 Yep, under the observation of the supervising pharmacist, pharmacy students can perform the same duties. Dr. Sean Kane 02:35 So what exactly counts as a new prescription? Because old prescriptions, if it's your fourth refill, doesn't count, right, correct. Speaker 1 02:41 So the definition of new over here is if the patient is new to your pharmacy, or the patient is belonging to your pharmacy but receives a new prescription, or if there is a change to the existing prescription in terms of a new dose, a new strength, a new route of administration, or new directions on how to take the medicine. Speaker 2 03:02 And again, the other piece of it that's important to look at is the offer to counsel is something that the pharmacist is responsible for, Speaker 1 03:08 and that's pretty much the same that's there been offered to counsel on all the other prescriptions, such as the refills Dr. Sean Kane 03:16 and Dr. Mo. We'll talk about this later, but we can't force a patient to listen to you, right? So does the patient have the ability to say, No, I don't want your counseling. Speaker 3 03:26 They do have the ability. Oftentimes, they will refuse with a technician, but the law states that the refusal can only be accepted by the pharmacist or the pharmacy student. And I Speaker 2 03:37 think the other important thing of that too, is the documentation piece of it to say, if it somebody does refuse to make sure you have that documented in your writing. Dr. Sean Kane 03:45 Now, in terms of what is counseling, it would be very easy for someone to say, You know what? This is your brand of generic. You're good to go. And that's really not what is appropriate in terms of an adequate counseling session. So within the rules, it does give some examples of good counseling points with the discretion of the pharmacist saying, you know, use your clinical judgment terms of what's important, what's not. Speaker 1 04:05 And I hate to go back to the Chicago Tribune again, but they did a follow up piece once this new law became effective, and they said, under the picture of our governor, Bruce Rauner, that, you know, because of whatever happened, due to our investigation, the governor is now requiring pharmacists to counsel patient on dangerous drug interactions. And it's that is a little bit misleading, and that's why we want to, importantly, talk about, what does this rule require as far as the counseling pertains, right? Speaker 2 04:35 So some of the things that are in it, and again, as Dr. Kane said, there's some professional judgment as far as what to include, but some suggested items are the drug name, the dosage form, the route, the duration of therapy, techniques for self-administration, storage. So again, thinking of medications like dabigatran — the product has to be stored a certain way. Refill info, missed-dose instructions, special directions. Side effects, adverse effects, or, as Dr. Patel mentioned, interactions. Dr. Sean Kane 05:00 Is that sounds a lot like the grading rubric would use for a pharmacy student, right? And clearly you can't touch on every aspect for every single patient that has a new or a modified prescription, right? So again, I think it's critically important that we understand that there is pharmacist judgment that goes into the concept of what you want to talk about with your patient. And even if all of those elements were required, think about how ineffective your counseling session would be if you gave them 100 different bullet points about the drug that they're picking up and then they pick up five new prescriptions. That would be ridiculous, right? So absolutely, some amount of clinical judgment must play a role here, Speaker 2 05:35 and the other piece of it too is that every pharmacy now has to show a sign and describes the new law, as well as how to file a complaint. Should you feel that you did not receive the adequate amount of counseling? Speaker 1 05:45 Yeah, and then this rule is a little bit relaxed in terms of your on site or off site. Institutional pharmacies, they're not bound by the law unless these pharmacies are providing discharge medications to the patients when they are institutionalized, then they're required to provide education and counseling and document accordingly. Dr. Sean Kane 06:06 So again, you know, a lot of this came out of this Tribune article that we won't get into. The law itself is actually fairly short. It's very easy to just read it and see what elements are in there. We've really covered probably 90% of it, but I'd encourage your listeners to take a look, and we'll have a link to the website of where that law is. To be able to review that, especially for the P fours who might be taking their law exam in Illinois in the future, be a great idea to just peruse that to see what the requirements are. So with that, we brought Dr. Moe in today, because he's kind of on the front lines, seeing how this rule has impacted pharmacies that are dispensing medications to patients and are now impacted by the requirement to provide this counseling. So Dr. Mo, would you mind just telling us a little bit about your pharmacy in terms of maybe how active your pharmacy is in terms of prescriptions per day, or any other metrics that you can provide us? Speaker 3 06:58 Of course, I do anywhere from 275 to 300 per day. As far as anything specific or unique about my store, I do have a number of senior homes in the area that we actually deliver to, so that there's been some questions raised about counseling requirements when we're doing deliveries because we're not actually seeing the patient or a representative. There's always going to be metrics, and that's the way with any retail pharmacy. Unfortunately, those have not changed at all in response to the laws. They've not adjusted those for difference in the amount of work. We have to do anything like that. Dr. Sean Kane 07:33 And you know, just to get a little bit more information about your store, do you have a drive up window? We do have a drive through. Is it a mono or a dual drive up window. We only have one. Okay, we only have one. And clearly, you know that plays a role in the concept of how, how you're able to communicate with your patient. It does without violating. Speaker 3 07:51 HIPAA, Yeah, unfortunately, that's a that's a difficult, difficult area to tread in when you're having to speak through a phone to somebody outside the store. Speaker 2 08:03 One other thing is, we think about again, what the impact of this is going to be on staffing or being able to control different areas of pharmacy. So do you have pharmacy students that work, work or operate within your store? And what do you think about about this potentially Speaker 3 08:15 expanding their role? I do. I have students that are actually employed by the company that work for me, they can assist in pretty much anything that I allow them to, as far as counseling immunizations, in regards to the counseling laws, it does help significantly when they're there and they're able to counsel the patients, but when they're on the clock, they're working as a technician, so Then it's pulling them away from other tasks that they need to be doing. Dr. Sean Kane 08:44 So and as you said, you know, one of the things to think about is your workflow, and how this impacts your workflow and your metrics and things like that. And clearly, I would imagine it would be frustrating to have the same metrics, but then have more work, which I think happens in a lot of different jobs, right? As you kind of, especially as you're in a job for a long period of time, you get more responsibilities without necessarily having more hours to do those things, right? Speaker 3 09:09 It absolutely gets frustrating, because, yes, they haven't really changed anything. As far as staffing goes. Dr. Sean Kane 09:15 No, I will say that the last time I went to a pharmacy to pick up a prescription at this particular pharmacy I went to, I saw a note that said that new prescriptions cannot be dispensed between 1230 and one because the pharmacist is on a lunch break and they're not able to provide that counseling. Is that something that you've kind of seen as a change, or is that just in that one store, maybe that I was at Speaker 3 09:36 no it has been a change historically; if a pharmacist was on duty by themselves, stand-alone, a nine-to-five store, there was actually no lunch break. However, since this new law was enacted, there are now 30 minute uninterrupted meal breaks. So yes, we do have signs posted that the pharmacist will be unavailable between a certain time to dispense new prescriptions. Because we don't actually close, so the technician is still back there. However, you know, I'm able to go sit down and actually eat a meal. Dr. Sean Kane 10:07 It's crazy that before the rule that that wasn't like built in, right? Speaker 1 10:12 Yeah, because obviously before that, pharmacists didn't need to Dr. Sean Kane 10:15 eat, right? Of course not. It was the pharmacist diet plan just don't eat. That's true. In terms of staffing. Has anything changed with that? No. Speaker 3 10:26 My Store actually has had the hours cut, so I have less staff than I did before, and our operating hours have changed, so now I'm open two hours less per day, doing the same volume with less staff. Awesome. Speaker 1 10:42 So how are you able to manage this new rule, and how are you able to incorporate that as a manager of your pharmacy? I know it's only been a month since the rule has been forced. So can you tell us a little bit about your difficulties or successes? Speaker 3 10:56 So difficulty is the company that I work for, they are very broad in terms of what a new prescription is. A lot of physicians now use electronic prescribing. So a patient will go to their physician normal yearly checkup. They send in all new prescriptions of all their previous medications in our system. It shows that it's new. However, if you review the profile, clearly they've been on lisinopril for three years. This is not a new prescription for them. However, the company I work for counts that as new and says it's required counseling. Dr. Sean Kane 11:29 So I can see that it could be frustrating if the Illinois law is less restrictive, but then your corporate rules are a little bit more restrictive in terms of the counseling requirements. That probably also conveys a little frustration to the patient too. Speaker 3 11:42 It does, you know they they're told by the technician that, because this is a new prescription, they have to be counseled by the pharmacist. And they look at the technician and saying that this is not new. I've been on this for years. However, they still have to step over and be counseled by the pharmacist. Oftentimes, those individuals are the ones that say, I don't need counseling. Just give me my prescription. Speaker 1 12:04 And this is the month of October. Usually, that's when all the vaccination, especially flu vaccination, starts. So not to forget that we need to maintain that workflow too. So I'm assuming, and you may expand on this, that this adds a little bit more difficulty and challenge and to manage your workflow, Speaker 3 12:22 it does. I have great technicians, so they're able to maintain workflow and manage it pretty well. Prior to the law, I would oftentimes go to the out window to help when there was a big line of people. Now I do that less and less, because if there's a line of people and I'm stuck helping one person and three people need counseling. I can't do that, so I try to not spend so much time out there, and so I'm available for counseling and questions. Dr. Sean Kane 12:50 And I think that's a really good point that I'd like to talk about a little bit more, is that the ratio of your time is going to be different now, and also your ability to, as you kind of put it, to help out in different areas of the pharmacy, you may be more restricted because you have to do this one task, whereas previously, you were able to, kind of manage your time and do different tasks based on what was necessary at the time. On the whole, do you view that as a good thing, where you're kind of forced to do this patient counseling aspect, or is it a bad thing in the sense of, now you aren't able to help out for these older prescriptions because you have this one newer prescription that's going to take Speaker 3 13:27 a lot of your time. It's good and bad. Obviously, you pointed out that not being able to help with other tasks throughout the pharmacy is something that you know tends to make more work, I guess, for the other for the technicians. However, I think the counseling rules are a positive in terms of what the patient gets and their understanding of their medications. Speaker 2 13:50 And actually to kind of move off that plane, but on a similar plane is so we think about again, the role of a pharmacist, and really focusing on some of those clinical outcomes. Do you feel that this new rule may improve patient perception of what a pharmacist does? Because, again, they see more in that natural habitat of doing the counseling, maybe, versus some of those other tasks? Speaker 3 14:10 Yeah, it absolutely does. You know, I've had a number of patients, thank me for giving them information about medications that they would have no idea. A lot of er prescriptions that, you know, er, docs and ER nurses don't necessarily go over medications with the patient. They give them their their pieces of paper, and then they're off. So having to discuss that with them is definitely a positive. Dr. Sean Kane 14:35 I think maybe a corollary to that is not just about the perception of the pharmacist, but maybe also, do they feel like they're able to use their medications in a safer way, where they know what to expect? They walk away their patient satisfaction outcomes in terms of, I'm familiar with my medication, I know what to look out for, their overall competency of their meds is better. Speaker 3 15:00 Yeah, I absolutely think so. You know, I've had a number of people that have been on, you know, we'll say Cipro, for instance, for a number of times. And you know, a new one comes in. And, you know, this discussion about, say, the metallic ions, iron and, you know, calcium. We know we can't take Cipro with those because it binds to it. They've been on it numerous times before. Nobody's ever told them that, you know. So they'll take their Cipro with a big glass of milk, you know, things like that. So I think their understanding of their medications and the obviously, the perception of the pharmacist has has increased. Speaker 1 15:35 And perhaps, you know, that's one perception of the pharmacists. But when we talk about pharmacy perception and the environment itself. I guess it doesn't feel so much like a McDonald's, you know, queue or a drive through. Or if they are approaching a drive through, they know that if it's a new prescription, it may take a little bit longer because the pharmacist has to counsel. Or if they're coming in with a new prescription for an antibiotic, like you just mentioned that they need to spend maybe a couple more minutes, even if they have their kid crying in the car, that, you know, because you need to educate them. Dr. Sean Kane 16:07 I wonder, too, if that changes the patient's viewpoint on the utility of the drive up window, that maybe they're less likely to use it because they they know that they're going to have to, you know, quote, unquote, sit down with the pharmacist for a little extra time, and it's not a simple transaction. And maybe some of those more complex patients won't go through the drive up where they're taking 15 minutes in the window, and instead would go in. Whether that's true or not, I don't know. Speaker 3 16:31 One would think, and one would hope, however, not always the case. You know, I just had somebody discharge from a significant stay in the hospital, and they had, I think, six different meds, all brand new to them through the drive through, you know. So I was there, which I'm okay with. I was there for probably 10 or 15 minutes going through each one with them, and I have no problem with that. But, you know, as you look out the window and see car after car after car after car lining up behind them, you know, the car behind them is not going to be okay with that. So and Dr. Sean Kane 17:03 even just the ability to communicate is so different in person versus through the phone or through the microphone, at least in many of the pharmacies I go to, because of the glare on the window, it's hard to even see them. And then even, like, you know, the nonverbal cues and stuff like that, it's just a completely different environment. Speaker 3 17:21 It is. It can be difficult at times. I try to do the best I can. Dr. Sean Kane 17:26 Well, with respect to that, do you have any metrics on your average wait time for a patient to go from beginning to end? And has it changed with the new rule? Speaker 3 17:36 There are metrics. As far as having prescriptions done by their promise time the there's no set amount of time that it has to be done within, so we don't have a timer that's going but, you know, obviously, if we tell somebody it'll be ready in an hour and a half, they the expectation of it being done in an hour half is still there, you know. So it's really on us to determine what we can actually do in the given amount of time. Dr. Sean Kane 18:03 So I guess maybe subjectively, would you say a wait time is a little bit longer than it normally would be because of the new rule, or have you been able to manage it where basically everything's the same from a patient perspective, with regards to wait time, we've Speaker 3 18:15 we've kicked it up, we've we've extended our wait times, just because we know there is going to be a significant amount of time taken out of what I'm able to do, and Dr. Sean Kane 18:25 I assume you're the only pharmacist work, and we should have clarified that earlier, Speaker 3 18:29 for the most part, we do have overlap later on in the day, so there is a couple hour overlap, but that's used for our pharmacist lunches and then essentially just catching up From what we had to do in the morning. Speaker 1 18:42 So you kind of gave a couple examples of how patients left with better understanding of how to use their medication and how to make a safe use of those medications. So I can conclude that one of the pro of this rule is that patients do have better understanding, and on the flip side, pharmacists have that fulfillment of their obligations, you know, career obligations too, but as far as the counseling goes, and maybe this was something that you were doing already, but in order to fit this requirement into your current workflow, do you have tips or tricks that you know, I have a five bullet points that I want to go over, and that includes everything about this medication. Or then you have a strategy to attack four new medications versus just the one new medication. How do you fit it in? Speaker 3 19:33 It's a good question. As far as one versus multiple, when there's multiple, obviously I'm looking at the specific things about the drugs. The more important. Things, I guess you can say, you know, I'll sometimes leave out storage. I typically go through the drug, name, directions, dose, and then major side effects or adverse reactions. That's generally what I what I go through that oftentimes. Leads to questions from the patient, so then I just kind of play off of them as far as what else I'm I'm talking to them about. Speaker 2 20:07 So kind of to take it again, back from the patient, back to you yourself. How is the new rule impacted your morale at your job and your overall job satisfaction, as well as maybe the satisfaction of your employees, your technicians, your colleagues. Speaker 3 20:21 So I am all for it. I like it. You know, I went to pharmacy school to be able to do this. This is, this is part of it. So I have no, I have no problem with the new counseling laws. I think it's beneficial for everybody. It keeps me up to date on, you know, thing, when it first started, I was looking at a lot of different drugs and going, man, what do I remember about this? But I like it. As far as job satisfaction, I'm still satisfied with my job. The fact that I don't want to say lack of lack of help, but the non increase in help makes it difficult at times. But I think overall, I'm I'm still pretty satisfied with my job. Speaker 2 21:02 And then you kind of mentioned a little bit about technicians that you know that you have feel like you have less of an opportunity to then kind of go and assist if there is a long life at the drop off window, for example. So how have, how have they responded to this? Speaker 3 21:16 They're taking it in stride. They know it's a law. They know it's something we have to do. So they're doing the best they can with what we're given. Dr. Sean Kane 21:24 I think that's really good to hear, because I think that that's one of the marks. And you said that you have great technicians. I think it's a mark of a great team, that instead of saying the sky is falling, there's no way we can do this, you guys figured out how to do it right, and you took it, like you said, in stride, and as a team, you've picked up the proper roles that you needed to in order to get it done and maintain your quality, maintain your workflow. I'm sure not all pharmacies are that way. I think that some probably aren't able to maintain the quality and things like that, but it sounds like you guys have done a really good job with that, and it probably speaks to your teamwork into your the team that you've built, right? Yeah. Speaker 3 22:03 I mean, we try, some days are better than others. Obviously, you know, there's days when we all leave and don't want to go back, but I think overall, we have a great team. Dr. Sean Kane 22:14 And I know earlier you mentioned kind of a typical patient response, especially that patient who's filled their Lipitor 900 times, and it's the 901st and a retail pharmacy computer says you have to do it again, right? You have to. It's a new prescription. Yeah, aside from those patients, which I totally understand, the level of frustration with that for everyone else, where it's a genuine new prescription, what's the typical reaction that you're seeing? Have patients kind of grown accustomed to it yet or not? Or do they even notice the difference? Speaker 3 22:45 They're starting to become accustomed to it. Typical reaction is, why am I doing this? You know? Why do I have to talk to the pharmacist? You know? I discuss this with my doctor. He already told me about it, and then when I mentioned something that clearly the doctor did not, you see, kind of a light bulb moment with the patient that, okay, this is, you know, this is a good thing then So, Speaker 2 23:10 and as you said, again, it's getting back to, I think what we all studied for and trained for is the opportunity to sit down and really go through the risks and benefits of these medications individually, With an individual versus kind of a rubber stamping, I think, with a silver lining approach. It does give you more of an opportunity to do exactly that. Speaker 3 23:27 It does. It's, I think people are starting to realize that, you know, prescription medications aren't just something that are benign. They don't have any issues, things like that. They're starting to realize why they're actually classified as a prescription? Dr. Sean Kane 23:42 Yeah, I'm really glad you mentioned that, because if you talk to a patient about, like, why they wear a seat belt, right, in terms of, like, what is your risk of having a fatal injury if you wear your seat belt versus not? Generally, they wear the seat belt because they appreciate the value in doing that. If you talk to them about, though, one to 2% risk of bleeding, of a nearly fatal bleed on their warfarin. When you actually address that, I think that it really puts into perspective how dangerous some meds are if you don't know how to properly monitor them. In terms of self monitoring, it's the equivalent of not wearing your seat belt, hanging your head out the car, you know, doing really not smart things that if you're properly educated, you know, hey, that Melena isn't normal, or this really horrible headache, and I'm on warfarin, not normal, right? Things like that are really important that I do think it is this critical critical mass, where once a good number of patients understand the importance of the counseling, that it becomes, you know, second nature, that this is what happens when you go to a pharmacy. Speaker 1 24:42 And if you think about the advocacy of pharmacy profession in general, we are all striving to get the provider status. And it's one thing to convince our colleagues that are practitioners, you know, physicians or nurse practitioners or PA providers, but it's it's really the change that. Will come about in the patient's perception that we are really a provider, is to provide this type of clinical content and expertise to the patient. So I think this rule kind of helps put the vision out there, in the normal public's view, that we're not just pill accounting and, you know, sticking type of pharmacist we are actually providing clinical counseling and expertise that we are trained for. I think Dr. Sean Kane 25:28 it's worth mentioning. Illinois is not the first state to do this like we are not alone in having this rule. And I've spoken to pharmacists in states that do have a counseling requirement, and they they absolutely have the philosophy of when it when it was enacted. It was kind of tough in the beginning, but then patients figured it out, and now it's second nature. It's a normal thing. So if anything, Illinois is joining the group of states that value patient safety, value the role the pharmacist and things like that. So if anything, I think we've joined, as opposed to being the trendsetters in the group? Absolutely. Speaker 1 26:02 Yeah, I practice in Wisconsin, and Wisconsin is one of those states that required counseling to begin with. So glad to join the progressive states of pharmacy practice. Speaker 3 26:12 Yeah, I have a couple of technician slash students that are from Wisconsin, you know. So when they were working and we started the transition, I would ask them, Hey, how do you guys do it up there? What is, you know, what's kind of the workflow, what's the role? How does it work up there? You know, to kind of get some, a little better insight as to how we can transition down here, Speaker 1 26:35 learn from the best practices. Yes, you Dr. Sean Kane 26:38 know, one thing that I think is interesting to talk about is kind of the rationale of from the patient safety point of view, the pharmacist point of view, but also kind of the corporate point of view, that generally speaking, this is not in the interest of a retail pharmacist, from a economic standpoint, to provide the service. So what's interesting is that, like many other things in life, sometimes you have to have a requirement of you have to counsel in order for a corporation, let's say, to do the right thing. And I think that this is a great example of that, that it would be very unlikely that a pharmacy would require all new prescriptions to be counseled, given the effort the time that is involved in that, but it is in the best interest of the patient. So this is one of those circumstances where economically, for an individual store, maybe not a great idea, but in terms of what's the right thing to do, it's a really good idea, and that law, I think, plays that role. So hopefully other states will be thinking about Illinois did this. Is it time for us to do this as well? Dr. Mo, if you were to sit down with a legislator from any other state that doesn't have this rule. What are some of the things that you talk to them about, either elements of the law that you think are really good or really bad to avoid, or just the rationale to do it or not to do it? Speaker 3 27:55 I think the laws as written is is sufficient. It requires counseling on new prescriptions the way the law is written, it does clarify as far as, say, schedule two prescriptions, because those have to be new every month, the law states those are not required counseling if the patient has been on them historically. So I think the law, the way the law is written, is sufficient. It provides a great experience for the patient, great information for them. As far as the implementation, there still needs to be some work with the retail pharmacies and what they can do to provide an efficient way to do this, as far as staffing goes, as far as hours goes, and things like that, because, you don't want an increase in errors on other prescriptions, because we are moving so fast trying to get, you know, these things done, because we know we're going to have to counsel all these patients. So I think there's, there's multiple avenues that have to be looked at as far as proper implementation. Dr. Sean Kane 28:58 What about you guys? Are there any elements that you think are really important or that you would try to avoid in a new law for a different state. And I Speaker 2 29:07 think one of them, I think was said, is to really have a clear understanding, again, about unintended consequences, and just making sure, then that as it's put in place, that it's not, you know, going to have. Is it an impact another piece of it, whether it's the order verification piece or the filling piece of that, there's nothing else that kind of gets squeezed in as a result. You said, All right, you know, our time is stuck. It's, you know, we have a certain amount of time allotted, and this takes up a piece of it, so everything else just kind of gets the short shrift. And so want to make sure, again, that that's not the case, that that there is some sort of change in the workflow or understanding about about the numbers, piece of it that needs to be addressed. Speaker 1 29:44 Yeah, in my opinion. I think, like Dr. Mo said, the law is written sufficiently to let the independent pharmacies or the corporate pharmacies to assume the role and fit this into the existing workflow. But what I am more. Interested in knowing is that the practice has really changed after the implementation of the law. And I guess it's not going to be something that the state will require for pharmacies to measure. It will be upon the independent pharmacies or the corporate pharmacies to kind of collect their own data and see, have we increased the pharmacist satisfaction of the job that they're doing this now, or have we increased patient satisfaction on the services they are receiving? Or have we increased the pharmacy technician satisfaction on what the overall workflow like, or the job burden is like? Dr. Sean Kane 30:30 That's a great point, Dr. Patel, because I think that burden, if you will, for to collect that kind of data is really on the store itself, because if they're not doing a good job taking care of their employees or improving satisfaction of their patients. Employees and patients are going to go somewhere different at some point if they don't foster that relationship. So for sure, not necessarily, not needed part of the law, but absolutely, these stores should be thinking about that to make sure that they're still getting the highest quality pharmacist that they can get, and that their patients are coming back, right? I think for me, two elements of the law that I really love that if I was to talk to another lawmaker in a different state, one is, I love the fact that they require a sign be posted, because I think that that's so important to empower the patient if they get a bad experience, to say, this is the number that you call if we did a bad job, and I can tell you personally, before the law, I've been to pharmacies where I don't even get asked, Do I have any questions? I filled four prescriptions and it gets thrown at me, and I'm on my way and they have no idea I'm a pharmacist, but as a pharmacy faculty member, that makes me cry a little bit inside, right? So to have that sign that says you should be counseled on this. It's not just Do you have questions, it's a legitimate counseling session, and you are entitled to that, I think, is really important. And then the other thing that I think is really important is that they weren't incredibly prescriptive about what you talk about. And when I first read the law, and again, the listeners, it's linked on our website at HelixTalk.com they have like, 10 or 15 elements that could potentially be included in a counseling session. And when I was reading that, the thing that says, like, use clinical judgment is at the very, very end, and I was thinking, holy cow, there's no way that you're going to talk about 10 elements for every prescription. So I love the fact that they gave a lot of good examples, but they still left it up to the pharmacist, as long as that isn't abused, where the pharmacist says, Well, my judgment I just have to talk about brand and generic. Clearly, that's not appropriate, but to offer that judgment call, I think, highlights our role as professionals, as content experts, and I think that that's critical, that you're not basically prescribed, that you have to talk about these five elements every time that they do offer some leeway, and I think that's really important, right? Speaker 2 32:42 Because, again, there's gonna be situations where you think of something like a bottle of some simethicone that may not have, you know, quite the emphasis on storage of something like, again, dabigatran, or something like an insulin as well. So the ability to focus on what is the biggest piece of it for that individual medication. Speaker 1 32:58 So, Dr. Kane, I know you mentioned your experiences prior to the law, but I can't help myself but share a couple experiences I had myself after the law was implemented. One prescription was for my mother, so I was going to pick it up, and the pharmacist was very adamant about counseling, despite I told them that I'm myself a pharmacist, and they were almost doubting me. So kudos to their pharmacist. They finished the counseling, and then just last week, I went to pick up my own prescription from a local pharmacy, and the pharmacist did not even ask if I had any question about the prescription. We were still seeing two sides, and I was actually looking for the sign to see if there is a sign posted that it's required by the law, and I can call if the pharmacist didn't do so, it was the end of the shift, and our pharmacy was almost closing, so then I didn't do so, but we're still seeing some discrepancies here. Maybe the law is very fresh, and the complete implementation, especially within the corporate or chain pharmacies, has not happened yet. Dr. Sean Kane 33:55 And I think that you know, for any law, you're going to see an adoption time period where there is that kind of transition period. But you know, especially for the listeners, as healthcare providers, as patients, we should be holding the feet to the fire of the pharmacies and the pharmacist, if they're not doing their job, then at some point it has to come back on them to be doing their job, because there's a reason that the law is in place. I think, from a patient safety standpoint, you can't tell me it's not a good thing for that, and I think that that should be our highest priority of all time, right? I hope that in the future, we don't get this regression down to brand and generic counseling. But if we do, I do hope that all listeners strongly consider, you know, providing that feedback back to the state or the state has a mechanism to be monitoring and tracking and potentially punishing if they're not doing what they should do. So to kind of summarize, you know, this new rule took effect in the state of Illinois in August, September of this year. So we've had basically month under our belt. So things are quite new. And currently, the rule says that if you fill a new prescription, or you have a modification of your prescription in terms of dose for. Frequency, things like that, that you have required counseling, and it is the patient who can defer that counseling, but they have to, you know, have a written deferment of that counseling opportunity, right? Speaker 2 35:10 And there are, there are also a number of components of the counseling piece, ones that are considered or recommended options. But however, there's a lot of flexibility, given both time and the individual medication about what may or be may be more or less vital for that individual prescription. Then the the pharmacist can use that professional judgment to determine what, what to focus on during that counseling time, exactly. Speaker 3 35:33 And the the new counseling laws are absolutely beneficial for the patient. However, the increase in workload for the retail pharmacies can sometimes be a little overwhelming, but it's just something that we have to have to learn how to handle. Speaker 1 35:47 And to the listeners, I would like to remind that this law is nothing new. For the other states, they're already doing it. So Illinois is following some of the states and providing this counseling and making it mandatory. But I think it's important as a nation, as we're trying to get gain this provider status, that we not only do so in the eyes of other healthcare providers, but do so in the eyes of our consumers, which are our patients. And I think this law does help with promoting pharmacists as providers in the eyes of our patients. Dr. Sean Kane 36:20 So with that, we'll go ahead and wrap up. If you want to actually read the rule that we've been talking about, you can get a link at HelixTalk.com this is episode 69 we've also linked to the frequently asked questions from the Illinois Department of Financial and Professional Regulation division of Professional Regulation. So they have an FAQ basically outlining some of the things that we've talked about today. If you have more questions about the rule, we're also on Twitter at HelixTalk, and with that, I'm Dr. Kane, I'm Dr. Schuman, and I'm Dr. Patel. And I'm Dr. Moe. Thank you so much for joining us today, and to the students out there: counsel hard. Narrator - Dr. Abel 36:56 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store, search for HelixTalk and place your review there Narrator - ? 37:07 to suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.