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  • 1.  Filling pill boxes for patients?

    Posted 29 days ago
    Does anyone offer a service at your clinic to fill pill boxes for patients? We've received several requests for this and I have heard of it being done at other sites. I am a little concerned about the legality of it all though and making sure everything is done to best practice standards. 

    The idea is that we have some patients who want us to store their medications for them and fill a pill box every 1-2 weeks for them to take home. For some this is for privacy reasons (so they don't have to keep their ART bottles in the home), for others it's for medical reasons such as severe Parkinsons or risk of intentional overdose. 

    Is anyone doing this? What are your best practices that you follow to keep the patient's safe and yourself safe from a liability standpoint?

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    Caitlin Prather, PharmD, BCACP, AAHIVP, TTS
    Clinical Pharmacist in Fairfax, VA
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  • 2.  RE: Filling pill boxes for patients?

    Posted 29 days ago

    I don't know of any services that fill pill boxes, but I do know there are pharmacies that separate pills into morning and night packs daily.  I think pill pack pharmacy does as a national chain. I know there are local Los Angeles Pharmacies that do similar things as well.  We also have managed care coordination for our non adherent HIV patients, so something like that would probably help them load their pill boxes. But I think your best easiest path would be to find a pharmacy that separates the meds for them.  

    Best 

    Kevin Rauchut,NP-C



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    Kevin Rauchut
    Van Nuys CA
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  • 3.  RE: Filling pill boxes for patients?

    Posted 28 days ago
    Edited by Ahmad Akbar Sapie 28 days ago
    Pillbox might help in medication adherence, but there are always other associated costs bound by the patients ie: travel costs, and time constraints. A study on cost-utility is needed from the perspective of patients/clients. 

    As regards the privacy reasons, it might help for the patient not to disclose her/his status, but does it sounds like stigma still here? I mean why does PLHIV wants to 'hide' what medication they are taking unless the stigma isn't it? 

    Otherwise, the Parkinson's and intentional overdose can be overcome by Home Medication Review services.

    thus far, my personal opinion is further research to evaluate the:
    1. Cost-utility
    2. Clinical outcomes
    3. Stigma reduction (psychological aspect)

    are three main pillars to inform which service is better and towards evidence-based practice. 

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    Akbar Jaya, BPharm (Hons)
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  • 4.  RE: Filling pill boxes for patients?

    Posted 28 days ago
    Our pharmacy offers the option of having medications packaged in compliance packs.  This has helped our patients with adherence issues tremendously.

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    Gwen Verlinghieri
    AIDS Care Group
    Swarthmore PA
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  • 5.  RE: Filling pill boxes for patients?

    Posted 28 days ago
    Some of the specialty pharmacies here in Seattle fill pill boxes and/or put the meds in blister packs for the patients. The legality may vary by state, depending on laws regarding pharmacy practice. Here it's perfectly legal and I don't think there's a liability risk.

    Peter

    Peter Shalit, MD, PhD, FACP, AAHIVS 
    Cabrini Tower, 901 Boren Ave Suite 850, Seattle, WA 98104 
    P 206-624-0688 F 206-624-2432  





  • 6.  RE: Filling pill boxes for patients?

    Posted 25 days ago
    Hi
    Filling pill boxes has been a part of Ryan White supported clinics I have staffed. This can be done with - not necessarily for - the patient. Storing the medicines for the patient not standard but something I personally would strive to do in some settings.
     
    Pharmacy dose packets have a very shabby record in my practice. They divorce the patient from their medicines which is not ideal. Some patients do like the service.
    Problems can arise when
    • Medical regimen are not stable and changes are needed
    • Multiple providers from subspecialties are prescribing
    • Hospitalization occurs
     
    David M. Bebinger, MD
     
     
    The information transmitted is intended only for the person or entity to which it is addressed and may contain confidential and/or privileged material. Any review, transmission, re-transmission, dissemination or other use of, or taking of any action in reliance upon this information by persons or entities other than the intended recipient is prohibited. If you received this in error, please contact the sender and delete the material from any computer.





  • 7.  RE: Filling pill boxes for patients?

    Posted 23 days ago

    As a community representative for this group, I thought it would be helpful to ask other members of the community I associated with, that might have a voice to share. I posed this question to my co-workers (which contains a significant number of community members). Below are their comments:

    • Individuals on multiple medications can benefit from this. The Nurse Educator at one of the agencies provides this service.
    • Pharmacies may not have time to provide this service unless they create a special position for this.
    • I know of several places that do this form of adherence support. This works especially for those who are unstably housed or homeless. This is great as it removes a barrier to care.
    • "I'm torn on this as I can see the benefits as well as the liability." Are there safeguards in place to ensure the medication are dispensed properly? Will this practice be done in the presence of the patient? Is their liability on the agency/servicing provider in the event the patient has complications related to the medications (i.e. mixed or missed dosage)?
    • Clinics can offer this as pharmacies lack holistic and comprehensive care needed to serve the unique needs of some patients, including but not limited to insurance support needs and medical care plans for applicable patients.
    • Rural areas outside any metropolitan area can benefit from this, especially in areas where access to care is limited for unique pharmacy needs.
    • This is a much-needed practice that would better support adherence to medical guidelines and care plans. However this type of service is typically offered at specialty pharmacies by way of insurance and mailing the medications.
    • Clinics and pharmacies should not offer this option because as dispensing agencies they are legally bound to distribute medications with correct packaging/labelling. Pills are stored in bottles mostly to ensure they are protected from external influences such as heat, moisture, dust, light etc. The integrity and longevity of pills are affected by all these. It should also be noted that the patient would have to be educated enough to differentiate between all the pills which is sometimes difficult due to preexisting conditions such as dementia or life circumstances such as low education level. To distribute them in such a manner or change their packaging poses legal risk to the pharmacy/clinics as well as a health risk to the patient. It also decreases how green pharmacies are by having to distribute more plastic based products.
    • In Jamaica, we did this practice with our adherence department in the clinic. For persons with difficulty adhering to medication regimes, our adherence counsellors would divide their pills into pill containers which removed the legal risk from the pharmacies but also patients were provided counselling to go along with this method, thus increasing adherence as well as adherence education.
    • Its like having an accountability partner. Using this method also helps the clinic or organization build closer relationships with the people/community we service.
    • One issue is that we may handicap some people and not allow them to become self-reliant on taking their meds.


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    Joseph Robinson
    Atlanta GA
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  • 8.  RE: Filling pill boxes for patients?

    Posted 20 days ago
    Hi - I have my pharmacies fill pill boxes for some of my patients.  At another job I worked at - we did fill pill boxes for the patients and it was like DOT for them - they came into the clinic to take the meds every day or take a pill box home every week.  I would recommend dot like provision of care but for the other - of filling the pill boxes and having them take them home - why not have the pharmacies do blister packs or pill boxes directly for the patients?

    Hope this helps.

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    Sara Back
    North Central Bronx Hospital
    New York NY
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  • 9.  RE: Filling pill boxes for patients?

    Posted 20 days ago
    Good afternoon,
    Most of the independent pharmacies  offer free blister pack service. You may request, if not. I am sure there shouldn't be any issue.
    Thanks

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    Gangadhar Revuluri
    Galaxy Specialty Pharmacy
    San Antonio TX
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