Department of Public Health – Assessment of pharmacy operations and impact of walk-in facilities

Audit Date: April 9, 2008
Audit Categories
  • Performance
Controller: Alan Butkovitz

Executive Summary


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Hon. Alan Butkovitz

City of Philadelphia

April 9, 2008


Thank you all for coming.

Last September I released our audit of the Philadelphia Health Department that found significant problems with the inventory and invoice verification of prescription drugs.

As a result of the problems we found in this prior audit, we decided to take a closer look at the District Health Center Pharmacies and patient primary care appointments.

Today I am releasing the results of that audit entitled: Assessment of Pharmacy Operations and Impact of Walk-in Patients at District Health Centers.

The inability to pay should not be a determining factor in the quality of medical care dispensed at our city health clinics. City Health Center patients deserve the same level of care as patients who see private physicians and who receive their prescriptions from private pharmacies.

In examining the city’s health centers, we were troubled to find that it took on average 165 days for a patient to get an appointment to see a primary care physician.

In comparing Philadelphia to other cities, we found it took only 15 days to get an appointment in New York City, 20 days in St. Louis, 14 days in Cleveland and only 7 days in Baltimore. In Houston – it took approximately 75 days—less than half the time in Philadelphia.

We also found pharmacists in our clinics were filling between 300 and 365 prescriptions per day – allowing for as little time as 75 seconds to fill each prescription. Included in this 75 second timeframe, the pharmacist is required to perform seven control steps before the prescription should be dispensed to the patient.

Under this very tight production quota schedule, it is very difficult for pharmacists to adequately check each prescription they fill, and to also provide patients with any prescription drug counseling.

Common sense would tell you that the higher the number of prescriptions filled under this extremely tight timeframe, the greater the risk for mistakes and harm to patients.

Aside from the inherent risks involved with this type of production quota setup, national studies have shown that counseling patients about their prescription drugs — significantly improves the patient’s health outcomes and reduces risks associated with taking many prescription drugs.

From a personal standpoint, I know how important prescription drug counseling is when picking up a prescription. Just the other day I submitted a prescription for an antibiotic for a sinus infection. Since the pharmacist has a history of my prescriptions, it was flagged that this antibiotic could cause a dangerously low sugar level. If the pharmacist did not have this history and took the time to counsel me, who knows what could have occurred.

Just this week, the American Academy of Pediatrics released a study that found a staggering rate of 11 “harmful” drug-related events for every 100 hospitalized children. These “harmful” events ran the gamut from outright overdoses of prescribed medications to actually giving pediatric patients the wrong medications.

Experts speculate that the problem is likely to be greater since their study did not include community hospitals. While the study did not focus on patient drug counseling, it does raise serious questions and calls for a more careful approach to dispensing prescription medications.

This rather large prescription quota system for pharmacists at city health centers, coupled with their inability to provide adequate prescription drug counseling – could pose a serious danger to the health of those who use the district health centers for both their medical care and their pharmaceutical needs.

Other Findings in our report include:

1. Patients generally have to wait two days to have prescriptions filled.

2. There is no control system to monitor and track the inventory of drugs, what drugs have been dispensed as well as what drugs have expired and should be disposed of.

3. There are limited hours for patients and family members to pick up prescriptions.

4. There is an inadequate computer system at best — to verify insurance and assistance coverage.

We must do a better job in scheduling appointments and getting patients in quicker to see a physician. It is bad enough having to wait a week or so to see a doctor when you’re sick, never mind having to wait five to six months.

This is totally unacceptable and aside for the stress and pain it causes patients, it can also lead to more serious long-term illness as a result of the five to six month wait period.

Studies show that prevention is often times the best medicine. In the case of our health clinics – prevention is on the back burner.

While the Health Department has acknowledged these problems do exist and say they have begun to address some of them, we have made a number of recommendations that include the following:

1. The Health Department must hire more pharmacists and do so right away.

2. Salaries for these new pharmacists should be more comparable and more competitive with salaries in the private sector taking into consideration other benefits the City provides.

3. Prescription drug counseling to patients should be a requirement and patient should be asked to sign a waiver that they do not need or want counseling – similar to how it done at most private pharmacies.

4. Revise the patient in-take procedure to ensure that all pertinent insurance coverage and benefit eligibility and income are appropriately secured.

5. Implement an incentive program to encourage pharmacies to maximize insurance reimbursements from all appropriate entities.

6. Institute an inventory control system and negotiate better prices for the city when purchasing top non-formulary drugs.

As I said previously, the inability to pay for medical care should not be a determining factor in the quality of care dispensed at our city health clinics. Patients deserve the same level of care as patients who see private physicians and who receive their prescriptions from private pharmacies.

I urge the Philadelphia Health Department to implement our recommendations and to ensure that patients and clients of the city’s district health centers receive the same level and quality of care as those received by patients who use private providers.

Thank you.

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