Improving Community Pharmacy Services Leads to Better Patient Outcomes
The Community Pharmacy Foundation (CPF) recently sponsored a study called “Evaluation Of Enhanced Community Pharmacy Services”. The research was performed by Patti Fabel, PharmD, and Gene Reeder, PhD, at the Kennedy Pharmacy Innovation Center in partnership with the University of South Carolina College of Pharmacy, and enhanced pharmaceutical services were performed by John Pugh, PharmD, and Carmen Monts, PharmD, at Prosperity Drug in Prosperity, South Carolina.
The primary objective of this study was to assess the impact of improved community pharmacy services on clinical and economic outcomes, and the secondary objective was to assess the impact of a value-based payment model for a community pharmacy that provides these services.
The study used data from January 1, 2017, to December 31, 2017, and looked at 1,725 insured patients (1,003 in the matched comparison group and 722 in the expanded services group). The control group was selected from independent pharmacies that did not offer improved services during the study period. Demographic information on patients, health care utilization, and costs was collected from paid claims.
John Pugh, PharmD, owner of Prosperity Drug in Prosperity, South Carolina, helped realize the enhanced services for the study. Several years ago, at an SCPhA meeting, he met Fabel and Reeder, where they collaborated on ideas and decided to approach CPF for a potential grant to study enhanced pharmacy services.
“We knew that in Iowa, Randy McDonough, BS, PharmD, MS, CGP, BCPS, FAPhA, (also a CPF grant recipient) demonstrated cost savings through improved services. We were curious whether or not our improved services would save money for both medical and pharmaceutical benefits,” Pugh said.
Pugh described the enhanced services offered at Prosperity Drug, which have always been and still are offered, regardless of the study:
- Obtaining future refills: work upfront with the patient on the latest refill to ensure the physician is contacted for further refills or to ensure the patient has an appointment.
- Blister packaging
- 24/7 access to an on-call pharmacist that a patient can call with any questions
- Medication synchronization/medication reconciliation
Pugh described how these services often go hand in hand: “Our goal is to keep patients out of the hospital/ER. We work closely with local doctors for an accurate medication list. If we’re going to refill a patient’s medications each month, I want to make sure we’re refilling the correct medications.
Pugh said he was fortunate to have adequate staff to provide these services. Carmen Monts, PharmD, winner of the 2018 SCPhA Excellence in Innovation Award, provides many services to Prosperity Drug patients.
By working together, pharmacists and technicians provide seamless patient care. “Pharmacists think about medication reconciliation, but technicians also play a very active role. For example, a technician can reach out to a patient to check their medications, remind them to take their medications, and ask when the patient has an upcoming appointment.
Data showed that improved pharmacy services reduced prescription use (14%) and medical costs (15.6%), which could lead to a significant return on investment. However, further research needs to be conducted, using more patients from multiple pharmacies that offer these enhanced services to determine the value of enhanced pharmacy services to payers.
For Pugh, pharmacy is “about developing relationships with patients. We talk with them, make sure to help them with their needs. As my colleague, Joe Moose, PharmD, says, “some patients need a prescription and some need a pharmacist”.
Pugh is proud that “our practice helps select patients who really need a pharmacist. We try to provide patients with an experience where the pharmacy experience is as professional as the doctor’s. Patients talk to us, trust us, feel that they can call us, we are in the field of prevention.
Although data collection has ended, said Pugh, “this service offering is normal practice for us, we continue to do what we do. We are always trying to think of new ways to care for patients and to continue to figure out how to keep patients out of the hospital or prevent readmissions He points to care transitions as a potential place where pharmacists can get involved.
“At the end of the day, it’s about caring for patients,” Pugh said. “They need to trust and feel comfortable with the pharmacy staff for all of these enhanced services to be meaningful.”
Pugh agrees that enhanced pharmacy services are a great niche for independent pharmacies because of the staffing situation. “You need to be able to have the right staff to be able to provide these services,” Pugh said. “In our pharmacy, the philosophy is to take care of the patient. If you take care of the patient, the money will take care of itself. The goal should be to provide the best care and as much care as possible to the patient. Pugh uses a long-term approach to caring for patients “like we would care for our family members.”
“We have to show the value and demonstrate the services. If we can show we’re saving on medical costs, that’s an opportunity for an insurer to invest more in pharmacy services so that they eventually become fee-based services,” Pugh said. At the end of the day, Pugh’s call to action is simply, “Be someone’s pharmacist.”
The Community Pharmacy Foundation, led by Anne Marie (Sesti) Kondic, PharmD, Executive Director, is a non-profit organization dedicated to advancing the practice of community pharmacy and the delivery of patient care through grants and resource sharing.