Evaluation of a Hybrid Medication Synchronization Training Module for Pharmacy Technicians.

BACKGROUND: Medication synchronization involves coordinating a patient's medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared to automatic refill-processing programs. Patients are two to six times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service. OBJECTIVE: To develop a training program for pharmacy technicians regarding medication synchronization and assess changes in knowledge and confidence before and after implementing a training program. PRACTICE DESCRIPTION: An independent community pharmacy in North Carolina. Pharmacists provide medication therapy management, reimbursed clinical services, medication synchronization, and immunizations. PRACTICE INNOVATION: The training program included medication synchronization basics, patient enrollment process, processing a synced patient, and a hands-on practice session. EVALUATION METHODS: Technicians took a pre-training questionnaire assessing knowledge and confidence before immediately completing a one-on-one pharmacist-led training session with a hands-on component on medication synchronization. Technicians took the same post-training questionnaire 2 weeks after completing the training session and utilizing medication synchronization in daily workflow. Pre- and post-training scores were assessed using a paired samples t-test. RESULTS: 10 technicians completed the training program; 40% of the technicians were certified and 30% were enrolled in a PharmD program. The mean pre-training knowledge score was 78% (7.1/9 points), the mean post-training knowledge score was 92% (8.3/9 points), the mean difference between the pre- and post- training knowledge scores was 13.4% (1.2 points), a statistically significant difference (p=0.0026). Confidence with conducting a medication synchronization call increased from 7.2 to 9.6 on a 10-point Likert scale and confidence scores increased regarding incorporating medication synchronization into workflow from 6.9 to 8.7. CONCLUSION: The standardized technician training program increased knowledge and confidence in technicians regarding managing a medication synchronization program.

The effect of community pharmacist-led health coaching on clinical outcomes.

OBJECTIVE: To evaluate the impact of a community pharmacist-driven health coaching program on clinical outcomes from baseline to 1 year. SETTING: Independent community pharmacy in western North Carolina. PRACTICE DESCRIPTION: Sona Pharmacy + Clinic is an independent community pharmacy offering enhanced clinical services such as medication synchronization, adherence packaging, and free delivery. Sona Benefits offers pharmacy benefit manager (PBM) services to self-funded plans in western North Carolina. PRACTICE INNOVATION: Sona Health Management Program is a disease management program offered to Sona Benefits PBM clients; the services began in October 2016. EVALUATION: Change in clinical outcome measures (total number of medications, blood pressure, hemoglobin A1c, weight, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], patient health questionnaire [PHQ-9] scores, and asthma control test [ACT] scores) were assessed for members who participated in the program for a minimum of 12 months for at least 2 of the following conditions: hypertension, hyperlipidemia, diabetes, depression, and asthma. RESULTS: Health coaching was provided to 42 members (mean age of 55.9 years and 2.7 qualifying disease states). The mean number of medications per patient significantly decreased from 7.2 to 6.2 (P = 0.02). Systolic and diastolic blood pressures were significantly reduced from 130.8 mm Hg to 125.7 mm Hg (P = 0.04) and 76.9 mm Hg to 73.7 mm Hg (P = 0.04), respectively. Other clinical outcome measures evaluated, such as hemoglobin A1c, weight, LDL-C, HDL-C, TG, and PHQ-9 and ACT scores, were improved but did not reach significance. CONCLUSION: These results suggest that community pharmacists can have a positive impact on patients with multiple chronic conditions through health coaching services. This project suggests a potential model of pharmacist health coaching through pharmacist-run PBM services.

Impact of a coordination of care program in an independent community pharmacy.

OBJECTIVE: The first objective was to determine the impact on hospital readmissions at 30- and 90-days after discharge. The second objective was to examine the change in number of medications a patient was taking before enrollment versus after enrollment and potential health care savings. SETTING: Independent community pharmacy in the southeastern United States. PRACTICE DESCRIPTION: Blue Ridge Pharmacy, Inc. is composed of 2 long-term care pharmacies, 2 community pharmacies, a compounding pharmacy, and a specialty pharmacy. PRACTICE INNOVATION: The Access Program is a transitions of care and coordination of care program. Sona Access helps patients who have undergone a transition of care from a skilled nursing facility, health system, physician office, or community partner. Access incorporates social care services and medication services such as free home delivery, home visit, monthly care calls, and adherence packaging. EVALUATION: This retrospective study included participants age 18 years and older who enrolled in the program between March 2015 and March 2016 and had at least 3 months of data. Data collected included patient demographics, reason for referral, admissions to hospitals or skilled nursing facilities, number of medications before enrollment, and number of medications three months after enrollment. RESULTS: The mean age (±SD) was 70 ± 13.8 years, and 65% of patients were female. The 123 patient enrollments yielded 113 total hospitalizations, resulting in a mean of 0.92 hospitalizations per patient. Pharmacist consultation and reconciliation decreased the average number of medications from 12 to 10 medications per patient. Within the 113 hospitalizations that occurred after enrollment, 5 occurred within 30 days, 13 occurred within 90 days, and 95 occurred at 91 days or greater. CONCLUSION: This study suggests that the delivery of coordination of care services through medication reconciliation, medication synchronization, and home visits has a positive effect on health outcomes for patients who have undergone a recent transition of care.

Evaluation of the economic and clinical impact of community pharmacist-driven pharmacy benefit management services.

OBJECTIVE: To evaluate the economic and clinical impact of community pharmacist-led pharmacy benefit management (PBM) services. SETTING: Independent community pharmacy in western North Carolina. PRACTICE DESCRIPTION: Sona Benefits is a PBM partner to self-funded plans in western North Carolina. The services provided by Sona Benefits are led by pharmacists at its affiliate company, Sona Pharmacy + Clinic. PRACTICE INNOVATION: In October 2016, Sona Benefits began providing PBM services to members employed by a local continuing care retirement community. EVALUATION: Economic outcome measures included change in total medical and prescription costs per member per year (PMPY) and change in cost per prescription from baseline. Change in clinical outcome measures (hemoglobin A1C, weight, blood pressure) was assessed for members who participated in 2 or more quarterly health coaching sessions. RESULTS: Prescription costs were reduced from $1219.72 to $858.57 PMPY and medical health care costs were reduced from $5910.76 to $4290.30 PMPY from baseline. This represented a total decrease of $1981.61 PMPY in health care costs. A reduction in the average cost per prescription from $95.10 to $61.88 was observed. For patients enrolled and active in health coaching, we observed reductions in weight, hemoglobin A1C, and blood pressure. Between the initial and final health coaching visits, average weight decreased from 204.6 lb (92.8 kg) to 203.6 lb (92.4 kg), the percentage of patients at hemoglobin A1C goal increased from 47% to 53%, and percentage of patients at goal for blood pressure increased from 58% to 78%. CONCLUSION: Inclusion of community pharmacists in PBM service delivery produced economic benefits for plan sponsors. Preliminary clinical data suggested benefits of pharmacist-led health coaching services, but further evaluation is needed to determine the long-term impact.

Vial-to-Pen: Community-Based Pharmacists Converting Insulin Regimens.

OBJECTIVE: To describe a vial-to-pen conversion program driven by community-based pharmacists and determine conversion success rate. METHODS: A report based on prescription claims was generated and identified 200 prescriptions filled for an insulin vial product and syringes. Patients were contacted by community-based pharmacists during a five-month period and were informed of the availability and potential benefits of insulin pen delivery systems (IPDS). If the patient agreed to the switch, the pharmacist contacted the prescriber to obtain a new prescription. Prescription refill records were tracked for six months post-intervention to determine whether patients who were converted remained on the IPDS. RESULTS: The overall vial-to-pen conversion success rate was 26% out of 121 potential conversions. In addition, 52% of patients reached were willing to switch and prescribers approved 71% of the recommendations to switch from vial-to-pen. Of the prescriptions successfully converted to an IPDS, 84% of prescriptions were still dispensed as pen products six months following the conversion. CONCLUSION: Community-based pharmacists can serve as a resource to provide education on insulin delivery options and increase use of IPDS in patients with diabetes.

Innovative Community Pharmacy Practice Models in North Carolina.

There are several different types and sizes of community pharmacies ranging from large chains to small individually owned pharmacies. Community pharmacies are located in supermarkets, drugstores, big box stores, and even shopping malls in neighborhoods across North Carolina. Pharmacists are the most accessible health professionals and the ones that many patients see most frequently. Many pharmacists provide services long after other health care professionals' offices have closed. The traditional role of the pharmacist-the health care professional who dispenses prescriptions written by doctors-is changing. In recent years many pharmacists have developed services to help manage highly complex patient populations and improve health care outcomes. The profiles below highlight four innovative community pharmacies in North Carolina that show the potential community pharmacies have to improve quality, outcomes, and cost of care.

Implementation of a pharmacogenomics service in a community pharmacy.

OBJECTIVE To determine the feasibility of implementing a pharmacogenomics service in a community pharmacy. SETTING A single community pharmacy that is part of a regional chain known for offering innovative pharmacy services. PRACTICE DESCRIPTION Community pharmacists at the project site routinely provide clinical pharmacy services, including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. PRACTICE INNOVATION The implementation of a pharmacogenomic testing and interpretation service for the liver isoenzyme cytochrome P450 2C19. PARTICIPANTS 18 patients taking clopidogrel, a drug metabolized by CYP2C19. MAIN OUTCOME MEASURES Rate of patient participation, rate of prescriber acceptance of pharmacist recommendation, time to perform genetic testing service, and number of claims submitted to and paid by insurance. RESULTS Of 41 patients taking clopidogrel and meeting project criteria, 18 (43.9%) enrolled and completed testing and interpretation of pharmacogenomic results. The mean time pharmacists spent completing all stages of the project with each participant was 76.6 minutes. The mean time to complete participation in the project (time between person's first and second visit) was 30.1 days. Nine patients had wild-type alleles, and pharmacists recommended continuation of therapy as ordered. Genetic variants were found in the other nine patients, and all pharmacist recommendations for modifications in therapy were ultimately accepted by prescribers. Overall, 17 patients consented to filing of reimbursement claims with their insurers. Five were not able to be billed due to submission difficulties. Of the remaining 12, none was paid. CONCLUSION A pharmacogenomics service can be an extension of medication therapy management services in a community pharmacy. Prescribers are receptive to having community pharmacists conduct pharmacogenomics testing, but reimbursement is a challenge.

Making pharmacogenetic testing a reality in a community pharmacy.

OBJECTIVE: To provide information for community pharmacies considering implementation of a pharmacogenetic testing service. SETTING: A single community pharmacy from a regional chain. PRACTICE DESCRIPTION: Community pharmacists at the study site routinely provide pharmacy services including medication therapy management, immunizations, point-of-care testing, blood pressure monitoring, and diabetes education. The pharmacy is a training site for post-graduate year 1 and 2 community-pharmacy residents and for introductory and advanced pharmacy practice experience students. PRACTICE INNOVATION: Implementation of a pharmacogenetics testing service in a community pharmacy. MAIN OUTCOME MEASURES: Feasibility of offering a pharmacogenetics testing service in a community pharmacy. RESULTS: Study investigators identified several internal and external barriers to the community pharmacy when initiating a pharmacogenetics service. This article shares experiences of the study team and solutions to the identified barriers. CONCLUSION: Community pharmacies interested in providing pharmacogenetic testing can overcome barriers by identifying practice partners and planning appropriately.

Exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy.

AIM: To describe the exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy. An institutional review board-approved protocol for a clopidogrel pharmacogenetic program in a community pharmacy was developed to address feasibility and evaluate the pilot program. STUDY CONCEPT: Subjects taking clopidogrel are asked to participate at the point of medication dispensing. A pharmacist schedules an appointment with subjects to discuss the study and collects a buccal swab sample for CYP2C19 testing. When the results are available, the pharmacist consults with the subject's prescriber regarding test result interpretation and associated recommendations, and schedules a second appointment with the participant to discuss results and review any physician-approved therapeutic changes. The intervention-associated consultation is then billed to the subject's insurance. RESULTS: Subject enrollment has begun. CONCLUSION: Community pharmacists may be valuable partners in pharmacogenetics.

Retrospective analysis of community pharmacists' recommendations in the North Carolina Medicaid medication therapy management program.

OBJECTIVES: To determine the economic impact of cost-saving alternatives on prescription drug costs for the North Carolina Medicaid medication therapy management (MTM) program and to assess the acceptance of recommendations made by pharmacists to prescribers and the implementation of accepted recommendations. DESIGN: Retrospective analysis. SETTING: 92 Kerr Drug pharmacies in North Carolina from August 1, 2006, to July 31, 2007. PARTICIPANTS: 88 North Carolina Medicaid beneficiaries who received at least 12 prescriptions each month and who completed four quarterly medication reviews by a Kerr Drug pharmacist. INTERVENTION: Assessed recommendations made by Kerr Drug pharmacists. MAIN OUTCOME MEASURES: Rate of acceptance of pharmacist recommendations and overall economic impact of changing from brand-name medications to cost-saving alternatives. RESULTS: Acceptance rate of pharmacist recommendations ranged from 42% to 60%. The rate at which the pharmacists' accepted recommendations were implemented at Kerr Drug pharmacy ranged from 62% to 86% across the four quarterly reviews. Overall economic impact resulted in an average cost savings of $107 per beneficiary to North Carolina Medicaid per year. Quarterly economic impact results revealed that the highest impact occurred during the first quarterly review at $63 per beneficiary. CONCLUSION: Prescriber acceptance and pharmacy implementation of cost-savings alternatives provided an annual average cost savings of $9,444 to North Carolina Medicaid. After pharmacist reimbursement, this savings totaled $2,724.