Incorporating medication therapy management into community pharmacy workflows.

Medication Therapy Management (MTM) is a group of pharmacist-provided services that optimize individual patients' drug therapy outcomes. Since community pharmacies' primary business platform is the dispensing of medications, and providing MTM services is a secondary source of revenue, pharmacies with limited resources are operationally challenged when trying to efficiently deliver both types of services. To address this problem, we follow a queueing network approach to develop an operational model of a community pharmacy workflow. Through our model, we derive structural results to determine conditions for a pharmacy to achieve economies of scope when providing both prescription and MTM services. We also develop a process simulation to compare different scenarios according to our economies of scope model, varying in provided services, personnel, service demand, and other operational variables. Outcomes examined include profitability, service rate, and sensitivity of some operation variables to profitability. Based on our results, we provide practical insights to help community pharmacy administrators and healthcare policy makers in their decision process.

Prescription drug monitoring programs in community pharmacy: An exploration of pharmacist time requirements and labor cost.

OBJECTIVE: To (1) measure the average time community pharmacists require to query prescription drug monitoring program (PDMP) reports, and (2) estimate pharmacist labor costs associated with PDMP use. DESIGN: This exploratory project consisted of an observational time study followed by analysis of existing PDMP data sets. Data collected included time spent by pharmacists in Final Verification of controlled substance prescriptions (CSPs), and whether or not they queried the PDMP. Zip code level PDMP query rates and prescription volume of opioid and benzodiazepines (O&BZD) were linked to time-study results to calculate cost estimates of pharmacist labor. SETTING AND PARTICIPANTS: Community pharmacists in Connecticut were observed and timed in their usual pharmacy setting as they verified CSPs. Deidentified PDMP data were obtained from the Connecticut Prescription Monitoring and Reporting System. OUTCOME MEASURES: (1) The time required by community pharmacists to query their PDMP in prescription filling workflow, and (2) the estimated labor costs associated with variable PDMP utilization rates. RESULTS: Between November 2018 and January 2019, 9 pharmacists in 4 independent community pharmacies were observed verifying 53 CSPs. Pharmacists spent more time verifying CSPs when they queried the PDMP versus when they did not query the PDMP (106 ± 66 seconds vs. 28 ± 27 seconds; p < 0.01). Between June 2016 and May 2017, community pharmacists in 24 community pharmacies in 4 represented zip codes queried the PDMP for 11% (n = 19,074) of CSPs dispensed, costing an estimated $24,769 in pharmacist labor. To meet a 100% PDMP query rate for O&BZDs alone, an additional 3735 hours of pharmacist labor ($224,100) would be required. CONCLUSION: Pharmacists require considerably more time to verify CSPs when they query PDMPs. This extra time requirement may challenge community pharmacy operating costs, and also impose time pressures on community pharmacists.

Three opportunities for standardization: A literature review of the variation among pharmacists' patient care services terminology.

BACKGROUND: Variation describing pharmacists' patient care services exist, and this variation contributes to the prevalent misunderstanding of pharmacists' roles. In contrast, standard phraseology is a critical practice among highly reliable organizations and a way to reduce variation and confusion. OBJECTIVE: This work aims to identify and define pharmacists' patient care service terms to identify redundancies and opportunities for standardization. METHODS: Between May to August 2018, terms and definitions were searched via PubMed, Google Scholar and statements/policies of professional pharmacy organizations. Two references per term were sought to provide an "early definition" and a "contemporary definition." Only literature published in English was included, and data gathered from each citation included the date published, the term's definition, and characterization of the reference's source as either a regulatory or professional body. A five-person expert panel used an iterative technique to revise and verify the list of included terms and subsequent literature review results. Terms were then searched in the National Library of Medicine's Medical Subject Heading Database (MeSH) in July, 2019. RESULTS: There are fifteen commonly misunderstood terms that refer to the patient care services provided by pharmacists. The appearance of these terms in the literature spanned nearly five decades. Nearly half of terms appeared first in regulatory, law or policy documents; of these, two terms had contemporary definitions appearing in the professional literature that differed from their early regulatory definition. Three opportunities to improve standardization include: (1) Implementation of standardized phraseology systems similar to nursing's Clinical Care Classification System; (2) Academics' adherence to standardized MeSH terms; and (3) Clarification of pharmacy education accreditation standards. CONCLUSION: Numerous terms are used to describe pharmacists' patient care services, with many definitions of terms overlapping in several key components. The profession has made concerted efforts to consolidate and standardize terminology in the past, but more opportunities exist.