Enactment of mandatory pharmacy technician certification in Kansas

This article discussed the process and accomplishment of an enactment of mandatory pharmacy technician certification in Kansas. In 2004, Kansas began the step in requiring registration of all pharmacy technicians. These technicians were required to register, however they did not require any certification. Later, on September 2012, the Kansas Board of Pharmacy created a task force to research practices of technician certification in other states and to make recommendations to the board of pharmacy on how to create mandatory technician certification. This task force then formed the steps needed to achieve the legislation to support mandatory technician certification. These recommendations were then finalized at the August 2013 Kansas Pharmacy Summit and proposed legislation was then passed during the 2014 session. This legislation outlined topics such as training requirements, age and education requirements, pharmacist to technician ratio, and more.

Pharmacists are not able to provide everything that a patient in a community setting will want. That is why having pharmacy technicians is important within the community field. As of now the state of Pennsylvania has a certification that is available for people interested in becoming a pharmacy technician, however this is not required. Along with this, there are no strict guidelines for being a pharmacy technician. These guidelines and requirements might make a positive impact on work conducted within a community setting. Having a more regular and monitored assistant position within a community pharmacy might also improve patient care and reduce the risk of mistakes.

Lucas A.. Massey L., Gill T., et al. Enactment of mandatory pharmacy technician certification in Kansas. Am J Health Syst Pharm. 2016; 73: 133-36

Pharmacists Home Visits: A 1-Year Experience from a Community Pharmacy

Pharmacists are increasingly becoming more involved as part of a medical team to provide direct care to patients. Most of these patient care services are focused in the clinical setting, however, and there is a greater opportunity for pharmacists in a community setting to make an impact on patient care. An independent community pharmacy in Buffalo, NY conducted a one year study in providing home visits that they felt could truly benefit the patients who utilized this service. They observed the overall costs, limitations, benefits, and drawbacks on pharmacists in the community providing home visits.

Home visits were conducted for a variety of reasons including, but not limited to, medication therapy management, medication reconciliation, adherence monitoring or packaging,  management of medications by providing pillboxes and other organizational tools, medical device or disease state counseling, formulary management, and hospital transition. Patients were selected based on need by pharmacists, physicians, pharmacists, and caregivers. These visits were approximately 2 hours each, and the average age of participants was 70 years old. Nearly 200 home visits were conducted over the course of the year.

The study found that these visits enhanced medication adherence and patient understanding of medications and devices. Patients were satisfied with the service, and the value of community pharmacists taking more clinical roles was observed. However, the service was costly to the pharmacy (~$20,000), and in many busier pharmacies, this type of practice may be too time consuming to be a realistic option.

I found this study to be extremely interesting, because I think more community pharmacies should attempt to meet the needs of patients with innovative services like this. Although the service may be costly, the benefits to the patient could be invaluable. Community pharmacists have a wealth of knowledge that could benefit patients of all demographics, and the move towards providing more clinical services is a step in the right direction. I am interested to see ways in which pharmacy practice will continue to advance and allow more opportunities to provide direct care.

J Am Pharm Assoc. 2016:56:67-72.

http://www.japha.org/article/S1544-3191(15)00003-5/fulltext#sec1

TransitionRx: Impact of community pharmacy postdischarge medication therapy management on hospital readmission rate

It has been found that nearly 20% of Medicare patients are readmitted to the hospital within 30 days of discharge. This high incidence of readmission can lead to increased costs for Medicare and its beneficiaries.  Because of this, the Centers for Medicare and Medicaid Services have begun penalizing hospitals with readmission rates higher than the national average for a particular disease state by decreasing reimbursement back to the hospital. The leading cause for readmission of these patients was attributed to a medication-related problem. A study conducted in Ohio looked to determine the impact that pharmacist intervention can have when implemented during transition of care.

Kroger pharmacies partnered with two small community hospitals in the Cincinnati area for patient referral as part of the TransitionRx program. At the time of hospital discharge, nurses counseled the patients on their medications with no input from pharmacists. Patients included in the study were aged 18 or older and diagnosed with either CHF, COPD, or pneumonia. Seven clinical pharmacists received training to provide MTM services with a special focus on counseling post-discharge patients. At the time of discharge, the hospitals faxed patient information, including discharge instruction and medications to the pharmacists at the designated Kroger locations. Pharmacists then made phone calls to these patients to schedule an in-person MTM session ideally within 3 days of discharge. During these appointments, the pharmacists provided a discussion of any changes in medication, a comprehensive medication review, and disease-state education, with a special focus on “red flags”. “Red flags” were defined as specific symptoms that patients could monitor for that could indicate their disease is deteriorating. Patients were provided with a personal medication record, health action plan, an appointment list, a self-monitoring log, if applicable, and a summary of the visit was sent to the patient’s physician. A follow-up was conducted via telephone.

90 patients participated in the study and 30 received the pharmacist intervention. Of the 60 patients that did not receive discharge counseling from a pharmacist, 20% were readmitted to the hospital within 30 days, while only 7% of patients in the intervention group were readmitted. Over 200 unique interventions were made by the pharmacists to the 30 patients that they saw, with 7 interventions per patient on average.

I enjoyed reading this article because the MTM sessions carried out by the pharmacists are extremely similar to what we have been learning to do in POP with standardized patients and with SilverScripts. It is encouraging to know that even as P1’s we are already preparing for our future careers and learning skills that will be essential to patient care in the future. Understanding Medicare STAR ratings and hospital reimbursements as the future of healthcare and realizing that patient health is the priority will help to develop a patient-centered approach as pharmacists. This article also highlights the need for pharmacists working with the interprofessional healthcare team and the benefits that can be provided. With just 7 participating pharmacists being able to identify over 200 drug therapy problems in 30 patients, the need for intervention is clear to see.

Reference:

J Am Pharm Assoc. 2015;55:246-254.

http://www.japha.org/article/S1544-3191(15)30055-8/pdf

Mobile App Features Sought by Patients of Giant Eagle

This purpose of this study was to gain information about what features patients look for in a mobile application for pharmacy services provided by Giant Eagle pharmacies. Giant Eagle has 218 locations across western Pennsylvania, West Virginia, Ohio, Maryland and Indiana. At the time of the study, the company had a mobile app for grocery service and a pharmacy services app in development that had not yet been launched. Services provided by Giant Eagle pharmacists include providing medication therapy management (MTM), immunizations, counseling on specialty medications and diabetes self-management.

Participant interviews for the study took place at 5 different Giant Eagle pharmacies in Pittsburgh, PA. Eligible participants included patients older than 35 years old who use and own a smartphone on a daily basis. They also had to have received a prescription from the pharmacy on a monthly basis to be eligible. Participants were recruited to the study at the pharmacy counter when they dropped off or picked up prescriptions. Before the interview about preferred features in a mobile app, demographic information was collected. A total of 24 interviews were conducted with participants at the different locations. All participants interviewed stated a need for an app to be “user friendly,” meaning an app that requires few steps to reach a certain function. There were a few different themes for an app that participants desired. The first theme being an app meant to foster an improved and convenient pharmacy experience. The second theme described features designed to help patients with self-management of their medications. The third theme involves features to increase timely and personalized access to pharmacists.

This study showed that patients desire more information from a mobile app for convenience and ease of access. This could have a positive impact on the workflow for pharmacists. An app that provides patients with comprehensive services, medication lists, and drug and disease state information could reduce the frequency of patient calls for simple requests. By reducing the number of phone calls for simple requests such as drug identification questions or checking on checking if an order is ready, pharmacists would have more time to focus on patient care services like MTM. Patients expressed that they want an app that makes it easy to communicate to a pharmacists via instant messaging, video chat, or email. This could improve patient outcomes, as it has been demonstrated before that outcomes improve when pharmacists interact directly with patients. Overall, the study showed that patient desires should be considered when creating a mobile pharmacy app. This study could be helpful for community pharmacies across the country when they design mobile applications.

McCartney E, Bacci JL, Ossman KL, et al. Mobile application features sought after by patients of a regional grocery store chain pharmacy. J Am Pharm Assoc. 2016;56(1):62-66.

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness

This study was designed to examine the effectiveness of a collaborative agreement between physicians and community pharmacists to treat influenza-like illness (ILI). Every year in the US, there are at least 48,000 deaths and 226,000 hospitalizations resulting from influenza. Normally neuraminidase inhibitors are used to treat it by preventing the cleavage of virions from infected cells, therefore halting the spread of the virus within the body. However, this does not eradiate the virus. Studies found that early detection of the disease if critical to achieving optimal outcomes for treatment, but this is challenging. Many people use OTC products to alleviate symptoms instead of seeking immediate medical attention, delaying actual treatment of the infection. When patients come into the pharmacy to obtain OTC products, this is an opportunity for pharmacist intervention. A study conducted during the 2007-2008 and 2008-2009 flu seasons found that a pharmacist-physician collaborative program resulted in more immediate identification and treatment for patients with ILI. This study conducted from October 2013 to May 2014 and examined clinical outcomes and healthcare utilizations.

The study took place across fifty-five pharmacies in Michigan, Minnesota, and Nebraska. The pharmacists screened adult patients that came to pharmacies presenting symptoms of ILI. Then, they carried point-of-care rapid influenza diagnostic test (RIDT), completed a brief physical examination, and provided a corresponding treatment or referral through an established collaborative practice agreement (CPA) with a local licensed prescriber. After the encounter, pharmacists followed up 24 to 48 hours afterwards with the patient to assess their status and if any further intervention is needed. The outcomes measured were the number of patients screened, tested, and treated for ILI.

There were 121 patients screened overall. Of these patients, 75 were eligible for participation, and 8 had a positive RIDT and were managed accordingly. Of the tested patients 38.7% visited a pharmacist outside of normal office hours and 34.6% did not have a primary care physician. Just 3% said they felt worse at the follow-up. This study found that using a CPA enabled pharmacists to provide timely treatment to patients with and without influenza. One limitation of this study is that it did not use confirmatory testing of the RIDT results. Therefore, there was a possibility that patients were misclassified of having or not having influenza. This study demonstrated that the improved performance of CLIA-waved RIDTs and increased clinical training for pharmacists have made an opportunity for pharmacists and physicians to use a CPA to improve early detected and treatment for patients with influenza. Overall, a CPA could improve the number of patients visiting a physician for causes that only require management of symptoms. If more studies regarding this topic are conducted, hopefully this will lead to better management of patients presenting ILI.

Klepser ME, Klepser DG, Dering-Anderson AM, et al. Effectiveness of pharmacist-physician collaborative program to manage influenza-like illness. J Am Pharm Assoc. 2016;56(1):14-21.

Blood Pressure kiosks for medication therapy management programs

For one month, the total revenue collected by using blood pressure kiosks was generated and measured to identify how valuable kiosks could be in identifying hypertensive patients. Studies currently show that hypertension affects twenty to thirty percent of North American adults, and one-half of this hypertensive population remain uncontrolled. Uncontrolled hypertension leads to many adverse effects, some of which include heart failure, myocardial infarction, and stroke. By implementing blood pressure kiosks, patients may more easily obtain their blood pressure readings, and therefore find help from pharmacists if deemed necessary.

From this study, researchers concluded that on average, 189 hypertensive patients per month would qualify for a drug review and patient consult with a pharmacist. These reviews and consults would qualify for revenue collected. Overall, more than 7.5 million readings from 341 pharmacies were taken on the blood pressure kiosks. Through calculations, researchers determined by pharmacies could collect an average of $12,270 annually in revenue from MTM services provided to patients who discovered their hypertension. It is evident that blood pressure kiosks are very valuable in a pharmaceutical setting.

I found this article interesting because I myself have used a similar kiosk at a local pharmacy. Although I had already known that I was not hypertensive and I was merely just playing with the technology, I did wonder how beneficial the kiosk was to the company that I was in. From this study, I have no doubt implementing a blood pressure kiosk can help pharmacists generate more patients, thereby providing the assistance and improving patient outcomes.

 

Houle SK, Chuck AW, Tsuyuki RT. Blood pressure kiosks for medication therapy management programs: Business opportunity for pharmacists.. J Am Pharm Assoc. 2003;52:188-194.

http://japha.org/article.aspx?articleid=1044014#Methods