Over the course of the year I’ve interviewed a number of pharmacists who have found ways to expand their practice beyond dispensing. One good example is the collaborative care program John Pugh, Pharm.D., established at his pharmacy, Prosperity Drug.
Pugh didn’t wake up one morning and say he was going to start a practice; there were a number of serendipitous events that led him to network with doctors and hospital administrators. In his article, “Pharmacy at the Center of Collaborative Care: A Case Study” in our July/August issue, Pugh shares what worked for him and how to apply a similar plan to your practice.
Here are some key take aways.
You may already have technology and workflow in play that supports a collaborative practice. For Prosperity, an idea that didn’t work out left the technology free for another use. Pugh had installed a Medicine-On-Time system to service an assisted-living facility, which then turned out not to be a good fit. With the automation installed, Pugh began offering packaging to at-home patients. Pugh learned a lot about medication reconciliation through filling the blister packs and found the med sync process meant his staff was talking with doctors about patients (in this case verifying the med list). This opened the door for pharmacy staff to ask for other clinical information, such as labs or drugs that patients tried and didn’t work, giving staff a full picture of the patient’s medication history. Pugh saw the value in sharing information and doctors quickly saw the benefit as well: Prosperity was offering a service by catching potential problems. Do you have relationships with doctors that you could expand?
Getting connected to the health-care environment outside the pharmacy is easier than it may seem. You probably have doctors you can call and talk about patients and ask for more clinical information or you can setup the program and then let doctors know you’re offering the service. Also, if there are smaller hospitals in your area, talk to the IT department or appropriate administrators. In Pugh’s case he knew an IT administrator at the local hospital. Hospital admin saw the benefits to continue its low readmissions rates and wanted to make the process as easy as possible. Through discussions about communication, Pugh learned the pharmacy could connect with the hospital IT through South Caroline’s HIE (SCHIEx), increasing the reliability of patient information moving from hospital system to pharmacy on demand. The SCHIEx allows staff to check other information, such as patient weight or renal functions in elderly patients, all good indications for pharmacy staff to review medications fit with the current health profile of the patient. Are you aware of HIE networks in your state?
Even in a busy pharmacy you probably already have the tools you need to track and manage patient profiles and interactions. For example, in Pugh’s QS/1 system, staff uses outcomes notes to document interactions and patient history. They also set triggers that alert staff when action is needed – if there is a script from a doctor associated with a hospital that would indicate a recent discharge, for example. (Read Property’s Triggers) This gives staff the opportunity to call the primary care doctor and let him or her know there is a new medication on the list and make recommendations based on the patients full medication profile. Doctors start to notice pretty quickly the pharmacy is leveraging its expertise. Doctors and hospitals are concerned about adherence with new emphasis on quality indicators — your pharmacy has a solution through a collaborative practice. Pugh says it well “We have to ensure we’re going out there and coming up with innovative ideas and practicing at the top of our license. We don’t want to miss the opportunity just because we haven’t done it that way before.”
Do you have questions about setting up a collaborative practice? Or have you started and practice and want to share what you learned? We’d love to hear what worked for you, including the business planning and technology that supported the program.