Enhanced Community Pharmacy Services Lead To Better Outcomes For Patients

The Community Pharmacy Foundation (CPF) recently sponsored a study entitled, “Evaluation Of Enhanced Community Pharmacy Services.” Research was done 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 pharmacy services were carried out by John Pugh, PharmD, and Carmen Monts, PharmD, at Prosperity Drug in Prosperity, South Carolina.

The primary objective of this study was to evaluate the impact of enhanced community pharmacy services on clinical and economic outcomes, and the secondary objective was to evaluate the impact of a value-based payment model for a community pharmacy that offers these services.

The study used data from January 1, 2017 to December 31, 2017, and looked at 1725 insured patients (1003 in the matched comparison group and 722 in the expanded services group). The control group was selected from independent pharmacies not offering enhanced services during the study period. Patient demographic information, health care utilization, and cost were collected from paid claims.

John Pugh, PharmD, owner of Prosperity Drug in Prosperity, South Carolina, helped to carry out the enhanced services for the study. Several years ago, at a SCPhA meeting, he met with Fabel and Reeder, where they collaborated on ideas and decided to contact CPF for a potential grant to study pharmacy enhanced services.

“We knew in Iowa, Randy McDonough, BS, PharmD, MS, CGP, BCPS, FAPhA, (also a CPF grantee) demonstrated cost savings with enhanced services. We were curious as to whether or not our enhanced services would provide a cost savings to both the medical and pharmacy benefit,” Pugh reflected.

Pugh outlined the enhanced services offered at Prosperity Drug, which have always been and are still offered, regardless of the study:

• Obtaining future refills: working ahead with the patient on the last refill to ensure the physician is contacted for more refills, or to make sure the patient has an appointment scheduled.
• Delivery
• Blister Packing
• Immunization
• 24/7 access to an on-call pharmacist that a patient can call with 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 physicians for an accurate medication list. If we are going to fill a patient’s medications every month, I want to make sure we are filling the correct medications.”

Pugh said that he is fortunate to have adequate staffing in order to provide these services. Carmen Monts, PharmD, winner of the 2018 Excellence in Innovation Award by the SCPhA, provides many of the services to Prosperity Drug Patients.

Working together, the pharmacists and techs provide care to the patients seamlessly. “The pharmacists do the thinking behind the medication reconciliation, but the technicians take a very active role as well.” For example, a technician may reach out to a patient to check on his/her medications, remind the patient to pick up medications, and ask when the patient has an upcoming appointment.

The data showed that enhanced pharmacy services reduced prescription utilization (14%) and medical costs (15.6%), which could result in a significant return on investment. However, more 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 “all about developing patient relationships. We talk with them, make sure we help them with their needs. As my colleague, Joe Moose, PharmD, says, ‘some patients need a prescription and some patients need a pharmacist.’”

Pugh is proud that “our practice helps select those patients who really need a pharmacist. We try to provide an experience for patients where the pharmacy experience is as professional as the physician experience. Patients talk to us, trust us, feel like they can call us - we are in the business of prevention.”

Although the data collection is over, Pugh said, “this offering of services is normal practice for us, we keep on doing what we do. We are always trying to think of new ways to take care of patients, and keep figuring out how to keep patients out of the hospital, or prevent readmissions.” He points to transitions of care as a potential place for pharmacists to get involved.

“At the end of the day, it’s about taking care of the patients,” Pugh said. “They have to trust and feel comfortable with the pharmacy staff for all of these enhanced services to be meaningful.”

Pugh recognizes that enhanced pharmacy services are a great niche for independent pharmacies because of the staffing situation. “You have to be able to staff appropriately to be able to provide these services,” Pugh said. “In our pharmacy, the philosophy is taking care of the patient. If you take care of the patient, the money will take care of itself. The goal must be to provide the best care and as much care as you can for the patient.” Pugh employs a long-term approach to taking care of patients “like we would take care of our family members.”

“We have to show value and demonstrate services. If we can show that we are saving on medical costs, this is an opportunity for an insurer to invest more in pharmacy services so ultimately these become paid services,” Pugh said. At the end of the day, Pugh’s call to action is to 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 community pharmacy practice and patient care delivery through grant funding and resource sharing.