Expert: Medically Integrated Pharmacies Offer Collaboration, Effective Patient Care

In an interview with Pharmacy Times, Neal Dave, PharmD, executive director of pharmacy services at Texas Oncology, discussed the benefits of medically integrated pharmacies for both patients and pharmacists. In addition to streamlining and strengthening patient care, Dave said working in a medically integrated pharmacy can be incredibly rewarding for pharmacists.

Q: How can medically integrated dispensing pharmacies benefit patient outcomes?

Neal Dave, PharmD: It's an important question. Medically integrated pharmacies are truly an integrated team. So, you have a physician, a nurse, and a nurse practitioner or physician’s assistant, and a pharmacist, the business office, social worker—you have the whole team that's working on behalf of the patient. And we share the same EMR record, so whatever information I have from the patient, from the pharmacy perspective, I enter that in whatever interaction I've had, and that is seen by everybody on the care team. And so that really helps facilitate patient care, and just makes it a little bit more efficient. The patient is not having to repeat everything that they're saying, or if they're suffering from a side effect, they're not having to explain that side effect over and over again, depending on who they're talking to.

I mean, if you look at even at the basic level, patients starting or getting their medication, in our medically integrated pharmacy, we've looked at abandonment rate, and it's, I mean, near non-existent. At the most basic level, patients are getting their medication every time it's prescribed. And there was a study a few years ago that was looking at medications and abandonment rate. When you're looking at a medically integrated pharmacy, when prescriptions are going outside of [a medically integrated pharmacy], and it was as high as 50% or close to 50% when the copay was $2,000. That's a lot of the medications that we dispense. And even at a $10 copay, it was still at 10%. And we're way [below that]—I mean, it's almost non-existent. We actually don't have an abandonment rate. Whenever a patient is seeing a physician and gets prescribed a drug, almost always we're dispensing that drug every time. There are barriers that affect that. We did a report recently where we internally looked at this, [and] we're right at around 3% abandonment, but that's not necessarily pharmacy abandonment. That's a patient coming to the doctor, a prescription coming to a pharmacy, and the patient, even though we have outreach to that patient, they've left the practice as a whole. So, they've gone somewhere else, and we've lost a line of sight into what's going on with that patient.

Q: What do pharmacists need to know about medically integrated pharmacies?

Neal Dave, PharmD: If you don't know what a medically integrated pharmacy is, I would say it is—and this is obviously my opinion, but a lot of people do share this—it's an ideal place to work as a pharmacist in practice. Whatever you learn in school about how a medical team operates with a physician, a pharmacist, a nurse, a nurse practitioner, that actually happens multiple times in a day, every single day [in a medically integrated pharmacy] while we're taking care of the same patient. Whether it's a question about what regimen, the patient’s not doing well on this regimen, what would be the next course of therapy, to a patient needs financial assistance, to coordinating what antibiotic to give this patient that's having neutropenic fever. All this is happening with coordination with the care team and the pharmacist is involved in all of this. It's a great mixture of different settings of pharmacy that exists, like you have a community or a hospital or maybe even like a pharmacist that rounds on the floors. It's a mixture of all of that all into one and it's just amazing how it works and how you interact.