Smart Bottles: Implementation Considerations

In past articles, some of the leading smart bottle products and their features were covered. Now, we will turn to considerations for implementing a smart bottle offering in your pharmacy. It may seem like a simple 'use the smart bottle instead of a regular bottle' process, but there a many variables, processes, and protocols to consider before going live with a smart bottle offering.

We will group these considerations under the headings of pre- and post-implementation, and start with pre-implementation in this article. Pre-implementation considerations include decisions to be made before going live, such as who will fund the cost of the smart bottle program and how will staff be trained. There are also decisions around recruitment and distribution of bottles to participating patients.

Funding

The first step to take before implementing a smart bottle offering at your pharmacy is to determine how it will be funded. Being new technology, these bottles are relatively expensive. If only bottle cost and the return on investment from increased medication adherence were considered, we would likely conclude that the offering comes at a loss. Furthermore, because these bottles can range from $75 to $200 per patient, per month (which may not include the supporting software costs), the pharmacy’s drug margins alone probably will not support a smart bottle program.

Today, most programs are set up as 3-party arrangements involving the pharmacy, the bottle company, and pharma, for 1 specific drug. This arrangement, for the right drug, becomes a win-win-win situation; pharma gets novel patient medication-taking behavior data, the bottle company gets business, and the pharmacy can demonstrate its progressiveness. All 3 parties also see benefits from bolstered patient adherence.

In considering how your program may be funded, be aware that the arrangement between pharma, pharmacy, and bottle company can vary. In some cases the bottle company may have a relationship with the pharma company, and the bottle company sets up agreements with 1 or more pharmacies to supply the patients. In other cases, pharma may approach the pharmacy about getting involved in a smart bottle program. And last, the pharmacy may try to gain pharma’s support in offering a bottle program for their drug. In all these scenarios, all 3 stakeholders may work together simultaneously, or there may be 2 sets of negotiations taking place.

Patient Inclusion

When we get to patient enrollment, 2 important areas to consider are what patients are offered with the smart bottle program and how, if at all, does your software system facilitate the process. In some arrangements, patient inclusion and exclusion criteria may already be set for you (e.g., you are one of many pharmacies recruiting patients into a bottle company’s program for a specific drug). In other cases, you will get to set the inclusion or exclusion criteria independently or collaboratively with another stakeholder. If you are able to have a hand in setting this criteria, it can be helpful to run historical reports to understand how many patients might qualify. This is important because the number of patients you recruit and manage within the program will impact your staff’s time involved.

Some specific questions to consider around patient inclusion, include:

• Will your smart bottle program be for new patients, refilling patients, or both?
• Will patients have to be of a certain age or geographic location?
• Are there certain regimens not compatible, such as multidose regimens?
• Does the patient have to possess a certain diagnosis?
• Will you target patients at risk for poor adherence, such as those with a history of late refills?

Once you’ve set your inclusion criteria, it has to be conveyed to your staff communicating with patients. The simplest and lowest-cost means of doing this is to provide a paper checklist; however, that may not be practical for larger programs, and can even result in missed opportunities as staff has to remember to reference that checklist when interacting with potential candidates. This is where using your pharmacy system could be helpful. Depending on the level of control you have of your patient care software, it may be advisable to implement a reminder or even a questionnaire based on patient characteristics that serves as a reminder to your staff to screen patients and offer the program if they qualify. Integration of this questionnaire can also help with data collection, and, if you’re working with a bottle company with an application programming interface (API), you could even pass patient data from your system to theirs, streamlining enrollment and minimizing transcription errors. When it comes to system integration, while it is nice to have, it will come at a cost. Be sure to factor that into your program budget.

Training

Training is important when providing a new smart bottle service. First, you don’t want to mess up what is reaching the patient. Second, you don’t want staff not being familiar with the project, and your pharmacy appearing disorganized to your patients. So training is necessary, but who should be trained? The answer to this will depend on the breadth of your patient population. If you’re expecting hundreds of patients to be involved, more of your staff needs to be trained on the offering. Of course, training requires time and money, so you do not want to pull everyone from their daily duties if it can be avoided. Instead, a starting point would be to ensure all patient-facing staff are aware of the program and know to whom to direct questions. Beyond that, your training decisions are related to the live trainings:

• What training content is used; is everyone training on everything, or do you train 1 group on enrollment, 1 group on bottle set up, and 1 group on interventions?
• Where does training take place? Does your pharmacy have more than 1 distribution site? Will all sites distribute the smart bottle?
• How will training be provided? Do you have an internal training department or will you be leveraging the bottle company’s trainers?

And last, and probably the most important aspect of training is providing an explanation to staff as to why a smart bottle program is being offered at your pharmacy. If possible, staff should also be involved in the project planning phase. Providing this engagement and context will greatly contribute to their buy-in and the success of the program.

Hopefully, these 3 areas of consideration will help you and your staff as you determine how to implement a smart bottle offering at your pharmacy.