Community Pharmacy: Landscape, Operations, Team Roles (9)

Attributes and value provided by the apothecary role

provide expertise, know how to prepare compounds, be able to use natural products and give advice

Attributes and value provided by the dispenser role

gatekeeper, provide drugs accurately according to prescription

Attributes and value provided by the clinician role

make sure patients take medications safely, optimize drug therapy

Aspects of the apothecary role remaining in community practice today

compounding, give advice on OTCs and dietary supplements

Aspects of the dispenser role remaining in community practice today

accurate, safe, legal medication distribution

Aspects of the clinician role remaining in community practice today

ensuring dispensed medications are appropriate, manager role

What is the job of a pharmacist according to the "pharmaceutical care" philosophy of Hepler & Strand?

to focus on optimizing drug therapy to prevent, detect and resolve DRPs/MRPs/DTPs

What was the importance of the Asheville Project?

demonstrates a community pharmacist's impact on diabetes care

What was the importance of RADM Giberson's 2011 Report to Surgeon General: "Improving Patient and Health System Outcomes through Advanced Pharmacy Practice" & Avalere Report: "Exploring Pharmacists' Role in a Changing Healthcare Environment" ?

outlining evidence that pharmacists improve outcomes

advocates for pharmacists’ reimmbursements for their time

What are the common locations of Community-based pharmacy practice according to the APhA definition?

- Chain/independent pharmacies

- Hospital based outpatient clinics/pharmacies

- Physician offices

- Free clinics

- Federally qualified health centers

- Nursing homes

- Telehealth

- Houses of worship

- Barber shops

- Community health events

What are the 4 tenets of community-based pharmacist practitioners?

providers of direct patient care

creating, advancing, and influencing team-based care

enhance management of community-based pharmacy practices

serving as leaders

____% of Americans live within __ miles of a community pharmacy

88.9%, 5 miles

Medicare beneficiares in 2016 had median ____ community pharmacy visits vs. ____ primary care encounters

- 13 community pharmacy visits

- 7 primary care encounters

Are there more locations of chains or independent pharmacies?

chains

How many pharmacies constitute a chain according to NACDS?

4 or more locations

What are examples of traditional chains?

cvs, walgreens, rite Aid

What are examples of supermarket/grocery store chains?

kroger, giant eagle, weis, wegmans

What are examples of mass merchant chains?

walmart, sam’s, costco, meijer

How many locations can an independent pharmacy have?

standalone or multiple locations

What are independent franchise examples?

medicine shoppe, medicap, health mart, good neighbor

What does it mean to be apart of a franchise?

company sells their name and business model to a local owner to operate under

What are examples of health-system outpatient pharmacies?

transitions of care, employee health visits

What does NACDS stand for?

national association of chain drug stores

What does NCPA stand for?

national community pharmacists association

What does ASHP stand for?

american society of health-system pharmacists

What are CPESN USA and PPCN and what do they do on behalf of member pharmacies?

- Pharmacy enhanced service networks

- A clinically integrated network

- Made of pharmacies that provide enhanced services that transcend conventional medication dispensing and improve the health of patients

- Groups together participating pharmacies to pursue payor contracts for enhanced services nationally

What are the steps of a typical community pharmacy workflow?

- 1. Intake, data entry, billing

- 2. Label generation

- 3. Filling

- 4. Final check/PDR/DTP resolution

- 5. Will call

- 6. Checkout and counseling

- 7. Patient leaves with follow up plan

What steps of a typical community pharmacy workflow align with the PPCP?

- 1. Intake, data entry, and billing align with "collect"

- 4. Final check/PDR align with "implement, " DTP resolution aligns with "plan"

- 6. Checkout and counseling align with "implement"

- 7. Patient leaves with a follow up plan aligns with "follow up, monitor and evaluate"

What do community pharmacy teams do daily?

self-care consults, patient and hcp questions, management and leadership

- Patient and HCP questions

- Management and leadership

What is involved in management and leadership tasks?

staff training and supervision, compliance, inventory

What is involved in inventory tasks?

placing and receiving orders, meeting needs without overstock, obtaining medications at the best price, checking for outdates

What is medication synchronization?

aligning all medications to be filled on the same date each month

Why is medication synchronization good for the patient?

- Convenience, reduced access barriers to adherence

- Pharmacy-driven refill process

Why is medication synchronization good for the pharmacy?

efficiency of a single touchpoint

enhances inventory and staff planning

whole patient view while checking maintenance medications

monthly "appointment" -> adherence monitoring

What is screenings performed by the pharmacy?

SDoH screenings and referrals

non-medical things in their health

What is point of care testing?

trying to diagnose acute illnesses/monitor chronic diseases

What is pharmacogenomic testing?

test to identify certain genotypes that might affect how they handle a different drug

customize their drugs

What is compounding?

specific dosage forms patient may need

What is speciality integrations?

partnering with specialty pharmacies where specialty medications are delivered

the patient can pick them up at the pharmacy

What is adherence packaging?

sort patient medications by day and time to take them

What is comprehensive medication management?

- Medication therapy management (MTM)

-Making sure medications are appropriate, safe, and effective

What is disease state management/remote patient (physiologic or therapeutic) monitoring (RPM/RTM)?

Looking at a particular disease state and talking about things beyond medications to manage it

What is bedtime delivery/transitions of care?

Partnering with hospital so patients have medications before leaving/understand their medications

What is collaborative practice agreement?

Allows the pharmacist to take certain medication management actions on behalf of a collaborating physician

Some states permit pharmacist__________ of certain types of medications that relates to _____ _____ _______, which if regulated at the state level

prescribing, scope of practice

Types of responsibilities of clerks

- Register transactions at pick up

- Knowing when to refer to a pharmacist

- No direct interaction with prescription medication

Types of responsibilities of technicians

- Patient interaction, collecting information

- Data entry, product retrieval, and preparation

- PA: immunizing with training (13 years old+ flu and covid)

Types of responsibilities of interns

- tech functions +/- some pharmacist functions under supervision

- PA: taking phone prescriptions, immunization with additional training and authorization (8 years old+)

Types of responsibilities of pharmacists

clinical judgment or tasks reserved by law, team supervision/management, safety and compliance

What are the expanded roles for pharmacy technicians?

- Immunization administration

- Tech-check-tech/technician product verification (TPV)

- Point-of-care testing

- Support for patient care services

- Pursuing community health worker designation for techs or delivery drivers

Administrative support for patient care services

Scheduling, documentation, billing

Clinical Support for patient care services

Collecting histories, organizing information

Which states allow tech-check-tech/technician product verification (TPV)?

idaho, iowa, north dakota, tennessee, wisconsin

What would pursuing a community health worker designation for techs or delivery drivers entail?

Referring patients to resources that can help them