Determining essential elements and functionalities for a patient record system in community pharmacy.

BACKGROUND: As community-based pharmacy continues to evolve from a focus on product distribution to a practice focused on patient care, a key requirement is for pharmacists to document their patient care activities. Some community-based pharmacies are working to routinely use the Pharmacist eCare Plan standard in documenting their new care activities. OBJECTIVES: With the need for a robust patient record in community-based pharmacies, the purpose of this study was to identify key elements and functionalities for a community-based pharmacy patient record. METHODS: An expert panel of 26 individuals participated in 3 rounds of surveys using an online Delphi method to develop consensus about the key data elements and functionalities for a pharmacy patient record system. RESULTS: A total of 46 items reached consensus: 16 as essential elements for a longitudinal pharmacy patient record, 7 as essential elements for a patient encounter, and 23 functionalities for a pharmacy patient record system. A rubric was developed to assess community-based pharmacy patient record systems. CONCLUSION: The functionalities can support pharmacists in fully adopting a standard care process and providing and documenting patient care, while coordinating and improving communication with patients, providers, and payers. Pharmacists are encouraged to use the rubric in evaluating software for their practices.

Implementation of a community pharmacy workflow process to identify and follow up with prescription abandonment.

OBJECTIVES: To describe a workflow process that uses members of the pharmacy staff to identify prescription abandonment and resolve barriers that contribute to medication nonadherence. SETTING: Independent community pharmacy in the southeastern United States. PRACTICE DESCRIPTION: Each of the 6 Moose Pharmacy locations provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication reviews, disease state management programs, point-of-care testing, and compounding. PRACTICE INNOVATION: A workflow process, including a conversation flowchart and will-call bag tag, were created to support prescription abandonment discussions. Patients were included if at least 1 refilled or newly authorized prescription was not picked up within 7 days of the medication being filled. Patients younger than 18 years and as-needed prescriptions were excluded. EVALUATION: During the 60-day study period, 73 patients met the criteria of having an abandoned prescription; 124 total prescriptions were identified as abandoned. The barriers to adherence identified with these patients were 32% forgotten, 18% cost, 11% transportation, 4% refusal, 16% other responses, and 19% of patients who were not able to be reached. After the process was completed, 56 patients (76.7%) received their medications. The average time to pick-up for subsequent successful contact was 3 days. Of the 73 patients, 15 (20.5%) were already enrolled in the medication synchronization program. With the use of a conversation flowchart, 2 additional patients were enrolled in the pharmacy's medication adherence program and 8 others were enrolled in the automatic notification program when prescriptions are filled. CONCLUSION: A workflow process such as the one used in this study can help to identify barriers contributing to prescription abandonment. Through this process, the pharmacy learned that educating all staff members regarding the workflow may help to expand interventions to curtail prescription abandonment and address medication adherence.

Financial impact of patients enrolled in a medication adherence program at an independent community pharmacy.

OBJECTIVES: To determine the financial impact of attributed patients enrolled in a medication adherence program at Community Pharmacy Enhanced Services Network (CPESN) pharmacies. SETTING: Five independently owned Moose Pharmacy locations in rural North Carolina, which are CPESN pharmacies. PRACTICE DESCRIPTION: Moose Pharmacy has a longstanding history of innovative change. Each Moose Pharmacy location provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication review, disease state management programs, point-of-care testing, and compounding. PRACTICE INNOVATION: Certain CPESN pharmacies, including Moose Pharmacy, were attributed complex Medicare or Medicaid patients having at least 1 chronic medication and at least 80% of medications filled at a CPESN pharmacy. Patients were included if they were attributed to a study location and enrolled in the Moose Medication Adherence Program (MooseMAP) for more than 12 months. Patients were excluded if they were younger than 18 years of age or had less than 12 months of prescription fill data. Reviewed data included patient demographics, chronic and acute medications, immunizations, MooseMAP type, number of chronic medication prescribers, chronic medication class, payer, and patient health risk indicators. Yearly profit for prescriptions filled was determined per patient. Independent-samples t test was used to assess data. EVALUATION: Yearly profit per prescription was $10.35 for combined chronic, acute, and immunization prescriptions, $10.57 for chronic prescriptions, $26.95 for acute prescriptions, and $27.69 for immunizations. Mean profit for strip packaging was $1561.82 per year compared with $1208.01 per year with bottles (P = 0.021). There was a positive correlation between profit and number of prescriptions filled per 12 months (r = 0.56; P < 0.001), number of medication classes (r = 0.27; P < 0.001), and higher-risk indicator scores (r = 0.21; P < 0.001). CONCLUSION: Enrolling complex patients in a medication adherence program can benefit community pharmacies, particularly CPESN pharmacies, through chronic medication fills and yearly profit. Greater profit is generated when prescriptions are dispensed in strip packaging instead of bottles.