Economic viability of tech-check-tech in an independent community pharmacy.

OBJECTIVES: To determine the economic feasibility of implementing community pharmacy-based tech-check-tech compared with other common community pharmacy practice models. METHODS: A decision tree analysis compared 4 community pharmacy practice models: (1) historical (pharmacist or technician fills prescriptions and pharmacist gives immunizations); (2) historical with tech-check-tech (technician or certified technician fills prescriptions and pharmacist gives vaccinations); (3) modern (historical model plus medication therapy management [MTM] services); and (4) modern with tech-check-tech (modern model but a technician or certified technician handles all fills). A series of summed Markov models with a 1-year time horizon compared strategies on gross profit with the use of cycles of 1 hour of work attributed to either filling prescriptions, giving vaccinations, or conducting MTM. RESULTS: Based on current MTM volume, the splitting of pharmacist time across all services (modern model) was the most profitable strategy, resulting in approximately $1700 more than the next most profitable approach (historical model). Models incorporating tech-check-tech need significant time to be filled by MTM services, vaccinations, or other billable services to make up for the investment made into pharmacists' time. For these models, the likelihood of conducting a comprehensive medication review (CMR) in a given hour needs to exceed 47% for allocating all pharmacist time to nonfilling functions to be more profitable. Performing targeted medication reviews alone (without the chance of a CMR) was not sufficient to make tech-check-tech a profitable strategy. At the current inputs, billable services of exceeding approximately $18 and $20 per hour are needed for tech-check-tech to be the most profitable model with and without MTM services, respectively. CONCLUSION: Tech-check-tech implementation in the community setting has the potential to be profitable if pharmacist time is adequately scheduled with other billable services. Future research in this area should increase the number of pharmacies included and expand analyses to encompass chain-based community pharmacies.

Design of an automated staff scheduling system for an independent pharmacy.

BACKGROUND: In service industries, employee salaries and wages often constitute the largest portion of the costs to the company. This is very true in the case of an independent pharmacy, which employs pharmacists and pharmacy technicians. Thus, for pharmacies to cost effectively meet the increasing demand for pharmaceuticals, it is crucial that pharmacy managers efficiently allocate the pharmacy staff's time. METHOD: Through a case study, this paper demonstrates the use of an Excel VBA based on a mathematical model to schedule the staff of an independent pharmacy. The whole year data was used in this study. After collection of whole year's data, the number of prescriptions to be filled for each day by hour of hour of the day were sourced and classified. RESULTS: It is indicated that the pharmacy employees' time could be more efficiently assigned to meet the demand of the pharmacy. The benefit of modeling the pharmacy employees at this pharmacy is based on the data (the number of total prescriptions filled on Friday in March) with the following results; 12 h shifts are covered where one employee must be between 04:00-16:00, two employees between 06:00-18:00, one employee between 07:00-19:00 and one employee between 15:00-03:00. CONCLUSION: In this study a basic model was presented that can be used schedule pharmacy employees in an independent pharmacy and solved by Excel VBA. This model can be further extended to meet the needs of a specific pharmacy.

Comparison on Human Resource Requirement between Manual and Automated Dispensing Systems.

OBJECTIVE: This study was conducted to compare human resource requirement among manual, automated, and modified automated dispensing systems. METHODS: Data were collected from the pharmacy department at the 2100-bed university hospital (Siriraj Hospital, Bangkok, Thailand). Data regarding the duration of the medication distribution process were collected by using self-reported forms for 1 month. The data on the automated dispensing machine (ADM) system were obtained from 1 piloted inpatient ward, whereas those on the manual system were the average of other wards. Data on dispensing, returned unused medication, and stock management processes under the traditional manual system and the ADM system were from actual activities, whereas the modified ADM system was modeled. The full-time equivalent (FTE) of each model was estimated for comparison. RESULTS: The result showed that the manual system required 46.84 FTEs of pharmacists and 132.66 FTEs of pharmacy technicians. By adding pharmacist roles on screening and verification under the ADM system, the ADM system required 117.61 FTEs of pharmacists. Replacing counting and filling medication functions by ADM has decreased the number of pharmacy technicians to 55.38 FTEs. After the modified ADM system canceled the return unused medication process, FTEs requirement for pharmacists and pharmacy technicians decreased to 69.78 and 51.90 FTEs, respectively. CONCLUSIONS: The ADM system decreased the workload of pharmacy technicians, whereas it required more time from pharmacists. However, the increased workload of pharmacists was associated with more comprehensive patient care functions, which resulted from the redesigned work process.

A Time and Motion Study of Pharmacists and Pharmacy Technicians Obtaining Admission Medication Histories.

Pharmacists' admission medication histories (AMHs) are known to reduce adverse drug events (ADEs). Pharmacist-supervised pharmacy technicians (PSPTs) have also been used in this role. Nonetheless, few studies estimate the costs of utilizing PSPTs to obtain AMHs. We used time and motion methodology to study the time and cost required for pharmacists and PSPTs to obtain AMHs for patients at high risk for ADEs. Pharmacists and PSPTs required 58.5 (95% confidence interval [CI], 46.9-70.1) and 79.4 (95% CI, 59.1-99.8) minutes per patient, respectively (P = 0.14). PSPT-obtained AMHs also required 26.0 (95% CI, 14.9-37.1) minutes of pharmacist supervision per patient. Based on 2015 US Bureau of Labor Statistics wage data, we estimated the cost of having pharmacists and PSPTs obtain AMHs to be $55.91 (95% CI, 44.9-67.0) and $45.00 (95% CI, 29.7-60.4), respectively, which included pharmacist supervisory cost, per patient (P = 0.32). Thus, we found no statistically significant difference in time or cost between the two provider types. Journal of Hospital Medicine 2017;12:180-183.

Can mobile phone messages to drug sellers improve treatment of childhood diarrhoea?--A randomized controlled trial in Ghana.

Oral rehydration solution (ORS) and zinc are the recommended treatment in developing countries for the management of uncomplicated diarrhoea in children under five (World Health Organization and UNICEF 2004). However, drug sellers often recommend costly and unnecessary treatments instead. This article reports findings from an experiment to encourage licensed chemical sellers (LCS) in Ghana to recommend ORS and zinc for the management of childhood diarrhoea. The intervention consisted of mobile phone text messages (Short Message Service or SMS) sent to a randomly assigned group of LCS who had been trained on the diarrhoea management protocols recommended by the World Health Organization (WHO). The SMS campaign comprised informational messages and interactive quizzes sent over an 8-week period. The study measured the impact of the SMS messages on both reported and actual practices. Analysis of data from both face-to-face interviews and mystery client visits shows that the SMS intervention improved providers' self-reported practices but not their actual practices. The study also finds that actual practices deviate substantially from reported practices.

Comparison of a hybrid medication distribution system to simulated decentralized distribution models.

PURPOSE: The results of a study to estimate the human resource and cost implications of changing the medication distribution model at a large medical center are presented. METHODS: A two-part study was conducted to evaluate alternatives to the hospital's existing hybrid distribution model (64% of doses dispensed via cart fill and 36% via automated dispensing cabinets [ADCs]). An assessment of nurse, pharmacist, and pharmacy technician workloads within the hybrid system was performed through direct observation, with time standards calculated for each dispensing task; similar time studies were conducted at a comparator hospital with a decentralized medication distribution system involving greater use of ADCs. The time study data were then used in simulation modeling of alternative distribution scenarios: one involving no use of cart fill, one involving no use of ADCs, and one heavily dependent on ADC dispensing (89% via ADC and 11% via cart fill). RESULTS: Simulation of the base-case and alternative scenarios indicated that as the modeled percentage of doses dispensed from ADCs rose, the calculated pharmacy technician labor requirements decreased, with a proportionately greater increase in the nursing staff workload. Given that nurses are a higher-cost resource than pharmacy technicians, the projected human resource opportunity cost of transitioning from the hybrid system to a decentralized system similar to the comparator facility's was estimated at $229,691 per annum. CONCLUSION: Based on the simulation results, it was decided that a transition from the existing hybrid medication distribution system to a more ADC-dependent model would result in an unfavorable shift in staff skill mix and corresponding human resource costs at the medical center.

Impact of drug shortages on U.S. health systems.

PURPOSE: A study was performed to quantify the personnel resources required to manage drug shortages, define the impact of drug shortages on health systems nationwide, and assess the adequacy of information resources available to manage drug shortages. METHODS: An online survey was sent to the 1322 members of the American Society of Health-System Pharmacists who were identified as directors of pharmacy. Survey recipients were asked to identify which of the 30 most recent drug shortages listed affected their health system, to identify actions taken to manage the shortage, and to rate the impact of each shortage. Employees responsible for completing predefined tasks were identified, and the average time spent by each type of employee completing these tasks was estimated. Labor costs associated with managing shortages were calculated. RESULTS: A total of 353 respondents completed the survey, yielding a response rate of 27%. Pharmacists and pharmacy technicians spent more time managing drug shortages than did physicians and nurses. There was a significant association between the time spent managing shortages and the size of the institution, the number of shortages managed, and the institution's level of automation. Overall, 70% of the respondents felt that the information resources available to manage drug shortages were not good. The labor costs associated with managing shortages in the United States is an estimated $216 million annually. CONCLUSION: A survey of directors of pharmacy revealed that labor costs and the time required to manage drug shortages are significant and that current information available to manage drug shortages is considered suboptimal.

Establishing an on-site influenza vaccination service in an assisted-living facility.

OBJECTIVE: To describe the establishment, implementation, and economic outcomes of a pharmacist-conducted on-site influenza vaccination service in an assisted-living facility (ALF). DESIGN: Retrospective descriptive report. SETTING: 75-unit senior housing complex in the International District of Seattle, WA, during the 2004 flu season. PATIENTS: 58 indigent, multiethnic, older Asian adult patients, of whom 44 were ALF residents and 14 were adult day health (ADH)/independent-dwelling clients. INTERVENTION: Patient charts were reviewed for contraindications, vaccines were administered, and postvaccination satisfaction surveys were conducted. MAIN OUTCOME MEASURES: Number of residents vaccinated, satisfaction survey results, time spent by a pharmacist and an assistant and their salary rate, cost of vaccines, cost of supplies, and reimbursement data. Service outcomes included vaccination rate and resident satisfaction. A cost analysis reflects the economic outcome. RESULTS: In two 2-hour sessions, 58 ALF residents and ADH clients (age 83.5 +/- 7.7 years [range 65-98]) were vaccinated. The immunization rate in the population improved from 64% in the previous year to 83% with the on-site service. Both the clients and the facility staff rated the service highly. The pharmacist spent a total of 22 hours and the assistant 4 hours providing vaccination services. A net income of $13 per vaccination was realized after making adjustments for costs (vaccines, supplies, and salaries). CONCLUSION: An on-site pharmacist-conducted influenza vaccination service in the ALF setting expanded the scope and economic outcome of pharmacist-provided pharmaceutical services. Influenza vaccination rates were improved, and patients and staff were highly satisfied with the service.

Survey of certified pharmacy technicians in the United States: a quality-of-worklife study.

OBJECTIVE: To describe a nationwide random sample of Certified Pharmacy Technicians (CPhTs) by various demographic and work-related characteristics, identify various worklife attitudes, and determine whether these attitudes differed by practice setting and personal characteristics of the respondents. DESIGN: Cross-sectional descriptive design. SETTING: A random sample of 3,200 CPhTs provided by the Pharmacy Technician Certification Board. INTERVENTIONS: Survey mailed in January 2004. MAIN OUTCOME MEASURES: Responses to previously validated instruments measuring quality-of-worklife attitudes, rankings of factors as probable causes of medication preparation errors, and topics for continuing education (CE) programming. RESULTS: The typical respondent was a white woman, 39 years of age, who was earning dollar 12.87 per hour. CPhTs exhibited modest levels of job satisfaction and career commitment and relatively low career turnover intention. They perceived modestly high levels of support from supervisors and coworkers, but less support from their employers. Quality-of-worklife attitudes were associated significantly with practice setting, rate of pay, and age, but not with gender and racial/ethnic background. CONCLUSION: In view of CPhTs' continuingly important role in the delivery of pharmacy care, employers of CPhTs may want to consider rewarding experienced CPhTs who have demonstrated competency and loyalty to the organization. Career ladders for CPhTs may be a viable option.