Establishing a clinical pharmacy technician at a United States Army military treatment facility.

OBJECTIVES: To describe the creation of a clinical pharmacy technician position within the U.S. Army and to identify the personal skills and characteristics required to meet the demands of this role. SETTING: An outpatient military treatment facility located in Maryland. PRACTICE DESCRIPTION: The clinical pharmacy technician position was designed to support clinical pharmacy services within a patient-centered medical home. PRACTICE INNOVATION: Funding and a position description were established to hire a clinical pharmacy technician. Expected duties included administrative (45%), patient education (30%), and dispensing (25%). Local policy, in accordance with federal law and U.S. Army regulations, was developed to define the expanded technician responsibility to deliver patient medication education. RESULTS: In the initial 3 months, the clinical pharmacy technician spent 24 hours per week on clinical activities, affording an additional 10-15 hours per week for clinical pharmacists to provide patient care. Completed consults increased from 41% to 56%, and patient-pharmacist encounters increased from 240 to 290 per month. The technician, acting as a clinical pharmacist extender, also completed an average of 90 patient encounters independently each month. As a result of these improvements, the decision was made to hire a second technician. Currently, the technicians spend 28-40 hours per week on clinical activities, offsetting an average of 26 hours per week for the clinical pharmacists. CONCLUSION: A patient-centered medical home clinical pharmacy technician can reduce the administrative workload for clinical pharmacists, improve their efficiency, and enhance the use of clinical pharmacy services. Several characteristics, particularly medication knowledge, make pharmacy technicians particularly suited for this role. The results from the implementation of a clinical pharmacy technician at this military treatment facility resulted in an Army-wide expansion of the position and suggested applicability in other practice sites, particularly in federal pharmacies.

Considerations for Retrograding Deployed Army Pharmacy Operations: What about Department of Defense Civilian Contractors? Lessons from Kosovo.

Background: Over the past two decades, changes in mission and expectations of deployed medical assets are requiring adaptations of pharmacy services. Specifically, the Department of Defense (DOD)-deployed contractors in theater are now eligible for varying levels of care from DOD-deployed assets. Pharmacy must now stock and maintain a complex medication footprint. This new requirement makes the attempt to retrograde a long established deployed pharmacy difficult and presents new challenges. Methods: We review the issues surrounding this quandary from the perspective of the deployed pharmacy in Kosovo, one of the longest standing theaters of deployed medical assets. Findings: Data from the 20th and 21st medical rotations in this theater demonstrate that DOD contractors consume a significant portion of pharmacy operational support. However, not only do contractors increase the volume but also pharmacy must address the use and monitoring of complex medications such as anticoagulants, antidiabetics, sleep, and psychiatric medications, as well as chronic obstructive pulmonary disease and asthma drugs, which are not typical in the deployed environment. Discussion/Impact/Recommendations: Contractors are now serving in the Balkan theater at a greater than 1:1 ratio of contractors to soldiers. Contractors are typically older than deployed soldiers and thus their pharmaceutical needs are more complex. This complicates the pharmacy operation, which on the one hand is trying to retrograde as the mission winds down, yet, on the other hand, must expand to more complex operations to support the DOD contractors in theater.

Implementation of a therapeutic-interchange clinic for HMG-CoA reductase inhibitors.

A therapeutic-interchange clinic for statins is described. In 1999, the Department of Defense mandated the use of cerivastatin and simvastatin as the formulary statins in all military health care facilities by April 2000. Cerivastatin was the preferred agent; the goal was to use this agent in 60-65% of all patients. Walter Reed Army Medical Center developed a voluntary therapeutic-interchange clinic for patients receiving statins. Goals included facilitating the rapid switching of patients to the formulary statins, maximizing the use of the preferred agent, maintaining or improving lipid control, monitoring safety, determining costs, educating patients about their treatment, and documenting satisfaction with the clinic. Written educational materials were prepared, an algorithm for statin conversion was created, and laboratory tests were performed, among other measures. Between January and April 2000, 1356 patients were seen by the therapeutic-interchange clinic; of these, 942 agreed to have the efficacy and safety of their therapy monitored by the clinic. Before the formulary change, the most commonly prescribed statins were atorvastatin (44% of patients) and pravastatin (42%). Under the conversion policy, 96% of patients received cerivastatin and 4% simvastatin. The percentage of patients achieving their targeted low-density-lipoprotein cholesterol concentration increased from 65% to 75%. The policy saved an average of $115 per patient in the first year. Most patients were satisfied with the clinic, but only 36% of providers were satisfied. Cerivastatin was withdrawn from the market in August 2001; simvastatin became the only formulary statin. A therapeutic-interchange clinic at a military medical center provided an efficient means of switching a large number of patients to alternative statin therapy, monitoring the outcomes, and individualizing patient care.