The Optimizing Care Model: A novel community pharmacy approach to enhance patient care delivery by leveraging the technician workforce through technician product verification

Extending COVID-19 Pharmacy Technician Duties: Impact on Safety and Pharmacist Jobs

Background: The 2019 coronavirus pandemic (COVID-19) led to an expanded scope of practice for pharmacy technicians. As the pandemic wanes, state governments are faced with the decision of whether or not to make permanent the authority of pharmacy technicians to perform extended duties. Objective: Determine the impacts on patient safety and job market demands preadoption and postadoption of Idaho's expanded technician duties in 2017 as a natural experiment for expanded technician duties. Methods: Data from the National Practitioner Data Bank (NPDB) is used to explore patient safety outcomes in Idaho preadoption and postadoption and as compared with its border states. Data from Pharmacy Demand Reports is used to compare job postings in Idaho and its border state, and National Association of Boards of Pharmacy census data are used to compare growth in the number of pharmacists and technicians in Idaho and its border states over time. Results: For Idaho pharmacists, the average number of disciplinary actions reported against both pharmacists and technicians dropped after implementation of expanded technician duties. Idaho also had a lower rate of discipline for pharmacists and technicians than its border states. Idaho had the third highest job postings for pharmacists and the second highest for technicians among its border states. Idaho also had the largest growth in the number of licensed pharmacists and technicians of the observed states in the study period. Conclusion: Available statewide data from Idaho as compared with its border states suggests that expanded technician duties did not adversely impact patient safety outcomes or the pharmacist job market. Additional states may wish to expand pharmacy technician duties in the years ahead.

Exploring the Membership Pharmacy Model: Initial impact and feasibility

BACKGROUND

There is a need to shift pharmacy payment models, given the expanding role of the community pharmacist in improving patient outcomes, misaligned incentives of the existing reimbursement model, and deleterious effects of a lack of transparency on prescription costs.

OBJECTIVES

The primary objective of this paper was to develop a payment strategy for a Membership Pharmacy Model within an independent community pharmacy setting. A secondary objective of this paper is to explore the early impact of a novel value-based pharmacy payment model on patients, pharmacies, and self-insured employers.

PRACTICE DESCRIPTION

Good Shepherd Pharmacy, a nonprofit Membership Pharmacy founded in Memphis, TN, in 2015.

PRACTICE INNOVATION

We discuss a novel, value-based payment model for community pharmacy, which involves a partnership between pharmacy and employer, without the use of a pharmacy benefit manager, using a recurring (i.e., membership pharmacy) business revenue model.

EVALUATION METHODS

The pilot program was assessed using the RE-AIM framework.

RESULTS

The pilot enrolled 34 patients for whom 1399 prescriptions were filled spanning 13 quarterly refill cycles from January 2019-March 2022. After the intervention, proportion of days covered for diabetes and cholesterol medications both increased: 96.7% and 100% (P < 0.05); 90.3% and 98.1% (P > 0.05). Financial savings for the employer group were realized across both fee charges and prescription medication costs. The net savings provided to the employer was $67,843, a 35% reduction in topline pharmacy spending. Revenue for the pharmacy was realized exclusively through synchronization fees of $30 per fill. Synchronization fees for the entire study totaled $41,970, and the average revenue per quarterly batch refill was $3228.

CONCLUSION

The Membership Pharmacy Model represents a potentially viable alternative to traditional fee-for-service, buy-and-bill pharmacy payment models through its use of medication pricing based on actual acquisition costs, lean pharmacy operations, and value-based reimbursement methods.

Community pharmacy technicians' engagement in the delivery of brief tobacco cessation interventions: Results of a randomized trial

BACKGROUND

In recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described.

OBJECTIVE

To compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation.

METHODS

Twenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training.

RESULTS

Over the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p < 0.001). The number of individual technicians who reported at least one intervention was 16 (of 26; 61.5%) in the minimal group and 24 (of 24; 100%) in the intensive group (p < 0.001). At the conclusion of the study, 100% of technicians in the intensive group self-rated their ability to interact with patients about quitting smoking as good, very good, or excellent compared to 73.9% in the minimal group (p = 0.10).

CONCLUSION

In both study arms, technicians documented high numbers of tobacco cessation interventions. The higher proportion of technicians providing one or more interventions in the intensive group suggests a greater overall engagement in the process, relative to those receiving minimal training. Technicians can play a key role in the delivery of tobacco cessation interventions in community pharmacies.

The Academy Is Well Positioned to Offer Pharmacy Technician Training Programs

Schools and colleges of pharmacy are optimally positioned to train the entire pharmacy team, including pharmacists and pharmacy support personnel, because they can provide comprehensive workforce development, utilize established faculty expertise, harness existing infrastructure, afford opportunities for intraprofessional education, and support institutional growth and reputability. As the emphasis of training shifts towards team-based approaches and expanded responsibilities, ensuring the existing and future pharmacy workforce is equipped to serve their communities becomes increasingly important. Thus, schools and colleges of pharmacy should consider offering a pharmacy technician training program to meet the needs of their community and the profession.

The Optimizing Care Model: Final findings of a novel community pharmacy practice model to enhance patient care delivery using technician product verification

BACKGROUND

The community pharmacy represents a convenient health care access point for patients and is increasingly used to deliver direct patient care services; however, several barriers exist that hinder widespread patient service implementation and scalability. Such barriers include scope of practice restrictions, a dearth of sustainable payment models, lack of pharmacist capacity given other responsibilities, and workflow models developed for dispensing medications rather than clinical care. In an effort to overcome the lack of pharmacist time and capacity, further task delegation to pharmacy technicians has been suggested.

OBJECTIVES

The primary objective of this study was to present the final outcomes of the Optimizing Care Model's impact. The model's impact on pharmacist patient care, workday composition, and rates of product selection errors not identified during final product verification are reported.

METHODS

The Optimizing Care Model is an innovative approach to community pharmacy practice aiming to foster a new patient-centered care delivery model that expands clinical service delivery and fosters collaboration across health care settings through task delegation, primarily through technician product verification (TPV). To investigate the impact of its sustained implementation, a quasi-experimental, 1-group pretest-posttest design was used. Outcomes assessed included medication errors, clinical activities, and workday composition.

RESULTS

Six chain and 3 independent pharmacies completed the final, continuation phase of the study. Overall pharmacist time spent delivering patient care services increased significantly upon implementation of the Optimizing Care Model (21% vs. 43%; P < 0.05), whereas pharmacist time spent performing dispensing-related activities decreased significantly (67% vs. 37%; P < 0.05). Total undetected error rates were significantly less in the Optimizing Care Model phase compared with the traditional model (0.05% vs. 0.01%; P < 0.001).

CONCLUSION

This study presented the final results of a 2-year assessment of the Optimizing Care Model. Results reaffirmed initial published findings that the model and its use of TPV increase the array and frequency of direct patient care services rendered while resulting in lower undetected error rates. Final project results of the Optimizing Care Model demonstrate increased clinical service delivery versus the traditional model, while also improving patient safety with lower rates of undetected dispensing errors within the Optimizing Care Model. The Optimizing Care Model continues to show promise as a future practice model for community pharmacies.

Scaling technician product verification: Contextual analysis for developing an implementation strategy for a large community pharmacy chain

OBJECTIVE

To identify facilitators and barriers of early implementation of a technician product verification (TPV) program in a large community pharmacy chain.

METHODS

A mixed-methods (surveys, semistructured interviews, and nondisguised direct observation) approach was used to ascertain facilitators and barriers to implementation and to subsequently develop a scalable implementation strategy with the aim to accelerate TPV scalability across a large community pharmacy chain in states where it is permitted. One-on-one staff interviews and observations provided qualitative data to identify facilitators and barriers to TPV. A Web-based survey was used to gather perceptions on a variety of implementation strategies that would make use of identified facilitators and work to overcome identified barriers.

RESULTS

During the mixed-method study, 3 key themes emerged: TPV is a complex intervention whose implementation is facilitated by both adaptability and trialability and is highly dependent on state practice regulations; the implementation climate of the pharmacy organization serves as a facilitator to TPV; and individual beliefs about TPV change over time as implementation experience increases.

CONCLUSION

TPV is an expansion of the technician role that allows the profession of pharmacy to increase the provision of clinical activities by delegation of a nonclinical-based task. Early adopters of TPV recognize that verification is a task that is increasingly automated by mail-order pharmacies and that verification may no longer be considered a pharmacist task. Pharmacies in this study tended to revert to comfortable, traditional workflow at the first sign of distress. To be successful in the future, TPV should be thought of as the primary workflow procedure and not as an option. TPV is a service that will require staff buy-in, patience, and championship.

Community pharmacist perceptions of increased technician responsibility

BACKGROUND

Pharmacists have struggled to find time to spend on clinical tasks. As such, regulatory steps have been taken by some states to expand the scope of practice for community pharmacy technicians.

OBJECTIVE

The objective of this study was to determine what settings and characteristics predict pharmacists' comfort levels with technicians giving or receiving verbal prescriptions, performing nonclinical medication therapy management tasks, administering vaccinations, and verifying prescriptions.

METHODS

This study employed a national Internet-based survey of community pharmacists using a health care marketing research panel. The Consolidated Framework for Implementation Research (CFIR) was used as a theoretical basis for inquiry, particularly the CFIR domains of "outer setting," "inner setting," and "individual characteristics." As the outcome variable of this study, the respondents were asked to report their comfort levels with technicians performing the 4 advanced tasks. Four multivariable linear regression models identified statistically significant predictors of pharmacists' comfort with each task. Repeated measures analysis of variance (ANOVA) was used to compare the pharmacists' comfort levels among tasks.

RESULTS

For all 4 tasks, pharmacists who believed that technicians had the ability to complete each task were more comfortable with technicians completing those tasks. In addition, pharmacists with perceptions of stronger technician interest in advanced tasks were found to be more comfortable with technicians taking on more responsibility for all tasks except vaccine administration. Repeated measures ANOVA found that pharmacists' comfort levels differed on all 4 tasks.

CONCLUSION

This study found that the CFIR domains of inner setting (pharmacy location) and individual characteristics (perceptions of technicians and pharmacist education) affect pharmacists' level of comfort with technicians taking on additional responsibilities, but outer setting variables such as regulations do not. This suggests that pharmacist characteristics may affect the expansion of technician task responsibilities, no matter what state regulations allow.

The intersection of pharmacy leadership and management with clinical skills: Education plays a key role

INTRODUCTION

Clinical pharmacy service expansion is a challenge of scalability, and education can play a big part in the profession's transition to patient care. Underdeveloped staff management and leadership skills may prohibit scalability of innovative patient care service models observed in research and academic pharmacy environments.

COMMENTARY

In today's rapidly evolving healthcare industry, formal education in leadership and management may provide the prerequisite skills for frontline pharmacists to innovate and scale clinical care services thereby improving quality patient outcomes. One important component of this is the use of pharmacist-extenders and team-based task delegation to eliminate technical tasks from the pharmacist's workload and maximize time spent in functions requiring professional judgment.

IMPLICATIONS

The Academy should develop leadership and management skills in tandem with patient care-related skills to optimize care delivery. Specifically, pharmacy educators should lean into concepts of organizational behavior and evidence-based management. The future of pharmacy is highly dependent on future pharmacist leaders; development of successful leaders is imperative to the profession of pharmacy.

Embracing the Evolution of Pharmacy Practice by Empowering Pharmacy Technicians

While pharmacy technician roles in some practice settings are expanding beyond the traditional dispensing activities to include advanced or specialized tasks such as immunization administration, medication history collection, and final product verification, these practices are not yet widespread. There are apparent barriers to expanding the role of pharmacy technicians, including inconsistency in the education, training, and certification requirements across the United States, and regulations that have not kept pace with the evolving role of pharmacy technicians. Every corner of the profession has an opportunity, and responsibility, to elevate pharmacy technicians in an effort to advance safety and better serve patients. Regulators can expand the responsibilities that may be delegated to technicians, professional organizations can bring pharmacy technicians into the fold, employers can build career ladders to allow for advancement, and individual pharmacists and pharmacy technicians can advocate and engage.

Exploring Pharmacy Technician Roles in the Implementation of an Appointment-Based Medication Synchronization Program

The objective of this study was to qualitatively explore the role of pharmacy technicians in the implementation of an appointment-based model (ABM) medication synchronization program. The purposeful sampling of technicians working within six different locations of a supermarket chain pharmacy in Mississippi and Tennessee was carried out, and the technicians were interviewed between January and April 2018. A semi-structured interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR). Questions gathered information around pharmacy technician demographics and CFIR domains (process, inner setting, outer setting and intervention characteristics). Interviews were audiotaped and transcribed. Two members of the research team performed thematic content analysis. Six full-time, certified pharmacy technicians with 8.3 ± 2.7 years of experience were interviewed. Findings suggest that including hands-on experience with program software is needed during training to successfully implement ABM. A barrier to implementation was the time needed to complete ABM tasks as compared to other tasks. Although some barriers exist regarding implementation, technicians believe that overall, this program has positive benefits for patients. Results from this study signify that ABM implementation can be challenging. Better ABM portal integration with the pharmacy patient profile and appropriate workforce budgeting are key to continued success.