More than "Just a pharmacy" agencies partner with onsite service providers to increase medication compliance and improve overall workflow.
Article Type: Report
Subject: Pharmacy (Customer relations)
Pharmacy (Alliances and partnerships)
Psychiatric clinics (Alliances and partnerships)
Author: Zubko, Nick
Pub Date: 01/01/2012
Publication: Name: Behavioral Healthcare Publisher: Vendome Group LLC Audience: Academic; Trade Format: Magazine/Journal Subject: Health; Health care industry; Psychology and mental health Copyright: COPYRIGHT 2012 Vendome Group LLC ISSN: 1931-7093
Issue: Date: Jan-Feb, 2012 Source Volume: 32 Source Issue: 1
Topic: Event Code: 240 Marketing procedures; 389 Alliances, partnerships
Accession Number: 282841917
Full Text: The idea of partnering with an onsite pharmacy service provider sounds like it should have some merit. Why wouldn't clients love the convenience of getting their prescriptions filled at a window down the hall? But if you're being pragmatic, there should be a little more to it for the endeavor to be truly worthwhile.

Over the last few years, onsite pharmacies have started introducing mental health consumers to a "one-stop shopping" experience, offering a higher level of customer service and pharmacists who understand their unique needs. But the services are also providing an opportunity for treatment centers to transform their own operation.

In addition to establishing valuable tools to address medication compliance and the integration of primary care, more agencies are finding that onsite pharmacy services can help stream line processes, evaluate how treatment modalities are approached, and improve overall workflow for the entire organization.

Exploring the options

In 2006, AspenPointe Health Service, a mental health treatment center in Colorado Springs, Colo., considered hiring a pharmacist and building a pharmacy to use as a new business line. But according to Fred Michel, AspenPointe's chief medical officer, it soon became clear that being a pharmacy was "not in their skill set."

"We thought about doing it ourselves, but we didn't really have anyone who knew how to make that happen," Michel recalls. "So we decided to bring in a national pharmacy that specialized in mental health. After doing our due diligence, we settled on QoL Meds."

Initially, AspenPointe's only goal in the process was to get a pharmacy up and running. "We didn't think about a whole lot more," he explains. "We had a sense that we wanted to offer more than 'just a pharmacy,' but beyond that we didn't know exactly what that would be."

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Indeed, the feeling is not uncommon. Prior to 2005, The Providence Center, a treatment center in Providence, R.I., worked with community pharmacies and had a pharmacy consultant on staff. When he retired, however, a replacement was needed. That's when they first started looking at pharmacy service providers.

Its management met with several providers and eventually chose Genoa Healthcare. According to Deb O'Brien, BS, RN, MPA, chief operating officer at The Providence Center, a key factor in the decision was the combination of pre-packaged medications, sample management and pharmacy consultation.

"We were already prepackaging as much medication as we could to make sure that our clients stayed compliant," explains O'Brien. "So the idea of having all of those services available right within our center was very appealing for us."

Eye on compliance

Of course, medication compliance is a key factor for treatment centers. In many cases, a pharmacy service will offer to call patients to conduct pill counts, determine the client's progress on completing their prescription, and match those findings with when refills are sent.

According to Michel, QoL will send patients their medication in the mail, as well as offer packaging systems cal led "MediPaks" that are designed to be received every 30 days. They are organized in morning and evening "bubbles."

"The system enables patients to take their meds without having to keep track of bottles," he says. "We've found that this is very helpful for people who are more disorganized in their medication regimens."

AspenPointe also utilizes QoL's Med Monitoring') program, in which case managers and doctors are informed when clients don't pick up their meds. Through regular visits with a case manager, clients go through a "medication education" process to help them stay compliant.

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The Providence Center implemented Genoa's medication prepackaging service as well, which O'Brien says was "rudimentary" at first, but has since become very sophisticated. Also using a "bubble" design, the packs hold eight to 10 pills and include a list of the pack's contents, "They provide a great system for sample management," notes O'Brien. "Our clients use them frequently and it's a very good tool for them."

While tracking compliance is difficult, O'Brien does offer a telling statistic. While The Providence Center has the largest group of severe and persistently mentally ill clients in Rhode Island, they also have the lowest hospitalization rate. "Being able to make sure clients take their medications is a significant part of that," she says.

Process improvements

For The Providence Center, prepackaging medications had become a very labor-intensive task. When medication was delivered from the local pharmacy, nurses had to take pills out of their bottles and put them into small envelopes or seven-day "Med Minder" packages.

"Obviously, packaging medications isn't a task that utilizes the skills of our nursing staff; it's purely administrative," O'Brien points out. "But until we did a time study, we didn't realize how much time we were actually spending on it."

When the results came back, the staff was more than a little surprised. Two full-time equivalents (FTEs) of nursing time (two 37.5-hour periods per week) were being spent pre-packaging medications. Once they partnered with Genoa, and its staff took over that responsibility, the savings was hard to ignore.

"We didn't lay off any nurses, but as there has been attrition we didn't necessarily fill those positions," O'Brien explains. "In addition, it helped us open up a significant amount of time that nurses could now spend treating clients."

According to Michel, helping patients with financial barriers was another way the service has helped lighten the load at AspenPointe. For example, while agencies often help uninsured clients through the process of qualifying for assistance programs, managing the application process can be a sizable task.

"The application is pretty simple, but it often requires the patient to come up with tax information, rent receipts, and lots of other documents," notes Michel. "For patients who are already disorganized, it can be difficult to come up with everything required for the application,"

With the help of a service provider, agencies are able to more easily gather information and submit the application on the client's behalf. According to Michel, the improved process has helped AspenPointe "bridge the gap" from the 800 clients covered by block grants to the full 2,300 who are in need of care.

A tool for integration

As the field continues to integrate primary care into treatment, organizations are starting to see a wide range of new opportunities. For example, AspenPointe took its first step toward primary care capabilities after their pharmacy was introduced on site.

"Once we had a pharmacy, it became obvious that having integrated care to go along with it would provide a real value for our clients," Michel says. "It also helped our primary care partners understand that we weren't just a clinic, but that we offered other services as well."

And, while companies like QoL and Genoa specialize in psychiatric medication, more options are available. "Along with their psych meds, clients can fill their prescriptions for antibiotics, birth control pills, antihypertensive medications, or anything else they might need," Michel explains.

Last year, The Providence Center introduced an onsite primary care clinic at its main adult treatment site, complete with a physician and two other clinical staffers. Now, doctors and physicians meet regularly with pharmacy staff to evaluate how medications are being prescribed.

According to O'Brien, the interaction provides a better overall understanding of which medications are being ordered, and why. "The pharmacists attend nursing peer review meetings every month, they talk regularly with the nurses and the doctors, and they become a valuable member of the team who helps us treat our clients," she explains. It establishes a nice continuity of care."

AspenPointe even requests monthly reports from QoL that detail which medications are being filled through that pharmacy. According to Michel, the process provides valuable insight into what medications doctors like to prescribe. In some cases, doctors find the results somewhat enlightening.

"While doctors may think they prescribe in a well-rounded fashion, sometimes that's not the case," he explains. "Sometimes it's just habit, but these reports make us aware of that and help us stay more informed about what we're doing."

Building for the future

Even with a wide range of services and a knowledgeable and thoughtful staff, pharmacies still need clients to take advantage. That's why service providers work with agencies to get clients interested in a service that could prove beneficial in their treatment.

"We often encourage our clients to go and try them out," Michel explains. "We make sure they know that there's a choice right down the hall designed for many of their specific needs. But patients always have that choice."

Periodically, AspenPointe receives updates from QoL in regard to trends in prescription volume, which Michel says keeps his staff "in the loop" and keeps the pharmacy's utilization front of mind. Currently, he estimates that one-third of AspenPointe's patients are getting their prescriptions from the pharmacy on site.

While treatment centers are unable to publicize the pharmacy service outside of the building, O'Brien notes that The Providence Center works with Genoa to make marketing materials available for clients in waiting rooms and elsewhere within the facility. In addition, the entire staff has been educated on all available services and what they can provide.

"The program is great, but it doesn't necessarily fit everyone's lifestyle," she notes. "Many clients are outpatient and still want to go to their community pharmacy. But the real benefit is being able to provide clients with medications daily, weekly, monthly, or whatever process works best to keep them safe."
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