Building Sustainable and Effective Patient Care Programs

Pharmacists are increasingly being called upon to provide direct patient care programs that improve chronic disease management and improve the public health. Pharmacist-provided MTM services, immunization, and smoking cessation are examples of patient-care services that can help achieve our nation’s 10-year health goals outlined in the Healthy People 2020 report. The Healthy People initiative provides science-based, 10-year national objectives for improving the health of all Americans. For 3 decades, Healthy People has established benchmarks and monitored progress over time in order to:

  • Encourage collaborations across sectors.
  • Guide individuals toward making informed health decisions.
  • Measure the impact of prevention activities.

Many pharmacist-provided patient care services are reimbursable from a variety of payers and networks. Others services may be offered on a cash-paying basis. When instituting patient care services, it is important to integrate them into the operations of the pharmacy for the long-term. This is referred to as sustainable patient care services. Building sustainability and measure a program’s effectiveness through economic, clinical, and humanistic outcomes helps position these programs for further reimbursement by an even wider community of payers.

Beyond positioning services for future reimbursement and recognition, sustainability is important so that valuable public health services are not offered on a limited basis. The pharmacy’s investment in infrastructure and staffing to offer services can be maximized by continuing to offer the service. So will fostering new relationships with patients and positioning the pharmacy as a health care destination. If new services are discontinued without replacing them with superior offerings, the pharmacy runs the risk of alienating patients who have come to rely on the service. Thus, planning new services to be sustainable is an important part of implementation.

Planning Ahead for Program Effectiveness

Implementing patient care services into the pharmacy’s more traditional dispensing environment requires care planning and considerations. Steps involved include:

  • Conducting a needs assessment
  • Creating programmatic goals
  • Designing the program
  • Implementing the program
  • Assessing and evaluating the program

Before committing resources to building a new program, its important to know if the service is desired and/or needed by the pharmacy’s patient population, both current and potential. Informal questions or suggestion boxes for patients to provide ideas has been used successfully by some independent pharmacies. Others have used formal patient questionnaires. A good example of a customer service survey may be found in the article by Doucette and McDonough, “Beyond the 4Ps: Using Relationship Marketing to Build Value and Demand for Pharmacy Services,” in the Journal of the American Pharmacists Association (JAPhA, 2002, 42:2:183-194.

Once a patient care service is selected, goal setting for the service follows. Goals should be specific, measurable, attainable, relevant, and timely. Staff should be involved in setting program goals to ensure their buy-in and input into reasonableness. Goals also determine the specific type of service that will be offered and to whom.

Designing the program comes next. A SWOT analysis can prove useful-that is assessing the pharmacy’s strengths, weaknesses, opportunities and threats (competition.) A good source for program models and examples is the monthly MTM Profiles and MTM Pearls features in Pharmacy Today ( America’s Pharmacist also runs pharmacy profiles and features regularly ( Attending local, state, and national meetings is also an excellent way to access program ideas and models that work.

Once a program design is determined, and the pharmacy’s assessed, the program is ready for implementation. This includes defining the program’s scope, the required staffing, time commitments and training needed, and how and what manner the service will be offered or accessible to the target audience. Implementing the program also includes building an awareness/marketing plan to let patients know about the program and physicians if they are going to be a source of referral.

Lastly, conducting program assessments and evaluations can help document service benefits, expand offerings, and allow continuous improvement. Objectives must be created to evaluate the service against; these may be process or outcomes oriented. For example, for a new immunization service, a process objective might be to input the patient data and give the vaccine within 15 minutes of a patient presenting at the in window. Outcome oriented measures may be economic, clinical or humanistic. An example of an economic measure for an immunization service may be to provide 1,000 vaccines during the flu season. A clinical outcome may be to identify all the pharmacy’s patients eligible for a particular vaccine and provide the vaccine to at least 50% of them during the flu season. Evaluations may also have an “impact” component where service outcomes are tracked over time to determine their long-term effectiveness.

Facilitating Program Sustainability
Ensuring a new patient care program’s sustainability can be involves four key factors:

  • A program champion
  • Service modifiability
  • Service compatibility
  • Service integration with pharmacy operations

A program champion is someone who is excited and supportive of implementing the new service and who has the influence with the pharmacist/owner(s) who may need to be convinced to offer the service if they are not the champion(s). Champions are able to compromise and negotiate effectively. Being able to modify the service based on ongoing assessment and evaluation is also important to ensure the service can change with your business, patients, and other factors. The compatibility of a new service with the pharmacy’s mission, goals, and long-term positioning is important. For example, an in-depth chronic disease management service may not fit with a pharmacy who’s mission is to mirror a “dollar” store’s convenience, low cost and low frills. Finally, services that are well-integrated within the pharmacy’s day-to-day operation are more likely to be sustainable, this includes integration into process, policies, and procedures.

Pharmacists are in an excellent position to contribute to achieving public health and patient care goals and are increasingly being called upon and reimburse to do so. When deciding to move forward in offering patient care services, it is important that they be implemented in a manner that allows sustainability and effectiveness for the long-term while having flexibility to evolve with the pharmacy’s business and marketplace.

Adapted from: Breland ML, Westrick SC. Building sustainability and effectiveness of pharmacy-based patient care services. America’s Pharm. 2010; Aug: 41-50.


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