Let’s start out this blog with a bit of a thought exercise.
Picture in your mind Bill and Sarah. Bill is an account executive for the local bank. He loves a fully starched collared shirt, irons all of his clothes regardless of the occasion, and enjoys gardening. Sarah leads a sales team for a small start up organization and is wheelchair bound. In her spare time, Sarah enjoys trading stocks and has a small side business creating bow-ties for dogs. Both have type II diabetes.
Both Bill and Sarah have appointments scheduled with their respective primary care physicians who provide them with regular checkups and monitor their overall health. After taking off work and waiting to see their physician, they both receive their annual prescriptions which are sent electronically to their preferred pharmacies.
Now here is where their paths diverge: When Bill’s appointment is done, he leaves his physician’s clinic and chooses to go to the nearest pharmacy located a few miles across town to fill his prescription. On the other hand, at Sarah’s clinic there is a telepharmacy on-site, so after Sarah’s appointment she decides to have her prescriptions filled right there on-site at the telepharmacy located in the clinic.
When Bill leaves the clinic, he has several other errands to run with his day off. After going to the grocery store, stopping by the post office, and putting gas in his car, he realizes his pharmacy is about to close. Instead he decides he better head home so he can get to his daughter’s recital by 7:00. Bill doesn’t make it to the pharmacy that day, but plans to make time to stop by in the next day or two.
Does Bill’s situation sound unique? Turns out it’s actually not as one in five new prescriptions are never even filled. Think about your own experience - have you forgotten to pick up a prescription before, or have you picked it up later than you should have?
How was Sarah able to easily fit this interaction with her pharmacist into her workflow, while Bill had to delay his therapy? Sarah’s therapy is boosted three-fold:
- If you remember, when Sarah is done with her appointment, she moves out to the waiting room where there is an on-site telepharmacy, owned by her local pharmacist. Here she can fill her prescriptions and receive counseling with her pharmacist face-to-face via a private video call.
- At any time, even without a prescription, she can ask questions about her medications and discuss any additional OTC products necessary to improve her health or symptoms with the pharmacist.
- Given the fact the telepharmacy is conveniently located inside the clinic, Sarah is able to converse with her physician and pharmacist at the same time if necessary. The streamlined communication that takes place between Sarah, her physician, and her pharmacist helps ensure the best treatment possible as they’re able to discuss her treatment plan and address any questions or improvements together.
In Sarah’s situation, there is one less roadblock to keep her from picking up her prescription, receiving a value-added pharmacist intervention even without a prescription, and she has the added benefit of the physician and pharmacist collaborating and designing treatment plans that benefit her most. Access has proven to be key in patient care, and safe access to a pharmacist is a crucial factor in successful outcomes of therapy.
What’s the Problem?
Medication adherence has become a big problem, and it’s one that can easily be addressed with the use of technology. In the healthcare world, medication non-adherence has drastic effects on overall health outcomes and avoidable healthcare costs. Every year, non-adherence accounts for 50% of treatment failures, 25% of hospitalizations, and 125,000 deaths, while costing the healthcare industry anywhere from $100-300 billion.
For Bill, the main issue was the lack of convenience that caused him to skip going to the pharmacy and filling his prescription, but there are many other factors that play a role in causing non-adherence. Below are the primary causes of non-adherence as determined by the CDC:
- Patient-related barriers include lack of engagement in treatment decisions, impaired cognition (e.g., related to aging or disease), substance abuse, depression, and other mental health conditions.
- Provider-related factors include barriers to communicating with patients and their caregivers, complex dosing regimens, and limited coordination of care among multiple providers.
- Health care system and service delivery factors include limited access to an appropriate provider for prescriptions or refills, … unclear medication labeling and instructions, … and inadequate provider time to review benefits, risks, and alternatives to prescribed medications.
With telepharmacies located on-site and in clinics, the delivery of pharmacy services is streamlined, making it more accessible and efficient for patients, while allowing the providers to communicate clearly and thoroughly with patients and their caregivers on dosing regimens, and ensuring patients have a clear understanding of proper adherence before ever leaving the presence of their physician and pharmacy team.
Let’s examine in more depth just how telepharmacies in clinics help to solve issues and provide value for all parties involve, from the patients, to the pharmacies, to the clinics and physicians.
- Maximum convenience
- Enhanced level of attention and care from pharmacist and physician
For patients like Sarah, the convenience alone is a huge benefit, as patients no longer have to make the additional trips to their nearest pharmacy, whether it be down the block, or 20 miles away (you can imagine both would be difficult for patients with mobility issues like Sarah). Instead patients can get their needs met in one place at one time. Imagine not having reliable transportation in the middle of a Chicago winter, and needing to walk a mile just to get your medications after your clinic appointment. If you’re anything like me, that scenario makes you channel your inner Randy Jackson, “that’s gonna be a no for me dog…”
The benefits of course extend beyond the convenience factor. When patients get their medications in a timely manner with proper education (including instructions regarding adherence) from both their physician and pharmacist, they are much more likely to actually be adherent. When patients are adherent, they stay healthier and out of the hospital, helping them to feel better, live longer, and avoid unnecessary medical bills.
- Reach more patients
- Cost-effectively expand pharmacy footprint
When pharmacies partner with clinics to operate a telepharmacy on-site, it allows the pharmacists to reach a new patient group and provide them with convenient access to their pharmacy services. Remember our adherence issue we discussed before? If patients are more adherent, there are more prescriptions being filled, which is a win-win for all pharmacies and patients involved. The managing pharmacy can count on filling the majority of prescriptions for patients of that clinic, which is business they may not have captured before having an on-site pharmacy presence.
Additionally, partnering with a clinic proves to be a very cost-effective way for pharmacies to expand their footprint and increase volume. As with any retail telepharmacy setup, sharing the pharmacist between the host pharmacy and the telepharmacy is an efficient way to maintain a low-volume pharmacy location. With a clinic partnership, there is also the added cost benefit of utilizing the clinic’s existing brick and mortar location for the site of the telepharmacy. This removes the potential barrier of buying or building a location, which is naturally a holdup for any new pharmacy.
- Provide maximum convenience for patients
- Boost clinic Star ratings and benefit compensation rates
- Enhance patient care and outcomes through collaboration with pharmacy team
When clinics provide this one-stop convenience for patients, it makes patients happy and (hopefully) loyal. There’s a reason we all keep coming back to McDonald’s time and time again (even if we don’t like to admit it). It’s fast, familiar, and easy. That’s a winning formula for making customers happy and keeping them around for a long time.
When physicians are able to ensure patients are filling their prescriptions and are knowledgeable about their regimens, it will lead to better outcomes, which is great for the clinic. For those clinics with value-based compensation rates, ensuring optimal outcomes is important also to the bottom line.
Lastly, by bridging the clinic-pharmacy gap, clinics improve their overall collaboration across the patient care team, which benefits all parties involved, including the physicians. When physicians are able to have frequent conversations with pharmacists and have access to patient medication adherence information, it makes them more informed on their patients’ medication habits so they can provide better education and care. When adherence issues or educational mishaps arise and are discussed across the patient care team, it makes everyone more prepared to address such issues in the future.
Bill and Sarah have the same condition, take the same medications, and require the same treatment, yet because Sarah’s clinic and pharmacy work collaboratively to provide timely medication fills, counseling on her regimens, and suggestions for improved health and outcomes, the outcomes of her therapy are much better than Bill’s.
Telepharmacy-clinic partnerships are a mutually beneficial and cost-effective way to enhance communication across the patient care team and ensure optimal patient outcomes.
Do you have a pharmacy or clinic and would like to explore partnering up to provide pharmacy services in a clinic setting? Contact us and we’ll be happy to help you find local connections to help make that happen!
If you're curious to learn from actual people utilizing telepharmacy in a clinic setting, check out this interview with Donavan Smith from Utah, or this one with Roger Rose from Arizona. Both are Directors of Pharmacy overseeing telepharmacy operations in a clinic location.