Woonsocket, RI — For years, the goal of investing in better, more desirable pharmacies seemed to be in making them smaller. Automated systems made it easy to call in a refill without talking to anyone. Drive-thru's limited one-on-one interaction to what you could hear through a crackly speaker or yell at a window. Mail order brought the Rx right to your front door. Text messages were all the reminder we needed.
Today’s pharmacy innovations couldn’t be more different. Pharmacists are coming out from behind the counter to consult and spend time with customers. They’re being trained to be specialists in motivational interviewing, adherence and management of specific chronic conditions. Even staying with patients as they make the transition into those successful first months of treatment.
Late last year, Manhattan Research interviewed almost 800 pharmacists and found that two-fifths of them are spending more time providing care and support for patients – particularly with people living with diabetes, cardiovascular or respiratory disease, pain and depression. That’s much more than the “minute clinic” injector model we hear so much about. It’s a drive toward speciality, fostering expertise around helping people make successful transitions onto new therapies.
The change has been led by the two warring corner pharmacies: Walgreens and CVS. Both have invested heavily in creating new roles for pharmacists – igniting trends that are having an effect everywhere from the grocery pharmacy to the online one.
Walgreen’s model has been built around the idea that pharmacists are the healthcare provider almost everyone has access to – a white coat who doesn’t require an appointment and is within a few miles of home. At many of their stores, pharmacists have an open desk (not behind a counter) where customers can approach them and a private counseling area nearby. They’re able to contact people who don’t refill prescriptions and actively work with patient and doctor to identify potential interactions between drugs and even recommend medications that might have been overlooked.
The face-to-face counseling has made a difference in adherence. A study published this year in Patient Preference and Adherence found a significant difference in early adherence to a cholesterol-reducing statin drugs among people who participated in two face-to-face counseling sessions with a pharmacist (over a a group who didn’t receive counseling.)
CVS just completed the successful pilot year of its Pharmacy Advisor program. Initially focused primarily on diabetes and cardio vascular disease, the program is designed to provide expert support right when people are initiating a new treatment. The protocols prompt pharmacists to offer additional information and a personal consult when customers are filling a prescription in store or initiate a phone call from an advisor if they’ve chosen mail delivery.
Both the in-person and phone programs are designed to provide the upfront advice and support that will help each person be more successful with treatment over time. That’s huge because the IMS Institute and others have reported that medication non-adherence is the single biggest driver of avoidable health costs ( $105 billion / year).
In a study with an Indiana-based employer, CVS’s Pharmacy Advisor program did show tangible outcomes – increasing both medication adherence rates and physician initiation of prescriptions. After 6 months, the interventions increased initiation rates by as much as 39% for the entire population studied and had an even higher increase (68%) for the group counseled at retail stores. Overall medication adherence rates increased by 2.1%, with face-to-face interventions by retail store pharmacists resulting in adherence rate increases of 3.9%. The return for the employer was $3 for every $1 spent on additional counseling. Next year, the program will expand to breast cancer, depression, chronic obstructive pulmonary disease, asthma and osteoporosis.
The idea of creating pharmacist-coaches began to gain popularity seven years ago when some Medicare plans started covering medication therapy management programs, paying $1 to $2 a minute to pharmacists to review patients’ medicines with them. More and more employers and insurance companies are also paying pharmacists to advise patients, a role that the new health care law encourages with potential grants for such programs.
Posted by: Leigh Householder
Original illustration by: David Wink