ABM Offers Opportunity for Professional Growth

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Pharmacy Times, September 2022, Volume 88, Issue 09

Appointment-based models are typically most effective when all pharmacy team members participate.

Medication nonadherence continues to plague medicine, with estimates putting it as high as 50% even in developed countries like the United States.1

Nonadherence can be attributed to numerous factors—from polypharmacy, adverse effects, and complex dosing regimens to socioeconomic disadvantage.2 Nonadherence has negative consequences for the US health care system as well as for patients.2 Studies estimate it can cost up to $300 billion a year.3 One way to promote adherence is through medication synchronization (med sync) programs that simplify the refill process and decrease the burden of taking multiple medications.

An appointment-based model (ABM) is a type of med sync program that allows patients to pick up their prescriptions on 1 or 2 predetermined days a month. On these days, pharmacists can also provide services like comprehensive medication reviews.4 Although reviews are highly advantageous for patients, they can be time consuming for pharmacists.4 That is why ABM med sync is most effective when the entire pharmacy team participates. Technicians can provide the additional services and thus help pharmacists focus on clinical work.

Med sync programs have been widely adopted in the United States, with 79% of independent pharmacies reportedly using them.5 Because the programs improve operational efficiency, more and more pharmacies are offering them. Another benefit, as described by initiatives like Flip the Pharmacy, is that they could be the first step in the transformation of pharmacy from a practice that offers prescription-level care to one that offers patient-centered care.6

Med sync programs can accomplish 5 tasks: identification and enrollment of patients, medication review and assessment, refill alignment, prescription medication preparation, and delivery of medications, immunizations, and other patient services.7 Technicians can play a significant role in the med sync process by performing various tasks. The results of a recent retrospective, cross-sectional study of 68 community pharmacies showed that technicians supported approximately 70% of med sync programs and that in 75% of the programs technicians helped with patient follow-up and problem-solving. Four components of ABM were associated with significant improvement in adherence among patients with chronic disease states, such as diabetes, hypercholesterolemia, and hypertension.7

The results of another study showed that technicians were integral to supporting med sync programs in their pharmacies by identifying patients who would benefit from enrollment, reviewing medications lists, scheduling medication pickup dates based on patient preference, contacting patients in preparation for dispensing, and engaging in pickup or delivery of medications or other services.8 Technicians stand to gain from working toward the programs’ success because med sync has been shown to promote better foresight regarding customer foot traffic, decreased phone calls and refill requests, enhanced workflow via increased inventory control, and improved patient and pharmacy staff connections.8

Technicians are often overworked due to customer demands, high prescription volume, and staff shortages. Med sync programs can alleviate the daily pressure of work for technicians.

In a recent study of community pharmacies using med sync for 50% or more of their prescriptions, participants said that leveraging technician support was key to the program’s success and that involving all staff members was particularly important given the challenging landscape of community pharmacy practice.8

In addition to supporting pharmacy operations, technicians may experience personal satisfaction from helping patients achieve better health outcomes. The results of a study that evaluated ABM med sync implementation showed that technicians perceived their efforts as beneficial to patient health.4 Buy-in from all members of the pharmacy team is critical to success and for pharmacists to leverage workflow efficiencies.4 Previous study results have shown that a high perceived quality of work life may decrease turnover levels among technicians.9

Tailoring med sync programs to local needs is something else that should not be overlooked. The pharmacy’s technological capacity should be considered, and it should be possible to adapt ABM programs as its operations evolve. The type of ABM software and how it is used are important, especially for technicians, because they are the individuals accessing patient information and thus the program’s primary users.

One study examining the implementation of a technician-run ABM program cited failure to integrate the ABM software with the pharmacy’s patient profile as especially problematic because medications were not updated or accurately represented.4 Software limitations may create confusion, lead to inefficiencies, and increase the likelihood of errors. This is a significant threat to the success of med sync programs whose goal is to streamline the refill process and improve the patient experience.

In addition, the software must be easy to use if the goal of creating efficiencies is to be met. If technicians are not properly trained or the software is too cumbersome, they are less likely to suggest that patients enroll. Some barriers to med sync implementation mentioned by technicians include lack of access to ongoing training, difficulty convincing patients to participate, and problems with sharing feedback among staff members across locations.10 Technicians should be aware of these barriers so that they can ask management to address them.

The results of a qualitative study exploring the use of technicians in ABM med sync programs showed that the training they received before the program’s implementation was often inadequate.4 One participant declared
the training “useless” because it lacked specific information about how to navigate the program’s interface.4 Technicians reportedly preferred shadow pharmacists who were using the program.4

Training is important for effective operation and to minimize user frustration. Investing in the time needed to train users helps alleviate their struggles with the system.

Using technicians in med sync programs may promote program success because they engage with patients frequently and thus can take the lead in patient recruitment and coordination.8 Technicians can explain program details to patients and prepare them for changes in their care. Another benefit of using technicians to support the new service is that they can assist other pharmacy staff members who need training or help using the program.

The results of another study focusing on the roles of technicians in med sync programs showed that pharmacists deferred questions about patient enrollment and synchronization to technicians, suggesting they may be trusted to play a leading role in program execution.10

One way to promote adoption of the program among pharmacy personnel may be by designating certain technicians as program champions. This allows them to feel invested in the program’s success and creates a sense of ownership about the new service. The results of another study showed particular success in using technicians to serve as the face of the program and actively engage with patients for enrollment. The technician champion was responsible for leading ABM implementation.4 Pharmacies using a champion in this role reported an increase in patient participation.4 Conversely, the results of another study showed that underutilization of technicians was common among those pharmacies struggling to implement med sync programs.10

Conclusion

Technicians can play a significant role in ABM med sync programs and be instrumental to their success. If technicians are allowed to participate in program implementation, they may find the program rewarding for a variety of reasons. In addition, pharmacy operations may be smoother and lead to greater efficiencies, better patient outcomes, and more satisfied customers. Technicians will be able to spend less time on transactions and more time building their professional skills, thus enhancing their marketability and salary potential. Technicians should be aware of the barriers reported by peers so they may advocate for ways to overcome them, share best practices, and ask management for support when necessary.

About The Authors

Valerie Wasem and Ashley Woodyard are PharmD candidates at Touro University California College of Pharmacy in Vallejo, California.

Shane P. Desselle, PhD, RPh, FAPhA, is a professor in the Department of Social, Behavioral & Administrative Sciences at Touro University California College of Pharmacy in Vallejo.

References

  1. Burkhart PV, Sabaté E. Adherence to long-term therapies: evidence for action. J Nurs Scholarsh. 2003;35(3):207.
  2. Renfro CP, Turner K, Seeto J, Ferreri SP. Medication synchronization adoption and pharmacy performance. Res Social Adm Pharm. 2021;17(8):1496-1500. doi:10.1016/j.sapharm.2020.11.009
  3. Medication adherence in America: a national report card. National Community Pharmacists Association. Accessed June 11, 2022.http://www.ncpa.co/adherence/AdherenceReportCard_Full.pdf
  4. Renfro C, Coulter D, Ly L, et al. Exploring pharmacy technician roles in the implementation of an appointment-based medication synchronization program. Pharmacy (Basel). 2020;8(1):28. doi:10.3390/pharmacy8010028
  5. 2019 NCPA Digest. National Community Pharmacists Association. Accessed August 22, 2022. http://www.ncpa.co/pdf/digest/2019/2019-digest.pdf
  6. Flip the Pharmacy. Accessed July 26, 2022. https://www.flipthepharmacy.com
  7. Cheng A, Hughes TD, Chen HH, Ozawa S, Ferrari SP. Beyond refill alignment: evaluating the impact of appointment-based model. Res Social Adm Pharm. 2022;18(10):3751-3757. doi:10.1016/j.sapharm.2022.05.004
  8. Hughes TD, Minshew LM, Cutrell S, Ferreri SP. T.E.A.M.S.Work: leveraging technicians to enhance ABM med sync in community pharmacies. Pharmacy (Basel). 2020;8(2):51. doi:10.3390/pharmacy8020051
  9. Desselle SP, Hoh R, Holmes ER, Gill A, Zamora L. Pharmacy technician self-efficacies: insight to aid future education, staff development, and workforce planning. Res Social Adm Pharm. 2018;14(6):581-588. doi:10.1016/j.sapharm.2017.07.005
  10. Herbert SMC, Heck LA, Vogel AN, et al. Strategies for implementing the appointment-based model at a rural independent chain of community pharmacies. J Am Pharm Assoc (2003). 2022;62(1):104-111.e2. doi:10.1016/j.japh.2021.09.009