Incorporation of Medication Synchronization in Community Pharmacy Workflow Enhances Delivery of Patient Care Services

The biggest advantage of med sync for a community pharmacy is the proactive selection of a date to have all the patient’s chronic medications filled simultaneously.

Pharmacists across the country are adopting medication synchronization (med sync) programs that enable patients to pick up their chronic medications at the pharmacy at once. Research shows that med sync programs improve medication adherence, a problem estimated to result in avoidable health problems for patients that cost the health care system approximately $300 billion a year.

Med sync helps improve adherence by eliminating the need for patients to remember to request prescription refills. Additionally, it saves the patient multiple trips to the pharmacy.

Med sync benefits the pharmacy by making the dispensing process workflow more efficient. The biggest advantage of med sync for a community pharmacy is the proactive selection of a date and day of the week to have all the patient’s chronic medications filled simultaneously.

This allows the pharmacy to predict their volume of prescriptions, which in turn helps in both scheduling staff and ordering inventory. All these advantages lead to reduction of on-demand prescription filling, which should free up pharmacists to perform more patient care and clinical services.

Being proactive with medication dispensing allows pharmacies to expand their practice beyond dispensing; however, many pharmacies struggle with implementation of a med sync program. The creation of a standard med sync workflow procedure and a more consistent implementation process will lead to better patient outcomes and a more predictable work environment for the pharmacy staff. A common language document for med sync can provide a framework to create consistency in implementation of the service.

How do I start a med sync program?

Pharmacy organizations have implementation guides for community pharmacies that want to get started. The American Pharmacists Association Med Sync Implementation Guide for Pharmacy Practices outlines med sync implementation in 10 steps and details processes of patient recruitment, synchronization of medications, and daily tasks and procedures.

Implementation tools have been developed to assist pharmacies with adoption of a med sync program that aligns with the pharmacists’ patient care process. All tools are available online at no cost. One how to guide for med sync focuses on changes that need to occur within the community pharmacy and an online survey tool helps to determine a pharmacy’s readiness to take on med sync.

Med sync begins with 2 decisions—how to engage patients and how to engage providers in the process. Advertising the program to patients by telling them the unique benefits of enrolling is key.

Assisting patients with financial barriers increases patient engagement. For some patients, filling all their medications on a single day each month may create a financial burden with all co-pays due on that day. Creating practical solutions to reduce expense often increases the likelihood of patient engagement.

Options to reduce the financial burden include medication assistance programs, prescription discount cards, biweekly synchronization and setting up specialized payment programs. While these solutions mitigate financial barriers, pharmacies may not have access to these programs or services.

As a result, staff members can also look for generic alternatives or consult with providers to help reduce monthly costs for patients.

Pro Tip: Once patients are enrolled you want to keep them enrolled. Dedicating personnel time to checking in with patients enrolled in med sync strengthens trust and relationships, which can improve patient engagement.

Addressing health literacy and transportation barriers also increases patient engagement. The more patients understand their medications, the more likely they will take their medications and remain in the program.

Adherence packaging may also assist patients with knowing how and when to take their medications. Medication synchronization services are tied to adherence packaging in many pharmacies to improve pharmacy workflow and improve patient engagement and adherence.

Additionally, med sync increases convenience for patients with limited or no access to transportation. Patients only need to make one trip to the pharmacy or if a pharmacy delivery service is available it allows the pharmacy to make one trip to the patient’s home.

Provider engagement

Provider engagement is also a facilitator in the implementation of med sync. Focusing on provider communication and provider-pharmacist relationships is essential. Providers will be engaged in med sync if they have a good relationship based on continuous and consistent communication with the pharmacist. Provider engagement is considered an external factor to the pharmacy and needs to be intentionally implemented to ensure continued collaboration.

Pharmacies with successful provider engagement educate providers about the program and its benefits before patient enrollment. Patients and caregivers are more likely to enroll in a med sync program when it is a referral request from their provider.

This proactive approach allows providers to identify patients who are struggling with medication adherence and promotes a team-based approach to patient care. Pharmacy staff can educate providers about their med sync program via in-person visits, phone calls, or fax.

Pro Tips

Pharmacies who successfully have more than 50% of their prescription volume synced find that in-person visits were most valuable to facilitate quality relationships with the providers.

To maintain continuous engagement with providers, pharmacy staff need to communicate regularly with providers about enrolled patients. Pharmacies should engage with providers to enact short fills, 90-day refill requests, pharmacy overrides, and follow-up on any medication-related problems identified as part of the med sync process.

How do I maintain a successful med sync program?

Program organization

The successful adoption of a med sync program requires adequate infrastructure that may consist of physical and human resources. Some pharmacies need a dedicated workspace and others embed it in their current workflow.

In either case, having a clear process for enrollment, documentation, filling, and counseling are required for success. Some pharmacies have adopted software systems to conduct med sync tasks, others use paper-based systems.

Human resources include having multiple team members engaged in the med sync program. Successful programs engage staff members beyond pharmacists, such as technicians, cashiers, and delivery drivers.

Pro Tip: Successful programs have defined criteria for patient enrollment. For example, some pharmacies specify a certain number of chronic medications as a criterion for enrollment. Other pharmacies identify patients who have low adherence scores. Some pharmacies automatically enroll all patients and allow others to opt out if they do not want their medications synced.

A major incentive for improving adherence rates is reduction in direct and indirect remuneration fees. This alone is the incentive many pharmacies are using to start and maintain a med sync program. Once criteria are defined and shared with pharmacy staff the program can be offered to patients.

Be sure to document that the offer was extended into the pharmacy system. This documentation allows staff to keep track of patient enrollment and allows providers to be notified once their patients enroll.

Staff engagement

Pharmacy technicians, cashiers, and delivery drivers are essential to successful adoption and maintenance. A team-based approach is an effective strategy since it helps overcome time constraints which are often cited as a challenge when implementing community pharmacy services.

Having defined roles and responsibilities for pharmacy staff within the program and creating formal and informal training approaches are essential for successful med sync adoption. Technicians, cashiers, and delivery drivers can easily identify patients for enrollment.

They can also educate patients on the benefits of the program as well as document that an offer was extended for enrollment. Technicians can call patients in advance of the sync date to identify if any medication changes have occurred since the last fill.

This can include whether the patient has been hospitalized or visited the doctor in the last month to probe for any medication changes. Technicians will also be essential to prepare the medications.

Pro Tip: Staff incentives is a strategy shown to increase skills and confidence as well as promote the adoption of med sync. Incentives provide personal and professional recognition that some staff members need. Incentives can include financial gain or positive praise. In some cases, incentives may need to be used to help keep staff engaged.

Research of the literature and real-world practice reveal a wide variety in med sync implementation efforts. Aligning patient care services with med sync drives workflow integration within the pharmacy and engages patients in a regular dialogue about the safety and efficacy of their medications and self-management of their chronic illnesses.

This regular dialogue allows for pharmacists to focus on disease state outcomes, such as lowering A1C levels for diabetes or blood pressure goals for patients with hypertension. Working with patients to optimize the benefits of their medicines leads to better health outcomes and lower overall costs of care.

About the Author

Stefanie P. Ferreri, PharmD, BCACP, FAPhA, is distinguished professor and chair of the practice advancement and clinical education division at the UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill.