Role of the Pharmacist in Improving Patient Outcomes


Experts discuss strategies that can be employed to communicate the significance of yearly flu vaccines to patients and improve patient- centered care offered by pharmacists.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Dr [Chad] Worz, what strategies can be employed to communicate the significance of these annual flu vaccines, as well as other vaccines, to patients?

Chad Worz, PharmD, BCGP, FASCP: I think you touched on a trigger word for me, relationship. The relationship is something we’ve seemed to drift away from over the past 3 or 4 decades. We’ve asked physicians to do more, and that’s taken time away from the relationship they might have with the patient. We need to get back to that because ultimately it’s that conversation with the patient that’s going to make them move one way or another on a recommendation. And we’ve got challenges ahead of us. We’ve got an annual flu vaccine. We’re going to have conversations about which flu vaccine in a lot of cases. We have the potential for a COVID-19 booster annually. We have the potential for an RSV [respiratory syncytial virus] vaccine annually, especially for the over-65 population. That’s a lot to ask somebody to participate in when you’re standing in front of them at the pharmacy or when you’re going into your practice setting. So we have to have a relationship, we have to be good communicators. We have to explain things like, your flu shot is really 4 different flu shots even though it’s in 1. So maybe that alleviates your concern about taking 3 vaccines at any given time. But being able to communicate those things and the information we get out of ACIP [the Advisory Committee on Immunization Practices] and out of CDC about multiple vaccinations is going to be important. And again, being that trusted, accessible, as [Dr McDonough] brought up earlier, clinician out in the community, like a pharmacist, you have to use that to build relationships and make good recommendations.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Yes, it’s interesting; communication, relationships, all commonsense stuff. I’ve even talked to my professional organizations and our accrediting bodies about health care in general needing to find a way even at the curriculum level. So again, getting off base a little bit, but teaching our students, future health care providers, how to do this better. How to communicate with people, because I think we’ve lost some of that for whatever reason. Whether it’s social media, or whether we’ve gone totally to electronic-based types of communication, we’ve lost just basic relationship building sometimes.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: Getting back to the term health care team, I always say we talk about it, I learned about it in school, but I really didn’t see it in practice. We [were] all kind of siloed from each other. But...we’re moving into...sharing of electronic records and making sure we’re both educating the patient but really working as a team so we know what the prescriber is doing, they know what we’re doing, [and] we’re communicating that information. So that relationship is just as important not only at the patient level but also at the provider level.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: Absolutely. As we’re getting close to this segment’s end, I’ve got one more [question] for you, Dr McDonough, to talk a little bit about chain pharmacies. Chain pharmacies are eliminating all task-based metrics for retail pharmacy staff as part of team members’ performance reviews to further enable pharmacists to practice at the top of their licenses. How are changes like this improving patient outcomes and patient-centered care offered by pharmacists?

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: That’s a good question.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: It’s a big one.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: That’s a big question, yes. I think first of all, it’s always good that you move away because the metrics that were there before were based on how fast you’re filling prescriptions. And that’s not equivalent to a patient getting an outcome with the medications. I think moving away from those metrics and into patient care is a good thing, but it’s not enough. You can change the metrics by saying we’re going to be evaluating you and rewarding you based on you providing patient care services, but if you don’t give them the resources to do it, then it can be frustrating for the pharmacist. Part of the work that I have been doing is a lot of practice transformation with pharmacies across the country and talking about how you free up the pharmacist to provide these services. And it’s not easy, because we’ve been in a way of doing things where it’s just [being] as efficient as you can to fill as many prescriptions as you can. Well, we know that it no longer is going to be a very financially viable way for us to survive in the long run. So we have to think of how we free up the pharmacist. And we looked at certain domains within the practice that allow you to do that. One is to make sure medication synchronization is a robust med sync program, that means 30% of your population at least. We got 3000 patients in our pharmacy. That means 30% at least. We’re talking close to 1000 patients who have to be synced up. That just improves efficiencies across the whole practice. So now you can have the appointments and you have time with the appointments with the patient to have that communication, to have that education, and [you can] provide the service as well. You have got to optimize the technology. And it’s no longer just about robots filling medications, but it’s also the technology of eCare plans. So you’re documenting that and, hopefully, these eCare plans are being shared because of the standards with other providers so they can see what you did, you can see what they did. So we got that going on. We’ve got to optimize the use of our nonpharmacist personnel. Looking at our technicians, I was so proud when Iowa, when we had the EUA [Emergency Use Authorization] and our technicians could immunize. All of our technicians stepped up and did that. Then Iowa passed the rule after the EUA saying this is going to be the regular regulation now. [It was a] wonderful opportunity for the technicians to again step up. Not only are they able to do that, but also do technician product verification of them, which is very cool as well. And then you’ve got to make sure that you’ve got these collaborations, very collaborative working relationships with other providers. Again, you’re not working in a vacuum, you’re working within a health care team. But if anything, as I said earlier, what I’ve learned with COVID-19 is I’m not just a solution for the patients who use my pharmacy, I’m a solution for the community. And how do I reach out to the community? Now we have our technicians who are being trained as community health workers, so they can go out, meet with the patients where they’re at, and look at some of the social determinants of health issues that are going on and build to connect them to the right resources. I’m just excited about where this all can go. But it’s more than just the metrics. It’s providing that infrastructure so that the pharmacists have time to provide these services.

Adam C. Welch, PharmD, MBA, FAPhA: I think what you said was so important because it’s really addressing the elephant in the room, that pharmacists are burned out, they’re tired. They’re exhausted from COVID-19 and everything that happened with that and the testing and the vaccinations. And now we’re saying, OK, you might have an RSV vaccine this fall. You will have a flu vaccine this fall and probably have some more COVID-19 [vaccines] to do. Three different vaccines for the upper respiratory symptoms that people come in [for] that they all think it’s the same virus anyway. People are exhausted. So yes, it takes a little bit more effort to sync everyone up on a common refill date, but once you have that in place, it will streamline your workflow tremendously, as you mentioned. And utilizing the technicians and the student pharmacists to help you do tasks that normally you would have done, delegating those and supervising your staff to do that, is going to go a long way to alleviate some of that burnout.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: What’s interesting about community pharmacy in particular, we’ve always been thought of as, they use the word retail. I will say to everybody, I do not like the word retail whatsoever. I say I’m a clinical community pharmacist, but we really have moved away from the product in the sense of it’s still a primary thing, in the sense of that which brings the patient to the pharmacy. It’s secondary, though, in terms of what it does financially for me, because 25% of the products we dispense we actually lose money on. So why am I so focused on dispensing? My focus should be on patient care. And as I said earlier, doing vaccines and immunizations is such a low-hanging fruit because I can make that work within my workflow and with the staff that I have, and technicians can do shots along with the pharmacist. So, really we’re now a service provider. We’re more of a service provider with product distribution being secondary. That’s a shift. That’s a flip right there within community pharmacy.

Chad Worz, PharmD, BCGP, FASCP: I’m so glad you said that because I think one of the things since I was in school 20-something years ago, what we’ve been talking about is pharmacists as providers. Pharmacists do more than just being associated with a product. During COVID-19, we were handed this responsibility: “You need to vaccinate.” I mean, I was on a phone call with the people who represent all of the nursing homes, and they said, “We can’t do it. We need the pharmacies to do it.” And in our world, in long-term care pharmacies, it was not typical to do vaccines. Like, it was more in the retail or the community environment. But the reality is that’s our entree into this provider world and we should openly accept that responsibility. Take advantage of it from the perspective of being responsible and using it as a way to get further down the road of being a provider in the community of other things.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: [Dr Worz], right before I left my practice, I filled out my form. It took multiple days because I had to get documentation and everything else for medical credentialing because one of our MCOs [managed care organizations] this year is going to credential pharmacists for vaccinations. That is another step to getting that provider status. Exciting stuff.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: It is. In general, we’re seeing that across all areas of health care, burnout and fatigue. I think ultimately we have to get back to understanding that among ourselves, and we have to be smarter about how we alleviate those issues with these ideas.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: With burnout, part of it comes because you’re doing things that you were not trained to do. You’re doing things that you don’t want to do. What you want to do is provide patient care. It gives you meaning. That’s when burnouts happen, when you lose that meaning. So how do we get connections?

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: That connection. That relationship.

Chad Worz, PharmD, BCGP, FASCP: I mean, we won’t solve those problems today on this panel, but I come back to that relationship point you make. We’ve forced clinicians to do more, faster, see more patients, and fill more prescriptions. We’ve got to figure out ways. Some of it is through efficiencies of your own practice. Some of it is in reform on the insurance company’s end to say, listen, they need time to talk to people and build relationships so that they can get the outcomes that we’re looking for. You can’t just say, “Hey, see 15 patients an hour, fill 100 scripts an hour.” It hasn’t worked.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: And it’s not just pharmacists it’s affecting. I talked about that physician. That’s the reason why she left that practice, she’s burned out, because she has to see so many patients to get reimbursed at the level that she needs to. She goes, “I didn’t want to be a physician anymore. I want to practice the way I was taught to practice.” So I do think you’re going to see more of that kind of change out there.

Rodney E. Rohde, PhD, MS, SM (ASCP) CM, SVCM, MBCM, FACSc: We talked about this before the session. I mean, it’s everywhere, because even in my profession, we’re seeing that those who diagnose the infection are tired. If you don’t get the right test and the right diagnosis, you can’t get the right drug or antibiotic or vaccine. So it’s very connected. It’s very based on relationship building. It’s something we’ve got to get back to.

Transcript edited for clarity.

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