In 2010, Jesse McCullough had a conversation with some industry thought leaders about a new model that was having an impact throughout the United States on pharmacists, their patients and their business.
By donalee Moulton
Illustration by Martin Bregman
Seven years later, McCullough, now director of business development and pharmacy initiatives with a national U.S. pharmacy chain, has helped make the appointment-based model (ABM) available in more than 4,500 pharmacies across the country.
“When I first heard about ABM, a lightbulb went off. This is about being proactive, not reactive, and having the time to do what you need to do for you and your patients,” says McCullough.
“ABM makes so much sense on so many levels,” he adds. “It’s more efficient, there is less waste, and the focus is on the patient.”
Before rolling out ABM across a national U.S. drugstore chain, McCullough ran a pilot test in 14 stores to confirm that the model would work in different types of pharmacies, neighbourhoods and demographics – and to identify and address any issues that might arise. One of those issues was practical: getting medication synced to one consistent schedule. Partial refills helped with this, notes McCullough.
Some pharmacists were also concerned that fewer visits to the pharmacy would affect front-of-store sales. This is a false assumption, says McCullough. “We often think that the more people come into our store, the more they will purchase. Research shows this isn’t the case.”
In fact, he notes, the appointment-based model may actually increase revenue. “You are creating a differential. People choose to shop at your store and they are loyal to you. It’s about service and value.”
One unforeseen issue that arose during the ABM pilot was financial. “We didn’t anticipate that when people get their medications filled at the same time, it can be a cost burden. Indeed, for some patients, this can be a large bill,” says McCullough.
Fortunately, there is an easy and effective solution: offer two medication synchronization dates. “We separate fill dates by a time period that works best for the patient,” explains McCullough. “When we stagger fill dates this way, cost isn’t a barrier.”
For Canadian pharmacists looking to implement ABM in their store, the key to success is to dive in, he advises. “You have to start,” stresses McCullough. “There is always a reason to delay. Look for a reason to implement ABM today.”
He recommends starting slowly – one or two patients a day – and building gradually from there. “That is a reasonable pace, and it will balance with the other ongoing work of the pharmacy.” Ultimately, a pharmacy will want to have as many patients enrolled in ABM as possible.
Pharmacists should also identify an ABM champion among staff. This is someone who can be the face of the program with patients, explain how it works and how it will benefit them. There is growing evidence that the appointment-based model improves adherence. The average patient (non-ABM) fills 7.4 out of 12 refills on each maintenance prescription. Studies have consistently shown that patients with their medications in sync fill 11 out of 12 refills, generating an additional 3.6 scripts annually per medication per patient. Improved adherence is tied to better patient outcomes.1
More formal, long-term research is under way to better understand the link between the model and adherence.
There is greater pressure on pharmacists and the profession to demonstrate results. “The stakes are being raised on being able to drive adherence,” notes McCullough. “ABM is the tool that will enable us to do this.”
- Holdford DA, Inocencio TJ. “Adherence and persistence associated with an appointment-based medication synchronization program.” J Am Pharm Assoc. 2013;53(6):576-83. Available at: http://japha.org/article.aspx?articleid=1765641 Accessed July 23, 2015.