Drug synchronization and an appointment-based model (ABM) are critical medication management practices that community pharmacies need to implement if they are to move in the direction of becoming the healthcare hubs they need to be.
By Talbot Boggs
Photos by J.P. Borchardt
“The future for Canadian pharmacies is to be accessible, trusted, low-cost community hubs for better primary care,” Jim Danahy, chief executive officer of AdhereRx told a Pfizer Canada-sponsored Collaborating on Adherence in Retail Environment (C.A.R.E.) Forum in Toronto. “Medication adherence should be every community pharmacy’s highest priority to improve both public health and business viability. Medication management is the solution to convert unsustainable transactions into high-value lasting relationships, and an appointment-based pharmacy is where to begin.”
The ABM model, which began two decades ago in the United States as a new way of providing care and doing business, is now making its way to Canada and gaining traction. It is a proactive model involving medication synchronization and regular, scheduled phone calls from the pharmacy, usually from a technician, to verify patients’ medication needs, order refills, and to set up a time to discuss medication management or to deliver other patient care services.
“The change to a new, more proactive approach suddenly put the pharmacist in control of workflow and the patients loved it,” said John Sykora, the California-based pharmacist attributed with pioneering ABM. “Synchronization is only the beginning. The most important part of ABM is the monthly personal phone calls to the patient.”
ABM benefits patients, pharmacists, physicians, hospitals and other healthcare providers. Patients benefit from convenience, fewer visits to the pharmacy, better adherence and outcomes, and greater satisfaction, while pharmacists benefit from improved proactive patient care, greater control of workflow and staffing, better inventory control, and more opportunities to manage drug therapy, improve outcomes and provide other clinical services.
More than 12,000 cardiovascular deaths in Canada each year are related to non-adherence, which costs pharmacies $12.5 billion in revenue each year collectively and $1.3 million individually, the C.A.R.E. Forum heard. Medication non-adherence is the fourth leading cause of accidental deaths in the U.S.
“The number one problem in treating illness today is patients’ failure to take prescription medication correctly,” said Danahy. “No other revenue source comes close to the value of un-filled prescriptions already written for your existing patients.”
Implementing change, however, can have challenges, and pharmacy owners/managers may have to change the attitudes and behaviours of staff and customers to successfully introduce an ABM/synchronization system, said Gerardo Delli Quadri, client relationship director at Willis Towers Watson. This involves understanding your stakeholders’ beliefs and concerns about the changes and helping them become more flexible and accurate in their interpretations of them.
“Find evidence ‘for’ and ‘against’ their beliefs, constructively and tactfully challenge their beliefs, play the devil’s advocate and try to prove the contrary, and help them identify potential upsides – under what conditions could it work?” Quadri said. “Help them find more realistic and flexible ways of looking at the situation and lastly, help them focus on what they can influence and shape and evoke action.”
Sykora urged conference attendees to select and train technicians who are smart and intuitive with a good work ethic and drug knowledge, are good team players, exhibit a caring attitude, and have good verbal, communication and computer skills.
Danahy issued a call to community pharmacies in Canada to embrace medication synchronization and ABM and act now. “Please don’t wait,” he said. “Start now, save more lives, reduce more suffering and make more money. Your patients will say, ‘Wow!’”
Here is what C.A.R.E. Forum attendees had to say:
“We have been advocating ABM/synchronization for the last year. Some early adapters are responding. This conference has demonstrated very clearly the impact it can have on the bottom line and on patient outcomes. This is a compelling argument which should really help to move pharmacists from “when” to “how” do I implement it in my pharmacy.
– Alicia Chin, Manager, Program Development and Pharmacy Services, McKesson Canada.
“This is just awesome. How else can pharmacists grow their revenue almost immediately without having to get any new customers? It’s incredible.”
– Jack Davies, pharmacist with PharmaChoice in Stellarton, NS
“This is a great information-gathering opportunity that really shows the benefits of the ABM model and medication synchronization for patients and for the business. It’s definitely something we will look at implementing across our brand.”
– Kamran Nisar, national manager, PharmaChoice
“One of the real challenges for independent pharmacists/owners is to redefine roles in the dispensary – to let go and realize they can’t do everything themselves. This conference really shows the importance of a new ABM model and the need to delegate responsibilities.”
– Igor Shaskin, manager, Stafford Pharmacy & Home Healthcare, Lethbridge, AB
“The CARE Forum was an energizing event. The speakers were ‘real’. While they provided their own experiences that MedSync can be done, they also acknowledged the challenges at getting started and maintaining this valuable service. This can (and should) be a pharmacy standard and not just another ‘program’. I truly appreciated the invite and look forward to sharing the information I learned with my colleagues.”
– Paul Warren, Regional Pharmacy Manager, Sobeys National Pharmacy Group