By donalee Moulton
The appointment-based model (ABM) is improving the way many pharmacists work and enhancing the relationship they have with patients. Still, misconceptions persist about the patient-centred approach to pharmacy services developed by California pharmacist John Sykora more than 20 years ago. This article debunks the top myths and misunderstandings:
Myth #1. It will take a lot of time to train staff and reengineer workflow. There is a learning curve to any new process. However, implementing medication synchronization and ABM does not and should not overwhelm staff or disrupt workflow. Moving patients to a regular prescription pickup requires some setup time on the front end, but once that’s done, ABM streamlines workflow, says Scarborough pharmacy owner Laura Furdas, who prints a list each day of patients who need to be called about medication refills. “It really does improve operations,” she notes. “Prescriptions are filled proactively, not reactively. We don’t have that same swamped feeling.”
Myth #2. ABM will not help improve adherence rates or patient outcomes. Adherence improves when patients understand why their medication is important and when issues regarding that medication can be effectively addressed. Med synchronization and ABM do both. “The biggest challenge for pharmacists is figuring out how to get time to interact with patients and find out why a patient is not adherent,” says David Edwards, associate dean with the Faculty of Science at the University of Waterloo. Ongoing interaction is built into the ABM, and better adherence is the result. Holdford and Inocencio found that enrollment in ABM makes patients three to six times more likely to be adherent.(1)
Al Chilton, president and CEO of Rubicon Pharmacies Canada Inc., in Regina, points out that ABM is about sustaining and nurturing interactions with patients—and that leads to greater adherence. “People you’ve built a relationship with, and who trust you, are more likely to take their medications,” he notes.
Myth #3. Revenues decline with fewer pharmacy visits. On the surface, this commonly-held belief makes sense. Not so in reality, says Jesse McCullough, who has implemented the appointment-based model in more than 4,500 U.S. pharmacies. “We often think that the more people come into our store, the more they will purchase. Research shows this isn’t the case.”
As well, studies have consistently shown that patients in medication synchronization and/or appointment based model programs will pick up 84 more days of refills compared to those not in the program.(1)
Myth #4. Patients won’t like ABM. The facts shows otherwise—definitively. A 2015 study found the majority of patients were highly satisfied with the medication synchronization program offered. And there was no significant differentiation based on age, gender, health, income or other patient demographics.(2) As McCullough notes, the ABM actually frees up blocks of time, providing greater opportunity for such one-on-one services as medication checks and reviews.
This improved adherence leads to better patient outcomes. But ABM is not about numbers, it’s about people. Michael Wright, chief business development officer at Rubicon Pharmacies, remembers one patient who wrote a poem about the impact ABM had on their life. Bottom line: they felt in greater control of their health.
- Holdford D,Inocencio T. Adherence and persistence associated with an appointment-based medication synchronization program, J.Am Pharm.Assn. 2013; 53:6: 576-583.
2.Butler KT, Rulsinger JF, Bates J, Prohaska ES, Melton BL. Participant satisfaction with a community-based medication synchronization program. J Am Pharm Assoc. 2015; 55(5)