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.
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)
When Laura Furdas was exploring ways to enhance efficiency in her Scarborough, Ont. pharmacy, she discovered that the appointment-based model (ABM) would enable her to do this—and more. It offers significant benefits to patients and their doctors as well as the pharmacy team.
“ABM allows us to have important conversations with our patients while streamlining our workflow—and these are only two of the many advantages,” says Furdas, pharmacist owner of The Medicine Shoppe in Scarborough’s Coppa’s Fresh Market Plaza.
As a starting point to implementing ABM in June, 2016, Furdas and her team identified patients who were coming in several times a week or month. “This makes it harder to track if they are taking their medicine correctly,” she notes. “It’s much easier to do that when medications are all due at the same time.”
ABM also opens the door to regular and ongoing discussions. In advance of pickup, patients receive a reminder call. “It’s a critical point of contact,” says Furdas. “Patients appreciate that connection, especially the elderly patients. They feel they are getting service above and beyond.”
In addition to building customer loyalty and enhancing adherence, the regular contact enables the pharmacy team to determine if there have been any changes in the patient’s health and if there are any concerns. “We can recommend a medication review if this would be helpful. At the very least, patients gain a better understanding of their medication and how to take it,” says Furdas. “Frankly, many patients are not aware that their adherence is as bad as it is. ABM helps address this.”
Once a problem is identified, of course, steps can be taken to correct it. Often the solution is simple, such as suggesting patients turn their medication bottle upside down once they have taken their daily dose, or recommending compliance packaging. “Offering this advice and checking in regularly with the patient is a real point of difference in the service we can provide,” says Furdas. “It is central to the business and it enriches the relationship with the patient.”
Synchronizing patients’ medication to one prescription pickup time requires some setup on the front end, but once that is done, it streamlines workflow, notes Furdas, who prints off a list each day of patients who will need to be called and whose medications need to be refilled. “It really does improve operations. It means we are not reacting. Prescriptions are filled proactively, not reactively. We don’t have that same swamped feeling.”
In addition, there is more efficient inventory control. Under the traditional pharmacy model, stores would have to carry a minimum inventory, including very expensive drugs, and anticipate patient needs. “Now,” says Furdas, “I can make sure inventory is ordered to avoid partial fills and other related issues.”
That’s a substantial time-saver, she notes. “When you owe a drug or have a partial refill, it requires doubling up on your work. If you can eliminate that, it is a tremendous advantage.”
The benefits also extend outside the shop. “For pharmacies that offer deliveries,” Furdas says, “the cost-savings with ABM could be significant.”
The Scarborough pharmacist is also using the appointment-based model to connect with doctors in the community. Now instead of having to send several faxes requesting refills, they only have to send one fax with all the refills listed. “This demonstrates that we are doing things to try to save them time,” says Furdas.
It’s a message that resonates, she notes. “In this market, you have to stand out.”
Illustration by Martin Bregman
Over the last several issues Pharmacy Business has explored the appointment-based model (ABM) and the benefits for Canadian pharmacists and their patients.
Together we have taken a step back in time to the formation of this innovative approach. We’ve also examined the mindset changes that need to occur as a first step to success, and in our last issue, we took a practical look at implementing medication synchronization.
Now we’d like to take you inside the appointment process, a cornerstone of the model. Central to this process is the pre-appointment call. The American Pharmacists Association Foundation says this call “fuels the engine that drives the ABM.”
Before the patient’s appointment day, a member of the pharmacy staff, often a technician, phones the patient to determine the refill order for that month. This call benefits both the patient and the pharmacist, says John Sykora, the California-based pharmacist who created ABM. “We realized the monthly call could be used to manage other health-related issues. We were also managing adherence.”
Sykora and his team would take this time to enquire about compliance, side-effects and other medication issues – and offer solutions. They also asked about physician and hospital visits and any recent health changes. The call is about being fully informed to more fully help patients. It is also about standing apart from the competition.
In the APhA Foundation’s guide, “Pharmacy’s Appointment Based Model: Implementation Guide for Pharmacy Practices” [http://www.aphafoundation.org/sites/default/files/ckeditor/files/ABMImplementationGuide-FINAL-20130923.pdf], authors Dr. Lindsay L. Watson and Benjamin M. Bluml point out that the pre-appointment call signals the uniqueness of the appointment-based model. “This call differentiates the ABM from an automatic refill program because it provides meaningful information about relevant changes in the medication profile since the last visit to the pharmacy.”
The pre-appointment call also reaffirms the important role the pharmacy plays and further cements the relationship with patients, driving greater customer loyalty. It is services like this, says Gerry Delli Quadri, client relationship director at Willis Towers Watson, “that demonstrate real value to the patient and, ultimately, to the business.”
Patients will have a scheduled appointment day, which is distinct from a scheduled appointment. It is not necessarily a specific time or place, and the pharmacist does not have to carve out a set amount of time for a one-on-one discussion with every patient every month. The scheduled appointment day, however, does offer an important opportunity to check in with patients as they pick up prescriptions. The check-in can include questions about medication issues as well as provide information about the treatments to help educate patients. The check-in could also be a scheduled appointment to provide a service that is appropriate for that particular customer, at that particular time. Whatever the content, the result is increased customer loyalty and stronger patient relationships.
“A pharmacy is a business, and at a minimum, it needs to respond to its patients and customers. Today, you need to go beyond the minimum to thrive,” says Delli Quadri.
Some pharmacists have questioned the wisdom of having customers come into the store monthly as opposed to dropping in more often. They are surprised at the answer. While patients may pick up a pack of gum on their way out of the store, this is not the same as having a sustained and significant relationship. With ABM, patients move from having a pharmacist in their neighbourhood to a trusted advisor, says Delli Quadri. “This increases levels of engagement and increases discretionary purchases.”
As the relationship becomes stronger, he notes, so does loyalty. “It opens the door to other opportunities that can have a dollar sign attached to them.”
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