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.”
Liz Tiefenthaler is president of Pharm Fresh Media, a full-service marketing company focused on helping independent pharmacies.
It’s an exciting time to be a community pharmacist—more than ever before, there are almost endless opportunities to showcase your clinical skills, turn your passion into a practice, or try something completely different, just to see if it flies.
In future issues of Pharmacy Practice+Business we’ll profile innovative pharmacist and pharmacies who are testing the waters with new clinical, practice and business concepts. As a taste, meet four pharmacies from across the country that are building their business on new services and fresh ideas.
Emma Kim tests patients’ pulmonary function.
Similkameen Pharmacy, Keremos, B.C.
Connie Chan, pharmacy manager and Emma Kim, staff pharmacist
The concept: With a strong focus on clinical services, Similkameen Pharmacy recently added a niche service: pulmonary function testing. Staff pharmacist Emma Kim joined the pharmacy two years ago after a stint as a researcher for an asthma/allergy study at a children’s hospital. Since then, Kim and pharmacy manager Connie Chan have completed a certified respiratory course and now offer a specialized service providing spirometry tests to measure lung function, as well as assessment and counselling for patients with breathing problems.
How it works: Kim and Chan hold a pulmonary function clinic once or twice a month at a nearby doctor’s office for patients referred by other providers. The pharmacists set their schedule based on the number of referrals. It takes about an hour for the pulmonary function test, assessment and counselling, and the referring prescriber receives a comprehensive report with assessment and therapy suggestion. “When a patient comes to our clinic, we do a whole assessment of other factors that can affect lung function, such as mental health, mobility issues and co-morbidities, to get a comprehensive sense of their health,” explains Kim. “The pulmonary function test gives us a clear picture of the lungs and sometimes we find that it is more likely their anxiety that is causing difficulty breathing. Sometimes we find that the lung function of a person with long smoking history is slowly declining. As well as medication management, we can provide a comprehensive look at the individual’s health including vaccines, other chronic medications and lifestyle.” It’s important to communicate with the prescriber, give suggestions and a heads-up about other potential problems to investigate, says Kim, adding that “although the physician makes the diagnosis, the pharmacist helps put the puzzle together.”
Who it serves, and the need it fills: Statistics Canada reports that about 8% of the population has asthma and 4% has chronic obstructive pulmonary disease. But not everyone with breathing difficulties necessarily has one of these diseases. “It is imperative that patients have a breathing test before medication is prescribed,” says Kim. “But typically, the patient comes in with an inhaler as an empiric treatment while waiting for a referral to the hospital.” It can take between four to nine months to get an appointment to see a specialist, which delays patients’ access to a thorough assessment and proper medication management. What the pharmacists provide, she explains, is a rapid access spirometry clinic from a comprehensive perspective.
Business model/proposition: Similkameen Pharmacy’s business model is based on providing high-quality clinical services and elevated patient-centered experience. As well as the spirometry testing and consultation, the pharmacy (which operates under The Medicine Centre banner) offers a range of services, including vaccines, medication reviews, adaptation, outreach to community and other healthcare providers, compression sock fitting, wound care and a walking group—and most of these services involve a fee. “We believe quality service is worth paying for,” says Kim. For the pulmonary function service, initial funding came through partnering with a pharmaceutical company. “The only equipment we need is the spirometer and a computer,” says Kim. The other investment is in pharmacist training. Longer term, the plan is to privatize the pulmonary function clinic and charge a fee as the referral volume and the pharmacists’ experience builds. The pharmacists expect that as an alternative to waiting for the services via hospital, patients may be willing to pay for the convenience and for the comprehensive health services offered through the clinic.
Final thoughts: “We are now considering implementing pulmonary function testing at our other location in West Kelowna,” says Kim. “After doing field research, we know that a lot of people need this service. Although respiratory therapists usually perform spirometry testing, pharmacists can approach complex health problems on a [holistic] level, given their expertise in medications.” —Sonya Felix
Redcliff Pharmasave, Redcliff, Alta. Co-owners Melissa and Rob Hozack
The concept: Helping patients lose weight to improve their health is a satisfying activity both financially and professionally for pharmacist Melissa Hozack, an authorized provider of the Ideal Protein Weight Loss Method since 2013. The whole concept started with Hozack’s own desire to drop weight and she introduced the Ideal Protein program to help encourage weight loss and better eating habits for patients, as well. “I was frustrated when I’d talk to patients about the importance of diet for managing diabetes and blood pressure and then see them go to the front of the store and buy pop and a candy bar,” she says. “I needed tools to help them and, together with pharmacists’ expanded scope of practice, I knew I could incorporate Ideal Protein into patient care and even reverse type 2 diabetes and hypertension.”
How it works: Ideal Protein is a turnkey weight-loss and lifestyle coaching program that Hozack says is easy to set up in the pharmacy. Within 10 days of ordering, the product arrived with a manual and price points that allow a good profit margin. Redcliff Pharmasave nowdedicates 16 feet of shelving to Ideal Protein food products, plus an additional 24 feet to specialty grocery items such as low carb condiments and locally produced frozen no-sugar products, including meats and greenhouse veggies. One-on-one counselling is at the core of the four-phase weight-loss method, which begins with a strict diet based on the Ideal Protein food products and progresses to learning about healthy lifestyle and how to maintain an ideal weight. As head coach, Hozack started out by spending three to four hours a week on the program, but this has grown to 25 hours a week, as well as many more hours connecting online with other coaches and dieters, learning about and sourcing new products, and speaking at training sessions and conferences. She’s since hired and trained several assistant coaches and an Ideal Protein retail manager.
Who it serves, and the need it fills: With 50% of Canadians considered obese or overweight, there is a ready market for weight loss services. And considering the link between obesity and chronic conditions such as diabetes and cardiovascular disease, Hozack believes her services can make a huge difference in improving the health of patients. Growing awareness of Ideal Protein and Hozack’s specialized services have brought in patients from “all over.” An Ideal Protein app helps her monitor even those patients who live out-of-town. “Often people newly diagnosed with [a chronic disease] don’t want to take medications and if they want to try Ideal Protein the doctor sends them to us,” she adds. “I can help them so they won’t have to take medications. Yes, that may take sales away from the dispensary but if the patient is healthy, that’s more rewarding.”
Business model/proposition: Wait a minute—is Hozack endorsing a program that can reduce dispensary sales in her pharmacy? Yes, and emphatically. Revenue from the wellness program more than compensates for any dip in revenues from diabetes or cholesterol meds. Redcliff Pharmasave has become one of the biggest Ideal Protein centres in Canada. “It doesn’t take long for this to be profitable,” says Hozack. “If you can get 25 dieters a week, you’ll do $100,000 in annual sales. Demand comes in highs and lows but we typically have 175 to 200 dieters a week.” And adjunct sales in the healthy, low-carb (but high-margin) foods that complement the program also boost the pharmacy’s bottom line.
Final thoughts: Managing such an intensive patient care service is a lot of work, admits Hozack, who in 2015 won a prestigious national Commitment to Care and Service Award (Health Promotion) for her efforts with this program. Having a business partner/husband who handles the dispensary management duties is the key, she admits. “I’m more about patient care—and I’m now thinking about how I can take this further.” —Sonya Felix
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