We are often asked how our practice evolved into what it is today with it’s diverse service offerings, a significant staff of pharmacists and technicians, and our ability to generate revenue beyond just dispensing medications. It started almost a decade ago when Mike and I decided to change our model of community pharmacy practice. Creating the capacity to provide patient care services was not an overnight fix, rather it was an evolution based on trial and error, feedback from staff and patients, and market forces. This is not saying that our practice developed out of random happenings, but rather we had laid a foundation for which we could easily adjust, improve, and add services as deemed necessary.
To create a capacity for patient care, we began by moving our practice to a technician driven dispensing model, repurposing pharmacists so that the majority of their time was spent evaluating patients’ medications, resolving drug therapy problems, and communicating with both patients and providers. This required changes in job descriptions and responsibilities, new positions being developed, and staff training. We put a lot of our focus on the dispensing pharmacist. Pharmacists traditionally focused performing final verification. In our practice, the pharmacist was asked to becoming a clinical interventionist–identifying and resolving drug therapy problems “on the run” in which we now called continuous medication monitoring (CMM). To make this transition, we had to develop a different documentation system, because our dispensing system, much like all the others, is great for making sure we have all the information needed for dispensing a product, but very limited in terms of documenting patient care. The system we created is now called PharmClin, and it leverages the information from our dispensing system and creates a clinical record, making it easier and more efficient for the dispensing pharmacist to provide CMM. Moving the pharmacist into this new role also required education and training on how to quickly clinically assess patients’ medications, develop an intervention to resolve medication issues, and document their patient care activities. Obviously, creating the technician driven dispensing process helped to free up the pharmacist more to focus their activities on patient care. We saw the need to create a new position for a pharmacist to oversee the operations of our dispensing system.
In addition to the changes in dispensing, simultaneously we remodeled our pharmacy to include two patient care areas. These areas are used to provide clinical services beyond the CMM process. Services included immunizations, medication therapy management services (MTMs), adherence programs, health promotion services, and case management. As our services continued to expand and more and more patients enrolling in them, it was time about adding some new positions. We created a community pharmacy resident position, but quickly realized that we also needed to hire another pharmacist to oversee all of our clinical services. Not only do these pharmacists manage our clinical services, but they serve as a resource for our dispensing pharmacists providing us with “slack resources” for more in-depth problems uncovered by the dispensing pharmacists, or providing more in-depth counseling to patients as needed.
Other features of our practice that help support our patient care services a marketing plan that we review monthly. Every month we determine which services or practice areas we want our marketing efforts to focus on and what media we will use to “spread the word”. We hired a marketing professional who oversees our marketing efforts.
We have remodeled our pharmacy several times in the past decade with each remodel planned to improve patient care processes. We created two patient care areas which also serve as offices for our clinical manager and our community pharmacy resident. We expanded our dispensing counter to give our dispensing pharmacists more room for their CMM activities. We also created a patient counseling area at the end of our dispensing counter.
We have implemented tech-check-tech services as part of a new practice model program in Iowa to free up our pharmacists to provide clinical services. We also have implemented new technologies in the practice to improve our efficiencies including using a Parata robot, the Eyecon medication counter, an interactive voice response (IVR) system, and automated programs that help with our medication synchronization program and help with patient selection into medicare plans.
With all of these changes, the following list provides the current patient care services we offer at Towncrest Pharmacy
Clinic Services: Med Check Program, Medication Adherence Program, Influenza and Pneumococcal Vaccinations, Zostavax Vaccination, Tdap Vaccination, Pharmaceutical Case Management (PCM), Medication Therapy Management (MTM), Nursing Home Consulting, CPAP service/Education, Ostomy Consultations, Drug Information Service, Compounding, Employer based health screenings
Wellness Center: Cholesterol screening, Blood glucose screening, BP screening, Height and Weight, BMI
Specialized Focused: Mental Health, Wellness, Geriatrics, End of life/palliative care
As we have mentioned before, our practice has evolved to have this type of capacity to provide patient care services to all of our patients. Although it didn’t happen overnight, we realized that we had to make the initial changes to provide the foundation.
