The idea of partnering with an onsite pharmacy service provider sounds like it should have some merit. Why wouldn’t clients love the convenience of getting their prescriptions filled at a window down the hall? But if you’re being pragmatic, there should be a little more to it for the endeavor to be truly worthwhile.
Over the last few years, onsite pharmacies have started introducing mental health consumers to a “one-stop shopping” experience, offering a higher level of customer service and pharmacists who understand their unique needs. But the services are also providing an opportunity for treatment centers to transform their own operation.
In addition to establishing valuable tools to address medication compliance and the integration of primary care, more agencies are finding that onsite pharmacy services can help streamline processes, evaluate how treatment modalities are approached, and improve overall workflow for the entire organization.
Exploring the options
In 2006, AspenPointe Health Service, a mental health treatment center in Colorado Springs, Colo., considered hiring a pharmacist and building a pharmacy to use as a new business line. But according to Fred Michel, AspenPointe’s chief medical officer, it soon became clear that being a pharmacy was “not in their skill set.”
“We thought about doing it ourselves, but we didn’t really have anyone who knew how to make that happen,” Michel recalls. “So we decided to bring in a national pharmacy that specialized in mental health. After doing our due diligence, we settled on QoL Meds.”
Initially, AspenPointe’s only goal in the process was to get a pharmacy up and running. “We didn’t think about a whole lot more,” he explains. “We had a sense that we wanted to offer more than ‘just a pharmacy,’ but beyond that we didn’t know exactly what that would be.”
Indeed, the feeling is not uncommon. Prior to 2005, The Providence Center, a treatment center in Providence, R.I., worked with community pharmacies and had a pharmacy consultant on staff. When he retired, however, a replacement was needed. That’s when they first started looking at pharmacy service providers.
Its management met with several providers and eventually chose Genoa Healthcare. According to Deb O’Brien, BS, RN, MPA, chief operating officer at The Providence Center, a key factor in the decision was the combination of pre-packaged medications, sample management and pharmacy consultation.
“We were already prepackaging as much medication as we could to make sure that our clients stayed compliant,” explains O’Brien. “So the idea of having all of those services available right within our center was very appealing for us.”
Eye on compliance
Of course, medication compliance is a key factor for treatment centers. In many cases, a pharmacy service will offer to call patients to conduct pill counts, determine the client’s progress on completing their prescription, and match those findings with when refills are sent.
According to Michel, QoL will send patients their medication in the mail, as well as offer packaging systems called “MediPaks” that are designed to be received every 30 days. They are organized in morning and evening “bubbles.”
“The system enables patients to take their meds without having to keep track of bottles,” he says. “We’ve found that this is very helpful for people who are more disorganized in their medication regimens.”
AspenPointe also utilizes QoL’s “Med Monitoring” program, in which case managers and doctors are informed when clients don’t pick up their meds. Through regular visits with a case manager, clients go through a “medication education” process to help them stay compliant.
The Providence Center implemented Genoa’s medication prepackaging service as well, which O’Brien says was “rudimentary” at first, but has since become very sophisticated. Also using a “bubble” design, the packs hold eight to 10 pills and include a list of the pack’s contents. “They provide a great system for sample management,” notes O’Brien. “Our clients use them frequently and it’s a very good tool for them.”
While tracking compliance is difficult, O’Brien does offer a telling statistic. While The Providence Center has the largest group of severe and persistently mentally ill clients in Rhode Island, they also have the lowest hospitalization rate. “Being able to make sure clients take their medications is a significant part of that,” she says.
For The Providence Center, prepackaging medications had become a very labor-intensive task. When medication was delivered from the local pharmacy, nurses had to take pills out of their bottles and put them into small envelopes or seven-day “Med Minder” packages.
“Obviously, packaging medications isn’t a task that utilizes the skills of our nursing staff; it’s purely administrative,” O’Brien points out. “But until we did a time study, we didn’t realize how much time we were actually spending on it.”
When the results came back, the staff was more than a little surprised. Two full-time equivalents (FTEs) of nursing time (two 37.5-hour periods per week) were being spent pre-packaging medications. Once they partnered with Genoa, and its staff took over that responsibility, the savings was hard to ignore.
“We didn’t lay off any nurses, but as there has been attrition we didn’t necessarily fill those positions,” O’Brien explains. “In addition, it helped us open up a significant amount of time that nurses could now spend treating clients.”