How pharmacies and health systems can utilize remote pharmacy models to boost medication access

The coronavirus pandemic has increased the need to remove barriers to medication access for vulnerable patients, as well as the need to reach patients in non-traditional ways. One strategy for pharmacies is to implement a remote model, which helps ensure they can plan for surges in volume due to any circumstance, whether it be severe weather, social unrest or a pandemic. It can also allow pharmacists to provide additional services, whether clinical or operational, with the help of off-site support. 

In an Oct. 29 webinar hosted by Becker's Hospital Review and sponsored by Cardinal Health, Christy Barr, senior vice president of national pharmacy operations at Renton, Wash.-based Genoa Healthcare, and David Silverman, PharmD, vice president of pharmacy services at Ontario, Canada-based Prime Healthcare, shared how their facilities have benefited from leveraging remote pharmacy models. They were joined by Kelly Morrison, director of remote and retail pharmacy services at Cardinal Health.

How a remote pharmacy model helps an alternate care system increase medication adherence and remove barriers to care 

Genoa Healthcare provides behavioral health and addiction treatment services and operates 546 pharmacies around the country. Ms. Barr cited a study that shows 50 percent of prescriptions for behavioral health medications aren't filled. It is critical for pharmacies to improve medication adherence and remove barriers to care and medications for this vulnerable patient population, she said, and one of the primary tools used to support adherence is pharmacist consults and potential medication interventions.

To expand clinical services and improve patient adherence and outcomes, increased pharmacy involvement is critical across all care settings, Ms. Morrison said. Off-site pharmacy teams—like Cardinal Health Remote Pharmacy Services—offer clinical outreach, new prescription transfers and patient profile requests, among other services, and they are available 24/7. 

At Genoa Healthcare, remote pharmacists review and approve medications and access Genoa's pharmacy system through a secure, HIPAA-compliant connection. Remote teams can do all clinical documentation and transfer medications for patients, to reduce medication errors throughout a patient’s care journey at multiple sites. Every morning, on-site Genoa pharmacists have reports from Cardinal Health detailing everything that the remote pharmacy team did—from prescription transfers to patient phone calls—enabling Genoa’s on-site staff to have more time for direct patient interactions and more time for clinical initiatives. Genoa's remote pharmacy model has allowed it to remove the barriers to medication adherence and achieve a 90 percent adherence rate. 

Remote pharmacy models help acute care health systems balance surges in volume and provide continuous patient care

Hospitals must have a flexible staffing model to adjust for volume changes and must always be prepared for emergency coverage needs, said Dr. Silverman, who oversees pharmacy operations for Prime Healthcare. A remote pharmacy team can provide pharmacy coverage during times of emergencies—such as severe weather, pandemic volume surges and times of civil unrest, he said. 

Pharmacy leaders must develop disaster plans and ask themselves: "How would I manage patient care with a 95 percent reduction in staff?" Dr. Silverman said. Sudden patient volume surges during a pandemic are an even greater challenge to staffing levels as some hospitals have had to cut large portions of their staff to offset operational losses. 

At Prime Healthcare, 19 hospitals have remote pharmacy support for emergency coverage needs and on-demand service for any facility that needs supplemental, off-site pharmacy coverage. Additionally, 11 prime hospitals leverage Cardinal Health to ensure routine24/7 pharmacy coverage. 

Deciding which remote pharmacy model is best for your facility 

There are four main models to consider when it comes to remote pharmacy, Dr. Silverman said. First, is the shared workforce or sister hospital coverage model. In general, this model works best when you have nearby affiliated hospitals where one of the hospitals is bigger, has a higher acuity and has 24-hour staffing. The larger hospital can absorb the increased workload for a smaller, lower-acuity hospital, without any detriments to patient care. Essentially, you’re leveraging existing staff to take on additional work. 

The second model is the centralized hub model, which may be a good model when you have a lot of small or low-acuity hospitals in one state or regional area. A dedicated health system team provides remote order entry services for the system’s member hospitals, and you can take advantage of the large order, low-acuity order volumes to offset the overhead cost.

The third model is outsourcing remote coverage to a vendor. This is designed to supplement on-site pharmacy teams (an outsourced hub model). The fourth model is a disaster preparedness model, which involves coverage for emergency needs only. 

Dr. Silverman suggests several guiding questions to help with the decision-making process. To decide which model is right for your facility, start by considering the size and complexity of your organization. Do you have locations in more than one state, which may require additional state licensure coverage? Where do you need help with workload balances or surges? 

Also consider that using different EHR systems throughout a nationwide system introduces additional operational complexities, said Dr. Silverman. Consider standardization in your formulary, policies, procedures and workflows and your ability to scale up or down at short notice. 

Another important consideration is the upfront IT and infrastructure costs needed for each model, Dr. Silverman said. Costs vary widely by program size and current IT infrastructure. But, when taking advantage of a vendor model, facilities don't have to worry about start-up costs or costs to train staff, he said.

Doing more with less has been an expectation in healthcare for years and it remains the norm, Ms. Morrison said. Pharmacy is at the forefront of key initiatives such as clinically reviewing and filling patient scripts, performing medication reconciliation, documenting interventions and providing patient education. Remote models give pharmacies the ability to succeed at these initiatives and more, no matter the circumstances.

To view the full webinar, click here. To learn more about Cardinal Health remote pharmacy services capabilities visit cardinalhealth.com/remotepharmacyservices.

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