1. Focus of pharmacist role
The Work-System of Value-Based Programs in Pharmacy: A Multi-Case Study
Joel Hoyman, Samantha Johnson, Matti Mason, Michael Parisi-Mercado, Dr. Bill Doucette
The University of Iowa College of Pharmacy
Background
Results
Discussion
The role of the pharmacist has been dynamic in recent years, with reimbursement payments focused more on pay-for-performance rather than a flat fee for service - or in this case, medication.
Focus of pharmacist role
Insurance companies have helped initiate change in the payer’s perspective, leading pharmacies to adjust their work system in order to accommodate providing new clinical services.
Iowa Pharmacy Association (IPA) supports pharmacies to make these changes through programs like the New Practice Model (NPM) and Community Pharmacy Enhanced Services Network (CPESN).
One of the areas with most change was within the people work-system area. Some pharmacies noted to be reducing hours or not hiring pharmacists at all. In contrast, pharmacies noted to be hiring more technicians and support staff. One challenge mentioned was that changes in workflow have resulted in lack of staff buy-in, especially with tech- check-tech. Pharmacy technicians expressed fear of implementation of technology resulting in job loss.
Just like how the role of the pharmacist is evolving, the role of pharmacy technicians are also evolving. Besides being involved in prescription verification and filling, pharmacy technicians are getting involved in certain clinical services like adherence packaging. These changes are supported by the New Practice Model.
Changes in workflow have the led the pharmacist to have more time for more detailed patient encounters.
This study has strengths and limitations that could have affected our outcomes. Some strengths were that once each interview was complete, two researchers coded the interview together to verify that the responses were matched correctly to the correct system area. We also completed an interview training session with the head researcher to standardize our interview process and keep them as consistent as possible. One limitation was that our interviews were completed over the phone instead of on-site. This limits our understanding of the spatial issues that some pharmacies addressed.
Out of 106 pharmacies, 9 pharmacies participated and completed our study.
Dispensing medications Clinical outcomes
Objectives
The goal of this study was to determine how pharmacies have changed their work system to create capacity to deliver care under the evolving value-based payment environment.
Figure 1. Description of commonalities and differences found in the five work system areas among all participating pharmacies.
Methods
This multi-case study utilized a qualitative approach for data collection.
Conclusion
The role of the pharmacist is shifting from a traditional dispensing role to one with a more clinical focus. This is mostly due to financial pressures where pharmacies are looking to expand services. To help accommodate these new services, pharmacies need to adjust their workflow system. This includes people, tasks, tools and technology, organization, and environment. Statewide organizations are supportive of these changes and are implementing initiatives that allow pharmacies to expand services. Challenges in implementing new changes include lack of pharmacist time, staff, space, communication, and legislation.
Future Directions
Next steps in this study include: perform more thorough comparisons, develop a quantitative approach utilizing structured survey questions and gaining a larger study population.
Figure 2. Description of overall strengths and areas for improvements in participating pharmacies.
Figure 3. Results of self-rating performance and staff distribution in participating pharmacies.
*Systems Engineering Initiative for Patient Safety