WASHINGTON, D.C. 27 June 2013—A community pharmacy chain's model of patient care received a boost from the Pharmacy Quality Alliance (PQA) in late May when the nonprofit organization announced it would support the expansion of the model into hundreds of sites nationally.
Minnesota-based Thrifty White Pharmacy, an employee-owned business whose approximately 160 stores and affiliate pharmacies serve patients in North Dakota, Minnesota, Montana, South Dakota, Wisconsin, and Iowa, launched the appointment-based model (ABM) of care in 2011.
Timothy Weippert, executive vice president of pharmacy for Thrifty White, said during PQA's annual meeting in May that ABM involves the synchronized filling of prescriptions for a patient's chronic conditions so that all of the medications are ready for pickup by appointment once a month.
About a week before the appointment, patients are contacted by phone to confirm the prescriptions, which are filled centrally by Thrifty White. The patients are also asked about any medical office or hospital visits that affect the medication regimen.
The patient comes into the pharmacy on the appointment day and meets with a pharmacist, who reviews the patient's medication profile. This appointment also offers an opportunity to provide immunizations and other patient care services, Weippert said.
The medication synchronization program is free to qualified patients, as are the pharmacy's medication therapy management services. Weippert said Thrifty White bears most of the cost of clinical services provided to patients.
Weippert said the pharmacy chain's use of a central-fill facility for maintenance prescriptions decreases the dispensing activities at the retail stores, giving pharmacists more time to work directly with their patients.
He also said the patient care services offered by Thrifty White align with national efforts to move away from fee-for-service patient care and toward a pay-for-performance system that rewards health care providers for doing the right things for their patients.
"The increased focus on this whole program is to use consultations to improve the health outcomes of the patients, which subsequently reduces overall health care expenses," Weippert said. "There is room for us, as a pharmacy, to make a difference."
Weippert said Thrifty White now has almost 27,000 patients enrolled in the ABM program in 91 stores.
Since the inception of the program, "we're seeing an increase in medication persistency, we're seeing decreased gaps in therapy," he said. "It increases the level of patient care we can provide for each patient."
Weippert said that care includes immunizations, comprehensive medication therapy management, discharge counseling, and, in rural areas, telepharmacy services. To coordinate these services, he said, Thrifty White has invested in a patient care center that is staffed by 5 clinical pharmacists and 15 pharmacy technicians, all employed by the chain.
Sam Stolpe, associate director for quality initiatives at PQA, said the alliance has received funding from Pfizer to promote the expansion of ABM (PDF).
Stolpe said PQA wants to implement the model in at least six chain pharmacies, with more than 50 pharmacies per chain offering ABM. He said PQA's goal is for the model to be active in upwards of 600 pharmacies nationally.
Among other things, Stolpe said, PQA will fund, train, and support project coordinators employed by the pharmacy chains and provide opportunities for research about the model.
"It's not enough for a pharmacy to think about their patients in that narrow 15-minute window when that patient happens to be your customer," Stolpe said. "We need to think about them when they're not at the pharmacy."
Weippert credited ABM with improving the likelihood that patients with chronic conditions will adhere to their medication regimen and not discontinue therapy prematurely.
A study (PDF) that was completed last year evaluated Thrifty White's ABM program for patients taking angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), β-blockers, dihydropyridine calcium-channel blockers, thiazide diuretics, metformin, or statins.
Compared with control patients, ABM program participants were more likely to take their prescribed medications at least 80% of the time, the defined lower threshold for adherence. Average adherence rates among ABM program participants ranged from 80% in those taking thiazide diuretics to 87% in patients prescribed ACE inhibitors or ARBs.
Overall, patients in the ABM group were 3.4–6.1 times as likely as control patients to be adherent to their prescribed regimen for the different medications.
The ABM group also had higher ratings than controls when measured against adherence components of the Medicare program's star rating system for Part D prescription drug plan quality.
The study was conducted by researchers at Virginia Commonwealth University and involved patients enrolled in the ABM program who had had at least two prescriptions filled for one or more medications of interest. Control patients who did not participate in the ABM program were matched with ABM program enrollees on the basis of age, sex, region, and medication start date.
The study took place from June 30, 2011, through October 31, 2012.