Social and Administrative Pharmacy PDF

SOCIAL and ADMINISTRATIVE PHARMACY MANAGED CARE INTRODUCTION TO MANAGED CARE Although the roles of managed care organizations (MCOs) and...

SOCIAL and ADMINISTRATIVE PHARMACY MANAGED CARE INTRODUCTION TO MANAGED CARE Although the roles of managed care organizations (MCOs) and PBMs include directing patients to equivalent and affordable INTRODUCTION therapeutic options, patients are sometimes surprised by A growing number of pharmacists are practicing in what could be insurance coverage denials, higher-than-expected copayment referred to as "nontraditional" practice roles or settings. amounts, or automatic generic substitutions. Pharmacists in such roles contribute directly to patient care (at This surprise can result in a patient view that managed care is the individual patient and population levels) and may have direct simply a barrier to prescription drug access. interactions with patients and healthcare professionals, but not Patients interact with managed care primarily at the point of necessarily face-to-face. medication dispensing-positioning pharmacists as mediator Pharmacists are also involved in providing care for animals. and educator about managed care to a large portion of the public. o Veterinary pharmacists receive special training in veterinary pharmacology and therapeutics and must be PHARMACISTS IN MANAGED CARE proficient at compounding, which is a key service for animal patients. A pharmacist in a managed care practice provides a markedly different type of professional activity, and as a result, additional MANAGED CARE is one of these nontraditional practice roles. competencies are required. For a pharmacist working in this environment MANAGED CARE o PATIENTS It is a body of clinical, financial and organizational activities ▪ Are monitored as a population database designed to ensure the provision of appropriate health care o PHARMACISTS services in a cost-efficient manner. ▪ Pharmacist care is directed through database review It is broad term and encompasses many different types of and querying. organizations, payment mechanisms, review mechanisms and ECONOMIC and CLINICAL OUTCOMES are weighed against, collaborations and is often misunderstood, as it refers to and with each other, to make appropriate decisions for a numerous aspects of healthcare management, payment and "population" of patients. organization. Pharmacists practicing in managed care organizations, including In the purest sense, all people working in healthcare and medical health plans and PBMs, are responsible for a broad range of insurance can be thought of as 'managing care. clinical, quality-oriented drug management services. MANAGED CARE ORGANIZATIONS ROLE OF PHARMACIST IN A MCO A generic term applied to a managed care plan. HPEP 1. Drug distribution and dispensing Includes: 2. Patient safety o Health Maintenance Organization (HMO) 3. Clinical program development o Preferred Provider Organization (PPO) 4. Communication with patients, prescribers and pharmacists o Exclusive Provider Organization (EPO) 5. Drug benefit design o Health Plan, or Prescription Benefit Management company 6. Business management (PBM) 7. Cost management ▪ Although the MCO may not conform exactly to any of these formats. DRUG DISTRIBUTION AND DISPENSING Through their own pharmacies: pharmacists provide enhanced HEALTH MANAGEMENT ORGANIZATIONS (HMO) pharmaceutical services, beyond traditional dispensing, because A form of health insurance in which its members prepay a they are members of a fully integrated patient care system premium for the HMO's health services, which generally include Through community pharmacies: broad-based networks of inpatient and ambulatory care. contracting pharmacies interface with managed care pharmacists For the patient, it means: to provide online eligibility and claims processing o Reduced out-of-pocket costs (eg, no deductible) Through mail order: pharmacists assess legitimacy of o Reduced paperwork (eg, insurance forms) prescriptions, eligibility for coverage, appropriateness and safety o Only a small co-payment for each office visit of the medication for the patient PHARMACY BENEFIT MANAGEMENT COMPANY (PBMs) PATIENT SAFETY These are organizations that manage pharmaceutical benefits for DRUG UTILIZATION REVIEW (DUR) managed care organizations, other medical providers or o A process that identifies potential prescription-related employers problems such as drug-drug interactions, duplication of Engage in numerous activities to promote managed care drugs, known allergies, under or overdosing or inappropriate principles, including therapy o Benefit plan design PRIOR AUTHORIZATION (PA) o Creation/administration of retail and mail service networks o An approval process that encourages proper use of o Claim processing medications and discourages inappropriate prescribing o Managed Prescription Drug Care Services such as MONITORING PROGRAMS for certain drugs that require lab- ▪ drug utilization review DF-GDP based monitoring for dosage adjustment. ▪ formulary management QUALITY ASSURANCE (QA) PROGRAMS that enhance patient ▪ generic dispensing safety and improve patient drug use ▪ prior authorization ▪ disease and health management. Prepared by: WAWARN  SOCIAL and ADMINISTRATIVE PHARMACY CLINICAL PROGRAM DEVELOPMENT RESEARCH AREAS ON SOCIAL AND ADMINISTRATIVE PHARMACY Use evidence-based clinical and research data to create disease management programs. Social and administrative pharmacy places its interest in the Evaluate scientific evidence in order to select appropriate drugs organization of pharmacy practice and the provision of evidence for for a patient population through a PHARMACY AND decision-making in all areas related to pharmacy policy and advocacy. THERAPEUTICS (P&T) COMMITTEE Design and conduct outcomes-based research in order to help Research Areas on Social and Administrative Pharmacy patients achieve the desired results from their drug therapy (According to FIP) Pharmacoeconomics COMMUNICATION WITH PATIENTS, PRESCRIBERS AND Professional society management PHARMACISTS Outcomes research Helps prescribers choose drugs that will meet patients' needs and Evaluation research qualify for coverage Research administration Provide and educate patients about their individual prescription Evidence-based practice history Quality assurance Provide a dispensing pharmacist with a patient's drug profile in Health planning order to identify potential adverse drug reactions or duplicate Pharmacoepidemiology therapies Regulatory Affairs Quality of life Studies DRUG BENEFIT DESIGN Health Policy Investigations DETERMINE Epidemiology o IF A FORMULARY (approved list of medications that the Patient Satisfaction plan will cover) SHOULD BE USED, ▪ Whether it should be "restricted" or "open" PHARMACOECONOMICS ▪ The use of patient cost-sharing structure for generic, covered brand-name drugs and non-formulary drugs. Defined as the description and analysis of the costs of drug o IF A "participating" PHARMACY NETWORK should be therapy to health care systems and society— it identifies, established and what the criteria for QA would be. measures, and compares the costs and consequences of o CRITERIA and PROCEDURES FOR DRUG UTILIZATION. pharmaceutical products and services. Pharmacoeconomic studies categorize costs into four types: BUSINESS MANAGEMENT o direct medical o direct nonmedical Negotiate with manufacturers for discounts on drug prices for o indirect clients in exchange for moving market share. o intangible Provide clients with customized clinical reporting that meets their population needs. OUTCOMES RESEARCH COST MANAGEMENT It tends to describe research that is concerned with the effectiveness of public-health interventions and health Encourage prescribers to make cost effective drug choices. services; that is, the outcomes of these services. o Identify compliance and noncompliance with prescribing Attention is frequently focused on the affected individual - with guidelines measures such as quality of life and preferences o Assess physician performance o Identify prescribing patterns that require improvement. May also refer to the effectiveness of healthcare delivery, with measures such as: o cost-effectiveness o health status o disease burden QUALITY ASSURANCE Can be defined as "part of quality management focused on providing confidence that quality requirements will be fulfilled." Also, QA can be defined as all the planned and systematic activities implemented within the quality system that can be demonstrated to provide confidence that a product or service will fulfill requirements for quality. PHARMACOEPIDEMIOLOGY The study of the use and effects of drugs in large numbers of people. It is a growing discipline that applies epidemiological techniques to study drug use in a large population QUALITY-OF-LIFE STUDIES An individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, personal beliefs, Prepared by: WAWARN  SOCIAL and ADMINISTRATIVE PHARMACY social relationships and their relationship to salient features of RESEARCH IN SAP: A FOCUS ON PATIENTS their environment. As mentioned, patient-related studies can be conducted within the context of social and administrative pharmacy. EPIDEMIOLOGY It is the study of the factors that determine the occurrence PATIENTS' ATTITUDE TOWARDS PHARMACY and distribution of diseases in populations often divided into PROFESSION o infectious disease epidemiology Since patients are essential partners in determining priorities and o chronic disease epidemiology resource allocation in the healthcare system, considerable efforts have been made to shift the focus of pharmacy profession from PATIENT SATISFACTION drug dispensing to patient-oriented care. Obtained using patient satisfaction surveys In a cross-sectional study conducted in a teaching hospital in A patient satisfaction survey can demonstrate that a practice is Jordan, a team of researchers determined patients' attitude interested in quality and in doing things better. towards pharmaceutical care services among the general Help to identify ways of improving practice which will ultimately population and their willingness to pay for this service. translate into better care for patients. They found out that most of the participants showed a positive attitude towards pharmaceutical care services, with an average EVALUATION RESEARCH attitude. Refers to a research purpose rather than a specific method. The majority of participants expressed their interest in This purpose is to evaluate the impact of social interventions such pharmacists checking their medications at least once per month. as: Most of the participants believed that the pharmacist should be o new treatment methods reimbursed for providing a pharmaceutical care service that o innovations in services would potentially reduce medication-related problems (MRPs) by o host of others 50% Of these, about 93.3% of the participants were willing to pay out EVIDENCE-BASED PRACTICE of their pockets an average maximum amount of $3.95 for the The conscientious and judicious use of current best pharmaceutical care services they may receive to reduce 50% of evidence in conjunction with clinical expertise and patient the risk of MRPs. values to guide health care decisions. The study revealed that Jordanian people have a supportive Best evidence includes: attitude regarding pharmacists' abilities in providing o empirical evidence from randomized controlled trials pharmaceutical care services in addition to dispensing. o evidence from other scientific methods such as descriptive and qualitative research PATIENTS AND MEDICATION ADHERENCE o use of information from case reports, scientific principles, The issue of medication adherence is also another area to and expert opinion. explore in SAP research. POOR ADHERENCE TO LONG-TERM THERAPIES is a public HEALTH PLANNING health concern that affects all populations. The orderly process of defining health problems, identifying Little is known about the context of adherence in chronic diseases unmet needs and surveying the resources to meet them, for the uninsured population. establishing priority goals that are realistic and feasible, and In a study published in the journal Research in Social and projecting administrative action. Administrative Pharmacy in 2018, which evaluated medication Concerned not only with the adequacy, efficacy and efficiency of adherence and barriers among low-income, uninsured adults health services but also with those factors of ecology and of social recently initiating new therapy for a chronic disease, it was found and individual behavior that affect the health of the individual and that medication non-adherence was common among low- the community. income, uninsured patients initiating therapy for chronic conditions. REGULATORY AFFAIRS Several modifiable barriers highlight opportunities to address A profession developed from the desire of governments to medication non-adherence through multidisciplinary protect public health by controlling the safety and efficacy of interventions. products in areas including pharmaceuticals, veterinary medicines, medical devices, pesticides, agrochemicals, PATIENT PREFERENCES cosmetics and complementary medicines, and by the companies Determining patient preferences about the pharmacy service they responsible for the discovery, testing, manufacture and marketing receive is crucial for pharmacies in order to develop strategies to of these products wanting to ensure that they supply products that improve their services. are safe and make a worthwhile contribution to public health and Patients select healthcare providers and facilities based on a welfare. complex array of factors. To help patients with their preferences, pharmacy-level quality HEALTH POLICY INVESTIGATIONS metrics have been discussed as a way to help direct patients Refers to decisions, plans, and actions that are undertaken to towards high-quality pharmacies. achieve specific health care goals within a society. Limited research has been conducted on the potential impact of An explicit health policy can achieve several things: quality metrics on the pharmacy selection process. o It defines a vision for the future which in turn helps to In a paper published in 2018, a group of researchers measured establish targets the relative strength of patient preferences for community o Points of reference for the short and medium term pharmacy attributes and described associations between patient It outlines priorities and the expected roles of different groups; sociodemographic and health characteristics and pharmacy and it builds consensus and informs people. preferences. They found out that the participants expressed the strongest preferences for competence-based pharmacy attributes, including DDI-specific and overall quality measures. Prepared by: WAWARN  SOCIAL and ADMINISTRATIVE PHARMACY They also noted that women ascribed higher utility to 5-star DDI THE USE OF TECHNOLOGY IN GATHERING DATA and overall quality ratings than men. It could be quite difficult to obtain data from pharmacists when Also, results showed that rural respondents and those with conducting studies about pharmacy practice. inadequate health literacy expressed stronger preferences for In 2018, a team of researchers in the Netherlands assessed the patient-pharmacist relationships than those in suburban areas amount of time community pharmacists spend on different and with adequate health literacy, respectively. activities (i.e., professional, semi-professional or non- These results suggest that the participants may perceive professional) and how these activities are divided over the medication safety to be a key role of community pharmacists. workweek. Future research on patient expectations of and preferences for In order to do so, a smartphone application was developed to community pharmacies can inform ways to effectively encourage register the activities of participating pharmacists. patient engagement with pharmacists to improve health The application randomly alerted pharmacists to record their outcomes. activities. Results indicated that the Dutch community pharmacists spent RESEARCH IN SAP: PHARMACY PRACTICE 51.5% of their time on professional activities, 35.4% on semi- Practice of pharmacy is faced with a lot of challenges. professional activities, and 13.1% on non-professional activities. In order to overcome and solve such challenges, researches are The proportion of time devoted to cognitive pharmaceutical conducted to have a better perspective of a particular problem so services (CPS) decreased during the workweek, whereas the that solutions can be presented. time spent on traditional task increased. PHARMACISTS AND THE TRADITIONAL AND COMPLEMENTARY MEDICINE PRODUCTS TRADITIONAL MEDICINE (TM) and COMPLEMENTARY MEDICINE (CM) products have played an increasingly important role in the business of pharmacy for over two decades in a number of countries. With a focus on the quality use of all medicines including complementary medicines, there have been a number of initiatives to encourage the integration of TM/CM products into professional practice. Recent studies report that many of the barriers that prevent such integration remain. In 2017, researchers published a study which explored the pharmacists' perspective regarding how barriers to the integration of TM/CM products into the professional practice of pharmacy could be resolved. In that study, the participating pharmacists proposed that five key stakeholders: o professional pharmacy organizations o universities o government o pharmacy owners o pharmacist Must enact developments that require a collaborative effort on education and training; building the evidence base; developing reliable and accessible information resources; and workplace support for best practice. RELUCTANCE AMONG PHARMACISTS IN CONDUCTING RESEARCH The role of pharmacists in healthcare has evolved towards patient-centered care. PHARMACY PRACTICE-BASED RESEARCH is essential to the advancement of practice; however, literature addressing attitudes and involvement of pharmacists in practice research indicates reluctance among them. In a systematic review published in 2014 which summarized and evaluated the views and attitudes of pharmacists regarding their involvement in pharmacy practice research as well as the barriers and enablers to such research, they found that pharmacists recognize the value of research in advancing pharmacy practice and indicate their willingness to be involved in independent research and in practice-based research networks (PBRNs). However, the lack of time, training and support were identified as the greatest limitations to participation in practice research. These findings therefore have important implications on promoting research capacity building through the development of PBRNs involving academic and pharmacy practitioners as well as informal research training programs. Prepared by: WAWARN