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How to Improve Pharmacy Practice through Medication Synchronization during the COVID-19 Pandemic

Boscobel Pharmacy owner Michelle Farrell and her team have continued to operate and care for their patients during the COVID-19 pandemic. Over the course of the COVID-19 timeline, the members of Boscobel Pharmacy have been following new developments and incorporating updated guidance from the Centers for Disease Control and Prevention (CDC) and other professional organizations, and have been collaborating with CPESN Wisconsin pharmacists in sharing information and best practices to improve care and clinical services for patients in the midst of the COVID-19 pandemic.

COVID-19 Impact on Community Pharmacy Practice

The novel coronavirus that causes the COVID-19 infection has had an unprecedented impact on pharmacy practice. Across the nation, pharmacies are adjusting to the pandemic by implementing into daily workflow guidance from the Centers for Disease Control and Prevention (CDC) on infection and exposure control, taking inspiration from pharmacies across the nation by learning how they are shifting their clinical services due to the pandemic, and using resources organized and compiled by professional organizations. The COVID-19 pandemic continues to rapidly evolve with new developments on a daily basis, changing the way that pharmacists interact and care for their patients at this time.

Community pharmacies have been adapting to the rapidly evolving pandemic and changing pharmacy practice to ensure the safety of their patients and their staff members. Such changes in daily workflow practices include restricting patients from entering the pharmacy by closing pharmacy lobbies to reduce infection risk, implementing daily temperature checks and weekly surveys to screen for potential infections for staff members, and shifting from in-pharmacy medication pickup to curbside and drive-through pickup as well as free medication deliveries and mailing. As community pharmacies continue to implement these changes, they must simultaneously educate their patients on these adjusted services in order to streamline the workflow process. Patients are now being informed that due to the COVID-19 pandemic, they must call for medication refills of anything that they will run out of within the next few weeks instead of within the next few days, they must stay outside of the pharmacy and call when they arrive such that designated personnel may interact with them outside of the pharmacy, and they must provide their payment information to charge prior to the pharmacy delivering medications to the patient. These key education points, alongside many other rules set forth by pharmacies, have been crucial in ensuring that patients play a role in adhering to and fitting within a safe environment.

Impact of Medication Synchronization during the COVID-19 Pandemic

Medication synchronization has been an important aspect of community pharmacy practice. Coordinating routine medication refills to a single day each month or every 3 months reduces the need for patients to call the pharmacy for their medication refills over multiple occasions each month, reduces the amount of time that patients need to take to travel to and from the pharmacy, allows patients the opportunity to consult with a pharmacist on a regular monthly or quarterly basis, and improves patient medication adherence. This in turn benefits the pharmacy by reducing the amount of time spent taking phone calls for medication refills, reducing the amount of time that patients will need to wait in the pharmacy by having all of their medications filled preemptively, and simplifying inventory management through scheduled ordering and filling of high-cost medications.

During the COVID-19 pandemic, the benefits of medication synchronization have become more apparent than ever before. The coordination of regular monthly or quarterly medication refills help to ensure patient safety during this time by reducing the risk of potential infection with patients having to spend less time travelling outside to and from the pharmacy. Medication synchronization reduces the number of trips to the pharmacy, which is especially crucial for areas with a greater population of elderly patients, while saving medication delivery resources by delivering all of a patient’s medications at once instead of multiple time-consuming deliveries over a longer period of time each month.

Many clinical services that are normally offered in community pharmacy settings are currently placed on hold until further notice in order to reduce the risk of infection and as a result, pharmacists are now finding more free time throughout the day. Pharmacists may utilize this free time to further develop pharmacy practice and establish additional clinical services as preparation for when the pandemic ends. This is an opportune time for both pharmacists and pharmacy technicians to both enroll more patients into a medication synchronization program and to educate patients about the benefits of medication synchronization which will in turn set up the pharmacy for a much more streamlined workflow for when the pandemic ends.

Starting Patients on a Medication Synchronization Program

If your pharmacy does not currently have a medication synchronization program established, the National Community Pharmacists Association (NCPA) provides information, tools, and support in setting up a medication synchronization program through Simplify My Meds®. Joining a pharmacy network can also help start up a program as pharmacies within the CPESN Wisconsin network continuously share resources and strategies amongst each other on improving pharmacy practice, including how to start and improve medication synchronization programs. Each pharmacy has their own method of maintaining their medication synchronization programs where some pharmacies may utilize their pharmacy software to schedule coordinated refills, while other pharmacies may utilize a paper format to keep track of enrolled patients and scheduled refill dates by sorting each card within a dated accordion binder.

If your pharmacy has already established a medication synchronization program, then all there is left to do is to target and enroll more patients into the program. Patients that are well-suited to be on a medication synchronization program and should be targeted for enrollment include:

· Patients with non-complex medication profiles, with only 1-2 chronic medications

· Patients with multiple chronic medications

· Patients with high-cost medications that are not normally kept in stock

· Patients who call in multiple medication refills and present to the pharmacy multiple times each month

· Elderly patients

· Patients that pick up medications for their entire family

Pharmacy technicians and pharmacists may identify these well-suited patients and utilize paper medication synchronization cards to be placed into their baskets which can help flag or prompt the pharmacist to educate and enroll patients at the time of delivery to the curbside or drive-through window.

This job does not have to solely involve the pharmacists in your practice, but can expand to the pharmacy technicians who speak to patients over the phone. While pharmacists should still be the ones to provide medication synchronization education to patients with relatively complicated medication regimens, pharmacy technicians can play a role in relieving some of the workload for pharmacists by speaking to patients with less complicated medication regimens to enroll them into a medication synchronization program, please see the sidebar for example verbiage that pharmacy technicians can use for program education and enrollment.


Scenario

There are familiar situations on a daily basis that indicate that a patient's medication regimen is not completely synched for pick up on a monthly or quarterly basis. A patient may present to the pharmacy multiple times throughout the course of the month to pick up their medications. Patients may call the pharmacy to fill particular medications, but not other medications in the profile that appear to be due for a refill. Some patients may tell you that they simply prefer to contact you when it comes time for their medications to be filled rather than have their medications filled automatically on a medication synchronization program.

Not sure about how to respond in these situations? Take a look at some sample scripts below to help your patients get started on a medication synchronization program.

"We are offering a service where you are able to pick up or have delivered all of your medications once monthly or every 3 months; this will allow you to avoid multiple trips to the pharmacy each month, especially during this COVID-19 pandemic where it is crucial to minimize your chances of getting sick. With this program, you don't have to spend as much time leaving the house to come to the pharmacy. Let me help you stay healthy by getting you all set up with our medication synchronization program and we'll fill your medications automatically either monthly or every 3 months, whichever you prefer."

"Let me help you avoid partial fills and decrease your number of trips to the pharmacy each month. We have a medication synchronization program that can allow you to pick up or have delivered or mailed all of your monthly prescriptions at one time. This way, you can spend more time safely indoors and less time outside travelling to and from the pharmacy. I can get you enrolled into the program quickly and easily right now."

"I think you would benefit from an established monthly visit at the pharmacy or even a visit every 3 months, where you can pick up all of your refills and any new medications at one time. You'll be able to cut down on your visits to the pharmacy each month, cut down on your chances of getting sick during the COVID-19 pandemic, and have the chance to talk one-on-one with the pharmacist each time you pick up your medications. I'll help enroll you into our medication synchronization program so we can make this happen."

"Let me help get you set up in our medication synchronization program so you can pick up or have delivered or mailed all of your medications for the month at one time. We can also fill your medications for a 3 month supply so that you don't have to worry about coming into the pharmacy multiple times each month and potentially increasing your chance of getting sick during the COVID-19 pandemic."


Post created by Ryan Fan, PharmD; UW Community Pharmacy Resident at Boscobel Pharmacy. Feel free to reach out at pharmacist@boscobelpharmacy.com with any questions regarding this content.

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