50 Stories from 50 States
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Idaho State University and
Shaver Pharmacy

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About the Pharmacy

Shaver Pharmacy and Compounding Center
Pocatello, ID
https://www.shaverpharmacy.com/

 

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Meet the Team
 

Faculty Lead Contact:

Shanna O’Connor
 

Pharmacist Lead Contact:

Karami Reed
 

Pharmacy Resident:

Christine Phan

Student Pharmacist:

Kristen Morse

Description of Pharmacy

Shaver Pharmacy & Compounding Center is a locally-owned community pharmacy serving the rural area of Pocatello, Idaho. This pharmacy is located in a designated medically underserved area where 9.4% of the population is uninsured and 17.2% are below the poverty line. Services offered at this site include conventional prescription filling, sterile and nonsterile compounding, durable medical equipment, medicare open enrollment, medication therapy management, mastectomy supplies and fitting, and much more. Shaver’s Pharmacy has currently implemented all 19 protocols finalized from ISU which includes: cold sores, uncomplicated UTIs, erectile dysfunction, statins in diabetes, mild burns, mild acne, acute migraine, pinworms, strep, pink eye, canker sore, naloxone, emergency contraception, flu prophylaxis and treatment, motion sickness, and hemorrhoids. Like the story above, any patient can come in for any of these conditions above. If they meet the inclusion criteria, they can be evaluated and prescribed medication in the pharmacy saving themselves time and money by avoiding a trip to the urgent care or emergency room.

PHARMACY STORY

Initial Presentation:

A husband, wife, and their three young children - 5, 2, and 1 years old - presented to the pharmacy after being notified they were exposed to strep throat over Christmas. Since they were experiencing symptoms, the mother wanted the family tested for strep throat. The mother filled out the intake questionnaire for her husband, herself and her 5-year-old son that indicated they qualified for a CLIA-waived strep throat test.

 

Background:

Because two children were under 5 years of age, they were excluded from treatment based on pharmacy protocol.

 

Patient Report:

The mother reported her son was the first to feel unwell with a fever a couple days ago, but that his fever subsided on the day of presentation. All presented with similar symptoms, and she was worried they all contracted strep at Christmas. She did not want to spread it to others at a New Years Eve party they were invited to.

 

Physical Observation:

The parents and younger children (1 and 2 years old) presented with a fever, no cough, and sore throat. The older child (5 years old) presented with a sore throat and no cough. There was a lack of white spots.

 

Intervention:

  1. Diagnosis and Treatment: The pharmacist initiated a CLIA-waived strep test to the wife, husband, and 5-year-old son that all came back positive for strep throat. The following actions were taken:

    • The father and mother were prescribed Amoxicillin tablets.

    • The son was prescribed an Amoxicillin suspension.

    • The family’s pediatrician was contacted and a prescription for antibiotics was sent to the pharmacy for the girls due to their similar strep-like symptoms.

  2. Follow up phone call the next day to check on symptom improvement and medication effects. The mother was appreciative of the quick, convenient, care provided to her family the day prior.

 

Outcomes of Care Provided:

Outcome 1: Cost and time savings to patient

The family was able to walk in without an appointment, get diagnosed, and pick up medication all in one place within 20 minutes, making it more time and cost efficient than an urgent care visit. Since two of the children were too young to be treated under the pharmacy’s protocol, the mother called their pediatrician and was able to get prescriptions sent over to the pharmacy that same day. This saved the mother the trouble of having to take sick kids to wait in the doctor’s office and then separately to the pharmacy to pick up medication. The pharmacist who provided the care stated, “As a mother of two, I understand how challenging it can be to coordinate care for young children and how life changing it is to find a location where I can have quick and efficient care for my children all in one place.”

 

Outcome 2: Positive public health intervention

Since all family members tested positive, they did not go to the New Year’s Eve party, and it prevented the unnecessary spreading of strep throat to others.

Outcome to the Pharmacy

  • The pharmacist documented the encounters with each family member and sent a notice via eFax to the family’s primary care provider within the hour to let them know about the diagnosis and treatment of their shared patients.

  • The family was insured and was able to bill their insurance for the prescriptions prescribed but had to pay cash price for the CLIA-waived tests since their insurance did not recognize pharmacists as providers.

State/Federal Connections/Advocacy/Impact:

The care provided to this family was made possible through the passing of House Bill 182 that granted pharmacist prescriptive authority for: conditions that don’t require a new diagnosis, emergency situations, minor/self-limiting conditions, or conditions diagnosed through a CLIA-waived test (like the story above).

 

At Idaho State University, faculty and students are helping to turn this law into practice. Through their work, 19 prescribing protocols have been finalized and are free to any pharmacy in the state that would like to implement them. Each protocol includes a patient intake questionnaire, inclusion and exclusion criteria, pharmacist and patient education, prescription label, billing template, case vignette, and questionnaire interpretation to guide treatment and referral decisions. Protocols can vary between pharmacies as protocols are up to pharmacist’s discretion and best practice.

 

Pharmacies are one of the most accessible and affordable health care providers for many patients, especially in rural states like Idaho. In order to make providing this level of care financially feasible at pharmacies, the next step for pharmacy practice advancement is to be recognized as health care providers. This will help ensure pharmacist provided services are billable to all insurances and available to people in all communities through their local pharmacy.

 

University of Colorado and
Clearspring Pharmacy

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About the Pharmacy

Clearspring Pharmacy
Denver, CO
https://clearspringrx.com/

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Meet the Team

Faculty Lead:
Wesley Nuffer

Pharmacist Lead:
Dana Sadowski

 

Description of Pharmacy

Clearspring Pharmacy is a 3-location independent pharmacy in the Denver and metro Denver area. The interaction described above took place at the pharmacy in the neighborhood of Cherry Creek in Denver. Cherry Creek is an affluent residential district with a vibrant shopping scene, boutiques, restaurants, and galleries. Services offered include, compounded medications, medication synchronization, diabetes self-management education classes,point-of-care testing, immunizations, as well as a wide selection of pharmaceutical-grade supplements.

PHARMACY STORY

Patient Presentation:

A 73-year old woman called Clearspring Pharmacy to let them know that her caretaker who was helping her organize her medications would no longer be able serve her. Patient was currently on 8 maintenance medications. She would also often call confused on when she needed to refill her medications claiming she was already running low despite a recent fill.

Outcomes of Care:

It was recommended that her medications become synched via the PrescribeWellness platform and then put into Dispill packaging monthly. The patient is called 7 days prior to her monthly fill to go over her medications and make sure no changes have occurred. After her medications have been packaged into the Dispill packaging, the patient is called to come in to pick up her medications. At that pick-up appointment, the patient’s blood pressure is taken, immunizations are done (if needed), and the pharmacist discusses the medications with the patient asking about side effects, new over-the-counter medications, and adherence.

Personal/Public Health Impact:

Patient Impact:

  • The patient is able to know what medications she needs to take and when she needs to take her medications without a caretaker since they are packaged neatly into the Dispillpacks. She can also look back and see if she forgot to take her medications based on the bubbles still full in the packs.

  • Since the pharmacist is monitoring her blood pressure monthly, the patient is aware ofher blood pressure goal and will have a better chance of getting to her goal of <120/80.

  • The patient is kept up to date on her immunizations. At 1 visit she received her influenza vaccine as well as her Covid-19 booster.

Pharmacy Impact:

  • The pharmacist documents each of the pick-up encounters via an eCare Plan and shares those plans with her provider.

  • Synching the patients medications and meeting with her monthly helps the pharmacies STAR ratings (quality rating for Medicare) due to adherence.

  • The pharmacy also has more time since the patient is no longer calling the store multiple times per month to refill her medications.-The patient is also on 1 very expensive medication and by having her medications filled at the same time every month, the pharmacy does not have to keep that medication sitting on their shelf but they are able to order right before it is needed.

State/Federal Connections/Advocacy/Impact:

Clearspring Pharmacy is part of CPESN as well as their Flip The Pharmacy program. This has helped the pharmacy transform to a more clinical patient-level care mindset and away from the point-in-time, prescription-level care process.

Clearspring Pharmacy participates in a grant through the Colorado Department of PublicHealth and Education which encourages the appointment-based-model and numerous clinical initiatives such as Diabetes Self-Management Education and Support (DSMES).

 

University of Iowa and
Greenwood Pharmacy

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Description of Pharmacy

Greenwood Pharmacy is one of five family-owned, independent pharmacies serving the communities of Waterloo, Cedar Falls, Evansdale, and surrounding areas since 1987. This pharmacy is located in a

designated Health Professional Shortage Area (HPSA) and Medically Underserved Area (MUA) by the United States Health Resources and Services Administration. Services offered at this site include medication synchronization, immunizations, comprehensive medication reviews, home delivery, diabetic shoes, long-acting injections, point of care testing, and medication compounding.

About the Pharmacy

Greenwood Pharmacy Compounding Center
Waterloo, IA
https://www.greenwoodpharmacy.com/

Meet the Team
 

Jim Hoehns, Pharm.D., BCPS, FCCP 
 

Matthew Witry, Pharm.D. Ph.D. 

PHARMACY STORY

A Community Pharmacy and Family Medicine Collaboration to provide for Chronic Care Management to Older Adults

 

Waterloo is one of the larger, more diverse communities in Iowa. MercyOne Northeast Iowa Family Medicine Clinic (MNEIAFM) provides primary care to the community and serves as a training site for many future health care providers. To advance the clinic’s position as a Patient-Centered Medical Home (PCMH), we were looking for ways to improve the pre-visit planning process to maximize the impact of clinic appointments where physicians must serve complex patients in often too brief appointments. Pre-visit planning includes anticipating future care needs, such as immunizations or identifying care gaps for chronic conditions. A large part of pre-visit planning includes medication review. We know the community pharmacist has special knowledge about how patients use their medications and our team wondered “can we prospectively get input from the community pharmacist to help with pre-visit planning?”

We created a business agreement with Greenwood Pharmacy to have community pharmacists (CPs) provide pre-visit planning to their Medicare patients who were enrolled in the clinic’s Chronic Care Management (CCM) program. The clinic provided Greenwood Pharmacy CPs with access to, and training on using the clinic electronic health record (EHR). A pre-visit templated CP note was created in the clinic EHR to streamline communication. Each week, the clinic provided Greenwood Pharmacy a list of patients who had a physician visit scheduled the following week. The CPs reviewed pharmacy records and the clinic EHR to identify potential drug therapy problems (DTPs) and document their note in the clinic EHR. The clinic physicians reviewed the CP pre-visit notes at the start of the patient encounters. Time tracking software in the EHR tracked captured both CP time and clinic staff time providing CCM services. CCM revenue was prorated and shared between the clinic and Greenwood Pharmacy based upon CCM billing time each party contributed.

Almost all (94%) of the 153 eligible subjects agreed to enroll in the joint CCM service. During the 8-month evaluation period, 95 patients received one or more pre-visit medication review. Greenwood CPs made 169 drug therapy recommendations for 107 patient visits. The physician acceptance rate of CP recommendations was 76%. There were 92 CCM claims billed and total CCM revenue was $3,585 (clinic: $1792, Greenwood Pharmacy: $1793). Ten of 11 Family Medicine physician participants “agreed” or “strongly agreed” that CP pre-visit recommendations were helpful to their practice. Dr. Anthony Day, MD, Program Director at MNEIAFM noted, “the amazing thing about this project is that utilizing the Chronic Care Management model, the pharmacist was reimbursed for their time helping with drug therapy without taking reimbursement out of the primary care physician’s pocket. This strategy should be very usable in communities all over the country.”

This project demonstrates how the unique position and expertise of community pharmacists can be leveraged to identify and communicate drug therapy recommendations before clinic encounter and also provide a mechanism for payment for their services.

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State/Federal Connections/Advocacy/Impact:

This project was supported by a grant from the Iowa Pharmacy Association Foundation. Allowing the community pharmacists at Greenwood Pharmacy access to the clinic EHR was instrumental for our project success. Pharmacists are not designated as “Qualified Healthcare Professionals” and are unable to bill CMS directly for CCM services. Rather they are considered “clinical staff” whose services must be billed incident to a physician. We created a business agreement between Greenwood Pharmacy and MNEIAFM for the physician clinic to bill for CCM services which were completed by the community pharmacist. While this was a success, pharmacists need to be recognized as health care providers to greatly simplify this process. The level of reimbursement realized by the community pharmacist in this project was inadequate to make this a financially feasible model.

 
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