2. Advancing Population Health Outcomes 2
THE EXPANDING SCOPE OF PHARMACY PRACTICE
Immunizations
Basic Screenings
Point of Care Testing
Initiating Drug Therapy
Modifying Drug Therapy
Acute
Care
Chronic
Disease
Mgmt
Preventative Services
3. Advancing Population Health Outcomes 3
• Increased Demands of an
aging and unhealthy
population
• Shortage of Primary Care
Professionals
Access
WHAT’S DRIVING THE EXPANDING ROLE OF THE
PHARMACIST?
25% with
undiagnosed
Diabetes
35% of patients
have no PCP
Increased Needs
4. Advancing Population Health Outcomes 4
BENEFITS OF ENGAGING THE PHARMACIST AS A PROVIDER
7 Day Access
No Appointment
Needed No office visit fees
Immediate access to
Medications &
Immunizations
93% of Americans live within 5
miles of a Pharmacy
300 Million
Customer visits to a pharmacy
every week
5. Advancing Population Health Outcomes 5
PREVIOUS PHARMACIST SCOPE EXPANSIONS
HAVE BEEN SUCCESSFUL
• Over 25% of people get
their flu shot at a
pharmacy
• Immunization rates for
Shingles have increased
from 12% in 2009 to 20%
in 2014
6. Advancing Population Health Outcomes 6
BASIC SCREENINGS TO SUPPORT POPULATION HEALTH
• Glucose
• Blood Pressure
• BMI
• Cholesterol
• A1C
Most states will allow pharmacists to perform CLIA waived testing
7. Advancing Population Health Outcomes 7
POINT OF CARE TESTING (POCT)
• Trained Pharmacists performing Rapid
Strep or Flu test and dispensing
appropriate therapy if positive
• Structured similar to Immunizations
– Special Training Course
– Collaborative Practice agreements
with Physicians to dispense therapy
• Current NACDS Pilots underway in
multiple states – started in MN, MI & NE
Strep test
Flu test
Most states will allow pharmacists to perform CLIA waived testing, but
not all will permit them to “act” upon a result even with a CPA
8. Advancing Population Health Outcomes 8
COLLABORATIVE PRACTICE AGREEMENTS
• Collaborative Practice Agreements with
Physicians To Dispense Medications
– Smoking Cessation Products
• CPA + CLIA testing capabilities:
– Strep and Flu
– Oral Diabetic & Statin medications to patients after
screenings
Benefit: The CPA should follow the CDC treatment protocols and ensure
prescribing guidelines are followed, no overprescribing and only dispensing
appropriate therapy
9. Advancing Population Health Outcomes 9
PROVIDE AFFORDABLE ACCESS TO TREATMENT
• CPAs combined with the ability to conduct basic
screenings will allow pharmacies to get patients on
therapy and into the healthcare system
Abnormal Screening result CPA “standing order” New or “modified” Rx
based on CPA
10. Advancing Population Health Outcomes 10
MOST STATES ALREADY ALLOW
• Ability of Pharmacist to MODIFY
drug therapy with a Collaborative
Practice Agreement
• Ability to INITIATE new drug therapy
with a Collaborative Practice
Agreement
45
38
11. Advancing Population Health Outcomes 11
How Advancing Pharmacy Scope could help
Public Health with Disease Surveillance
12. Advancing Population Health Outcomes 12
HELP IN BATTLING INFLUENZA
• Pharmacist flu testing in stores provides
quick access to patients
• Treatment with anti-virals will decrease the
severity and minimize the contagious period
• Provide real-time reporting to the states
• Immunizing negative test patients
13. Advancing Population Health Outcomes 13
SCREENINGS FOR HEP C AND HIV
• Testing patients for Hep C and HIV, reporting
reactive and non-reactive cases to state and
referring to public health for diagnosis and
follow up
• Pharmacy barriers to performing today are:
– Privacy concerns (space issue)
– Pharmacist training on having these difficult
conversations with patients
14. Advancing Population Health Outcomes 14
ZIKA VIRUS OR ANY NEW “THREAT”
• Providing education to patients
• As soon as CLIA waived test available, could
test patients
• As soon as vaccine is available could
immunize patients to prevent spread
• Reporting desired information to the states
15. Advancing Population Health Outcomes 15
HOW PUBLIC HEALTH COULD HELP PHARMACIES
• Collaborative Practice Agreements are a big
barrier for Pharmacies in treating strep and
flu
– Would the public health protocol physician
consider partnering with pharmacies?
Hinweis der Redaktion
First off they are a highly trained and qualified provider
The first big expansion for pharmacist’s was immunizations. The fact that 25% of Seniors now get their flu shot from a pharmacy shows that it’s working and patients have embraced the availability of expanded services at their pharmacy. And the easy access and availability is moving us in the right direction. Immunization rates for Shingles have grown from 12% to over 20% in 5 years – and that’s with the dramatic increase in patient eligibility driven by the boomers. So what once was theory, about using pharmacists as a primary care touch point to improve patient health is now proven. This is opening up additional services as infectious disease and public health officials are taking notice of these successes.
Many pharmacies are already providing this service… However, until they have provider status they are doing it for free or patient is paying cash for test
Other tests could be Hep C, HIV, Vitamin D, etc.
Point of Care testing or Rapid diagnostic testing. This is a specially trained pharmacist performing a rapid strep or flu tests and DISPENSING medication if positive. Think of it, if you get sick on a Friday afternoon or a Saturday, you think you may have strep, maybe your kid just had it and now you have it, you can go in and see a pharmacist, get swabbed, and less than an hour later, walk away with a script in hand.
POCT is where immunizations was about 7-8 years ago, it’s about to take off. From a cursory glance, looks like we could do it in about 80% of states. It requires special training course, structured almost exactly like the APhA training for Immunizations – including a train the trainer type program. Need to have a collaborative practice agreement with a physician – outlines protocols – allows you to dispense the scripts if test is positive.
There was a current NACDS pilot underway in 3 states this year, they have expanded that to 5 states now. We are looking to get into this pilot this year in a small number of stores.