Lt Col David A. Gettman, USAFR, BSCAssociate Chief, Pharmacy ServicesPatrick Air Force Base, Florida

Global Pharmacy Operations In the Military

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OVERVIEW

• AIR FORCE MEDICAL SERVICE MISSION

• PATRICK AFB PHARMACY OPERATION

• MANAGEMENT ISSUES

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MILITARY SERVICES

• Air Force• Army• Navy• Marines

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Air Force Medical Service (AFMS) Missions

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PREPARE

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POWER

Peacetime Engagement & Crisis Response Deterrence & Contingency Operations

War Winning Operations

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THE BUSINESS OF THE AFMS

• Medical Readiness• Provide optimal operational support to three major

functional areas

• War Winning Operations• Humanitarian & Civic Assistance• Disaster Response

• Peacetime Healthcare• Provide quality healthcare to our beneficiaries in a

fiscally-sound manner

• Ensure and improve health and fitness of our beneficiaries by Building Healthy Communities

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What is the Air Force Medical Service (AFMS)?

• $5.3B COST TO DoD

• $3.1B BUDGET AUTHORITY

• 2,300,000+ ELIGIBLE BENEFICIARIES

• 5,000+ CIVIL SERVICE EMPLOYEES

• 12,000+ OFFICERS

• 22,000+ ENLISTED

• 5 ACADEMIC MEDICAL CENTERS

• 53 CONTINENTAL US CLINICS / HOSPITALS

• 18 OVERSEAS CLINICS / HOSPITALS

Notable Benchmark:

General Motors Corporation Health Plan

1.25 million beneficiaries at $3.9 Billion (FY 2000)

Integrity – Service - Excellence

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PHARMACY: Patrick AFB

• Outpatient Clinic• 2 sites (main clinic and satellite building)

• Workload• 2600 new & refills daily

• Budget: $20,600,000 • Beneficiaries : ~ 50K• 3-lane Drive Thru• Point of Service

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PHARMACY: Patrick AFB

• 6 Pharmacists: 4 officers & 2 contractors• 36 Technicians• 19 military • 14 civilian contractors• 4 federal employees

• > 100 Red Cross Volunteers

MANPOWER

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MILITRY vs. CIVILIAN PHARMACY

SIMILARITIES• Profession of

Pharmacy• Staffing• Laws/Regulations/

Company Policies• Accountability• Licensure• Chain of Command• Drug Reps• Etc

DIFFERENCES• Exchange of Cash• Deployments

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ROLES

• Pharmacist• Oversight• Clinicians

• Technician Dispensing• Tech check tech• Patient Counseling

• Red Cross Volunteers

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STAFFING

• AF Technician Training• ASHP accredited training programs

• 14 week didactic / 3 week clinical rotation

• Upgrade training immediately after graduation• 6- 12 months textbook base

• At 5 – 7 year point: additional training

• Competencies• Personnel Issues• Performance• Disciplinary

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RISK MANAGEMENT & PREVENTION

• Technology• Automation

• Computers (screening, patient leaflets)• Provider order entry• Barcoding• Robotics

• Quality Improvement Program• Interventions• Trend analysis• Performance Metrics

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OVERSIGHT

• JCAHO• Federal• State• EPA• DEA• Air Force Inspector General• Secretary of Defense, Health Affairs• Congress

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CHALLENGES & OPPORTUNITIES

BenefitReadinessBenefitReadiness

Interdependent vs Independent MissionsReadiness and Benefit Missions: Synergistic and Cost Effective

Finding the Right Balance

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FISCAL ENVIRONMENT

“Go back to sleep, John. You’re just havin’ a nightmare… of course, we are still in hell.”

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CHALLENGES & OPPORTUNITIES

• Inflation• Formulary Additions: New & Expensive

Drugs• Less Discretionary Spending• Shrinking Funding Stream• Rapidly changing, costly technology• Pharmacoeconomics

FISCAL ENVIRONMENT

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What You Need to Tell the Boss Needs Versus Wants…

• Complete asset inventory• People• Equipment• Contracts• Leases

• Identify “baseline,” requirements; “One-times”• “Most dear – Least dear”

• Where do you need to be?• Where do you want to be?

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CHALLENGES & OPPORTUNIES

• Staffing• Morale• Competency• Retention/shortfalls

• Compliance• Evolving Practice of Medicine• Risk Management• Strategic Planning• Rising Expectations (deployments, patients, etc.)• Leadership

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QUESTIONS?

Lieutenant Colonel David A. Gettman, USAFR, BSC

David.gettman@patrick.mednet.af.mil

(321) 494-8203