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UNlVERSITY OF UTAH COLLEGE"' PHARMACY S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of Advanced . Pharmacy Technician Services ProPosal to the Utah Departmentof Professional and Occupational I ., Licensing (Utah Board of Pharmacy) ! . Mark·A. Munger, Pharm.D., F.C.C.P., F.A.C.C., F.H.F.S.A. . . . Professor; Pharmacotherapy; · Adjunct Professqr, .Internal Medicine; Associate Dean, College Affairs, College of Pharmacy University of Utah · and· Mike Feehan, Ph.D. Managing Partner, Analytics ·Practice, Kantar Millard Brown I Prepared Jor the Utah Board of Pharmacy 05/22/2018 I

S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

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Page 1: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

UNlVERSITY OF UTAH COLLEGE"' PHARMACY ~ S. SKAGGS PHARMACY INSTITUTE

2q1a National Survey of Advanced . Pharmacy Technician Services ProPosal to the Utah Departmentof Professional and Occupational

I . , Licensing (Utah Board of Pharmacy) ! .

Mark·A. Munger, Pharm.D., F.C.C.P., F.A.C.C., F.H.F.S.A.

. . . Professor; Pharmacotherapy; · Adjunct Professqr, .Internal Medicine;

Associate Dean, College Affairs, College of Pharmacy University of Utah ·

and·

Mike Feehan, Ph.D.

Managing Partner, Analytics ·Practice, Kantar Millard Brown

I Prepared Jor the Utah Board of Pharmacy 05/22/2018 I

Page 2: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

Healthcare Delivery in 2020 Closer to Patient

Emergency Care

Intensive Care

Major Surgery

Minor Surgical Procedures

Basic Diagnostics and Prescribing by Mid­Level Practitioners

{(Life Checks"

Web-based Diagn (Wearables)

IT Healthcare {M.D., Rx, Personal Health

Records)

OTC drugs for chronic and non-chronic

conditions

uwellness" services

Page 3: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

DC PREVENTATIVE HEALTH CHECKLIST

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I . . . . . • . .

Centers for Disease Control Prevention Checklist. 'http:l/www.cdc:go'v/prev~ntion/

!

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UNIVERSITY OF UTAH CO LUGE"' PHARMACY L. S. SKAGGS FHARMACYINSTITUTL

Pharmacist Reimbursement Activities

• Preventative Care Education and Follow-Up

• Self-Care Education and Principles .I ;

• Comprehensive Medication Management (CMM) I

• CMM was first defined in 2010 by the Patient-Centered Primary ~are Collaborative as a practice intended for high-risk, chronically ill p~tients in which pharmacists assess each patient's medications (whether they are prescription, nonprescription, alternative, traditional, vitamins~ or

- I

nutritional supplements) to determine that each medication is: j

• Appropriate for the patient I

• Effective for the medical condition

• Safe, given the comorbidities [concurrent medical conditions] and ot~er medications being taken I

• Able to be taken by the patient as intended

These assessments are part of an individualized care plan that includes appropriate follow-up to determine actual patient outcomes. ]

I I 4

Page 5: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

. -----------r-- ----------- ----------··· --- ~--- -------------------------- ---· --- -~-- -----·--·----- ··---------- ---------- -------

I

Natio~al Health Service-UK ./.

I•

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• NHSj England is today launching a scheme to get 1,500 more clinical pharmacists working in GP surgeries (clinics)- a move set to benefit patie/nts across the country. 12/2016

• By tdking responsibility for patients with chronic diseases, clinical pharmacists can free up GPs for other appointments and so reducing thedumbers of people presenting atA&E (emergency) departments. and ·so ease pressures on ·other parts of the health service. ·

. I . . • The iinitial £15m pliot, supported by~ Health Education England, the

RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in November 2015:. This led to more than 490 clinical_ pharmacists working in approximately 650. practices across 90 pilot sites.

• Applications for this next phase, worth over £100m, open next month as NHS England and its partners target a further 1 ,500 clinical phar~acists working in general practice by 2020/21- ·

• 'Theiway clinical pharmacists in general practice can help patients and support them is so important and helps prevent mc:>re ~~rio us illness."

https://www.england. nhs.uk/20 16/12/clinical-pharmacy/

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i . . I

UNIVERSITY OF UTAH COLLEGE 0 ' PHARMACY L. S. S;:AGGS FHARMACYINSTIT\Jl"L

Critical Time for Advanced Service Evaluation·s of . I

Community Pharmacy Technicians to Maximlize Pharmacists Clinical Time I

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Page 7: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

-------1- -- ------------- ----- -_ -- ------ ---------- ----- ---------------- --~ -------------- ----- -- ----

1

Pharmacy Technicians (Community Pharmacy) . 1·- . . ' '

I. , I·

Frort-line support personnel for commu~ity phar~acy .

Mo~t frequent pharm~cy personnel that 1nteract w1th pat1ents I . .

Cutirent roles: I • Support pharmacists; __ .

• IT system prescription .input ..

• · Communicate with insurance companies;. · I . . . . . ·- . . . . I

I• Fill and label prescriptions; and

• ·Access prescriptions for completeness, accuracy, and reimbursement eligibility.

UNIVERSITY OF UTAH COLLEGE"'PHARMACY L S. SKAGGS PHARMACY INSTITUn

World H1ealth Organ~zat~on. The World Health Rep_ort 2000- Health Syste111s: _l~provi~g Performance, Geneva, Switzerland:

World Health Organrzat1on; 2000. http:/lwww:who.Jnt/whr/2000/ent . . · • · - _

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Page 8: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

UNIVERSITY OF UTAH COLLE.GE 01 PHARMACY L. S. SKAGGS PHARMACY INSTITUl"t

. Background Literature

• Community pharmacy technicians (CPhT) started in the early 1

19th century as pharmacy assistants.

• The title of pharmacy technician was adopted around the 197~-80's with the growth of technology and prescription volume.

• Pharmacies viewed pharmacy technicians as a way to time efficiently. improve services to the patient consumer.

• Today, pharmacy technicians' job openings are greater than pharmacists.

https://www.ccitraining.edu/blog/pharmacy-technicians-the-past-present-and-future/

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Page 9: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

Background Literature

UNIVERSITY OF UTAH COLLEGE"'PHARMACY L. S. SKAGGS PHARMACY INSTITUTL

. I - . . _. - .. . . . . . • ·With the greater need, use, and openings for pharmacy technicians.

thelpast 30 years have seen considerable international s-urvey· lite~ature _about pharmacy. technician practice. · ·: . . - · ·

I . ·. . .

I . . . . . . . . .· ·~ . . . . .

• The literature includes greater Llnderstanding of pharmacy tec~ni?ic:msatisfadio? an~ str~ss, levels of professional ..

· · co~m1tment,.profess1onallsm, 1ssues around error report1ng, and the undertainty of future ·roles of techni<;;ians. · · · · · ·

.. , ; ·, '' ... ' . ·, . . : . ' .. . . • . ·. . .. i '. . .

. . - . ; ~-· . . . . -

I

I

Johri C et al. Res Soc Admin Pharm 2017;13:297-99. KoehlerT et al. Res SocAdminPharm 2017;13:?97-99. Oeselle SP. Am J Ph arm Assoc 2005;45(3):458-65. Deselle SP. Am J Pharm Assoc 2005;45(4):676-83.

·Schmitt MR et aL J Pharm Techno/2009;25(1):79~88. · · Deselle $P et al. Am J Pharm Assoc 2007;47:58-72. Desselle SP Am J Health Syst Ph arm 2005;62: 1992-7. Schmitt MR, et aL J Pharm Techno/ 201 0;26(4):340.;51. Raymond CS, et aL Can J Hosp Pharm 2011 ;64(3):218-20.

-Totton JS, et al. Can JHosp Pharm 2008;61(2):133-7 .. ·. FrostTP et al. JAm PharmAssoc 2016;:1-5. · Odukoya OK, et al. Pharmacy (Basel) 2015;3(4):330-43, Shireman Tl, et al. JAm Pharm Assoc 2016:56:389-96.

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Page 10: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

UNIVERSITY OF UTAH COLLEGE"'PHARMACY L. S. SKAGGS FHARMACY INSTITUTE

Background Literature

Studies have also shown that pharmacists have greater confidenbe in delegating tasks to CPhTs.

• In Canada under a collaborative care model, pharmacists provide medication management and patient health outcomes, and pharrhacy

· technicians focus on medicine distribution. i • A recent _study exami!'led supe_rvi~ion of pharmacy te~hnicians ·b~

pharmacists from a d1stance, f1ndmg that use of on-s1te pharmacy technicians led to an increase in the number of clinical interventions and a decrease in pharmacist time require to provide the interventions.

I

• Obtained medical histories & tracked laboratory test results allo~ing pharmacists greater time for collaborative practice. . '

• •

• •

Transcribe pharmacist interventions .

Seventeen states allow pharmacy technicians to accept verbal prescriptions called in by a prescriber or prescriber's agent, or transfer a prescription order. I

I

Safety net for pharmacists in e-prescribing. i

Measure blood pressure in a randomized, practice-based intervehtion community-based study to improve blood pressure control in African American patients. · . I

· References Slide #~ I 10 I

I

Page 11: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

- ----- --------- ------~---------- --- ~-- -- ------------ ---- ~ ·~ ---- - ~----- --------------

. '

2018 National Survey of Advanced Pharma Technician Services

i -- UNMET NEED

• ThJre is a clear need to appraise and willingness of Pharmacy Tedhnicians to participate in Advanced Practice Services to ma~imize Pharmacist Clinical Time - - - . ·

I - - . -• Important information for employers, community pharmacists,

I . . . - . . .

regulators, and payers. -

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UNIVERSITY OF UTAH COLLEGE or PHARMACY l. S. SKAGGS PHARMACYINSTITUTt

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Page 12: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

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Gr. UNIVERSITY OF UTAH. COLlEGE 0 'PHARMACY w L S. SKAGGS FH.\RMACYINSTITUTt

2018 National Survey of Advanced Pharmacy Technician Services

• Objectives . I

• Determine pharmacy technicians appraisal of fixed scenarios highlighting new delivery services; 1

I

• Understand pharmacy technician attitudes regarding the profession and their organization; and

• Characterize pharmacy technicians responses by demographic, attitudinal, and occupational practice characteristics.

• Methods

• 1000 Certified Pharmacy Technicians

• Pharmacy Technician Certification Board Database

• Consistent employment as CPhT for 2 years

• Part-time (> 20hours/week) or Full-time employment at < 2 lo~ations

• Not enrolled in ;3n accredited Pharm.D. program I

• Distributed across the United States and rurality pattern

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Page 13: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

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I . 201 S National Survey o.f Advance·d Pharmacy Tec~nician Services ·.. .

I

• Me~hods • Data Collection (20-30 minute on-line survey)

• Place of employment

• Method of pharmacy technician training

UNIVERSITY OF UTAH COLLEGE m PHARMACY l. S. SKAGGS PHARMACY IN!ITITUTE

• Perceived level of involvement and importance to the organization collected across wide variety of current (see slide #13) and advanced services (below)

• Short Batteries of Satisfaction and Stress with current·employment

• Advanced Service Buckets Physical Assessment ·

Prescription taking Authority

Technician verification .of Prescriptions

Inventory Control Methods

Obtaining Patient History

Supervisioq of other Pharmacy Personnel

Patient Educatio-n Practices

Obtaining . Laboratory Tests

Providing Preventative Care Measures

Information Technology System Managen1er:tt

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Page 14: S. SKAGGS PHARMACY INSTITUTE 2q1a National Survey of ... · RCG;P and the BMA, has proved so popular with patients and GP practices that NHS England doubled the funding to £31m in

2018 National Survey of Advanced Pharmacy Technician Services

• Deliverables (University of Utah and Kantar Millward Brown)

• Screener- and Questionnaire

• Regular Field Updates

• Final Powerpoint-Siide Deck of Methods and Results

• , Raw Data ( de~indentified) ·.

• Compl~ted within 3-4 months of funding

• Abstract(s): [2019 APhA Annual Meeting]

• Manuscript(s): [JAPhA or Annals of Pharmacotherapy]

- .t ...

UNIVERSITY OF UTAH COLLEGE oiPHARMACY L. S. SKAGGS PHARMACY INSTITUTE

• All publications identified with: Fuhded by U~a-h:State Departrl]lent of Professional and Occupationai:,Licensing·and Utah Board of Pharmacy

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