7.12 Additional Health Services in a Community Pharmacy

More and more, community pharmacy staff fulfills other services besides just providing prescriptions and retail services. Here are some other services that customers or insurance providers are seeking from pharmacists.

Medication Therapy Management Services

Pharmacists are increasingly receiving requests from pharmacy benefit managers (health insurance claims management companies) to counsel patients on the proper medications or to investigate perceived medication problems. For example, the patient may be prescribed two similar cholesterol medications and the insurance company asks the pharmacist to check on this overlap, or a patient may be seemingly noncompliant on chronic disease medications. The technician can assist by raising questions when looking at the prescription or computer alerts and documenting outcomes for insurance companies. In terms of monitoring drug therapies, the technician can alert the pharmacist to a patient who is “late” in requesting refills. The pharmacist can try to identify reasons for noncompliance to drug therapy (cost, side effects, the patient forgot, etc.) and offer counsel or suggestions to resolve the issue.

Vaccinations

Some community pharmacies are now offering vaccine administration for patients over the age of 12 (age may vary depending on the state). Common vaccines include flu, pneumonia, and shingles; there are also vaccines for diphtheria/tetanus, typhoid, and other diseases. Pharmacists must complete specialized vaccine and basic life support (BLS) training in order to provide this service.

The role of the technician is to prepare the paperwork (including a signed consent form) and billing, and in some states to prepare the vaccine for administration. The pharmacist then counsels the patient, administers the vaccine, and completes the paperwork. The technician then notifies the primary care physician that a vaccine has been administered at the pharmacy. In the future, it is projected that certified technicians who have received specialty training may be able to legally administer vaccines.

Blood Pressure Checks

A prescriber often requests the pharmacist to check a patient’s blood pressure in association with a high blood pressure prescription or is asked by a patient for this service. Over 30,000 pharmacies also offer self-testing, automatic blood pressure monitors as a customer service to patients. In some locations, the American Heart Association offers its “Check. Change. Control.” program for Heart Health. To check for a program near you, visit https://PharmPractice7e.ParadigmEducation.com/BPMonitor.

In pharmacies without an automated monitor, the pharmacists can check the patient’s blood pressure. Regular blood pressure checks can help educate patients on their own bodies and how best to control their hypertension. The pharmacist and physician can offer dietary and lifestyle recommendations and suggest better administration times for taking blood pressure medications. This service may be provided free or at a cost to the patient.

Glucose and Cholesterol Screenings

The American Diabetes Association (ADA) recommends that every three years people with normal levels and few risk factors should get a full-panel blood glucose test. Those who are overweight and/or over the age of 45 may be recommended by physicians to have the test more often. According to the ADA, over one-fourth of seniors have diabetes, and childhood diabetes is skyrocketing. Diabetes has been the seventh leading cause of death in the United States. That is why pharmacy screenings are so helpful. Many chain stores, such as Walgreens, offer these screenings for individuals over the age of 18 at their locations where the state allows it. If pharmacists are allowed to do finger-stick blood testing, the cost of the service is borne by the patient; insurance will not cover these costs. The pharmacist can counsel on nutrition and lifestyle choices as well as medications if blood sugars are too high or too low.

Glucose and cholesterol levels can be checked in the same test. The full-panel cholesterol findings include the LDL (“bad cholesterol”), HDL (“good cholesterol”), triglycerides, and total cholesterol. This information can help the pharmacist in offering the proper medication, nutrition, and lifestyle counseling to help prevent heart attacks, stroke, chronic high blood pressure, vascular disease, and diabetes. Technicians assist in scheduling, collecting screening supplies, and documentation.

Point-of-Care Testing

Point-of-care testing (POCT)—diagnostic testing completed at or near the time and place of patient care is an example where the roles of the pharmacist and the pharmacy technician are expanding beyond medication dispensing. In pharmacy POCT, patients typically provide a blood sample (often from a finger prick), and a pharmacist or a pharmacy technician operates portable analyzers that provide laboratory-caliber test results quickly. Examples of commonly used POCT include blood glucose and hemoglobin A1c (for patients with diabetes), cholesterol profiles (for patients with high cholesterol), and anticoagulation measurements (for patients at increased risk for blood clots).

A main benefit of POCT is the timeliness of test results. For example, a hemoglobin A1c measurement can be obtained within minutes utilizing point-of-care analyzers. The same test measurement may take hours to be returned utilizing traditional blood draws and laboratories. Quick results enable healthcare providers to make rapid treatment decisions. This can be especially convenient for patients who can complete blood work and receive care based upon their results at the same visit. Another benefit is that POCT usually requires only a small blood sample from the finger; venipuncture is not typically used.

POCT is different from glucose and cholesterol screening (discussed previously). Glucose and cholesterol screening is a tool used to assess a patient’s blood sugar and cholesterol. Screening is not meant to be diagnostic. Because POCT is considered diagnostic and is used to influence decisions regarding a patient’s care, it requires more oversight than screenings. Most sites that perform POCT must receive a waiver from the Centers for Medicare and Medicaid Services. Furthermore, pharmacists and pharmacy technicians who perform POCT have additional Occupational Safety and Health Administration (OSHA) training requirements. The OSHA Bloodborne Pathogens standard is an example of an additional training requirement.

Smoking Cessation Programs

Some pharmacists have been trained to work with patients on smoking cessation programs, with some success. If a pharmacist has shown and documented positive outcomes at smoking cessation, the pharmacy may be reimbursed from some insurance providers. Other pharmacies hire nurse practitioners to come in to offer this type of health care and other prevention education programs.

Nursing Homes, Home Care, and Hospice Pharmaceutical Services

Many community pharmacies are contracted to provide drug therapy services for nursing homes (long-term care facilities, or LTCFs), home healthcare services, and hospice facilities. When working with nursing homes, pharmacies are required by law to provide and document online monthly profile reviews for all patients, which are commonly conducted by a board-certified consultant pharmacist. A critical role of that pharmacist is to ensure rational, appropriate, and safe medication use through the review of a patient’s medication therapy and patient history for potential adverse drug reactions. The monthly profile review is critical, as these patients are often prescribed multiple drugs and have age-related physiological changes in organ function (such as the kidney) with minimum physician oversight. Home care and hospice facilities contract the services that best fit them, often working with the nurses and nurse practitioners assigned to the patient cases.