Date: 30 September 2015
The win was announced at PBN2015 in Melbourne where Guild National President George Tambassis awarded Rebecka $2000 for her essay titled ‘Professional Servicescape Essential in Delivering Three Fee-For-Service Models’.
In the essay, Rebecka describes three types of fee-for-service models which include a MedsCheck for customers with fewer than five medicines, an ‘AllergyFighter’ medication review service and a nappy rash observation service.
Read the full essay below:
By Rebecka Odlander, BPharm(Hons), University of Queensland
With increasing competition it is difficult to invent something extremely new and original within community pharmacy, but sometimes all we need to do is to focus on improving what we have and identifying what we can do better. In this proposal of three fee-for-service models, I have focused on the first two models being based on services already being partly preformed but directly related to pharmacist involvement and medication management. The third model is a novel idea that could be improved or could be proved difficult to implement, but nonetheless a novel idea.
To justify a fee-for-service model I believe that a pharmacy has to develop the image of a professional servicescape. This includes delivering consultations in a dedicated counselling room not only to highlight that professionalism but also to make the patient feel that it’s safe for them to share all their concerns. This allows an opportunity for trust to be gained. Keys to delivering a service can be summarised as:
When 68% of total revenue to community pharmacies is prescription medications, pharmacists need to become more involved in managing this entire sector – our sector, since pharmacists are the medication experts.1 In the following paragraphs are the details for my three proposed fee-for-service models.
The MedsCheck service currently funded under the Community Pharmacy Agreement allows a patient to have an in-pharmacy review of their medication management one-on-one with a pharmacist.2 However, to receive this government-funded service the patient must meet certain criteria to be eligible such as; be living at home in a community setting, having not received a MedsCheck in the last 12 months, and be taking more than five medications.2 But what about the patient taking four medications? Even if a subsidised service is not available to the patients taking less than five medications, this shouldn’t deny them from being given the opportunity to access the same kind of service.
I’m proposing a model where a patient taking less than five medications can book in an appointment to have the same one-on-one in-pharmacy review of their medications with a pharmacist: MedsCheck4Under5. Just as with a normal MedsChek, the pharmacist can discuss with the patient any concerns or problems, having the time and attention to answer those difficult questions, provide in-depth education and possibly identify if any medications are unnecessary and could be de-prescribed. The patient will leave the consultation room feeling educated and empowered, as well as taking with them physical evidence of the interaction such as any relevant evidence-based information or a letter to their GP highlighting recommendations by the pharmacist on medication changes if necessary. In the process of conducting this review, the pharmacist may come across significant clinical interventions that they address with the patient and can be renumerated for through the CPA, similarly if a patient takes any inhaler medications, the pharmacist can conduct an inhaler technique check. If there is time, the pharmacist could also promote the eHealth record system and even offer to help set it up for the patient. Better yet, since there are no restrictions on providing this service, the patient can rebook again as many times as they need to in a 12 month period.
The time for this service delivery should be advertised as a 15-20 minute consultation at a cost of $30 which is roughly comparable to the MedsCheck which takes about 30 minutes to complete and is renumerated at a payment of $62.18.2 With concerns on who would pay for this service; although 80% of Australia’s pharmaceutical is consumed by the 65 and over population, it’s important to consider that 45% of revenue within the community pharmacy industry comes from consumers aged 45 to 64.1 Those within this age group have two common trends defining them from the other age groups – a high disposable income and high likelihood of taking prescription medications.1 When a professional service goes beyond the basic over-the-counter advice and solves a patient’s medication management problems, then this service will be justified as a fee-for-service.
Cost of implementation of the service would not be anything extra other than development of procedures for delivering and charging for the service. It would best suit a pharmacy that already has a private consultation room equipped with a GuildCare accessible computer and pharmacists that are already experienced in delivering MedsChecks.
With the further de-scheduling of intranasal corticosteroids, there’s almost no need for allergy sufferers to go to their GP anymore because so much is now available for them over-the-counter without a prescription. However, removing the barrier of a consumer needing to see a GP means that the only health professionals that could identify misuse of medications, incorrect use of devices and inadequate management of the sufferer’s symptoms is the pharmacist and pharmacy assistant.
Australia is amongst the highest allergy sufferers in the world with 1 in 7 suffering from allergic rhinitis.3 1 in 10 Australians have asthma, and a lot of them have allergies too, but sometimes not all allergy sufferers have asthma and some may have ‘mild’ asthma where they get an OTC salbutamol puffer every now and then.4 In the end, patients are able to access treatments without the diagnosis or recommendation of a GP. Pharmacists need to make their wealth of knowledge prominently known and available and be able to educate patients on correct use of medications and encourage them to see their GP when necessary.
This service proposes to offer a medication review service marketed to allergy sufferers. The consultation would include collecting a history of symptoms, treatments used and offering changes and advice for the future. If the patient is an asthma sufferer, again like the previous service mentioned, the pharmacist can perform an inhaler technique check as well as introducing an asthma action plan if the patient does not already have one. The patient would be able to walk away with physical evidence of the transaction in the form of evidence-based information about their condition, treatments and action plans, and knowing that they can be a successful ‘AllergyFighter’.
To make this appeal to customers as a valuable but also professional service, it could be presented as a service that could be delivered immediately (without appointment) but ideally in a consultation room. The cost of the service would be $20 for a 10 minute consultation and this cost could be redeemable on purchase of any recommended product in store that day to encourage the consumer to purchase the recommended product.
Cost of implementation would not be anything extra other than development of procedures for delivering and charging for the service as well as ideally have a consultation room to deliver the service.
Nappy rashes are a minor ailment that’s extremely common in community pharmacy. In these cases it can be difficult to recommend treatments without really seeing the look of the rash. However, pharmacies aren’t really always prepared to address these situations in an appropriate, hygienic and private way. So I propose installing a nappy change fold down table into the consultation rooms. This will mean that parents can bring in their child and the pharmacist can review the rash appropriately and in the privacy of the consultation room. A better assessment can be made by the pharmacist in whether it can be treated over the counter or whether referral to the GP is needed.
The actual fee-for-service model that would accommodate installing the fold-down table would actually be for an ‘Emergency Nappy Change Station’ service. For a fee of $5, parents could have access to a private, sanitary, nappy change table, in the convenience of a pharmacy when nappy change tables are sparse and few in the community. The pharmacy would also provide cleansing wipes and allow the parent to dispose of waste in a biohazard bin for the pharmacy to dispose of for them.
Cost of implementation would include the cost of a fold down change table, and installation into a consultation room as well as a biohazard bin (which may already exist in pharmacies that conduct immunisations and do other testing).
Contact: Rebecka Odlander