Implementing the "Right" Service that Fits

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Implementation of value-added services requires a comprehensive strategic plan that includes a mission statement, SWOT analysis, goals and objectives that the practice hopes to achieve, and strategies to achieve the objectives. The plan provides direction for the practice and guides the allocation of resources and efforts. Value-added services can be thought to exist along a continuum where on one end pharmacists are more narrowly focused on drug therapy issues that occur during the dispensing functions, and on the other, pharmacists provide ongoing therapy management for patients with multiple comorbidities requiring complex therapeutic regimens. Other types of services fall in-between. It is important to categorize these potential services not just the sake of doing so but to help prioritize and implement services that match the needs of your patients with the capabilities your pharmacy has to deliver them. This will help ensure their long-term sustainability. 

Lelubre et al employed implementation science strategies to devise an intermediate medication review program in community pharmacies.1 They described having learned from a previously failed attempt to launch a new service for asthma patients that did not include a piloting phase and that which did not consider implementation after initial development. This new service was a medication review (MR) program called “intermediate”, as it was more advanced that a lower-level service because it involved interaction with patients, but not advanced, as it did not include access to medical data. The MR service included: patient inclusion at the counter; interview preparation; interview; phamacotherapeutic analysis; second interview to discuss interventions and treatment plan; and follow-up interview upon the next patient visit. There were 55 pharmacies included in the MR service. The researchers evaluated time to implement, time needed to conduct the service, barriers and facilitators, extra training needed, work satisfaction of pharmacists, and long-term support needed. For sustained implementation, they observed requiring reorganization of workload and broad-based media campaigns to increase physicians’ and patients’ awareness, and modifications to the software used for the service.

Pharmacy managers will be more successful at implementing services when carefully planned and piloted, which includes evaluation for what will be needed long-term to help activate clients and scale the service up when it becomes larger (enrolls more patients). Successful implantation also requires that the service is appropriately conceptualized and categorized as having a match, or “fit”, with the pharmacy business, rather than trying to shoehorn something that does not align with the pharmacy's mission.

Additional information about Implementing Value-Added Pharmacy Services can be found in Pharmacy Management: Essentials for All Practice Settings, 5e. If you or your institution subscribes to AccessPharmacy, use or create your MyAccess Profile to sign-in to Pharmacy Management: Essentials for All Practice Settings, 5e. If your institution does not provide access, ask your medical librarian about subscribing.

Lelubre M, Wuyst J, Maesschailck J, et al. Implementation of an intermediate medication review in Belgian community pharmacies. Res Social Adm Pharm.  2019;15(6):710-723.

Shane Desselle

Professor of Social and Behavioral Pharmacy, Touro University California

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