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Harry P. Hagel, RPh, MS

December 5, 2012

• Funded by the Community Pharmacy Foundation in March 2011

• Project Objectives

- Facilitate rural pharmacy integration into emerging health care models

- Identify opportunities for community pharmacy collaboration

- Provide tools/resources for rural pharmacies

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• Learn how pharmacists can help improve health care quality and patient safety.

• Utilize rural health survey results related to rural health priorities and pharmacy service gaps.

• Learn how to identify potential opportunities for rural health collaboration with community pharmacies and pharmacists.

• Aging rural population and more chronic health conditions

• Pharmacists may be one of only a few health care providers in a community

• Pharmacists can improve medication use, safety and outcomes

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• Patient health – Self-treatment and non-prescription medications

– Referral to care

– Medication use

• Provider education/collaboration – MD, DVS, DDS

• Local economy – Direct/Indirect sales revenue, taxes

– Migration of other business and services

• 7,455 independently owned rural pharmacies in the United States (2007 data)

– 2,019 only pharmacy in their community and 1,044 are located at least 10 miles from the next nearest pharmacy

• 998 closed, 495 opened between 2006-2008

– 158 closures were the only pharmacy servicing their community at the time

Source: Rural Policy Research Institute, Policy Brief No. 2007-6

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• Shrinking/Changing prescription payment

– Medicare Part D

– Emerging health delivery systems

• Expanding patient options, requirements and incentives for prescription access

• Workforce trends

– age, gender, disparity

• Ownership transition

• 2-year pre-professional curriculum

• 4-year Pharm.D. professional curriculum

• Individual State licensure required to practice

• Optional:

– General clinical residency training

– Advanced specialty residency training

– Board certifications

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• Major focus of professional education/training

• Often related terms:

– Clinical pharmacy

– Pharmaceutical care

“Improve the safety and efficacy of patient medication use to achieve optimal clinical

outcomes that improve a patient’s quality of life.”

Source: American Pharmacists Association, www.pharmacist.com/mtm

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Measure

Number of

Studies

Percent

Favorable

Blood Pressure 59 84.7%

Cholesterol 54 81.5%

Hemoglobin A1c 36 88.9%

Hospitalization/Readmission 35 51.4%

Length of hospital stay 32 59.4%

ER visits 25 52%

INR / PT / aPTT 20 85%

Mortality 18 72.2%

Body mass index 16 62.5%

Source: Chisholm-Burns MA, et al. Medical Care, 48;10, October 2010

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Safety Measure Number of

Studies

Percent

Favorable

Adverse event 28 78.6%

Adverse drug reaction 15 60%

Medication errors 11 81.8%

Humanistic Measure

Patient adherence 54 48.1%

Patient knowledge 35 57.1%

Patient satisfaction 41 48.8%

Quality of life 31 38.7%

Source: Chisholm-Burns MA, et al. Medical Care, 48;10, October 2010

• Provide pharmacists insight into the rural health priorities in their State

• Highlight opportunities for collaboration/diversification

• Identify gaps in pharmacy services

• Create awareness and interest

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• Content Development – State Rural Health Annual Reports/Plans – Pharmacist capabilities/scope of practice – Advisory Board review/input

• Completion – Web-based platform – All State Offices of Rural Health

• 68% response rate

• Analysis – State Priorities/Gaps – National Trends

Source: Traynor A, et. al, Minnesota Pharmacist. September/October 2007

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Service Description Percent Low

Availability

Percent High

Importance

Adherence counseling 23.5% 44.1%

Affordable medication access 20.6% 67.6%

Chronic disease management 11.8% 70.6%

Immunizations 5.9% 64.7%

340B pharmacy services 14.7% 32.4%

Hospital drug distribution 11.8% 26.5%

Hospital clinical services 23.5% 29.4%

Medication Therapy Management 23.5% 44.1%

Wellness screening/education 11.8% 38.2%

Description Percent High to

Some Priority

Percent Low to

No Priority

Medication reconciliation 87.9% 12.1%

Medication adherence 81.8% 18.2%

Medication access/affordability 87.9% 12.1%

Narcotic opioid use/abuse 75.8% 24.2%

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Description Percent High to

Some Priority

Percent Low to

No Priority

Care transitions 93.9% 6.1%

Chronic disease management 93.9% 6.1%

Diabetes prevention or management 97.0% 3.0%

Tobacco use/smoking cessation 90.9% 9.1%

Mental health service access/quality 93.9% 6.1%

Women's health (contraception, HPV, etc.) 78.8% 21.2%

Alcohol or drug abuse 81.3% 18.8%

Description Percent High to

Some Priority

Percent Low to

No Priority

Senior care (independent living, medication

use, etc.) 81.8% 18.2%

Sexual health (STD treatment or prevention) 57.6% 42.4%

HIV care/screening and prevention 60.6% 39.4%

Immunizations (any patient group or type) 90.9% 9.1%

Children's health (care access, childhood

immunizations, etc.) 84.8% 15.2%

Oral health 93.9% 6.1%

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Description Percent High to

Some Priority

Percent Low to

No Priority

Primary care provider recruitment/access 100.0% 0.0%

Community pharmacy access 81.8% 18.2%

Pharmacist recruitment/staffing 60.6% 39.4%

Pharmacy service quality 69.7% 30.3%

Enhancing overall quality of care 100.0% 0.0%

Improving access to health services 97.0% 3.0%

Nurse recruitment/staffing 84.8% 15.2%

Description Percent High to

Some Priority

Percent Low to

No Priority

340B drug discount program participation 87.9% 12.1%

Quality Improvement Organizations 96.9% 3.1%

Accountable care organization development 87.5% 12.5%

Patient-centered primary care home

advancement 93.9% 6.1%

Sustaining viability of rural hospitals 97.0% 3.0%

Improving access to emergency medical

services 100.0% 0.0%

Fostering interdisciplinary community

integration 97.0% 3.0%

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High Importance & Low Availability

• Affordable medication access

• Adherence counseling

• Chronic disease management

• Medication Therapy Management

• Wellness screening/education

• Primary care provider recruitment/access

• Enhancing overall quality of care

• Improving access to emergency medical services

• Diabetes prevention or management

• Improving access to health services

• Sustaining viability of rural hospitals

• Nurse recruitment/staffing

• Quality Improvement Organizations

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• Patients

• Pharmacists

• Health-systems

• Communities

• Rural Health Offices

• Colleges of Pharmacy

• State and Federal Policymakers

• Assessment/Planning

• Education/Preparation

• Collaboration/Cooperation

• Adaptation/Innovation

• Regulation/Legislation

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www.rxcaresystems.com/ruralrx3/statesurveys.asp

To complete or update your State survey responses: www.rxcaresystems.com/ruralrx/ruralhealthsurvey.asp

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