The Role of the Pharmacist in a Dynamic Healthcare

Environment

Brent I. Fox, PharmD, PhD, FASHPAssociate Professor

Health Outcomes Research and PolicyHarrison School of Pharmacy

Auburn Universityfoxbren@auburn.edu

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Objectives

1. Identify prevailing forces in the current and future healthcare landscape

2. Describe the impact of prevailing forces on pharmacists and pharmacy practice

3. Discuss technology’s role to support pharmacists’ patient-care efforts in the current and future healthcare environment

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Opioids & Overdose

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Triggers for PDMP Review

• Traveling an unusual distance to the pharmacy• Refusing to show ID• Paying cash (especially with insurance on file)•Multiple prescribers (for all meds, not just controlled substances)• Requesting early fills• Known to use more than one pharmacy• Prescriptions from unknown prescribers• Rejected insurance claim•Other triggers…

Garrett Aikens, PharmD, BCACP

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Indicators in PDMP Data (i.e., “flags”)

•Overlapping medication fills

•Multiple prescribers and/or pharmacies

•High risk combinations

•MME/day > 50 mg

•Narx Score > 200

•Overdose Risk Score (ORS) > 450• Previous overdose events (3rd digit)

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Garrett Aikens, PharmD, BCACP

Sample Data

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Patient Information

Risk Indicators

Graphical Presentation

Summary Information

Prescription Data

Readmissions

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www.dreamstime.com

Transitions of Carewww.nyschp.org

We Are What We Eat.

•~1:1 microbial to human cells

•Microbiome weighs ~5 pounds

•Microbiota pivotal to health

•Composition is influenced by delivery mode of birth

•Diversity of microbiota directly connected to health

•AI and the microbiome

8www.frontiersin.org/articles/10.3389/fmicb.2020.00393/full

Digital Health

9https://www.mobihealthnews.com/sites/default/files/Digital%20Therapeutics.png

•Aligns with patient ownership of health

• Focuses on prevention and monitoring

•Connectivity between devices

• Large amounts of data result

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https://www.commonwealthfund.org

Continuous Glucose Monitoring (CGM)

• Core components• Sensor wire• Transmitter• Receiver• Software

• Trends (lower than venous bg?)

• Finger pricks (twice/day to calibrate)

• Visualize effect of diet and exercise (accurate at low levels?)

• Alerts

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Mail Order Pharmacy

•Culture of convenience

•Comfort with online interactions

•Major names enter the mix

12www.kff.org

2019

The COVID-19 Effect

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14www.irinablok.com

Opioids & Overdose

15www.ama-assn.org%2Fsystem%2Ffiles%2F2020-10%2Fissue-brief-increases-in-opioid-related-overdose.pdf

16www.naspa.us

Who Should Have Naloxone?

▪Anyone with a history of opioid use disorder, actively in treatment, or in a 12-step program

▪Anyone who has opioid in the home

▪Businesses, places of worship, public facilities or schools that may serve any of the first two groups

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Disease Prevention

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Storage and Supply Patient Care / Professional Support

• Help customers differentiate masks

• Reduce pharmacy traffic within facility

• Contact-free dispensing

• Promote safe practices to community

• Drug supply measures to address changes in demand

• Develop new storage methods

• Virtual dashboard display of supply inventory

• Patient counseling (VC)

• Interdisciplinary rounds (VC)

• Update colleagues on COVID research

• Dose adjustments with patients via mobile app

Vaccines

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Digital Health

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NIH All of UsAbilify Mycite Research 2 Guidance

Is there trust?

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Connected Pharmacies and Patients…. Information Security

• Foundational IS Principles• Private, Authentic, Accessible

• Security is an operating cost

•Training in best practices

•_______ is the primary threat

•Test procedures, systems, and personnel

•The cost of a significant breach?

23https://www.comtact.co.uk/wp-content/uploads/2020/06/What-is-the-CIA-triad_431804671-550x500px.png

Connected Pharmacies and Patients…. Information Security

24https://osgiot.com/smart-healthcare/

Context of Practice

•We are social beings.

•Access before/after COVID

•Click and collect (BOPUS)

•Reimbursement has not improved.

•Expanding services to account for reimbursement reality

• JD Power• 48% of pharmacy customers used at least 1 H&W pharmacy service (2019: 43%)• Customer satisfaction increased 2.6% among customers using H&W service• H&W customers spend avg $35 ($24 non-H&W)• Avg spend $58/customer if >2 H&W services

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Gallup

Context of Practice

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“What has not been clear until now is exactly how consumers would react to the shift. Simply put, they’re embracing it, and it’s driving higher overall satisfaction and increased spending as they use more health and wellness-oriented services.” James Beem, JD Power

Mail Order Pharmacy

27https://www.pioneerrx.com

Telehealth and Telepharmacy

US consumers’ use of telehealth pre-COVID?

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CCM MTMS TCM

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Contact Tracing

South Korea

• Debit/credit transactions• Highest proportion of

cashless transactions globally

•Mobile phone usage• Phones > People• Locations tracked with

complete accuracy

• CCTV• 2010

• 83x/day

• Every 9s while travelling32

nytimes.com

And Others…

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Health and Wellness AI

Provided as an SDK

“Medical grade accuracy”

No wearables necessary

Any age, gender, skin color

34https://www.binah.ai/

PBM News

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State-level regulation of pricing

http://communityoncology.org/wp-content/uploads/sites/20/2018/05/ill1.jpg

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PBM News

Pharmacy Workforce• Schools/colleges – 2002: 83 | 2018: 148

• 2010 – flattening of applicant numbers

• Spring 2018 – 14,500 graduates

• Fall 2017 – first time enrollments down 0.6%

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https://www.aacp.org/sites/default/files/2020-03/2019_NPWS_Final_Report.pdfhttps://www.ajpe.org/content/83/4/7593 https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2753258

• 1 in 8 (12.5%) of pharmacies closed between 2009-2015

• Urban >> Nonurban• Independent > Chain • Urban serving low income areas

greatest risk• Opportunity for those that persist

•Pre-COVID environment consistent with predictions

•COVID turned everything upside down…mostly

•Opioids vs Telehealth

•Opportunities for pharmacy• Testing• Vaccines• Telepharmacy• Convenience services• Reimbursement

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