Training pharmacy staff-and yourself-to make the most of a new technology shouldn’t be a major challenge. Vendors provide training along with their new products. Don’t they? 

Yes and no, says Carlie Traylor, PharmD, associate director of Strategic Initiatives for the National Community Pharmacists Association. She was previously director of clinical services for an independent pharmacy group and oversaw staff training.

“Yes, vendors provide training, but vendor trainers go home eventually,” she said. “Training tasks fall to the store in the end. What you have to remember is that training, including technology training, is never done.”

So what’s a store owner or manager to do?

For starters, rethink the term “training.” Talk of staff training raises too many visions of tedious sessions trying to learn a task or a skill that is totally impenetrable. The problem isn’t the subject, but the way it is presented.

“It is all about your approach,” says Beth Tomac, owner of Broad Street Pharmacy in Chesaning, WI. A long-time pharmacy technician, she became a pharmacy owner when a prior workplace sold to a chain and the working atmosphere changed dramatically.

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“You can tell your staff they have to learn something, and it won’t go very well,” she explains. 

“Or you can talk about the excitement of a new technology and how it is going to solve a specific problem that everybody knows about and make their lives easier. And about how utterly cool this new tech is going to be. When everyone knows that a new technology isn’t going to interfere with their position but will enhance it, attitudes change. You just gave them reasons to succeed instead of reasons to fail.”

No argument from pharmacy management system PioneerRx. The company prides itself on on-site customer training, says education manager Will Tuft. Training teams spend a week at each pharmacy on every installation. But the pharmacy’s approach to training has a lot to do with the success of new management software.

“It is a huge expense to implement new technology in the pharmacy, so there’s a good reason you are making that investment and making that huge change in the way you and your staff work,” Tuft says. “If you look at it like ‘Hey, here’s this new technology you have to learn,’ you just made the new technology a roadblock instead of an opportunity. 

“If you focus your team on the why-why we are implementing this new technology, why we’re climbing this learning curve and how much it is going to help-you can get buy-in from your team to make that big push. Your attitude, and their buy-in, makes all the difference.”

Patients are part of your team, too, Tomac says. 

It becomes clear when staff are training patients on a device like a new glucose meter or talking through familiar issues such as medication adherence. Staffers can make mastering that new patient-facing technology easier for the patient.

“It’s all about making their life better, not making it more complicated,” Tomac says. “If the patient isn’t comfortable with that new insulin pen or glucose monitor or whatever, they won’t use it. It’s all about helping them understand the advantages to learning that new device, how it is going to help them. It’s all about your attitude.”

One way to help acclimate patients to new technology is to talk about it. When Broad Street Pharmacy installed their ScriptPro robots, Tomac encouraged staffers to talk about it with patients, letting them know the pharmacy was installing the latest and greatest technology to make filling scripts faster and safer. Those conversations drove home the idea that the pharmacy cares enough to make a significant investment to make life better for patients.

That’s a double message, Tomac says. Talking with customers about the wonderful new tech helps shape public perception of the pharmacy.

When patients have to do the learning, they better understand the rewards technology can bring.

“Talking about what we do behind the counter with technology just reinforces the message that we care and that we are always available to help,” Tomac says. “And it reminds the staff what a difference they are making, too. Just by changing your approach you have changed a task (learning new technology) into a goal (making your life better).”

That kind of attention to attitude plays out in larger pharmacy organizations, too. Tabula Rasa HealthCare doesn’t let new technicians anywhere near a dispensing line until they have finished a training program. For managers who focus on the bottom line, training is a dollars and cents issue.

“Pharmacy techs used to be readily available and now not so much,” says Steve Gilbert, Tabula Rasa vice president, Performance Improvement. “You don’t want to create a revolving door with constantly bringing people on board. We can either prepare them to succeed or prepare them to fail. Preparing people to succeed is the right thing to do, but it’s an economic decision at the same time.”

Training staff to succeed helps them be more comfortable in their role, Gilbert adds, which can ultimately lead to better productivity. Better training also means fewer mistakes. Minimizing errors improves patient safety. And it’s cheaper to fill a script correctly the first time than to have to replace something that was misfiled.

“Every time you teach a system or a device, you become more competent yourself,” Traylor said. “Tech vendors have great training videos, but the staffer who actually uses the system is the best one to help the trainee translate the video to the specific system they will be working with. Don’t ignore vendor resources, but it’s up to you to make their resources work within the system as configured for your store.”

Pharmacy owners and managers are responsible for training, but they shouldn’t be doing it all personally. Leave training to the operational expert. The manager is seldom the most knowledgeable person about any specific system or technology; let the staffer who knows more about the system than you train the newcomer.

The Equashield Pro automated compounding unit is in beta testing in several US sites. The company says its closed system reduces surface contamination with antineoplastic agents, is faster to compound, and covers more routes of exposure than alternative compounding robots.

QS/1 Introduced its new SharpPOS and a new register during the summer. Improvements include automatic SIGIS file updates, checking and issuing a refund in the same transaction, and unlimited department keys. The new register runs both the current POS system and the SharpPOS with dramatically reduced footprint compared to current registers.

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HBS has released the integration of its Pharmacy Services Portal with PickPoint’s will-call retrieval and bagging systems. The integrations mean a single application can help pharmacy staff cut wait times and improve service. 

Capsa Healthcare released the new Kirby LesterKL-SR robotic dispenser for busy retail and hospital outpatient pharmacies. It manages filling of a pharmacy’s most common scripts using universal cassettes that require no technician calibration, eliminating an important source of error when changing the medication in a cassette.

Most pharmacy associations have a training department, but many are focused on clinical and business services such as medication therapy management or expanding immunization programs. Staff training materials can be harder to find.

The National Community Pharmacy Association devoted multiple sessions at its 2019 convention to staff training and training techniques. The group will release a new series of staff training videos later in 2019.

NCPA also has a training webinar, Management Techniques to Increase the Pharmacy’s Financial Success. A six part online course,  Comprehensive Motivational Interviewing Training, can  help staff train patients in a new technology or help change behavior as part of tobacco cessation or diabetes education program. Both are available through the NCPA Innovation Center. 

The Association for Talent Development (TD.org) trains trainers-and pharmacy owners/managers.

Every CE session is a training seminar. Don’t just listen to the content, watch how the presenter structures the information and the mechanics of their teaching techniques. Some work well, some don’t-and all can help you to brush up your own teaching skills.

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How to set up a new technology for success and get employees-and patients-excited about it.

Train Staff on New Technology: Tips for Pharmacy Managers

Migraine is a very common neurological disease-as the third most prevalent illness worldwide, it affects 39 million women and children in the US, 

according to the Migraine Research Foundation

. Despite its prevalence, migraine often goes undiagnosed and undertreated.  

Every year in the US, $36 billion is spent on migraine-associated healthcare and lost productivity costs, and 157 million days of work are missed due to migraine. More than 4 million adults suffer from 15 or more migraine days monthly, known as chronic daily migraine. Medication overuse often contributes to chronic migraine. Chronic migraine is also associated with depression, anxiety, and sleep disturbance.

, preventive treatment for migraine is an important part of the treatment plan. Drugs with established efficacy include anti-epileptic drugs (divalproex sodium, topiramate), beta blockers (metoprolol, propranolol), and BOTOX. 

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Drugs categorized as probably effective include the antidepressants venlafaxine and amitriptyline, and beta blockers atenolol or nadolol. Several other drugs are categorized as possibly effective, including carbamazepine, lisinopril, and clonidine, among others.

Currently, four injectable drugs are available for prevention, including BOTOX and monoclonal antibodies. BOTOX (onabotulinumtoxinA) is approved for chronic migraine with a recommended total dose of 155 units.

Another migraine drug, lasmiditan (Reyvow, Eli Lilly), was approved last month. Lasmiditan tablets were approved for acute (active/short-term) treatment of migraine with or without aura in adults. The most common side effects are dizziness, fatigue, paresthesia, and sedation. The drug may cause driving impairment; patients are advised not to drive within eight hours of taking the medication. 

Monoclonal antibodies are approved for episodic and chronic migraine and may be promising in patients who have failed prior preventive treatments; three are currently available with another, eptinezumab, in the pipeline. All three are administered subcutaneously. 

240 mg loading dose, followed by monthly doses of 120 mg.

available in 2 doses (70 mg and 140 mg, either can be used as a starting dose), given once monthly. 

dosed as 225 mg monthly or 675 mg every 3 months.

An acute migraine should be treated immediately. For a mild/moderate attack, NSAIDs, acetaminophen, or combination drugs with caffeine (aspirin/acetaminophen/caffeine) can be used.

For a moderate/severe attack, or if the above treatment does not provide relief, triptans or dihydroergotamine are recommended.

The American Academy of Neurology does not recommend opioids or butalbital in the treatment of migraine, 

, as routine use of these medications often causes more frequent and severe headaches.

Patients regularly using medications for acute headache should be evaluated to ensure they are receiving preventive treatment to help avoid development of medication overuse (rebound) headaches.

Patients who prefer nondrug therapies or have failed to respond to or cannot tolerate medications may be candidates for neuromodulation. Neuromodulation, which can be used as an acute or preventive treatment, uses an electric current or magnetic field to stimulate the nervous system. FDA-approved devices include Cefaly, Spring TMS, and gammaCore.

As accessible healthcare professionals, pharmacists can be a valuable resource to patients who suffer from migraine. In addition to counseling patients on medications, pharmacists can help patients with nonpharmacologic advice.

From medications to novel treatment methods, a guide to helping your migraine patients.

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As the vaping crisis continues, pharmacists are being called upon in growing numbers to help counsel patients about recent deaths and how individuals can protect themselves. Research into the pathology of vaping-associated lung injury is in its infancy. However, a 

 has found that lung injuries from vaping are most likely caused by direct toxicity or tissue damage from noxious chemical fumes.

Researchers at the Mayo Clinic reviewed lung biopsies from 17 patients, all of whom had vaped and were suspected to have vaping-associated lung injury. The study found no evidence of tissue injury caused by accumulation of lipids, which had been suspected as a possible cause. In recent months, CDC has received almost 2,000 lung injury reports associated with vaping and dozens of deaths. 

, pediatric pulmonologist at Washington University School of Medicine in St. Louis, Missouri, has thoroughly investigated the threat of electronic cigarettes in children and adolescents and helped develop a 

. “We are not certain what anyone is inhaling when they use electronic cigarettes. Their vapors can contain ultrafine particulates, volatile organic compounds, and heavy metals, such as nickel, tin, and lead. Other reports have shown that these products can be contaminated with bacterial and fungal toxins,” Ferkol says. 

He says electronic cigarettes were designed to deliver nicotine, and the nicotine content in vapors can be as high and often higher than combustible cigarettes. Other chemicals he says are common in these products are propylene glycol and glycerin-solvents for nicotine and flavorings. 

“A growing literature has shown that e-cigarette exposure causes acute inflammation, injury, oxidative stress, and other toxicities in the lung,” says Ferkol.

Vaping among American middle school and high school students is also on the rise. Ferkol cites preliminary data reported by the National Youth Tobacco Survey which shows continued increase among high school students: 30-day nicotine vaping rates are at 28% this year, compared to 21% last year and 12% in 2017. “The warning signs for chronic [e-cigarette] use are the same as those seen in nicotine addiction. In addition, bronchitic symptoms have been associated with e-cigarette use in adolescents, manifested as a persistent, daily productive or ‘wet’ cough for several weeks,” says Ferkol.

Recent deaths and illnesses linked to vaping prompted New York in September to become the first state to ban flavored e-cigarettes; since then other states have imposed temporary bans on the sale of e-cigarettes or the flavored 

liquids used in them until more is known. The CDC 

 that e-cigarettes should not be used by children, young adults, pregnant women, or adults who don’t already use tobacco products. 

Many young and pregnant women are using e-cigarettes as a safer alternative to smoking, but little is known about the effects on fertility and pregnancy outcomes. In a mouse model, researchers at the University of North Carolina at Chapel Hill found that e-cigarette usage prior to conception significantly 

delayed implantation of a fertilized embryo

 to the uterus. They also discovered that e-cigarette usage throughout pregnancy changed the long-term health and metabolism of female offspring. 

, assistant professor in pulmonary and critical care medicine, University of Utah, says pharmacists have to be concise and direct when counseling individuals. He said the message needs to be clear that the potential lung damage and other sequalae is still unknown.  

Direct and concise information will dissuade dangerous use.

The Vaping Crisis: Counseling Patients

30.3 million individuals in the U.S. have diabetes, and 7.2 million people living with the disease are undiagnosed. This showcases the need for diabetes management programs and continuous patient education and monitoring.

, pharmacist-led interventions in a rural primary care clinic were associated with the majority of patients experiencing an A1C reduction of at least 1%, which has the potential to reduce the risk of complications and decrease diabetes associated costs. Pharmacists’ have a unique skillset as drug experts and play an integral role as part of the healthcare team-not only improving patient outcomes, but also expanding business opportunities.  

Pharmacists can play an integral role in establishing diabetes management services in the community and health system settings. According to a study published in 

, 96% of the providers approved of the collaborative practice agreement for pharmacist-led diabetes services. 

Additionally, pharmacists’ satisfaction with the new protocol was high. The majority (89%) of patients were referred by providers who received a personalized provider report card, which identified patients who met the criteria (A1C > 9%) for pharmacist referral under the protocol. Pharmacists can use these personalized provider report cards to establish a relationship with physicians and expand diabetes management services. This may lead to expanded patient care opportunities and enhanced communication with prescribers.

 offers reimbursement for Medicare beneficiaries for diabetes self-management training (DSMT), provided that individuals have been recently diagnosed with diabetes or are at risk for complications. Pharmacies first need accreditation to provide DSMT. The National Community Pharmacists Association (

) has teamed up with the American Association of Diabetes Educators to provide an educational program known as “Diabetes Accreditation Standards-Practical Applications” (DASPA), which provides the necessary requirements for accreditation to be recognized as a certified program provider. Approved program instructors may include pharmacists, registered nurses, and registered dietitians, which demonstrates the importance of interprofessional patient care programs. The DSMT programs should include education on self-monitoring blood glucose (SMBG), diet and exercise counseling, an insulin treatment plan, and motivation to use skills for diabetes self-management. 

Bhavana Mutha, RPh, BCMAS, a clinical consultant in Woodstock, GA, with over 14 years of practice experience in different retail centers says “personal support and guided education to manage and control different aspects of diabetes can lead to a very balanced approach in disease management.” Mutha also says she believes in the importance of keeping up with the profession and expanding her horizons, so she is pursuing additional training and certification for diabetes. 

Pharmacists are being recognized by Medicare Part B for their role in managing patients with diabetes, even in perhaps unconventional ways. Part B covers furnishing and fitting of custom-molded shoes and inserts, and pharmacists are recognized as other qualified individuals besides podiatrists that are able to provide those options for patients. However, individual states may require additional requirements for pharmacists to prescribe therapeutic shoes, so they should double check with their state laws.

Medication therapy management is a great way for pharmacists to become a one-stop-shop for management of comorbidities and receive reimbursement for their services. These services can be provided face-to-face or via phone and may consist of identifying potential drug interactions, dose optimization, therapeutic outcomes, and medication adherence. Immunizations are extremely important for individuals with diabetes as they are at higher risk for vaccine-preventable diseases, and pharmacists can play an important role in this process through education and administration.    

Pharmacists can also participate in the program 

 for opportunities and ideas for diabetes services like wellness coaching and insulin pump training. Various programs exist for the certification of pump training and offer reimbursement for different services provided to patients. 

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Rx for the National Diabetes Prevention Program

 helps pharmacists get involved in prevention by identifying and reaching out to patients at risk for developing type 2 diabetes. This resource provides pharmacy case studies and how pharmacists can play an integral role through raising awareness; screening, testing, and referring; and delivering the program.   

Ultimately, managing medications is about building trust and makes a much deeper impact on the patient than dispensing a medication without counseling. Mutha says patients who have diabetes will in turn be grateful for the medication management and counseling points for their health. Even if there is not always a profit, the pharmacist-patient relationship is continually enhanced to promote disease state management, which will in turn advance the business side. 

Many deaths seen in the news have resulted from various factors affecting access to insulin, (i.e. cost), and have caused patients to turn to rationing or going without the important drug therapy. Pharmacists can play an important role in addressing these timely issues to ensure patients have access to these life-saving medications. “Personally, I have undertaken such cases and made life changing impacts in many ways by providing education, counseling, and teaching patients the A1C targets, glycemic index, lifestyle modifications, body mass index, symptoms of hypo and hyperglycemia, and guidance to personalize cost effective solutions for diabetes,” says Mutha.

 may offer unique opportunities for pharmacists to make a huge impact on patient care. “Considering the imbalance in the profession with a growing number of pharmacists and job saturation, telehealth could be a niche way to fill the gaps in care and make an impact on population health with diabetes and comorbidities,” says Mutha. 

Mutha adds that “the current trend of telehealth care could play a vital role in helping the community with diabetes management.” Pharmacists as drug therapy experts can play a vital role in disease state management remotely as technology is continuously expanding. The CPT codes 99453, 99454, and 99457 may be used by pharmacists in the future for reimbursements through remote patient monitoring or telehealth.  

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What does this mean? “With availability of continuous glucose monitoring (CGM) systems, Bluetooth-guided meters, and remote patient monitoring or monitoring under collaborative practice agreements, diabetes management can be taken to a whole new level due to the ease of data accessibility and enhanced communication,” says Mutha. 

 to the Standards of Medical Care in Diabetes. These recommendations discuss SMBG, CGMs, and automated delivery systems. Pharmacists can counsel patients about these technologies to make monitoring blood glucose easier in their daily lives. Most patients using intensive insulin regimens (multiple daily injections or insulin pump therapy) should check glucose levels using SMBG or CGM before meals and snacks, at bedtime, occasionally postprandially,  before exercise, when they suspect low blood glucose, after treating low blood glucose until the levels are normal, and before critical tasks like driving.      

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, diabetes care provided by a clinical pharmacy specialist via clinical video telehealth was as effective for type 2 diabetes management compared to face-to-face management by a pharmacist. Patients with type 2 diabetes who were managed between April 2013 and October 2014 were included in the retrospective study, and the primary outcome was the average A1C reduction at three and six months.

Great patient care and new business opportunities don’t have to be mutually exclusive.

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As with many chronic conditions, rheumatoid arthritis (RA) needs to be managed even when there are no symptoms. 

“When providing consultation to patients with RA, pharmacists should remind patients that even though they may feel fine, daily management with medication helps lessen the impact of RA,” says 

 and EVP of specialty pharmacy at CVS Health. “In addition, pharmacists should discuss activity and the importance of regular exercise and movement, as well as ensure patients keep up with routine monitoring such as blood tests and x-rays recommended by their physician.”

 include NSAIDS, corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and biologic agents. 

“The medication regimens are fairly complex and require very close monitoring for safety,” says 

, associate professor of pharmacy at Albany College of Pharmacy and Health Sciences. “It is important that patients are being treated by a rheumatologist or at least co-managed by their doctor and a rheumatologist.”

Potential side effects of RA medications may require immediate attention.

“Some of the RA drugs have some pretty severe side effects, so that’s always something that the pharmacist can help the patient understand,” says 

 and senior director of professional affairs, National Community Pharmacists Association (NCPA).  

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“You may need to speak to patients about their pain level and additional medications to manage the pain they’re experiencing, what is appropriate with their other medications, as well as the supplements they can take and their diet,” said 

A non-inflammatory diet, which has been shown to help 

, features ample fruits, veggies, and cold water fish, plus whole grains, beans, and lentils. 

Data suggests that fish oil and turmeric may help treat inflammatory disease, while RA patients may also benefit from vitamin D supplementation to prevent bone loss. 

“Everyone experiences bone loss as they age, but if someone is taking medication, a steroid in particular, to control RA flares, long term use can accelerate that bone loss,” said Schwartz.

Regular physical activity is recommended, but in moderation.

“Weight bearing and strenuous exercise can sometimes cause an exacerbation or flare-up of their disease,” said Farrell. “Water exercises are really good because they are not weight bearing and  strengthen muscles around the joints to help stabilize them.” Preventing joint deformity and protecting mobility are important goals in managing RA.

On a practical level, pharmacists can help RA patients cope with limited mobility through gestures as simple as fitting medication with easy open caps.

“It is something the patient has to request, but it is helpful to remind folks with RA medications that it might be a good conversation to have,” said Schwartz. “A lot of community pharmacies tend to carry unique medical equipment that will help RA patients as their disease progresses, such as reachers, grab bars, and raised toilet seats. We have things that may make daily living a little easier when you are having a bad day with your RA.”

From dietary advice to medications, tips to aid RA patients.

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While a visit from the Board is not something you look forward to, the pharmacy should nevertheless be ready for it at all times. 

What does it mean to be ready for an inspection? You might be surprised: not only does it include proper record-keeping, inventory maintenance, and drug security; but also such apparently trivial things as, among other things, dust-free shelves, staff appearance, and bathroom functionality (yes, bathrooms are often inspected too). 

If the inspector concludes that the pharmacy provides sub-standard services and does not comply with pharmacy regulations, the Board may commence an administrative action against the pharmacy or issue a citation/fine (depending on the inspector’s observations). Therefore, it is important to anticipate an inspection and prepare the pharmacy and its staff for the process. 

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The inspection process differs from state to state, but most pharmacy boards focus on a few common things. For example, virtually all boards require that the inspectors introduce themselves and state the purpose of their visit prior to commencing an inspection. Most states allow the inspectors to take pharmacy records off-site (provided they issue a receipt to the pharmacy). And the inspectors are required to provide the pharmacy with the inspection report or written observations after the conclusion of the inspection. 

The inspection report is the most important document during the inspection because it lists potential violations, suggestions for improvements, and other concerns of the inspector. An experienced pharmacy attorney, for example, can simply glance at the report and tell you whether it is likely that the Board will commence an administrative action against the pharmacy, issue a citation/fine, or if no further actions would follow. 

Therefore, it is imperative for the pharmacy to review the inspection report and address its allegations or observation, if applicable. If, for example, the inspection report states that the pharmacy has no policies and procedures on dispensing controlled substances, the pharmacy should draft such policies and send them to the inspector shortly after the conclusion of the inspection. On the other hand, if the inspector notes that there is expired inventory in stock, prepare a corrective action plan on how this issue had been addressed. I cannot stress enough the importance of the inspection report as an opportunity to avoid a costly license defense in the future. 

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The inspector may ask you for additional information and documentation as required by your state laws. I had cases where inspectors asked for financial business information (tax returns, billing records, etc.). However, most states provide that pharmacies must only provide access to 1) all stock of dangerous drugs and devices, and to 2) all records of manufacture, sale, acquisition, receipt, shipment, and disposition. Therefore, If the inspector asks anything that is not on the above list or not expressly authorized by a statute, you should discuss the request with your legal consultant to analyze the validity and the Board’s authority for such request.

A checklist of what you need to be prepared for a Board of Pharmcacy inspection.

Are You Ready for Pharmacy Inspection?

An estimated 47 million adults living in the United States were age 65 and older in 2017, according to research 

 that number will more than double to nearly 100 million individuals by 2060. The combination of the expanding elderly population taken together with an average lifespan of 78.6 years for men and slightly more than 81 years for women highlights the need to improve medication-related outcomes in this population. Facilitating how senior citizens manage their medications by engaging technology, support systems, healthcare providers, and other resources are good places to start.  

Geriatric patients face many challenges in managing their medications, which is sometimes very complex due to their medical conditions,” says 

, an assistant clinical professor of health sciences in the department of family medicine at University of Southern California, Riverside.

Experts have varying opinions when it comes to pinpointing the biggest hurdle in helping senior citizens manage their medications. However, polypharmacy appears to be a recurring theme-especially as prescription medication use continues to rise. 

Prescription medication use among the geriatric population has more than doubled over the last 20 years. A 

 that evaluated data from 13,869 adults ages 65 and older in the National Health & Nutrition Examination Survey (1988-2010) found that older patients took a median number of two medications in 1988; by 2010, that number had doubled to four medications with 40% of the patients taking 5 or more medications. 

, assistant professor of pharmacy practice at Butler University College and ambulatory care clinical pharmacy specialist at Eskenazi Health in Indianapolis, notes the medication management is not exclusive to prescription medications. Comprehensive medication management should also include over-the-counter medications, dietary supplements, and herbal products.  

, BCGP, an ambulatory clinical pharmacy specialist at Banner Pharmacy Services in Phoenix, taking multiple medications can have serious consequences. A high pill burden contributes to low adherence rates, but poor understanding or lack of education on the medications also hinders patient adherence.

“I find that many of my patients do not know the indications for all of their medications, so they do not understand the importance of taking them every day,” she observes.

Hagarty also finds that some patients may feel overwhelmed by managing their medications. Many patients are also worried about side effects and interactions, but they do not always express these concerns to their health care providers.

Polypharmacy, the need for increased collaboration among healthcare professionals, and improving communication are not the only challenges in the world of medication management. Kim-Paglingayen points out that particular circumstances such as language barriers, lack of transportation, and physical or mental disabilities require unique solutions.

Older patients who are disabled or without access to transportation may also lack social support, such as having a family or friend to pick up their medications and refill requests promptly. Those who have mental or physical disabilities may not be able to adhere to high-maintenance medication regimens, such as those requiring frequent glucose checks and stringent dietary restrictions to avoid dangerous drops in their blood sugar.

Age-related changes add another layer of complexity. Declining or compromised kidney and liver function may hinder the speed by which medications are cleared from the body, causing medications to last longer and increase the risk for side effects. 

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Triboletti cites other age-related changes, such as additional sources of complexities. For example, factors such as increased fatty tissue, decreased bodily fluid, and overall weight-loss can alter the volume of distribution, warranting the need to adjust medication doses.

Special populations, such as homebound patients-both young and old-may face a greater risk for adverse drug events associated with complex medication regimens. Frequently, these individuals live with multiple chronic conditions and take multiple medications to treat each condition, increasing the risk for complications and costly medication regimens and poor medication adherence.

, a geriatrician with Christiana Care Health System’s Department of Medicine who specializes in home-based primary care with Christiana Care’s Visiting Nurse Association says that open lines of communication between all healthcare providers involved-including caregivers-is imperative to improving the patient experience and outcomes. 

She cites the increased potential for OTC drug interactions as an example. Many OTC medications are combination products with multiple different medications, which can increase the risk for unintentional overdoses of medications such as acetaminophen.  

Triboletti agrees. “Communication is key, and pharmacists are in a unique position to provide accessible and consistent medication support,” she says. “Conversation with patients and caregivers are important  to help identify concerns, barriers, and underlying causes for nonadherence.”

Hagarty emphasizes the importance of reviewing medications with the patient can help increase their understanding. Doing so could potentially improve patient adherence while facilitating the pharmacist’s ability to identify opportunities to optimize their medication therapy. Examples of this include discontinuing unnecessary medication and duplicate therapy, identifying new drug interactions, and finding solutions to barriers to access such as transportation or cost. Sometimes, healthcare providers must adjust the solutions to suit the patient’s environment.

“Home health providers should identify the over-the-counter medications a patient is taking when conducting a medication review, including asking about medication bottles seen during the visit that the patient may forget to mention such as the over-the-counter sleep medication on their nightstand,” Morgan-Gouveia says. “They alert the patient’s primary care provider [and the pharmacist] about any over-the-counter medication a patient is taking that is not on their medication list.”

Healthcare is no stranger to new technologies designed to engage users-in this case, patients. While some stereotypes regarding senior citizen’s affinity for and ability to use technology persist, internet use among senior citizens is on the uptick. The number of senior citizens who own smartphones more than doubled from 23% in 2013 to roughly 50% in 2017, depending on the age range, according to a report from 

. As many as 59% of senior citizens aged 65 -69 years reportedly owned smartphones and 49% of 70- to 74-year-olds owned smartphones in 2017. While lower, those numbers still remain relatively high for the 75+ group: 31% of 75-79-year-olds owned a smartphone and 17% of seniors aged 80 years and older having owned smartphones in 2017.

Similarly, internet use among this population has soared. Only 14% of senior citizens used the internet in 2000, but that number soared to at least 67% by 2017. Furthermore, the usage statistics pattern those of geriatric smartphone owners, with the 65-69-year-old-age groups being the most robust internet user, followed by those in the 70-74-age group; usage drops off after that point. However, recruiting technology to solve medication management problems may require insight that transcends the gadget and the application.

“These hurdles are not just technological-they’re life hurdles,” says Maureen Williams, marketing solutions manager, consumer and physician experience for 

. For Williams, a healthcare technology industry professional who also cares for her aging mother, the reality hits home. “Any technology that gets deployed needs to be easy-to-incorporate into that patient’s daily life.”

For patients who might benefit from technological interventions, Williams recommends that healthcare professionals work with patients to ensure the technology is something the patient finds easy-to-use, easy-to-understand, and easy-to-incorporate into their daily life. It is also crucial that the patient finds the technology both meaningful and useful enough to continue using it. 

“If an alarm is going off every 2 minutes, the patient is just going to cut it off,” Williams cautions, referencing a phenomenon known as alert fatigue. 

In addition to addressing the patient’s ability to manage medications, Williams says that providers frequently encounter challenges helping patients address costs. Meditech has a patient portal that facilitates real-time communication between all interested parties. Both printable and downloadable, patients can access the list to share with healthcare providers and family members.

However, not all platforms offer the same features. Williams’ mother must phone in refill requests for certain prescriptions, and subsequently, call the pharmacy to ensure the script went through. For patients who have a portal to refill prescriptions (as well as their care providers that leverage real-time benefit check and Electronic Prior Authorization), the refill process is much more efficient and smoother.

Kim-Paglingayen says that, while technology offers an opportunity to help seniors better manage their medications, it may not be a suitable choice for every member of the golden-years community.

“There are tech-savvy elders who have a list of their medications and dosages in their smartphone ‘note’ section,” says Kim-Paglingayen. “But most elders I know would rather have a handwritten list in their wallet or note pad that they bring along with them to the hospital or the clinic.”

In cases where a patient’s medication list is unclear, Kim-Paglingayen’s staff usually places a call to the patient’s family, pharmacy, or PCP for collateral information. However, there are times when phones come in handy, as she says some patients come in with pictures that they took of their pill bottle.

Ultimately, using technology depends on the patient’s reception, comfort level, and access to specific resources.

“Depending on the person, apps and online resources can be a great tool to keep patients engaged in their own health care,” says Triboletti.

The specific medication challenges of seniors-and the tools and tricks to help them stay healthy.

Senior Medication Management: Helping a Vulnerable Population

The majority of pharmacies in the United States now offer vaccinations, but there is still significant opportunity to turn a well-run vaccination program into a profitable endeavor that benefits both patient and pharmacy.

Many adults still fail to get the recommended vaccinations each year. According to the CDC, just 37.1% of adults received the flu vaccine during the 2017-2018 flu season. This presents a significant opportunity for pharmacies to improve these numbers by expanding their immunization efforts, marketing their programs to the community, and relying on what makes a pharmacy a unique healthcare setting. 

“Pharmacies have a huge advantage right off the bat of being readily available and accessible,” says Beverly Schaeffer, RPh, of Katterman’s Sandpoint Pharmacy in Seattle, WA. 

Katterman’s was one of the first to offer vaccines-starting their program back in 1996. Schaeffer says the pharmacy had been hoping to give 300 vaccines but found themselves administering 1,200. Since then, the program has continued to grow and the pharmacy now offers all available vaccines in the state and can even administer to children and infants. 

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“All pharmacists could be doing more immunizations than they are if they wanted to,” she says. 

Expanding immunization efforts can not only improve public health, but it can also serve as an increased revenue stream for community pharmacies. Close to 100 million Americans get the flu shot each year, translating to $4 billion to $5 billion in revenue, PBA Health reports. 

Immunizations outside the influenza vaccine can often bring in even larger administration fees for pharmacies. “Almost all immunizations pay an administration fee that varies from plan to plan, but you get paid for the vaccine plus an administration fee,” Schaeffer says.

Vincent Hartzell, PharmD, president of Hartzell’s Pharmacy in Catasauqua, PA, says successful immunization programs not only provide revenue for a pharmacy on their own, but they also often drive other areas of business. “Vaccines have allowed us to provide marketing and attract new customers,” he says.

The most effective marketing strategies, he says, don’t always have to be costly and can be as simple as an effective social media post, informing local physicians and area senior centers of the pharmacy’s immunization services, or using banners and signs. 

Schaeffer has found one of her best marketing tools is a sandwich board placed outside the pharmacy each day that highlights different services such as its tetanus shots, travel vaccines, or the highly sought-after shingles vaccine. 

Her pharmacy does a significant amount of business in travel vaccines, so she also tries to drive other store business through a separate travel aisle where customers can find everything needed for an upcoming trip-anti-diarrhea medications, rehydration packets,  eye drops-all in one convenient area.  

Hartzell believes it’s important that all the pharmacists in a community pharmacy be trained to give immunizations so that there is always an available staff member whenever a customer arrives at the store. 

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To improve the workflow, he says, non-pharmacist staff should also be a critical aspect of vaccination programs. Those workers should have ways to identify patients who may be behind on immunizations or could benefit from annual vaccines such as the influenza and pneumococcal vaccines.

“Make sure that your technicians know how to do the billing, make sure your technicians know how to fill out the consent forms because that’s stuff that you don’t need a pharmacist for,” he says.

Overall, Schaeffer and Hartzell agree, successful vaccination programs can yield big rewards for community pharmacies and their patients.

Enhancing vaccination programs increase revenue and clientele base.

Vaccination Programs Bring Pharmacy Profits

It’s no secret that healthcare is in a state of rapid shifts-it has been for a long time, and it shows no sign of slowing in its evolution-and pharmacy is no exception. From independents to big box to large chains to hospitals, every pharmacist is going to feel (and is already feeling) significant changes. 

Perhaps the greatest shift in recent years, however, has come from chains. Changes in chains affect not only the pharmacists working in those chains, but show how pharmacy as a whole is evolving. 

Pharmacy is continuing its shift away from solely dispensing medications to providing total care of a patient through drug therapy management, active patient engagement, and the ability to expand clinical services like administering flu shots and vaccines. The major chains are expanding the coverage of healthcare services from pharmacy to incorporating retail healthcare clinics into their locations and having pharmacists practice at the top of their licenses, such as strep testing and treatments.

, chief pharmacy officer at RxSense, a Boston-based healthcare tech company, believes pharmacy chains of the future will be offering more convenience in healthcare by expanding their in-store clinics, partnering with health insurers and health systems and providing a one-stop shop for patient care. 

“With the retail chains already having pharmacists on-site and incorporating diagnostic services through clinics, they can provide a multi-disciplined team of clinicians who can manage the patient holistically,” he says. 

He also notes patients are shifting how they consume healthcare. They are more educated about the costs of medications and services as a way to save money. 

“Patients are comparative shopping for their medications and taking advantage of prescription savings services like SingleCare to save money on their medications,” Yacoub says. “Pharmacists play a vital role in helping patients become consumers of medications, as they are well informed of the cost of medications and less costly alternatives. I think you will see more transparency in pharmacy both demanded by the consumer but also by state and federal requirements, which will result in a more educated consumer.” 

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, RPh, vice president, health policy and industry relations, at San Francisco-based FDB, which provides drug and medical information, says in the coming years, chains-like independents-will continue to develop and deepen the important role of pharmacists within the value-based care delivery framework, especially as it relates to primary care delivery and identifying and addressing social determinants of health.

“As we have already seen, retail chains will expand pharmacy services beyond medication dispensing by addressing a growing number of basic healthcare needs, enabling pharmacists to practice at the top of their licensure,” he says. “Of course, pharmacists will continue to serve their communities as the most trusted source of medication and drug information.”

How chains are evolving-and how pharmacists will fit in.

Drug Topics November 2019

Train Staff on New Technology: Tips for Pharmacy Managers

What Pharmacists Need to Know About Migraine

The Vaping Crisis: Counseling Patients

How Diabetes Care Is a Business Opportunity

How Pharmacists Can Help Rheumatoid Arthritis Patients

Are You Ready for Pharmacy Inspection?

Senior Medication Management: Helping a Vulnerable Population

Vaccination Programs Bring Pharmacy Profits

The Future of Pharmacy Chains

Chains Implementing Tech to Help Track Opioid Misuse

CDC, Retailers Urge Flu Vaccine Due to Early Season

California Bill Allows Pharmacists to Initiate HIV Medication Without Prescription

Physicians On-board with Herpes Zoster Vaccine

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