MARCH 2020 - A novel qualitative research study illuminates how comprehensive annual care plans (CACPs) can provide tremendous value to patients, pharmacists and other healthcare providers.
“The new service required a lot of change in the pharmacy, but we found that there was a lot of value in terms of how pharmacists were interacting with patients, and how patients and physicians saw the value of the pharmacist’s role,” said Christine Hughes, co-principal investigator and professor at the University of Alberta.
Hughes and fellow U of A researchers Terri Schindel and Rene Breault are the first to take such an in-depth look at how Alberta pharmacists provide remunerated CACPS, and how patients, physicians, nurses and other pharmacy staff experience these services. With funding from the Canadian Foundation for Pharmacy’s Innovation Fund and the Alberta Pharmacists’ Association, they and their research team collected data around care planning services provided at four community pharmacies between May 2016 and January 2018. Investigators visited each site three times over the course of the study, involving 77 hours of interviews (with pharmacists, patients and other healthcare providers), 94 hours of observation and 61 site-specific documents (such as documentation templates).
Perceptions of value
Patients consistently valued the CACPs, according to the research paper published in Pharmacy in July 2019. Increased engagement with their care, reduced wait times, convenience and comfort were among the benefits cited.
“I waited actually over 15 months to see a specialist…. The pharmacist in five minutes told me more than that specialist did, and there was no waiting period,” said one of the interviewed patients. Another referred to the pharmacist as a "secret doctor."
Interviewed patients also appreciated that CACP discussions were more conversational than appointments with physicians, and they felt more like they were speaking with “family.” One patient said: “It made a difference to me…. I appreciate the chance to go over my meds and things that bother me at the time or what we could do about one thing or another.”
Over the course of the year, the sense of "being cared for" grew. “The CACP was more than a document that recorded important information about patients and their goals. It caused things to happen and made a difference in patients’ experiences with health care services," noted the research paper.
Pharmacists also reported feeling better positioned to support patients through "rough times."
“I like the structure and deliberateness . . . [it] is a remarkable way to connect with people and to help them manage their health,” said one of the pharmacy managers.
Interviewed physicians were also generally positive about their experiences with community pharmacists’ care planning services. Said one: "It’s a wonderful adjunct to my practice. It makes my practice better . . . It makes me think about things in a different way."
Collaboration in the form of information sharing was valued by pharmacists and other health care professionals; however, researchers observed different means of sharing information. At sites where the physicians and pharmacists knew each other and had established working relationships, the process of information-sharing was more efficient and included telephone, face-to-face conversations and text messages in addition to facsimile. Proactive information-sharing that occurred before completing the CACP was highly valued, as clarifications, new information and collaborative decision-making could occur.
The study also considered pharmacists’ perceptions of value in light of the time required for the service. Some initial CACPs took up to four hours from start to finish. Reimbursement from the provincial drug plan was a flat fee of $100. Yet most pharmacists consistently described the service as worthwhile, regardless of the time required.
Pharmacists participating in this study reported high levels of satisfaction with their experiences providing the CACP service, due to interactions with patients and other healthcare providers and the value of being compensated for a service, noted the study. "In addition, the CACP service renewed their sense of responsibility and meaning to their role," said Hughes.
Implementation of CACPs
When it comes to implementation, the research found that four major components emerged:
A second research paper, published by the Journal of the American Pharmacists Association and available online as of December 2019, explores these components in more detail.
All four components require time, both for implementation and evolution. “This type of change won’t happen quickly, and the amount of time is individual for everyone,” said Hughes. “It depends on the level of support in the pharmacy, and its policies. And for pharmacists, it may take more time to feel comfortable providing the service, or to learn to document.”
Professional development, technology and the changing roles of pharmacy technicians and other staff were important facilitators, as was the process of learning through experience while implementing the compensated services.
“On the one hand it takes time, on the other hand you have to start somewhere. Over the course of the study, all of the pharmacies were still making changes and improvements, and always re-evaluating,” said Hughes.