HCI Exam 2 Junk
application
- 1st step of the hiring process - screens unqualified candidates and provides background about candidate for interview
Screening
- 2nd step in hiring process - attempts to weed out unqualified candidates from pool of potential candidates; can include standardized testing that has been validated
Progressive discipline
- A series of acts taken by management in response to unacceptable performance by employees - Role is to escalate the consequences of poor employee performance incrementally with a goal of improving behavior, not punish - serves as documentation for termination - steps include verbal warning, written warning, suspension, termination
Social awareness
- Ability to accurately perceive your own emotions - stay aware of your emotions as they happen - keep on top of how you tend to respond to specific situations and people - be empathetic
Emotional intelligence (EI)
- Ability to recognize and understand emotions - Using the awareness to manage yourself and relationships with others - learn to recognize and label the emotions that you and others are having - use that knowledge to work more effectively with others - people with higher EI have improved job performance and more effective leadership skills
Healthcare access and quality
- Access to regular source of care that provides early screening, preventative services, and prompt treatment is an important component to achieving health - Barriers such as inadequate health insurance or shortage of providers may prevent people from getting these services
Requirements for test to treat
- Active license - board certification to test and screen - CE hours - liability coverage - report diagnosis of public health significance - maintain records for 5 years and provide them upon request - follow board guidelines - written protocol between pharmacist & physician - Written patient info to advise on follow up plan
Patient invovles
- Administering and taking (MTM, mobile apps, clinical services and documentation software) - monitoring and reporting
Recruitment
- All activities associated with attracting qualified candidates to fill job vacancies - purpose is to attract the most qualified candidate - proactive and continuous - active vs passive
Pharmacy practice model initiative/recommendations
- All patients should have the right to the care of a pharmacist - Characteristics, requirements, & challenges of optimal pharmacy models should be defined - Advancement of application of info tech in med use process - Advancement of use of pharm techs - successful implementation of new pharmacy practice models
Advantages of charge accounts
- Appeals to patients (patients may choose your pharmacy because of this) -- patients that live paycheck to paycheck -- may not have to be present at the time of delivery -- patient's family/caregiver can pick up prescription
Clinical decision support system (CDSS)
- Assists clinical decision making to improve patient outcomes - basic and advanced features - provides notifications - assists in following evidence based guidelines - medication safety
Pharmacy Information management system (PIMS)
- Backbone of medication use process technologies - May function as independent ordering systems requiring verification OR can be integrated with prescribing systems to reduce the potential for errors in medication verification - Assist with managing inventory, point of sale, and prescription benefit reimbursements
How can pharmacists impact the SDOH at the community level
- Community engagements (partner with local orgs, service learning, volunteering) - community needs assessment and advocate - political advocacy
Where can you complete medication therapy management?
- Community pharmacy (Face to face, telephone) - Ambulatory care pharmacy (Face to face, telephone) - Long term care pharmacy (face to face) - Telehealth
U.S. centers for medicare and medicaid services (CMS)
- Compulsory training and compliance programs for individuals and organizations who provide health or administrative services to medicare or medicaid enrolles or who receive payments form medicare/medicaid system - helps establish expectations for compliance, disclosure, transparency, and quality of care - employers are required to provide fraud waste and abuse awareness training to all employees within 90 days of hiring and annually thereafter
Management
- Concerned with day-to-day functioning of organization (operation focused) - Concerned with handling the complexities involved in running an organization - may not necessarily be a leader, however a good manager should be a leader
Mission
- Creates a sense of purpose of the company for customers and employees
Mission statement
- Defines what the company does or is - Statement of the present going ahead into the near future - Helps differentiate a company from others - short (less than two sentences)
Pharmacy practice model
- Describes how a pharmacy department's resources are deployed to provide patient care - Includes pharmacist, techs, automation, technology
Business planning purpose
- Determine feasibility of specific business or program - Used to make decisions about investing and and moving forward with a program
Rewards and recognition
- Employees want to be rewarded regularly with thoughtful and significant awards - its not always about a monetary reward - pay for performance
Strategic planning purpose
- Ensure organizations doing the right things - Addresses what business you are - Provide framework for more detailed planning and day to day decisions - Helps determine long-term goals for an organization
Neighborhood and built environment
- Environmental conditions where people live, access to healthy foods and quality housing, and the absence/presence of violence and crime, all play a significant role in people's health - Environmental contaminants affect the air people breath, the water they drink, and the chemicals they are exposed to - Living in an area of high crime may affect your physical, mental, and emotional well-being
Office of inspector general (OIG)
- Federal gov entity responsible for oversight of waste, fraud, and abuse and improve efficiency of medicare, medicaid, and many more departments of health and human services (HHS)
When can you complete medication therapy management?
- From a billing perspective: CMR should be annual and TMR should be quarterly/as needed - From a pharmacist perspective: ANYTIME
Barriers to health literacy
- Hospital signage (cant read/navigate) - Completing health information forms (incomplete/inaccurate) - Comprehension of medication instructions and dosing (inappropriate use, missed refills, adherence) - Describing referral process and follow up appointments (fragmented healthcare access, continuity of care)
Pharmaceutical care model
- Integrated practice model - Member of interdisciplinary team - Includes most pharmacists - Patient-focused
How can pharmacists impact the SDOH at the institutional (practice) level
- Interdisciplinary collaboration (CPA, improved communication) - Prevention strategies (immunizations, health screenings) - Social needs screenings (food pantries, transportation assistance)
How can you complete medication therapy managment?
- Many software/platforms - OutcomesMTM
Sponsors of MTM
- Medicare part D - Private/commercial insurance companies - patient - employer
Beneficiaries of MTM
- Medicare part D patients - Patients < 65 - ANYONE who can use meds (OTC, herbal, dietary supplements, prescription)
MAP
- Medication action plan - Patient centered document detailing a list of actions for the beneficiary to use in tracking progress for self management beneficiaries via mail, in person, or fax
How can pharmacists impact the SDOH at the individual (patient level)
- Medication affordability - Culturally sensitive patient education - prescription counseling - disease state management - addressing implicit bias
Cons of compliance packaging
- Medication changes - Time consuming for certain cases (pharmacy)
Drug distribution model
- Medication order focused - No direct patient care - No involvement in patient outcomes - Focuses on timely delivery
MTR
- Medication therapy review - Systemic process of collecting patient specific information, assessing medication therapies, to identify MRP (medication related problems), developing a prioritized list of MRP, and creating a plan to resolve MRPs
MTM services
- Medication therapy review (MTR) [CMR, TMR] - pharmacotherapy consults - disease management coach/support - pharmacogenomics applications - anticoagulation management - other clinical services - medication safety surveillance - Health, wellness, public health - immunizations
Business planning characteristics
- Midterm (1-10 years) - Scope specific to resources defined in the plan (human, IT, financial, capital, facilites)
Replenishment inventory model
- NO 340b purchased drugs are kept in stock at the contract pharmacy - when filling prescriptions on behalf of the covered entity, the contract uses its own non-340b purchased drugs - when a sufficient quantify of a given drug has been dispensed on behalf of the covered entity, the covered entity will purchase the quantity of the drug at the discounted 340B price and has it delivered to the contract pharmacy (in this way, the 340B purchased drugs replenishes the non-340B originally dispensed on behalf of the covered entity) - uses computerized tracking system
Core product
- NOT ALWAYS THE DRUG - DEFINED BY CONSUMER
O in SWOT
- Opportunities - external & positive - Ex: MTM, immunizations, product placement, staying connected, active locally, health camps, aging pop, mobile apps
Pharmacist clinical services
- OutcomesMTM = MTM - Clinical service documentation systems may be used in community setting , generally focused on preventative health: immunization documentation, care plans
Compliance packaging
- Packaging all medications a patient is taking into one package (pouch or blister) - Organized by day of week, time of day, and dose - Makes it easier for patient to take medications
Charge accounts
- Patients in good standing with pharmacy can set up an account in which pharmacy stuff may be charged on credit - depending on the pharmacy qualifications, what can be charged, how much can be charged a month, and how bills are sent out/due will vary
Social and community context
- People's relationships and interactions with family, friends, co-workers, and community members can have a major impact on their health and well-being. - Those that participate in community activities can make social connections, become more fit, and better manage mental health - Structural discrimination, or policies in public and private institutions that disproportionally affect particular groups, can also impact health. (ex. redlining, segregation)
PMR aka PML
- Personal medication record OR list - Comprehensive record of the patient's medications
What are the types of pharmacy practice models?
- Pharmaceutical care model - Clinical pharmacy model - Drug distribution model
Who can complete medication therapy management?
- Pharmacist - Pharmacy Intern - Pharmacy techs - Physicians - registered nurse - nurse practitioner - licensed practical nurse - physician assistant
Test to treat
- Pharmacist can screen/test for and treat minor non chronic conditions (short-term condition that can be managed with minimal treatment)
Intervention/referral
- Pharmacist consultation with other healthcare providers to resolve existing/potential DTPs (drug therapy problems); referral when necessary
Disadvantages of charge accounts
- Pharmacy needs to make enough funds without charge accounts to ensure they can still run their business - what happens if the patient does not pay
Non clinical/administrative services (repeat)
- Population based - Immunizations (clinical & non-clinical) - Charge accounts - Compounding - Pill packaging - Prescription wholesale to physicians office - Geriatrics - Delivery - Interpreter - DME
Non-clinical administrative services
- Population based - Immunizations (clinical & non-clinical) - Charge accounts - Compounding - Pill packaging - Prescription wholesale to physicians office - Geriatrics - Delivery - Interpreter - DME
Factors of health disparities
- Poverty - Environmental threats - Inadequate access to healthcare - Individual and behavioral factors - Education inequialities
Compounding
- Preparation of customized medications on prescription basis - Meets unique need of physician and patient need - Cannot be commercially available - Preparations often made from scratch - Solves patient problems (avoiding dyes/preservatives/filers/allergies/side effects, taste, dosage form, etc)
language barriers can increase...
- Prescription medication misuse - treatment non adherence, treatment failures - adverse medication reactions
E-prescribing
- Provides standardized, secure, and safe vehicle for transporting and sharing info across health sys & community pharmacy - Allows for transmission of prescription
Behavioral interviewing style
- Recount past experiences - Based on the theory that past behavior is usually a decent predictor of future behavior - conceptually sound but flawed bc there can be scripted responses and loaded words and closed ended questions
Clinical pharmacy model
- Rounding with little distributive functions - Pharmacist acts as consultant - Requires specialized skillset - Focus on quality of care
Delivery
- Same day or next day deliver - any location - any product
Product as economic solution
- Saves time - lowers hassles - lowers costs - makes money - offers a deal
Pharmacy Information management system invovles
- Selection - Procurement - Storage - Ordering or prescribing (e-prescribing)
Developing plan for new services: assessment
- Step 1 - Complete assessment of model that you have (performance of model, analyze productivity of resources, evaluate integration and use of tech, review culture of others to pharmacy)
Developing plan for new services: conduct research
- Step 2 - Complete a review of literature to determine best practices, industry standards, or regulatory changes - Summary of literature regarding pharmacy service - Identify and review pertinent pharmacy and health system data (patient outcomes associated with readmisison rates and with reduction in payment from payers, benchmarks)
Developing plan for new services: development
- Step 3 - Near clear vision and description of activities and expectations - develop new service - metrics need to be developed to demonstrate effectiveness of new service - identify necessary resources
Developing plan for new services: implementation
- Step 4 - most difficult phase - should include realistic timeline for implementation - development of infrastructure - obtain resources - ongoing monitoring and feedback about new services
Community pharmacy inovles
- Storing - ordering/ prescribing (e-prescribing) - transcribing and verifying (clinical decision support tools) - dispensing and delivering (automated dispensing systems, robotics, IVR, barcoding)
S in SWOT
- Strengths - internal & positive - Ex: niche market, reputation, hardworking staff, adv tech, financial, workflow, customer service, extended hours, value added services
Low health literacy outcomes
- Strong predictor of poor health - individuals struggle with self care behaviors, receive fewer preventative measures, and have increased all-cause mortality - people with low health literacy may use more resources through more frequent use of inpatient and emergency department visits and have higher care costs with poorer health outcomes
Pharmacists product can be (examples)
- Tangible object (drug, DME, med device, adherence packaging) - Intangible service (med reviews, point of care testing, appointment based med synchronization, drug info services) - Smart, connected goods & services (smart insulin injection devices, smart pills with ingestible sensors, smart inhaler monitoring tech, industrialized intimacy) - Solution (solution to problems, jobs to be done)
What are clinical pharmacy services
- Test to treat - immunizations - Medication therapy management
Integrated voice response (IVR) system
- The automated menu that a caller is prompted through using the phone number pad - intention is to reduce the number of calls to pharmacy staff -- may route refill request to PIMS, provide rx status to pt, provide pharmacy info - May be coupled with text messaging system
What if I am working in a 340b contracted community pharmacy?
- The contract pharmacies dispense the covered entity's meds, typically for a fee, and the covered entity keeps the profit - Covered entity gets access to a pharmacy if they don't have one, or gets access to larger network of pharmacies, while the contract pharmacy gets new source of revenue - While responsibility for program compliance falls on covered entity, it is critical for contract pharmacies to have staff that understand and stay in good standing with the 340b program
Pre-purchased inventory model
- The covered entity's 340b purchased drugs are kept in stock at the contract pharmacy - when filling prescriptions on behalf of the covered entity, the contract pharmacy uses the covered entity's 340b purchased drugs - When filling other prescriptions, the contract pharmacy uses its own non-340b drugs
In the medication management process, where does pharmacy operations apply?
- The entire process Selection Procurement Storage Prescribing/ordering Transcribing and verifying Dispensing & delivering Administration/Taking Monitoring & reporting
Human resource management (HRM)
- The process of achieving organizational objectives through the management of people - essential duty of all pharmacists
T in SWOT
- Threats - external & negative - Ex: competition, chain stores, PBM, shrinking margins, canadian drugs, amazon, cost of goods, product lines, mail order
Value only occurs...
- Through experiences, NOT tangible things - When the customer is satisfied with the experience provided
Leadership theories
- Trait - behavioral - situational or contingency based - leader-member exchange
Expected product
- What the customer anticipates from pharmacist - solution specific
Leadership theories - situational or contingency based
- a good leader can change their style to situations - based on 3 dimensions of task and relationship orientation and follow readiness
Bad Ad hoc performance reviews
- address unacceptable employee behavior or performance immediately - park of progressive discipline
What not to ask in an interview
- age - place of birth, citizenship, nationality - marital, family, or children status - gender, or gender identity - religion - have you ever been arrested - health, disability status, physical characteristics
Augmented product
- anything provided that is beyond what consumer expects
Trained interpreters help to
- assure effective communication between the client and their provider - support effective use of time during the clinical encounter - improve outcomes
agreement that pharmacists embedded in patient-centered care do/help...
- avoid/reduce medication related errors - improve collaboration with physicians
Leadership theories - transactional
- based on exchanges between leader and follower - followers are rewarded for meeting specific goals or performance criteria (extrinsic motivation)
Leadership theories - transfomrational
- creates a vision and inspires subordinates to strive beyond required expectations (intrinsic motivation) - makes subordinates more conscious of the importance of their tasks outcomes
Practice analytics
- data generally discrete elements - information = data has meaning - business intelligence (BI) and analytics (BA) transform data into info, providing insight for organizational leadership to improve overall performance and maintain their competitive advantage
BI and BA must include the following
- data is standardized, structured, and modeled - effective analytic tools that allow for multiple formats and layers of analysis - development, maintenance, and quality assurance of clinical, operational, and financial dashboards, scorecards, screening, and surveillance tools to guide achievement of treatment and strategic goals - driving analytics to the front line by creating greater end user accessibility to BI and BA tools - Monitoring effectiveness of tools and information to deploy or further develop POC or analytic systems
Formal performance feedback
- delayed - longterm planning where managers help employee review previous progress and identify areas for improvement, and establish goals and objectives for next year in collaboration with the employee - no surprises - may or may not be associated with merrit - should be delivered on time
FL rules and regulations for prescription department manager
- designation as prescription department manager - a permit for a community or internet pharmacy cannot be given unless a licensed pharmacist is designated the role - applications for permits for a special parenteral and enteral, special closed system, or nuclear pharmacy require the supervising licensed pharmacist to be designated as the PDM - Applications for special sterile compounding permit require the supervising licensed pharmacist of consultant pharmacist to be designated as the PDM or consultant pharmacist of record
termination
- employee can be terminated at any time during probationary period if it is clear they will not succeed in job - can occur without verbal, written or suspension
Barcoding
- extensively used in institutional - packaging/repackaging of unit dose meds - patient specific data (ID band) - intended to improve safety at point of care, med errors, and improve billing accuracy
interviewing
- extremely critical process and should include top ranked candidates - ensure you find the right candidate to be successful and grow in position while brining benefit to organization - GOAL: determine as much as possible of what applicant know, how has applicant applied and tested work skills, strength & weaknesses - Could include current employee but risks vs benefits
Medicare
- federal health insurance program - people 65 and older; younger with 65 with certain disabilities, anyone with ESRD
Medicare (repeat)
- federal health insurance program - people 65 and older; younger with 65 with certain disabilities, anyone with ESRD - consists of part A, b, c, d
Pharmacy practice model initiative (PPMI)
- focused on moving from pharmacy-centric (aka product centric) to patient-centric
Leadership theories - behavioral
- focuses on the behaviors of the leader rather than traits -- autocratic, democratic, laissez-faire - good leaders have specific skills - rather than being born a leader, people can learn to become great leaders
Leadership theories - trait
- focuses on the qualities and personality traits that make a good leader - those who can communicate and listen make fantastic leaders - those who are creative, smart, and responsible are seen as great leaders as well - leaders are born not made
Leadership
- getting a group of people to move toward a particular vision or idea - concerned with making organizational change and motivating employees to move toward a shared vision - not always a specific position - need to be developed in all pharmacists
Chronic care management
- goal: reduce cost, improve quality of care & outcomes & metrics - focus: adherence and med safety - may be offered under collaborative practice agreement or drug therapy management plan - common chronic disease states: diabetes, HTN, cholesterol, asthma, anticoagulation, heart failure, HepC, contraception, menopause
Chronic health conditions covered by collaborative pharmacy practice agreement
- hyperlipidemia, HTN, anti-coagulation, nicotine dependence, opioid use disorder, arthritis, asthma, COPD, T2D, HIV/AIDS, obesity, or any other chronic condition adopted by the board
Informal performance feedback
- immediate -- day to day feedback coaching from manager or coworker
Training
- improve employee performance with current tasks and jobs - essential for current needs - 2 types: orientation and job
Pros of compliance packaging
- improves adherence - everything is in a single container - improves administration (right drug, right time) - increases patient loyalty - increases refills and portion of days covered - profit (pharmacy)
Placement
- includes application, screening, interviewing, selection, and hiring processes - Pharmacy involvement in developing job criteria, interviewing qualified candidates, and making final choices
Red flags that indicate low health literacy
- incomplete or inaccurately completed forms - frequently missed appointments for MTM, point of care testing, specialty services - lack of follow up with referrals or tests - non adherence with medication - inability to explain the name, purpose in treatment, or administration instructions of medications - requesting return of prescription bottles that may have markings - referring to medications by color or shape - opens prescription bottle to look at the medication rather than reading the name on the label
Goal for use of health informatics technology (HIT)
- inform clinical practice by brining electronic health records to point of care - interconnect clinicians - personalize care - improve patient population by enhancing public health monitoring, improving the process
What should be included in the mission statement
- intended or target customers - core values of the pharmacy - key services and products provided by the pharmacy - benefits incurred by customers - desired public image of the pharmacy
Presentation of information
- labels should be clear to patients - considerations: -- error prone abbreviations -- use TALL MAN lettering -- use commas -- use of words to reduce error with zeros with avoidance of abbreviations -- careful use of mnemonics
Leadership theories - leader-member exchange
- leaders establish special relationship with small group of followers early on; in group vs out group
Choosing a pharmacy practice model depends on
- logistics - utilization/deployment of pharm techs - automation/tech - pharmacist training - scope of pharmacy practice - licensure (NO standardized model developed yet)
Strategic planning characteristics
- long term (5-10 years) - includes all aspects of organization - external viewpoint
language barriers are associated with
- lower quality of care - poor clinical outcomes - longer hospital stays - higher rates of hospital readmissions
Medication use process / pharmacy operations invovles
- multiple handoffs - complex - diverse arenas - numerous stakeholders - data sources
Population based
- nonclinical administration services - Chronic condition management (CCM) - specialty meds
Who should not serve as health care interpreters
- patient's family & friends - children under 18 - other patients or visitors - untrained volunteers
Best practices for e-prescribing
- physicians should enter electronic prescriptions or closely review - CDDS software should be enabled for prescribers - receipt of an e-prescription should trigger PIMS - pharmacy procedures should eliminate the process of printing and re-entering prescriptions into PIMS - electronic prescribing systems should allow pharmacist to request additional info and prescriber respond
Development
- prepares employees for new responsibilities and positions - investment in future needs - requires a greater intensity of education and instruction than training - 10-80-10 rule
Drug utilization review (DUR)
- prospective, concurrent, or retrospective - helps with CDSS (concurrent)
Product as emotional solution
- provides hope - makes one feel special - lowers anxiety - offers nostalgia - aesthetically pleasing - fun/entertaining
Product as symbolic solution
- providing a personal connection with others - belonging to something bigger - with like-minded people - seeking a transcendent life
Trained health care interpreters can
- reduce liability - help ensure appropriate utilization - increase adherence and satisfaction
Product as functional solution
- reduces effort - simplifies tasks - higher quality - improves health - offers wellness - more convenient - gives variety - lowers risk - connects to others - integrates with other parts - organizes things - informs/educates - sensory appeal
Prescription department manager
- responsible for ensuring the pharmacy permittee's compliance with all statutes and rules governing the practice of the profession of pharmacy - FDoH, BOP = liaison and administrative role for permit, responsibilities - organizational = business and operational - may be hybrid role/responsibilities
Specialty medication
- self administrated injectable med, excluding insulin - may require special handling, admin, or monitoring - may be a high-cost medication
Cognitive and emotional traps that can exacerbate and contribute to the need for resolution
- self-serving fairness interpretations - overconfidence - escalation of commitments - conflict avoidance
Medication therapy managment
- service that optimizes therapeutic outcomes for individual patients - Can be independent or occur in conjunction with the medication product
Conditions that can be treated under the test to treat thingy
- streptococcus - influenza - lice - skin conditions: athletes foot, ringworm - minor, uncomplicated infections
Who can serve as healthcare interpreter
- trained bilingual staff - on staff interpreters - contract interpreters - telephone interpreters - trained volunteers
DME criteria
- usable life: 3 years - Medicare: use at home - Medicaid: use at home & community
W in SWOT
- weaknesses - internal & negative - Ex: long wait times, poor training, no marketing plan, not punctual, poor inventory, visibility, not connected locally, no feedback, specialty drugs
Vision
- what the pharmacy organization wants to be at some future point in time (clear goal) - used in strategic planning as both a beginning and end
Potential reasons for pharmacy deserts
1. Economic factors = population, insurance coverage, poverty 2. profit margins 3. workforce shortages 4. Consolidation
The domains of SDOH
1. Economic stability 2. Education access and quality 3. Health care access and quality 4. Neighborhood and built environment 5. Social and community context
What MTM services must sponsors offer to all eligible beneficiaries ?
1. MTR (medication therapy review) 2. PMR (personal medication record) 3. MAP (medication action plan) 4. Intervention/referral 5. Documentation/Follow up
Stages to developing plan for new services
1. complete assessment of current service(s) 2. Conduct research 3. Development of the service(s) 4. Implement and assessment of new services
Major aspects that encompasses the structure of organization
1. differentiation (Degree to which units are dissimilar; can occur horizontally, vertically, or spatially) 2. formalization (degree to which jobs in the organization are standardized) 3. centralization (extent to which decision-making is concentrated at single point in the organization) 4. division of labor (Degree to which actives are divided into separate jobs) 5. unity of command (preserves concept of unbroken line of authority) 6. span of control (determines number of levels and managers an organization creates) 7. departmentalization (way in which jobs must be grouped to coordinate common tasks)
Implications of pharmacy deserts
1. medication non-adherence 2. delayed or missed diagnoses 3. lack of access to preventative care 4. increased costs (patients)
Standard elements for DMEPOS
1. required elements of a standard written order/prescription 2. master list of items requiring face-to-face encounter (within prev 6 months) and written order prior to delivery 3. master list of items requiring prior authorization prior to delivery
How many levels make up the core product?
3 levels
Medicaid
A federal and state assistance program that pays for health care services for people with low income and assists elder/disables with nursing home and other expenses eligibility is determined by income and assets
Collaborative practice agreement
A formal agreement in which a licensed provider makes a diagnosis, supervises patient care, and refers patients to a pharmacist under a protocol that allows the pharmacist to perform specific patient care functions
What is the pharmacists product?
ANY solution produced by pharmacists that can satisfy the medication related needs and wants of the patient
Self awareness
Ability to accurately perceive your own emotions
Clinical pharmacy services
Activities & processes that - ensure optimal therapeutic outcomes - minimize adverse drug events - promote cost effective strategies - engage interprofessional activities Can be provided in all health settings where a pharmacist may practice
Factors of economic stability
Affordable housing, Employment that provides a living wage, Worker protections
Pharmacy services
An action or set of actions taken to optimize the process of care, with the aim to improve health outcomes and value of healthcare
CMS patient eligibility criteria Group 2
At risk beneficiaries - beneficiaries with an active coverage limitation under drug management plan or have been identified as at risk in the previous year
Horizontal differentiation
Based on how many different types of people or units are included in organization
Why complete medication therapy managment?
Comprehensive patient care
What are the levels that comprise a core product?
Core product Expected product Augmented product
Immunizations
Covid-19 influenza & influenza high dose (flu shot) pneumonia shingles hep a heb b hpv menigitis mmr tetanus/diptheria tetanus/diptheria/pertussis varicella (chickenpox)
Differentiation
Degree to which units are dissimilar; can occur horizontally, vertically, or spatially
Organizational charts
Depicts reporting relationships and hierarchy of authority in an organization
Upper managment
Designation: C-suite, GM, President, VP Responsibilities: Setting long term goals, products, markets, business, organizing, vision, mission, values Skill requirement: conceptual/visionary
Lower managment
Designation: assistant manager, team leader, supervisor Responsibilities: implementation of plans Skill requirement: technical
Middle management
Designation: divisional head, departmental manager Responsibilities: interpretation of plans and sets of actions Skill requirement: human with some conceptual and technical
Strategic planning
Efforts that enable optimal deployment of organizational resources within current and future environmental constraints
Fair labor standards acts (FLSA)
Equal pay act: gender overtime/minimum wage: overtime for hours greater than 40 (1.5 x wage); salaried employees exempt
Health equality vs. health equity
Equality: everyone gets the same - regardless if its needed or right for them Equity: everyone gets what they need - understanding the barriers, circumstances, and conditions
Documentation/Follow up
Essential documentation of services and interventions performed for evaluation of patient progress and billing purposes
Occupational Safety and health act 1970
Established OSHA to develop and enforce workplace standards designed to prevent work-related injuries, illnesses, and deaths OSHA's ergonomic workplace standards and rules for preventing exposure to hazardous chemicals and blood borne pathogens
Common solutions sought by customers
Functional (practical or usefulness) Economic (financial and non-financial costs) Emotional (arousing or characterized by intense feeling) Symbolic (associated with symbolic meaning)
Automated dispensing systems/robotics
Include - drug purchasing and supply management systems - automated distribution systems - preparation system Improve patient care, customer service, and resource utilization
Education access and quality
Individuals with higher levels of education are more likely to earn higher paying jobs. Some children from low-income families are more likely to attend poorly performing schools and may face difficulty applying for and attending college
Conflict resolution
Informal or formal process that two or more parties use to find a peaceful solution to their dispute
Medicare Part A (repeat)
Inpatient coverage, home health, hospice, hospital
Job description
Is the result of a job analysis; defines the knowlege, skills, abilities, and behaviors needed to form the job description -- a specific and unbiased job description allows candidates to be evaluated objectively -- should be the basis of evaluation process and used frequently during employment
Benefits of resolving conflict
Limiting work disruptions Increasing productivity Higher rates of project success lower absenteeism minimal turnover decreased termination
Medicare Part B
Medical insurance
Medicare Part C
Medicare Advantage Plans (private insurance companies)
DME is covered by
Medicare Part B, Medicaid, and some coverage under regular health plans
Marketing shift to value-based model
Model sees customer & service provided to the customer as central to the creation of value
CMS patient eligibility criteria Group 1
Multiple chronic diseases (2-3) Specific disease (if targeted, need to include 5) - Alzheimer's - Chronic heart failure - Diabetes - Dyslipidemia - ESRD - HTN - Respiratory disease - Bone disease arthritis - Mental health Multiple medications (2-8) Incur annual cost > MTM
E prescribing uses
NCPDP Script = national standard Surescripts = third party
Pharmaceutical services
Operational Non-clinical Clinical
How can pharmacists address health literacy?
Patient centered communication - re-explaining the health information - show or draw pictures (infographics) - limiting information to 3-5 key points (repeat) - teach-back method - solicit questions (open ended) - demonstrating respect and patience - demonstrating empathy to develop rapport
Economic stability
People have the resources essential to a healthy life
Contract pharmacy arrangements (340b) inventory models
Pre-purchased inventory model Replenishment inventory model
step of the medication use process with the most errors
Prescribing (MOST resolved tho) Administering (Less resolved)
Medicare Part D
Prescription drug coverage, MTM
Medicare Part D (repeat)
Prescription drug coverage, MTM, immunizations
tasks of human resource management (HRM)
Recruiting placement coaching performance conflict resolution
340b drug pricing program
Requires drug manufacturers to provide as much as a 25-50% discount to - federally qualified health centers (FQHCs) - ambulatory care clinics - safety net and disproportionate share hospitals - rural facilites - pharmacies contracting with any of these entities
Change in prescription department manager
Requires permit & newly designated prescription department manager to notify board of pharmacy within 10 days of any change
Authority
Rights given to certain position in organization to give orders and the expectation that those orders are carried out: associated responsibility for ensuring work is completed and accepted
Strategic planning objective
SMART Specific Measurable Aggressive but attainable Time bound
Tangible services directed at things
Services directed at goods and other physical possessions - drug dispensing - OTC counseling - DME - herbal meds - veterinary meds - mail order pharmacy
Intangible services directed at things
Services directed at intangible assets - Drug insurance design - pharmacy benefit management - Drug use review
Tangible services directed at people
Services directed at people's bodies - Vaccinations - BP monitoring - Cholesterol testing - Diabetes screening
Intangible services directed at people
Services directed at people's minds - patient education - Drug info services - alternative medicine
Pure services
Services that NEED NO TANGIBLE PRODUCT to provide value to customers
Total product concept
THE value pharmacists provided is NOT the physical drug; it exists mainly in the SERVICES that accompany the physical drug
Social determinants of health (SDOH)
The conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks
Personal health literacy
The degree to which individuals have the ability to find, understand, and use info and services to inform health-related decisions and actions for themselves and others Emphasis is on the person's ability to use the information to make well informed decisions
Pharmacy operations
The process by which resources (people, capital, and materials), INPUTS are combined to produce goods and services consumed by the public, OUTPUTS
Culture
The system of shared meaning held by members that distinguishes one organization from another; understanding or belief of 'how things are done' - influenced by company's reason for existence, structure, organizational ethics, and nature of relationship company establishes with employees - affects climate
What about community pharmacy - Pharmacy practice models?
There is store level drift, not everything fits into one model
Organizational structure and behavior
To make goals of an organization reality, a structure needs to be put in place to make the organization operational - Reporting relationships, communication patterns, decision making procedures, responsibility/accountability, norms, rewards
What is pharmacy informatics?
Use and integration of data, information, knowledge, technology, and automation in the medication use process for the purpose of improving health outcomes
Importance of conflict resolution in the workplace
Vital for managers to maintain positive and comfortable work environment Quick and effective resolution demonstrates a care for well being of employees and positive culture in workplace
health
a state of complete physical, mental, and social well-being and NOT merely the absence of disease or infirmity. It is also not measured simply by the ability to perform daily tasks.
Relationship management
ability to use awareness of your emotions and the others' emotions to manage interactions successfully
Self management
ability to use awareness of your emotions to stay flexible and to direct your behavior positively
selection
based on how well candidate addresses the following 1. can this person perform the basic job 2. how well do the candidate's skills and capabilities mesh with the organization's needs 3. will the candidate make my/our job(s) easier 4. would i want to work with this person
Interpreter
convert oral messages from one language to another
translater
converts written text from one language to another
Spatial differentation
degree to which location of organizational's units in one place of spread across several locations; related to amount of horizontal and vertical differentiation
Medicare Part B (repeat)
doctor visit, lab tests, medical equipment, outpatient, preventative care, vaccinations
Pharmacogenomics
field of research that studies how a person's genes affect how he or she responds to medications
Pharmacy operations management
functional area of pharmacy business devoted to creation, planning, and management of resource capabilities used by a firm to create product(s) or services
Hiring
generally cannot occur until personnel department completes a reference and background check; if everything found to be acceptable, a compensation package is put together and an offer is extended -- imperative that pharmacy is involved in this process to ensue the offer is not mishandled
Medicare Part A
hospital insurance
HRM coaching
includes training and development
Health disparities
inequitable and directly related to the historical and current unequal distribution of social, political, economic, and environmental resources
what type of feedback do employees learn more from
informal feedback; immediate feedback has greater impact; more strategic process changes had larger impact with delayed tho
Equal employment opportunity commission (EEOC)
monitors discrimination and files lawsuits to correct discriminatory practices in the work place
implicit bias
negative attitudes of which one is not aware against a specific social group
Pharmacy desert
neighborhoods with the average distance to the nearest pharmacy is at least 1 mile
Closing of pharmacy
notify board of pharmacy ahead of closure by submitting in writing; completion of closing requirements ≤ 10 days after closing date
Long term care facilities
nursing home, retirement care, mental care, intermed care facility/developmentally disabled, inpatient psychiatric facilites NOT assisted living facilites
Populations most at risk for low health literacy and health disparities overlap
older adults racial and ethnic minorities non-native english speakers low income low educational attainment
Steps of the medication use process
prescribing, transcribing, dispensing, administration, monitoring
Climate
produced by the structure or physiological atmosphere of the organization; amount of trust, level of morale, and support employees experience
Federal civil rights act of 1964
prohibit discrimination in employment hiring, promotion, compensation, and treatment of protected employee groups - protected groups: gender, sexual preference, national origin, race, age, religion, height, weight, arrest record, financial records, military record, disablity
E-prescribing process
provider -> electronic hub -> e prescribing provider -> switching company -> pharmacy Pharmacy benefit manager sees the inbetween from provider to pharmacy BUT patient does NOT
Good Ad hoc performance reviews
recognition for outstanding performance - may be accompanied by award or gift - individualize rewards
Emotional intelligence skills
self-awareness, self-management, social awareness, relationship management
Value added service
service that ACCOMPANY a tangible product & add value by augmenting the value proposition of the tangible product
Niche market
services can be developed to fill a niche in the community pharmacy setting
Vision statement
should make people think and motivate them to create a different and better future for the organization
Behavioral management as part of HRM
shown to reduce errors and improve patient safety
Product exists to provide...
solutions to problems
SWOT
strengths, weaknesses, opportunities, threats
Most think of what? when describing pharmacy practice model?
the brick and mortar, location, or size (physical identity of pharmacy
Organizational health literacy
the degree to which organizations equitably enable individuals to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Emphasis is on the person's ability to use the information to make well informed decisions
Vertical differentiation
the depth of organizational hierarchy (aka organizational chart)
Health equity
the state in which everyone has a fair and just opportunity to attain their highest level of health to achieve this, it requires us to value everyone equally with societal efforts to address avoidable inequalities and health disparities
Rewards and recognition should be
timely, meaningful, individualized, longterm
Levels of management
upper, middle, lower managment
Relationship between vision, goals, strategy, and objectives
vision encompasses your goals your strategy gets you to your goals the tasks/objectives define the strategy
Rewards and recognition programs
• Social recognition• Points-based awards • Peer-to-Peer recognition • Recognition from leadership • Personal and team milestones
