A Pharmacy Clinical Service Model – Innovating and Adapting from Others

Recently, in my capacity as a management consultant, I was asked to review some policies for a security company I had an association with, in a health capacity.
Security guards, because of their continual work during the night and early mornings, suffer from health problems related to their interrupted circadian rhythms.
The first casualty is sleep deprivation as sleep is not fully compensated for during daylight hours.
Certainly melatonin production from the pineal gland is disrupted because it is only produced and secreted in the brain around midnight to early morning – in complete darkness and being asleep.

Low levels of melatonin also impedes the circadian rhythm involving adrenal cortex hormones, so this can be a disruptive mechanism regarding the body’s regulation of the associated hormones that can cause chronic fatigue, elevated/low blood sugar and hypertension.

Sleep deprivation of this type can eventually cause sleep apnea and depression as well as an underactive immune system.
Lack of exposure to sunlight can also result in lower levels of natural vitamin D3 production – a key agent for many biological transactions in the body.

The working hours for security guards also work against family interactions, so there are many relationship and family issues within the security industry.

But one policy in this company caught my attention and it was titled Employee Assistance Provider (EAP), and the processes involved to allow employees could access such a program.

As I unravelled what an EAP actually did I found that it was a service that was already available in unstructured segments by community pharmacists as part of their normal daily activities, providing a clinical input directly or a triage service through referral to other health providers.

How so?
Because most of the problems involving security guards involves prescription drug dependence, illicit drug use, or excessive alcohol use.
Those issues evolve because of health issues cascading from sleep deprivation.
Part of the way along the spectrum of issues you have to add relationship breakdown and the potential for domestic violence.

Now pharmacists at some time in their career are confronted with all of the above issues.
But in my research I could not find a pharmacist among the group of health professionals attached to an EAP.
Psychologists and nurses feature, but application is open to any health practitioner registered with AHPRA.
Preference appears to be slanted to those practitioners already registered as Medicare providers.

While that does not preclude a clinical pharmacist working within this system, it is an area that perhaps the Pharmaceutical Society of Australia could address on behalf of clinical pharmacists.

So here we have a program where the infrastructure can be provided by a community pharmacy that involves constructing outreach workflows that can synchronise with any workplace, with one or more professionals contracted to provide a needed service including a clinical pharmacist service.

One model that I looked at involved recruiting individual companies or businesses for an annual fee of $1100.00.
Each business was asked to nominate the number of consultations it would fund per employee.
The average was two to three consultations with extensions seeming to be able to be arranged with Medicare (hence why provider status may be necessary).
Consultation cost was set at $85.00 per consultation with the first one free.

Other non-health consultants may need to be recruited for the program in the form of financial consultants, human resource consultants or management consultants.

I can personally recall some years ago, visiting a patient in a hospital as the ward clinical pharmacist.
I was about to brief a heart-attack patient, who was being discharged the following morning, about his new range of drugs.
I noticed that as I started the counselling process he seemed to be disinterested/ distracted.
I asked him if he would like me to come back at another time.
He said “No” and apologised, saying that his heart attack was a result of major stress due to his farm becoming insolvent.
His concern lay with the future of his wife and four children.

So I said to him “Would you like me to put on my management consultant hat and work our way through the issues you may face?
Better to have a plan on discharge than no plan at all.”
The patient immediately relaxed and poured out his story.
Thirty minutes later we had a strategy worked out and some potential solutions.
Delightedly, he asked if I would mind coming back and repeating the performance during his wife’s visit for that afternoon, so that she could understand the process and take notes.
That happened and I still fitted in some drug education to a very attentive patient.

So that was a practical example of an EAP process, even though the client was an owner/manager of a farm business currently a hospital patient.

Other workplace problems may be rooted in personal financial distress, bullying in the workplace or problems in accessing childcare but I am sure that most pharmacists could cope with a triage process where the service scope is beyond the pharmacist level of competence.
If you did not have an immediate professional to refer to, it would not take long to find one with a bit of investigation.

So in overview, a proposed pharmacy business model for this service would look like:

1. A community pharmacy creates a business division to become an Employee Assistance Provider (EAP).
Office space and suitable notepad/laptop equipment, like a portátil ofertas, made available along with other needed resources.

2. The pharmacy division applies for membership of Employee Assistance Professional Association of Australasia (Inc).
The registration fee for an EAP with 2-5 consultants would be $715.00 per annum.

There is potential here for a pharmacy leadership organisation to negotiate a bulk fee for their own members.

3. The community pharmacy EAP sells itself to a diverse range of workplaces on the basis of an annual fee of $1100 plus a fee for each consultation of $85 (or whatever fee structure may be otherwise determined).

4. The first consultation (survey consultation) is free and paid for by the pharmacy EAP and the remainder of consultations (negotiated with workplace – usually 2-3) is paid for by the employer for each employee.

5. The pharmacy EAP provides the first consultation and prepares an action plan that includes triage referrals to clinical pharmacist contractors and other professionals who agree to work under a contract prepared by the pharmacy EAP.
Contractors must be willing to work hours outside of 9am – 5pm to suit client workplace conditions and may also be required to travel and hold interviews in other settings.

6. Fee splitting occurs on a 70:30 basis (consultant:pharmacy EAP)

7. Additional consultancy input provided by negotiation with Medicare and consultant, or by separate negotiation with employer.
Pharmacists need to acquire provider status for the long-term viability of pharmacist income.

Click here for a sample EAP service

Click here for access to The Employee Assistance Professional Association of Australasia (Inc)

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