PHARMACISTS DON'T HAVE TIME FOR PATIENTS: STUDY

MATTHEW W. EVANS

NEW YORK -- During a time when supermarket pharmacists are being called upon to focus heavily on patient care and whole-health education, a study commissioned by the National Association of Chain Drug Stores, Alexandra, Va., revealed that pharmacists have little time to spend on these important matters.

Instead, they are devoting two-thirds of their time to administrative tasks such as data entry required for processing prescriptions, administering insurance claims and resolving conflicts with pharmacy benefit managers, the study found.

Conducted by Arthur Andersen LLP, through a grant from the NACDS Education Foundation, the study, entitled "Pharmacy Activity Cost and Productivity Study," also found that pharmacists spend 22% of their time on dispensing drugs by counting, pouring, labeling and packaging prescriptions. Such tasks could be better handled by technicians if regulations limiting the use of such personnel can be broadened.

Through the study, released at a press conference here earlier this month, NACDS hopes to make state regulators aware of some restrictions placed on pharmacy operations that increase the pharmacist's administrative workload. The goal is to allow health-care professionals focus on helping patients, pointed out Craig Fuller, NACDS' newly appointed president and chief executive officer. With 42% of the NACDS membership now represented by supermarket chains, some 7,000 supermarket pharmacies stand to benefit if changes can be enacted.

"This study has confirmed what we've feared," said Fuller. "Two-thirds of pharmacists' time is spent on activities not directly related to patient care."

Andersen based its analysis on 354 surveys sent to 22 NACDS member companies that included supermarket chains. In addition, the consultant performed on-site time studies at 15 retail locations based upon the survey's findings. The survey queried operators on 89 discrete activities associated with a pharmacist's duties.

"We think that pharmacists need to be involved with reviewing and interpreting the prescription, assessing patients' drug therapy (including drug interaction), resolving clinical conflicts, contacting doctors concerning approvals or prescription clarification, and counseling patients about their prescription," the report stated.

The NACDS plans to use the study as exhibit A in the cause to change state laws that restrict the use of technicians, electronic prescription transfers and centralized dispensing facilities, said Frank Newman, NACDS chairman of the board, who is chairman, president and chief executive officer of Eckerd Corp., Largo, Fla. While many states have made progress in updating outdated regulations that restrict use of technology and support personnel, Newman said, the association is striving for consistency among the states on these issues.

Outdated state practice regulations that limit the number of technicians to pharmacists have been obstacles to patient care, according to the NACDS. "In New York, there is a state pharmacy regulation that says you can only have one technician on the premises per pharmacist," said Newman. "If you're a pharmacist, that means you can only have one person helping you at a time. If you move to Florida, you can have three technicians. There are nine or 10 states where you can have four or five, whatever your particular practice setting applies."

Newman also noted the amount of time pharmacists spend on data entry. "If you look at the study, 20% of the pharmacist's time is spent on data entry. That's not what they went to school for -- to punch the keys. Techs can do that and they're much better equipped to do it. We think the appropriate thing is to allow the pharmacist to determine how many techs he needs in the same way a surgeon determines how many nurses he needs."

The NACDS executive mentioned four states that have switched to the use of central fill facilities. Elsewhere, regulations prohibit the practice.

Fuller said he visited such facilities and observed fill robots that were monitored for errors for several months without making any. "With that level of accuracy," he said, "it's odd that in some states people would restrict you from using central filling."

Administering insurance program requirements is also consuming the pharmacist's time. This includes entering customers' medical information into computer systems and verifying third party eligibility through plan manuals, computers and phone calls. "All too often pharmacists find themselves acting as the patient's ombudsman, attempting to resolve insurance coverage disputes. Additionally, patients, benefit plan administrators and physicians expect pharmacists to police, manage and administer numerous coverage options which are inconsistent from plan to plan and from patient to patient," stated Fuller.

Fuller and Newman also addressed electronic transmission of prescription information. "In certain states you can't transfer a prescription electronically," said Newman. "It has to be the actual piece of paper, which, in the coming millennium is a pretty antiquated regulation."

"Change should come sooner than later," said Fuller, especially with the help of the study.