September 14, 2018
Inside: Discover how an independent healthcare center integrated a pharmacy and a clinic to help mental health patients thrive.
For Alivation Pharmacy, health is about more than the body.
The pharmacy helps patients struggling with mental health disorders. And it does so as an on-site pharmacy in a clinic specializing in brain and behavioral health services.
Alivation Health, an integrated healthcare center, began as a behavioral services clinic in 1998 and expanded into a full-service health center in 2017 offering primary care, neurology, and research studies. And, most recently, pharmacy.
The clinic had partnered with another pharmacy before deciding it wanted its own in-house pharmacy. “We knew it was a great benefit from a care perspective. Compliance goes up with an on-site pharmacy, and patient care goes up with an on-site pharmacy,” said Matt Duffy, MBA, Chief Strategy Officer at Alivation Health. “We wanted to change the method in which we were delivering the service to be part of the clinic instead of a separate organization in the same building.”
And so far, the pharmacy has been a great benefit to the clinic and its patients.
Coupling pharmacy and primary care in one location under a single company eliminates typical communication barriers.
It also improves and streamlines patient care. “It’s really the idea of having a fully integrated clinic,” said Rachel Scoggins, Pharm.D., R.Ph., Pharmacy Manager at Alivation Health. “A lot of times pharmacies will have a piece of the puzzle. So, having that here and being able to provide that for the patient before they leave the office is really the most beneficial thing for everyone involved.”
With the pharmacy and clinic under the same company, pharmacists can easily access patients’ medical records. No need for the usual back-and-forth phones calls to track down information.
Staff members in the pharmacy and the clinic can easily talk to one another in person at a moment’s notice while the patient is there. They don’t have to worry about whether patients will pick up their medications or if they can access the medications when they leave the clinic. “We get to ensure that the patient leaves with the medication that’s the best for them,” Duffy said. “It just closes that loop quicker.”
Patients get everything they need in a single visit and know that their entire care team is on the same page. “We wanted our patients to have a consistent message, a consistent protocol, a consistent care plan, and consistent quality,” Duffy said.
These advantages are especially important for a clinic serving patients with mental health disorders, many of whom need injectable antipsychotic medications.
Finding a pharmacy that carries injectable medications isn’t easy, Duffy said. And, with off-site pharmacies, clinics have a harder time making sure patients receive the injections they need, which can be highly dangerous.
“A lot of patients who are on injections are on them because they can’t remember their meds, they have problems with adherence, or they have other cognitive issues going on potentially,” Duffy said.
Most of the clinic’s patients suffer from chronic conditions requiring continual medication, which makes an integrated pharmacy all the more important to patient outcomes. The pharmacy provides adherence bubble packaging to help with compliance. And, the heightened collaboration between physicians and pharmacists increases accountability and accessibility for those patients.
The pharmacy’s integration with the clinic also helps mental health patients who may become anxious around unfamiliar people, like those with obsessive-compulsive disorder or schizophrenia.
“Having the pharmacy here on-site as an extension of what they’ve already been experiencing can help lessen those concerns that the patient may have or decrease the symptoms they may experience when they need to interact with someone new,” Duffy said.
The pharmacy also offers many traditional pharmacy services helpful for chronic conditions, including:
As a mental health-focused pharmacy, specialty injectable antipsychotics make up the majority of its specialty prescriptions. They also bring a host of administrative issues.
“A lot of times these meds are not the primary ones that insurance wants to cover,” Scoggins said. So, the pharmacy spends a lot of time trying to get patients’ coverage approved or finding them assistance.
Another challenge is cost. Because of the high price of specialty medications, pharmacies tend to not carry them. “So, they’re not as accessible to the patient in a timely fashion,” Scoggins said. “Making sure we have it available for the patients that need it is another challenge but one that we’ve gladly taken on.”
While the integration of the pharmacy with the clinic offers many benefits, it comes with its own difficulties. “It’s not easy,” Duffy said. “There are a lot of workflow hiccups that happen. You need to have staff members who are willing to work through those issues and who are dedicated enough to patient care to want to spend the time to solve those problems. Because there’s an added level of stress when you’re on-site.”
For pharmacies looking to partner with a mental health clinic, or to set up shop within one, Duffy said it’s rewarding, even if difficult. “Like most things in patient care, the things that have the greatest outcome often have some of the hardest workloads to set up at the start,” he said. “It is an adventure if you’re going to venture into this type of working relationship.”
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