Development of a patient-based practice model in community pharmacy practice: Academic-practice interface

American Journal of Pharmaceutical Education, Summer 1999 by Reutzel, Thomas J, Hogan, Melissa, Kazerooni, Parisa Vatanka

The purpose of this paper is to describe shared faculty arrangements between a large chain pharmacy corporation and two schools of pharmacy. The two faculty members involved worked jointly on programs intended to improve the level of drug therapy-related services provided in the participating pharmacies, develop high quality experiential education sites for students, and enhance the morale and capabilities of staff pharmacists. The paper is built around two conceptual frameworks. One is a model of interorganizational relations used to organize the complexity of the relationships among the three organizational entities involved in this project. The other is a functional model of patient-based pharmacy practice that evolved along with the project and its intended and unintended turns. The paper concludes with a summary of lessons learned that may be of use to others involved in similar projects. These include the view that upgrading of community pharmacy services must begin with enhancing the skill levels of present staff. Also, patience is required after alterations to practice are made. One of the most important recommendations of this paper is that a coordinating committee made up of representatives from all involved organizations be formed prior to the start of the project and meet on a periodic basis throughout the project to iron out differences, anticipate problems, and generally enhance the productivity of the relationships. Such a body was used in the project described here and proved successful.

INTRODUCTION

The goals of an individual organization are generally achieved through a coordinated effort within that organization. However, some goals may be more completely achieved through collaboration with other organizations that possess congruent goals. This is a paper that describes a project involving Midwestern University (Midwestern), Drake University (Drake), and American Drug Stores (ADS). Midwestern and Drake wished to expand sites for student rotations and to develop and evaluate patient-based models in the community pharmacy setting. American Drug Stores wanted to maximize its ability to recruit, satisfy, and retain pharmacists and be responsive to potential changes in the pharmacy market place. A patient-based practice model was sketched out prior to the beginning of the project, and this model evolved as the project progressed. A model of interorganizational relations also evolved along with the project. This paper describes the conceptualization and evolution of the project using the practice and interorganizational models as organizing frameworks. In this way, the experience described here may be of use to others.

The paper provides an analytical description of the cooperative enterprise up to the present time and attempts to extract some lessons from the experience that may be of value to those involved in similar undertakings. Other overviews and indepth descriptions of specific aspects of the project are presented elsewhere1-44(1-4).

After describing, first, the background and, second, the context, of this project, the paragraphs that follow go on to identify an interorganizational framework that can be used to analyze the relationships among the three participating organizations. Then, using this framework as an analytical road map, the environmental context of this interorganizational experience is outlined, relevant characteristics and motivations of the three cooperating organizations are discussed, and the nature of the relationships among these three organizations is described. This includes a description of the development and use of a coordinating committee. A functional practice model used as the starting point for development of patient-based pharmacy services is explained next. This is followed by descriptions of the implementation and evolution of this practice model, including its responsiveness to pressures and opportunities arising in the managed care sector. This amounts, in large part, to a commentary on the problems and opportunities inherent in the implementation of patient-based practice models in today's community pharmacy environment. The nature of the learning experience the effort provides for pharmacy students is addressed next. The final sections of this paper include a look at the current status and future possibilities of the project, a discussion of the lessons learned from this experience, some of which should benefit pharmacy schools and chain pharmacy corporations attempting similar initiatives, and some other conclusions.

BACKGROUND OF THE PROJECT

American Drug Stores, marketed as Osco Drug/Sav-On, a national community pharmacy chain of over 900 stores, has been interested in exploring new ways to improve patient care and customer service provided by its pharmacists. Likewise, Midwestern University and Drake University continually seek to improve educational opportunities and experiences for pharmacy students and to contribute to the profession of pharmacy and to rational drug therapy. These goals resulted in the formation of a unique relationship among American Drug Stores, Midwestern University Chicago College of Pharmacy, Downers Grove, Illinois, and Drake University College of Pharmacy & Health Sciences, Des Moines, Iowa. The relationship began in May, 1995, when Midwestern and ADS jointly hired a faculty member to report to both organizations. In October, 1995, Drake University, in conjunction with ADS, hired a faculty member to be based in the Chicagoland area and work with both organizations. Shortly after the Drake faculty member assumed her position, the two faculty members discovered that they had similar goals and agreed to fully collaborate. The efforts described in this article reflect the collaboration of the two colleges and ADS.