By Annette M. Boyle
FORT CAMPBELL, KY – In February, Fort Campbell’s hospital projected that budget cuts driven by sequestration and accompanying furloughs would require significant reductions in pharmacy hours and services. Thanks to help from the 101st Airborne Division and 86th Combat Support Hospital, however, most of the cuts have been averted.
Initially, Blanchfield Army Community Hospital (BACH) announced that it would cut a popular self-care program that enabled patients to get free over-the-counter medications, such as cold and flu treatments, from the hospital’s pharmacies. In addition, early plans projected closing the pharmacy at the LaPointe Soldier Health Clinic at noon on Fridays, reducing hours at the Main Pharmacy and shuttering the pharmacy at the Byrd Family Care Clinic.
“We were initially concerned about the impact of sequestration on our ability to meet our mission of safely providing quality healthcare,” Capt. Jessica R. Hull, PharmD, acting chief of pharmacy for Blanchfield Army Community Hospital, told U.S. Medicine. “With the furloughs, our staffing was reduced by 20%, and the hiring freeze meant we were unable to replace those who left. So we were worried about having the minimum staff to stay open.”
Leadership with the 86th Airborne and 101st Combat Support Hospital stepped up to provide desperately needed resources by enabling BACH to use the services of embedded pharmacy technicians, home from deployment.
“The 101st Airborne Division and 86th Combat Support Hospital leadership have extended great support to Blanchfield Army Community Hospital’s pharmacy services by offering their pharmacy technicians to work at BACH pharmacies during sequestration and the pending furloughs. The borrowed manpower has been helping BACH continue to provide excellent and safe pharmaceutical services to soldiers, retirees and their family members,” BACH commander Col. Paul R. Cordts told U.S. Medicine.
BACH has four pharmacies. The additional personnel enabled BACH to keep the Town Center and LaPointe pharmacies open as usual. While the Byrd pharmacy did not close, it now is open only four hours, from 7 a.m. to 11 a.m. Hours at the main pharmacy now correspond to the clinic hours and end at 4 p.m. instead of 6 p.m.
BACH also avoided discontinuing the over-the-counter benefit, instead making several changes to better align the program with national usage and dosage recommendations, Hull said.
“The American Academy of Family Physicians does not support the use of cough, cold and flu medications in pediatric patients, so we went ahead and took those off formulary, as their risks outweigh benefits. We also reduced the strength of Tylenol available to better align with Food and Drug Administration recommendations on acetaminophen dosing,” she said.
Soldiers and their families still may obtain OTC medications but first must complete a self-care class that educates them about the appropriate treatment for nonserious illnesses.
“Patients also have an interview with the pharmacist to help them determine whether an over-the-counter medication is appropriate and to pick out the best medication for their symptoms. Pharmacists engage patients to determine how they are using the medication and also whether there are potential drug interactions with other medications the patient takes,” Hull said.
BACH’s 21 full-time pharmacists fill 70,000 to 80,000 prescriptions per month and see about 350,000 patients each year. Even at that volume, they counsel every patient.
“In general, our pharmacists are very involved in counseling, much more than you would see in retail pharmacy. We operate on a bank teller model with the patient standing in front of the pharmacist for counseling and in front of the technician while the prescription is being filled. Our pharmacists see 100% of patients with new prescriptions,” Hull said.
With pharmacists devoting so much time to working with patients, having pharmacy technicians available to fill prescriptions is vital. Using the embedded pharmacy personnel “enable us to do some things we didn’t think possible at the beginning of the year, such as keeping all the pharmacies open,” said Hull. “It wasn’t so much a budgetary problem as a lack of staff to service patients.
“Sequestration and furloughs are significant challenges that we must overcome, but we’re an agile organization committed to meeting our mission. Leadership and cooperation made it possible,” she added.
Whatever happens with furloughs in the future, Hull said she is hopeful BACH can maintain pharmacy services at current levels.
For the soldiers and their families at Fort Campbell, that’s good news.
“We are grateful we could continue to offer the services. Our actual situation is much more positive than we were expecting last winter,” said BACH spokesperson Laura Boyd.
With pharmacy cutbacks across the military, the National Military Family Association warns members on its website that they “may also find that the military pharmacy is trying to save money by no longer stocking some medications or filling prescriptions for a smaller number of days than usual. Pharmacy civilian staff will also be furloughed and so wait times at the pharmacies may climb.”
The group encourages beneficiaries to use TRICARE home delivery instead.