By Stephen Spotswood
HILL AIR FORCE BASE, UT—When Air Force Maj. David Jarnot became the 75th Medical Group’s Pharmacy Flight Commander in 2012, pharmacists at Hill Air Force Base had 84 direct patient-to-pharmacist clinical interactions a year. Today there are 9,600 patient interactions.
That exponential growth is due in large part to the leadership of Jarnot, who’s made it his mission to help ensure that pharmacists are made an integral part of the primary care team across the entire Air Force.
His efforts were honored recently when he was named the military pharmacist of the year in the 2015 Next Generation Pharmacists awards, sponsored by Parata Systems and Pharmacy Times.
From high school through to the Air Force, Jarnot has never worked anywhere but in a pharmacy. A recipient of a USAF health professions scholarship, Jarnot’s first duty was at the Fairchild AFB in Spokane, WA.
‘That’s where I got my feet wet with military pharmacy and everything that goes along with practicing medicine in the military,” Jarnot said. While there. he not only became involved in pharmacy operations but started a clinic where pharmacists could have regular, direct interaction with patients.
After Fairchild, he went to Wright-Patterson AFB in Ohio and was chosen to lead the Air Force Pharmacy Subject Interest Group (SIG). The SIG’s goal was to standardize pharmacy best practices across Air Force medical services.
“In the military, there are instructions for what you have to do and how you have to do it,” Jarnot explained. “But it doesn’t go into details on an operational level—what are the individual steps that are involved.”
The main product of the Pharmacy SIG is the creation of a pharmacy best practices manual. The manual goes into every step of an operation—a ready reference for a flight commander tackling a new procedure.
The SIG also works to find ways to leverage the limited technological resources USAF physicians find themselves working with.
“Currently we use an old electronic health record system to maintain prescription records. We’re basically creating macros that ride on this platform and simplify activities,” Jarnot said. A macro is a sequence of keystrokes that can be saved and then activated with a single key.
Among the macros Jarnot and his group created are one that automatically prints fax transfer sheets for prescriptions and one that automatically returns prescriptions to stock. What used to eat up pharmacists’ time can now be done in an instant.
As a result of this work when he arrived at Hill AFB, Jarnot had a deep knowledge of how pharmacists fit into the Air Force’s medical structure. In 2012, the pharmacy had one clinical service—an anticoagulant clinic. Jarnot has expanded that to 15 services, ranging from chronic disease management to acute care to therapy management.
Under his direction, Hill is the first Air Force base to embed pharmacists into the primary care clinic. While there were some administrative growing pains, the buy-in from physicians and base leadership was almost immediate.
“Pharmacist provider services save money,” Jarnot said. “When we intervene and patients go from non-adherent to adherent, the cost to the healthcare system is improved. But there hasn’t been research. We’re at the front end and we’re building the data.”
Jarnot is overseeing a clinical trial to evaluate outcomes of patients seen by embedded pharmacists. The end goal is to provide more data and ammunition to support the use of pharmacists in primary care.
He also hopes the data will help convince legislators to give pharmacists provider status under law.
“In the military, pharmacists can write prescriptions like a provider,” Jarnot said. “We’re a closed system, so patients only have TRICARE. We have a lot of freedom without worrying about billing.”
Thing are different on the civilian side. Pharmacists don’t have provider status under Medicare/Medicaid law, although legislation is currently circulating in Congress to remedy that.
In October, what Jarnot has done with the pharmacy program at Hill will be replicated at 11 other USAF sites—the first step in what he hopes is a service-wide revolution.
“The ideal future is that what we’re doing here becomes standard,” he said. “Pharmacists embedded in patient care, working with the provider team, and maximizing what can be done in the patient care area.”
More than a dozen military treatment facility pharmacies have implemented a pilot customer service system that gives patients greater control over how they spend their time while waiting for prescriptions to be filled.
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