By Annette M. Boyle
ALTUS AIR FORCE BASE, OK—In January, the pharmacy at Altus Air Force Base in Oklahoma instituted a new system which streamlined access to cold and influenza treatments for airmen, medical staff and their families. The program not only saves time, it also is saving money.
Prior to initiation of the Cold and Flu Self-Care Program, patients had to have an appointment with a clinic provider to get standard over-the-counter (OTC) medications at the base pharmacy but could obtain them by walking into any off-base pharmacy, explained Michael Johnson, PharmD, pharmacy flight commander at Altus Air Force Base.
“It didn’t make sense for the patients to wait or the doctors to spend their time seeing patients for medications that were easy to obtain elsewhere,” he said. Medications in the program include allergy medications, nasal sprays, decongestants, cough medicines and analgesics.
The program leverages the skills of pharmacists to increase overall efficiency of the base healthcare system. “Any pharmacist would know the ins and outs of major over-the-counter medications and could distinguish patients who should be taking one versus another. It makes sense to use that skill set to save time for patients and providers,” Johnson said.
Now, patients come into the pharmacy, complete a brief questionnaire and discuss their symptoms with a member of the pharmacy staff. If the patient does not meet any of the exclusion criteria, the pharmacist will recommend appropriate OTC medications to address the symptoms.
“We find out what’s most bothering them and find a good match within the list of medications. We also use our expertise to see what a patient’s illness could be moving to and stay ahead of symptoms as well,” Johnson explained.
About 20 patients use the program each month, Johnson said, with the pace slowing in summer.
For each of them, the time savings can be significant. “If you think about the time involved in seeing a provider, you have to go to the clinic, arrive 15 minutes early to check in, you may have to wait, then have a 15-minute appointment and go to the pharmacy. It could an hour to an hour and a half,” Johnston pointed out. “We try to do it in 15 minutes total.”
The clinic staff saves time, too. Just looking at the time saved by providers not having to see members who have minor ailments for an appointment, Johnson calculated that the savings totaled more than $10,000 as of mid-August. “It could be more when you think about everyone involved in ordering medications, logistics, coding, everyone involved,” he said.
The new system allows patients to save money as well. “Our beneficiaries can show up without a penny and receive care. Cold medications like Zyrtec D or Mucinex D could be $15-$20 for just one package elsewhere, but our beneficiaries receive them at no cost, so this represents tremendous savings for patients,” he said.
Several categories of individuals cannot receive medications through the program, including airmen on flying status, women who are pregnant or breastfeeding, dependents under the age of 17 and individuals over age 65. Shortness of breath not resulting from nasal congestion and use of the self-care program within the previous two weeks also excludes patients from expedited access to OTC medications.
“There are some telltale signs like symptoms persisting for more than a week that indicate an illness may be more bacterial in nature” that would lead a pharmacist to recommend that a patient make an appointment to see their primary care provider, Johnson explained.
Those that are able to participate in the program are cautioned to pay attention to their symptoms. “We tell them that if they do not see improvement within x-number of days, they should make an appointment,” he said. The questionnaire reinforces the message by recommending seeing a provider if symptoms do not improve or worsen within 48 to 72 hours.
In addition, patients with chronic illnesses such as asthma, chronic obstructive pulmonary disorder, diabetes, heart disease or hypertension cannot use the program unless they have a waiver from their primary care provider that indicates that their illnesses are under control.
“Patients may not want to report all chronic conditions so that they can use the program,” Johnson noted. “We have to be diligent to make sure we look at the full medical profile, as some over-the-counter medications may increase high blood pressure or worsen other conditions. We want to be cautious and make sure everything goes well with the medications used.”
Getting the medications from the base pharmacy also ensures that information about the illness and its treatment goes into the patient’s medical record. Patients receive counseling on all medications prescribed as well as a trifold cold and flu handout. The completed symptom questionnaire is filed like a prescription and the encounter with the pharmacy staff member is documented in the Armed Forces Health Longitudinal Technology Application (AHLTA), the DoD’s electronic medical record.
Johnson offered some cautious advice for other bases that may consider adding a similar program at their pharmacies. “Bigger bases with higher workload may not be able to do this. Smaller works better, as pharmacists are able to give more one-on-one care and focus on each patient.”