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Learn how Crusader Community Health launched a streamlined prescription management program for chronic medications that they anticipate will save hundreds of hours of provider time each month. This time saved will be reallocated to building more meaningful relationships with patients, reaching out to patients who missed appointments, and overall improving patient care at the organization.
Crusader Community Health (Crusader) is a nonprofit organization of 75 providers caring for the underserved in Rockford, Illinois. Most of the providers specialize in primary care. More than 230,000 outpatient visits take place each year at the 8 Crusader Community Health clinic locations. Crusader serves more than 55,000 patients every year, including 40% of the area's underinsured population.
Each year, leadership holds a half-day retreat to honor hard work and reenergize the staff. One year, leadership invited an AMA speaker to the annual retreat to share her experiences as a primary care provider and highlight efficiencies that could be applied at Crusader. One area that came to light was the time spent managing prescriptions for chronic medications. Primary care practitioner John Adamson, PA-C, was struck by the amount of time that could be saved by writing a prescription for a chronic medicine for 1 year rather than every 6 months.
The intent of streamlined prescription management of chronic medications was to allow providers more time to care for patients in meaningful ways and bring back their joy in medicine.
Adamson began writing a 90-day supply that refilled 4 times, often abbreviated as “90 x 4”, for many medications taken chronically. For his patients, this included statins, antihypertensives, and antidiabetic drugs.
At the same time Adamson moved to yearly prescribing, the Pharmacy and Therapeutics Committee discussed implementing a policy where medications would be refilled for one year by appropriately trained support staff. Pharmacist Laura Dee championed the idea. She reviewed available research and proposed medications that were safe to prescribe for 1 year. After the Committee reached a consensus and developed a list of approved drugs, the list was sent to Crusader Community Health's Board of Directors for approval.
Once the Board of Directors approved the annual prescription renewal medication list, a task force was developed to implement the change. Now certain medications are refilled for 1 year (90 × 4).
There was initially some hesitation about refilling prescriptions for a year. Providers voiced concerns that this could result in a higher no-show rate among a population that needed regular follow-up to manage chronic medical conditions.
Providers, the Committee, and the Board of Directors needed to see research and evidence that this policy would be beneficial. Once that information was shared, the decision to implement the change was easier.
It took about 6 months for Adamson to see a difference. Once patients no longer needed to contact him for renewals, he discovered 3 benefits:
He was saving about 30 minutes a day because he had fewer refills to address.
His inbox was empty by end of the day.
He was leaving work on time.
This, in turn, adds up to saving 120 hours or 3 weeks of time each year. If other providers experience the same results as Adamson after moving to 90 x 4 prescribing, the organization could save up to 600 days in wasted provider time each year. This correlates to adding 2 full- time clinicians at no cost to the organization.
While patients were initially surprised by the 90 x 4 approach, they found it saved them time as well. Patients experienced fewer gaps in access to their medications, which resulted in improved adherence and made follow-up appointments more productive. Patients were no longer saying, “I ran out of refills,” which meant that Adamson was no longer spending precious time during the visit stressing medication adherence. John Adamson believes that changing how he refills medications gives him more time to address concerns that will promote more meaningful and trusting relationships.
System-wide effects are still being evaluated. The task force that implemented the standardized annual prescription renewal medication list anticipates capturing decreases in telephone encounters and determining how much time clinicians are saving each day. To date, it does not appear that providing a year's worth of refills has affected no-show rates.
“The original intent of the policy was to improve patient care. The time saved, arriving home earlier, and an empty inbox were an added bonus for me and our team!”—John Adamson, PA-C
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