Case Study: Outpatient Pharmacy Integration

Mar 19, 2018 • Focus Area: Innovation & Technology • Program: Catalyst

Integrating Outpatient Pharmacy Services

For HIV/AIDS patients, medication adherence is a matter of life or death.

UCLA-Olive View Medical Center’s Positive Care Clinic is the patient-centered medical home for patients living with HIV/AIDS. Patients taking their daily pill is the cornerstone of HIV control. But long wait times, poor customer service, and medication mistakes had become huge obstacles to using the outpatient pharmacy. Moreover, without an established partnership between the clinic and the pharmacy, patients and staff were often just unaware of the various services.

In our 2017 cycle of Catalyst, the Olive View team set out to integrate pharmacy services with the medical center and improve on past patient experiences.

Project Profile

UCLA-Olive View Medical Center is a Los Angeles county hospital located in the north end of the San Fernando Valley. Built in 1987, the medical center provides acute care and ambulatory medical services to low-income and indigent patients, as well as the surrounding middle-class community.

Organization	UCLA-Olive View Medical Center
Issue	Patients living with HIV/AIDS must adhere to their medications, but patients had poor experiences with pharmacy services.
Solution Tested	Launch a campaign to enroll patients in the pharmacy and mail order services.
Stage	Piloted on a small scale.
Financial Investment	$$
Partners	Outpatient Pharmacy Director, RN Care Manager, CMA, LVN Care Coordinator, LSW

Key Challenges

No Pharmacy Partnership

There was no partnership or integration between the Positive Care Clinic and the outpatient pharmacy.

Lack of Knowledge

Patients and staff were unaware of outpatient pharmacy services and the option to receive medication by mail.

Negative Bias

Past experiences with the pharmacy’s long wait times, mistakes, and poor customer service had fostered unfavorable opinions among patients, staff, and providers.

Testing Pharmacy Integration

Olive View launched a pharmacy enrollment campaign and a new clinic workflow to integrate its outpatient pharmacy with the Positive Care Clinic.

To do this, the team first conducted hour-long interviews with patients from their Positive Care Clinic about their care experience. The team then used Catalyst methods, like affinity mapping, to narrow down the focus of its pilot.

In co-design sessions, staff and patients developed pharmacy enrollment communication materials, including a flyer and postcards, that share information about enrollment and mail order medication services. The team also developed a new workflow to improve communication and coordination between the clinic and pharmacy staff.

Patients participated in the pilot

Patients in the pilot enrolled in pharmacy services

Patient in the pilot opted-in to receive mail-order medication refills

Project Timeline

Date	Milestone
August 2017	Co-design session to develop a workflow for a pilot to schedule and implement a pre-clinic visit for patients, then set up mail-order refill delivery for recruited patients.
September 2017	Co-design session to develop promotional materials, and a recruitment script for the pharmacy enrollment campaign.
October 2017	Promotional materials for Olive View pharmacy enrollment campaign finalized.
November 2017	Pilot launched. Five out of the six patient participants enrolled in the pharmacy. One patient opted in to mail-order refills.
November 2017	Conducted a phone survey with all participants, following up on their pharmacy experience, if they enrolled, and their thoughts on the pre-clinic visit.

Lessons Learned

It was important to have the staff that knew the patients, like care coordinators and managers, be the ones to invite them to this pilot project.
The interviews conducted with patients revealed a lot of useful information, including pain points and opportunity areas for organizational improvement.
Through the interviews, the team learned that the patient’s experience with HIV is directly tied to their experience at Olive View.
Co-designing with patients makes pharmacy services more patient-centered.

Next Steps

Estimate revenue generated for the institution.
Conduct ongoing data collection on medication fill rates through Olive View’s pharmacy location and mail order system. Collect longterm data on medication adherence and clinical end-points of HIV control.
Administer phone surveys regarding the mail-order pharmacy and promotional materials.
Continue co-design sessions with patients
Expand the initiative to other institutions in Los Angeles County.