Pharmacy Technicians Help Improve CVD Outcomes

by Robin Luke, CPhT

As pharmacy technicians advance their education and experience, many entities are moving forward and factoring in technicians into their programs. It is exciting to see so many opportunities popping up everywhere and pharmacy technicians expanding into areas that would not have been an option only a few years ago.
For example, Kaiser Permanente Colorado has integrated pharmacy technicians and clinical decision support into a pharmacist-managed cardiovascular (CVD) risk reduction service. This decision has helped achieve better patient outcomes and allows clinical pharmacists to utilize time more strategically.

For nearly 20 years, clinical pharmacists with the medical practice did the bulk of support work, primarily in the form of maintaining a registry of all patients with documented cardiovascular disease in its cardiovascular risk reduction service, according to Kari Olson, PharmD, BCPS, a clinical pharmacy specialist in pharmacy outcomes research for Kaiser Permanente’s National Pharmacy. Pharmacists did most of the patient outreach, from providing lab results to adjusting medications.

In recent years, Olson added that the service had grown to the point where about 15 clinical pharmacy specialists each had a panel of around 1,200 to 1,300 patients and helped manage lipids, blood pressure, some diabetes markers, and medication adherence. During this time, pharmacy technicians were limited to handling incoming calls and contacting patients overdue for lab draws.

When the practice incorporated the registry into its electronic medical record (EMR; Epic) in 2019, managers reorganized the service to take advantage of new technology capabilities and to further utilize pharmacy technicians giving them more advanced responsibilities.

The new registry had additional functions, so pharmacy technicians could identify patients who were due for labs quickly and send out bulk mailings to 1,000 to 1,500 patients per month. In addition, because medical records containing all information necessary, pharmacy technicians could easily see who already had come in for labs, identify patients overdue for labs, and streamline workflows across other services.

In the new system, the pharmacy technicians handle basic outreach to patients and send notices if lab results are within normal limits as determined by established protocols. The revised system also allows pharmacy technicians to place orders for patients who are due for lab draws that would to the pharmacist for a quick sign-off. In addition, patients whose disease was well-controlled no longer had to go to the pharmacist for review.

The expanded pharmacy technician program yielded major benefits, according to a study by Olson and her colleagues. The study included 6,813 patients, 3,130 in the older pharmacist-driven group, and 3,683 patients in the newer technician-enhanced group. The mean age was 70.2 years of age; about 71% were men. After one year of enrollment in each protocol, the proportion of patients who attained cholesterol (low-density lipoprotein [LDL] cholesterol <70 mg/dL, non–high-density lipoprotein [HDL] cholesterol <100 mg/dL), and blood pressure (BP <140/90 mm Hg) target goals was higher in the tech-enhanced group.

Specifically, 71.2% of patients in the technician-enhanced group reached LDL goals versus 58.6% in the pharmacist-driven group (P<0.001); 73% of those in the technician-enhanced group attained non-HDL goals versus 60.7% in the pharmacist-driven group (P<0.001); and 88.9% of those in the technician-enhanced group achieved BP goals versus 86% in the pharmacist-driven group (P<0.06). The percentage of encounters handled by pharmacists in the prior system was 84%, compared with 44.7% in the technician-enhanced group (P<0.001).

Based on the program's success, the medical practice intends to expand it to cover patients with diabetes and those with hypertension; Olson said adding the expansion will be done as a subset of the larger cardiovascular risk group.

Olson and her team presented the initiative during the American College of Clinical Pharmacy 2020 virtual annual meeting, where it was well-received.