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AMBULATORY CARE

Pharmacists' Participation in an Inhaled Respiratory Medication Program: Reimbursement of Professional Fees

Research Fellow, Drug Use Management and Policy, College of Pharmacy, Dalhousie University; Assistant Professor, School of Nursing, Dalhousie University, Halifax, Nova Scotia

Neil J MacKinnon, MScPharm PhD

Associate Professor, College of Pharmacy, School of Health Services Administration, Department of Community Health and Epidemiology, Dalhousie University

Priti S Flanagan, PharmD

at time of writing, Research Fellow, College of Pharmacy and Division of Geriatric Medicine, Dalhousie University; now, Clinical Pharmacy Specialist, Frail Seniors Program, Fraser Health Authority, Langley, British Columbia, Canada

Susan K Bowles, PharmD

Associate Professor, College of Pharmacy, Dalhousie University; Clinical Pharmacy Specialist–Geriatrics, Centre for Health Care of the Elderly, Division of Geriatric Medicine and Department of Pharmacy, Capital District Health Authority, Halifax

Ingrid S Sketris, PharmD MPA(HSA)

Professor, College of Pharmacy, Dalhousie University

Reprints: Dr. Sketris, College of Pharmacy, Dalhousie University, 5968 College St., Halifax, Nova Scotia B3H 3J5, Canada, fax 902/494-1396, Ingrid.sketris{at}dal.ca

BACKGROUND: An intervention (termed Initiative) was initiated to facilitate converting beneficiaries of a public drug insurance program in the province of Nova Scotia from respiratory nebulization medications to inhalers. Community pharmacists provided patient education and billed professional fees for conversions or optimizing inhaled respiratory medication technique.

OBJECTIVE: To determine community pharmacists' self-reported participation rate and identify facilitators and barriers to billing for professional fees.

METHODS: A survey was developed and mailed to Nova Scotia pharmacists. Information on demographics, work environment, professional experience, financial aspects, billing experiences, and the billing process was collected. Quantitative and qualitative data were evaluated using bivariate and multivariate analyses, and a thematic process, respectively.

RESULTS: Two hundred ninety-seven pharmacists responded. Self-reported billing rates for fees were 34% (switching delivery devices), 58% (optimizing AeroChamber use), and 37% (follow-up when replacing Aerochambers). Awareness of fees and the perception of consistent claim reimbursement were associated with billing for each fee (p < 0.05). Predisposing billing factors included awareness of fees, identifying situations requiring education, owner/manager position, male gender, perception that billing for education for optimizing technique is a minimum standard of practice, and prescription volume. Themes identified as barriers included inefficient billing process, inadequate fees, and lack of Initiative awareness.

CONCLUSIONS: Predisposing factors were the most important facilitators of community pharmacists' participation in this program, while a cumbersome and time-consuming billing process was the primary barrier. Further research should determine the impact of the professional fee on patient health outcomes.

Key Words: cognitive services, inhaled respiratory medications, reimbursement

Published Online, February 22, 2005. www.theannals.com, DOI 10.1345/aph.1E286

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				E. J. Jones, N. J MacKinnon, and R. T Tsuyuki Pharmaceutical Care in Community Pharmacies: Practice and Research in Canada Ann. Pharmacother., September 1, 2005; 39(9): 1527 - 1533. [Abstract] [Full Text] [PDF]