Time Wasted and Implications for Patient Care: A Retrospective Analysis of Prescription Telephone Transfer Encounters

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Co-authors: Michell Zulu, PharmD; Kelli Brignac

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Key Takeaways:

  1. Prescription transfers between pharmacy chains are a significant, time-consuming problem, with far-reaching consequences for patients, pharmacies, prescribers and the health care system.
  2. This study, conducted by Good Shepherd Health Institute, reveals alarming inefficiencies in the prescription transfer process, with some encounters lasting days and involving only a few prescriptions. CVS, Walgreens and Walmart had the highest number of encounters and the highest number of average hours per encounter.
  3. To address inefficiencies in the prescription transfer process, Good Shepherd Health proposes advocating for changes in state laws to allow pharmacy staff members to assist in transfers; implementing advanced technologies to make the process more efficient; and fostering collaboration among pharmacies, prescribers and other health care organizations to standardize the system and identify best practices nationwide.

 

The problem

Prescription transfers between pharmacy chains are common, but for many patients, the process is more complex and time-consuming than it should be. Patients must locate their prescriptions at the incorrect pharmacy, contact the correct pharmacy, and request a verbal transfer. Although prescriptions can be faxed, the correct pharmacy must still call the incorrect pharmacy to request that fax. Furthermore, many states require that only pharmacists can transfer prescriptions, leaving technicians unable to assist. This restriction poses significant challenges. Currently, just 17 states allow technicians to take verbal orders for new or transferred prescriptions. In most states, pharmacists are solely responsible for handling prescription transfers, adding to their already heavy workload and increasing the risk of errors and delays.

The human toll of prescription transfers cannot be understated. When patients cannot obtain their medications in a timely manner, they may experience missed doses – which can lead to serious health consequences. For example, patients with chronic conditions such as diabetes, hypertension, or mental health disorders may suffer from uncontrolled symptoms or even hospitalization due to missed medications. Also, the stress and frustration associated with the transfer process can take a mental and emotional toll on patients, particularly those already dealing with the challenges of managing their health conditions.

The problems arising from missed doses due to late fills are another critical concern. When patients cannot obtain their medications on time, they may experience a gap in treatment, which can lead to a worsening of their condition or even the development of new health problems. For example, patients with asthma who miss doses of their controller medications may be more likely to experience exacerbations or even require emergency care. Similarly, patients with mental health conditions who miss doses of their antidepressants or antipsychotics may be at increased risk of relapse or hospitalization.

In addition to the clinical implications, prescription transfers also take a toll on pharmacies from an operational standpoint. When a prescription transfer is initiated, the original pharmacy must process and then reverse the prescription claim, which can be time-consuming and may result in billing discrepancies. Furthermore, if the prescription has already been filled, the pharmacy must then restock the medication, leading to potential inventory management issues and increased costs. The transfer process often involves numerous phone calls between the two pharmacies, which can be a drain on staff time and resources. Pharmacists and technicians may spend hours on hold or playing phone tag, taking them away from their primary duties of dispensing medications and counseling patients. This reduces the pharmacy’s overall efficiency and contributes to increased job stress and burnout among pharmacy staff. Moreover, the repetitive nature of prescription transfers can lead to a higher risk of errors, as staff may become fatigued or distracted by the constant interruptions. This can result in mistakes such as incorrect patient information, wrong medication or dosage, or even the failure to complete the transfer altogether, further exacerbating the clinical risks associated with delayed or missed doses.

This study aims to quantify the time spent on prescription transfers and examine the associated implications to identify areas for improvement. By shedding light on the magnitude of the problem and its far-reaching consequences, both clinical and operational, we hope to raise awareness of this serious issue that has been hiding in plain sight. It is crucial that policymakers, health care providers, and pharmacy chains work together to streamline the prescription transfer process, reduce the burden on pharmacies, and ensure that patients have timely access to the medications they need to maintain their health and well-being. Addressing this problem will not only improve patient outcomes but also help alleviate the operational strain on pharmacies, ultimately leading to a more efficient and effective health care system.

 

How we did it

Good Shepherd Health Institute conducted a retrospective analysis of prescription transfer encounters recorded from August 15, 2021, to March 20, 2024. The initial dataset included 1,126 prescriptions across 394 encounters and 43 pharmacy chains. To focus on the most relevant data, we limited the study to pharmacies with at least three encounters, reducing the numbers to 329 encounters, 1,019 prescriptions, and 14 pharmacy chains. For each encounter, the time (in minutes) was measured from the creation of the task in Microsoft Teams to its completion. We used descriptive statistics and regression analysis to identify pharmacy chains with the highest number of hours per encounter and examine the relationship between the number of prescriptions transferred and hours per encounter.

Next, we conducted a regional analysis to examine variations in prescription transfer encounters across different U.S. Census divisions. Each encounter was assigned to its corresponding Census division based on the state where the pharmacy was located. We then calculated the incidence of encounters, the percentage of encounters lasting less than 0.5 hours, and the percentage of encounters lasting more than 0.5 hours for each pharmacy chain within each Census division. This allowed us to identify regional patterns and differences in the efficiency of prescription transfers.

 

Results

The analysis revealed alarming inefficiencies in the prescription transfer process. Walmart, CVS and Walgreens had the highest number of encounters, with average hours per encounter at 49.7, 24.2, and 67 hours, respectively. We discovered only a weak positive correlation between the number of prescriptions and the likelihood that an encounter will take longer than 0.5 hours.

At CVS, 39.2% of encounters took less than 0.5 hours, with an average of 2.4 prescriptions transferred per encounter. However, 60.8% of encounters averaged 82.3 hours (approximately 3.5 days) to transfer an average of 3.9 prescriptions. Of the 90 encounters that lasted more than 0.5 hours, 53 involved transferring just 1-2 prescriptions. We observed similar patterns at Walgreens and Walmart, with many encounters lasting days and involving only a few prescriptions.

The analysis of prescription transfer encounters by US Census division reveals significant regional variations, with most encounters (68.2%) occurring in the South Atlantic division, which includes states such as Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia and West Virginia. This trend is consistent across all three pharmacy chains, with the South Atlantic division accounting for the highest percentage of encounters lasting both less than 0.5 hours and more than 0.5 hours. The West South-Central division, which primarily includes Texas in this study, has the second-highest incidence of prescription transfer encounters at 15.5%, followed by the Mid-Atlantic division, comprising New Jersey, New York, and Pennsylvania, at 5.7%.

A closer examination of encounter duration among and within pharmacy chains reveals some interesting patterns.

  • For CVS, the percentage of encounters lasting more than 0.5 hours was highest in the South Atlantic division (77.5%), while the Mid-Atlantic division had the lowest percentage (1.1%).
  • Walgreens showed more variability, with the percentage of encounters lasting more than 0.5 hours ranging from 0.0% in the Mid-Atlantic to 65.7% in the South Atlantic.
  • Walmart had the most inconsistent performance across regions, with the percentage of encounters lasting more than 0.5 hours ranging from 0.0% in the East North Central division to 50.0% in the South Atlantic.

Within the top three regions by encounters, the pharmacy chains performed differently. In the South Atlantic division, CVS had the highest percentage of encounters lasting more than 0.5 hours at 77.5%, followed by Walgreens at 65.7% and Walmart at 50.0%. In the West South-Central division, Walmart had the highest percentage at 22.7%, followed by Walgreens at 17.1% and CVS at 12.4%. In the Mid-Atlantic division, Walmart had the highest percentage at 18.2%, while CVS and Walgreens had much lower percentages at 1.1% and 0.0%, respectively. These findings highlight the need for targeted, region-specific solutions and collaborations to address the variations in encounter duration among and within pharmacy chains, ultimately improving the efficiency of prescription transfers and patient care.

Key Results:

1. Performance varies among pharmacy chains. CVS, Walgreens, and Walmart had the highest number of encounters, with Walmart having the highest average hours per encounter (67 hours), followed by CVS (49.7 hours) and Walgreens (24.2 hours) (see Table 1).

 

 

2. Prescription transfer efficiency varies by region. The South Atlantic division had the highest percentage of encounters (68.2%), followed by the West South-Central division (15.5%) and the Mid Atlantic division (5.7%). The performance of pharmacy chains varied within and among regions, with some regions consistently outperforming others.

 

 

3. The number of prescriptions transferred has a weak correlation with encounter duration. Although the study found a strong positive correlation between the number of prescriptions transferred and the hours per encounter (Table 2), further analysis revealed that the number of prescriptions had a weak positive correlation with the likelihood of an encounter lasting longer than 0.5 hours (Tables 3 and 4). This suggests that factors other than the number of prescriptions play a more significant role in determining the efficiency of the prescription transfer process.

 

 

 

 

 

 

 

 

Discussion

The prescription transfer process is an unnecessarily time-consuming issue, with far-reaching consequences for patients, pharmacies, prescribers and the entire healthcare system. Patients experience delays in receiving their medications, pharmacies face operational challenges, and prescribers encounter disruptions in treatment plans. Moreover, these issues contribute to increased costs in an already overburdened health care system.

Several factors contribute to inefficiencies in the prescription transfer process, including individual state laws that restrict technicians from performing transfers, outdated technology and understaffed pharmacies. The pharmacy industry faces significant challenges, from overworked pharmacists to the closure of independent pharmacies, to decreasing reimbursement from PBMs. Understaffed pharmacies struggle to manage their workload, and some chains have resorted to blocking calls for extended periods.

To address these issues, we propose advocating for changes in state laws to allow technicians to perform prescription transfers, implementing advanced technologies to streamline the transfer process, and fostering collaboration among pharmacies, prescribers, and health care organizations to develop best practices for prescription transfers. Additionally, investing in staffing and resources is crucial to improving efficiency and reducing redundant work.

 

Results

While this study provides valuable insights into the inefficiencies of prescription transfer encounters, it is essential to acknowledge several limitations that impact the generalizability and interpretability of our findings.

  1. The retrospective analysis relies on data collected from a single pharmacy, which may not be representative of the experiences and processes of other health care providers or pharmacy chains. This limitation may introduce potential biases and affect the validity of the results when applied to broader contexts.
  2. The study focuses on prescription transfer encounters involving 14 pharmacy chains, with the vast majority (68.2%) of encounters occurring in the South Atlantic region, which includes states such as Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia and West Virginia. This geographic concentration limits the generalizability of the findings to other regions, as pharmacy practices, state regulations and patient demographics may vary significantly across the United States.
  3. The data collection period spans from August 15, 2021, to March 20, 2024, which may not account for seasonal variations or temporary disruptions in pharmacy operations.
  4. The study primarily focuses on quantitative data, such as the duration of prescription transfer encounters and the number of prescriptions transferred. Limited qualitative data was collected to better understand the root causes of inefficiencies and the challenges faced by pharmacists, technicians and patients during the transfer process. Incorporating qualitative data could provide a more comprehensive understanding of the prescription transfer landscape and help identify targeted solutions for improving the process.
  5. The exclusion of smaller, independent pharmacies might limit the generalizability of the findings, as these establishments may have different operational procedures and resources compared to the larger chains included in the analysis. This limitation is particularly relevant given the geographic concentration of the study, as the practices of independent pharmacies in the South Atlantic region may differ from those in other parts of the country. Future research should consider addressing these limitations by incorporating data from multiple health care organizations, expanding the geographic scope to include a more diverse range of regions, and collecting qualitative data to provide a more nuanced understanding of the prescription transfer process. Additionally, longitudinal studies could help evaluate the impact of proposed interventions and the evolution of prescription transfer processes over time.

Despite these limitations, this study offers valuable insights into the inefficiencies of prescription transfer encounters in the South Atlantic region and highlights the need for targeted solutions to improve patient care and reduce the burden on healthcare providers in this area.

 

Conclusion

The time wasted on prescription transfers between pharmacy chains is more significant than previously realized, with profound implications for patient care and the health care system as a whole. The findings of this study underscore the urgent need for practical solutions to address the inefficiencies caused by individual state laws, outdated technology and understaffed pharmacies. By advocating for change, implementing advanced technologies, collaborating with stakeholders, and investing in staffing and resources, we can streamline the prescription transfer process and improve overall efficiency. Ultimately, this will reduce the burden on pharmacists, enhance patient care, and lead to better outcomes for all involved.

At Good Shepherd Health Institute, we are committed to developing and implementing solutions that address these inefficiencies and prioritize patient care. We invite community pharmacists, academic pharmacists, benefit advisors and plan sponsors to join us in this endeavor, working together to create a patients-first pharmacy industry and ensure the best possible outcomes for all involved. Together, we can lead the charge for transparency, collaboration and patient-centered solutions.

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