Practice Change in Community Pharmacy: A Case Study of Multiple Stakeholders' Perspectives

Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change. Design: Qualitative study. Setting: Community pharmacy in rural Mississippi. Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4), support staff (n=2), collaborating providers (n=4), patients (n=3), and a payer (n=1). Intervention: Semi-structured interviews and participant-observation techniques were used. Main outcome measures: Description of the community pharmacy's practice and business model and identification of practice change facilitators. Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges. Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy's successful establishment of a patient care practice.   Type: Case Stud

Fellowships in Community Pharmacy Research: Experiences of Five Schools and Colleges of Pharmacy

Objective To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. Setting: Five schools and colleges of pharmacy in the United States. Practice description: Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. Practice innovation: Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. Evaluation: Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. Results: Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. Conclusion: Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice

Stakeholder-Guided Formation of a Statewide Community Pharmacy Practice-Based Research Network

Community pharmacies across the United States are forming clinically integrated networks (CINs) to facilitate the provision of patient-centered care. These networks need to continually innovate and demonstrate how their patient care services positively impact health outcomes. One way to do this is to develop a practice-based research network (PBRN) in partnership with existing CINs to perform robust outcome evaluations. The objective of this study was to learn pharmacists’ opinions on participating in research to facilitate the formation of a community pharmacy PBRN in Pennsylvania. A 20-item survey gathered information on pharmacists’ research interests, perceived benefits of research participation, and preferences on communication and patient engagement. Descriptive statistics and Chi-square tests were used to analyze quantitative data. Seventy-three participants completed the survey, with 47% representing independent pharmacies. The majority (96%) were interested in research opportunities and 86% believed improving workflow and patient care was the most valuable benefit. Eighty percent of pharmacists reported it is very important to demonstrate that pharmacists care about making patients’ health better. Connecting pharmacists with other health care providers was reported as very important by 75% of respondents. Pharmacists reported face-to-face communication (76%) as their preferred way to approach patients about research and 72% supported using student pharmacists to assist with patient engagement. The results from this study can inform others who are structuring processes and developing communication strategies for community pharmacy PBRNs, particularly in partnership with CINs

Practice Change in Community Pharmacy: A Case Study of Multiple Stakeholders' Perspectives

Objective: To obtain a multi-stakeholder perspective of community pharmacy practice change. Design: Qualitative study. Setting: Community pharmacy in rural Mississippi. Participants: Fourteen key stakeholders of the patient care practice including pharmacists (n=4), support staff (n=2), collaborating providers (n=4), patients (n=3), and a payer (n=1). Intervention: Semi-structured interviews and participant-observation techniques were used. Main outcome measures: Description of the community pharmacy's practice and business model and identification of practice change facilitators. Results: Change facilitators for this practice included: a positive reputation in the community, forming solid relationships with providers, and convenience of patient services. Communication in and outside of the practice, adequate reimbursement, and resource allocation were identified as challenges. Conclusions: This case study is a multi-stakeholder examination of community pharmacy practice change and readers are provided with a real-world example of a community pharmacy's successful establishment of a patient care practice.   Type: Case Stud

Evaluating Pennsylvania Pharmacists’ Provision of Community-based Patient Care Services

Objective: To identify and describe Pennsylvania pharmacists who currently provide or are interested in providing community-based patient care services and are interested in joining a statewide practice network. Design: Cross-sectional survey. Setting: February to June 2009 in Pennsylvania. Participants: 1700 pharmacists. Intervention: Mailed and electronic survey. Main outcome measures: Number and geographic location of pharmacists providing or interested in providing community-based patient care in Pennsylvania. Description of patient care documentation methods; physical space; services provided; perceived barriers to providing patient care; training needs; and interest in joining a statewide practice network. Results: The final analysis included data from 1700 pharmacists. Approximately one-third of pharmacists (n=554) were providing patient care services to community-based patients. Most were routinely documenting (67.5%) and many had a semi-private or private space to provide care. MTM and immunizations were the most common services provided. Respondents reported the most significant barrier to providing MTM, diabetes education, and smoking cessation education was time constraints, whereas training was a barrier for immunization provision. Most pharmacists were not being compensated for patient care services. Of the 869 pharmacists interested in joining a statewide network, those providing care were more interested in joining than those who were not (70.8% vs. 43.8%, p < 0.001). Conclusion: Pennsylvania pharmacists are interested in providing community-based patient care services and joining a statewide practice network focused on providing community-based patient care services. This research serves as a foundation for building a pharmacist practice network in Pennsylvania

A Student Pharmacist Quality Engagement Team to Support Initial Implementation of Comprehensive Medication Management within Independent Community Pharmacies

In 2017, the Pennsylvania Pharmacists Care Network (PPCN), an enhanced pharmacy services network, and STRAND Clinical Technologies partnered to launch a payor contract with a Pennsylvania Medicaid Managed Care Organization for the provision of comprehensive medication management (CMM) at PPCN pharmacies. PPCN and the Community Leadership and Innovation in Practice Center at the University of Pittsburgh School of Pharmacy partnered to create the Quality Engagement Team (QET), a group of student pharmacists formed with the intent to support the initial implementation of this contract. The QET supported the pharmacies through biweekly phone calls, which led to increased pharmacist engagement and produced impactful patient encounter stories that were then reported back to the payor. We utilized Active Implementation Frameworks and select implementation strategies from the Expert Recommendations for Implementing Change project throughout the implementation period. The QET supported the successful implementation of this payor contract, which saw an increase in CMM encounters completed by the pharmacists during each month of the four-month contract period. Students, pharmacists and the payor each derived meaningful benefits from this initiative. Student pharmacists can be a powerful asset in the implementation of payor programs within an enhanced pharmacy services network, resulting in the mutually beneficial and sustainable support of the network

Implementation of a Health Risk Assessment into Workflow of the Appointment-Based Model at an Independent Community Pharmacy

Health risk assessments (HRAs) are tools used to collect information on patients’ current health conditions, personal and family medical history, and lifestyle factors that can impact their overall health. The objectives of this pilot project were to implement an HRA as part of the appointment-based model workflow and to assess the resulting pharmacy-patient-care service opportunities. Sixteen HRA questions from a single health plan were incorporated into the appointment-based model workflow at an independent community pharmacy. Questions were administered either telephonically or in person over two patient encounters. Pharmacy staff were trained on how to administer the HRA, what to do if patients needed immediate assistance, how to provide referrals, and how to document of responses. Forty-nine patients were contacted and 38 (77.6%) completed the HRA. The median time for HRA completion was 19 min and the identified opportunities were vaccination (49), smoking cessation (15), diabetes prevention program (14), asthma control assessments (8), and substance use disorder screening and referral (3). This pilot project demonstrates that community pharmacies can implement HRAs and utilize the results to identify new pharmacy-patient-care service opportunities that can contribute to improved patient care and practice sustainability

Impact of a Medication Adherence Packaging Service on Patient-Centered Outcomes at an Independent Community Pharmacy

The purpose of this project was to evaluate the impact of a comprehensive medication adherence packaging (RxMAP) service on patient medication-taking behaviors and patient-centered outcomes. Adult patients who utilized a single independent community pharmacy, enrolled in the RxMAP service for at least two consecutive cycles, and managed their own medications were eligible. The RxMAP service consists of multi-dose blister packaging in 28-day cycles, medication synchronization, monthly touchpoint calls, and delivery/mailing. A 13-item telephonic survey was administered, and patients&rsquo; verbal responses were captured by audio-recording and detailed note taking. Descriptive statistics were used to quantify the results and illustrative quotes representing the interview domains were selected. There were 42 patients who completed the survey: 88% reported they missed fewer doses compared to before using RxMAP; 71% were more likely to take their medications on time each day; 86% were more confident with managing their medications; and 74% were more independent. Finally, 64% of patients stated their overall quality of life was better now compared to before using the packaging service. These results demonstrate that medication adherence packaging services can positively impact patients&rsquo; medication-taking behaviors, increase their confidence in medication management, and improve perceived quality of life