ABSTRACT
BACKGROUND: To extend the reach of primary care physicians, Collaborative Practice Agreements (CPA) and Pharmacist Clinician Licenses (PCL) have emerged as possible solutions to allow clinical pharmacists acting under a protocol to perform specific patient care functions, such as smoking cessation counseling. While studies have supported the efficacy of this approach, few data are available on the frequency of their use. METHODS: A list of pharmacies in the state of New Jersey (NJ) and New Mexico (NM) was obtained through the GoodRx Gold membership program list, which included 1,396 pharmacies in New Jersey and 151 in New Mexico. We randomly selected 113 pharmacies in New Jersey, which we contacted between December 2020 to March 2021. From New Mexico, we randomly selected 104 pharmacies, which we contacted between February 2021 and December 2021. Our interviewer-administered survey, which was designed to assess practice in 2019 (pre-pandemic), included questions on the presence of a CPA or PCL and the counseling provided (duration, frequency and type of counseling). RESULTS: In NJ, 83/113 (73%) pharmacies completed the survey, 17 declined to participate and awaiting reply from 13. Only 8/83 pharmacies reported having a CPA in place. One pharmacy had a CPA plan for diabetes medication management pre-pandemic but plans were postponed due to COVID-19. Another pharmacy stated that they had a CPA but declined any further participation in the survey. Of the remaining pharmacies participating in CPAs, 5 had agreements with physicians and 1 with nurse practitioner along with physician assistant. Three pharmacies provided smoking cessation counseling, two provided other counseling services and 1 solely provided naloxone treatment. Among the pharmacies participating in CPAs, they estimated completing 15-30 counseling interventions during 2019, with interventions ranging 5 minutes to 15 minutes. The pharmacies that provided smoking cessation counseling estimated less than 15 interventions in 2019, ranging from 5 minutes to 30 minutes. In NM, 61/104 (59%) pharmacies contacted, 24 declined to participate and awaiting reply from 19. Of the 61 pharmacies that participated, 7 had a PCL while the other 54 pharmacies did not. Of the pharmacies with PCLs, 4 declined further participation in the survey and of the remaining 3 pharmacies, 1 included smoking cessation counseling. Among the pharmacies recorded in the survey as participating in PCLs, they estimated 15 to 30 interventions during 2019 with interventions ranging 5 minutes to 15 minutes. The pharmacy that provided smoking cessation counseling estimated less than 15 interventions per year ranging from 15 minutes to 20 minutes. CONCLUSIONS: Pharmacists are effective at providing lifestyle counseling and legal agreements exist to support their doing so. We found that this potential remains vastly underutilized. Future studies should further examine barriers to having pharmacists deliver lifestyle counseling and test interventions to increase it.