Implementation of a community pharmacy workflow process to identify and follow up with prescription abandonment.

OBJECTIVES: To describe a workflow process that uses members of the pharmacy staff to identify prescription abandonment and resolve barriers that contribute to medication nonadherence. SETTING: Independent community pharmacy in the southeastern United States. PRACTICE DESCRIPTION: Each of the 6 Moose Pharmacy locations provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication reviews, disease state management programs, point-of-care testing, and compounding. PRACTICE INNOVATION: A workflow process, including a conversation flowchart and will-call bag tag, were created to support prescription abandonment discussions. Patients were included if at least 1 refilled or newly authorized prescription was not picked up within 7 days of the medication being filled. Patients younger than 18 years and as-needed prescriptions were excluded. EVALUATION: During the 60-day study period, 73 patients met the criteria of having an abandoned prescription; 124 total prescriptions were identified as abandoned. The barriers to adherence identified with these patients were 32% forgotten, 18% cost, 11% transportation, 4% refusal, 16% other responses, and 19% of patients who were not able to be reached. After the process was completed, 56 patients (76.7%) received their medications. The average time to pick-up for subsequent successful contact was 3 days. Of the 73 patients, 15 (20.5%) were already enrolled in the medication synchronization program. With the use of a conversation flowchart, 2 additional patients were enrolled in the pharmacy's medication adherence program and 8 others were enrolled in the automatic notification program when prescriptions are filled. CONCLUSION: A workflow process such as the one used in this study can help to identify barriers contributing to prescription abandonment. Through this process, the pharmacy learned that educating all staff members regarding the workflow may help to expand interventions to curtail prescription abandonment and address medication adherence.

Financial impact of patients enrolled in a medication adherence program at an independent community pharmacy.

OBJECTIVES: To determine the financial impact of attributed patients enrolled in a medication adherence program at Community Pharmacy Enhanced Services Network (CPESN) pharmacies. SETTING: Five independently owned Moose Pharmacy locations in rural North Carolina, which are CPESN pharmacies. PRACTICE DESCRIPTION: Moose Pharmacy has a longstanding history of innovative change. Each Moose Pharmacy location provides enhanced pharmacy services, including adherence packaging, medication synchronization programs, immunizations, home visits, home delivery, comprehensive medication review, disease state management programs, point-of-care testing, and compounding. PRACTICE INNOVATION: Certain CPESN pharmacies, including Moose Pharmacy, were attributed complex Medicare or Medicaid patients having at least 1 chronic medication and at least 80% of medications filled at a CPESN pharmacy. Patients were included if they were attributed to a study location and enrolled in the Moose Medication Adherence Program (MooseMAP) for more than 12 months. Patients were excluded if they were younger than 18 years of age or had less than 12 months of prescription fill data. Reviewed data included patient demographics, chronic and acute medications, immunizations, MooseMAP type, number of chronic medication prescribers, chronic medication class, payer, and patient health risk indicators. Yearly profit for prescriptions filled was determined per patient. Independent-samples t test was used to assess data. EVALUATION: Yearly profit per prescription was $10.35 for combined chronic, acute, and immunization prescriptions, $10.57 for chronic prescriptions, $26.95 for acute prescriptions, and $27.69 for immunizations. Mean profit for strip packaging was $1561.82 per year compared with $1208.01 per year with bottles (P = 0.021). There was a positive correlation between profit and number of prescriptions filled per 12 months (r = 0.56; P < 0.001), number of medication classes (r = 0.27; P < 0.001), and higher-risk indicator scores (r = 0.21; P < 0.001). CONCLUSION: Enrolling complex patients in a medication adherence program can benefit community pharmacies, particularly CPESN pharmacies, through chronic medication fills and yearly profit. Greater profit is generated when prescriptions are dispensed in strip packaging instead of bottles.

Identifying barriers to dispensing naloxone: A survey of community pharmacists in North Carolina.

OBJECTIVES: The primary objective of this study was to identify barriers to dispensing naloxone under the North Carolina statewide standing order in the community pharmacy setting. Secondary objectives included identifying areas for additional training. METHODS: This study was conducted as a cross-sectional survey distributed to community pharmacists in North Carolina through an Internet-based questionnaire platform. The questions assessed pharmacists' training regarding naloxone, willingness to dispense naloxone, knowledge of naloxone and opioid overdose, perceived barriers to implementing a naloxone distribution program, and demographic information. Descriptive statistics and Pearson correlation coefficient were used in data analysis. RESULTS: Only 30% of survey respondents scored greater than 90% on the knowledge assessment portion of the survey. Furthermore, more than 50% of respondents indicated that they were not very comfortable dispensing naloxone, based on their responses to a series of Likert-type scale statements. A statistically significant positive correlation (r = 0.288; P < 0.001) was found between pharmacists' knowledge of naloxone and opioid overdose and willingness to dispense naloxone. The majority of respondents indicated that lack of training was a major barrier to dispensing naloxone. Additional training needs included information regarding naloxone, strategies to initiate patient discussion, identifying eligible patients, and workflow implementation. More than 95% of respondents indicated that the pharmacy in which they are employed would benefit from additional naloxone training. CONCLUSION: Community pharmacists in North Carolina would like to receive additional training regarding naloxone and opioid overdose. Given the statistically significant positive correlation between knowledge concerning naloxone and opioid overdose and willingness to dispense naloxone, it is possible that increased pharmacist training could lead to increased willingness to dispense naloxone under the statewide standing order. These results can be used in a meaningful way to determine the best ways to better educate pharmacists on naloxone and improve patient access to this life-saving medication.

Implementation of a vaccine screening program at an independent community pharmacy.

OBJECTIVES: To implement a comprehensive vaccine screening program and to identify best practices in workflow for a vaccine screening program. SETTING: Five independent community pharmacy locations with a common owner. PRACTICE DESCRIPTION: Moose Pharmacy is an independent family owned and operated pharmacy in rural North Carolina. Moose Pharmacy has 5 dispensing pharmacy locations that fill from 750 to 2800 prescriptions weekly. Each pharmacy regularly uses clinical pharmacists and pharmacy residents to provide comprehensive patient care. PRACTICE INNOVATION: A vaccine screening tool and documentation form were developed by the authors based on recommendations from the Centers for Disease Control and Prevention for immunizations that may be pharmacist administered by protocol in North Carolina. INTERVENTIONS: A pharmacy team member used the screening tool to identify vaccination opportunities in the patient population. Patients 18 years of age or older who entered the pharmacy workflow process were eligible for screening. EVALUATION: If pharmacy staff identified needed vaccinations for a patient, a pharmacist evaluated the screening and recommended immunization(s) to the patient. If the recommendation was accepted, the vaccine was administered. If the patient declined vaccination, a brief reason was designated from a predefined selection of choices. RESULTS: During the 30-day study period, 631 screenings were performed. Pharmacy technicians and pharmacists performed 95.4% and 4.6% of screenings, respectively. Of completed screenings, 81.5% were completed at data entry, 13.9% at fill station, 4.1% at prescription verification, and 0.5% during a clinical consultation. As a result of this study the following vaccines were administered: influenza (n = 11), pneumococcal conjugate (n = 5), pneumococcal polysaccharide (n = 1), Tdap (n = 5), and zoster (n = 6). CONCLUSION: A comprehensive vaccine screening tool was successfully used by pharmacy technicians and pharmacists at data entry and fill station during the traditional workflow at an independent community pharmacy.

Measuring Satisfaction and Usability of FaceTime for Virtual Visits in Patients with Uncontrolled Diabetes.

BACKGROUND: The interconnection capabilities of mobile device platforms offer the opportunity for efficient delivery of healthcare and afford the potential to increase access to patients with chronic diseases. With the increased incidence of diabetes mellitus in the United States, innovative strategies to improve access to healthcare teams are necessary. The aim of this study was to determine satisfaction and usability of patients and diabetes care team members with videoconferencing capabilities using an iPad®2 (Apple, Cupertino, CA). MATERIALS AND METHODS: Patients were provided an iPad2 with videoconferencing capabilities using FaceTime® (Apple) (n=34). Patients were scheduled virtual visits with a multidisciplinary diabetes care team. Participants were given a 12-item survey at Day 90 of study enrollment. Members of the diabetes care team were provided a five-item survey at Days 30, 90, and 180 of the study period. RESULTS: Sixty-five percent of patients reported satisfaction using FaceTime for visits. Seventy-six percent of patients agreed that FaceTime was effective in improving diabetes. Overall satisfaction with technology declined over the study period among members of the diabetes care team. CONCLUSIONS: The results provide practical information on using video technology to conduct chronic disease care. Overall, patients and the diabetes care team reported positive ratings in terms of usability and satisfaction with selected technology for virtual visits. Although limitations using FaceTime virtual visits exist, FaceTime has potential to increase patient access to a multidisciplinary care team. Additional research is warranted to determine economic and clinical outcomes for two-way visual technology.

Measuring North Carolina pharmacists' support for expanded authority to administer human papillomavirus vaccines.

PURPOSE: To assess North Carolina pharmacists' level of support for expanded authority to administer human papillomavirus (HPV) vaccines to identify concerns/benefits about expanded authority and to understand what factors predict support for expanded authority. METHOD: A 16-item electronic survey was e-mailed to all the pharmacists registered with the North Carolina Board of Pharmacy (n = 9502) between January and February 2011 (1600 pharmacists responded). The survey assessed HPV knowledge, level of support for expanded authority, and comfort level of HPV vaccine administration. RESULTS: Many (64%) pharmacists were supportive of a rule change/legislation that would authorize pharmacists to administer HPV vaccines. Younger pharmacists were more supportive of expansion when compared to older pharmacists (r = -.138, P < .001). Pharmacists with higher knowledge scores were more supportive of expansion (r = .223, P < .001). Reporting a higher level of comfort in administering HPV vaccines at their pharmacy was significantly and positively correlated with higher level of support for expansion (r = .624, P < .001). In the multivariate analysis, HPV knowledge, comfort level in administering vaccine, patient age, and type of pharmacy were all predictive of higher level of support for expanded authority where employed. CONCLUSION: A large proportion of pharmacists were supportive of an expanded role in providing HPV vaccines. Exploring alternate delivery mechanisms like this one is advantageous.

Retrospective analysis of estimated cost avoidance following pharmacist-provided medication therapy management services.

OBJECTIVE: To compare the estimated cost avoidance (ECA) of pharmacist-provided medication therapy management (MTM) services among common disease states encountered in community pharmacy practice. DESIGN: Retrospective analysis. SETTING: Nine community pharmacies in North Carolina. PATIENTS: Three hundred and sixty-four patients who are 65 years of age or older, a Medicare Part D beneficiary and a North Carolina resident. INTERVENTIONS: An MTM pharmacist-provider conducted medication reviews to eligible patients between July 2009 and October 2009. For each encounter, patient interventions, pharmacist recommendations, and ECA were recorded. MAIN OUTCOME MEASURE: ECA. RESULTS: In 9 pharmacy locations, 634 MTM interventions were documented during the study period. The ECA in a 4-month period yielded approximately $494 000. Comprehensive medication reviews, new prescription counseling and appropriate medication administration, and technique counseling made up nearly two-thirds of interventions. Overall, the probability that an MTM intervention would result in an ECA greater than $0 was .35. CONCLUSIONS: Pharmacist-provided MTM effectively reduced costs associated with patient medication use. Such interventions reduced costs in overall health care specifically in the areas of cardiovascular, gastroesophageal reflux disease, pulmonary, and diabetes groups.