Exploring the early phase of implementation of a vaccine-based clinical decision support system in the community pharmacy.

OBJECTIVE: To explore the implementation strategy of a recombinant zoster vaccine (RZV) clinical decision support (CDS) intervention in community pharmacy workflow to increase second-dose vaccination rates. SETTING: The level of analysis was the unit (e.g., pharmacy). The participants were selected from across approximately 2200 pharmacies in 37 states on the basis of criteria believed to affect implementation success (e.g., size, location) using a sampling matrix. PRACTICE DESCRIPTION: Large supermarket pharmacy chain. PRACTICE INNOVATION: Vaccine-based CDS intervention in community pharmacy workflow. EVALUATION: A mixed-methods contextual inquiry approach explored the implementation of a new RZV CDS workflow intervention. Data collection involved key informant, semistructured interviews and an electronic, Web-based survey. The survey was based on a validated instrument and was made available to all pharmacists nationwide within the study organization to assess views of the implementation's appropriateness, acceptability, and feasibility during early implementation. Afterward, a series of semistructured, in-depth interviews were conducted until a point of saturation was reached. The interview guide was based on selected constructs of the Consolidated Framework for Implementation Research. RESULTS: A total of 1128 survey responses were collected. Survey respondents agreed or strongly agreed that the implementation was acceptable (78.34%), appropriate (79.92%), and feasible (80.53%). Twelve pharmacist participants were interviewed via telephone. Five themes emerged from the interviews, revealing facilitators and barriers that affected implementation of the intervention: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. CONCLUSION: The implementation of the RZV CDS "nudge" intervention was welcomed, suitable, and operable in the community pharmacy setting to meet the needs of the organization, employees, and patients. The contextual factors identified during the implementation process of this CDS intervention in a community pharmacy setting may be used in scaling this and future CDS interventions for public health initiatives aimed at pharmacists in this setting.

Exploring the expanded role of the pharmacy technician in medication therapy management service implementation in the community pharmacy.

OBJECTIVES: To explore the current roles of the pharmacy technician in the provision of medication therapy management (MTM) and their relation to organizational behavior at "high-performing" community pharmacies within a nationwide supermarket chain. DESIGN: Qualitative research study using methodologic triangulation with the use of semistructured interviews of key informants, direct observation at "high-performing" pharmacy sites, and respondent journals. SETTING AND PARTICIPANTS: High-performing pharmacy sites within a large supermarket pharmacy chain in Tennessee. A high-performing site was defined as a pharmacy that has successfully implemented MTM into its pharmacy workflow. MAIN OUTCOME MEASURES: Themes related to pharmacy technician roles in the delivery of direct patient care services. RESULTS: A total of 28 key informants were interviewed from May 2015 to May 2016. Key informants included 10 certified technicians, 5 noncertified technicians, and 13 pharmacists across 8 pharmacies in central and eastern Tennessee. Three themes were identified. At high-performing sites, pharmacy technicians were engaged in both clinical support activities as well as nonclinical support activities with the goal of improving clinical service implementation. Several barriers and facilitators were revealed. CONCLUSION: Within high-performing teams, expanded technician roles to support patient care service delivery were associated with successful clinical service implementation. Future studies should further explore these expanded technician duties, as well as the role of organizational culture, climate, and team dynamics, in the delivery of patient care and clinical services across a heterogeneous pharmacy setting.

The impact of an immunization check-up at a pharmacist-provided employee health screening.

OBJECTIVES: To determine which types of vaccine recommendations were accepted and acted upon by patients after an immunization check-up at a pharmacist-provided employee health screening, and to evaluate if there was a difference between influenza and non-influenza vaccines. DESIGN: Retrospective, observational. SETTING: Supermarket chain. PATIENTS: Employees and covered spouses. INTERVENTION: Immunization check-up. MAIN OUTCOME MEASURES: Acceptance rate of immunization recommendation. METHODS: This retrospective observational study evaluated the impact of an immunization check-up in individuals who participated in one of the 252 pharmacist-provided health screenings in central Virginia in 2015. All employee health screenings were completed from July 1, 2015, to September 30, 2015. Because immunization status was assessed 6 months after each person received his or her health screening, data were collected from January 1, 2016, to March 30, 2016, and analyzed to collect the number and type of vaccines recommended during the immunization check-up. Each eligible participant's profile was evaluated to determine if he or she received the vaccines at any Kroger pharmacy within 6 months. Patient identifiers were not collected; however, demographics including age, relevant disease state history, and smoking status were collected with immunization recommendations and uptake. Data were analyzed with the use of descriptive statistics. RESULTS: A total of 349 immunization recommendations were made, including 248 influenza; 42 pneumococcal polysaccharide (PPSV23); 40 tetanus, diphtheria, and pertussis (Tdap); 12 herpes zoster; 4 pneumococcal conjugate (PCV13); and 3 hepatitis B. Both influenza and PCV13 had acceptance rates of 50%, and herpes zoster, Tdap, hepatitis B, and PPSV23 had 42%, 35%, 33%, and 24% acceptance rates, respectively. Influenza recommendations had a 50% acceptance rate compared with a 32% acceptance rate of non-influenza recommendations (P = 0.002). CONCLUSION: An immunization check-up performed at a pharmacist-provided employee health screening can lead to patient acceptance of recommendations and receipt of needed immunizations.

Pharmacist intervention in patient selection of nonprescription and self-care products.

OBJECTIVES: To evaluate the potential outcomes of pharmacist intervention on patient selection of nonprescription and self-care products and to evaluate patient confidence and satisfaction with the assistance of the pharmacist. METHODS: A prospective, convenience sample study was conducted at 3 locations of a national supermarket chain pharmacy in the Charlottesville, Virginia, area over 4 months. Patients were recruited for the study if they approached the pharmacy counter and requested assistance with nonprescription and self-care product selection or if the investigating pharmacists approached the patient in the self-care aisles. Men and nonpregnant women age 18 years and older were included in the study. Patients self-selected into the study by agreeing to participate in the study intervention and answering questions relating to their experience with the pharmacist consultation. The study intervention was the pharmacist consultation with the patient to assess the self-care complaint and to make an appropriate recommendation. RESULTS: Forty-two patients participated, the mean (±SD) age was 57 ± 20.8 years, and 62% of patients were female. Sixty percent of patients had used pharmacist help in the past in selecting nonprescription and self-care products. There were 87 total potential outcomes, and a mean of 2.1 potential outcomes per patient. The most potential common outcomes were reduced drug cost, avoided physician visit, corrected product use, and avoided a new prescription. Mean patient confidence (±SD) was 4.38 ± 0.96. Mean patient satisfaction was 4.98. Every patient (100%) stated that they would be more willing to ask for pharmacist help in the future with self-care product selection. The mean encounter time was 6 minutes. CONCLUSION: Pharmacists' active involvement in patient self-care consultation may help patients to select the most effective and safe product and improve patient outcomes. Patients are highly satisfied with pharmacists' help with the selection of nonprescription and self-care products and are more confident with future self-treatment.