Reprint of: A retrospective review of the impact of immunization eCare plans in community-based pharmacy setting.

BACKGROUND: The Pharmacist Electronic Care (eCare) plan is an electronic documentation and billing platform that allows for exchanging and integrating pharmacy patient care information. eCare plans make it easier for pharmacists to track recommendations and referrals to both patients and providers and to bill for services. OBJECTIVES: To determine the impact on the type and number of vaccines administered after the completion of immunization eCare plans and to examine sociodemographic differences in patients who received immunizations were documented in an eCare plan in a community-based pharmacy setting. PRACTICE DESCRIPTION: Bremo Pharmacy is an independently owned pharmacy located in Richmond, Virginia. Bremo Pharmacy offers a medication synchronization program targeting patients for enrollment in compliance packaging and clinical services. PRACTICE INNOVATION: Bremo Pharmacists use eCare plans to track patient and provider interactions, goals, and medication-related information. Pharmacists used eCare plans to document vaccine recommendations and interactions with patients as a tool to increase vaccinations. EVALUATION METHODS: Reports were generated to extract data containing information from each eCare plan during the intervention period and the number and type of vaccines administered 1 and 2 years before the intervention. Percent change was used to calculate the change in vaccines administered between years. The sociodemographic data was analyzed using descriptive statistics and bivariate statistical analysis using SAS 9.0 (Cary, NC). RESULTS: There were a total of 1105 immunization eCare plans completed. An increase of 136.6% in vaccines administered occurred after the implementation of the eCare plans. While the number of vaccines administered increased, no significant differences were found in vaccine uptake by gender or age. CONCLUSION: Immunization eCare plans are a useful tool to help pharmacists increase the number of vaccines administered in an independent pharmacy.

A retrospective review of the impact of immunization eCare plans in community-based pharmacy setting.

BACKGROUND: The Pharmacist Electronic Care (eCare) plan is an electronic documentation and billing platform that allows for exchanging and integrating pharmacy patient care information. eCare plans make it easier for pharmacists to track recommendations and referrals to both patients and providers and to bill for services. OBJECTIVES: To determine the impact on the type and number of vaccines administered after the completion of immunization eCare plans and to examine sociodemographic differences in patients who received immunizations were documented in an eCare plan in a community-based pharmacy setting. PRACTICE DESCRIPTION: Bremo Pharmacy is an independently owned pharmacy located in Richmond, Virginia. Bremo Pharmacy offers a medication synchronization program targeting patients for enrollment in compliance packaging and clinical services. PRACTICE INNOVATION: Bremo Pharmacists use eCare plans to track patient and provider interactions, goals, and medication-related information. Pharmacists used eCare plans to document vaccine recommendations and interactions with patients as a tool to increase vaccinations. EVALUATION METHODS: Reports were generated to extract data containing information from each eCare plan during the intervention period and the number and type of vaccines administered 1 and 2 years before the intervention. Percent change was used to calculate the change in vaccines administered between years. The sociodemographic data was analyzed using descriptive statistics and bivariate statistical analysis using SAS 9.0 (Cary, NC). RESULTS: There were a total of 1105 immunization eCare plans completed. An increase of 136.6% in vaccines administered occurred after the implementation of the eCare plans. While the number of vaccines administered increased, no significant differences were found in vaccine uptake by gender or age. CONCLUSION: Immunization eCare plans are a useful tool to help pharmacists increase the number of vaccines administered in an independent pharmacy.

Evaluation of patient satisfaction and perceptions of a long-acting injectable antipsychotic medication administration service in a community-based pharmacy during the COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic, restrictions, and social distancing requirements for medical offices reduced scheduling availability and increased virtual televisits by providers. COVID-19 restrictions created a barrier to health care access for patients who are being administered long-acting injectable antipsychotics (LAIs) in an already vulnerable population. OBJECTIVE: To describe an LAI medication administration service at a community-based pharmacy during the COVID-19 pandemic, to evaluate patient satisfaction with the administration of LAIs by a pharmacist service in a community-based pharmacy during the COVID-19 pandemic, and to compare the patient's perceptions of receiving LAIs in a community-based pharmacy with those in another setting previously used for medication administration. PRACTICE DESCRIPTION: Independent full-service community-based pharmacy. PRACTICE INNOVATION: Implementation of an LAI administration service after an increase in provider referrals of patients to the community-based pharmacy during the COVID-19 pandemic. EVALUATION METHODS: A 4-month prospective convenience sample study conducted to evaluate the LAI medication administration service. The survey containing 32 questions was adapted with permission from a previous survey administered in a large grocery store chain to a similar population. Survey results were reported using descriptive statistics. RESULTS: Eleven patients completed the survey. A total of 82% of patients strongly agreed that they felt comfortable with receiving this service at the community-based pharmacy and were satisfied with the privacy during the service. Seventy-one percent of patients who received this service elsewhere strongly agreed the LAI medication administration service was more convenient than a similar service received elsewhere, yet only 18% of patients strongly agreed that the community-based pharmacy was near their work or home. CONCLUSION: A medication administration service for LAIs was developed in a community-based pharmacy, and patients were satisfied with the service. Further research needs to be completed to evaluate health outcomes and financial implications of this service for the patient and health care system.

Assessment of hemp oil-based cannabidiol use in a community-based pharmacy setting.

BACKGROUND: The Agricultural Improvement Act of 2018 legalized the commercial use of hemp-based products, including cannabidiol (CBD). However, the U.S. Food and Drug Administration (FDA) does not currently regulate the commercial sale of hemp oil-based CBD, and there is no FDA-approved indication for its nonprescription formulations despite the growing demand for, and use of, hemp oil-based CBD. OBJECTIVES: Characterize the use of hemp oil-based CBD, including brands, formulations, and reasons for use, in a community pharmacy setting and identify the perceived barriers related to the use of hemp oil-based CBD. METHODS: A pretested 17-question survey was distributed at the point of care at 2 community pharmacy locations and at hemp oil-based CBD education presentations over a 3-month period. The survey consisted of multiple-choice, open-ended, and select-all-that-apply questions, which were analyzed using univariate and bivariate analyses. RESULTS: A total of 101 participants completed the survey: 38 were CBD-naive, and 63 were CBD-exposed. Most of the participants were women (79%) and Caucasian (81.6%), with an average age of 59 years (SD 17.26). In the CBD-naive group, the most commonly stated barrier to using hemp oil-based CBD was not enough information about the product. Among the participants who had used or were using at least 1 CBD product, the most commonly used dosage form was sublingual, followed by topical: 46 (46/63 [73%]) and 34 (34/63 [54%]) participants, respectively. Thirty-eight participants used hemp oil-based CBD for pain, 24 participants for sleep, and 17 participants for anxiety. Of these, 62% of the participants informed a health care provider that they were using a hemp oil-based CBD product. CONCLUSION: The participants were using different brands and formulations of hemp oil-based CBD for multiple reasons. The greatest barrier to trying CBD was limited education, which may suggest a need for community education about hemp oil-based CBD products.

Primary healthcare policy and vision for community pharmacy and pharmacists in the United States.

The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges.

Primary healthcare policy and vision for community pharmacy and pharmacists in the United States

The United States (US) has a complex healthcare system with a mix of public, private, nonprofit, and for-profit insurers, healthcare institutions and organizations, and providers. Unlike other developed countries, there is not a single payer healthcare system or a national pharmaceutical benefits scheme/plan. Despite spending over USD 10,000 per capita in healthcare, the US is among the worst performers compared to other developed countries in outcomes including life expectancy at birth, infant mortality, safety during childbirth, and unmanaged chronic conditions (e.g., asthma, diabetes). Primary care is delivered by physicians and advanced practice providers (i.e., nurse practitioners and physician assistants) in a variety of settings including large health systems, federally qualified health centers or free clinics that provide care to the underserved, or specific facilities for veterans or American Indian and Alaska native peoples. Since 2010, primary care delivery has shifted toward providing patient-centered, coordinated, comprehensive care focused on providing proactive, rather than reactive, population health management, and on the quality, versus volume, of care. Community pharmacy comprises a mix of independently owned, chain, supermarket and mass merchant pharmacies. Community pharmacies provide services such as immunizations, medication therapy management, medication packaging, medication synchronization, point-of-care testing and, in specific states where legislation has been passed, hormonal contraception, opioid reversal agents, and smoking cessation services. There has been criticism regarding the lack of standard terminology for services such as medication synchronization and medication therapy management, their components and how they should be provided, which hampers comparability across studies. One of the main challenges for pharmacists in the US is the lack of provider status at the federal level. This means that pharmacists are not allowed to use existing fee-for-service health insurance billing codes to receive reimbursement for non-dispensing services. In addition, despite there being regulatory infrastructure in multiple states, the extent of service implementation is either low or unknown. Research found that pharmacists face numerous barriers when providing some of these services. State fragmentation and the lack of a single pharmacy organization and vision for the profession are additional challenges

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Decision-maker and staff perceptions of the pharmacist's role in transitions of care programs.

OBJECTIVES: To identify perceptions of decision-makers and staff at a local hospital about the pharmacist's role in transitions of care (TOC) programs. SETTING: Independent community pharmacy located inside a local community hospital. PRACTICE DESCRIPTION: Pharmacy personnel offer a bedside delivery service to hospital patients and have professional relationships with administration. PRACTICE INNOVATION: Pharmacy personnel intend to expand the bedside delivery service to a comprehensive TOC program. Researchers believed it would be important to gather the perceptions of pharmacist's role in TOC programs from nonpharmacist clinicians and administration to successfully develop the program. EVALUATION: This project would identify perceptions to help develop a TOC program. METHODS: A 22-question survey was developed after consulting with key staff and informed by literature regarding TOC and pharmacists' roles in patient care services. Collected demographic information included primary department, number of years worked at the institution, and involvement in TOC. After an 8-week survey distribution period, descriptive statistics were performed on the data collected. RESULTS: A total of 13 decision-makers and staff responded to the survey with a response rate of 87%. Eleven of 12 respondents (92%) thought that pharmacists should be involved in TOC and can be the communication link between patients and other health care providers to ensure continuity of care. All of the participants thought that pharmacists should provide medication reconciliation and patient and caregiver education through TOC services. The participants were less likely to think that pharmacists should offer follow-up care after discharge. CONCLUSION: Participants agreed that pharmacists should be involved in TOC services but had varied perceptions on the pharmacist's specific role. Decision-maker and staff perceptions identified in this study will be used to develop the pharmacist's role in a TOC program at the institution.

Impact of pharmacist identification of medication-related problems in a nontraditional long-term care pharmacy.

OBJECTIVES: To characterize the most common medication-related problems and interventions and to evaluate the acceptance rates of pharmacist identification of medication-related problems through percent acceptance rates of interventions in a nontraditional long-term care pharmacy. METHODS: A retrospective chart review of long-term care pharmacy patients 18 years of age or older was used to evaluate pharmacist interventions from January 2014 to August 2016. Data collection included the date and type of intervention, patient demographic information (age, sex), drug class involved, physician provider type (primary care or specialist), intervention outcome, and resolution type. Accepted and rejected interventions were reviewed and classified based on Hepler and Strand's 8 medication-related problems: untreated indications, improper drug selection, subtherapeutic dosage, failure to receive medication, overdosage, adverse drug reactions, drug interactions, and medication use without indication. Data were analyzed with the use of descriptive statistics. RESULTS: Four hundred seventeen interventions were documented over 18 months, approximately 13 interventions per month. Prescribers accepted 47% of interventions and rejected 29%. The remaining 24% of interventions did not have a response from the prescriber. Of the medication-related problems, "untreated indication" and "overdosage" were the most commonly intervened with and accepted interventions. Regarding drug class, pharmacists made the most interventions regarding immunizations (41%), diabetes medications (11%), cholesterol medications (10%), and hypertension medications (7%). CONCLUSION: Pharmacists are improving the care of patients living in small group homes through various types of recommendations regarding complex disease states, such as diabetes, hyperlipidemia, and hypertension, further complicated by mental illness. With almost one-half of all recommendations accepted by prescribers, pharmacists consistently provided recommendations to improve care.