Findings From a National Survey of Older US Adults on Patient Willingness to Use Telehealth Services: Cross-Sectional Survey.

BACKGROUND: Telehealth (telemedicine and telepharmacy) services increase access to patient services and ensure continuity of care. However, few studies have assessed factors that influence patients' willingness to use telehealth services, and we sought to investigate this. OBJECTIVE: This study aims to examine respondents' (aged between 45 and 75 years) willingness to use telehealth services (telepharmacy and telemedicine) and the correlates of the willingness to use telehealth services. METHODS: We administered a cross-sectional national survey of 1045 noninstitutionalized US adults aged between 45 and 75 years in March and April 2021. Multiple logistic regression analyses were used to identify demographic and health service use correlates of self-reported willingness to use telehealth services. RESULTS: Overall willingness to use telemedicine was high (674/1045, 64.5%). Adults aged 55 years and older were less willing to use telemedicine (aged between 55 and 64 years: odds ratio [OR] 0.61, 95% CI 0.42-0.86; aged 65 years or older: OR 0.33, 95% CI 0.22-0.49) than those younger than 55 years. Those with a regular provider (OR 1.01, 95% CI 1-1.02) and long travel times (OR 1.75, 95% CI 1.03-2.98) were more willing to use telemedicine compared to those without a regular provider and had shorter travel times, respectively. Willingness to use telemedicine services increased from 64.5% (674/1045) to 83% (867/1045) if the service was low-cost or insurance-covered, was with their existing health care provider, or was easy-to-use. Overall willingness to use telepharmacy was 76.7% (801/1045). Adults aged older than 55 years were less willing to use telepharmacy (aged between 55 and 64 years: OR 0.57, 95% CI 0.38-0.86; aged 65 years or older: OR 0.24, 95% CI 0.15-0.37) than those younger than 55 years. Those who rated pharmacy service quality higher were more willing to use telepharmacy (OR 1.06, 95% CI 1.03-1.09) than those who did not. CONCLUSIONS: Respondents were generally willing to use telehealth (telemedicine and telepharmacy) services, but the likelihood of their being willing to use telehealth decreased as they were older. For those initially unwilling (aged 55 years or older) to use telemedicine services, inexpensive or insurance-covered services were acceptable.

Colorectal cancer screening knowledge among community pharmacists: A national survey.

BACKGROUND: Colorectal cancer (CRC) screening can reduce CRC morbidity and mortality. Community pharmacies could be a viable option for delivering home-based CRC screening tests such as fecal immunochemical tests (FITs). However, little is known about community pharmacists' knowledge about CRC screening guidelines. OBJECTIVE: We assessed community pharmacists' knowledge about CRC screening to identify education and training needs for a pharmacy-based CRC screening program. METHODS: Between September 2022 and January 2023, we conducted an online national survey of community pharmacists practicing in the United States. Responders were eligible if they were currently-licensed community pharmacists and currently practiced in the United States. The survey assessed knowledge of national CRC screening guidelines, including recommended starting age, frequency of screening, different screening modalities, and follow-up care. Using multiple linear regression, we evaluated correlates of community pharmacists' level of CRC screening knowledge, defined as the total number of knowledge questions answered correctly from "0" (no questions correct) to "5" (all questions correct). RESULTS: A total of 578 eligible community pharmacists completed the survey, with a response rate of 59%. Most community pharmacists correctly answered the question about the next steps following a positive FIT (87%) and the question about where a FIT can be done (84%). A minority of community pharmacists responded correctly to questions about the age to start screening with FIT (34%) and how often a FIT should be repeated (28%). Only 5% of pharmacists answered all knowledge questions correctly. Community pharmacists answered more CRC screening knowledge questions correctly as their years in practice increased. Board-certified community pharmacists answered more CRC screening knowledge questions correctly compared to those who were not board-certified. CONCLUSION: To ensure the successful implementation of a pharmacy-based CRC screening program, community pharmacists need to be educated about CRC screening and trained to ensure comprehensive patient counseling and preventive service delivery.

College student perceptions of pharmacist-provided hormonal contraception.

BACKGROUND: North Carolina immunizing pharmacists are authorized to provide oral and transdermal hormonal contraception to eligible patients. In March 2022, implementation of this enhanced patient care service began statewide, after approval of standing orders and published training from the North Carolina Association of Pharmacists. Two pharmacy locations on a college campus began offering pharmacist-provided hormonal contraception shortly after approval. OBJECTIVE: The objective of this study was to assess the willingness of students to seek pharmacist-provided hormonal contraception and the willingness of students to pay for this service. METHODS: This cross-sectional study was conducted on the campus of a public, research-intensive university. To be included, individuals must have been 18 years of age or older, enrolled as a student or postdoc at the university, and must have used prescribed hormonal oral contraception within the last year. Individuals who declined consent or surveys that were not at least 90% complete were excluded. The survey was administered via Qualtrics and distributed via e-mail and printed flyers with a QR code. The survey opened February 10, 2023, and closed April 24, 2023. RESULTS: In total, 170 survey responses were analyzed. Almost three-fourths of participants (72.9%) were not aware that pharmacists could provide hormonal contraception in North Carolina. All participants identified at least one benefit to pharmacist-provided contraception, with the most common responses being "I believe it would save time" (85.3%) and "appointment not needed" (89.4%). Almost two-thirds of participants (65.3%) identified at least one barrier that would prevent them from seeking pharmacist-provided contraception. The most common barrier identified was privacy at the pharmacy (20.0%). Most participants (81.8%) reported that they are willing to pay for this service, with the majority willing to pay up to $29. CONCLUSION: Students on this campus seem to have a receptive attitude toward pharmacist-provided hormonal contraception and are willing to pay for a consultation.

Incorporating Social Determinants of Health into Patient Care Workflows Within a Health System Specialty Pharmacy.

BACKGROUND: The influence of adverse factors on social determinants of health (SDOH) and their impact on patient outcomes is widely recognized. Pharmacists, as accessible healthcare professionals, can play a pivotal role in identifying and addressing SDOH concerns. Health system specialty pharmacies have consistently assisted patients in accessing expensive specialty medications and ensuring adherence to therapy. As such, they are uniquely positioned to address SDOH concerns of patients. OBJECTIVE: To assess the effectiveness of incorporating standardized SDOH screening and referral methods into the patient care workflows of a health-system specialty pharmacy. PRACTICE DESCRIPTION: The University of North Carolina Health Care (UNC Health) Specialty and Home Delivery Pharmacy is a health-system owned specialty pharmacy serving patients in North Carolina, South Carolina, and Virginia. It holds accreditations from the Utilization Review Accreditation Commission and Accreditation Commission for Health Care. PRACTICE INNOVATION: A standardized SDOH screening and referral method was integrated into patient care workflows of a health-system specialty pharmacy. If SDOH concerns were identified upon screening by a specialty pharmacist, patients were referred to an entity within the health system responsible for connecting patients to local community resources to address their SDOH concerns. EVALUATION METHODS: The types of SDOH concerns, frequency of SDOH referrals, referral turnaround time, outcomes of the referrals, and patient demographics were evaluated to determine the impact of this project. Descriptive statistics were used to analyze results. RESULTS: Sixty-nine patients were included (female: n=38, 55.1%; age (mean±SD: 48.9±16.3). Eighty-seven SDOH concerns were reported, 54 patients (78.3%) were connected to local resources upon referral, and the average turnaround time of referrals was 2.2 business days. CONCLUSION: The findings of this pilot study highlight the effectiveness of incorporating SDOH screening and referral methods into specialty pharmacy workflows. Specialty pharmacies can successfully identify and address non-medical factors impacting patients.

Impact of Health Information Exchange Access on Medication Management Recommendations in a Community-based Pharmacy Setting.

BACKGROUND: Community-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a Health Information Exchange (HIE) on pharmacist recommendations during a medication management encounter. OBJECTIVE: The objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE. PRACTICE DESCRIPTION: Moose Pharmacy is one of few community pharmacies in North Carolina with access to a large health-system HIE. PRACTICE INNOVATION: This cohort study reviewed data over four months. Patients were identified for medication management based on filling eligible medications for atherosclerotic cardiovascular disease (ASCVD), hypertension, diabetes, dyslipidemia, or heart disease. Pharmacy personnel utilized the HIE to acquire lab results. At the medication management appointment, the pharmacist collected blood pressure (BP), assessed smoking history, and medication/disease concerns. ASCVD risk score, statin therapy, A1c, and BP were assessed. Follow up with the patient or provider was determined, if needed, and documented. EVALUATION METHODS: Collected records were reviewed to quantify the number and type of clinical recommendations made by the pharmacist, and their acceptance status by the prescriber. Descriptive analyses were used to analyze results. RESULTS: Thirty-four encounters were included. Most participants had diabetes (n=21, 62%) and hypertension (n=31, 91%). Nearly one-third (n=11, 32%) of encounters resulted in a pharmacist recommendation. Recommendations were for BP dose adjustments (n=4, 36%), diabetes medication changes (n=3, 27%), and statin initiations/escalations (n=4, 36%). Four (36%) recommendations were accepted, with one requiring modifications from the provider, 3 (27%) recommendations were declined, and 3 (27%) recommendations were unanswered. CONCLUSION: Access to progress notes and lab values using an HIE enhanced the pharmacist's ability to provide enhanced patient care recommendations during medication management consultations.

Evaluation of a Hybrid Medication Synchronization Training Module for Pharmacy Technicians.

BACKGROUND: Medication synchronization involves coordinating a patient's medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared to automatic refill-processing programs. Patients are two to six times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service. OBJECTIVE: To develop a training program for pharmacy technicians regarding medication synchronization and assess changes in knowledge and confidence before and after implementing a training program. PRACTICE DESCRIPTION: An independent community pharmacy in North Carolina. Pharmacists provide medication therapy management, reimbursed clinical services, medication synchronization, and immunizations. PRACTICE INNOVATION: The training program included medication synchronization basics, patient enrollment process, processing a synced patient, and a hands-on practice session. EVALUATION METHODS: Technicians took a pre-training questionnaire assessing knowledge and confidence before immediately completing a one-on-one pharmacist-led training session with a hands-on component on medication synchronization. Technicians took the same post-training questionnaire 2 weeks after completing the training session and utilizing medication synchronization in daily workflow. Pre- and post-training scores were assessed using a paired samples t-test. RESULTS: 10 technicians completed the training program; 40% of the technicians were certified and 30% were enrolled in a PharmD program. The mean pre-training knowledge score was 78% (7.1/9 points), the mean post-training knowledge score was 92% (8.3/9 points), the mean difference between the pre- and post- training knowledge scores was 13.4% (1.2 points), a statistically significant difference (p=0.0026). Confidence with conducting a medication synchronization call increased from 7.2 to 9.6 on a 10-point Likert scale and confidence scores increased regarding incorporating medication synchronization into workflow from 6.9 to 8.7. CONCLUSION: The standardized technician training program increased knowledge and confidence in technicians regarding managing a medication synchronization program.

Evaluation of a community-based pharmacy resident-led continuous glucose monitoring program within a family medicine clinic.

BACKGROUND: Pharmacist-driven continuous glucose monitoring (CGM) is associated with reduced hemoglobin A1c (HbA1c) and achievement of daily glycemic goals. Community-based pharmacists are well-positioned to improve CGM uptake among patients with diabetes due to their accessibility and expertise. However, little data exists evaluating the outcomes of CGM services led by a community-based pharmacist. OBJECTIVE: To evaluate the impact of a community-based pharmacy resident-driven CGM service on HbA1c, revenue, and patient satisfaction. PRACTICE DESCRIPTION: Independent community pharmacy sharing a clinical services agreement with a primary care clinic for Postgraduate Year One (PGY1) Community-based Pharmacy Residents to provide patient care under general supervision of the physician. PRACTICE INNOVATION: Patients were offered CGM services if they were 18+ years with an HbA1c > 7.0% and had insurance coverage for CGM. Enrolled patients engaged in three months of pharmacist-led appointments for CGM application, data interpretation, diabetes education, and lifestyle management. Current Procedural Terminology (CPT) codes 99211, 95250, or 95251 were billed based on each encounter. HbA1c values were collected at program enrollment and conclusion. Patients completed a satisfaction survey at program conclusion. EVALUATION METHODS: Demographics and billed CPT codes were collected from the electronic health record. Descriptive statistics were used to analyze data. RESULTS: Eighteen patients were included. A mean reduction of 1.2% occurred in HbA1c (n = 12; 9.7%-8.5%). Forty CPT codes were billed, generating $3671.40 of revenue. Satisfaction surveys were collected for 50% of participants (n = 9). Most were satisfied with the CGM service and its individual components (n = 8, 89%). Most were willing to continue using CGM devices and receive diabetes education from a pharmacist (n = 8, 89%). CONCLUSION: A community-based pharmacist-led CGM service demonstrated a reduction in HbA1c and generated revenue for the clinic. Patients reported satisfaction and willingness to continue the service.

Patient Willingness to Use a Pharmacy-Based Colorectal Cancer Screening Service: A National Survey of U.S. Adults.

BACKGROUND: We aimed to understand U.S. adults' willingness to use a pharmacy-based fecal immunochemical test (FIT) distribution service for routine colorectal cancer screening called PharmFIT using Diffusion of Innovation Theory, evaluating patient's appraisals of the program's relative advantage, compatibility, and complexity. METHODS: From March to April 2021, we conducted a national online survey of 1,045 U.S. adults ages 45 to 75. We identified correlates of patient willingness to use PharmFIT using structural equation modeling. RESULTS: Most respondents (72%) were willing to get a FIT from their pharmacy for their regular colorectal cancer screening. Respondents were more willing to participate in PharmFIT if they perceived higher relative advantage ($\hat{\beta}$= 0.184; confidence interval, CI95%: 0.055-0.325) and perceived higher compatibility ($\hat{\beta}$ = 0.422; CI95%: 0.253-0.599) to get screened in a pharmacy, had longer travel times to their primary health care provider ($\hat{\beta}$ = 0.007; CI95%: 0.004-0.010). Respondents were less willing to participate in PharmFIT if they were 65 years or older ($\hat{\beta}$ = -0.220; CI95%: -0.362 to -0.070). CONCLUSIONS: Most U.S. adults would be willing to participate in PharmFIT for their routine colorectal cancer screening. Patient perceptions of the relative advantage and compatibility of PharmFIT were strongly associated with their willingness to use PharmFIT. Pharmacies should account for patient preferences for these two traits of PharmFIT to increase adoption and use. IMPACT: Pharmacy-based colorectal cancer screening may be a viable public health strategy to significantly increase equitable access to screening for U.S. residents.

The Report of the 2022-2023 AACP Professional Affairs Standing Committee: Focused Integration of Community-Based Pharmacy Practice Within the AACP Transformation Center.

The 2022-2023 Professional Affairs Committee was charged to (1) Devise a framework and 3-year workplan for the Academia-Community Pharmacy Transformation Pharmacy Collaborative to be integrated within the American Association of Colleges of Pharmacy (AACP) Transformation Center. This plan should include the focus area(s) to be continued and developed by the Center, potential milestone dates or events, and necessary resources; and (2) Provide recommendations on focus areas and/or potential questions for the Pharmacy Workforce Center to consider for the 2024 National Pharmacist Workforce Study. This report provides the background and methodology utilized to develop the framework and 3-year workplan focused on (1) community-based pharmacy pipeline development for recruitment, programming, and retention, (2) programming and resources for community-based pharmacy practice, and (3) research areas for community-based pharmacy practice. The Committee offers suggested revisions for 5 current AACP policy statements, 7 recommendations pertaining to the first charge, and 9 recommendations pertaining to the second charge.

Patient preferences for the design of a pharmacy-based colorectal cancer screening program.

PURPOSE: To assess preferences for design of a pharmacy-based colorectal cancer (CRC) screening program (PharmFIT™) among screening-eligible adults in the United States (US) and explore the impact of rurality on pharmacy use patterns (e.g., pharmacy type, prescription pick-up preference, service quality rating). METHODS: We conducted a national online survey of non-institutionalized US adults through panels managed by Qualtrics, a survey research company. A total of 1,045 adults (response rate 62%) completed the survey between March and April 2021. Sampling quotas matched respondents to the 2010 US Census and oversampled rural residents. We assessed pharmacy use patterns by rurality and design preferences for learning about PharmFIT™; receiving a FIT kit from a pharmacy; and completing and returning the FIT kit. RESULTS: Pharmacy use patterns varied, with some notable differences across rurality. Rural respondents used local, independently owned pharmacies more than non-rural respondents (20.4%, 6.3%, p < 0.001) and rated pharmacy service quality higher than non-rural respondents. Non-rural respondents preferred digital communication to learn about PharmFIT™ (36% vs 47%; p < 0.001) as well as digital FIT counseling (41% vs 49%; p = 0.02) more frequently than rural participants. Preferences for receiving and returning FITs were associated with pharmacy use patterns: respondents who pick up prescriptions in-person preferred to get their FIT (OR 7.7; 5.3-11.2) and return it in-person at the pharmacy (OR 1.7; 1.1-2.4). CONCLUSION: Pharmacies are highly accessible and could be useful for expanding access to CRC screening services. Local context and pharmacy use patterns should be considered in the design and implementation of PharmFIT™.

Impact of a statewide community pharmacy approach to opioid harm reduction.

BACKGROUND: The past several years have seen sharp increases in opioid overdose mortality. Harm reduction resources, such as nonprescription syringes and naloxone, are used to save lives. OBJECTIVES: To develop a statewide approach to increase the use of opioid harm reduction services through community pharmacies. PRACTICE DESCRIPTION: The North Carolina Association of Pharmacists was awarded a grant to address opioid mortality across the state, using community pharmacies to address opioid use disorder. PRACTICE INNOVATION: A statewide, standardized approach was implemented to increase knowledge and use of opioid harm reduction resources in the community pharmacy setting. EVALUATION METHODS: Pharmacies were offered training related to harm reduction. Participating pharmacies provided monthly updates related to staff training, syringe access status, naloxone kits distributed, and comments about how the training was changing their practice. At the project conclusion, pharmacies provided retrospective naloxone dispensing data along with naloxone dispensing during the intervention period. Pharmacies shared the greatest benefit of the program, a potential change to make implementation simpler, and the biggest change in the pharmacist(s) as a result of the project. Descriptive statistics were used to analyze data. RESULTS: A total of 58 pharmacies across 33 counties participated in the harm reduction project. Of the 100 North Carolina counties, 15 counties were identified as high-need, and 14 of the 15 high-need counties (93%) participated in this project. Of the 58 participating pharmacies, 40 pharmacies (69%) had or implemented a nondiscriminatory nonprescription syringe policy within their pharmacy. During the baseline period (January 1, 2018, to June 15, 2018), 177 prescriptions for naloxone were dispensed by participating pharmacies. During the intervention period (January 1, 2019, to June 15, 2019), 639 prescriptions for naloxone were dispensed, representing a 361% increase in naloxone dispensing. CONCLUSION: The successful implementation of a standardized, statewide approach increased access to harm reduction services.

An Exploration of Preceptor-Provided Written Feedback on Entrustable Professional Activities During Early Practice Experiences.

Objective. To explore and evaluate open-ended feedback on entrustable professional activities (EPAs) provided by preceptors to Doctor of Pharmacy (PharmD) students completing their first practice experience.Methods. A retrospective review was conducted of qualitative data collected from preceptor evaluations of student pharmacists who had completed a two-month practice experience in either community or health-system pharmacy at the end of their first professional year. Preceptors had used a validated EPA framework to assess students. A codebook was developed around the EPA framework and sub-coding was used to indicate positive, negative, or neutral assessment within each EPA. After several rounds of coding, consensus was reached for all codes by two investigators. A dependability audit was implemented to ensure the trustworthiness of the findings.Results. Preceptor evaluations of 153 student pharmacists were included in the study. Eighty students (52.3%) had completed a community experience and 73 (47.7%) had completed a health-system experience between May and August 2018. The preceptors at both practice settings provided overwhelmingly positive feedback on all EPAs. Opportunities to optimize preceptor-provided feedback were identified. The feedback provided by the preceptors in health-system and community practice settings focused on knowledge and behavior, respectively, with both emphasizing students' skill-based performance.Conclusion. This study provides valuable insight into optimizing preceptor-provided written feedback on EPAs. Conducting deeper analysis of preceptor feedback using focus groups or structured interviews is suggested to further explore preceptors' provision of EPA assessment to student pharmacists practicing in real-world settings.

Implementation of a community-based pharmacist-run attention deficit hyperactivity disorder clinic in a college health center.

BACKGROUND: Published evidence is lacking to describe the pharmacist's role in medication management within an attention deficit hyperactivity disorder (ADHD) specialty clinic. OBJECTIVES: The objectives were (1) to measure the growth of an ADHD clinic in a college health center after the integration of clinical pharmacists and (2) to evaluate provider adherence to clinic policies and procedures before and after pharmacist integration. PRACTICE DESCRIPTION: In 2017, a pharmacist-run ADHD clinic was established at a college campus. PRACTICE INNOVATION: Pharmacists conducted collaborative initial visits with psychiatrists and independently provided follow-up appointments for patients with ADHD. EVALUATION METHODS: Data were extracted from the electronic health record for patients aged 18 years or older with an ADHD diagnosis who completed a medication evaluation or medication follow-up visit from July 1, 2016 to June 30, 2019. Data were excluded if it was for another visit type, was a non-ADHD clinic provider visit, or if the visit note was classified. Data before the pharmacist integration (July 1, 2016-June 30, 2017) were compared with data after the pharmacist integration (July 1, 2017-June 30, 2019). Chi-square tests of independence evaluated differences in blood pressure monitoring, heart rate monitoring, and stimulant medication contract signature between psychiatrist- and pharmacist-run appointments. RESULTS: Pharmacist presence in the ADHD clinic increased from 0 full-time equivalent (FTE) to 0.2 FTE over 3 years. The number of appointments increased by 1003% (from 26 to 287). Compared with psychiatrist-run appointments, pharmacist-run appointments were more adherent to monitoring blood pressure (11% vs. 77%, P < 0.001) and heart rate (6% vs. 75%, P < 0.001), as well as clinic policy requiring a patient's signature on a stimulant medication contract (64% vs. 75%, P = 0.019). CONCLUSION: Pharmacists can assist psychiatrists in medication management of ADHD in the college health setting. A pharmacist-psychiatrist collaboration increased quality of care and monitoring of medication adverse effects.

Analysis of provider-generated revenue and impact on medication reconciliation from a pharmacist-led chronic care management service.

BACKGROUND: Published data on pharmacist-provided chronic care management (CCM) services is limited, particularly for programs led by community-based pharmacists. OBJECTIVE: The objective was to quantify the total revenue generated from a community pharmacist-led CCM service, including CCM billing and appointment referrals. A second objective was to identify the types and frequencies of medication discrepancies identified during medication reconciliation. PRACTICE DESCRIPTION: Realo Drugs is a group of 18 independent community pharmacies serving eastern North Carolina. PRACTICE INNOVATION: Exploration of revenue generated from a community pharmacist-led CCM service. EVALUATION METHODS: This retrospective analysis assessed interventions completed by pharmacists between April 1, 2018 through June 30, 2019. Data was extracted from the electronic health record (EHR), including revenue generated from CCM billing codes, appointment referrals made by the pharmacist resulting in a completed in-office appointment, and which patients received medication reconciliation. The types and frequencies of medication discrepancies were documented, including medication no longer being used by the patient, medication omission, and strength or dose mismatch. Descriptive statistics were used to analyze data. RESULTS: Over 15 months with a total of 112 patients, a total of $26,148 was generated from CCM services, representing an average of $15.56 per patient per month. The majority (approximately 80%) of the revenue was generated from noncomplex patient encounters. Of the 239 medication reconciliations completed, 609 medication discrepancies were identified. The majority of medication discrepancies (67%) were categorized as "patient no longer takes medication listed on EHR medication list." The second most common discrepancy was "patient takes medication not listed on the EHR medication list" (22%), followed by "strength/dose mismatch" (10%). CONCLUSION: These data can demonstrate to provider partners the sources of revenue that can be provided through CCM services. In addition to revenue, pharmacists can positively impact patient care through identification of medication discrepancies through medication reconciliation.

Analysis of prior authorization success and timeliness at a community-based specialty care pharmacy.

BACKGROUND: Specialty medications may require a prior authorization (PA) before a patient can access the medication. Providers often identify PA approval as a burden for the practice. Pharmacists can facilitate the completion of the PA process. OBJECTIVE: The primary objective was to evaluate the time to first PA decision (approval or denial) for dermatologic medications dispensed by a community-based specialty pharmacy. A secondary objective was to compare PA timeliness (time to PA approval and time to first medication fill) between a community-based specialty pharmacy and a dermatology provider office. PRACTICE DESCRIPTION: Realo Specialty Care is a community-based independent specialty pharmacy that provides comprehensive care to patients with complex and chronic conditions such as plaque psoriasis, hidradenitis suppurativa, and atopic dermatitis. Pharmacy services include PA assistance, comprehensive medication management, patient education, and adherence monitoring. PRACTICE INNOVATION: Pharmacy dispensing system data were used to conduct a retrospective analysis of the effectiveness at resolving PA requests. PAs are traditionally completed by a provider's practice, and data are documented within the pharmacy system as a PA task. EVALUATION METHODS: Data included PA tasks for dermatology prescriptions for patients aged 18 years or older between January 1, 2017, and June 30, 2019. Initial receipt of the prescription, PA decision, and PA decision date were noted in the PA task and confirmed via fax documentation. The date of first fill was confirmed by prescription data. RESULTS: The pharmacy completed 677 PA tasks with a mean time to PA decision of 1.9 days, whereas the provider's office averaged 20.9 days (P < 0.001). The pharmacy demonstrated a mean time to first fill of 6.6 days, whereas the provider's office averaged 16.2 days (P < 0.001). CONCLUSION: Pharmacies can effectively complete PAs to expedite the filling process for patients and increase medication access. Provider practices could benefit from delegating these tasks to a partnered pharmacy.

Community-based pharmacy use of the Pharmacist eCare Plan: A retrospective review.

BACKGROUND: Pharmacists in community-based settings document patient care using the Pharmacist eCare Plan (PeCP). OBJECTIVE: To conduct a pilot evaluation of the PeCP use and documentation of Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes within select community-based pharmacies. PRACTICE DESCRIPTION: Moose Pharmacy operates 7 locations in rural North Carolina that are part of the Community Pharmacy Enhanced Services Network (CPESN). The Moose Pharmacy Medication Adherence Program (MooseMAP) targets patients with a chronic condition who would benefit from medication synchronization, adherence packaging, and monthly calls. PRACTICE INNOVATION: CPESN pharmacies use the PeCP to track a patient's concerns, goals, interventions, and medication-related information. The PeCP standard requires pharmacies to detail a patient's current medication regimen and health concerns as well as the pharmacy's interventions and patient's health over time. EVALUATION METHODS: Data were included if the patient was enrolled in MooseMAP and had a free-text note in the eCare Plan. Data were excluded if the medication-related problem (MRP) or intervention was a general health problem without a valid SNOMED CT code. Data were categorized into MRPs, medication interventions, education, and referrals. The International SNOMED CT browser and pharmacy health information technology (PHIT) value sets were searched; data sets without existing codes were submitted to the appropriate oversight authorities for future inclusion. Data were analyzed using descriptive statistics. RESULTS: Emerging codes were identified that resulted in 91 recommendations to PHIT for development of new SNOMED CT codes and 113 recommendations to PHIT for inclusion in the PHIT value sets. In total, 66% of MRPs did not have a valid SNOMED CT code, and 78% of MRPs were not included in a PHIT value set. The most prevalent gap in MRP or intervention documentation related to medication use issues. CONCLUSION: Incorporating emerging codes into documentation systems should enable the profession to better communicate value to health care stakeholders.

A systematic review of the role of pharmacists in vaccination services in low-and middle-income countries.

BACKGROUND: Pharmacists' role in vaccination has expanded in some countries with pharmacists having greater authority to perform various immunization activities, from vaccine storage, vaccine adverse event reporting, vaccination education and advocacy, to vaccine administration. However, pharmacists' present involvement in vaccination services is poorly understood across low- and middle-income countries (LMICs). OBJECTIVE: To identify and synthesize evidence on pharmacists' roles in offering vaccination services in LMICs. METHODS: We searched three databases (PubMed, Embase, Scopus) and the gray literature to identify articles which described pharmacist involvement in vaccination services in LMICs. We abstracted data on reported roles of pharmacists in vaccination, as well as relevant country, vaccines, and populations served. RESULTS: From the initial 612 records we identified, twenty-five (n = 25) studies representing 25 LMICs met our inclusion criteria. The most commonly reported role of pharmacists in vaccination across identified LMICs was vaccine advocacy and education (n = 15 countries). Pharmacist administered vaccination and storage of vaccines at pharmacies was reported in 8 countries. An additional 6 countries reported allowing vaccination at community pharmacies by other healthcare professionals. Immunization related training for pharmacists was reported or required in 8 countries. Fewer studies reported that pharmacists have access to patient immunization records in their respective LMICs (n = 6 countries) or had reported pharmacist involvement in vaccine adverse event reporting (n = 4 countries). CONCLUSIONS: Pharmacists have the potential to play an important role in increasing access to vaccines and improving coverage, yet evidence of their role in vaccinations remains limited across LMICs. Greater documentation of pharmacists' involvement in vaccination services in LMICs is needed to demonstrate the value of successful integration of pharmacists in immunization programs.

Role of Pharmacists in Hormonal Contraceptive Access: A Survey of North Carolina Pharmacists.

The role of pharmacy in healthcare continues to evolve as pharmacists gain increased clinical responsibilities in the United States, such as the opportunity to prescribe hormonal contraception. Currently, North Carolina (NC) pharmacists do not have this ability. While previous research focused on the perceptions of community pharmacists surrounding this practice, no previous research surveyed all pharmacists in a state. This cross-sectional, web-based survey was distributed to all actively licensed pharmacists residing in the state of NC in November 2018. The primary objective was to determine the likelihood of NC community pharmacists to prescribe hormonal contraception. Secondary outcomes included: evaluation of all respondent support and perceptions of this practice as advocacy occurs on the state organization level and unified support is critical; opinions regarding over-the-counter (OTC) status of contraception; and potential barriers to prescribing. Overall, 83% of community pharmacists were likely to prescribe hormonal contraception. No differences in likelihood to prescribe were detected between geographic settings. Community pharmacists reported that the most common barriers to impact prescribing were added responsibility and liability (69.8%) and time constraints (67.2%). Fewer than 10% of respondents felt that hormonal contraception should be classified as OTC (7.9%). Noncommunity pharmacists were significantly more likely to agree that prescribing hormonal contraception allows pharmacists to practice at a higher level, that increased access to hormonal contraception is an important public health issue, and that rural areas would benefit from pharmacist-prescribed hormonal contraception. Overall, this study found a willingness to prescribe and support from the majority of both community and noncommunity pharmacists. Limitations of the study included a low response rate and potential nonresponse bias. Future research is needed to address solutions to potential barriers and uptake of this practice, if implemented.

Using pharmacy technicians to maximize pharmacist intervention with home health service patients.

OBJECTIVES: The objectives of this study were to assess 30- and 60-day hospitalizations and to determine the number of medication therapy problems (MTPs) identified during pharmacy technician-driven medication reconciliation for high- to very high-risk home health patients. SETTING: The study was conducted in 8 independent community pharmacy locations. PRACTICE DESCRIPTION: Realo Discount Drugs is a group of 16 independent community pharmacies serving eastern North Carolina. PRACTICE INNOVATION: Realo Discount Drugs partnered with Well Care Home Health to provide medication reconciliation services to high- and very high-risk patients. A pharmacy technician contacts the patient to obtain an accurate medication list and complete a falls risk assessment and depression screening. The technician updates the medication list, allergies, and vaccination status in the electronic health record (EHR). The pharmacist reviews the medication list for completeness; assesses for falls risk, depression, and medication interactions; and generates communication to the provider for clarifications or recommendations, if needed. Additional counseling points that need to be conveyed to the patient by the home health nurse are documented in the EHR. EVALUATION: Thirty- and 60-day hospitalizations for enrolled patients were manually pulled from documented transfers in the EHR and compared with data from a third-party administrator. MTPs were categorized by the pharmacist and documented. Descriptive statistics were used to evaluate the data collected. RESULTS: At 30 days from the start of care, 13.4% (93/695) of patients who received pharmacy services were hospitalized compared with 26.8% (143/534) of patients who did not receive pharmacy services (P < 0.01). At 60 days from the start of care, 20.9% (145/695) of patients who received pharmacy services were hospitalized compared with 33.3% (178/534) of patients who did not receive pharmacy services (P < 0.01). CONCLUSION: A technician-driven medication reconciliation process led to a reduction in hospitalizations and identified MTPs in home health patients.

Impact of quality measures performed through pharmacist collaboration with a primary care clinic.

OBJECTIVE: The objective was to assess the clinical and financial impact of a pharmacist integrated within a primary care practice on quality measures of the merit-based incentive payment system (MIPS). SETTING: The study was conducted in a multidisciplinary primary care practice in Charlotte, NC. PRACTICE DESCRIPTION: A collaborating pharmacist from an independent community pharmacy is integrated within clinic workflow. In this team-based model, pharmacists work alongside providers to furnish comprehensive care, focusing on MIPS quality measure improvement through Medicare annual wellness visits (AWVs) and chronic care management (CCM). PRACTICE INNOVATION: Quality measure achievement was assessed from completed face-to-face AWVs, phone call CCM, or both. EVALUATION: From January 1, 2017, to December 31, 2018, 403 patients in 2017 and 565 patients in 2018 were eligible to be seen by the collaborating pharmacist for either an AWV, CCM, or both services. Measure achievement was characterized using descriptive statistics. Billing reports were used to determine the average monthly dollar amount of Medicare Part B claims submitted. RESULTS: The percentage of patients achieving quality measures increased for 3 measures, decreased for 2 measures, and was neutral for 1 measure. The percentage of patients achieving quality measures resulted in a MIPS quality performance score of 60 of 60 points, which contributed to a final MIPS score of 100 of 100 points and a positive (+) 1.88% payment adjustment in 2019. Extrapolating from previous volume, the provider's total MIPS payment adjustment may result in an additional $16,920 in annual reimbursement. CONCLUSION: Pharmacist-provided collaborative clinical services in the primary care setting appear to ensure achievement of MIPS quality measure benchmarks, potentially increasing the practice's annual MIPS reimbursement by $16,920.