Coaching strategies for the Flip the Pharmacy practice transformation initiative in Pennsylvania independent community pharmacies.

BACKGROUND: Flip the Pharmacy (FtP) is a nationwide initiative to scale practice transformation in community pharmacies. Participating pharmacies are coached through monthly practice transformation initiatives and document their patient-care activities through Pharmacist electronic Care (eCare) Plans. OBJECTIVES: The objective of this study was to identify peer coaching strategies to facilitate practice transformation in Pennsylvania community pharmacies. METHODS: This was a qualitative study using semistructured interviews with practice transformation coaches and pharmacy champions participating in Pennsylvania's FtP program. The interview guide was informed by the Consolidated Framework for Implementation Research and elicited information using the intervention characteristics, inner setting, characteristics of individuals, and process domains. Interviews were conducted in person or via telephone over a 3-month period. An inductive qualitative thematic analysis was performed to identify coaching strategies. RESULTS: A total of 18 key informants were interviewed: 6 pharmacy champions and 12 practice transformation coaches. The following 5 coaching strategies emerged: (1) learn to use the pharmacy's specific Pharmacist eCare Plan software, (2) build a trusting relationship with the pharmacy, (3) engage all pharmacy team members in practice transformation, (4) adapt communication strategies to the pharmacy's preference, and (5) tailor goals to the pharmacy's stage of practice transformation. CONCLUSION: This study elicited 5 peer coaching strategies to support community pharmacy practice transformation initiatives. These findings can be used to further practice transformation efforts in community pharmacies through FtP and other initiatives aimed at expansion of community pharmacy patient care services.

Implementation of a Health Risk Assessment into Workflow of the Appointment-Based Model at an Independent Community Pharmacy.

Health risk assessments (HRAs) are tools used to collect information on patients' current health conditions, personal and family medical history, and lifestyle factors that can impact their overall health. The objectives of this pilot project were to implement an HRA as part of the appointment-based model workflow and to assess the resulting pharmacy-patient-care service opportunities. Sixteen HRA questions from a single health plan were incorporated into the appointment-based model workflow at an independent community pharmacy. Questions were administered either telephonically or in person over two patient encounters. Pharmacy staff were trained on how to administer the HRA, what to do if patients needed immediate assistance, how to provide referrals, and how to document of responses. Forty-nine patients were contacted and 38 (77.6%) completed the HRA. The median time for HRA completion was 19 min and the identified opportunities were vaccination (49), smoking cessation (15), diabetes prevention program (14), asthma control assessments (8), and substance use disorder screening and referral (3). This pilot project demonstrates that community pharmacies can implement HRAs and utilize the results to identify new pharmacy-patient-care service opportunities that can contribute to improved patient care and practice sustainability.

Impact of a Medication Adherence Packaging Service on Patient-Centered Outcomes at an Independent Community Pharmacy.

The purpose of this project was to evaluate the impact of a comprehensive medication adherence packaging (RxMAP) service on patient medication-taking behaviors and patient-centered outcomes. Adult patients who utilized a single independent community pharmacy, enrolled in the RxMAP service for at least two consecutive cycles, and managed their own medications were eligible. The RxMAP service consists of multi-dose blister packaging in 28-day cycles, medication synchronization, monthly touchpoint calls, and delivery/mailing. A 13-item telephonic survey was administered, and patients' verbal responses were captured by audio-recording and detailed note taking. Descriptive statistics were used to quantify the results and illustrative quotes representing the interview domains were selected. There were 42 patients who completed the survey: 88% reported they missed fewer doses compared to before using RxMAP; 71% were more likely to take their medications on time each day; 86% were more confident with managing their medications; and 74% were more independent. Finally, 64% of patients stated their overall quality of life was better now compared to before using the packaging service. These results demonstrate that medication adherence packaging services can positively impact patients' medication-taking behaviors, increase their confidence in medication management, and improve perceived quality of life.

A Student Pharmacist Quality Engagement Team to Support Initial Implementation of Comprehensive Medication Management within Independent Community Pharmacies.

In 2017, the Pennsylvania Pharmacists Care Network (PPCN), an enhanced pharmacy services network, and STRAND Clinical Technologies partnered to launch a payor contract with a Pennsylvania Medicaid Managed Care Organization for the provision of comprehensive medication management (CMM) at PPCN pharmacies. PPCN and the Community Leadership and Innovation in Practice Center at the University of Pittsburgh School of Pharmacy partnered to create the Quality Engagement Team (QET), a group of student pharmacists formed with the intent to support the initial implementation of this contract. The QET supported the pharmacies through biweekly phone calls, which led to increased pharmacist engagement and produced impactful patient encounter stories that were then reported back to the payor. We utilized Active Implementation Frameworks and select implementation strategies from the Expert Recommendations for Implementing Change project throughout the implementation period. The QET supported the successful implementation of this payor contract, which saw an increase in CMM encounters completed by the pharmacists during each month of the four-month contract period. Students, pharmacists and the payor each derived meaningful benefits from this initiative. Student pharmacists can be a powerful asset in the implementation of payor programs within an enhanced pharmacy services network, resulting in the mutually beneficial and sustainable support of the network.

Stakeholder-Guided Formation of a Statewide Community Pharmacy Practice-Based Research Network.

Community pharmacies across the United States are forming clinically integrated networks (CINs) to facilitate the provision of patient-centered care. These networks need to continually innovate and demonstrate how their patient care services positively impact health outcomes. One way to do this is to develop a practice-based research network (PBRN) in partnership with existing CINs to perform robust outcome evaluations. The objective of this study was to learn pharmacists' opinions on participating in research to facilitate the formation of a community pharmacy PBRN in Pennsylvania. A 20-item survey gathered information on pharmacists' research interests, perceived benefits of research participation, and preferences on communication and patient engagement. Descriptive statistics and Chi-square tests were used to analyze quantitative data. Seventy-three participants completed the survey, with 47% representing independent pharmacies. The majority (96%) were interested in research opportunities and 86% believed improving workflow and patient care was the most valuable benefit. Eighty percent of pharmacists reported it is very important to demonstrate that pharmacists care about making patients' health better. Connecting pharmacists with other health care providers was reported as very important by 75% of respondents. Pharmacists reported face-to-face communication (76%) as their preferred way to approach patients about research and 72% supported using student pharmacists to assist with patient engagement. The results from this study can inform others who are structuring processes and developing communication strategies for community pharmacy PBRNs, particularly in partnership with CINs.

Facilitating pandemic influenza vaccination implementation in grocery store chain community pharmacies.

OBJECTIVE: The objective of this study was to determine strategies to implement influenza pandemic vaccinations effectively at grocery store chain community pharmacies. METHODS: Clinical pharmacy coordinators and pharmacy managers representing 3 grocery store chain community pharmacies across Pennsylvania were identified for participation in semistructured telephone interviews. Interviews were audio-recorded and transcribed. Transcripts were independently coded by 2 investigators and coding discrepancies were resolved. A thematic analysis was conducted, and supporting quotes were selected for each theme. RESULTS: Twelve pharmacists participated in the interviews, which were conducted from September 2016 to November 2017. Five key themes were identified: (1) mobilize pharmacy staff members to specific locations to prepare for a high volume of vaccinations; (2) implement vaccination clinics during high-volume scenarios; (3) utilize nonpharmacy spaces to increase vaccination capabilities; (4) determine vaccine distribution by highest risk populations that each pharmacy serves; and (5) conduct training customized to the pharmacy chain that supplements national pandemic influenza training. CONCLUSION: Grocery store chain community pharmacies are desirable sites for pandemic vaccination because of a variety of factors, such as space and staffing flexibility. Developing a pandemic vaccination plan will enable community pharmacists to contribute more effectively during influenza pandemics.

Implementation of comprehensive medication management at supermarket pharmacies in a pharmacy network.

OBJECTIVE: To garner experience with the early implementation of pharmacist-provided comprehensive medication management at a regional supermarket pharmacy during the initial launch of a statewide community pharmacy enhanced services network payer contract. METHODS: A series of key informant interviews were conducted with pharmacists at Giant Eagle Pharmacy locations in Pennsylvania. To be eligible to participate, pharmacists must have been trained by the Pennsylvania Pharmacists Care Network to deliver contracted comprehensive medication management services and willing to participate in audio recorded, telephonic interviews every 2 weeks. Interviews concluded when each pharmacist completed a total of 6 interviews or when the project period ended. A semistructured interview guide was developed by the investigators to elicit the pharmacists' experience providing contracted services. Interviews were transcribed and coded by 2 independent investigators. Coding discrepancies were resolved. The final coded transcripts were presented back to the project team to identify and finalize major themes. Illustrative quotes were selected to represent each theme. RESULTS: Interviews from 10 pharmacists were included in the analysis. Five themes emerged as keys of successful early implementation: (1) promote commitment of the pharmacy team, (2) use effective whole-team patient engagement strategies, (3) personalize patient encounters by providing patient-centered care and practicing interpersonal skills, (4) make workflow and staffing resources easily accessible, and (5) make clinical patient care tools readily available. CONCLUSION: These results highlight thematic trends for how pharmacists can successfully engage their patients in contracted comprehensive medication management services. Understanding the success of early implementation at a regional supermarket pharmacy can serve as a framework for other participants in community pharmacy enhanced services networks to replicate and scale contracted patient care services.

Using prescription dispensing data infographics to facilitate collaborative pharmacist-prescriber discussions on mutual patients.

OBJECTIVE: To develop prescriber-specific infographics containing community pharmacy prescription dispensing data and share them with targeted prescribers to determine their utility in facilitating initial collaborative conversations regarding the care of mutual patients. METHODS: Prescription dispensing data from an independent community pharmacy in western Pennsylvania was collected to generate highly visual infographics for the most frequent prescribers to the pharmacy. Infographics were individualized for prescribers, and they included information on mutual patients between the pharmacy and the prescriber. Infographics were then shared with prescribers during semistructured, audio-recorded interviews. Interview questions elicited feedback on prescriber medication-related needs, quality and performance measures, infographic format and utility, and prescriber-pharmacist collaboration. Interviews were transcribed and coded by 2 independent investigators using qualitative analysis software. Coding discrepancies were resolved. A thematic analysis of the interview data was conducted. RESULTS: Eight interviews were conducted with prescribers. The following themes emerged: (1) the infographic prompted prescribers to recognize potential collaborative opportunities with community pharmacists; (2) the infographic stimulated discussion on prescribing patterns and mutual patient populations; (3) prescribers value discussing the infographic data in a face-to-face meeting; (4) prescribers want to hear from pharmacists when mutual patients have medication-related problems; and (5) the infographic helped prescribers identify quality measures that they were not currently meeting. CONCLUSION: Infographics containing prescription dispensing data for mutual patients may be a useful tool when shared by community pharmacists to facilitate collaborative discussions with prescribers.

Evaluation of targeted human papillomavirus vaccination education among undergraduate college students.

Objective: To design and evaluate pharmacy student-led educational sessions to improve health beliefs about the HPV vaccine in college-aged students. Participants: Students aged 18-26 attending a large, urban university, including 545 respondents to a December 2014 needs assessment survey about HPV-related health beliefs, 131 students participating in educational sessions during 2015-2016 (intervention group), and 369 undergraduate respondents completing the needs assessment survey (control group). Methods: A needs assessment survey was conducted to inform design and implementation of pharmacy student-led educational sessions. A similar survey was administered to students after attending educational sessions. Health beliefs were compared for the intervention versus control group. Results: The intervention group was less likely to report high perceived barriers to HPV vaccination and more likely to report high perceived benefits and intention to vaccinate (if previously unvaccinated). Conclusions: Pharmacy student-led, health belief-based educational sessions were associated with improved health beliefs about HPV vaccination.

Pharmacist-Delivered Comprehensive Medication Management Within Family Medicine Practices An Evaluation of the SCRIPT Project.

BACKGROUND AND OBJECTIVES: Pharmacist inclusion in patient-centered medical home (PCMH) teams has been shown to benefit both patients and practices. However, pharmacists' inclusion on these teams is not widespread, partly because the work they do is not well known. The Successful Collaborative Relationships to Improve PatienT care (SCRIPT) project was started in August 2009 to understand the clinical and economic impact of pharmacists providing direct patient care. The objective of this study was to describe the work of pharmacists practicing as integrated members of the patient care team within PCMHs through retrospective analysis of their patient care documentation over a 4-year time frame. Two pharmacists were placed into four suburban medical home practices in Pittsburgh, Pennsylvania to perform comprehensive medication management (CMM). These pharmacists documented their CMM encounters in an electronic health record and a database for reporting purposes. METHODS: This study is a retrospective, descriptive analysis of pharmacist-documented CMM encounters from February 2010 through February 2014. Pharmacists' work-including patient demographics, disease states, and medication therapy problems-was recorded in a Microsoft Access database and tabulated. RESULTS: The pharmacists conducted 11,206 CMM encounters with 3,777 unique patients during the study period. The pharmacists identified 9,375 medication therapy problems (MTPs) and performed 14,092 interventions. Pharmacists most commonly worked with patients with diabetes, hypertension, pain, and hyperlipidemia. Physician and patient acceptance of the pharmacists' work was high. CONCLUSIONS: Pharmacists working in family medicine offices contribute to patient care through identification and resolution of MTPs and also by collaborating with PCMH teams.

An Analysis of Community Pharmacy Shared Faculty Members' Contributions to Teaching, Service, and Scholarship.

Objective. To identify community pharmacy shared faculty members across the United States and to describe their roles and responsibilities in terms of teaching, service, and scholarship. Methods. This study was a mixed-methods analysis using surveys and key informant interviews. Results. Twenty-two faculty members completed the survey; nine were interviewed. Their major roles and responsibilities included teaching in community-based and experiential learning courses, precepting students and/or residents, being actively involved in professional organizations, providing patient care while leading innovation, and disseminating findings through scholarship. Conclusion. Community pharmacy shared faculty members contribute to their academic institutions and community pharmacy organizations by educating learners, providing direct patient care, and advancing community practice through innovation and service to the profession. Findings of this study can be used as a guide for academic institutions and community pharmacy organizations interested in partnering to develop a community pharmacy shared faculty position.

Strategies to facilitate the implementation of collaborative practice agreements in chain community pharmacies.

OBJECTIVES: The objectives of this study were to describe (1) key factors affecting the implementation and scalability of collaborative practice agreements (CPAs) and (2) CPA implementation strategies that have been used by chain community pharmacy organizations. DESIGN: Qualitative analysis using a work system approach. SETTING: Eight chain community pharmacy organizations with at least one pharmacy location in New York, Ohio, Pennsylvania, or West Virginia from August 2014 to March 2015. PARTICIPANTS: Ten clinical pharmacist managers and 9 practicing community pharmacists. INTERVENTION: Semistructured interviews with study participants. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work system and patient safety. MAIN OUTCOME MEASURES: Clinical pharmacist managers' and community pharmacists' perceptions of key factors and strategies for implementing and scaling CPAs, tools, and resources that could facilitate the implementation of CPAs. RESULTS: Seven themes emerged as key factors for the implementation and scalability of CPAs within the person, organization, external environment, and task domains of the SEIPS model, which include the need for building relationships with physicians and other health care providers, optimizing pharmacists' education and training, addressing patient perceptions, ensuring consistent operations, developing a sustainable business model, advocating for permissive state and federal legislation, and structuring time and workload. Examples of specific strategies included using existing physician relationships, identifying pharmacy- and regional-level champions, and allocating staffing based on prescription volume and clinical services. CONCLUSION: A number of key factors were identified that, when addressed, can facilitate the implementation and scalability of patient care services and CPAs. Chain community pharmacies should use the specific strategies for addressing each key factor that match the needs of their organization.

Fellowships in community pharmacy research: Experiences of five schools and colleges of pharmacy.

OBJECTIVE: To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. SETTING: Five schools and colleges of pharmacy in the United States. PRACTICE DESCRIPTION: Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. PRACTICE INNOVATION: Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. EVALUATION: Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. RESULTS: Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. CONCLUSION: Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice.

Mobile application features sought after by patients of a regional grocery store chain pharmacy.

OBJECTIVE: To determine the mobile application features for pharmacy services sought after by patients of a grocery store chain pharmacy. METHODS: Key informant interviews were conducted at 5 Giant Eagle Pharmacy locations in the Greater Pittsburgh area. Patients older than 35 years who receive 1 prescription monthly from Giant Eagle and use a smartphone daily were eligible to participate. Interviews were audio recorded, and transcripts underwent thematic analysis. RESULTS: Twenty-four interviews were conducted from February to March 2014. The average age of participants was 51 years. About one-half of the participants (46%) were currently using mobile applications to manage their health. Three themes emerged regarding patients' desires for a mobile application: design that fosters an improved, convenient pharmacy experience; features that support the self-management of health; and design that increases personalized, timely access to pharmacists. CONCLUSION: This qualitative analysis revealed that pharmacy patients desire a mobile application that improves the convenience of their pharmacy experience, enables them to self-manage their health, and increases their access to their pharmacist.

Implementation of targeted medication adherence interventions within a community chain pharmacy practice: The Pennsylvania Project.

OBJECTIVE: To identify facilitators and barriers to implementing targeted medication adherence interventions in community chain pharmacies, and describe adaptations of the targeted intervention and organizational structure within each individual pharmacy practice. DESIGN: Qualitative study. SETTING: Central and western Pennsylvania from February to April 2012. PARTICIPANTS: Rite Aid pharmacists staffed at the 118 Pennsylvania Project intervention sites. MAIN OUTCOME MEASURES: Qualitative analysis of pharmacists' perceptions of facilitators and barriers experienced, targeted intervention and organizational structure adaptations implemented, and training and preparation prior to implementation. RESULTS: A total of 15 key informant interviews were conducted from February to April 2012. Ten pharmacists from "early adopter" practices and five pharmacists from "traditionalist" practices were interviewed. Five themes emerged regarding the implementation of targeted interventions, including all pharmacists' need to understand the relationship of patient care programs to their corporation's vision; providing individualized, continual support and mentoring to pharmacists; anticipating barriers before implementation of patient care programs; encouraging active patient engagement; and establishing best practices regarding implementation of patient care services. CONCLUSION: This qualitative analysis revealed that there are a series of key steps that can be taken before the execution of targeted interventions that may promote successful implementation of medication therapy management in community chain pharmacies.

An introductory pharmacy practice experience providing pharmaceutical care to elderly patients.

OBJECTIVE: To develop, integrate, and assess an introductory pharmacy practice experience (IPPE) in providing pharmaceutical care to patients at senior centers (Silver Scripts). DESIGN: First-year pharmacy students learned and practiced the pharmaceutical care process in the classroom to prepare for participation in the Silver Scripts program, in which the students, under faculty mentorship, conducted comprehensive medication reviews for senior citizens attending senior centers in Pittsburgh, Pennsylvania. ASSESSMENT: Students, preceptors, and senior center staff members indicated the experience was positive. Specifically, first-year students felt they gained benefit both from an educational standpoint and in their own personal growth and development, while staff contacts indicated the patients appreciated the interaction with the students. CONCLUSION: The Silver Scripts experience is a model for linking classroom experiences and experiential learning. The cycle of experiencing, reflecting, and learning has provided not only a meaningful experience for our P1 students but also a worthwhile focused review of seniors' medication use. This experience could be used as a model for other colleges and schools of pharmacy and their communities.

Pharmacist integration into the medical home: qualitative analysis.

OBJECTIVE: To determine the acceptance and attitudes of family medicine physicians, clinical and nonclinical office staff, pharmacists, and patients during pharmacist integration into a medical home. DESIGN: Qualitative study. SETTING: Pittsburgh, PA, area from August 2009 to June 2010. PARTICIPANTS: Physicians, staff, pharmacists, and patients at four single-specialty family medicine office practices functioning as medical homes. MAIN OUTCOME MEASURES: Attitudes, acceptance, barriers, and problems identified by participants. RESULTS: A total of 84 interviews were conducted: 21 interviews with family medicine physicians, 26 with patient care staff, 9 with nonclinical staff, 13 with patients, 6 with pharmacists, and 8 with office managers. Five main themes emerged from each group regarding the integration of a pharmacist, including positive overall feeling; clinical, educational, and time-saving benefits to the various groups; challenges understanding the role of the pharmacist; improved workflow and integration resulting from pharmacist flexibility and motivation; and suggestions to increase the pharmacists' time in each office. Pharmacists felt that they were accepted within 6 months of the integration process and that time management was a challenge. CONCLUSION: Participants felt that inclusion of a pharmacist into their practice improves the quality of patient care, provides a valuable resource for all providers and staff, and empowers patients. The initial concerns of the clinical and nonclinical staff disappeared within the first months of pharmacist integration. These results provide guidance to clinicians and insight into strategies for building a pharmacist-integrated medical home team.

Evaluating Pennsylvania Pharmacists' Provision of Community-based Patient Care Services to Develop a Statewide Practice Network.

OBJECTIVE: To identify and describe Pennsylvania pharmacists who currently provide or are interested in providing community-based patient care services and are interested in joining a statewide practice network. DESIGN: Cross-sectional survey. SETTING: February to June 2009 in Pennsylvania. PARTICIPANTS: 1700 pharmacists. INTERVENTION: Mailed and electronic survey. MAIN OUTCOME MEASURES: Number and geographic location of pharmacists providing or interested in providing community-based patient care in Pennsylvania. Description of patient care documentation methods; physical space; services provided; perceived barriers to providing patient care; training needs; and interest in joining a statewide practice network. RESULTS: The final analysis included data from 1700 pharmacists. Approximately one-third of pharmacists (n=554) were providing patient care services to community-based patients. Most were routinely documenting (67.5%) and many had a semi-private or private space to provide care. MTM and immunizations were the most common services provided. Respondents reported the most significant barrier to providing MTM, diabetes education, and smoking cessation education was time constraints, whereas training was a barrier for immunization provision. Most pharmacists were not being compensated for patient care services. Of the 869 pharmacists interested in joining a statewide network, those providing care were more interested in joining than those who were not (70.8% vs. 43.8%, p < 0.001). CONCLUSION: Pennsylvania pharmacists are interested in providing community-based patient care services and joining a statewide practice network focused on providing community-based patient care services. This research serves as a foundation for building a pharmacist practice network in Pennsylvania.

Physician perceptions of pharmacist-provided medication therapy management: qualitative analysis.

OBJECTIVE: To identify physician perceptions of community pharmacist-provided medication therapy management (MTM). METHODS: Three focus groups consisting of family and internal medicine physicians were conducted in Pittsburgh, York, and Philadelphia, PA, using a semistructured topic guide to facilitate discussions. Each participant completed an exit survey at session conclusion. RESULTS: 23 physicians participated in one of three focus groups conducted in Pittsburgh (n = 9), York (n = 6), and Philadelphia (n = 8). Participants identified common medication issues in their practices: nonadherence, adverse effects, drug interactions, medication costs, and incomplete patient understanding of the medication regimen. Receipt of a complete patient medication list was reported as the greatest potential benefit of MTM. Participants believed that physicians would be better suited as MTM providers than pharmacists. Concerns identified were the mechanism of pharmacist payment, reimbursement of time spent by physicians to coordinate care, and the training/preparation of the pharmacist. The need for a trusting relationship between a patient's primary care physician and the pharmacists providing MTM was identified. CONCLUSION: This study provides information to assist pharmacists when approaching physicians to propose collaboration through MTM. Pharmacists should tell physicians that they will receive an updated patient medication list after each visit and emphasize that direct communication is essential to coordinate care.