Impact of pharmacist counseling to enhance the accessibility of naloxone nasal spray to patients in a community pharmacy setting.

BACKGROUND: The Centers for Disease Control and Prevention guidelines recommend naloxone for every high-dose opioid prescription; in 2018, only 1 naloxone prescription was dispensed for every 69 high-dose opioid prescriptions. In Virginia, strategies for creating awareness and availability include the REVIVE! training and the standing protocol for pharmacists to dispense naloxone. OBJECTIVES: To evaluate if a proactive offer for counseling by pharmacists improves the percent change of patients who receive a prescription for naloxone nasal spray compared with the previous year's naloxone nasal spray fill history and to determine if the pharmacist's counseling affects a patient's confidence with opioid overdose and naloxone use. METHODS: Prospective 4-month, interventional study in southwest Virginia conducted at 5 geographically similar large community chain pharmacies. A National Drug Code activity report within each store was used to identify patients, aged 18-64 years, filling opioid medication without naloxone. A pharmacist recommended naloxone to patients at the point of care. Patients accepting the recommendation for naloxone received pharmacist counseling from a standardized counseling script and by using a naloxone nasal spray demo kit. All eligible patients were provided a postintervention survey assessing their confidence with naloxone, if naloxone had been recommended before, and if they were picking up naloxone on the basis of the pharmacist's recommendation. Results were analyzed using univariate and bivariate analyses. RESULTS: A total of 121 naloxone prescriptions were dispensed; an increase of 36% compared with the same period during the previous year. In total, 38 patients completed the postintervention survey. After receiving pharmacist counseling, patients indicated being very confident with administering naloxone correctly and for recognizing an opioid overdose, 73.9% and 65.2%, respectively. Of the patients who completed the survey, 60.5% received naloxone and accepted counseling from the pharmacist. CONCLUSION: After pharmacist counseling, naloxone dispensing increased, and patients were confident with both administration and recognition.

Impact of Adherence Education and Monitoring on Community Pharmacy Performance Scores and Patient Satisfaction.

BACKGROUND: Adherence, specifically to noninsulin diabetes medications, statins, and renin-angiotensin system antagonists (i.e. angiotensin-converting-enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARBs), and aliskiren), is a measure tracked by the Centers for Medicare and Medicaid Services (CMS) to give Medicare Part D plans a star rating; pharmacies are impacted by these star ratings. The pharmacy is given a performance score based on the measure. Some pharmacies use a performance information management platform (PIMP) that allows pharmacies to better understand performance information to impact patient care. OBJECTIVES: (1) To evaluate if a monthly adherence monitoring and education service impacts the percentage of patientsadherent determined by pharmacy performance scores; (2) To determine patient satisfaction with the service in a large community pharmacy chain. METHODS: A six-month prospective interventional pilot study including patients with a proportion of days covered (PDC) of less than 80% for oral diabetes or renin-angiotensin system antagonists (RASA) medications was conducted in two pharmacies of a large community pharmacy chain in Southwest Virginia. Using pharmacy internal data analytics and PIMP data, the percentage of patients who are adherent to oral diabetes or RASA medications was determined including the baseline PDC for each patient. At the start of the study, the standard of care in this large community chain pharmacy was to address adherence, follow-up in one month and every three months thereafter. In this study, pharmacists provided monthly telephonic adherence monitoring and education for a six-month period. Each session was scripted for medication adherence history, education and data collection. The pharmacist provided guidance and counseling based on how the patient answered the questions. Pharmacists gathered information about adherence patterns and behaviors using a 14 item Likert-scale and multiple choice-based questionnaire during the first session. After completion of the final adherence monitoring and education session, pharmacists gathered patient satisfaction information using an eight item Likert-scale questionnaire. At the end of the six-month period, using PIMP data, the percentage of patients adherent to oral diabetes or RASA medications was determined based on pharmacy performance scores. The data was analyzed using uni-variate and bi-variate statistics to determine if there was a difference in pharmacy performance scores from the pre-study analysis. The adherence patterns and behaviors, as well as patient satisfaction with the program was evaluated to determine factors influencing nonadherence. RESULTS: A total of 55 patients were identified in two pharmacies, ten of which were excluded or declined involvement, leaving 45 enrolled in the adherence monitoring and education service. Of the 45 enrolled patients, ten completed the adherence patterns and behaviors questionnaire. About half of the patients were men (50.95%) with an average age of 71.17 years and taking an average of 6.55 prescription medications. All patients had Medicare Part D insurance and majority had a yearly income of less than $40,000. The average baseline PDC was 68.92. In pharmacy 1, the average performance score for oral diabetes medications trended down and the average performance score for hypertension medications trended up over the study period. In pharmacy 2, the average performance score for oral diabetes medications trended up and the average performance score in hypertension medications trended up over the study period. The adherence patterns and behaviors questionnaire revealed the majority of patients rarely forgot to take medications or run out of medications. Additionally, cost of medications did not seem to impact adherence and majority of patients knew the names and indications of their medications. Only one patient completed the patient satisfaction survey. CONCLUSIONS: An adherence monitoring and education service had mixed results in improving patient adherence and pharmacy performance scores. Only one patient completed the satisfaction survey, thus no conclusions can be made regarding patient satisfaction of the program. More research needs to be done regarding telephonic adherence programs.

Impact of Live Training on Medication Errors in a Community-Based Pharmacy Setting.

OBJECTIVE: To compare community-based pharmacy medication errors before and after a one-hour live interactive training session for both pharmacists and technicians. METHODS: A one group pre-post intervention design study was conducted in 20 community-based pharmacies in a district of a large national community pharmacy chain. A one-hour live, interactive session was developed based on incident reports and medication error trends including medication error definition, ways in which medication errors occur, strategies for mitigating errors, information about human error, and methods and habits to improve patient safety. At least 50% of full-time staff for each of the 20 pharmacies were required to attend a training session between December 1, 2017-January 15, 2018. Participants completed a demographics survey documenting gender, age, credentials, number of years of experience, and years of service with the company. Pharmacies were categorized as low, medium or high volume based on prescription count. Medication errors were compared six months pre- and post-live education session. Data were analyzed using SAS version 9.4. RESULTS: One hundred and thirty- five errors and 111 errors were reported pre-and post-live training (mean 6.85 and 5.55, p < 0.301), respectively. Nine pharmacies were low, eight medium, and three high volume with the mean number of medication errors reported pre- and post-live training; low 4.33 vs 4.11 p<0.478, medium 9.37 vs 6.87 p<0.443, and high 7.66 vs 6.33 p<0.593, respectively. Sixty pharmacy staff (34 pharmacists, 26 technicians) attended one of the live training sessions; 73% female; most frequently reported age range 35-50 years; 23 Doctor of Pharmacy, 11 Bachelor of Science in Pharmacy, and 26 Certified Technician; and average number of years' experience was 13.6 and average service with the company was 8.6 years. CONCLUSIONS: A live training session for both pharmacists and technicians did not significantly decrease medication errors, but could be incorporated as an element of a medication safety program. It should be considered for implementation in other districts of this large national pharmacy chain as a part of an improved patient safety effort.

Pharmacists' comfort level and knowledge about prescribing hormonal contraception in a supermarket chain pharmacy.

OBJECTIVES: To compare community pharmacists' comfort levels and knowledge prescribing hormonal contraception before and after a training session and to identify perceived barriers and resources needed to prescribe hormonal contraception. METHODS: In this pre-post convenience sample survey study, all 350 pharmacists in the Mid-Atlantic Division of Kroger (which spans parts of Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia) were surveyed before and after a training session. The survey consisted of several sections: 1) questions rating comfort, 2) knowledge-based multiple-choice assessment questions, 3) perceptions of barriers and resources needed to prescribe hormonal contraception, and 4) demographics. The training session was a 1-hour continuing education about hormonal contraception. Data were analyzed with the use of univariate and bivariate statistics to compare pre- and post-training survey information. RESULTS: Seventy-eight pharmacists completed both surveys (22.3% response rate). Pharmacists averaged 14 years in pharmacy practice, and 66.6% were female. More pharmacists (31.8%) perceived liability concern as the greatest barrier to pharmacist-initiated contraception. Pharmacist knowledge about hormonal contraception increased in some domains after the training session (P < 0.001). If allowed as a scope of practice in their state, the comfort level of pharmacists in prescribing any type of hormonal contraceptive significantly increased after the training session (P < 0.004). CONCLUSION: Pharmacists have an initial lack of knowledge and perceived lack of comfort with prescribing hormonal contraception if allowed in their state of practice. A training session was identified as an effective tool and intervention to increase pharmacists' comfort levels in prescribing hormonal contraception.