Motivational interviewing for medication adherence.

OBJECTIVE: To familiarize pharmacists with motivational interviewing as a way to engage patients in discussions about medication adherence. SUMMARY: Motivational interviewing is a collaborative, patient-centered communications skill set that can increase behavior change by stimulating a patient's own internal motivation for change. Pharmacists using motivational interviewing can explore factors associated with medication nonadherence, assess patient ambivalence and/or resistance, and educate a patient to promote medication-adherent behaviors. CONCLUSION: Pharmacists can use motivational interviewing to effectively engage patients in a conversation that addresses medication adherence.

Consumer, physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network.

BACKGROUND: Health care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers. OBJECTIVES: To assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based "health care team;" determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model. METHODS: This project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer. RESULTS: Most consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient care and/or prevented adverse drug events, and the services were cost neutral (at a minimum). CONCLUSIONS: It was difficult for most consumers and physicians to envision pharmacists practicing in non-dispensing roles. The pharmacy profession must disseminate the existing body of evidence on pharmacists as care providers of medication management services and the related impact on clinical outcomes, patient safety, and cost savings to external audiences. Without such, new pharmacist practice models may have limited acceptance by consumers, primary care physicians, and payers.

Pharmacist self-reported antidepressant medication counseling.

OBJECTIVES: To identify the extent of pharmacists' self-reported antidepressant counseling (SRAC) and to identify factors that may affect pharmacists' decisions to provide antidepressant counseling. DESIGN: Cross-sectional study. SETTING: Alabama community pharmacies in 2011. PARTICIPANTS: Full-time pharmacists from 600 community pharmacies. INTERVENTION: Self-administered survey; three mail contacts with alternate electronic surveys were used. MAIN OUTCOME MEASURES: Pharmacists' SRAC behavior and its relationship with pharmacists' illness perceptions of depression, self-efficacy, and organizational and environmental influences. RESULTS: 600 surveys were sent; 22 were undeliverable, 1 was partially completed (<80% questions answered), and 118 were completed (20.6% overall response rate). Pharmacists reported low rates of involvement in antidepressant counseling; 61% reported assessing patient knowledge and understanding of depression, and 36% discussed options for managing adverse effects with no more than a few patients. More than one-quarter (28.6%) never asked patients whether they had barriers to taking antidepressants. Pharmacists' perceptions regarding consequences, control/cure, and the episodic nature of depression, as well as their self-efficacy, had significant relationships ( P < 0.05) with pharmacists' involvement in antidepressant counseling. CONCLUSION: Low rates of pharmacists' involvement in antidepressant counseling were reported. Pharmacists must become more involved in counseling patients about their antidepressant medications and overcoming barriers preventing greater involvement.

Characteristics of Social and Administrative Sciences graduate programs and strategies for student recruitment and future faculty development in the United States.

BACKGROUND: The rising demand of faculty in Social and Administrative Sciences (SAS) in pharmacy in the United States heightens the need to increase the number of Doctor of Philosophy (PhD) graduates in SAS who choose to pursue an academic career. OBJECTIVES: To describe the characteristics of SAS graduate programs and graduate students and identify strategies for student recruitment and future faculty development. METHODS: An Internet survey (phase I) with key informants (graduate program officers/department chairs) and semistructured telephone interviews (phase II) with phase I respondents were used. Items solicited data on recruitment strategies, number of students, stipends, support, and other relevant issues pertaining to graduate program administration. Descriptive statistics were tabulated. RESULTS: Of the 40 SAS graduate programs identified and contacted, 24 completed the Internet survey (response rate [RR]=60.0%) and, of these, 16 completed the telephone interview (RR=66.7%). At the time of the survey, the median number of graduate students with a U.S.-based PharmD degree was 3. An average annual stipend for graduate assistants was $20,825. The average time to PhD degree completion was 4.57 years, and approximately 31% of PhD graduates entered academia. Various strategies for recruitment and future faculty development were identified and documented. CONCLUSIONS: Findings allow SAS graduate programs to benchmark against other institutions with respect to their own achievement/strategies to remain competitive in student recruitment and development. Additional research is needed to determine the success of various recruitment strategies and identify potential new ones.

Factors influencing pharmacy students' attendance decisions in large lectures.

OBJECTIVES: To identify reasons for pharmacy student attendance and absenteeism in large lectures and to determine whether certain student characteristics affect student absenteeism. METHODS: Pharmacy students' reasons to attend and not attend 3 large lecture courses were identified. Using a Web-based survey instrument, second-year pharmacy students were asked to rate to what degree various reasons affected their decision to attend or not attend classes for 3 courses. Bivariate analyses were used to assess the relationships between student characteristics and degree of absenteeism. RESULTS: Ninety-eight students (75%) completed the survey instrument. The degree of student absenteeism differed among the 3 courses. Most student demographic characteristics examined were not related to the degree of absenteeism. Different reasons to attend and not to attend class were identified for each of the 3 courses, suggesting that attendance decisions were complex. CONCLUSIONS: Respondents wanted to take their own notes and the instructor highlighted what was important to know were the top 2 common reasons for pharmacy students to attend classes. Better understanding of factors influencing student absenteeism may help pharmacy educators design effective interventions to facilitate student attendance.

Sustainability of pharmacy-based innovations: the case of in-house immunization services.

OBJECTIVE: To examine the effect of organization-level factors on sustainability of pharmacy-based in-house immunization services. DESIGN: Cross-sectional study. SETTING: Washington State community pharmacies in 2006. PARTICIPANTS: Key informants of 490 community pharmacies. INTERVENTION: Mixed-mode survey; five mail and telephone contacts were used. MAIN OUTCOME MEASURES: Effectiveness of champions (i.e., influential individuals within the host organization who actively and continuously promote the service), formal evaluation process, degree of modifications made to in-house services, degree of compatibility between in-house services and the host pharmacy, and sustainability of in-house immunization services were measured and included in the proposed model. Using survey responses, factor analysis and path analysis were performed to determine the relationships among these variables. RESULTS: Of the 490 survey instruments sent, 1 was undeliverable, 2 were incomplete, and 206 were completed (42.1% response rate). A total of 104 pharmacies that reported offering immunization services in 2006 were included in the analysis. Compatibility, which was defined as the fit between in-house immunization services and the host pharmacy, was the key to sustainability of immunization services. To enhance compatibility between in-house services and the host pharmacy, two pathways were found. First, in-house services underwent formal evaluations and subsequent modifications were made to the services. The second pathway bypassed the adaptation process. Through the second pathway, an operational champion implemented in-house services in a way that was already compatible with the host pharmacy. CONCLUSION: Organizational leaders and practitioners had the potential to sustain in-house services. The key factors included in the model should be incorporated as an integral part of programs planning to foster sustainability of in-house immunization services.

Community pharmacy involvement in vaccine distribution and administration.

This study identified the type and number of doses of vaccine purchased, distributed, and administered in community pharmacies. Telephone interviews were conducted with 1704 community pharmacies in 17 states (response rate=69.1%). The 17-state population-level projections reveal that about 10% of hepatitis A, hepatitis B, meningococcal, MMR, and tetanus-containing vaccines for adults were administered in pharmacies and 90% were distributed to other sources for administration during July 2004-June 2005. Further, 24.1% of diphtheria-tetanus-pertussis for children (DTaP), 30.4% of influenza, 36.2% of pneumococcal polysaccharide, and 68.1% of travel vaccines in pharmacy inventory were administered in pharmacies, while the rest of vaccine doses were distributed to other immunizers.

Pharmacy stages of involvement in pharmacy-based immunization services: results from a 17-state survey.

OBJECTIVES: To describe pharmacy stages of involvement in outsourced and inhouse immunization services and to explore the variability of stages of involvement across the sampled states. DESIGN: Cross-sectional study. SETTING: Community pharmacies in 17 states, between July 2005 and February 2006. PARTICIPANTS: Key informants of 2,558 community pharmacies. INTERVENTION: Computer-assisted telephone interviews regarding pharmacy involvement in immunization services. MAIN OUTCOME MEASURE: Pharmacies' stage of involvement in immunization services, based on the following categories: no interest; interested, no plan; planning; implemented; discontinued; and no response. RESULTS: Of 2,558 community pharmacies, 1,707 (69.1%) completed the interview. For outsourced immunization services, about one-half of participating pharmacies (50.6%) implemented and planned to implement the services while only 20.7% had no interest in offering the services. These percentages contrast sharply with inhouse immunization services: 24.7% of pharmacies in this category implemented and planned to implement the services and 38.1% indicated no interest in offering the services. Involvement in immunization services varied widely across the 17 states. For outsourced services, implementation ranged from 17.5% to 68.8% of pharmacies, while 13.5% to 39.3% had no interest in the services. For in-house services, implementation ranged from 0% to 42.1% of pharmacies; 19.6% to 49.5% had no interest. CONCLUSION: Understanding stages of pharmacy involvement in immunization services should allow design and implementation of more effective strategies for increasing involvement and decreasing abandonment of immunization practices.