Community Pharmacist-Centered training program improves confidence in delivering epilepsy care.

RATIONALE: Incorporating pharmacists into interdisciplinary healthcare teams can improve patient outcomes across disease states; however, there is little evidence describing pharmacists' contributions to epilepsy care. Previous research from our group revealed that community pharmacists are well positioned to serve as patient advocates, monitor medications, and provide education for people living with epilepsy. However, pharmacists would like to receive additional training in epilepsy management. Advanced training in neurology is not a practical approach for community pharmacists who engage daily with patients having a variety of conditions and medications. OBJECTIVE: To develop and evaluate a flexible, community pharmacist-centered training program to improve both confidence and competence in delivering epilepsy care. METHODS: The training program consisted of five 1-hour, self-paced online modules and two 90-minute synchronous virtual sessions. Topics included the classification of the epilepsies, comorbid conditions, antiseizure medicine (ASM) therapy, special populations (pregnancy, people of childbearing potential, older adults), seizure emergencies, and sudden unexpected death in epilepsy (SUDEP), as well as social determinants of health. The training program was delivered over 6 weeks to pharmacists located at two community pharmacies in Washington State. Learning was assessed using a pre- and post-training questionnaire containing questions that evaluated knowledge and confidence in the training material. RESULTS: The training program did not significantly change pharmacists' mastery of the material. However, the pharmacists' confidence in delivering the material significantly improved in 14 of the 16 areas that were evaluated. Pharmacists' mastery and confidence were strongest in areas around ASM management, SUDEP and seizure emergencies, people of child-bearing potential and older adults with epilepsy, and comorbidities, whereas social health disparities in epilepsy care remained an area that required further training. CONCLUSION: Our findings support the idea that community pharmacists are well positioned with the knowledge to play an important role in epilepsy care. However, dedicated training tailored to community pharmacists' needs may improve their confidence in providing such care.

Locations and characteristics of pharmacy deserts in the United States: a geospatial study.

Pharmacies are important health care access points, but no national map currently exists of where pharmacy deserts are located. This cross-sectional study used pharmacy address data and Census Bureau surveys to define pharmacy deserts at the census tract level in all 50 US states and the District of Columbia. We also compared sociodemographic characteristics of pharmacy desert vs non-pharmacy desert communities. Nationally, 15.8 million (4.7%) of all people in the United States live in pharmacy deserts, spanning urban and rural settings in all 50 states. On average, communities that are pharmacy deserts have a higher proportion of people who have a high school education or less, have no health insurance, have low self-reported English ability, have an ambulatory disability, and identify as a racial or ethnic minority. While, on average, pharmacies are the most accessible health care setting in the United States, many people still do not have access to them. Further, the people living in pharmacy deserts are often marginalized groups who have historically faced structural barriers to health care. This study demonstrates a need to improve access to pharmacies and pharmacy services to advance health equity.

Using design thinking to strengthen the community pharmacist's role in epilepsy care.

OBJECTIVE: To use design thinking to develop a community pharmacist-led intervention for people living with epilepsy (PWE) with desirable, feasible, and viable features. METHODS: This study used design thinking. Three patient personas were created based on previous research: a newly diagnosed PWE, a well-controlled PWE, and a complex PWE with uncontrolled seizures. An intervention prototype was developed for each of the three personas. Structured interviews were conducted with pharmacists, pharmacy students, patients with diagnosed epilepsy, and caregivers to elicit feedback on which features of each intervention prototype were desirable, feasible, and viable. Interviews were analyzed using rapid content analysis. A multidisciplinary advisory group and the research team prioritized features of the prototypes to include in the final intervention. RESULTS: The following four features were identified as desirable, feasible, and viable for a pharmacist-led intervention for PWE: (1) pharmacist-patient consultations, (2) care plan development, (3) regular check-ins, and (4) care coordination with other health care providers. SIGNIFICANCE: This study identified evidence-based features for a community pharmacist intervention to support epilepsy care using design thinking. A pilot study to evaluate this intervention on the quality of life (QoL), health outcomes and satisfaction of PWE can inform the implementation and feasibility of such patient services.

Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce.

This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.

A Qualitative Study of Experiences Contributing to Professional Identity Formation in Recent Pharmacy Graduates.

OBJECTIVE: A professional identity has been described as "an individual thinking, acting, and feeling" like a person within the profession. The objective of this study was to learn about professional identity formation (PIF) in recent graduates of a pharmacy program. METHODS: In-depth interviews were conducted with students graduating from a doctor of pharmacy degree program. Investigators performed a thematic content analysis of interview transcripts. RESULTS: Participants were from community pharmacy practice (4), residencies (4), industry (1), and ambulatory care (1). At the time of the interview, participants were a range of 5-13 months out from graduation. Analysis of the data revealed 4 thematic findings. First, thinking and acting like a pharmacist occurred frequently while in school but feeling like a pharmacist occurred mostly after graduation. Second, feeling like a pharmacist meant participants felt confident in their knowledge base and ability to independently make decisions. Third, real-world practice is critical to PIF, particularly through interactions with patients. Finally, feedback, mentoring, and reflection support PIF and can aid in reconciling the tensions between concepts taught in school and experiences in practice. CONCLUSIONS: In this qualitative analysis of data about PIF obtained from recent graduates from a pharmacy school, we found that thinking and acting like a pharmacist preceded feeling like a pharmacist; feeling like a pharmacist involved confidence in the ability to work autonomously; feedback, mentoring, and reflection on experiences supported PIF; and real-world experiences were critical to PIF.

Impact of Pre-Advanced Pharmacy Practice Experience (APPE) Curriculum on Student Pharmacists' Professional Identity Formation.

OBJECTIVE: To (1) evaluate changes in student pharmacists' professional identity during a curriculum prior to advanced pharmacy practice experiences (APPEs) and (2) describe the components of a pre-APPE curriculum that positively and negatively influenced students' professional identity formation (PIF). METHODS: The University of Washington School of Pharmacy launched a new curriculum in 2019 featuring components intentionally designed to support students' PIF. The Macleod-Clark Professional Identity Scale (MCPIS) was administered to the class of 2023 before starting pharmacy school (pre) and upon completion of the pre-APPE curriculum (post). The postsurvey also contained 2 open-response questions asking students to identify the most positive and negative influences on their PIF. Mean pre- and post-responses were calculated for all MCPIS items and each MCPIS item and compared using paired t tests. Responses to the open-ended questions were sorted into categories using inductive thematic analysis and frequencies were calculated. RESULTS: A total of 99 students (96%) completed both surveys. Mean MCPIS pre-scores and post-scores were both 3.3, indicating no statistically significant change in professional identity. The most frequently reported positive influences on PIF were didactic coursework (40%), experiential learning (30%), and student organizations (27%). The most frequently reported negative influences were didactic coursework (27%), none (25%), and perceptions of the pharmacy profession (22%). CONCLUSION: Students' overall professional identity, as measured by the MCPIS, did not change during the pre-APPE curriculum. Didactic coursework had the most common positive and negative influence on professional identity prior to APPEs.

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.

Readying Community Pharmacies to Participate in COVID-19 Testing and Vaccination.

OBJECTIVE: Washington State established a Memorandum of Understanding (MOU) and operational plan in 2012 to coordinate pharmacy infrastructure and workforce during a public health emergency. The objectives of this study were to adapt the MOU operational plan to the context of the coronavirus disease 2019 (COVID-19) pandemic and assess community pharmacies' organizational readiness to implement COVID-19 testing and vaccination. METHODS: This mixed methods study was conducted June-August 2020. Three facilitated discussions were conducted with community pharmacists and local health jurisdiction (LHJ) representatives to test the MOU operational plan. Facilitated discussions were thematically analyzed to inform adaptations to the operational plan. Pharmacists were surveyed to assess their organization's readiness for COVID-19 testing and vaccination before and after the facilitated discussions using the Organizational Readiness for Implementing Change (ORIC) measure. Survey responses were analyzed using descriptive statistics. RESULTS: Six pharmacists from 5 community pharmacy organizations and 4 representatives from 2 LHJs participated in at least 1 facilitated discussion. Facilitated discussions resulted in 3 themes and 16 adaptations to the operational plan. Five of 6 community pharmacists (83% response rate) completed both surveys. Mean organizational readiness decreased from baseline to follow-up for COVID-19 testing and vaccination. CONCLUSIONS: Operational plan adaptations highlight opportunities to strengthen MOUs between local and state health departments and community pharmacies to support future emergency preparedness and readiness efforts.

Community pharmacist intervention to optimize statin adherence in diabetes care: The GuIDE-S study.

BACKGROUND: Statin use in people with type 2 diabetes (T2D) reduces cardiovascular events, yet adherence remains suboptimal. OBJECTIVE: This study evaluated the impact of a community pharmacist intervention on statin adherence in new users with T2D. METHODS: As part of a quasi-experimental study, community pharmacy staff proactively identified adult patients with T2D who were not prescribed a statin. When appropriate, the pharmacist prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from another prescriber. Patients received individualized education and follow-up and monitoring for 1 year. Adherence was defined as the proportion of days covered (PDC) by a statin over 12 months. Linear and logistic regression were used to compare the effect of the intervention on continuous and a binary adherence threshold, defined as PDC ≥ 80%, respectively. RESULTS: Overall, 185 patients started statin therapy and were matched to 370 control patients for analysis. Adjusted average PDC was 3.1% higher in the intervention group (95% CI -0.037 to 0.098). Patients in the intervention group were 21.2% more likely to have PDC ≥ 80% (95% CI 0.828-1.774). CONCLUSION: The intervention resulted in higher statin adherence than usual care; however, the differences were not statistically significant.

A taxonomy for community pharmacy patient care services reported in Pharmacist eCare Plans.

BACKGROUND: Pharmacies belonging to the Community Pharmacy Enhanced Service Networks (CPESN) are transforming their practices with support of the Flip the Pharmacy initiative. These pharmacies are submitting eCare plans that describe care that they have provided to patients. OBJECTIVES: The objectives of this study were (1) To develop a taxonomy for services reported by community pharmacies participating in year 1 of the Flip the Pharmacy initiative and (2) to illustrate the use of the taxonomy for hypertension-related services. METHODS: A retrospective observational study design was used. The analyzed data were extracted from eCare plans submitted by participating pharmacies during the first year of the Flip the Pharmacy initiative (October 1, 2019-September 30, 2020). Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) codes submitted for encounter reason and for procedures were sorted into categories based on similarity of terminology in the SNOMED-CT code labels. All SNOMED-CT codes in the encounter reasons that had blood pressure or hypertension in their labels were mapped to taxonomy categories. Descriptive statistics were calculated for all variables. RESULTS: A total of 368,297 eCare plans reporting 1,049,061 SNOMED-CT procedures were submitted for 133,210 patients by 526 pharmacies. Seven categories of community pharmacy patient care services were identified: medication synchronization, medication review, monitoring, immunizations, patient education, adherence, and recommendations. Over half of the encounter reasons (63.5%) and procedures (56.2%) were for medication synchronization. Both medication review and monitoring accounted for about 10% of the encounters, and medication review made up over 30% of procedures. A total of 18,307 encounters were related to hypertension. Of these, monitoring was the most frequent, with 11,285 encounters (61.6%) encounters, followed by patient education, with 5173 encounters (28.3%). CONCLUSION: CPESN pharmacies are delivering a wide range of patient care services. This taxonomy provides a concise way to organize and report services being delivered by community pharmacies.

Community pharmacist intervention to close statin gaps in diabetes care: The GuIDE-S study.

BACKGROUND: Statin therapy is recommended for people with type 2 diabetes (T2D) to lower cardiovascular risk; however, evidence suggests that significant gaps in statin therapy exist. OBJECTIVE: To evaluate (1) the impact of a community pharmacist-led model for initiating statin therapy in people with type 2 diabetes (T2D) on statin initiation and (2) pharmacists' self-reported perceptions of the intervention feasibility and fidelity to the intervention. METHODS: This was a type 1 hybrid effectiveness-implementation study of 9 intervention and 18 control pharmacies within a community pharmacy chain. Pharmacy staff proactively identified patients with T2D not taking a statin and prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from the patient's preferred prescriber. The eligible population included patients aged 18-84 years with T2D, who had filled ≥60 days' supply of one, noninsulin, diabetes medication in a rolling 6-month period, and who had not filled a statin during the same period. A Cox proportional hazards model was used to compare time to statin initiation. Pharmacists at intervention pharmacies completed a survey at 6 and 12 months after implementation (March and August 2019, respectively) to assess intervention feasibility and fidelity. RESULTS: For the statin initiation analysis, 1670 intervention patients were matched to 3358 control patients. Overall, 26.3% (n=442) of intervention patients and 25.4% (n=854) of control patients initiated a statin within 12 months of their index date. There was no difference in statin initiation likelihood between intervention and control patients (hazard ratio: 1.00; 95% CI: 0.83, 1.21). Fifteen pharmacists completed the 6-month survey (33% response rate), and 12 completed the 12-month survey (26%). The intervention's feasibility score was 4.0 at 6 months and 4.2 at 12 months, indicating an increase in perceived feasibility. Fidelity decreased from 6 to 12 months. CONCLUSION: The community pharmacist-led intervention resulted in more patients initiating statin therapy as compared to usual care; however, the differences were not statistically significant. Pharmacists perceived the intervention to be feasible; however, fidelity decreased over time.

Pharmacy deserts and COVID-19 risk at the census tract level in the State of Washington.

Community pharmacies are a crucial component of healthcare infrastructure, including for COVID-19 pandemic prevention services like testing and vaccination. Communities that are "pharmacy deserts," experience healthcare inequities. However, little research has characterized where these communities are, making it difficult for local leaders to prioritize resources for them. This study identifies pharmacy deserts at the census tract level in Washington state for the first time and explores their association with COVID-19 risk. Out of 1,441 tracts, 127 were pharmacy deserts, comprising approximately 454,000 adults, or 8% of the state's adult population. Among those tracts identified as pharmacy deserts, 67% were considered high risk for COVID-19. Solutions are needed to expand equitable access to pharmacy services in these communities. The methods and data presented herein provide healthcare leaders with information to address this pharmacy access gap in Washington and could be similarly applied to other settings. Three categories of policy changes could address health inequities found in our study: 1) improve financial incentives for pharmacists to practice in underserved areas, 2) prevent pharmacy closures, and 3) deploy innovative care delivery methods such as telehealth services.

Stakeholder perceptions of community pharmacist population health management of people living with epilepsy.

OBJECTIVE: To identify the predisposing, enabling, and reinforcing factors influencing the integration of community pharmacists in population health approaches to epilepsy care. METHODS: Key informant interviews were conducted with 32 stakeholders, including five people living with epilepsy (PWE), ten caregivers of PWE, seven epileptologists, one neurologist, one epilepsy nurse, and eight community pharmacists in Washington State and Oregon from September 2019 to February 2020. Interviews were audio recorded, transcribed, and analyzed using a rapid content analysis approach guided by the PRECEDE-PROCEED Model to identify predisposing, enabling, and reinforcing factors influencing integration of community pharmacists in population health approaches to epilepsy care. RESULTS: Four predisposing, four enabling, three positive reinforcing factors, and two negative reinforcing factors emerged as influencing integration of community pharmacists in a population health approach to epilepsy care across all stakeholder groups. Predisposing factors included patient advocacy, medication adherence, medication monitoring, and medication education. Enabling factors were a shared vision, collaboration structure, efficient communication, and pharmacist attributes (knowledge, experience, and attitude). Positive reinforcing factors included a team approach, easy to access support, and medication adherence. Negative reinforcing factors were duplicate or conflicting care and limited time and resources. SIGNIFICANCE: This study identified several predisposing, enabling, and reinforcing factors influencing integration of community pharmacists in population health approaches to epilepsy care based on stakeholder perceptions. Community pharmacists may consider these factors when implementing services for patients with epilepsy.

Pharmacist-led interventions to improve medication adherence in older adults: A meta-analysis.

BACKGROUND/OBJECTIVE: As pharmacists work to ensure reimbursement for chronic disease management services on the national level, evidence of their impact on important health metrics, such as medication adherence, is needed. However, summative evidence is lacking on the effectiveness of pharmacists to improve medication adherence in older adults. The objective was to assess the effectiveness of pharmacist-led interventions on medication adherence in older adults (65+ years). DESIGN/SETTING/PARTICIPANTS: Using a systematic review and meta-analytic approach, a comprehensive search of publications in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar was conducted through April 2, 2020 for randomized clinical trials of pharmacist-led interventions to improve medication adherence in older adults. A standardized mean difference effect size (Cohen's d) was calculated for medication adherence in each study. Study effect sizes were pooled using a random-effects model, with effect sizes weighted by inverse of its total variance. MEASUREMENTS: Medication adherence using any method of measurement. RESULTS: Among 40 unique randomized trials of pharmacist-led interventions with data from 8822 unique patients (mean age, range: 65-85 years), the mean effect size was 0.57 (k = 40; 95% Confidence Interval [CI]: 0.38-0.76). When two outlier studies were excluded from the analysis, the mean effect size reduced to 0.41 (k = 38; 95% CI: 0.27-0.54). A sensitivity analysis of medication adherence outcome by time point resulted in a mean effect size of 0.64 at 3 months (k = 12; 95% CI: 0.32-0.97), 0.30 at 6 months (k = 13; 95% CI: 0.11-0.48), 0.22 at 12 months (k = 12; 95% CI: 0.08-0.37), and 0.36 for outcome time points beyond 12 months (k = 5; 95% CI: 0.02-0.70). CONCLUSION: This meta-analysis found a significant improvement in medication adherence among older adults receiving pharmacist-led interventions. Implementation of pharmacist-led interventions supported by Medicare reimbursement could ensure older adults' access to effective medication adherence support.

Building Implementation Science Capacity in Academic Pharmacy: Report of the 2020-2021 AACP Research and Graduate Affairs Committee.

EXECUTIVE SUMMARY The 2020-2021 AACP Research and Graduate Affairs Committee (RGAC) continued the work begun by the 2019-2020 RGAC to increase awareness of and capacity for implementation research to advance practice transformation in academic pharmacy. AACP President Anne Lin charged the RGAC with developing resources and programs for training faculty and graduate students in implementation science. The committee was further charged with developing a mechanism to pair pharmacy faculty and implementation experts on practice advancement projects. In its work, the committee focused on generating near-term opportunities for pharmacy practice faculty to pursue projects while developing programs that would support ongoing career development and future implementation practice and research by pharmacy faculty and trainees.

Community pharmacists' role in caring for people living with epilepsy: A scoping review.

OBJECTIVE: To identify and describe studies about pharmacist-provided services for people with epilepsy and their caregivers. METHODS: PubMed/MEDLINE and EMBASE were searched for articles that were: (1) written in English, (2) published in 1985 or later, (3) a peer-reviewed empirical study or practice report, and (4) describing an intervention provided by a pharmacist for people with epilepsy and/or their caregivers in an outpatient pharmacy setting. The abstracts and full text, when necessary, were reviewed by two investigators to assess eligibility. Data were extracted from each article by two investigators using a standardized abstraction form based on the Pharmacist Patient Care Services Intervention Reporting (PaCIR) checklist. Data elements of interest included components of service, mode of service delivery, frequency, number and duration of sessions for the service, roles and responsibilities of the community pharmacist, type of community pharmacy, outcomes and measures evaluated along with data sources, and findings and results. Risk of bias was not assessed due to the descriptive nature of the review. RESULTS: Twelve articles were included, seven of which reported services conducted in the United States. The most common service reported was medication management (n = 7) followed by education and counseling (n = 4). One article described a care coordination documentation tool that could be used by pharmacists and physicians in epilepsy care. Most interventions were evaluated using observational designs (n = 5) or did not have an evaluation component (n = 4). SIGNIFICANCE: This review provides examples of community pharmacists providing care to people living with epilepsy that extend beyond dispensing medications. Findings demonstrate that there is little published evidence on community pharmacists' contributions to epilepsy care and suggest opportunities for further exploration and innovation. This review serves as the first step in a project that seeks to develop a stakeholder-driven community pharmacist integrated population health intervention for people living with epilepsy.

Strengthening pandemic preparedness through pharmacy and public health collaborations: Findings from a facilitated discussion exercise.

BACKGROUND: Community pharmacists are key partners to public health agencies during pandemics and other emergencies. Community pharmacy and public health agencies can establish memoranda of understanding (MOUs) for dispensing and administering medical countermeasures and providing related services to affected population(s) during a public health incident. OBJECTIVE: The objective of this facilitated discussion exercise was to identify the strengths and opportunities associated with the activation of a statewide pharmacy-public health agencies MOU with community pharmacists on the basis of a simulated pandemic influenza event. METHODS: A facilitated discussion exercise was held in the Puget Sound region of the State of Washington in May 2017. The participants included pharmacists from 2 community pharmacy organizations, emergency preparedness officials from 2 local health departments and the state health department, staff of the state pharmacy association, and faculty from a school of pharmacy. The evaluators recorded the discussions and observations, augmented by a postexercise telephone call with participants from each of the participating community pharmacy organizations. Key themes from the exercise are reported. RESULTS: Five themes were identified during the facilitated discussion exercise. Two themes described the strengths of the MOU and its operational plan: (1) collaboration strengthens preparedness and response planning, and (2) an MOU provides a framework for effective collaboration. Three themes acknowledged the opportunities to optimize activation of the existing MOU: (1) early and active engagement between health department personnel and community pharmacists, (2) establishing pharmacy policies and procedures to support readiness and response, and (3) addressing the training or other educational needs of community pharmacists. CONCLUSION: This exercise provided community pharmacists and public health agency personnel an opportunity to better plan for responding to a pandemic. The open dialogue in this facilitated discussion allowed the exercise participants to identify the strengths, priorities, and perspectives as well as the gaps in the MOU operational plan. The lessons learned in this exercise can inform the community pharmacy and public health response to the coronavirus disease pandemic.

Enhancing adult immunization care by community pharmacists: A qualitative analysis of Project VACCINATE.

BACKGROUND: Project VACCINATE was a 1-year demonstration project conducted in 70 community pharmacies in Washington from September 1, 2016 to August 31, 2017 aimed at increasing adult vaccination and documentation in the state immunization information system (IIS). Key intervention features aligned with the Standards for Adult Immunization Practices and included incorporation of an immunization interface to facilitate proactive immunization screenings, patient engagement regarding vaccine needs, and vaccine documentation in the IIS as enhancements to the vaccination workflow. OBJECTIVE: The objective of this qualitative study, a subanalysis of Project VACCINATE, was to identify community pharmacy staff members' perceptions of work system factors that influenced the implementation of key intervention features. METHODS: Pharmacy staff at all Project VACCINATE locations were eligible to participate and were recruited by e-mail. Key informant interviews lasting 15-30 minutes were conducted by telephone using a semistructured interview guide. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work systems. RESULTS: A total of 7 interviews were conducted with pharmacists from different pharmacy locations from September to December 2017. Nine factors emerged across all domains of the SEIPS 2.0 model regarding the implementation of the key intervention features. These factors were pharmacist-patient relationships, team culture, individualized patient education, technician involvement, electronic access to vaccine records, pharmacy layout, staff training, immunization documentation in other care settings, and insurance coverage. CONCLUSIONS: Several key factors were identified that, when addressed, can enable the incorporation of proactive immunization screenings, patient engagement, and vaccine documentation as enhancements to the community pharmacy-based vaccination process. Community pharmacy organizations should consider incorporating the described factors into existing immunization programs when assessing the unique dynamics of their work system.

Exploring the impact of workforce turnover on the sustainability of evidence-based programs: A scoping review.

Background: Evidence-based programs (EBPs) are used across disciplines to integrate research into practice and improve outcomes at the individual and/or community level. Despite widespread development and implementation of EBPs, many programs are not sustained beyond the initial implementation period due to many factors, including workforce turnover. This scoping review summarizes research on the impact of workforce turnover on the sustainability of EBPs and recommendations for mitigating these impacts. Methods: We searched 10 databases for articles that focused on an EBP and described an association between workforce turnover and the sustainment or sustainability of the program. We created a data abstraction tool to extract relevant information from each article and applied the data abstraction tool to all included articles to create the dataset. Data were mapped and analyzed using the program sustainability framework (PSF). Results and Discussion: A total of 30 articles were included in this scoping review and mapped to the PSF. Twenty-nine articles described impacts of workforce turnover and 18 articles proposed recommendations to address the impacts. The most frequent impacts of workforce turnover included increased need for training, loss of organizational knowledge, lack of EBP fidelity, and financial stress. Recommendations to address the impact of workforce turnover included affordable and alternative training modalities, the use of champions or volunteers, increasing program alignment with organizational goals, and generating diverse funding portfolios. Conclusion: The sustainment of EBPs is critical to ensure and maintain the short- and long-term benefits of the EBP for all participants and communities. Understanding the impacts of workforce turnover, a determinant of sustainability, can create awareness among EBP-implementing organizations and allow for proactive planning to increase the likelihood of program sustainability.