The Need for Faculty Knowledge and Promotion of Postgraduate Year One Community-Based Pharmacy Residencies.

Postgraduate year one (PGY1) community-based pharmacy residency programs are intended to build upon the Doctor of Pharmacy (PharmD) education and outcomes. The goal of the residency program is to develop community-based pharmacist practitioners with diverse patient care, leadership, and education skills. This commentary will inform faculty mentors about the history, evolution, structure, and design of PGY1 community-based pharmacy residency programs. This commentary will also review the equivalency of PGY1 community-based pharmacy residency programs to other PGY1 programs, specifically to PGY1 pharmacy programs typically administered in hospitals and health systems. Faculty who are knowledgeable about PGY1 community-based pharmacy residency programs will be able to provide mentorship and promotion for student pharmacists who are interested in direct patient care.

Clinical pharmacists in primary care: Provider satisfaction and perceived impact on quality of care provided.

PURPOSE: The purpose of this study is to evaluate primary care provider satisfaction and perceived impact of clinical pharmacy services on the disease state management in primary care. METHODS: A cross-sectional survey with 24 items and 4 domains was distributed anonymously to pharmacy residency program directors across the United States who were requested to forward the survey to their primary care provider colleagues. Primary care providers were asked to complete the survey. RESULTS: A total of 144 primary care providers responded to the survey, with 130 reporting a clinical pharmacist within their primary care practice and 114 completing the entire survey. Primary care providers report pharmacists positively impact quality of care (mean = 5.5 on Likert scale of 1-6; standard deviation = 0.72), high satisfaction with pharmacy services provided (5.5; standard deviation = 0.79), and no increase in workload as a result of clinical pharmacists (5.5; standard deviation = 0.77). Primary care providers would recommend clinical pharmacists to other primary care practices (5.7; standard deviation = 0.59). Primary care providers perceived specific types of pharmacy services to have the greatest impact on patient care: medication therapy management (38.6%), disease-focused management (29.82%), and medication reconciliation (11.4%). Primary care providers indicated the most valuable disease-focused pharmacy services as diabetes (58.78%), hypertension (9.65%), and pain (11.4%). CONCLUSION: Primary care providers report high satisfaction with and perceived benefit of clinical pharmacy services in primary care and viewed medication therapy management and disease-focused management of diabetes, hypertension, and pain as the most valuable clinical pharmacy services. These results can be used to inform development or expansion of clinical pharmacy services in primary care.

Recognition of community-based pharmacist practitioners: Essential health care providers.

OBJECTIVES: To introduce the term community-based pharmacist practitioner (CPP), detail how community pharmacists are transitioning into this essential role, suggest 4 tenets of CPPs, and discuss the role of CPPs in future pharmacy practice. SUMMARY: The focus and nature of community pharmacy is expanding into new practice settings and including enhanced patient care services. With these shifts toward better meeting the health care needs of the communities they serve, community-based pharmacists who provide patient care services have refined specialized skills and should be widely viewed and accepted by the profession, patients, other health care providers, and the public as health care practitioners. Four suggested tenets of CPPs are: deliver direct patient care, contribute to team-based care, manage patient care services, and serve as leaders for advancing patient care. CONCLUSION: Pharmacist-provided patient care services are expanding in a variety of community-based settings. The term "community-based pharmacist practitioner" highlights the unique skillset that pharmacists use when they provide patient care services, and it brings recognition to the value community pharmacists contribute to patients, communities, and the health care system.

Impact of an Elective Course in Community and Ambulatory Care Pharmacy Practices on Student Perception of Patient Care.

Objective. To determine the impact of an elective course on students' perception of opportunities and of their preparedness for patient care in community and ambulatory pharmacy settings. Design. Each course meeting included a lecture and discussion to introduce concepts and active-learning activities to apply concepts to patient care or practice development in a community or ambulatory pharmacy setting. Assessment. A survey was administered to students before and after the course. Descriptive statistics were used to assess student responses to survey questions, and Wilcoxon signed rank tests were used to analyze the improvement in student responses with an alpha level set at 0.05. Students felt more prepared to provide patient care, develop or improve a clinical service, and effectively communicate recommendations to other health care providers after course completion. Conclusion. This elective course equipped students with the skills necessary to increase their confidence in providing patient care services in community and ambulatory settings.

Heart failure assessment at the community pharmacy level: a feasibility pilot study.

BACKGROUND: A key element missing in disease-management programs for heart failure (HF) is participation of the community pharmacist. The purpose of this study is to determine if a simple and efficient clinical tool will allow community pharmacists to identify patients at risk for worsening HF. DESIGN: The One Minute Clinic for Heart Failure (TOM-C HF) was developed as a simple six-item symptom screening tool to be used during routine patient/customer interactions. SETTING: Ten community pharmacies located in the upper Midwest. PATIENTS: Self-identified HF patients. RESULTS: 121 unique patients were evaluated over a 12-month period. The application of this clinical tool took between 1 and 5 minutes in over 80% of the interactions. Seventy-five patients (62%) had one or more signs or symptoms of worsening HF. The most common symptoms detected included edema (39%) and increased shortness of breath (17%). Self-reported weight gain of more than 5 pounds was seen in 19% of patients. CONCLUSION: The TOM-C HF tool was used to identify patients in a time-efficient manner in the community pharmacy setting who appear to be developing worsening HF. Inclusion of the community pharmacists as an early screen for HF decompensation may be an important link in disease-management programs to help reduce hospital readmission rates.

Current trends in outpatient pharmacy services and billing.

OBJECTIVES: To provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services. DESIGN: Cross-sectional study. SETTING: United States, February 2011. PARTICIPANTS: Members of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community. INTERVENTION: Online survey. MAIN OUTCOME MEASURES: Practice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing. RESULTS: MTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002). CONCLUSION: A variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.

Factors influencing community pharmacists' enrollment in a state prescription monitoring program.

OBJECTIVES: To determine factors influencing enrollment for community pharmacists registered and not registered in Ohio's prescription monitoring program (PMP), the Ohio Automated Rx Reporting System (OARRS); to identify association of OARRS enrollment with demographics, availability of Internet access at work, educational background, and/or previous PMP education received; and to compare knowledge of OARRS for enrollees versus nonenrollees. DESIGN: Descriptive, nonexperimental, cross-sectional study. SETTING: Ohio in November and December 2008. PARTICIPANTS: Pharmacists licensed and living in Ohio with a valid e-mail address on file with the state board of pharmacy. INTERVENTION: Online survey developed and administered via Zoomerang. MAIN OUTCOME MEASURE: Factors influencing enrollment for community pharmacists registered and not registered with OARRS. RESULTS: 2,511 complete responses were recorded, and 1,434 respondents indicated community pharmacy as their primary practice setting. Pharmacists not registered with OARRS noted "time available to access the OARRS report" as the top factor influencing their decision not to enroll in OARRS. Pharmacists registered with OARRS noted "being able to assist with decreasing doctor shopping" as the top factor influencing their decision to enroll in OARRS. CONCLUSION: Factors influencing enrollment as indicated by pharmacists not registered with OARRS should be the primary focus of initial efforts to increase enrollment.

Assessing the impact of lifestyle modification education on knowledge and behavior changes in gastroesophageal reflux disease patients on proton pump inhibitors.

OBJECTIVES: To assess patients' knowledge of gastroesophageal reflux disease (GERD) lifestyle modifications and to identify patients' behaviors associated with GERD management before and after an educational intervention. METHODS: The study was conducted at five indigent health centers in Columbus, OH, from January to May 2007. A total of 30 adult patients with GERD receiving proton pump inhibitor (PPI) therapy were assessed. In both the control and intervention groups, a pretest consisting of 23 questions assessed patients' knowledge regarding GERD and lifestyle modifications. A presurvey consisting of eight questions assessed patients' current behaviors associated with GERD management using both lifestyle modifications and PPIs. The intervention group also received approximately 10 minutes of education on lifestyle modifications. A posttest and postsurvey were given 8 to 12 weeks after the initial session to both groups. Main outcome measures included change in test score for patients in the control versus intervention groups. Outcomes measured on the pre- and postsurvey included source of heartburn information/education, smoking status, trigger foods eaten weekly, frequency of monthly heartburn episodes, and PPI adherence. RESULTS: The average change in test scores was 1.33 and 2.73 in the control and intervention groups, respectively (P = 0.11; two-sample t test). The frequency of monthly heartburn episodes increased postsurvey in the control group; however, the frequency of monthly episodes decreased in the intervention group. For the presurvey, no patients reported ever having received GERD education from a pharmacist. For the postsurvey, all 15 patients in the intervention group stated that they had received education from a pharmacist. CONCLUSION: The intervention group patients had higher mean change in test scores compared with the control group, although this difference did not reach statistical significance. The failure to achieve statistical significance may have resulted from the small sample size. The pharmacist-patient interaction improved patient knowledge and some behaviors made in GERD management and symptom reduction.

Development of a medication therapy management superbill for ambulatory care/community pharmacy practice.

OBJECTIVES: To explain the purpose of superbills, suggest strategies for incorporating superbills into pharmacy practice, and propose a model superbill for consideration by practitioners. PRACTICE DESCRIPTION: Ambulatory pharmacies in the United States. PRACTICE INNOVATION: Superbills have been used by physicians and other health care providers for many years as a way of efficiently communicating to the office staff, the patient, and even the insurer the types of services that have been provided at the point of care. The profession of pharmacy has not routinely used superbills in the past; however, given the recognition of pharmacists as providers of medication therapy management (MTM) services, immunizations, disease management, and other specialty preventive health services, the time has come for pharmacists to begin using superbills. MAIN OUTCOME MEASURES: Not applicable. RESULTS: A sample superbill, suitable for adaptation by individual providers of medication therapy management and other clinical pharmacy services, is provided in this article. CONCLUSION: Superbills may or may not improve the pharmacist's overall ability to receive insurance remuneration, but the authors believe that greater recognition by patients of the nondispensing activities of pharmacists can be achieved by using a superbill and that this may lead to more opportunities for payment for MTM in the future. Research is needed to assess whether incorporating superbills into a variety of pharmacy practice settings improves patient perceptions of the pharmacist and to discover how superbills effect practice efficiency.

Evaluation of pharmacists' barriers to the implementation of medication therapy management services.

OBJECTIVES: To assess pharmacists' actual and perceived barriers to implementing medication therapy management (MTM) services in the outpatient setting and to assess demographic and other factors associated with identified barriers. DESIGN: Cross-sectional study. SETTING: United States in 2007. PARTICIPANTS: 970 pharmacists practicing in an outpatient setting. INTERVENTION: E-mail invitation to participate in an Internet-based survey. MAIN OUTCOME MEASURES: Barriers to implementing MTM, practice characteristic influences on barriers, and personal characteristic influences on barriers. RESULTS: 776 of the 970 respondents (80.0%) were providing MTM or direct patient care services. Of respondents, 35% were compensated and 45% were not compensated for providing MTM services they provided to patients. The most common barriers identified for pharmacists providing MTM services with or without compensation were related to compensation. The most common barriers identified for those interested in providing MTM services were lack of additional staffing (89.6%) and poor access to medical information (84.0%). Pharmacists providing MTM with compensation were significantly less likely to agree with barriers relating to management, documentation, and compensation compared with those providing MTM without compensation. Those providing MTM with compensation were less likely to agree with most barriers compared with pharmacists who were interested in providing MTM services. Pharmacists practicing in a noncommunity setting were less likely to agree with barriers related to interprofessional relationships and documentation. CONCLUSION: These results show that the most important barriers to implementing MTM services in the outpatient setting identified by pharmacist survey respondents were related to interprofessional relationships, documentation, and compensation. Despite the resources available to pharmacists, barriers continue to hinder the expansion of MTM and direct patient care services.

Practice-based research network as a research training model for community/ambulatory pharmacy residents.

OBJECTIVE: To describe our experience with a practice-based research training network (PBRTN) in a 1-year residency program. SETTING: Ohio State University in Columbus from 1997 to 2007. PRACTICE DESCRIPTION: The program includes two accredited postgraduate year 1 residencies and one postgraduate year 2 residency. Seven residents, 11 preceptors, and three faculty members participated during the time frame discussed in this article. Practice settings included three community sites and three ambulatory sites. PRACTICE INNOVATION: The PBRTN includes a residency director, a research director, preceptor and resident members, and research faculty. The group works collaboratively to meet training goals. The PBRTN maintains a project timeline, foundational training, and structured research development, implementation, and presentation phases. Each resident submits five required research products: abstract, grant, poster, podium presentation, and research manuscript. MAIN OUTCOME MEASURES: Quantitative measures included the number of abstracts, grants, and peer-reviewed publications over two time periods, one before and one after a deliberate attempt to increase the research focus of the residencies. The ratio of research products to number of residents was used as a measure of productivity. Postresidency career choice and postresidency publications are reported. RESULTS: Over a decade, the program has produced 37 graduates, 50 abstracts, 15 grants, and 12 peer-reviewed publications. The publication-to-resident ratio increased from 0.25 in the pre-emphasis period of 1997-2001 to 0.56 in 2002-2007, after the research focus was intensified. Of graduates, 38% are in faculty positions, with 48 postresidency publications. CONCLUSION: Use of a PBRTN has successfully provided research training and improved research outcomes for the program. This model could be implemented in other residencies.

Practice-based research networks: Keeping the highway running through the pharmacy community.

This issue of the Journal of the American Pharmacists Association focuses on a topic vital to the pharmacy profession-practice-based research networks (PBRNs) of pharmacy practitioners and researchers. Now, vital is a pretty value-based word and is in the eye of the beholder. Why do we think pharmacy practice-based research is vital? During our many years as practitioners, faculty members, and pharmacy leaders, the phrase "pharmacy is at a crossroad" has been overused regularly. One could say that we are now at another professional crossroad, but crossroads probably understates the seriousness of the times; potentially, we are at a "bypass." Let us use an analogy to illustrate our concerns and then tell you why we think the profession is at a bypass.

Improving communication skills of pharmacy students through effective precepting.

Pharmacy students should be given opportunities to learn and practice interpersonal communication skills during their community advanced pharmacy practice experience (APPE). Preceptors have the responsibility of setting the stage for the pharmacy students during their initial encounter. During this orientation to the site, students should become familiar with the history of the practice, the types of services provided, and the staff members. Once the orientation is completed, preceptors can develop strategies for incorporating the students into the practice's patient care activities. Students should participate in patient counseling, interviewing, and educational sessions. Also, students should participate in collaborative work with other health care providers. To ensure the development of communication skills in pharmacy students, preceptors can incorporate the teaching process "see one, do one, teach one" into their teaching activities. By following these strategies, preceptors can effectively and positively impact the communication skills of their students.

Advancing patient care through innovative practice: the Clinical Partners Program.

PURPOSE: The development, implementation, and outcomes assessment of an innovative pharmacist-managed ambulatory care and community pharmacy practice clinic are described. SUMMARY: The Clinical Partners Program at The Ohio State University (OSU) provides an active learning environment for students and residents, offers a patient-focused practice model based on pharmaceutical care principles, and serves as an arena for applied research in pharmacy practice. The program offers multiple services, including anticoagulation management, diabetes self-management, cholesterol management, hepatitis C education, herbal product and dietary supplement consultations, medication management, smoking cessation, and wellness. The practice is currently staffed by two faculty members from the college of pharmacy, with a 0.8 full-time-equivalent (FTE) pharmacist and a 0.65 FTE community pharmacy resident. It has served as a training site for 17 pharmacy residents, 28 bachelor of science (B.S.) in pharmacy students, 30 post-B.S. doctor of pharmacy (Pharm.D.) students, and 132 entry-level Pharm.D. students at various levels of training. The most successful methods of reimbursement for programs have been contracted services with OSU Managed Health Care Systems, Inc., which serves OSU faculty and staff and fee-for-service billing, charged directly to non-OSU patients. Numerous studies have shown that Clinical Partners has consistently demonstrated improved therapeutic outcomes over those achieved in traditional practice. Faculty are exploring outreach services, including the development of advanced practice community sites for the college, establishing patient care services within physician offices, and providing disease management services for self-insured employers. CONCLUSION: The Clinical Partners Program has improved patient care and provided education and training opportunities for pharmacy students and residents.