Identifying Barriers That Prevent the Usage of Health Information Exchange in Ohio.

Background: As clinical services expand in community pharmacies, access to patient information through a health information exchange (HIE) may be of increased benefit to patient care. Objectives: To identify perceptions and barriers to the use of HIE by high-performing clinical pharmacists within a grocery store chain and collect other health care provider perceptions of using HIE. Methods: Two web-based surveys consisting of multiple choice, select all that apply, and 5-point Likert-type scale questions were administered via email to Ohio pharmacists working in high clinical performing pharmacies and Ohio health care providers utilizing CliniSync, an Ohio-based HIE program. Outcomes measured included pharmacist perceptions of preparedness to participate in HIE, their relationship with patients and health care providers, and barriers to utilizing HIE. Provider outcomes included perceptions of relationships with patients, awareness of community pharmacy services, referral habits, and perceived benefit of a HIE. Results: Pharmacists tend to believe they have the skill (median 5, interquartile range [IQR] 1) and desire (median 5, IQR 1) to be a part of the HIE network. Pharmacists appear confident in their abilities to provide patient care as a part of HIE networks (median 4, IQR 1). While 66% of providers surveyed are aware of services provided by community pharmacists, 75% state that they do not refer patients to a pharmacy for those services. Conclusion: Implementing HIE into clinical pharmacy workflow and encouraging providers to use it to make patient health information available to pharmacists would provide additional information for pharmacists to review when providing clinical services in the community pharmacy setting, ultimately benefiting patient care.

Community Pharmacist-Provided Wellness and Monitoring Services in an Employee Wellness Program: A Four-Year Summary.

Objective: To assess the clinical outcomes of participants of an employee wellness program during four years of service implementation. Methods: A prospective cohort study was conducted at 15 independent community pharmacy chain locations in northwest and central Missouri. A total of 200 participants were enrolled in an employee wellness program, and the program included five monitoring groups-cholesterol, blood pressure, blood glucose, weight, and healthy participant groups. Participants selected a pharmacist wellness coordinator and wellness appointments were conducted, consisting of education, goal-setting, and monitoring through physical assessment and point of care testing. The primary outcome measures were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), body mass index (BMI), and waist circumference (WC). The secondary outcome measures were the proportion of patients who achieved the clinical value goals at baseline versus 48 months. The primary outcome measures among data collection time points were compared using one-way analysis of variance (ANOVA) tests, and the secondary outcomes were compared between baseline and 48 months by Chi-square or Fisher's exact tests. One-way ANOVA post hoc tests were also performed using least significant difference, to further identify which time points differed from each other. Results: At baseline, there were 134 patients in the cholesterol monitoring group, 129 in the weight monitoring group, 117 in the blood pressure monitoring group, 46 in the blood glucose monitoring group, and 26 in the healthy participant monitoring group. For patients in the blood pressure monitoring group, compared with baseline, there was a significant decrease in DBP at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood pressure goals at 48 months. For patients in the blood glucose monitoring group, compared with baseline, there was a significant decrease in FBG at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood glucose goals at 48 months. Conclusions: Pharmacist-led wellness visits provided to employee wellness patients in a community pharmacy may lead to improvements in BP and FBG values.

Perspectives of athletes and pharmacists on pharmacist-provided sports supplement counseling: An exploratory study.

OBJECTIVES: To identify athletes' interests in receiving advice about sports supplements from a pharmacist in a supermarket setting and to identify pharmacists' knowledge, confidence, and enthusiasm for providing counseling on various sports supplements. METHODS: Two cross-sectional surveys were developed and administered. One survey was administered to athletes at local northwestern Ohio fitness facilities, and 1 survey was administered to pharmacists in chain pharmacies during mid-February to mid-March 2017. The athlete survey gathered demographic information, information sources, products purchased, including their location and selection factors, and perceptions of pharmacists providing sports supplement counseling. The pharmacist survey gathered demographic information; knowledge, confidence, and enthusiasm for providing sports supplement counseling; perceptions of counseling benefit; and barriers to implementation of providing a sports supplement counseling service. RESULTS: The athlete survey had 129 participants. Athletes primarily reported obtaining sports supplement information from supplement stores, and only 2% indicated using a pharmacist. Although 52% said they would talk to a pharmacist about sports supplements, 66% said their perception of a pharmacist's fitness level would influence whether or not they would approach him or her. The pharmacist survey had 143 participants. On a 5-point Likert-type scale (1 = strongly disagree and 5 = strongly agree), the mean (SD) of their knowledge, confidence, and enthusiasm statements were 2.49 (0.89); 2.61 (0.94); and 3.54 (0.87), respectively. Ninety-two percent (n = 130) of pharmacists thought it would be beneficial to provide counseling on sports supplements. Perceived barriers included lack of knowledge, evidence, and time. CONCLUSION: Pharmacists were not identified as a primary resource for sports supplements, but athletes would be willing to discuss this topic with knowledgeable and physically fit pharmacists. Pharmacists felt that they lacked knowledge and confidence regarding sports supplement products but noted enthusiasm to provide counseling. Sports pharmacy counseling could be a viable expansion of pharmacy services in community pharmacies with proper education and tools.

Physicians' Preferences for Communication of Pharmacist-Provided Medication Therapy Management in Community Pharmacy.

OBJECTIVES: (1) To identify physicians' preferences in regard to pharmacist-provided medication therapy management (MTM) communication in the community pharmacy setting; (2) to identify physicians' perceived barriers to communicating with a pharmacist regarding MTM; and (3) to determine whether Missouri physicians feel MTM is beneficial for their patients. METHODS: A cross-sectional prospective survey study of 2021 family and general practice physicians registered with MO HealthNet, Missouri's Medicaid program. RESULTS: The majority (52.8%) of physicians preferred MTM data to be communicated via fax. Most physicians who provided care to patients in long-term care (LTC) facilities (81.0%) preferred to be contacted at their practice location as opposed to the LTC facility. The greatest barriers to communication were lack of time and inefficient communication practices. Improved/enhanced communication was the most common suggestion for improvement in the MTM process. Approximately 67% of respondents reported MTM as beneficial or somewhat beneficial for their patients. CONCLUSIONS: Survey respondents saw value in the MTM services offered by pharmacists. However, pharmacists should use the identified preferences and barriers to improve their currently utilized communication practices in hopes of increasing acceptance of recommendations. Ultimately, this may assist MTM providers in working collaboratively with patients' physicians.

Rural health systems' perceptions of referral to community pharmacists during transitions of care.

OBJECTIVES: To identify rural health systems' perceptions of value, benefits, barriers, and opportunities associated with community pharmacist involvement in patient transitions of care. SETTING: Rural health systems in northwest and central Missouri. PRACTICE DESCRIPTION AND INNOVATION: Qualitative descriptive study of key informant interviews with self-identified decision makers of rural health systems within a 50-mile radius of 15 independent community pharmacy chain locations. EVALUATION: Interviews were recorded, transcribed, and coded to evaluate themes in participant responses. RESULTS: Fifteen interviews were conducted at 8 rural health systems. Participants expressed significant value in community pharmacist involvement in transitions of care and highlighted several benefits, barriers, and opportunities related to potential collaboration. Benefits that were identified included medication monitoring, resource for patient information, and desire among health care providers to work with community pharmacists. Barriers included legal and regulatory issues with referral, communication, and prescriber utilization. Opportunities described included: patient education, monitoring, and follow-up; targeted interventions; medication access assistance; bedside medication delivery; and collaboration between community pharmacies and health care entities. CONCLUSION: Rural health system informants perceived community pharmacy involvement to be valuable and were receptive to collaboration during transitional care to improve patient outcomes. They highlighted barriers to overcome to truly incorporate community pharmacists into the transitional care arena. Understanding these rural health systems' perceptions can guide community pharmacies in developing collaborative relationships and patient care services to assist with care transitions.

Community pharmacy patient perceptions of a pharmacy-initiated mobile technology app to improve adherence.

OBJECTIVES: To determine patient perceptions of using a demonstration application (app) of mobile technology to improve medication adherence and to identify desired features to assist in the management of medications. METHODS: A qualitative study using key informant interviews was conducted in a community pharmacy chain for patients aged 50 and older, on statin therapy and owning a smart device. KEY FINDINGS: Three main themes emerged from 24 interviews at four pharmacy locations, which included benefits, barriers and desired features of the app. Benefits such as accessibility, privacy, pros of appearance and beneficiaries were more likely to lead to usage of the app. Barriers that might prevent usage of the app were related to concerns of appearance, the burden it might cause for others, cost, privacy, motivation and reliability. Specific features patients desired were categorized under appearance, customization, communication, functionality, input and the app platform. CONCLUSIONS: Patients provided opinions about using a mobile app to improve medication adherence and assist with managing medications. Patients envisioned the app within their lifestyle and expressed important considerations, identifying benefits to using this technology and voicing relevant concerns. App developers can use patient perceptions to guide development of a mobile app addressing patient medication-related needs.

Impact of wellness coaching and monitoring services provided in a community pharmacy.

OBJECTIVE: To assess the clinical and patient-centered outcomes of health coaching provided in the workplace by community pharmacists. DESIGN: Prospective interventional cohort study. SETTING: 11 independent community pharmacy chain locations in northwest and central Missouri, from January 2010 to January 2011. PARTICIPANTS: 81 benefit-eligible patients and 23 community pharmacy coaches employed by the self-insured pharmacy chain. INTERVENTION: Patients were stratified into monitoring groups according to baseline screening values for cholesterol, blood pressure, fasting blood glucose (FBG), body mass index (BMI), and waist circumference. Patients selected their pharmacist coach. Follow-up appointments occurred monthly to quarterly. Appointments consisted of education, goal setting, and monitoring through evaluation of treatment goals and physical assessment. MAIN OUTCOME MEASURES: Change from baseline in mean total cholesterol, serum triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, systolic blood pressure (SBP), diastolic blood pressure (DBP), FBG, weight, BMI, waist circumference, health-related quality of life (HRQoL), and patient satisfaction. RESULTS: Patients' total cholesterol, LDL cholesterol, HDL cholesterol, DBP, and FBG were reduced significantly. Mean changes in triglycerides, SBP, weight, BMI, and waist circumference were not statistically significant. The 36-Item Short-Form Health Survey version 2.0 showed improvements in both the Physical and Mental Component Summaries but did not reach statistical significance. More than 90% of patients were satisfied with the service and the care they received. CONCLUSION: Wellness coaching by a pharmacist provided in a community pharmacy can result in significant improvements in cardiovascular risk factors, with a trend toward improved HRQoL. In addition, patients were satisfied with the wellness program from the start of the project.