Impact of a pharmacist-led, primary medication nonadherence intervention program on prescription fills in underserved patient populations.

BACKGROUND: Poor medication adherence is a critical barrier to improving patient health. Patients who are medically underserved are prone to a chronic disease state diagnosis and experience different social determinants of health. OBJECTIVE: This study aimed to determine the impact of a primary medication nonadherence (PMN) intervention on prescription fills in underserved patient populations. METHODS: This randomized control trial included 8 pharmacies that were chosen based on current poverty demographic data for each region in a metropolitan area as reported by the U.S. Census Bureau. Randomization was completed by a random number generator into (1) an intervention group or (2) a control group: (1) initiation of a PMN intervention and (2) no intervention offered on PMN. The intervention consists of a pharmacist addressing and resolving patient-specific barriers. Patients were enrolled in a PMN intervention at day 7 of a newly prescribed medication or a medication that has not been used in the previous 180 days, not being obtained for therapy. Data were collected to determine the number of eligible medications or therapeutic alternatives that were obtained after a PMN intervention was initiated and if that medication was refilled. RESULTS: The intervention group consisted of 98 patients and the control group had 103. Rate of PMN was higher (P = 0.037) in the control group (71.15%) than the intervention group (47.96%). Cost and forgetfulness encompassed 53% of the barriers experienced by patients in the interventional group. The most commonly prescribed medication classes associated with PMN included statins (32.98%), renin angiotensin system antagonists (26.18%), oral diabetes medications (25.65%), and chronic obstructive pulmonary disease and corticosteroid inhalers (10.47%). CONCLUSION: The rate of PMN had a statistically significant decrease when a pharmacist-led, evidence-based intervention was conducted with the patient. Although this study depicted a statistically significant decrease in PMN rates, larger studies are needed to strengthen the correlation between the decrease in PMN and a pharmacist-led, PMN intervention program.

A Pilot Study Exploring the Impact of a Primary Medication Non-Adherence Intervention among Four Chronic Disease States in One Regional Division of a Large Community Pharmacy Chain.

There is a 12.2% rate of primary medication non-adherence (PMN) among community pharmacy patients. The Pharmacy Quality Alliance (PQA) has developed a standardized definition of PMN to aid stakeholders in addressing PMN. However, little research had been conducted to date on how to address PMN. The objective of the study was to determine the impact of an evidence-based adherence intervention program on PMN rates among four chronic disease states and to identify and characterize factors associated with PMN. Patients at risk of PMN were randomized into a control or intervention group. Those in the intervention group received a live call from a pharmacist to determine reason for and to discuss solutions to overcome PMN. Subjects included adult patients with newly prescribed medications used to treat diabetes, hypertension, hyperlipidemia, and/or chronic obstructive pulmonary disease (COPD). This study occurred in six pharmacies across one regional division of a national supermarket, community pharmacy chain. Prescriptions were considered newly initiated when the same drug, or its generic equivalent, had not been filled during the preceding 180 days. Prescriptions were considered at risk if they had not been obtained by day 7 of it being filled. Prescriptions were considered PMN if the patient had not obtained it, or an appropriate alternative, within 30 days after it was prescribed. During the 4-month intervention period, 203 prescriptions were included in the study with 94 in the intervention group and 109 in the control group. There was a 9% difference (p = 0.193) in PMN between the intervention group (44 patients, 47%) and the control group (61 patients, 56%). The therapeutic class most at risk of PMN was statins (34%). Cost (26%) and confusion/miscommunication (15%) were the most common reasons for PMN within the intervention group. Among the four chronic disease states studied, the intervention had the largest impact on hypertension. The PMN intervention did not significantly decrease PMN rates.

Scaling technician product verification: Contextual analysis for developing an implementation strategy for a large community pharmacy chain.

OBJECTIVE: To identify facilitators and barriers of early implementation of a technician product verification (TPV) program in a large community pharmacy chain. METHODS: A mixed-methods (surveys, semistructured interviews, and nondisguised direct observation) approach was used to ascertain facilitators and barriers to implementation and to subsequently develop a scalable implementation strategy with the aim to accelerate TPV scalability across a large community pharmacy chain in states where it is permitted. One-on-one staff interviews and observations provided qualitative data to identify facilitators and barriers to TPV. A Web-based survey was used to gather perceptions on a variety of implementation strategies that would make use of identified facilitators and work to overcome identified barriers. RESULTS: During the mixed-method study, 3 key themes emerged: TPV is a complex intervention whose implementation is facilitated by both adaptability and trialability and is highly dependent on state practice regulations; the implementation climate of the pharmacy organization serves as a facilitator to TPV; and individual beliefs about TPV change over time as implementation experience increases. CONCLUSION: TPV is an expansion of the technician role that allows the profession of pharmacy to increase the provision of clinical activities by delegation of a nonclinical-based task. Early adopters of TPV recognize that verification is a task that is increasingly automated by mail-order pharmacies and that verification may no longer be considered a pharmacist task. Pharmacies in this study tended to revert to comfortable, traditional workflow at the first sign of distress. To be successful in the future, TPV should be thought of as the primary workflow procedure and not as an option. TPV is a service that will require staff buy-in, patience, and championship.

Exploring the early phase of implementation of a vaccine-based clinical decision support system in the community pharmacy.

OBJECTIVE: To explore the implementation strategy of a recombinant zoster vaccine (RZV) clinical decision support (CDS) intervention in community pharmacy workflow to increase second-dose vaccination rates. SETTING: The level of analysis was the unit (e.g., pharmacy). The participants were selected from across approximately 2200 pharmacies in 37 states on the basis of criteria believed to affect implementation success (e.g., size, location) using a sampling matrix. PRACTICE DESCRIPTION: Large supermarket pharmacy chain. PRACTICE INNOVATION: Vaccine-based CDS intervention in community pharmacy workflow. EVALUATION: A mixed-methods contextual inquiry approach explored the implementation of a new RZV CDS workflow intervention. Data collection involved key informant, semistructured interviews and an electronic, Web-based survey. The survey was based on a validated instrument and was made available to all pharmacists nationwide within the study organization to assess views of the implementation's appropriateness, acceptability, and feasibility during early implementation. Afterward, a series of semistructured, in-depth interviews were conducted until a point of saturation was reached. The interview guide was based on selected constructs of the Consolidated Framework for Implementation Research. RESULTS: A total of 1128 survey responses were collected. Survey respondents agreed or strongly agreed that the implementation was acceptable (78.34%), appropriate (79.92%), and feasible (80.53%). Twelve pharmacist participants were interviewed via telephone. Five themes emerged from the interviews, revealing facilitators and barriers that affected implementation of the intervention: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. CONCLUSION: The implementation of the RZV CDS "nudge" intervention was welcomed, suitable, and operable in the community pharmacy setting to meet the needs of the organization, employees, and patients. The contextual factors identified during the implementation process of this CDS intervention in a community pharmacy setting may be used in scaling this and future CDS interventions for public health initiatives aimed at pharmacists in this setting.