Journal of the American Pharmacists Association最新文献

Background: The Community Pharmacy Enhanced Services Network (CPESN) is a clinically integrated network (CIN) of approximately 3,500 community-based pharmacies in 48 local networks across the United States. CPESN USA promotes expansion of innovative programs within community-based pharmacies including value-based contracting for patient care services. As opportunities grow, it is important to define strategies and tools needed to implement payer-partner programs.

Objective: To explore strategies and resources utilized when implementing payer-partner programs within a CIN.

Methods: This cross-sectional electronic survey was emailed to forty-eight MNFs representing forty-eight local CPESN networks across the United States. An electronic survey was emailed to the MNF of each local CPESN network. Fourteen questions collected the MNFs experience with (1) opportunities at the local network, (2) resources found helpful for implementing payer-partner programs, (3) barriers to implementing payer-partner programs, (4) confidence with tasks related to payer-partner program implementation, and (5) reporting what types of teammates they work with or manage when implementing a payer-partner program. The survey was open for data collection for 65 days. Data was analyzed using descriptive statistics.

Results: 42 completed surveys were returned (response rate 87.5%). MNFs ranked the barriers most frequently experienced as buy-in effect (n=16, 41.0%) and management of pharmacy/network follow-through (n = 11, 28.2%). MNFs reported helpful resources for program implementation as peer-to-peer guidance (n=31, 79.5%) and program handouts/guides (n=30, 76.9%). MNFs reported additional resources needed as subject matter experts (n=23, 59.0%) and templated communications (n=22, 56.4%). MNFs expressed their highest levels of confidence in tasks related to leadership management (n=30, 76.9%) and implementing programs (n=28, 71.8%).

Conclusion: Barriers to payer-partner program implementation within the clinically integrated network were buy-in effect, management of pharmacy/network follow-through, management of peers, and management of pharmacy/network implementation. Leaders within the CIN reported desires for a toolkit which iterates successful strategies and education on building community and accountability within local networks. Development of tailored support and resources can enhance the capacity of network leaders to scale payer-partner programs within community-based pharmacies.

Background: Growing evidence has shown feasibility for HIV prevention service integration in pharmacies, including HIV testing and screening for pre-exposure prophylaxis (PrEP). Yet, further work is needed to determine whether pharmacies can effectively reach those at increased risk of HIV transmission.

Objectives: We aimed to describe the HIV risk profiles and willingness to obtain HIV prevention services of a sample of pharmacy clients.

Methods: This was a cross-sectional pilot study aimed to develop a culturally appropriate pharmacy-based PrEP delivery model among Black men who have sex with men (MSM). Two pharmacies were recruited from low-income, underserved communities and participants were recruited within pharmacies for screener and social and behavioral surveys. Individuals were grouped by PrEP eligibility due to sexual risk, injection drug use risk, or both, and demographic and willingness measures were compared.

Results: Among 460 pharmacy clients, 81 (17.6%) would have been eligible for PrEP due to sex or injection drug use risk. Most were eligible due to sexual risk (58.0%), while a substantial proportion were eligible due to injection drug use (27.2%) or a combination of sexual and injection drug use risk behaviors (42.0%). Of these eligible, median age was 31 years (IQR=28,32) and most had ≥1 female (75.3%) or male (96.3%) partner in the past 6 months. There was high willingness to receive a free HIV test in a pharmacy (90.1%). Most were willing to screen for PrEP in a pharmacy (95.1%) despite these services not being available in the state where this study was performed. There were no differences in willingness to obtain pharmacy-based HIV prevention services across risk groups.

Conclusion: This study shows that pharmacies in disadvantaged areas can serve a key role in preventing and decreasing the transmission of HIV by reaching populations with high HIV burden and providing HIV prevention services.

Background: New pharmacists, PharmD graduates of 2020 and 2021, faced the unique challenge of entering the workforce during the volatile and divisive COVID-19 pandemic. They had to navigate patient-driven misinformation while adapting to evolving roles, including the distribution and administration of COVID-19 vaccines. Understanding the experiences of new pharmacists during this period is crucial for professional development and patient care.

Objectives: The study aimed to describe new pharmacists' experiences of handling COVID-19 vaccine misinformation presented by patients.

Methods: Semi-structured Zoom interviews were conducted with PharmD 2020 and 2021 graduates recruited from St. John's University College of Pharmacy and Health Sciences (SJUCPHS) and the University of Mississippi School of Pharmacy (UMSOP) until saturation was achieved. Interview questions were based on constructs of the HURIER model and WHO algorithm on how to respond to vocal vaccine deniers. Data analysis was performed through deductive thematic content analysis, and findings were reported using the Consolidated Criteria for Reporting Qualitative Research.

Results: A total of 13 interviews were conducted, with 61.5% of participants from SJU and 38.5% from UM. They worked in various pharmacy settings, including independent (30.8%), chain (23.0%), long-term care (15.4%), and ambulatory care/hospital pharmacies (30.8%). The types of COVID-19 misinformation new pharmacists heard during the pandemic align with the techniques and topics of anti-vaccine arguments outlined by the WHO's algorithm. New pharmacists utilized evaluation skills to identify credible sources and information, interpreted patients' language and sources, and assessed patients' willingness to be corrected. All new pharmacists responded to misinformation regardless of the technique or topic; however, the mechanism of response may have differed depending on whether a technique or topic was presented.

Conclusions: This baseline understanding of new pharmacists' practices in managing health misinformation can inform the development of recommendations for health misinformation management and assist pharmacy schools in identifying areas for further training for student pharmacists.

Background: The contribution of Social Determinants of Health to health disparities and patient outcomes is widely acknowledged. Much less has been done to characterize provider SDOH, and in particular their effect on delivery of structurally competent care. Differing lived experiences create blind spots to the critical upstream factors contributing to health.

Objectives: The primary objective of this study was to examine the association between Structural Awareness (SA) and Social Determinants of Health (SDOH) when controlling for year of first licensure, primary setting of pharmacy practice, race, and gender. The secondary objective was to examine the difference in mean SA scores with four stand-alone predictor variables: reliance on public transportation, insurance coverage gaps, food insecurity, and housing insecurity.

Methods: This study is a cross-sectional web-based survey of 606 Minnesota pharmacists. SDOH risk and SA scores were assessed using modified versions of the PRAPARE and CCSAQ tools, respectively. The association of these scores was assessed using a multiple linear regression model and the association with stand-alone variables was done using t-tests.

Results: SDOH risk was significantly associated with SA at the 95% confidence level with a p-value of 0.0016. Food and housing insecurity were also significantly associated with SA score while reliance on public transportation and insurance coverage gaps were not.

Conclusion: Pharmacy and other healthcare professional training programs should create opportunities for exposure to the SDOH experienced by their patients through immersive learning and/or experiential education.

Objective: The COVID-19 pandemic resulted in health care workers experiencing temporary or permanent changes in employment due to layoffs, quits, and postpandemic increased job demand. Analyzing the association of the COVID-19 pandemic with employment changes and results of changes for practicing pharmacists and understanding the associations with demographic and work-related factors could inform practice, policy, and educational programs. This study aimed to explore the frequency, characteristics, and results of employment status changes (ESCs) experienced by pharmacists practicing pharmacy in March 2020 (ie, the start of the COVID-19 pandemic).

Methods: A descriptive, cross-sectional survey research design was used to collect data from a random sample of 93,990 licensed pharmacists in the United States. The study team developed an online survey questionnaire designed to assess the impacts of the COVID-19 pandemic on pharmacists' work and work-life. The survey items used for this study related to ESCs, work-life characteristics, work characteristics in March 2020 and 2022, and demographic variables. A total of 4947 usable responses were received between November 2022 and January 2023.

Results: Overall, 36.4% of respondents reported experiencing an ESC and approximately 70% of those reporting an ESC reported experiencing just 1 ECS. Overall, 39.5% of respondents who experienced an ESC stopped working (ie, were unemployed) pursuant to an ESC. Respondents who experienced an ESC reported significantly lower levels of work exhaustion and interprofessional disengagement and significantly higher levels of professional fulfillment in their current employment than respondents that did not experience an ESC.

Conclusion: The overall increase in demand for workers in the health care sector appeared to provide opportunities for pharmacists, especially pharmacists with 1 to 10 years of experience, to change their employment situation, resulting in better work-life characteristics. Given projections of a pharmacist shortage, research, policy, and educational programs could determine the best practices to improve work settings and the work-life characteristics of practicing pharmacists to improve the health of the current pharmacist workforce.

Background: Despite sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor/neprilysin inhibitors (ARNi) being cost-effective evidenced-based therapies for the management of Heart Failure with Reduced Ejection Fraction (HFrEF), research shows that less than 30% of patients with HFrEF are prescribed these agents.

Objective: This study aimed to understand clinician-perceived barriers and facilitators to prescribing ARNi and SGLT2i in patients with HFrEF.

Methods: We conducted virtual and in-person semi-structured interviews in a large integrated healthcare delivery system in the United States. Twenty cardiology clinicians managing patients with HFrEF were recruited using purposeful sampling to target providers across professions and practice sites. The interview guide was developed based on a literature review and insights from a practicing cardiologist. It inquired about perceived prescribing behaviors, focusing on factors affecting the use of ARNi and SGLT2i. We identified key themes using rapid qualitative analysis.

Results: Twenty clinicians were interviewed: 13 physicians, five advanced practitioners, and two clinic-based pharmacists. Eighteen interviews were analyzed; we excluded two as the clinicians interviewed did not meet the inclusion criteria. Three major themes were identified: 1) clinician-reported prescribing patterns don't always align with the American College of Cardiology/American Heart Association guidelines for the use of SGLT2i and ARNi due to clinical inertia, lack of familiarity, knowledge, and comfort with use, and concerns over polypharmacy or adverse events, 2) clinician-perceived and actual out-of-pocket cost reduced prescribing of ARNi or SGLT2i to patients, exacerbated by a lack of visibility into patients' prescription coverage, denials of coverage by insurance, and navigating prior authorization related workflows, and 3) incorporation of a clinic-based pharmacist increased the prescribing of these medications.

Conclusions: Increasing cost transparency, implementing interventions to overcome clinical inertia and cost hurdles, and increasing clinic-based pharmacist support may improve evidenced-based prescribing in patients with HFrEF, especially for comparatively novel classes such as ARNi and SGLT2i.

Background: Pharmacists are not billable healthcare providers under Medicare Part B or most insurance plans. Because of this, pharmacist services are relegated to incident-to-provider billing, despite pharmacists routinely providing services high in complexity. This discrepancy may negatively skew perceptions of pharmacists' contributions to outpatient clinic care.

Objectives: The objective of this study was to identify the potential revenue generation for pharmacist-delivered services at a single, rural South Dakota clinic if pharmacists were considered billable healthcare providers.

Methods: This retrospective, single center study utilized a chart review of first-quarter data from a single ambulatory clinic served by a 0.5 full time equivalent pharmacist serving Chronic Disease Management (CDM) and COVID-19 patients. For each appointment, the chart note was reviewed for elements that would satisfy requirements for Current Procedural Terminology (CPT®) billing codes. Medicare and Medicaid reimbursement was determined using official 2022 Physician Fee Schedules and private insurance reimbursement was set at a single rate of 60% of the fee schedule of the most common private payer.

Results: During the three-month study period, 118 patients (206 appointments) were seen by the pharmacist. The amount paid to the clinic was estimated at $2,174.91. The hypothetical amount paid to the clinic if pharmacists were considered billable healthcare providers is $10,415.31 for CDM clinic and $7,953.48 for COVID-19 clinic, totaling $18,368.79. Excluding uninsured patients, the hypothetical total is $17,102.03, with a total unrealized revenue of $16,193.88.

Conclusion: If pharmacists were considered billable healthcare providers and their services were billed accordingly, the potential revenue generation is significantly higher than actually generated revenue. This estimated data can be used to better quantify and qualify appointment-related data for non-pharmacist clinic managers.

Background: Sustainable career advancement opportunities for pharmacy technicians will be a critical part of patient-centered community pharmacy environments as the role of the pharmacist provider expands.

Objectives: (1) To determine the impact of a Pharmacy Technician Certification Board pharmacy (PTCB) certification on career advancement and professional growth metrics; (2) To assess technicians' role in advanced pharmacy services before and after certification; and (3) To identify changes in pharmacist services when a certified pharmacy technician (CPhT) was added to the provider team.

Methods: A 73-question web-based survey was distributed to all PTCB certified pharmacy technicians (CPhT) in the United States, Washing D.C., Puerto Rico, Guam, and the US Virgin Islands. The survey was distributed by PTCB in April 2021 with a 28-day collection period. The survey included multiple choice, rating scale, and free text questions centered on five domains: Practice experience, Career aspirations, Compensation, Pharmacy practice motivations, and Impact of COVID-19 pandemic.

Results: 23,007 CPhTs completed the survey. Respondents were primarily female (85.5%), age 30-39 (32.8%), and ≥ 10 years CPhT experience (42.8%). The majority of respondents cited improvement of patient health (77.4%), career advancement opportunities (53.5%), the ability to expand their role during emergencies (e.g., COVID-19) (52.6%), and future career advancement opportunities (51.7%) as benefits of CPhT certification. Increases in job responsibility after certification included changes occurring in roles related to clinical pharmacy services, patient education, preventive health services, provider communication, and staff training. Respondents agreed that PTCB-certification allowed for the expansion of pharmacists' services where they practiced, including clinical services (18.5%), patient education (18.3%), and preventive health services (18.1%).

Conclusion: CPhT's value certification for its benefits on career advancement, personal growth, and salary enhancement. Affirmation of skill and training through certification is also recognized to positively influence patient care and the pharmacy's ability to provide advanced patient care and services.

Background: Sexually transmitted infection (STI) surveillance showed more than 2.5 million cases of chlamydia, gonorrhea, and syphilis nationally in the United States in 2022. Individuals often seek out non-emergency medical care at pharmacies. This makes community pharmacies well-positioned to address rising STI rates by offering services to screen and treat common STIs. A local health department, an independent pharmacy, and a school of pharmacy in Pennsylvania partnered to implement a test-to-treat service for chlamydia and gonorrhea within a pharmacy. This pilot program utilized: (1) patient self-collected test kits for chlamydia and gonorrhea screening and; (2) standing orders for treatment at the pharmacy. One goal of this pilot was to develop resources others can use to implement similar pharmacy-based chlamydia and gonorrhea testing and treatment services.

Objective: Develop an expert-informed implementation toolkit for a chlamydia and gonorrhea test-to-treat program at a community pharmacy.

Methods: The "How to Build an Implementation Toolkit from Start to Finish" framework from the University of California at Berkeley was used to design the initial toolkit outline. Toolkit content was triangulated from three sources: (1) comprehensive literature review; (2) pilot program implementation team meetings; and (3) feedback from public health and other experts. Pilot program partners met regularly to review and edit the toolkit. The draft toolkit was then reviewed by outside experts and potential end-users .

Results: An 11-item toolkit was developed. Toolkit contents were reviewed by 11 outside experts and potential end-users. Toolkit resources included STI training resources for pharmacy teams, testing and treatment standing orders, pharmacy treatment screening form, marketing strategies, patient education materials, sample workflow, essential supply list, and other key resources.

Conclusion: Pharmacies may need additional resources for STI testing and treatment program implementation. Toolkit resources developed from this pilot program may help pharmacies overcome implementation barriers for similar programs.

Background: Primary medication nonadherence (PMN) occurs when a new medication is prescribed, but the patient does not obtain the medication, or an appropriate alternative. Medication knowledge may be a factor contributing to high PMN rates. A variety of approaches and technologies have been developed to enhance patient medication knowledge, though the impact of these interventions on PMN rates has not been studied.

Objectives: The objectives of this study were to: 1) compare community pharmacy PMN rates between pharmacies that offer patient medication educational video services and those that do not, and 2) assess the relationships between video service delivery and PMN status.

Methods: This cohort study utilized data from six pharmacies (three case, three control). Adult individuals with a new electronic prescription for medications were assessed for PMN using the Pharmacy Quality Alliance (PQA) measure specifications. A 6-month measurement period was used to assess if medications or an appropriate alternative were dispensed within 30 days. Descriptive statistics were used to evaluate differences in PMN rates between case and control pharmacies. The relationships between medication education video service use and PMN status were assessed using multivariable logistic regression models.

Results: A total of 4038 patients were included in the analyses, contributing 6311 prescriptions for PMN assessment. Case pharmacies had significantly lower (25.9% versus 29.1%) PMN rates than control pharmacies (p=0.0090). Prescriptions filled at pharmacies that utilized medication educational videos had lower odds of PMN status [OR = 0.58 (0.43, 0.78)] than controls. Video use was associated with lower odds of PMN status [OR = 0.83 (0.70, 0.98)] when compared to prescriptions where patients did not receive the service.

Conclusions: The use of health literacy-conscious, patient educational videos were associated with improved (lower) PMN rates. Medication education technologies represent a scalable solution to improve PMN and medication access.