Journal of the American Pharmacists Association最新文献

{"title":"Evaluating the financial sustainability of pharmacist-led primary care services: Real-world evidence from Idaho","authors":"Jordin Millward,&nbsp;Zachary Rosko","doi":"10.1016/j.japh.2025.102970","DOIUrl":"10.1016/j.japh.2025.102970","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the financial viability and scalability of pharmacist-led chronic disease management services using commercial payor Evaluation and Management (E/M) billing codes in a rural primary care setting.</div></div><div><h3>Practice description</h3><div>In June 2023, a clinical pharmacist was embedded into a physician-owned family medicine clinic in Idaho. The pharmacist practiced at approximately 0.25 full-time equivalent (FTE), managing diabetes and polypharmacy collaboratively with referring providers. Patients were referred directly by providers or identified through chart review. Current Procedural Terminology codes billed included 99212–99214 for commercial and Medicaid beneficiaries and chronic care management (CCM) code 99490 for Medicare beneficiaries. Payment for pharmacist claims first occurred in October 2024 and reimbursement data was evaluated through June 2025 (9 months). Hemoglobin A1c (HbA1c) improvement was evaluated over the entire study period (24 months).</div></div><div><h3>Practice innovation</h3><div>The model leveraged Idaho's independent prescribing authority for pharmacists. The pharmacist was independently credentialed with 6 commercial payors as well as Idaho Medicaid and followed standard E/M and CCM coding practices. Real-time data informed iterative service refinements.</div></div><div><h3>Evaluation methods</h3><div>Descriptive reimbursement data were extracted from the electronic health record and average reimbursement rates per visit were calculated. Break-even scenarios were modeled using Idaho-specific salary and benefit benchmarks. Different staffing models were evaluated.</div></div><div><h3>Results</h3><div>Average reimbursement per visit was $123.25. The break-even threshold (1.0 FTE, no support staff, 30% benefits) was 6 patients per 8-hour clinic day. At 1.0 FTE with support staff, sustainability required 8 patients per clinic day. To target an additional profit of $100,000 per year for a 1.0 FTE pharmacist with support staff, the threshold was 12 patients per clinic day. Over the entire evaluation period, the average HbA1c of patients seen by the pharmacist was reduced by 1.8% and patients with HbA1c value below 7% increased by 35%.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102970"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145440543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lessons learned in optimizing recruitment and data collection for a pharmacy-based implementation trial","authors":"Abigail G. Shackley,&nbsp;Delesha M. Carpenter,&nbsp;Heidi Charton,&nbsp;Benjamin S. Teeter,&nbsp;Megan Smith,&nbsp;Tessa J. Hastings,&nbsp;Tamera Hughes,&nbsp;Geoffrey Curran","doi":"10.1016/j.japh.2025.102972","DOIUrl":"10.1016/j.japh.2025.102972","url":null,"abstract":"<div><h3>Background</h3><div>In Fall 2023, we initiated a National Institutes of Health-funded study to test the effectiveness of implementation strategies to support pharmacy implementation of a COVID-19 vaccine hesitancy counseling intervention. Our stepped-wedge trial compared a standard implementation condition (training and technical assistance) to a virtual facilitation (or one-on-one coaching) intervention. Within 6-8 weeks, problems emerged related to pharmacist engagement and data collection that threatened the study's success.</div></div><div><h3>Objective</h3><div>To describe formative evaluation results for the initial trial year and the strategies we developed and deployed in Fall 2024 to address identified engagement and data collection problems.</div></div><div><h3>Methods</h3><div>The formative evaluation consisted of 5 semistructured key informant interviews with highly-engaged and unengaged pharmacists and a review of coaches' notes. All qualitative data were coded using a rapid template analysis method. To interpret the results and identify solutions, we consulted rural patient and implementation science expert advisory panels. Consensus was reached on study modification recommendations, which received funder approval.</div></div><div><h3>Results</h3><div>Numerous barriers impacted pharmacist engagement and data collection, such as poor demand for the COVID-19 vaccine, most patients declining to be audio-recorded to assess our primary outcome of pharmacist counseling fidelity, difficulties submitting encounter forms (our secondary outcome), staffing shortfalls, and pharmacist reluctance to approach “very hesitant” patients.</div></div><div><h3>Discussion</h3><div>Study modifications included changes to data collection (e.g., shift to using standardized patients for fidelity assessments), pharmacy recruitment, and the standard implementation approach (e.g., more training and tools). These modifications were deployed in the new first year of our implementation trial (August 2024 – April 2025) and we saw major improvements in study engagement and data collection.</div></div><div><h3>Conclusion</h3><div>Implementation trials often encounter potentially fatal problems due to shifting contexts. Studies can be salvaged if the team takes quick action, in partnership with funders and other constituents, to systematically understand the problems and develop solutions.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102972"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of community pharmacy-based testing and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae in Nova Scotia (Swab-Rx study)","authors":"Mackenzie d’Entremont-Harris,&nbsp;Tasha D. Ramsey,&nbsp;Shea J.L. McInnis,&nbsp;Connor Booker,&nbsp;Dylan DeYoung,&nbsp;Andrea Bishop,&nbsp;Kirk Furlotte,&nbsp;Todd F. Hatchette,&nbsp;Kyle John Wilby","doi":"10.1016/j.japh.2025.102973","DOIUrl":"10.1016/j.japh.2025.102973","url":null,"abstract":"<div><h3>Background</h3><div>Chlamydia and gonorrhea are the most reported bacterial sexually transmitted infections in North America. Accessible, efficient, and convenient testing mechanisms are essential to identify infections, reduce transmission, access treatment, and prevent complications.</div></div><div><h3>Objective</h3><div>This study aimed to implement pharmacy-based asymptomatic chlamydia and gonorrhea management in Nova Scotian community pharmacies and evaluate effectiveness and patient acceptability.</div></div><div><h3>Methods</h3><div>The study occurred in 4 community pharmacies in Nova Scotia, Canada. Pharmacists offered chlamydia and gonorrhea testing using patient self-collected swabs and first-catch urine. Specimens were tested at the Central Zone Microbiology Laboratory and reported back to the pharmacist who then provided results to the patient and prescribed treatment for any identified infection(s). An electronic questionnaire and posttesting interview explored patient acceptability. Pharmacist workload was explored in time per encounter and tests per week. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Framework of Acceptability informed the study design.</div></div><div><h3>Results</h3><div>Ninety-seven discrete participants were enrolled for 99 testing encounters. Eighty percent (78/97) of participants responded to the sociodemographic questionnaire, of which 64% were between the ages of 25 and 44, 26% identified as sexually diverse, and 15% as gender diverse. Many respondents reported never having been tested for chlamydia (23%) or gonorrhea (27%). Of the participants tested, 17% had positive test results; 14% had chlamydia and 3% gonorrhea infections. All participants with positive test results were prescribed antibiotic treatment by the pharmacist. Pharmacists required an average of 21 minutes for testing and 17 minutes for treatment encounters. Participants predominantly reported the service was highly acceptable, should always be available, and they would not have been tested if it was not available. Participants raised concerns regarding privacy, increased workload on pharmacists, and cost of the service.</div></div><div><h3>Conclusion</h3><div>Community pharmacy–based testing and treatment of asymptomatic chlamydia and gonorrhea was highly acceptable to service users. The model successfully identified new cases and pharmacists efficiently prescribed treatment.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102973"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145454507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Best practices and barriers to implementing value-based payer programs in community pharmacies: An application of the EPIS framework","authors":"Jordan Marie Ballou,&nbsp;La’Kendra Bell,&nbsp;Anna Greer Johnson,&nbsp;Reagan Page,&nbsp;Meagen Rosenthal","doi":"10.1016/j.japh.2025.102980","DOIUrl":"10.1016/j.japh.2025.102980","url":null,"abstract":"<div><h3>Background</h3><div>The advancement of clinical services in the community pharmacy setting hinges on workflow augmentations that will assist pharmacies in successful implementation. Community Pharmacy Enhanced Services Network (CPESN) Mississippi is a network of community-based pharmacies collaborating to optimize medication use to promote positive patient health outcomes.</div></div><div><h3>Objective</h3><div>The purpose of this study was to evaluate barriers to and best practices for implementing patient care services while participating in payer engagements.</div></div><div><h3>Methods</h3><div>This qualitative, quality improvement study was approved as exempt by the University of Mississippi Institutional Review Board. Subjects included owners or managers of pharmacies participating in CPESN Mississippi, an accountable pharmacy organization. Investigators developed two interview guides using the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. One interview guide was intended to gather information on best practices for the implementation of services, while the other was geared toward assessing barriers to implementation. Pharmacies were sorted into 2 groups to receive either the barriers or best practices questions based on their participation in a payer program in the fall of 2021. Interviews were conducted via telephone and were digitally recorded. Three attempts to contact each pharmacy were made on different days and times. Interviews were transcribed via Trint and underwent analysis for thematic content.</div></div><div><h3>Results</h3><div>A total of 21 pharmacists at community pharmacies in CPESN Mississippi were interviewed for a response rate of 41%. There were 8 interviews in the best practices group and 13 in the barriers group. The content analysis identified 4 themes in best practices (role specialization, clear communication, support from leadership, and patient engagement) and 4 themes in barriers (infrastructure needs, documentation complications, staff buy-in, and reimbursement).</div></div><div><h3>Conclusion</h3><div>Study findings concluded that community pharmacists are eager to find alternative sources of revenue but require support with implementation. The use of the EPIS Framework allows for the identification of specific implementation strategies for testing in future studies and creating sustainable and scalable change in the community pharmacy setting.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102980"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy staff willingness to establish pre-exposure prophylaxis-based collaborative practice agreements in the Southeast United States","authors":"Annabel Nicholas,&nbsp;Christina Chandra,&nbsp;Seth Zissette,&nbsp;Alexis Hudson,&nbsp;Chante Hamilton,&nbsp;Donald Klepser,&nbsp;Alvan Quamina,&nbsp;David P. Holland,&nbsp;Natalie D. Crawford","doi":"10.1016/j.japh.2025.102986","DOIUrl":"10.1016/j.japh.2025.102986","url":null,"abstract":"<div><h3>Background</h3><div>A collaborative practice agreement (CPA) allows a pharmacist to provide various patient care functions (i.e., ordering labs and modifying drug therapies) under the supervision of a provider. CPAs could facilitate pharmacists to provide human immunodeficiency virus (HIV) prevention services such as pre-exposure prophylaxis screening and prescribing, which could enhance HIV prevention services in places with historically low access.</div></div><div><h3>Objective</h3><div>We evaluate correlates of pharmacy staff willingness to establish CPAs and to provide specific patient care functions.</div></div><div><h3>Methods</h3><div>The Collaborative Agreement-based pre-exposure prophylaxis Using Pharmacists study conducted online surveys among pharmacy staff from 8 states in the Southeast United States. Data collection began in January 2024 and is ongoing. Survey questions were developed using Consolidated Framework for Implementation Research constructs and capture the history of CPA usage, attitudes about CPAs, and willingness to establish CPAs. Descriptive analysis and Poisson regression were performed using preliminary data to evaluate pharmacy staff willingness to offer specific patient care functions through CPAs.</div></div><div><h3>Results</h3><div>Among 246 respondents, 67 (27%) currently have at least 1 CPA in place, with 20 (30%) of those CPAs involving infectious disease care. About 75% were willing to establish a CPA to provide additional services to their patients. Most pharmacy staffs were willing to provide medication therapy management (91%), patient counseling (82%), and modification of existing therapy (73%); fewer were willing to interpret laboratory tests (54%), order laboratory tests (52%), and perform laboratory tests (39%). The strongest correlate of willingness to establish a CPA was having received formal training on CPAs.</div></div><div><h3>Conclusion</h3><div>Most pharmacy staffs were willing to establish CPAs to provide additional services beyond their current scope of practice, but few have experience with infectious disease CPAs. Future research is needed to identify factors that will allow for successful development and implementation of HIV prevention-specific CPAs and understand barriers to willingness for pharmacy staff who are unwilling to establish CPAs.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102986"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"10.1016/j.japh.2025.102995","DOIUrl":"10.1016/j.japh.2025.102995","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102995"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146187768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102934"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146629539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 103006"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146629543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102998"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146629546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"","authors":"","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102945"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146629553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}