Pharmacist-reported practice change as a result of a statewide community pharmacy accreditation program

ObjectivesTo assess pharmacist-reported practice change as a result of participation in a community pharmacy accreditation program.SettingCommunity pharmacy practice in Wisconsin.Practice innovationThe Wisconsin Pharmacy Quality Collaborative (WPQC) is a network of pharmacies and pharmacists who provide standardized pharmacy services. WPQC is based on a unique set of quality-based best practices designed to improve patient safety in the medication use process. WPQC is supported by the statewide pharmacy organization, the Pharmacy Society of Wisconsin (PSW), which provides resources focused on implementation and engagement to support the success of WPQC-accredited pharmacies.Program evaluationPSW used a 24-question online survey to evaluate the degree of pharmacist-reported practice change as a result of the WPQC quality-based best practices.ResultsPharmacist-reported frequency and consistency of all quality-based best practices and services increased after WPQC accreditation (P < 0.05), with the exception of robotic dispensing systems, holding regular staff meetings for team communication, and providing incentives for recording quality-related events. In addition, quality-based best practices and WPQC services had a positive impact on pharmacist perceptions of their quality of patient care, patient safety, patient satisfaction, and patient relationships in WPQC-accredited pharmacies. The majority of pharmacies valued WPQC accreditation and shared positive comments about their experiences.ConclusionA community pharmacy accreditation program using standardized quality-based best practices can create and reinforce behavior change in the community pharmacy setting to positively affect patient care and medication safety. Research is needed to determine if there are actual behavior changes as a result of WPQC accreditation compared with pharmacies that have elected not to participate.     

新形势下DTP药房对执业药师专业药学服务需求探讨

目的：提升专业药房（DTP药房）执业药师专业能力水平，助力DTP药房健康有序发展。方法：梳理国内外DTP药房产生的背景和发展状况，分析我国DTP药房特点和作用，提出DTP药房对执业药师专业能力的要求。结果：我国DTP药房以提供全周期专业化药学服务为特色，在处方外流、药品带量采购、“双通道”管理机制等政策的激励下，DTP药房面临重要发展机遇。结论：执业药师应不断提升专业的药学服务能力、书写药历和开展药物警戒能力、患者用药信息收集分析能力、全流程药品质量管理能力、沟通协调和人文关怀服务能力，以适应新形势下我国DTP药房发展需求，促进DTP药房为患者提供有价值的健康服务。     

Integration and differentiation: A conceptual model of general practitioner and community pharmacist collaboration

BackgroundThe drive for integrative systems and collaboration across organizations and professions involved in the provision of health and social care has led to the development of a number of scales and models that conceptualize collaborative behavior. Few models have captured the dynamics of the collaboration between community pharmacy and general medicine, 2 professional groups that are increasingly being encouraged to adopt more collaborative practices to improve patient care.ObjectivesThis article presents a new model of collaboration derived from interviews with general practitioners (GPs) and community pharmacists in England involved in service provision that required some form of collaboration.MethodsQualitative interviews were conducted with purposive samples of 13 GPs and 18 community pharmacists involved in the provision of local pharmaceutical services pilots and 14 GPs and 13 community pharmacists involved in the provision of repeat dispensing.ResultsThe model highlights key components of collaboration, including the importance of trust, communication, professional respect, and “knowing” each other. It is argued here that previous models fail to recognize the asymmetry and differentiation between GPs and community pharmacists, including differences in perception toward and importance assigned to trust and communication. GPs were found to adopt demarcation strategies toward community pharmacies and pharmacists, with independent pharmacies being favored over multiple chains and regular pharmacists favored over locum/sessional pharmacists. This differentiation was repeatedly highlighted by GPs and found to affect their ability or willingness to collaborate.ConclusionThe model provides a foundation for the future development of strategy and research focused on the improvement or study of collaborative relationships between community pharmacy and general practice.     

Consumer,physician, and payer perspectives on primary care medication management services with a shared resource pharmacists network

BackgroundHealth care reform initiatives are examining new care delivery models and payment reform alternatives such as medical homes, health homes, community-based care transitions teams, medical neighborhoods and accountable care organizations (ACOs). Of particular interest is the extent to which pharmacists are integrated in team-based health care reform initiatives and the related perspectives of consumers, physicians, and payers.ObjectivesTo assess the current knowledge of consumers and physicians about pharmacist training/expertise and capacity to provide primary care medication management services in a shared resource network; determine factors that will facilitate/limit consumer interest in having pharmacists as a member of a community-based “health care team;” determine factors that will facilitate/limit physician utilization of pharmacists for medication management services; and determine factors that will facilitate/limit payer reimbursement models for medication management services using a shared resource pharmacist network model.MethodsThis project used qualitative research methods to assess the perceptions of consumers, primary care physicians, and payers on pharmacist-provided medication management services using a shared resource network of pharmacists. Focus groups were conducted with primary care physicians and consumers, while semi-structured discussions were conducted with a public and private payer.ResultsMost consumers viewed pharmacists in traditional dispensing roles and were unaware of the direct patient care responsibilities of pharmacists as part of community-based health teams. Physicians noted several chronic disease states where clinically-trained pharmacists could collaborate as health care team members yet had uncertainties about integrating pharmacists into their practice workflow and payment sources for pharmacist services. Payers were interested in having credentialed pharmacists provide medication management services if the services improved quality of patient care and/or prevented adverse drug events, and the services were cost neutral (at a minimum).ConclusionsIt was difficult for most consumers and physicians to envision pharmacists practicing in non-dispensing roles. The pharmacy profession must disseminate the existing body of evidence on pharmacists as care providers of medication management services and the related impact on clinical outcomes, patient safety, and cost savings to external audiences. Without such, new pharmacist practice models may have limited acceptance by consumers, primary care physicians, and payers.     

Pharmacist provider status: Geoprocessing analysis of pharmacy locations,medically underserved areas,populations, and health professional shortage areas

BackgroundPayment reform for pharmacists is both an important and urgent issue that needs to be addressed.Objective(s)The purpose of this paper is to assess the use of medically underserved areas, medically underserved populations, and primary care health professional shortage areas in The Pharmacy and Medically Underserved Areas Enhancement Act; and provide policy recommendations for national pharmacy associations to achieve provider status.MethodsPharmacy location addresses were determined using public domain data from the National Plan & Provider Enumeration System (NPPES) National Provider Identifier (NPI) Registry. Medically Underserved Areas/Populations (MUAs/MUPs) and Health Professional Shortage Areas (HPSAs) were gathered through public data provided by the Health Resources and Services Administration as Keyhole Markup Language (KML) files. Addresses and KML files were analyzed and mapped using the geographic information software, QGIS. A series of maps depicting the location of all MUAs/MUPs, HPSAs, HPSA facility locations, and community pharmacy locations in the U.S. were then created. These maps were overlayed, and geoprocessing tools were used to create the analysis.ResultsAfter analyzing all community pharmacy locations in the United States, we found that only 56% are located within a current MUA/MUP or HPSA. The percentage of pharmacies in healthcare underserved areas differs widely between states from the lowest in New Jersey of 18.26% of pharmacies to the highest of Guam, the Northern Mariana Islands and the Virgin Islands with 100% of pharmacies.ConclusionsAligning the pharmacist business model to be comparable to other health care professionals will ensure patients receive access to pharmacist-provided cognitive patient care services, which have higher value than product-centered services. Future attempts to recognize pharmacists as providers and allow for their reimbursement under Medicare Part B should consider strategies to increase the number of pharmacists that are eligible to participate in order to exemplify value to the public and elected leaders.     

The I-Tribe Community Pharmacy Practice Model: Professional pharmacy unshackled

ObjectiveTo describe a mechanism by which pharmacists could create a disruptive innovation to provide professional primary care services via a Web-based delivery model.SummarySeveral obstacles have prevented pharmacists from using available technology to develop business models that capitalize on their clinical skills in primary care. Community practice has experienced multiple sustaining innovations that have improved dispensing productivity but have not stimulated sufficient demand for pharmacy services to disrupt the marketplace and provide new opportunities for pharmacists. Pharmacists are in a unique position to bridge the gap between demand for basic primary medical care and access to a competent medical professional. Building on the historic strengths of community pharmacy practice, modern pharmacists could provide a disruptive innovation in the marketplace for primary care by taking advantage of new technology and implementing the I-Tribe Community Pharmacy Practice Model (I-Tribe). This model would directly connect pharmacists to patients through an interactive, secure Web presence that would liberate the relationship from geographic restrictions.ConclusionThe I-Tribe is a disruptive innovation that could become the foundation for a vibrant market in pharmacist professional service offerings. The I-Tribe model could benefit society by expanding access to primary medical care while simultaneously providing a new source of revenue for community practice pharmacists. Entrepreneurial innovation through I-Tribe pharmacy would free pharmacists to become the care providers envisioned by the profession's thought leaders.     

The role of network ties to support implementation of a community pharmacy enhanced services network

BackgroundLimited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients.ObjectivesThe aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network.MethodsUsing a semi-structured interview guide, we interviewed 40 community pharmacy representatives responsible for implementation of a community pharmacy enhanced services program. We analyzed for themes using social network theory to compare network ties among 24 high- and 16 low-performing community pharmacies.ResultsThe study found that high-performing pharmacies had a greater diversity of network ties (e.g., relationships with healthcare providers, care managers, and public health agencies). High-performing pharmacies were able to use those ties to support implementation of NC-CPESN. High- and low-performing pharmacies used similar strategies for establishing ties with patients, such as motivational interviewing and assigning staff members to be responsible for engaging high-risk patients. High-performing pharmacies used additional strategies such as assessing patient preferences to support patient engagement, increasing patient receptivity towards enhanced services.ConclusionsCommunity pharmacies may vary in their ability to develop relationships with other healthcare providers, care management and public agencies, and patients. As enhanced services interventions that require care coordination are scaled up and spread, additional research is needed to test implementation strategies that support community pharmacies with developing and maintaining relationships across a diverse group of stakeholders (e.g., healthcare providers, care managers, public health agencies, patients).     

Obligations of Investigators in Clinical Research a Pharmacist's Perspective

Abstract

The Department of Pharmacy Practice at the University of Illinois at Chicago, College of Pharmacy currently employs 40 fulltime clinical pharmacists who have minimal drug distribution responsibilities and provide pharmacy services to a specific patient care team and are involved with the education of pharmacy and medical students. In addition, these clinical pharmacists have collaborated in the clinical research activities of the medical and surgical staffs at the University of Illinois, Since many of these pharmacists have gain recognition as primary and co-investigators by various study sponsors, the Department of Pharmacy Practice has developed a program to inform each clinical pharmacist of his/her responsibilities as a clinical investigator. The following document summarizes the Department's policies and procedures.     

An exploration of the utility of appraisals for the revalidation of pharmacy professionals in community pharmacy in Great Britain

BackgroundWith revalidation in pharmacy in the United Kingdom fast approaching, appropriate systems of revalidation in community pharmacy are required. With little known about the potential use of appraisals for evaluating fitness to practice in pharmacy professionals (pharmacists and pharmacy technicians) in this sector, research was undertaken to explore their potential utility in a revalidation process.ObjectivesTo examine existing structures and processes in community pharmacy appraisals in Great Britain (ie, England, Scotland, and Wales) and consider the views of pharmacy stakeholders on if, and how, appraisals could contribute to revalidation of pharmacy professionals.MethodsSemi-structured telephone interviews were conducted with senior staff (eg, superintendents and professional development managers) from chain community pharmacies as well as pharmacy managers/owners from independent pharmacies. Senior staff from locum agencies and pharmacy technician stakeholders were also interviewed.ResultsAppraisals were in place for pharmacists in most chain pharmacies but not in independent pharmacies. Locum pharmacists were not appraised, either by the companies they worked for or by the locum agencies. Pharmacy managers/owners working in independent pharmacies were also not appraised. Pharmacy technicians were appraised in most chain pharmacies but only in some independent pharmacies. Where appraisals were in operation, they were carried out by line managers who may or may not be a pharmacist. Appraisals did not seem to cover areas relevant to fitness to practice but instead focused more on performance related to business targets. This was particularly true for those in more senior positions within the organization such as area managers and superintendent pharmacists.ConclusionsExisting systems of appraisal, on their own, do not seem to be suitable for revalidating a pharmacy professional. Considerable changes to the existing appraisal systems in community pharmacy and employer engagement may be necessary if they are to play a role in revalidation.