Pharmacists' desired and actual times in work activities: evidence of gaps from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe pharmacists' work activities in the United States during 2004 in terms of (1) the desired amount of time they would like to spend in each of four work activities (medication dispensing, consultation, business management, drug use management), (2) the amount of time they actually spend in each activity, and (3) the gaps between desired and actual time reported in each activity. DESIGN: Cross-sectional study. SETTING: Pharmacies (community chain, community independent, hospital, and other) in the United States. PARTICIPANTS: 1,564 actively practicing pharmacists. INTERVENTION: Mailed survey from portions of the 2004 National Pharmacist Workforce Survey. MAIN OUTCOME MEASURES: Differences between desired and actual time spent in work activities in medication dispensing, consultation, business management, and drug use management and the associations between practice setting characteristics and demographic variables were explored using linear and logistic regression analyses. Practice variables included position, years in current position, working part time, work with other pharmacists, work with technicians, proportion of staff who are pharmacists, staff size, dispensing level. Demographic variables included age, gender, race, marital status, and year of licensure with respondents' reported work activity amounts and gaps. Linear regression results were interpreted based on standardized beta coefficients and corresponding P values. Logistic regression results were interpreted based on 95% confidence intervals for odds ratios. RESULTS: The proportion of time pharmacists devoted to medication dispensing, consultation, business management, and drug use management did not change between 2000 and 2004. Practice setting was the most consistently influential variable on pharmacists' work activities when controlling for other variables. Pharmacists in all practice settings would like to spend more time in consultation and drug use management and less time in medication dispensing, but compared with community pharmacists, hospital and other patient care pharmacists were less likely to report a gap between desired and actual time spent in dispensing activities. Age was a significant predictor of gaps between desired and actual time spent in various activities, but only the oldest age groups (ages of 60 or 70 years and older) were significantly different from the reference group of pharmacists aged 23 to 30 years. CONCLUSION: Pharmacists would like to devote more of their time to consultation and drug use management activities in community pharmacy settings but have not yet been afforded a full opportunity to engage in these activities to the extent that they desire.     

An intersectional review of discrimination and harassment experiences in pharmacy: Findings from the 2019 National Pharmacist Workforce Survey

BackgroundMost pharmacists in the United States are women, and the profession is becoming more racially diverse. The recent increase in political and social movements in the United States has heightened our awareness of the importance of better understanding the experiences of underrepresented individuals and groups. Little is known about discrimination and harassment in the profession of pharmacy in the United States.ObjectivesThe purpose of this study was to provide evidence that discrimination and harassment exist in the pharmacy profession and explore differences in discrimination and harassment using the intersectionality of race and sex.MethodsThe 2019 National Pharmacist Workforce Survey (NPWS) utilized an electronic survey that was distributed using a 3-contact Dillman approach by email to a randomized sample of 96,110 licensed pharmacists from all 50 U.S. states using the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS included a new battery of questions to assess the prevalence of discrimination and harassment in pharmacy.ResultsThe most common bases of discrimination experienced were based on age (31.2%), sex (29%), and race or ethnicity (16.6%). The most common type of harassment experienced was “hearing demeaning comments related to race or ethnicity” at 15.6%. The intersectionality analysis revealed different experiences among sex or race combinations. Black and Asian male pharmacists had the highest rate of “hearing demeaning comments about race or ethnicity.” Nonwhite pharmacists were more likely to experience harassment from customers or patients compared with their white colleagues. Black female pharmacists had the highest rate of being “very unsatisfied” with the results of reporting discrimination and harassment to their employer.ConclusionDiscrimination, including harassment and sexual harassment, is illegal, immoral, and unjust. As the profession of pharmacy continues to become more diverse, there must be a conscious, systemic, and sustained effort to create and maintain workplaces that are safe, equitable, and free of discrimination.     

Pharmacist compensation for cognitive services: focus on the physician office and community pharmacy

We provide a stepwise approach for the clinical pharmacy practitioner in the physician clinic or community pharmacy setting to secure compensation for cognitive services. How to establish compensation for pharmacist services is explored, including evaluating the payer mix, developing a relationship with the first- or third-party payer, becoming credentialed with a third-party payer, and creating a fee structure. We detail the physical process of billing, which involves completing appropriate billing forms, appropriately using billing codes, documenting cognitive services in the patient record, and obtaining the proper waivers and/or approvals to provide specific services such as laboratory services and immunizations. This comprehensive review of compensation for cognitive services available in the community pharmacy and physician office environment is designed to be a template for pharmacists to further develop specific strategies, implement fee structures, and obtain compensation in their pharmacy environment and payer mix. Exploration into these innovative markets will enable pharmacists to increase revenue as they enhance and expand their cognitive services for patients.     

Designing a theory and evidence informed pharmacogenomic testing service in community pharmacy in England

IntroductionPharmacogenomics (PGx) uses DNA to predict an individual's response to a medicine. Internationally, the delivery of PGx is frequently via community pharmacies, who can take a saliva sample, send it off for analysis and contribute to the final clinical decision making. No similar service has been set up in England.AimTo identify the barriers, enablers and Behaviour Change Techniques (BCTs) to inform a service specification for delivery of a community pharmacy based PGx service in England.MethodThis qualitative co-design research study was designed in three stages using action-orientated theory-based frameworks and tools. The first stage mapped perceptions, barriers to, and enablers for, implementing a community pharmacy based PGx service, derived from a previous qualitative study onto the Theoretical Domains Framework (TDF). The second stage utilised the Theory and Techniques Tool (TTT) to link the identified TDF domain with corresponding BCTs. The final stage used a Delphi survey followed by a Nominal Group Technique session to facilitate community pharmacists selecting their preferred BCTs to include in a service specification.ResultsThe existing qualitative data were mapped onto six TDF domains: Knowledge, Skills, Social/professional role and identity, Optimism, Beliefs about Consequences, and Environmental context and resources. Forty-six BCTs were identified using the TTT and the consensus methods resulted in nine selected BCTs: Review outcome goal(s), Feedback on behaviour, Instruction on how to perform behaviour, Demonstration of the behaviour, Credible source and Adding objects to the environment.ConclusionUsing a range of action-orientated theoretical frameworks and tools, pragmatic BCTs have been identified as part of a co-design process, which can now be used as the basis to develop a service specification for the implementation of a PGx testing service in a community pharmacy setting in England.     

Implementation of a community liaison pharmacy service: a randomised controlled trial

Objective The aim of this study was to provide a pharmacy service to improve continuity of patient care across the primary‐secondary care interface. Setting The study involved patients discharged from two acute‐care tertiary teaching hospitals in Melbourne, Australia, returning to independent living. Methods Consecutive patients admitted to both hospitals who met the study criteria and provided consent were recruited. Recruited patients were randomised to receive either standard care (discharge counselling, provision of compliance aids and communication with primary healthcare providers when necessary) or the intervention (standard care and a home visit from a community liaison pharmacist (CLP) within 5 days of discharge). Participant medication was reviewed during the visit according to set protocols and compliance and medication understanding was measured. All participants were telephoned 8–12weeks after discharge to assess the impact of the intervention on adherence and medication knowledge. Key findings The CLP visited 142 patients with a mean time of 4.2 days following hospital discharge (range = 1–14 days). Consultations lasted 15–105 min (mean, 49 min; SD, ± 21 min). The CLPs retrospectively coded 766 activities and interventions that occurred during home visits, subsequently categorised into three groups: counselling and education, therapeutic interventions and other interventions. No statistical difference was detected in the number of medications patients reported taking at follow‐up: the mean value was 7.72 (SD, ± 3.27) for intervention patients and 7.55 (SD, ± 3.27) for standard‐care patients (P = 0.662). At follow‐up self‐perceived medication understanding was found to have improved in intervention patients (P < 0.001) and significant improvements from baseline in medication adherence were found in both standard‐care (P < 0.022) and intervention (P < 0.005) groups; however, adherence had improved more in intervention patients. Conclusion The community liaison pharmacy service provided critical and useful interventions and support to patients, minimising the risk of medication misadventure when patients were discharged from hospital to home.     

Formation of a statewide community pharmacy practice-based research network: Pharmacist opinions on research participation and engagement

ObjectiveTo gather the insights and opinions of pharmacist stakeholders to inform the creation of a community pharmacy practice-based research network (PBRN) in Pennsylvania.DesignA stakeholder advisory board of pharmacists, patients, and researchers was established to guide this research. This was a qualitative study using a semistructured interview guide.Setting and participantsCommunity pharmacists from the Pennsylvania Pharmacist Care Network.Outcome measuresThemes were identified that describe pharmacist insights and opinions on research participation and preferences for engagement in the PBRN.ResultsA total of 16 pharmacists participated in the study. The pharmacists believed that participating in research would help demonstrate their value and commitment to improving patients’ health. Enhancing patient-pharmacist relationships and driving innovation were additional benefits that were reported. The pharmacists believed that they could effectively leverage their relationships with patients to engage them in research opportunities. The pharmacists reported that they would like to share research ideas and successful research practices with other members of the PBRN.ConclusionGathering pharmacists’ opinions on participating in research was an important step in developing a community pharmacy PBRN that meets stakeholder needs. The results of this study can help others who seek to form community pharmacy PBRNs that facilitate stakeholder-driven research.     

Exploring the expanded role of the pharmacy technician in medication therapy management service implementation in the community pharmacy

Objectives

To explore the current roles of the pharmacy technician in the provision of medication therapy management (MTM) and their relation to organizational behavior at “high-performing” community pharmacies within a nationwide supermarket chain.

The pharmacy care plan service: Evaluation and estimate of cost-effectiveness

Background

The UK Community Pharmacy Future group developed the Pharmacy Care Plan (PCP) service with a focus on patient activation, goal setting and therapy management.