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.     

Pharmacy provision of influenza vaccinations in medically underserved communities

ObjectivesTo demonstrate the extent to which a community pharmacy can provide influenza immunizations in communities designated as medically underserved.MethodsThis retrospective study examined the number of influenza immunizations administered and populations served in areas with limited access to health care by Walgreens pharmacies during the 2009–10 influenza season.ResultsMore than 43% of the U.S. population resides in medically underserved areas (MUAs), and our results show that Walgreens pharmacies served nearly one-half of this population. Nationwide, more than one-third of influenza immunizations were administered by pharmacies located in MUAs. In states with the highest proportion of their population in MUAs, the percentage of influenza vaccines provided in MUAs was much greater (up to 77.1%).ConclusionCommunity pharmacies are convenient and accessible venues at which patients can obtain seasonal influenza vaccines and other immunizations. They are well-positioned throughout the country, including in areas that are otherwise medically underserved. These factors help community pharmacists eliminate one of the most important barriers to vaccination: accessibility.     

Planning for health information exchange: Perspectives of community pharmacists in the Community Pharmacy Enhanced Services Network of Indiana

BackgroundCommunity pharmacists are one of the most accessible health professionals and provide many different services. However, lack of access to complete patient information is a barrier to making meaningful patient interventions.ObjectivesTo determine (1) current and desired health information access among community pharmacists in the Community Pharmacy Enhanced Services Network (CPESN) of Indiana and (2) design considerations for a health information exchange tool for use by community pharmacists.MethodsThis voluntary study was conducted over an 8-day survey period in which 40 pharmacies within the CPESN Indiana network were contacted during regular business hours and asked to take part in a 15-minute telephone survey. Questions asked were informed by the following Consolidated Framework for Implementation Research intervention characteristics domain constructs: relative advantage, evidence strength and quality, adaptability, trialability, complexity, costs, and design quality and packaging.ResultsOf the 40 contacted pharmacies, 32 (80%) completed the survey. Most pharmacies reported access to immunization registry data; no other routine access was reported by any pharmacy. In questions assessing the relative advantage of Health Information Exchange (HIE) access compared with their current information access, at least 84.4% said that they agreed or strongly agreed with all statements. When choosing the data element most desirable to have access to via HIE in a community pharmacy, the most frequently selected choices were updated medication orders (n = 18, 56.3%), progress notes (n = 5, 15.6%), and laboratory tests (n = 4, 12.5%). Suggestions to improve ease of implementation included integration within dispensing software and clinical decision-making support features, such as alerts for pertinent lab values.ConclusionIntegrating HIE data into community pharmacies would provide community pharmacists with access to important patient data, and pharmacists believed that this would improve their practice. Future research should explore whether implementation of this type of tool leads to better patient outcomes and improved pharmacist job satisfaction.     

How youth-friendly are pharmacies in New Zealand? Surveying aspects of accessibility and the pharmacy environment using a youth participatory approach

BackgroundThe international youth population has significant unmet health needs, and there have been many calls to increase youth health care access. Community pharmacies may be able to help address these needs, but very little research has investigated this area and it is not known whether the current community pharmacy setting is acceptable or appropriate for youth.Objectives1) To obtain information on physical factors which could affect young people's use of community pharmacies in New Zealand, including accessibility, opening times and the physical youth-friendliness of the pharmacy environment. 2) To involve and utilize young people in the research process, in order to understand their needs and interpretation of survey data.MethodsThis study applied a cross sectional survey design, informed by a sequential youth participatory approach. A questionnaire was developed in consultation with a youth advisory group (YAG). Questionnaires distributed to pharmacists at 500 randomly selected pharmacies nationwide between May and September 2011 collected information on whether the pharmacy met selected youth-friendly criteria. These included physical aspects of youth-friendliness, such as opening times and the pharmacy environment. The YAG also provided a youth perspective in the interpretation of the results.ResultsThree mail shots achieved a response rate of 50.5%. Most respondents reported the pharmacy to be accessible by public transport and many had extended opening hours. Although most pharmacies met some youth-friendly criteria with regards to the pharmacy environment (e.g. having a private consultation area), more specific criteria (such as displaying youth health information) were usually not met. Interpretive feedback from the YAG highlighted areas for improvement.ConclusionsPharmacies show potential as youth-friendly health care access points and most already meet some youth-friendly criteria. Areas identified for improvement will require a greater youth focus from the profession, and should be undertaken in consultation with young people. We recommend the use of youth participation approaches in future pharmacy practice research into youth health services.     

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.     

Recommendations and guidance for providing pharmaceutical care services during COVID-19 pandemic: A China perspective

BackgroundThe novel coronavirus pneumonia (COVID-19), which was first detected in Wuhan City, has now became a pandemic that affecting patients around the world. Particularly, the community patient population are at high risk of infection and are facing potential failure of proper medication use during the pandemic.ObjectiveTo discuss community pharmacists’ role and the content of pharmaceutical care (PC) during the novel coronavirus pandemic to promote effective prevention and control and safe drug use of the community patient population.MethodCollect and summarize the experience Chinese community pharmacies gained from providing pharmacy services during the COVID-19 outbreak, and taking patients' PC needs into consideration, analyze and discuss the methods and strategies that community pharmacies and pharmacists shall use to provide PC during the pandemic.ResultsCommunity pharmacy management teams shall support PC services by providing adequate supply of COVID-19 related medications and preventative products, following environment regulations, and providing sufficient staff trainings. Pharmacists shall use various approaches to provide PC services in drug dispensing, consulting and referrals, chronic disease management, safe use of infusions, patient education, home care guidance and psychological support to promote the COVID-19 pandemic control and ensure safe medication use of community patients during the pandemic.ConclusionPC services in communities during the COVID-19 shall possess different properties due to disease characteristics and related change in patients' need. Community pharmacies shall work as a strong supporter of patient's medication and protective equipment supply. Community pharmacists shall be prepared to provide skilled and effective PC services for community patient population to ensure medication safety and promote the overall COVID-19 pandemic control.     

The changing roles of pharmacists in community pharmacies: perception of reality in India

Aim of the review To summarise the state of community pharmacy in India including: the provision of patient care, pharmacy education, the pharmaceutical market, healthcare delivery, community pharmacy services, the professional role of community pharmacists, and future developments. Method Medline, Scirus, and Google Scholar databases and the journals “Indian Journal of Pharmaceutical Sciences” and “Indian Journal of Hospital Pharmacy” were searched up to the end of December 2008. In addition to these, other available sources were used to identify relevant articles. Results India has a fast growing pharmaceutical industry sector and a need for well educated pharmacists. Domestic sale of medicines is estimated to be $5 billion during 2006 and increasing. The supply of medicines to the population is undertaken by privately owned community pharmacies and sometimes also by hospital pharmacies. Community pharmacists are involved only in dispensing medicines. Community pharmacists have an opportunity to improve healthcare of the population, particularly of the disadvantaged section of the society that does not have the resources to visit clinics (both the poor and rural population). However, important barriers to the provision of pharmaceutical care exists, including lack of proper education and training of pharmacists, weak implementation of existing laws, and lack of recognition of the pharmacy as a profession by the other healthcare professionals. Conclusion The healthcare services in community pharmacies, currently insignificant, must undergo reforms to meet the changing needs of modern medicines users. The pharmacist’s role in patient care is expected to grow as professional and educational standards develop. Although pharmacists’ contributions to health care are not yet recognized, there is every reason to be optimistic toward making patient care in community pharmacy setting a success. For this, the educational system for pharmacists has to be adapted.     

A qualitative case study exploring the implementation of pharmacist care planning services in community pharmacies

ObjectivesTo describe the comprehensive annual care plan (CACP) process and to conceptualize how remunerated CACP services were implemented by community pharmacists.DesignA comparative, multiple case study approach with data comprising document review, observation, and semistructured interviews.Setting and participantsPharmacists, pharmacy technicians and staff, and student pharmacists from 4 different community pharmacy sites in Alberta, Canada, including independent, franchise, and corporate chain pharmacies. In addition, patients and other health care providers were included in the interviews.Outcome measuresConstructivist grounded theory was used to understand how care planning services were implemented in the real-world context of community pharmacies and how pharmacists provided CACPs within their practice.ResultsBetween May 2016 and January 2018, a total of 77 interviews and 94 hours of observations were completed at the 4 pharmacy sites, and 61 documents were collected. The CACP service required adaptation of the workflow at each of the sites. However, pharmacists and other pharmacy staff recognized benefits of the service with respect to pharmacists’ role expansion. The overarching grounded theory concept was changing the status quo. The following 4 themes emerged representing how the service was implemented: engaging patients, professional development and learning from experience, creating a supportive environment, and building community connections.ConclusionThis study found that practice change or changing the status quo was needed to implement remunerated care planning services in community pharmacies. The results of this study may be of interest to community pharmacists, pharmacy managers, and policy makers who are implementing remunerated care planning services in other jurisdictions.     

Patient perceptions of acute infectious disease point-of-care tests and treatment within community pharmacy settings

BackgroundCommunity pharmacies are well-positioned to help patients overcome many health care barriers they experience when trying to receive care. Community pharmacists are ready and equipped to provide patient care interventions like the test-and-treat model for acute infectious diseases.ObjectivesThe objective of this study was to determine patients’ experiences with rapid strep and influenza tests administered at community pharmacies, focusing on what impacted patients’ decisions to receive care, their perception of the care received, and if offering these tests in community pharmacies expanded their access to care.MethodsSeven independently owned pharmacies in Tennessee and Kentucky from November 2020 to April 2021 recruited study participants. Qualitative semi-structured key informant interviews were conducted using the theory of planned behavior as a theoretical framework. Participant interviews were audio recorded, transcribed, and independently coded by 2 investigators and reviewed by a third investigator. A qualitative analysis was completed, with a selection of supporting quotations for each theme. Qualitative analysis identified participant perceptions of rapid strep and flu POCT and treatments provided in community pharmacies, consistency and quality of patient care, and if these interventions expanded their access to care.ResultsA total of 11 patients participated in the interviews; of which, 9 (81.8%) participants were female, and participants ages ranged from 22 to 64 years (median, 40 years). Of 11, 7 participants received a strep test, 3 participants received a flu test, and 1 participant received both the tests. The analysis uncovered 10 major themes within the following 4 different categories: (1) convenience to patients, (2) quality of care received, (3) improved access to care, and (4) additional interventions for which patients want expanded access to care.ConclusionPharmacies offering services like rapid strep and flu tests provide convenience and quality care that can help expand patient access to health care and could help provide expanded access for underserved populations.     

Evaluation of community pharmacy service mix: evidence from the 2004 National Pharmacist Workforce Study.

OBJECTIVES: To describe the mix of pharmacy services being offered in different types of community pharmacy practices and to identify factors associated with a community pharmacy offering pharmacy services. DESIGN: Cross-sectional study. SETTING: Community pharmacies (independent, chain, mass merchandiser, and supermarket pharmacies). PARTICIPANTS: Pharmacists practicing full-time or part-time who worked in community pharmacies and responded to the 2004 National Pharmacist Workforce Survey. INTERVENTION: Mailed survey from the 2004 National Pharmacist Workforce Survey, which included core content questions for all sampled pharmacists and supplemental surveys that included workplace questions for a selected subsample of pharmacists. MAIN OUTCOME MEASURES: Type and frequency of pharmacy services being offered in a community pharmacy, including dispensing and product-related services (e.g., specialty compounding), and pharmacist care services (e.g., immunizations, smoking cessation, health screening, medication therapy management, wellness screening, nutritional support, and disease management services). RESULTS: Four pharmacist care services were reported as being offered at more than 10% of community pharmacy practices: immunizations, smoking cessation, health screening, and diabetes management. The number of pharmacist care services offered at a community pharmacy was positively associated with having at least three pharmacists on duty, innovativeness of the pharmacy, status as an independent pharmacy, and status as a supermarket pharmacy. More than one half of the community pharmacy practices did not offer any of the eight pharmacist care services included in a pharmacy service index. CONCLUSION: Pharmacy services were reported at relatively few community pharmacies, and were associated with pharmacy innovativeness, pharmacist staffing levels, and pharmacy setting. Some community pharmacies are offering pharmacy services as part of their business strategy, while others are dedicated to dispensing services. Continued study of pharmacy service availability in community pharmacies is needed to improve our understanding of our capacity to deliver such services, including medication therapy management services.