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.

Assessment of a computerised decision support system for allergic rhino-conjunctivitis counselling in German pharmacy

Objective In a prospective two-phase intervention study we evaluated a newly developed computerised pharmacy decision support system (PDSS) for the counselling of patients with allergic rhinitis and conjunctivitis. Method Community pharmacists were invited to counsel a virtual patient in a first interview. Immediately thereafter, we trained pharmacists to operate the PDSS, which they applied in a second patient interview immediately following the training. We assessed the completeness of mandatory questions asked as defined by national guidelines. Results Participating pharmacists (n?=?50, 78% female, mean age 34 [IQR: 27?C40] years, 8 [2?C14.5] years of practical experience, 32% specialised in community pharmacy) asked considerably more mandatory questions to confirm appropriateness of self-medication with 7 (5.25?C9; 78%) from 9 questions compared to 2 (1?C3; 22%) without PDSS (median; P?<?0.001). In particular, using the PDSS more than doubled mandatory questions (9/12, 6.25?C10; 75% vs. 4/12, 3?C5; 33%; P?<?0.001) relevant for appropriate drug selection. Conclusion Pharmacists omitted many questions mandatory to assess whether self-medication is appropriate. Using the newly developed PDSS more than doubled the number of mandatory questions asked. The results suggest that the PDSS is ready for evaluation of its impact in real patients.     

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).     

Exploring employer perceptions of pharmacy technician certification in the community pharmacy setting

BackgroundWith the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers.ObjectivesThe aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs).MethodsUsing a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory.ResultsEmployers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management).ConclusionsNew emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification.     

Issues of decision support in institutional pharmacy systems

This article discusses the challenges of implementation and maintenance of a decision support system operating within an institutional pharmacy information system. The basic principles of database building and configuration are reviewed. Issues with the common alert systems, allergy, drug interactions, drug-food, and duplicate are discussed. The challenges within dose-ranging programs are also described. Pharmacists are encouraged to develop population-based decision support systems and systems which add value at the individual patient level.     

Exploring communications around medication review in community pharmacy

Objectives Investigation into aspects that influence outcomes of medication reviews have been called for. The aim of this study was to assess how pharmacy internship students in a Danish medication review and reconciliation model communicated with both diabetes patients and the patients?? General Practitioners (GPs) when conveying the results of the review by writing letters to the different parties. Special attention was drawn to how differences in health care provider and patient perspectives of the disease as well as inclusion of the patient in the decision making process is influenced by the identified practices of communication. Setting 18 Danish community pharmacies with The Department of Pharmacology and Pharmacotherapy at the Faculty of Pharmaceutical Sciences, University of Copenhagen. Method Number of identified drug related problems, life-world problems and solutions to these described in the letters sent to patients and their GPs were registered. Further a qualitative documentary analysis was conducted by analyzing the letters using the theory of transactional analysis, developed by Berne. Main outcome measures Identified and conveyed drug related and life-world related problems when comparing patients?? letters with GPs?? letters. Whether students assumed a superior, inferior or equal role in relation to the recipient of the letter and compared whether students assumed the same role in relation to patients and GPs. Results 18 pairs of patient and GP letters were analyzed. The analysis showed that students conveyed more drug-related problems to GPs than to patients. Furthermore, students assumed an equal relationship to GPs, whereas they frequently took superior positions when writing to patients. Students reported lifestyle problems both to GPs and to patients. Conclusion Pharmacy students in a Danish medication review and reconciliation model managed to detect and address lifestyle problems of patients to their GPs, thereby facilitating the merger of their professionaltechnical perspective with the life-world perspective of patients. However, patients were not encouraged to become more involved in the disease management process.     

Benefits of clinical pharmacy services in a community hospital

The purpose of this analysis was to itemize the long term cost-avoidance and benefits of the Clinical Pharmacy Program at York Hospital and compare them to the cost of the program. It was assumed that the major actual reduction in drug cost would occur within the first year of clinical activities. Therefore, to determine the long term benefits, the hypothetical cost-avoidance of drug expenditures were calculated for the subsequent years after the clinical programs were instituted. For fiscal year 1991 these significant benefits amounted to an estimated monetary cost-avoidance of $416,000, a reduction in numerous hours in preparations and administration of 39,000 IVs, and numerous non-quantifiable benefits. The cost of the program in fiscal year 1991 for the pharmacist and administrative salaries related to the Pharmacy Clinical Program was approximately $140,000. Thus, the Clinical Pharmacy Program was cost-effective at York Hospital.     

Retroactive application of the EPIS framework to promote future implementation success in community pharmacy clinical interventions

BackgroundThe assessment of the implementation process of a clinical intervention in a community pharmacy setting can reveal useful insights for future implementation efforts.ObjectiveWe aimed to examine the implementation of a community pharmacist-led prospective registry and practice tool (R_xING, Epidemiology Research Coordinating Center and the University of Alberta) designed to reduce cardiovascular risk among patients with diabetes and to assess how the participating pharmacists could be supported at each of these stages.MethodsSemistructured interviews were conducted developed using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. The EPIS framework was used to evaluate the implementation of an online, guideline-driven tool (R_xING tool) designed to help pharmacists implement and document the care of patients with diabetes by a group of community pharmacies located in Alberta, Canada.ResultsIn relation to the preparation phase, responses focused more on suitability of the work environments and less on workflow adjustment. With regard to the implementation stage, participants mentioned that often the pharmacy manager or owner received the training to operate the R_xING tool, complicating their ability to engage in regular patient recruitment and follow-up. Most pharmacies did not have specific goals relating to patient recruitment and retention. Concerns hindering sustainability of the evidence-based practice centered around the time-consuming online documentation process and patient retention. Finally, innovation factors identified from the pharmacists’ responses were related to patient recruitment and streamlining the documentation process.ConclusionsThis study identified 17 key recommendations that should be considered when designing and implementing future community pharmacy-led projects. In particular, providing assistance and training to pharmacies on-site, specific planning for program roll-out, identifying participating staff who have the time to engage with the program, and troubleshooting how to best integrate programs in normal workflow processes are some key recommendations.     

Exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy

AIM: To describe the exploratory planning and implementation of a pilot pharmacogenetic program in a community pharmacy. An institutional review board-approved protocol for a clopidogrel pharmacogenetic program in a community pharmacy was developed to address feasibility and evaluate the pilot program. STUDY CONCEPT: Subjects taking clopidogrel are asked to participate at the point of medication dispensing. A pharmacist schedules an appointment with subjects to discuss the study and collects a buccal swab sample for CYP2C19 testing. When the results are available, the pharmacist consults with the subject's prescriber regarding test result interpretation and associated recommendations, and schedules a second appointment with the participant to discuss results and review any physician-approved therapeutic changes. The intervention-associated consultation is then billed to the subject's insurance. Results: Subject enrollment has begun. CONCLUSION: Community pharmacists may be valuable partners in pharmacogenetics.     

Development and implementation of a smoking cessation clinic in community pharmacy practice

OBJECTIVE: To describe a pharmacist-operated program to help people stop smoking. SETTING: Community chain (mass-merchandise) pharmacy practice sites in Virginia. PARTICIPANTS: Faculty at the Virginia Commonwealth University School of Pharmacy (VCU) and 15 practicing pharmacists. PRACTICE DESCRIPTION: Smoking cessation clinics within the pharmacy departments of seven Target stores. PRACTICE INNOVATION: With input from the practicing pharmacists and using the most current strategies reported in the literature, faculty at VCU developed a training manual for smoking cessation counseling. This manual was used to facilitate a 4-hour training session and also served as a resource for pharmacists in the smoking cessation clinics. Pharmacists were taught about behavioral modifications, the Transtheoretical Model of Change as applied to smoking cessation, documentation, the Fagerstr?m Test for Nicotine Dependence, smoking cessation therapies, patient counseling techniques, physical assessment skills, and how to develop an individualized action plan for smoking cessation. As pharmacists established smoking cessation clinics, issues such as workflow, continuous quality improvement, and marketing were addressed by the faculty members and practitioners. RESULTS: Using the process and tools described in this article, pharmacists successfully established and operated smoking cessation clinics. CONCLUSION: The process and materials developed for this demonstration project can serve as templates for other pharmacy faculty members and community pharmacists who wish to offer smoking cessation clinics.     

The impact of pharmacy computerised clinical decision support on prescribing,clinical and patient outcomes: a systematic review of the literature

Objectives Computerised clinical decision support systems (CDSSs) are being used increasingly to support evidence‐based decision‐making by health care professionals. This systematic review evaluated the impact of CDSSs targeting pharmacists on physician prescribing, clinical and patient outcomes. We compared the impact of CDSSs addressing safety concerns (drug interactions, contraindications, dose monitoring and adjustment) and those focusing on medicines use in line with guideline recommendations (hereafter referred to as Quality Use of Medicines, or QUM). We also examined the influence of clinical setting (institutional versus ambulatory care), system‐ or user‐initiation of CDSS, prescribing versus clinical outcomes reported and use of multi‐faceted versus single interventions on system effectiveness. Methods We searched Medline, Embase, CINAHL and PsycINFO (1990–2009) for methodologically adequate studies (experiments and strong quasi‐experiments) comparing a CDSS with usual pharmacy care. Individual study results are reported as positive trends or statistically significant results in the direction of the intentions of the CDSS being tested. Studies are aggregated and compared as the proportions of studies showing the effectiveness of the CDSS on the majority (≥ 50%) of outcomes reported in the individual study. Key findings Of 21 eligible studies, 11 addressed safety and 10 QUM issues. CDSSs addressing safety issues were more effective than CDSSs focusing on QUM (10/11 versus 4/10 studies reporting statistically significant improvements in favour of CDSSs on ≥ 50% of all outcomes reported; P= 0.01). A number of QUM studies noted the limited contact between pharmacists and physicians relating to QUM treatment recommendations. More studies demonstrated CDSS benefits on prescribing outcomes than clinical outcomes (10/10 versus 0/3 studies; P= 0.002). There were too few studies to assess the impact of system‐ versus user‐initiated CDSS, the influence of setting or multi‐faceted interventions on CDSS effectiveness. Conclusions Our study demonstrated greater effectiveness of safety‐focused compared with QUM‐focused CDSSs. Medicine safety issues are traditional areas of pharmacy activity. Without good communication between pharmacists and physicians, the full benefits of QUM‐focused CDSSs may not be realised. Developments in pharmacy‐based CDSSs need to consider these inter‐professional relationships as well as computer‐system enhancements.     

Design and implementation of a cost-accounting system in hospital pharmacy

The design and implementation of a cost-accounting system in a hospital pharmacy department is described. Pharmacy resource use (labor, drugs, supplies, and overhead), or pharmacy's intermediate products, was clearly defined in terms of dosage forms (10 groupings representing variable labor and supplies) and drug products (more than 100 categories that incorporate cost and volume of use for 3000 line items). Costs were defined as variable or nonvariable (fixed), based on whether they were related to a specific medication order. Labor was divided into variable and fixed components. Time standards were developed using time and motion studies. Variable labor hours were determined as follows: specified hours (the volume of each dosage form multiplied by the standard time for each dosage form); nonspecified hours (time not directly associated with production); hours worked (specified plus nonspecified hours); and hours paid (hours worked plus sick leave and vacation). A standard cost for each drug product was based on the weighted average of volume and cost of the individual line items. The total drug budget was constructed by multiplying the standard cost for each drug product times the projected volume for each drug product. The pharmacy budget was developed by calculating the number and mix of pharmacy products used in association with the projected number and type of cases for the fiscal year. The monthly pharmacy budget reports were assembled with data from the payroll, billing, and cost-accounting systems.(ABSTRACT TRUNCATED AT 250 WORDS)