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.     

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.     

The ethical challenges in pharmacy practice in community Pharmacies: A qualitative study

BackgroundPharmacists as a group of health care professionals, face different types of ethical challenges in their everyday routine that may impede pharmaceutical care.ObjectivesIn this study, we aimed at evaluation and recognition of the ethical challenges of pharmacy practice in community pharmacies.MethodsThis exploratory study was conducted as a qualitative study consisting of open-ended in-depth interviews and focus group discussions followed by content analysis. The study participants were chosen from pharmacists with PharmD degree who had at least 4 years work experience and were the founders or technical managers of community pharmacies, either as governmental or private. Interviews continued until data saturation and transcribed verbatim. The content analysis was done by Graneheim and Lundman method. The codes were generated, and categorized. After assessment and final modifications, the results of the study were discussed and confirmed in a focus group discussion conducted by 7 experts who teach medical ethics and/or pharmacy ethics.ResultsOverall, 40 pharmacists were interviewed (mean age 46 ± 11.3 years). The extracted ethical challenges of pharmacy practice were categorized into 3 main themes, 11 subthemes and 102 codes. The themes were achieved as challenges related to professionalism and professional practice, challenges related to professional communications and challenges related to regulations and policies.ConclusionTaken together, it seems that most of the challenges of pharmacy practice are related to professionalism and professional commitment; however, the regulations and policies provide serious obstacles for pharmacy practice and pharmaceutical care. More efforts towards teaching professionalism and modification of regulations and policies are recommended.     

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).     

Implementing screening interventions in community pharmacy to promote interprofessional coordination of primary care – A mixed methods evaluation

BackgroundScreening is a critical component of efforts to reduce the population burden of cardiovascular disease (CVD), by facilitating early use of cost-effective prevention and treatment strategies. While international evidence suggests that screening in community pharmacies improves screening access and identifies at-risk individuals, concerns from medical organisations about the absence of interdisciplinary coordination and related lack of continuity of care with general practice have significantly contributed to reluctance from some stakeholders to endorse, and engage with, pharmacy-based screening initiatives. The Cardiovascular Absolute Risk Screening (CARS) study was designed to address these challenges and promote an interprofessional approach to screening for cardiovascular disease risk by pharmacists. This study describes the impact of the CARS implementation model on interdisciplinary coordination and continuity of care.MethodsIn addition to clinical training, pharmacists at eleven participating pharmacies were provided with implementation training, resources and support to promote interprofessional coordination. Completion of training and pharmacy implementation plans, both of which highlighted GP engagement strategies, were pre-requisites for screening commencement. Using mixed methods approaches, data were analyzed from screening records (n = 388), researcher interviews with patients at 6–10 weeks post-screening (n = 248, 64%), and pharmacist interviews (n = 10).ResultsScreening records suggested that 94% of screened individuals were advised to seek formal GP assessment, and 98% consented to sharing of results. Among interviewed participants, 81% recalled direct pharmacist action to facilitate GP engagement. Among interviewees who had seen their GP already (n = 70), 79% reported that their GP was aware of the results (another 16% were uncertain). Pharmacists reported positive GP feedback stemming from efforts at early engagement, but an absence of ongoing collaboration.ConclusionsUse of implementation planning by pharmacists, alongside clinical training, can effectively promote an interdisciplinary coordination focus by pharmacists.     

Patient assessment and documentation integrated in community practice: Chat,check, and chart

ObjectiveTo explore how pharmacists integrated the Chat,Check andChart (CCC) tools in community practice and to identify barriers and facilitators to use.DesignConcurrent nested mixed-method study. Open-ended, semi-structured qualitative interviews on tools use and a quantitative survey were completed via telephone.SettingCommunity-based pharmacy practice.Participants39 community pharmacists consented to interviews2 months after the CCC training workshop; 22 completed an interview.InterventionWorkshop training on CCC tools and workplace implementation strategies.Main outcome measuresBarriers, facilitators and implementation strategies for CCC tools.ResultsMore pharmacists were implementing or had made patient assessment part of their practice (54%) than documentation of patient care (36%). Integration was facilitated by patient success, collaborative worksite, personal beliefs, and provincial regulations. Lack of routines, patient expectations, reimbursement, and time were familiar barriers. Strategies to overcome these barriers included practicing new habits, using technology, starting small, using physical reminders, and recognizing benefits.ConclusionPatient care tools for assessment and documentation had both positive and negativeeffects on patients, pharmacists, and community pharmacies because of demands on time, lack of resources, and limited personal, external, and patient expectations of pharmacists’ care. Findings resulted in Alberta College of Pharmacists academic detailing of the CCC tools duringonsite pharmacy assessments to help pharmacists meet or exceed provincial practice standards.     

Factors associated with how often community pharmacists offer and dispense naloxone

BackgroundA recent Surgeon General's report encourages people to ask pharmacists about naloxone, but whether pharmacists are well-prepared to respond to these requests is unclear.ObjectivesDetermine factors that are associated with how often pharmacists offer and dispense naloxone.MethodsA convenience sample of 457 community pharmacists in North Carolina completed a 5-min online survey. Linear regressions were conducted to identify factors that are associated with how often pharmacists offer and dispense naloxone. Pharmacists' self-reported barriers to teaching naloxone administration were identified.ResultsMost pharmacists (81.2%) worked in pharmacies that stocked naloxone, but many never offered (36.6%) or dispensed (19.4%) naloxone. Pharmacists offered (β = 0.15, p < 0.01) and dispensed (β = 0.15, p < 0.01) naloxone more often when their pharmacy stocked more naloxone formulations. Pharmacists who were more comfortable discussing naloxone offered it more often (β = 0.26, p = 0.001). Pharmacists who worked in regional/local/grocery chain pharmacies dispensed and offered naloxone less often than other pharmacy types. Barriers to teaching naloxone administration included: time constraints, inadequate training, and perceived lack of patient comprehension.ConclusionsMany community pharmacists do not offer or dispense naloxone. Pharmacists who are uncomfortable discussing naloxone or work at smaller chain pharmacies may benefit from targeted naloxone training.     

Community pharmacy-based injectable naltrexone service delivery models and best practices

BackgroundOpioid use disorder (OUD) is a major public health issue in the United States. Medications for OUD (MOUD), which combines the use of approved medications with counseling and behavioral therapies, represents an evidence-based approach to treat individuals living with an OUD. However, MOUD has not kept up with increased demand and new treatment approaches are needed. One approach is injectable naltrexone, an approved and effective MOUD treatment, provided by pharmacists, who are more geographically accessible and have legal authority to administer it in some states.ObjectivesTo explore how different community pharmacists provide injectable naltrexone treatment and identify best practices.MethodsAn exploratory sequential mixed-methods design was used to investigate pharmacy-based naltrexone injection practices, involving a pharmacist questionnaire and interviews with pharmacists, prescribers, and community stakeholders. An inductive/iterative content analysis approach, guided by an initial straw model, was used to identify and explore conceptual categories for the interviews.ResultsThe final sample included 68 pharmacy surveys and 14 total interviews with pharmacists (n = 9), prescribers (n = 3), and community stakeholders (n = 2). Pharmacies providing naltrexone injections reported administering over 700 injections in the past year. Interviews revealed benefits and barriers to pharmacist-provided injections and the importance of the prescriber-pharmacist relationship in OUD treatment. Three pharmacy treatment delivery models were identified, compared to the initial straw model, and informed development of a best practices checklist for community pharmacies interested in establishing or expanding a naltrexone injection service.ConclusionsThe study demonstrates how community pharmacies developed and implemented a naltrexone injection service. Pharmacists' and prescribers' feedback clearly suggests an untapped interest, as well as resources, in realizing pharmacists’ roles as providers of injectable naltrexone treatment. Implementation research could inform the development and evaluation of an intervention based on these best practices to further explore the utility of community pharmacy-based naltrexone injection services.     

Continuing pharmacy education practices in geriatric care among pharmacists in the Upper Midwest

ObjectivesTo summarize select continuing pharmacy education (CPE) topics and hours related to geriatric care completed by community, hospital/clinic, and long-term care (LTC)/consultant pharmacists in the previous 12 months, whether pharmacy workplace influenced topic selection or completion, and to describe CPE sources used by community versus hospital/clinic pharmacists.DesignCross-sectional survey (2017).Setting and participantsLicensed pharmacists in North Dakota, South Dakota, Minnesota, Iowa, and Nebraska with primary practice settings in community pharmacies, hospitals, or clinics or those practicing as consultant pharmacists.Main outcome measuresCPE on geriatric-related topics and hours completed in the previous 12 months, CPE providers and sources used, and differences in CPE topic completion and CPE providers and sources by primary pharmacy practice setting.ResultsPharmacists’ response rates for states ranged from 10.5% to 17.1%. Pharmacists (n = 1082) reported limited completion of geriatric-related topics. Almost one-third completed CPE credit in Alzheimer disease (AD) but fewer than 20% of pharmacists in selected age-related chronic diseases (e.g., Parkinson disease, dementia with Lewy bodies, epilepsy, vascular dementia, geriatric syndrome). LTC/consultant pharmacists completed significantly more hours in geriatric-related topics compared with other pharmacists. In contrast, diabetes mellitus, hypertension, asthma, and heart failure were completed by 34% to 64% of the pharmacists. Pharmacist’s Letter (57.2%), Power-Pak CE (42.4%), conferences, conventions, and symposia (32.5%), and Pharmacy Times (21.8%), were the most used CPE sources. Other sources were used by fewer than 18% of the pharmacists. Online CPE providers used by high numbers of study participants offered limited AD- or dementia-related topics and hours.ConclusionFindings revealed modest to minimal CPE completion in select geriatric care topics among pharmacists in the Upper Midwest. Completion rates were higher for LTC pharmacists compared with hospital, clinic, and community pharmacists. Only a few CPE sources were heavily used, and those offered minimal CPE in AD/dementia-related care. Given current findings and previous research, current CPE use habits and CPE offerings from major providers and sources seem insufficient for ensuring continued high-quality patient-centered care for growing U.S. aging populations.