Current trends in outpatient pharmacy services and billing

ObjectivesTo provide a summary of community and ambulatory pharmacy practices and billing patterns for medication therapy management (MTM) services and to identify reasons pharmacists report not billing for direct patient care services.DesignCross-sectional study.SettingUnited States, February 2011.ParticipantsMembers of the American College of Clinical Pharmacy Ambulatory Care Practice and Research Network, American Society of Health-System Pharmacists Ambulatory and Chronic Care Practitioners, and American Pharmacists Association MTM e-community.InterventionOnline survey.Main outcome measuresPractice setting, pharmacy services performed, billing technique, and payer, as well as reasons for not billing.ResultsMTM services were provided by 287 pharmacists. The most common practice settings included physician office (23.6%), health-system outpatient facility (21.7%), and community pharmacy (20.2%). A total of 149 of 276 pharmacists (54.0%) reported billing for MTM services; 16 of 276 (5.8%) did not know if they were currently billing. Community pharmacists were more likely to bill than all other sites combined (80.5% vs. 53.1%, P < 0.001), and pharmacists with >75% of visits face-to-face were more likely to bill (66.2% vs. 46.6%, P < 0.002).ConclusionA variety of MTM services are provided in outpatient settings with inconsistent billing techniques and reimbursement. Pharmacists should continue to work toward consistent, sustainable reimbursement to expand MTM services.     

Impact of a blended learning program on community pharmacists’ barriers,knowledge, and counseling practice with regard to preconception,pregnancy and lactation

BackgroundCommunity pharmacists acknowledge to have an important role in providing pharmaceutical care during preconception, pregnancy and lactation. However, pharmacists’ knowledge and counseling regarding this topic is still insufficient. Hence, educational initiatives are urgently needed.ObjectivesTo assess the impact of a blended learning program (‘intervention’) on community pharmacists' barriers, knowledge, and counseling practice with regard to preconception, pregnancy and lactation.MethodsA pre-post study was performed in collaboration with 40 randomly selected pharmacies belonging to a large pharmacy chain in Belgium. All pharmacists employed in these pharmacies were eligible to participate in a blended learning program consisting of an e-learning and an on-site training day. Data were collected using online surveys, mystery shopping visits and pharmacy records. Pharmacy conversations were assessed on information gathering, dispensed product, and case-specific information. A retention knowledge test was completed 3–6 months after the intervention.ResultsIn total, 60 pharmacists completed the post-intervention surveys (response rate: 95%). The total number of barriers decreased after the intervention, while organizational barriers such as lack of privacy (73%) and lack of time (67%) became more prevalent. Pharmacists’ short and long-term knowledge improved after the intervention (p ≤ 0.001), although knowledge declined again over time (p ≤ 0.001). During counseling, pharmacists more often spontaneously provided information about folic acid when dispensing a pregnancy test, and more often suggested the correct dose/dosage for the dispensed OTC-product against pregnancy-related nausea. However, poor information gathering, dosing errors and incomplete information were still observed.ConclusionThe blended learning decreased pharmacists' barriers and improved their short- and long-term knowledge, while counseling practice only partially improved. Hence, the blended learning was insufficient to enhance pharmacists’ information gathering competences and to fully implement pharmaceutical care services with regard to preconception, pregnancy and lactation.     

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.     

Educational campaign for proper medication disposal

ObjectivesTo assess the effect of an educational intervention on pharmacists' attitudes and knowledge about medication disposal.MethodsIn September 2005, a survey was mailed to 488 registered pharmacists serving as experiential education preceptors to Massachusetts College of Pharmacy and Health Sciences students in 27 states throughout the country. Mailing of this presurvey occurred 2 months before an educational intervention. An identical postsurvey was mailed to the 223 respondents to the presurvey 3 months after the intervention. The main outcome measure was change in pharmacist attitudes and knowledge about medication disposal after educational intervention.Results158 pharmacists (32% response rate) completed the pre- and postsurveys. Before the intervention, 47% of pharmacists perceived inappropriate medication disposal to be an environmental problem compared with 57% after the intervention (P = 0.03). Similarly, when asked about medication disposal, 10% correctly indicated that patients could arrange for hazardous waste pick up compared with 20% postintervention (P< 0.01). Conversely, 19% incorrectly indicated that patients should wash medications down the sink compared with 5.6% postintervention (P< 0.01).ConclusionA brief educational intervention is effective at changing pharmacists' attitudes and knowledge of inappropriate and environmentally unsafe medication disposal practices. Pharmacists receiving the educational intervention were more likely to report that they would recommend appropriate methods of medication disposal. Further educational efforts are necessary for improving pharmacists' knowledge regarding safe medication disposal practices.     

Impact of pharmacist prescribing through direct pharmacy access policies on access to hormonal contraception

Background/ObjectiveThis study assesses the impact of direct pharmacy access (DPA) policies that allow pharmacists to prescribe hormonal contraceptives on women’s access by comparing access among 3 groups: (1) women in a state without DPA (Indiana), (2) women in a state with DPA, but not using DPA, and (3) women in a state with DPA and using DPA.MethodsThis cross-sectional survey, including a scale to measure access to contraceptives, perception items, and demographics, was distributed through Amazon Mechanical Turk (Amazon.com, Inc). Kruskal–Wallis tests and linear regression analysis were used.ResultsThe sample size was 316. When controlling for education, income, and age, the women not using DPA (in Indiana and a DPA state, respectively) reported significantly higher levels of approachability (P < 0.001 and P < 0.001, respectively), acceptability (P < 0.001 and P < 0.001, respectively), availability and accommodation (P < 0.001 and P = 0.009, respectively), affordability (P < 0.001 and P < 0.001, respectively), and appropriateness (P < 0.001 and P < 0.001) access than the women using DPA. The women using DPA reported significantly lower levels of privacy access than those not using DPA in a DPA state (P = 0.004) when controlling for education, income, and age. However, 78.9% of women using DPA agreed DPA made obtaining contraceptives easier. Most of the women who had never used DPA were previously unaware of DPA (81.1% in DPA states and 86.2% in Indiana) but felt that it would improve access (82.8% and 80.0%, respectively).ConclusionUnderstanding the effects of DPA policies on women’s access to contraceptives can inform future policies and support implementation. Lower levels of access across all dimensions among those using DPA may be influenced by imperfect implementation and failure to legislatively enable the sustainability of this service rather than pharmacists’ ability to improve women’s access.     

An evaluation of Australian pharmacist’s attitudes on expanding their prescribing role

Objectives To evaluate the views of Australian pharmacists on expanded pharmacist prescribing roles and identify important drivers and barriers to its implementation. Setting Pharmacists in Australia. Method Data were collected using a self-administered questionnaire distributed nationally to a random sample of pharmacists either directly, or in the case of one state, via community pharmacies. One-way ANOVA and ?² testing were used to identify significant associations. Factor analysis was conducted to pool variables and the derived factors were subjected to regression analysis. Main outcome measures Perceptions of Australian pharmacists on expanded prescribing and the relationships between variables derived. Results A total of 2592 questionnaires were distributed and a response rate of 40.4% was achieved (n = 1049). Of the respondents 83.9% strongly agreed/agreed to an expanded prescribing role for pharmacists and 97.1% reported they would need further training. Of the respondents 896 agreed that pharmacists should engage in supplementary, independent prescribing or both. Of these 69.1% preferred only supplementary prescribing, 3.3% independent prescribing and 27.4% both models. Both models were found to be positive predictors of expanding pharmaceutical services through prescribing (P < 0.001) with supplementary prescribing showing a stronger association (β = 0.52 vs. β = 0.18). Pharmacists’ opinion based on their current perceptions of their clients was an important predictor in expanding pharmaceutical services through prescribing (P = 0.005). Inadequate training in patient assessment, diagnosis and monitoring were the strongest barriers to expanded pharmacist prescribing (P < 0.001). Conclusions The majority of Australian pharmacists supported an expanded pharmacist prescribing role. Support for supplementary was stronger than independent prescribing. Pharmacists acknowledged that they would need further training to perform such roles.     

Using theory to predict implementation of a physician–pharmacist collaborative intervention within a practice-based research network

BackgroundStudies have demonstrated that physician/pharmacist collaboration can improve management of chronic conditions.ObjectiveThe purpose of this study was to determine whether a correlation exists between existing clinical pharmacy services within a practice-based research network (PBRN) and provider attitudes and beliefs regarding implementing a new pharmacy intervention based on the Theory of Planned Behavior (TPB).MethodsA validated survey was completed by one clinical pharmacist from each office. This instrument evaluated the current clinical pharmacy services provided in the medical office. TPB instruments were developed that measured beliefs concerning implementation of a clinical pharmacy intervention for either blood pressure or asthma. The pharmacy services and TPB surveys were then administered to physicians and pharmacists in 32 primary care offices throughout the United States.ResultsPhysicians returned 321 (35.9%) surveys, while pharmacists returned 40 (75.5%). The Cronbach's alpha coefficients generally ranged from 0.65 to 0.98. TPB subscale scores were lower in offices rated with lower pharmacy service scores, but these differences were not statistically significant. There was no correlation between clinical pharmacy service score and providers' TPB subscale scores. In both the hypertension and asthma groups, pharmacists scores were significantly higher than physicians' scores on the attitudes subscale in the multivariate analysis (P < 0.001 and P < 0.05, respectively).ConclusionsPharmacists consistently scored higher than physicians on the TPB, indicating that they felt the hypertension or asthma intervention would be more straightforward for them to implement than did physicians. There was no significant correlation between clinical pharmacy service scores and attitudes toward implementing a future physician/pharmacist collaborative intervention using the TPB. Future studies should investigate the ability of the TPB instrument to predict implementation of a similar intervention in offices of physicians never exposed to clinical pharmacy services.     

A web-based training program to support chronic kidney disease screening by community pharmacists

Background Community pharmacists’ role in screening of several chronic diseases has been widely explored. The global health burden of chronic kidney disease is high; however, the progression and adverse outcomes can be prevented or delayed by detecting and treating the disease in its initial stages 1–3. Therefore, a web-based training program was developed to enhance pharmacists’ knowledge and skills required to perform a chronic kidney disease screening service in a community setting. Objective The aim of this study was to evaluate the impact of a web-based training program on community pharmacists’ knowledge and skills associated with chronic kidney disease screening. As secondary aim, pharmacists’ satisfaction with the training program was assessed. Setting Community pharmacy practice. Method A web-based training program was developed by four pharmacists and a nephrologist. Quantitative data was collected by employing a self-administered, web-based questionnaire, which comprised a set of five multiple-choice knowledge questions and one clinical vignette to assess skills. A nine-item Likert scale was used to determine pharmacists’ satisfaction with the training program. Main outcome measure Pharmacists’ knowledge and skills scores at pre and post-training, reliability of the Likert scale, and the proportion of responses to the individual nine items of the satisfaction survey. Results Fifty pharmacists participated in the pre-questionnaire and 38 pharmacists completed the web-based training and post-questionnaire. Significant differences were observed in the knowledge scores (p < 0.001) and skills scores (p < 0.001) at pre- and post-training. Cronbach’s alpha for the nine-item satisfaction scale was 0.73 and the majority pharmacists (92.1–100 %) were satisfied with the various aspects of the training program. Conclusion The web-based training program positively enhanced pharmacists’ knowledge and skills associated with chronic kidney disease screening. These findings support further development and widespread implementation of the training program to facilitate health promotion and early identification of chronic kidney disease in a community setting.     

Social and legislative shaping of access to contraceptives and the pharmacist's role: A literature review

BackgroundDespite years of research and numerous policies, access to contraceptives in the United States remains imperfect. Largely due to lack of access to contraceptives, unintended pregnancy rates remain high.ObjectiveTo provide researchers and policy-makers with a comprehensive review of the legislative and social landscape that has shaped contraceptive access in the United States, which may help to guide future research and policies.MethodsA narrative overview of existing literature on policies and research regarding women's access to contraceptives was compiled, with a focus on the role of pharmacists.ResultsContraceptive access has been heavily influenced by laws and policies throughout the years, and disparities remain in underserved populations. Pharmacists are beginning to play a role in improving access to contraceptives through provision of contraceptives using direct pharmacy access policies.ConclusionsContinued research and new policies aimed at improving contraceptive access are warranted.     

Knowledge and opinion of pharmacists on emergency contraceptive pills in Hungary

Background Emergency contraceptive pills (ECPs) are used to prevent unintended pregnancy. There is a worldwide intention to improve access to ECPs; therefore, identifying potential barriers to introducing over-the counter (OTC) access is of utmost importance. As pharmacists are the key personnel to convey accurate drug information, their knowledge and attitude on ECPs is important. Objective We aimed to conduct a nationwide study to assess pharmacists’ knowledge on ECPs and to survey their opinion on sales category change of ECPs (i.e. to introduce OTC access in pharmacies). Setting Registered pharmacists in Hungary. Method A prospective cross-sectional study was conducted with an anonymous, web-based questionnaire. Univariate analysis (Mann–Whitney U test and Fischer’s exact test) was used to identify factors associated with supportive opinion toward OTC provision. Main outcome measure Knowledge level of pharmacists, proportion of pharmacists with supportive opinion on OTC access. Results 357 out of 2019 pharmacists completed the questionnaire, yielding a 17.7% response rate. Almost 30% of pharmacists (N = 99) agreed that ECPs should have an OTC availability in Hungary. More than 40% of pharmacists (N = 145) considered ECPs as contraceptives. On average, 55.18% (standard deviation: ±12.40%) of the answers were correct, showing moderate knowledge of the pharmacists. Age and rating ECPs as contraceptives were significantly associated with supportive opinion toward OTC provision (p < 0.001). The effect of knowledge on the pharmacist’s opinion was significant in young pharmacists (p = 0.02). Conclusion Pharmacists’ knowledge and opinion on ECPs should be improved, especially that of the young ones. Currently the attitude of pharmacists does not favor sales category changes of ECPs in Hungary.