Pharmacist-Community-Based Organization Collaboration to Address Health-Related Social Needs.

BACKGROUND: Community-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimal medication use. OBJECTIVES: To develop and evaluate two models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications. METHODS: Two different pharmacy-CBO models were studied. The CBO-initiated model had two CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses. RESULTS: The CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication and establishing relationships between pharmacy and CBO personnel. CONCLUSION: Both pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.

Determining essential elements and functionalities for a patient record system in community pharmacy.

BACKGROUND: As community-based pharmacy continues to evolve from a focus on product distribution to a practice focused on patient care, a key requirement is for pharmacists to document their patient care activities. Some community-based pharmacies are working to routinely use the Pharmacist eCare Plan standard in documenting their new care activities. OBJECTIVES: With the need for a robust patient record in community-based pharmacies, the purpose of this study was to identify key elements and functionalities for a community-based pharmacy patient record. METHODS: An expert panel of 26 individuals participated in 3 rounds of surveys using an online Delphi method to develop consensus about the key data elements and functionalities for a pharmacy patient record system. RESULTS: A total of 46 items reached consensus: 16 as essential elements for a longitudinal pharmacy patient record, 7 as essential elements for a patient encounter, and 23 functionalities for a pharmacy patient record system. A rubric was developed to assess community-based pharmacy patient record systems. CONCLUSION: The functionalities can support pharmacists in fully adopting a standard care process and providing and documenting patient care, while coordinating and improving communication with patients, providers, and payers. Pharmacists are encouraged to use the rubric in evaluating software for their practices.

Effect of an Innovative Immunization Practice Model to Improve Population Health: Results of the Project IMPACT Immunizations Scaled Demonstration.

Background: U.S. adult vaccination rates remain low. Community pharmacists have skills and opportunity to improve this shortcoming. This study sought to evaluate an innovative practice model on identification of unmet vaccination needs and their resolution. Methods: This prospective, multi-site, multi-state, observational study was conducted in 22 community pharmacy practices in Iowa and Washington. Adults receiving influenza vaccination, medication therapy review, prescriptions for diabetes or cardiovascular disease, or another clinical encounter with a participating pharmacist from December 2017 through November 2019 were included. Pharmacists reviewed vaccination forecasts generated by clinical decision support technology based on their state immunization information system (IIS) to identify unmet vaccination needs, educate patients, and improve vaccination rates. The primary outcomes were numbers of vaccination forecast reviews, patients educated, unmet vaccination needs identified and resolved, and vaccinations administered. Secondary outcomes included numbers of vaccination declinations; times a forecasted vaccine was not recommended because a contraindication was identified by the pharmacist; and times the patients declined a forecasted vaccine due to self-reported vaccination despite lack of documentation in the state IIS. Descriptive statistics were calculated. Results: Pharmacists reviewed vaccination forecasts for 6,234 patients. The vaccination forecasts predicted there were 11,789 vaccinations needed (1.9 per person). 6,405 of the 11,789 unmet vaccination needs (54.3%) were fulfilled during the study period, including 60% on the same day. Of the forecasted needs, 1,085 (9.2%) were found to be previously administered and 59 (0.5%) contraindicated. The remaining patients received information about their personal vaccination needs and recommendations to be vaccinated. Conclusion: Availability of vaccination histories during patient encounters allowed pharmacists to identify and resolve adult vaccination needs in independent and chain community practice settings.

Examining the case for direct contracting: A multistakeholder case study.

BACKGROUND: Employers and pharmacies are challenged by a complex system for prescription payment. Cost plus direct contracts for prescriptions and bundled services may yield benefits. OBJECTIVES: This study aimed to (1) explore direct contracting using multistakeholder interviews, (2) compare employer costs and employee copays for 6 months of prescription charges under their pharmacy benefit manager (PBM) with projected costs under a pharmacy direct contract, (3) project pharmacy revenue, costs, and net profit had these prescriptions been processed through the direct contract, and (4) assess employee satisfaction under the direct contract. METHODS: Semistructured stakeholder interviews were recorded transcribed and analyzed to identify different perspectives on direct contracting. Employer PBM invoices for 412 employee prescriptions over 6 months were analyzed to calculate employer and employee costs and reanalyzed for the invoice cost plus $12 professional fee direct contract. For the pharmacy financial analysis projection, invoice costs and a $9.82 cost of dispensing were subtracted from total revenue to yield an estimated profit had the parties been under the arrangement. A 34-item satisfaction survey was mailed using a 4-contact design with cash incentives to the 20 employees serviced by the direct contract that were analyzed descriptively. RESULTS: Eight stakeholder interviews described the benefits and potential challenges of such direct contracts. The financial analysis suggested the employer costs would be $5664 lower and employee copays would have been $1918 lower had all prescriptions been paid using the direct contract. The estimated profit for the pharmacy was projected at $899. Survey respondents were generally satisfied with the direct contract, but few used the bundled services. CONCLUSION: The direct contract may be financially beneficial for all parties. It also may offer more transparent pricing that may be desirable for the employer and pharmacy. Greater uptake of bundled services may increase the value to the employer.

Influence of exposure time, physicochemical properties, and plant transpiration on the uptake dynamics and translocation of pharmaceutical and personal care products in the aquatic macrophyte Typha latifolia.

Typha latifolia is widely used as a phytoremediation model plant for organic compounds. However, the dynamic uptake and translocation of pharmaceutical and personal care products (PPCPs) and their relationship with physicochemical properties, such as lipophilicity (LogKow), ionization behavior (pKa), pH-dependent lipophilicity (LogDow), exposure time and transpiration, are scarcely studied. In the current study, hydroponically grown T. latifolia was exposed to carbamazepine, fluoxetine, gemfibrozil, and triclosan at environmentally relevant concentrations (20 µg/L each). Eighteen out of thirty-six plants were exposed to the PPCPs and the other eighteen were untreated. Plants were harvested at 7, 14, 21, 28, 35, and 42 days and separated into root, rhizome, sprouts, stem, and lower, middle, and upper leaf sections. Dry tissue biomass was determined. PPCP tissue concentrations were analyzed by LC-MS/MS. PPCP mass per tissue type was calculated for each individual compound and for the sum of all compounds during each exposure time. Carbamazepine, fluoxetine, and triclosan were detected in all tissues, while gemfibrozil was detected only in roots and rhizomes. In roots, triclosan and gemfibrozil mass surpassed 80% of the PPCP mass, while in leaf carbamazepine and fluoxetine mass represented 90%. Fluoxetine accumulated mainly in the stem and the lower and middle leaf, while carbamazepine accumulated in the upper leaf. The PPCP mass in roots and rhizome was strongly positively correlated with LogDow, while in leaf it was correlated with water transpired and pKa. PPCP uptake and translocation in T. latifolia is a dynamic process determined by the properties of contaminants and plants.

Establishing the Approach of Norm Balance toward Intention Prediction across Six Behaviors under the Theory of Planned Behavior.

Background: An innovative approach of Norm Balance is proposed under the Theory of Planned Behavior (TPB). In this approach, the measurement score of subjective norm is weighted by the relative importance of others, and the measurement score of self-identity is weighted by the relative importance of self. The study objective was to examine the effect of Norm Balance to predict behavioral intentions in two groups of college students. Methods: Cross-sectional surveys were used in two studies. For 153 business undergraduates, Study 1 examined three common intentions: eating a low-fat diet, exercising regularly, and dressing business-like. For 176 PharmD students, Study 2 examined three pharmacy-related intentions: informing relatives about counterfeit medications, buying prescription medications online, and completing a pharmacy residency. The relative importance of others vs. self was measured by asking study subjects to allocate 10 points between important others and oneself. Two sets of regressions were conducted and compared across six intentions using the traditional model and the Norm Balance model. Results: The 12 regressions explained 59-77% of intention variance. The variance explained by the two models was similar. When subjective norm or self-identity was non-significant in the traditional model, the corresponding Norm Balance component was significant in the Norm Balance model, except for eating a low-fat diet. When both subjective norm and self-identity were significant in the traditional model, the two Norm Balance components were significant in the Norm Balance model with increased coefficients. Conclusions: The proposed approach of Norm Balance provides a different view about the significance and coefficients of subjective norm and self-identity toward intention prediction.

What drives job satisfaction among community pharmacists? An application of relative importance analysis.

Background: Pharmacy employers want to improve pharmacists' job satisfaction, but ratings of job satisfaction are highly subjective, as evaluating job satisfaction involves weighing simultaneously the importance of multiple correlated determinants that are often perceived unequally. Objectives: To 1) describe the application of relative importance analysis in estimating the predictive ability of correlated determinants of job satisfaction, and to rank the determinants in order of relative importance, and 2) explore how the perceived relative importance of job satisfaction predictors may vary across community pharmacists' age, gender, and work setting categories. Methods: Data were obtained from the 2019 National Pharmacy Workforce Survey administered to 96,110 licensed U.S. pharmacists. Multiple regression analysis (MR) and relative weight analysis (RWA) were used to assess the predictive ability of determinants to explain pharmacists' job satisfaction. Subgroup analyses were performed to explore variations in the perceived relative importance of predictors across pharmacists' age, gender and work setting categories. Results: Over the entire sample of community pharmacists, no personal experience of workplace discrimination [RW = 0.0613, rank = 1] and less reported engagement in advanced dispensing activities [RW = 0.0235, rank = 2] were most associated with greater job satisfaction, as both predictors jointly accounted for 67.5% of the predicted criterion variance (R 2). Pharmacists' compensation was observed to have the lowest perceived relative importance for predicting job satisfaction [RW = 0.0005, rank = 6], accounting for 0.5% of R 2. Between-group comparisons showed that, no personal experience of workplace discrimination had the highest perceived relative importance for job satisfaction across pharmacists' age groups, among women, and across most work settings except small chain pharmacies. Within-group comparisons showed that pharmacists' compensation was significantly more important than professional interactions (ΔRW(PC-PPI) 0.2900 [0.0637, 0.5360]) for job satisfaction among pharmacists in large chain pharmacies, while patient-care services was significantly more important than compensation for job satisfaction in independent (ΔRW(PPS-PC) 0.1761 [0.0017, 0.5980]) and health system retail pharmacists (ΔRW(PPS-PC) 0.4190 [0.0444, 0.8303]). Conclusions: Relative importance analysis corroborated multiple regression and provided a more interpretable presentation of variable influence on community pharmacists job satisfaction as the importance of personal and workplace characteristics in how pharmacists evaluate their job satisfaction varied across age, gender and work setting categories.

Patient preferences and willingness-to-pay for community pharmacy-led Medicare Part D consultation services: A discrete choice experiment.

INTRODUCTION: Community pharmacies currently offer Medicare Part D consultation services, often at no-cost. Despite facilitating plan-switching behavior, identifying potential cost-savings, and increasing medication adherence, patient uptake of these services remains low. OBJECTIVES: To investigate patient preferences for specific service-offering attributes and marginal willingness-to-pay (mWTP) for an enhanced community pharmacy Medicare Part D consultation service. METHODS: A discrete choice experiment (DCE) guided by the SERVQUAL framework was developed and administered using a national online survey panel. Study participants were English-speaking adults (≥65 years) residing in the United States enrolled in a Medicare Part D or Medicare Advantage plan and had filled a prescription at a community pharmacy within the last 12 months. An orthogonal design resulted in 120 paired-choice tasks distributed equally across 10 survey blocks. Data were analyzed using mixed logit and latent class models. RESULTS: In total, 540 responses were collected, with the average age of respondents being 71 years. The majority of respondents were females (60%) and reported taking four or more prescription medication (51%). Service attribute levels with the highest utility were: 15-min intervention duration (0.392), discussion of services + a follow-up phone call (0.069), in-person at the pharmacy (0.328), provided by a pharmacist the patient knew (0.578), and no-cost (3.382). The attribute with the largest mWTP value was a service provided by a pharmacist the participant knew ($8.42). Latent class analysis revealed that patient preferences for service attributes significantly differed by gender and difficulty affording prescription medications. CONCLUSIONS: Quantifying patient preference using discrete choice methodology provides pharmacies with information needed to design service offerings that balance patient preference and sustainability. Pharmacies may consider providing interventions at no-cost to subsets of patients placing high importance on a service cost attribute. Further, patient preference for 15-min interventions may inform Medicare Part D service delivery and facilitate service sustainability.

Quantifying the Root-to-Shoot Transfer of 4,4'-Methylenedianiline Using Pressure Chamber and Intact Plant Methods.

The high-production-volume chemical 4,4'-methylenedianiline (4,4'-MDA) is an aromatic amine used to manufacture 4,4'-methylenedianiline diisocyanate for polyurethane production. Based on 4,4'-MDA's octanol/water partition coefficient (KOW ) and correlations with the transpiration stream concentration factor (TSCF), significant plant uptake and root-to-shoot transfer are predicted. However, most correlations between KOW and TSCF were developed for neutral organics and may not be applicable for ionizable bases such as 4,4'-MDA. To investigate, TSCF values for 4,4'-MDA were measured using pressure chamber and intact plant approaches for tomato, soybean, and wheat (intact plants only). 14 C-labeled 4,4'-MDA was used to increase analytical sensitivity and facilitate measurement of distribution within plant tissues. The TSCF of 14 C-MDA determined using the pressure chamber method was 0.04 ± 0.00 for tomato and 0.17 ± 0.10 for soybean. These values were lower than predicted from log KOW and within the range of values for 14 C-pyrene also measured in our study (0.14 ± 0.00 for tomato and 0.16 ± 0.09 for soybean). The TSCF values calculated from measurements made from intact plants grown to maturity were statistically equivalent to those obtained from the pressure chamber method for soybean and tomato. The distributions of 14 C within the three plants species were similar, with the roots > leaves ≈ stems > fruit. The log root concentration factors for 4,4'-MDA ranged from 3.68 to 4.33 for the three plant species. This finding indicates that the aromatic amine sorption to root materials is much greater than would be predicted based on its log KOW and may be the reason for the limited root-to-shoot transfer observed in the pressure chamber and intact plant studies. Environ Toxicol Chem 2023;42:655-662. © 2023 SETAC.

Ambulatory care pharmacy practice: Findings from the 2019 National Pharmacist Workforce Survey.

PURPOSE: The purpose of this study was to describe the demographics, training, clinical specialties, and practice activities of ambulatory care pharmacists using data from the 2019 National Pharmacist Workforce Study (NPWS). SUMMARY: The 2019 NPWS was conducted using a 3-contact electronic survey sent to a random sample of 94,803 pharmacists using the National Association of Boards of Pharmacy Foundation e-Profile system. The 2019 NPWS had a response rate of 67.3% (5,705/8,466), based on the number of prospective respondents who clicked the survey link. A subset of pharmacists' responses (n = 4,557) was used for this analysis, which included those who selected an employment status of "practicing as a pharmacist." Of the 4,557 actively practicing pharmacists responding, 338 (8.0%) reported working in the ambulatory care setting. Ambulatory care pharmacists were predominately White (71.6%), women (67.5%), and/or between the ages of 31 and 40 years (36.9%). A total of 41.3% had completed PGY1 residency training, 14% had completed PGY2 residency training, and 29.3% had completed one or more board certifications. Their most common clinical specialty areas were anticoagulation (21.7%), endocrinology (19.7%), hematology/oncology (16.2%), and primary care (16.2%). A total of 49.6% reported using a collaborative practice agreement. CONCLUSION: Ambulatory care pharmacists reported more training and certifications than the overall sample of pharmacists. These pharmacists practiced in a variety of clinical specialty areas and engaged in a range of in-person and telecommunication medication management activities. This study provides a baseline assessment of the ambulatory care pharmacist workforce that can be used to assess changes over time.

A taxonomy for community pharmacy patient care services reported in Pharmacist eCare Plans.

BACKGROUND: Pharmacies belonging to the Community Pharmacy Enhanced Service Networks (CPESN) are transforming their practices with support of the Flip the Pharmacy initiative. These pharmacies are submitting eCare plans that describe care that they have provided to patients. OBJECTIVES: The objectives of this study were (1) To develop a taxonomy for services reported by community pharmacies participating in year 1 of the Flip the Pharmacy initiative and (2) to illustrate the use of the taxonomy for hypertension-related services. METHODS: A retrospective observational study design was used. The analyzed data were extracted from eCare plans submitted by participating pharmacies during the first year of the Flip the Pharmacy initiative (October 1, 2019-September 30, 2020). Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) codes submitted for encounter reason and for procedures were sorted into categories based on similarity of terminology in the SNOMED-CT code labels. All SNOMED-CT codes in the encounter reasons that had blood pressure or hypertension in their labels were mapped to taxonomy categories. Descriptive statistics were calculated for all variables. RESULTS: A total of 368,297 eCare plans reporting 1,049,061 SNOMED-CT procedures were submitted for 133,210 patients by 526 pharmacies. Seven categories of community pharmacy patient care services were identified: medication synchronization, medication review, monitoring, immunizations, patient education, adherence, and recommendations. Over half of the encounter reasons (63.5%) and procedures (56.2%) were for medication synchronization. Both medication review and monitoring accounted for about 10% of the encounters, and medication review made up over 30% of procedures. A total of 18,307 encounters were related to hypertension. Of these, monitoring was the most frequent, with 11,285 encounters (61.6%) encounters, followed by patient education, with 5173 encounters (28.3%). CONCLUSION: CPESN pharmacies are delivering a wide range of patient care services. This taxonomy provides a concise way to organize and report services being delivered by community pharmacies.

Leadership aspiration: An intersectional analysis of racial and gender equity in pharmacy.

BACKGROUND: The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes. OBJECTIVES: The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership. METHODS: The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics. RESULTS: Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898). CONCLUSION: Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions.

Identifying Services Provided in Community Pharmacy Practice Settings.

Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.

Medication-Related Problems and Interventions Identified and Addressed by Pharmacists Conducting Enhanced Medication Therapy Management Services.

Pharmacists identify, resolve, and document medication-related problems (MRPs) in community pharmacies. Enhanced medication therapy management (eMTM) targets specific situations, such as high-risk medications, while continuous medication monitoring (CoMM) occurs for every patient and is integrated into the dispensing process. This study describes types and frequencies of MRPs and interventions for health plan-directed eMTM and pharmacist-identified CoMM for a cohort of Medicare Part D patients. Pharmacy dispensing and clinical records from one independent community pharmacy in the Midwest were reviewed for patients eligible for eMTM in 2019. Data were coded for medication-related problems and interventions; descriptive statistics were calculated. Forty-seven patients were included in the study, resulting in 439 health plan-directed and 775 pharmacist-identified MRPs and corresponding interventions for a total of 1214 over 12 months. The average age of the patients was 77; they received an average of about 14 medications dispensed over 25 dates. Nonadherence was the most common MRP overall, as well as for the two categories separately. Patient Counseling and Lab Values Needed MRPs were found more often by pharmacists. Continue to Monitor was the most common intervention flagged overall. Medication Discontinued was found more often in health plan-directed interventions; Patient Counseling occurred more frequently in pharmacist-identified interventions. Using pharmacists to identify MRPs can complement health plan-driven eMTM, which can provide more complete medication management. Future work is needed to determine if this approach is reproducible in other pharmacies.

Evaluating the coaches' experience in the Flip the Pharmacy program.

BACKGROUND: The Flip the Pharmacy (FtP) program aims to transform pharmacy practice to be patient centered and professionally sustainable through hands-on peer coaching, where the peer coaches' roles are to support their teams and provide them with feedback. There is a need to describe the coaches' experiences in transforming pharmacy practice, to better use coaching in future programs. OBJECTIVES: This study aims to (1) describe peer coaches' experiences in cohort 1 year 1 of the FtP program, (2) identify barriers and facilitators for program implementation, and (3) provide recommendations for future coaches. METHODS: A qualitative design used semistructured telephone interviews with all 7 peer coaches at FtP Team Iowa. They were interviewed about their coaching approach, experiences, and perceived facilitators and barriers to FtP program implementation by 30 pharmacies. The transcripts were coded by 2 researchers independently using thematic analysis, the emergent codes were discussed until agreement was reached, and then codes were aggregated and organized. RESULTS: Coaches' experience contained 3 themes: training received in preparation for the program, role clarity, and pharmacy visits (face to face vs. virtual). Themes also emerged for perceived facilitators and barriers to program implementation. Opportunities and recommendations contained 3 themes: accountability, in which the coach has clear expectations and uses consistent reporting; knowledge sharing, where peer coaches can exchange ideas and experiences; and training, where coaches can receive technical and interpersonal training. CONCLUSION: Consistency and role clarity for the coaches can be increased by training on communication with teams, setting clear expectations, and providing a system for sharing their experiences and knowledge. Peer coaches can help establish service value that can improve contract opportunities and program execution through routinizing workflow. More research should be done about the effects of peer coaches' roles on sustaining practice transformation for successful service execution.

Exploring the moderating role of job resources in how job demands influence burnout and professional fulfillment among U.S. pharmacists.

BACKGROUND: Job stress, burnout, and fulfillment can be modeled using the Job Demands and Resources model (JD-R). OBJECTIVE: This study explores the relationship between job demands and burnout and professional fulfillment in pharmacists, and the moderating role of job resources. METHODS: Data were obtained from the 2019 National Pharmacist Workforce Survey of a random sample of U.S. licensed pharmacists. The survey assessed pharmacist demographics (age, gender, and work setting), job demands (workload and work-home conflict), job resources (job control, time spent in various work activities, and social support), as well as burnout and professional fulfillment. Hierarchical regression analyses were used to assess the relationship between job demands-resources variables and pharmacists' professional fulfillment and burnout. Moderation was assessed by including interaction terms (job demands x job resources) in the regression models. The change in marginal mean burnout and professional fulfillment for different combinations of job demands and job resources was used to assess the salience of significant moderation effects. RESULTS: Women and community pharmacists accounted for 64.8% and 45.8% of the study sample, respectively. Age was negatively associated with burnout. Job demands were positively associated with burnout and negatively associated with professional fulfillment, and the converse was true for job resources. Significant moderation effects were observed for 7 out of 12 interaction terms assessed. The moderating effect of job resources was more salient under varying conditions of job demands in 5 out of 7 instances where significant interaction effects were observed. CONCLUSION: While pharmacist characteristics explained a significant amount of variation in burnout and professional fulfillment, also considering the moderating effects of job resources on the association of job demands with burnout and professional fulfillment identified additional information, such as the increased importance of job control and task variety in high workload environments.

Use of medication regimen complexity to target services in the community.

BACKGROUND: In the community, successful medication therapy depends on patients managing complex medication regimens. To assist, pharmacists can sort patients on the basis of their regimen complexity and then tailor care appropriately. OBJECTIVES: Objectives were to (1) develop a medication regimen complexity score and assess its reliability and validity, (2) design and implement a Less Complex program to tailor medication management services to the complexity of medication regimens, and (3) evaluate the impact that a Less Complex program had on identification and resolution of medication-related problems (MRPs). METHODS: Patients in the Less Complex program were stratified into complexity categories on the basis of Iowa Medication Complexity Scores (IMECSs) to receive pharmacy services tailored to their complexity category. Types and numbers of MRPs identified and associated pharmacist interventions were extracted. Frequencies and descriptive statistics were calculated. To assess the reliability and validity of the IMECS, a stratified random sample of 125 patients was drawn. For each of these patients, baseline and end of 9-month scores for IMECS were compared with Medication Regimen Complexity Index (MRCI) scores using paired t tests. RESULTS: A total of 661 patients had both baseline and post-IMECSs. The mean IMECS for the sample of 661 patients decreased from 28.6 at baseline to 27.3 during the postperiod. For the stratified sample (n = 113), the MRCI showed a nonsignificant change from baseline to the end of treatment period, whereas the IMECS showed a statistically significant decrease from baseline to the end of treatment period. A total of 10,535 MRPs and 10,482 interventions were documented during the 9-month treatment period for 1019 patients. CONCLUSION: Evidence supported initial reliability and validity of the IMECS. The Less Complex program identified and addressed many MRPs by matching patient complexity to service type. Future work is needed to evaluate a similar approach in other pharmacies.

Evaluation of a modified and abbreviated scale for assessing chronic illness care for medication therapy management practice.

BACKGROUND: The central goals of MTM align with those of the Chronic Care Model (CCM). However, reliable and valid assessments are needed to estimate the extent to which components of MTM care delivery are consistent with the CCM. The Assessment of Chronic Illness Care (ACIC) is a 34-item scale for administration in primary care offices to estimate the extent to which chronic care delivery aligns with the six elements of the CCM. The ACIC appears to be responsive for care delivery interventions aimed at improving various chronic illnesses. However, the potential value of the ACIC as a measure for evaluating MTM delivery is unknown. OBJECTIVE: A modified and abbreviated version of the ACIC could be a useful evaluation tool for pharmacist-provided medication therapy management (MTM). The objective of this study was to assess the construct and criterion-related validity, and internal consistency, of the abbreviated (12-item) "MTM ACIC." METHODS: The abbreviated MTM ACIC was administered to pharmacists employed at 27,560 community pharmacies. Construct validity and internal consistency were estimated through principal components analysis, item-to-total correlations, and Cronbach's alpha estimate of internal consistency. To assess criterion-related validity, a univariate negative binomial model estimated the association between ACIC scores and pharmacy-level MTM completion rates. RESULTS: A one-component model accounted for 64% of the variance, and Cronbach's alpha was 0.95. Scores on the abbreviated MTM ACIC were associated with MTM completion rates (rate ratio: 1.02; 95% CI: 1.01 to 1.03). CONCLUSION: The abbreviated MTM ACIC exhibited acceptable construct and criterion-related validity and internal consistency and could serve as a valuable tool for evaluating chronic illness care within the MTM setting.

Contaminants of emerging concern (CECs) in Zea mays: Uptake, translocation and distribution tissue patterns over the time and its relation with physicochemical properties and plant transpiration rate.

Passive uptake of contaminants of emerging concern (CECs) and its relationship with physicochemical properties, such as lipophilicity (LogKow), ionization behavior (pKa), distribution coefficient (LogDow) and transpiration rate are scarcely studied. In the current study, hydroponically grown corn (Zea mays) was exposed to carbamazepine (CBZ), fluoxetine (FLX), gemfibrozil (GBZ), triclosan (TRI) and atrazine (ATZ)) at environmentally relevant concentrations (20 µg/L each one). Plant tissue concentrations of CECs were determined several times over 21 days. Eighteen plants were used, nine exposed to the CECs and nine untreated. Whole plants were harvested at 7, 14 and 21 days and separated into roots, stem, leaf and male bud flower (only at 21 days). Hydroponic solution was maintained at pH 5.5 throughout the study. CECs concentrations in the exposure solution and tissues were determined by LC-MS/MS. ATZ metabolites desisopropylatrazine (DIA) and desethylatrazine (DEA) were determined by LC-DAD. In shoot tissues, CBZ, FLX and ATZ were detected, while TRI and GBZ were detected only in roots. Root concentrations were related with LogKow (R2ROOT = 0.415). Leaf and stem concentrations of CBZ, FLX and ATZ were linked with LogKow and strongly linked with pKa. Transpiration was related with CBZ and ATZ in shoot, but not related with FLX shoot levels. Neutral compounds such as CBZ (pKa = 13.94; 100% neutral) and ATZ (pKa = 1.6; 85% neutral) were taken up passively with transpiration. Root accumulation was related with CECs lipophilicity, while translocation and bioaccumulation in shoot were not only related with lipophilicity, but also with CECs ionization behavior and transpiration.

Atrazine uptake, translocation, bioaccumulation and biodegradation in cattail (Typha latifolia) as a function of exposure time.

The extensive use and environmental persistence of atrazine has resulted in its ubiquitous occurrence in water resources. Some reports have described atrazine bioaccumulation and biodegradation pathways in terrestrial plants, but few have done so in aquatic macrophytes. Thus, in this study, we aimed to analyze morphological changes, uptake, translocation and bioaccumulation patterns in tissues of the aquatic macrophyte Typha latifolia (cattail) after long-term atrazine exposure and to determine the presence of atrazine biodegradation metabolites, desethylatrazine (DEA) and desisopropylatrazine (DIA), in tissues. Plants were hydroponically exposed to 20 µg/L atrazine (18 exposed and 18 non-exposed) for 7, 14, 21, 28, 35 and 42 days. Plants were separated into root, rhizome, stem, and lower, middle and upper leaf sections. Atrazine was analyzed by LC-MS/MS and DIA and DEA by LC-DAD. Plants showed reductions in weight (after 21 days) and transpiration (after 28 days), both symptoms of chronic phytotoxicity. The distribution of atrazine within tissues, expressed as concentration levels (µg/kg dry weight), was as follows: middle leaf (406.10 ± 71.77) = upper leaf (339.15 ± 47.60) = lower leaf (262.43 ± 7.66) = sprout (274.53 ± 58.1) > stem (38.63 ± 7.55) = root (36.00 ± 3.49) = rhizome (26.15 ± 3.96). In submerged tissues, DEA and DIA were detected at similar concentrations. In leaves, DIA was the main metabolite identified. Results indicated that atrazine was taken up from roots to shoots and induced phytotoxicity effects that reduced the translocation to shoots. Typha likely is able to biodegrade atrazine via different metabolic pathways.