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BACKGROUND: The vaccine coverage rate (VCR) for human papillomavirus (HPV) in France is one of the lowest in Europe, well below the target of 80% announced in the French Cancer Plan 2021-2030. The extension of vaccination competencies (prescription and administration) to new health care providers, such as community pharmacists (CPs), was a decisive step by the French Health Authority (HAS) in 2022 to simplify access to vaccination and improve the VCR. This research assessed the economic and organizational impacts (OIs) of the extension of vaccination competencies in France. METHODS: A model was developed in Excel® to compare the current HPV vaccination pathway focused on general practitioners (GPs) to a mix of pathways (new and current) that extends pharmacists' competencies (prescription and/or injection). The simulated population corresponded to girls and boys targeted by the French recommendations. The model was run from 2023 to 2030. HAS guidelines were used to identify OIs related to these new pathways. Model inputs were collected from national data sources and an acceptability study. The results focused on three OIs (HPV vaccination ability [defined as the number of adolescents who could be vaccinated in each pathway], the VCR projection, and flows of activity between health care professionals]). The economic impact was evaluated from the National Health Insurance (NHI) perspective in 2022. RESULTS: With a mix of vaccination pathways, including an increasing role of pharmacists, the target of an 80% VCR could be reached in 2030 (versus 2032 with the current pathway) with lower investment than the current situation, resulting in cost savings for the NHI of 212 million. Expanding vaccination competencies will provide pharmacists with additional revenue (an average of 755,000/month for all vaccinating pharmacies) and will free up medical time for GPs (average of 603,000 consultations/year for all GPs). CONCLUSIONS: Expanding vaccination competencies to pharmacists has a positive impact on the entire ecosystem. From a public health perspective, the national VCR target can be achieved and better access to care can be provided, freeing up medical time. From an economic perspective, this approach can provide savings for the NHI and additional revenue for pharmacists.
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Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Farmacéuticos , Humanos , Francia , Vacunas contra Papillomavirus/economía , Vacunas contra Papillomavirus/administración & dosificación , Femenino , Masculino , Infecciones por Papillomavirus/prevención & control , Adolescente , Vacunación/economía , Servicios Comunitarios de Farmacia/organización & administración , Servicios Comunitarios de Farmacia/economía , Competencia Clínica , Virus del Papiloma HumanoRESUMEN
BACKGROUND: Interprofessional collaborative care such as a split-shared care model involving family physicians and community pharmacists can reduce the economic burden of diabetes management. This study aimed to evaluate the economic outcome of a split-shared care model between family physicians and community pharmacists within a pharmacy chain in managing people with uncontrolled type 2 diabetes and polypharmacy. METHOD: This was a multi-center, parallel arm, open label, randomized controlled trial comparing the direct and indirect economic outcomes of people who received collaborative care involving community pharmacists (intervention) versus those who received usual care without community pharmacist involvement (control). People with uncontrolled type 2 diabetes, defined as HbA1c > 7.0% and taking ≥ 5 chronic medications were included while people with missing baseline economic data (such as consultation costs, medication costs) were excluded. Direct medical costs were extracted from the institution's financial database while indirect costs were calculated from self-reported gross income and productivity loss, using Work Productivity Activity Impairment Global Health questionnaire. Separate generalized linear models with log link function and gamma distribution were used to analyze changes in direct and indirect medical costs. RESULTS: A total of 175 patients (intervention = 70, control = 105) completed the trial and were included for analysis. The mean age of the participants was 66.9 (9.2) years, with majority being male and Chinese. The direct medical costs were significantly lower in the intervention than the control group over 6 months (intervention: -US$70.51, control: -US$47.66, p < 0.001). Medication cost was the main driver in both groups. There were no significant changes in productivity loss and indirect costs in both groups. CONCLUSION: Implementation of split-shared visits with frontline community partners may reduce economic burden for patient with uncontrolled type 2 diabetes and polypharmacy. TRIAL REGISTRATION: Clinicaltrials.gov Reference Number: NCT03531944 (Date of registration: June 6, 2018).
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Costo de Enfermedad , Diabetes Mellitus Tipo 2 , Farmacéuticos , Polifarmacia , Humanos , Diabetes Mellitus Tipo 2/terapia , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/economía , Masculino , Femenino , Persona de Mediana Edad , Anciano , Médicos de Familia , Grupo de Atención al Paciente/economía , Grupo de Atención al Paciente/organización & administración , Servicios Comunitarios de Farmacia/economía , Servicios Comunitarios de Farmacia/organización & administraciónRESUMEN
BACKGROUND: According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription. OBJECTIVE: The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC. METHODS: A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023. Trained "secret shoppers" enacted a standardized script and recorded whether naloxone was available and its cost. We examined the relationship between out-of-pocket naloxone cost, pharmacy type, and rurality. RESULTS: Naloxone could be purchased in 53% of the pharmacies contacted; 26% incorrectly noting that naloxone could be filled only with a provider prescription and 21% did not sell naloxone. Naloxone availability by standing order was statistically different by pharmacy type (chain/independent) (χ2 = 20.58, df = 4, P value < 0.001), with a higher frequency of willingness to dispense according to the standing order by chain pharmacies in comparison to independent pharmacies. The average quoted cost for naloxone nasal spray at chain pharmacies was $84.69; the cost was significantly more ($113.54; P < 0.001) at independent pharmacies. Naloxone cost did not significantly differ by pharmacy rurality (F2,136 = 2.38, P = 0.10). CONCLUSION: Approximately half of NC community pharmacies audited dispense naloxone according to the statewide standing order, limiting same-day access to this life-saving medication. Costs were higher at independent pharmacies, which could be due to store-level policies. Future studies should further investigate these cost differences, especially as intranasal naloxone transitions from a prescription only to over-the-counter product.
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Servicios Comunitarios de Farmacia , Accesibilidad a los Servicios de Salud , Naloxona , Antagonistas de Narcóticos , Naloxona/provisión & distribución , Naloxona/administración & dosificación , Naloxona/economía , North Carolina , Humanos , Estudios Transversales , Antagonistas de Narcóticos/economía , Antagonistas de Narcóticos/provisión & distribución , Antagonistas de Narcóticos/administración & dosificación , Accesibilidad a los Servicios de Salud/economía , Servicios Comunitarios de Farmacia/economía , Órdenes Permanentes , Farmacias/economía , Farmacias/estadística & datos numéricosRESUMEN
OBJECTIVE: Mergers of big chain retail community pharmacies can affect the competitiveness of the pharmacy workforce to negotiate better wages and work conditions. However, it is unclear whether these types of mergers are generalizable to the U.S. pharmacy workforce. We should observe this effect when comparing annual wage trends between retail community pharmacy workers and nonretail community pharmacy workers. In the absence of this effect, annual wage trends would be similar. To examine this theory, annual wage trends for community pharmacy workers were compared with hospital pharmacy workers between 2012 and 2022. DESIGN, SETTING AND PARTICIPANTS: A serial cross-sectional study was performed to compare the annual wages between retail community pharmacy workers and hospital pharmacy workers between 2012 and 2022 using data from the U.S. Bureau of Labor and Statistics (BLS). Pharmacy workforce was categorized as pharmacists, pharmacy technicians, and pharmacy aides (clerks) and grouped into retail or hospital pharmacy settings based on the North American Industry Classification System. Pharmacy workers' annual wages were based on the U.S. BLS Quarterly Census of Employment and Wages data. OUTCOME MEASURES: Annual wages. RESULTS: Between 2012 and 2022, statistically significant annual wage reduction was greater among pharmacists in the retail than pharmacists in the hospital setting by -$1974 (95% CI -$2921 to -$1026) per year. However, these trends were not statistically significant among pharmacy technicians and pharmacy aides. Pharmacy technicians in the retail and hospital settings had a 3.4% and 7.0% increase in average annual wages, respectively. Pharmacy aides in the retail and hospital settings had a 16.8% and 21.6% increase in average annual wages, respectively. CONCLUSION: Although pharmacists' annual wages decreased, it is unclear whether this was caused by the monopsony labor market. These findings suggest that there may be inefficiencies in the retail community pharmacy labor market, which may stimulate policies to improve pharmacy workforce conditions and patient safety.
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Servicios Comunitarios de Farmacia , Farmacias , Farmacéuticos , Técnicos de Farmacia , Salarios y Beneficios , Humanos , Salarios y Beneficios/estadística & datos numéricos , Estudios Transversales , Farmacéuticos/estadística & datos numéricos , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Servicios Comunitarios de Farmacia/economía , Estados Unidos , Técnicos de Farmacia/estadística & datos numéricos , Farmacias/estadística & datos numéricos , Servicio de Farmacia en Hospital/estadística & datos numéricos , Recursos Humanos/estadística & datos numéricos , FemeninoRESUMEN
BACKGROUND: Many countries are experiencing an increased demand for health care and a shortage of health professionals in rural areas, impacting an individual's ability to receive timely treatment. The management of uncomplicated urinary tract infections by community pharmacists is usual practice in some regions of the United Kingdom and Canada, and Queensland, Australia. AIM: To systematically gather, assess, and synthesize the available peer-reviewed published literature on the management of uncomplicated UTIs by community pharmacists in women aged 16-65 years, provide an understanding of the clinical and economic evidence, while also identifying the essential components of interventions employed. METHOD: A systematic review was conducted to identify primary studies detailing interventions for the management of uncomplicated UTIs by community pharmacists. PubMed, PsycINFO, Scopus, Cochrane, CINAHL, EMBASE, and Web of Science were searched to February 2023. Non-primary and qualitative studies were excluded. Study details were recorded in a tailored data extraction form. The quality of studies was assessed using the Joanna Briggs Institute tools. RESULTS: Ten publications were included following review of 2129 records. High self-reported cure rates between 84 and 89% and referral rates of about 7% were reported. A single study found pharmacist management was cost effective compared to general practitioner management. No randomized controlled trials were found and papers were of variable quality. CONCLUSION: Preliminary evidence suggests pharmacist-led management of uncomplicated UTIs is safe and effective, however no firm conclusion can be provided since the methodologies reported in included studies have significant limitations.
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Servicios Comunitarios de Farmacia , Farmacéuticos , Rol Profesional , Infecciones Urinarias , Humanos , Infecciones Urinarias/tratamiento farmacológico , Infecciones Urinarias/economía , Femenino , Farmacéuticos/economía , Servicios Comunitarios de Farmacia/economía , Persona de Mediana Edad , Adolescente , Adulto , Anciano , Adulto Joven , Análisis Costo-BeneficioRESUMEN
BACKGROUND: In the United States, the shift towards value-based health care seeks to improve patient outcomes while reducing health care spending. Although the federal government has led the implementation of performance-based models for physicians and health care systems, commercial entities have largely been responsible for the development of similar models within pharmacy. For the purposes of this study, performance-based pharmacy payment models (PBPPMs) were defined as prescription drug payment models that determine reimbursement or fees for community pharmacies based in part on measured performance. These PBPPMs incentivize pharmacies to improve patient care by linking reimbursement to performance measures. However, the design and implementation of PBPPMs lack transparency and have not been described in the literature. OBJECTIVES: To (1) describe the structure of PBPPMs in the United States and (2) identify contextual and motivational influences that need to be considered for successful uptake and integration of these models. METHODS: A search of peer-reviewed and grey literature was undertaken. In addition, semi-structured stakeholder interviews were conducted with a convenience sample of 17 individuals who were community pharmacists, payers, quality measure developers and vendors, academics, and pharmacy advocacy organization leaders. Data were analyzed to understand the current structure of PBPPMs and opportunities for improvement, as well as implementation considerations that included facilitators, barriers, and key insights. RESULTS: This study identified 4 major components of US PBPPMs: attribution, performance and quality measures, incentive structures, and patient care services. A number of barriers (eg, lack of alignment) and recommendations to improve the current structure of PBPPMs (eg, the need for adequate incentives to facilitate change) were highlighted. Notable implementation considerations centered around (1) establishing common ground among stakeholders to avoid misalignment and encourage engagement; (2) the importance of a quality-driven, innovative, and flexible organizational culture with access to data infrastructure, adjusted workflows, and relevant trainings; (3) supporting the cultural transition to value-based health care; and (4) application of financial incentives at the pharmacy or pharmacist level. CONCLUSIONS: To better develop and implement PBPPMs, it is first critical to understand the key components that define these models and the needed changes to their structure. In addition, identifying the contextual and motivational factors that influence their successful integration can improve future uptake. This study illustrates the landscape of PBPPMs in the United States, as well as makes recommendations for improvement in their design. To improve future development and implementation of these models, the following recommendations are highlighted: (1) increase transparency and alignment of measures with the incentive structure; (2) embrace innovative business models; (3) carefully plan and use roadmaps that outline successful uptake and implementation; and (4) foster culture of quality at all levels of health care. DISCLOSURES: This study was sponsored by Pharm-Alliance, an alliance between the pharmacy schools of the University of North Carolina at Chapel Hill, Monash University, and University College London. Urick reports consulting fees from Pharmacy Quality Solutions and Cardinal Health, unrelated to this work. The other authors have nothing to disclose. This study was a podium presentation under the title "What Makes Performance-Based Pharmacy Payment Models Work?" at AMCP Nexus Virtual, October 2020.
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Servicios Comunitarios de Farmacia/economía , Modelos Organizacionales , Mecanismo de Reembolso , Compra Basada en Calidad , Humanos , Entrevistas como Asunto , Investigación Cualitativa , Estados UnidosRESUMEN
BACKGROUND: Value-based payment models have been shown to limit health care spending and waste while improving quality of care. Evidence from value-based pharmacy programs (VBPPs) is needed to guide the use of these mechanisms in health care. OBJECTIVE: To evaluate financial outcomes of a VBPP implemented in 73 community pharmacies for about 40,000 commercial beneficiaries of Wellmark, Inc. METHODS: Beneficiaries were attributed to pharmacies based on the number of prescriptions dispensed. The VBPP paid community pharmacies a per capita payment based on their performance on a set of metrics to deliver care the pharmacists believed was necessary to optimize the beneficiaries' medication therapy and associated outcomes. Financial outcome variables were analyzed for the calendar year of 2018, including total cost of care, hospital admissions, and emergency department (ED) visits. Hospital admissions and ED visits were identified through claims data. Generalized linear models were used to test the effect of the VBPP on each of the outcome variables by comparing outcomes for beneficiaries attributed to the pharmacies participating in the VBPP (73 pharmacies) to Wellmark's beneficiaries attributed to nonparticipating pharmacies (847 pharmacies). Independent variables used in the models to control for possible confounding included beneficiary demographics and complexity scores, region code, accountable care organization (ACO) attribution, beneficiary product type (health maintenance organization (HMO), preferred provider organization (PPO), and several disease indicator variables. RESULTS: Analyses showed in 2018 that the per beneficiary per month total costs of care for the beneficiaries going to the VBPP pharmacies (N = 15,463) was $30.48 (4.5%; 95% CI = -6.2% to -2.7%) lower than that of the non-VBPP group (N = 140,717). The hospital admission rate for the VBPP group was 5.1% lower but was not statistically significant (95% CI = -12.9% to 3.3%). Similarly, the ED visit rate for the VBPP group was 2.1% lower than the non-VBPP group but did not reach statistical significance (95% CI = -8.6% to 3.3%). CONCLUSIONS: With the growing need for solutions to improve quality of care while reducing health care costs and waste, a value-based payment program using performance-determined capitated payments to community pharmacies offering enhanced clinical services significantly reduced total costs of care in a commercial population with one or more chronic conditions. Future work with this promising model is encouraged. DISCLOSURES: No external funding was obtained to support this study. Devolder and Heggen are employed by Wellmark, Inc. Doucette is supported by the Deborah K. Veale Professorship in Healthcare Policy at the University of Iowa. The authors have no other potential conflicts of interest to disclose.
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Servicios Comunitarios de Farmacia/economía , Compra Basada en Calidad , Organizaciones Responsables por la Atención , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
Introduction: Pharmacy-based point-of-care testing has long had the potential to improve patient access to timely care, but adoption has been slowed by financial and regulatory barriers. The COVID-19 pandemic reduced or temporarily eliminated many of the barriers to pharmacy-based testing. This review examines how the changes brought on by may impact pharmacy-based testing after the pandemic.Areas covered: This review searched peer-reviewed, lay, and regulatory literature to explore the implementation of pharmacy-based COVID-19 testing. This includes a review of regulatory and financial changes that removed barriers to testing. Additionally, it reviews the literature related to the growth of pharmacy-based testing.Expert opinion: It is clear that the COVID-19 pandemic created an awareness and opportunity for pharmacy-based point-of-care testing. The changes made in response to the pandemic have the potential to increase the role of pharmacy-based testing, but additional regulatory changes and wider pharmacy adoption are still needed to maximize the value of such services.
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Prueba de COVID-19 , Servicios Comunitarios de Farmacia , Pruebas en el Punto de Atención/organización & administración , COVID-19/epidemiología , Servicios Comunitarios de Farmacia/economía , Servicios Comunitarios de Farmacia/legislación & jurisprudencia , Humanos , Pruebas en el Punto de Atención/economía , Pruebas en el Punto de Atención/legislación & jurisprudencia , Mecanismo de ReembolsoRESUMEN
BACKGROUND: Community pharmacy participation in performance-based payment models has increased in recent years. Despite this, there has been neither much research done to evaluate the effect of these models on health care quality and spending nor is there extensive literature on the design of these models. OBJECTIVES: To (a) describe the types of measures used in performance-based pharmacy payment models (PBPPMs); (b) describe the financial impact of PBPPMs on pharmacies; (3) explore pharmacy owners' perceptions of PBPPMs; and (4) describe any practice changes made in response to PBPPMs. METHODS: This is a cross-sectional study that surveyed independent community pharmacy owners between November 2019 and January 2020. The survey included 45 items split into 5 sections that covered respondent characteristics and the 4 domain objectives. Descriptive statistics were used for quantitative responses, and free-text responses were assessed for themes. RESULTS: Of the 68 individuals who responded to the survey, 42 were community pharmacy owners who met the study eligibility criteria, and 30 responded to most survey items. Owners expressed frustration at the design of PBPPMs, with 90% stating that they did not feel that the actions necessary to meet or exceed performance standards were within their control, and 90% also reported a loss of revenue because of these models. In addition, large numbers of respondents felt that they did not have enough information on how performance measures were computed (76.7%) or how cut-points were determined (86.7%). Despite negative feelings, most owners reported implementing changes in service offerings as a result of these models. CONCLUSIONS: PBPPMs appear to be commonplace and put substantial financial burden on community pharmacies. Study results suggest that greater education by payers could improve pharmacist engagement, as could involvement of pharmacies in the design and maintenance of PBPPMs. DISCLOSURES: This work was supported by a grant from the American Association of Colleges of Pharmacy, which was not involved in the collection, analysis, and interpretation of data; writing of the report; or the decision to submit this article for publication. Urick reports consulting fees from Pharmacy Quality Solutions. The other authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Servicios Comunitarios de Farmacia/economía , Farmacéuticos/economía , Reembolso de Incentivo , Servicios Comunitarios de Farmacia/normas , Estudios Transversales , Humanos , North Carolina , Garantía de la Calidad de Atención de Salud , Encuestas y CuestionariosRESUMEN
BACKGROUND: COVID-19 is a worldwide public health concern. Disruptions in the drug market are expected and shortages might worsen. Community pharmacies can contribute to early identification and report of medicines' supply and demand issues. OBJECTIVE: The aim of this study is to characterize the impact of the COVID-19 outbreak on outpatient medicines' sales and shortages. METHODS: A retrospective, time-trend analysis of medicine sales, shortages and laboratory-confirmed COVID-19 cases was performed from February 1st to April 30th, 2020, and its homologous period (regarding sales only). A detailed analysis of 6 pharmaceutical substances was performed. All data were subjected to rescaling using the min-max normalization method, in order to become comparable. Data analysis was performed using Microsoft® Excel. RESULTS: The pandemic resulted in an increase in medicines' demand and reported shortages during the early stage of the outbreak. The maximum proportion of medicine sales was registered on March 13th, 2020, 4 days after the WHO declared COVID-19 a pandemic. By the end of March, sales have already dropped to proportions similar to those of 2019. The maximum proportion of drug shortages was reached about one week after the sales peak and by the end of the study period were below those recorded in the pre-COVID-19 period. The analyzed drugs were paracetamol, ascorbic acid, dapagliflozin plus metformin, rosuvastatin plus ezetimibe, formoterol, and hydroxychloroquine, as these pharmaceutical substances registered the highest growth rate in sales and shortages when compared to the same period in the previous year. Hydroxychloroquine showed the most different pattern trends on sales and shortages of these medicines. CONCLUSIONS: Pharmacies can provide timely and real-world data regarding sales and shortages. The adopted measures to guarantee the continuous supply of the medicine market seem to have worked. The long-term impacts of this pandemic are unknown and should continue to be closely monitored.
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COVID-19 , Comercio/tendencias , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Preparaciones Farmacéuticas/provisión & distribución , Servicios Comunitarios de Farmacia/economía , Brotes de Enfermedades , Humanos , Preparaciones Farmacéuticas/economía , Estudios Retrospectivos , Factores de TiempoRESUMEN
The COVID-19 outbreak is a global public health crisis which has affected healthcare practice across professions. In the context of this pandemic, there is a need to highlight the roles and responsibilities of pharmacists. Community pharmacists are the most accessible healthcare professionals to the general public and have a lot to offer amid the COVID-19 response. This have led to significant changes in the health systems of many countries. This article seeks to highlight additional roles and activities relating to the public health response that can be undertaken by community pharmacists that could help to reduce pressure on general practice and other areas of the health service.
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COVID-19/epidemiología , COVID-19/terapia , Servicios Comunitarios de Farmacia/tendencias , Países en Desarrollo , Accesibilidad a los Servicios de Salud/tendencias , Farmacéuticos/tendencias , COVID-19/economía , Servicios Comunitarios de Farmacia/economía , Países en Desarrollo/economía , Accesibilidad a los Servicios de Salud/economía , Humanos , Farmacéuticos/economía , Pruebas en el Punto de Atención/economía , Pruebas en el Punto de Atención/tendenciasRESUMEN
OBJECTIVE: To measure the situation of the non-prescription sale of antibiotics and the service quality of community pharmacies in Guangzhou, China. METHODS: A simulated client method was conducted to estimate the non-prescription sale of antibiotics and service quality based on scenarios about adult acute upper respiratory tract infection in 2019. A total of 595 community pharmacies from 11 districts were investigated in Guangzhou, China. We used binary logistic regression to evaluate the factors associated with the non-prescription sale of antibiotics. RESULTS: The proportion of non-prescription dispensing of antibiotics was 63.1% in Guangzhou, China, with a higher incidence of antibiotic dispensing without prescription in outer districts (69.3%). Cephalosporin (44.1%) and Amoxicillin (39.0%) were sold more often than other antibiotics. Chain pharmacies had better performance on the prescription sale of antibiotics and service quality. Traditional Chinese medicine was commonly recommended by pharmacy staff. CONCLUSION: Since the non-prescription sale of antibiotics is prevalent in Guangzhou, effective solutions should be determined. Strengthened public awareness and regulatory system innovation are needed.
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Antibacterianos/economía , Servicios Comunitarios de Farmacia/tendencias , Farmacias/tendencias , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Cefalosporinas/uso terapéutico , China/epidemiología , Comercio , Servicios Comunitarios de Farmacia/economía , Servicios de Salud , Humanos , Farmacias/economía , Farmacéuticos/economía , Infecciones del Sistema Respiratorio/tratamiento farmacológicoRESUMEN
OBJECTIVE: To determine actions taken by community pharmacies to be successful under a value-based pharmacy program (VBPP). METHOD: An exploratory sequential mixed methods approach was used to evaluate pharmacies participating in the VBPP, with qualitative data collected and analyzed in the first phase, followed by quantitative measurement through a 30-item survey instrument in the second phase. RESULTS: The qualitative data showed that participating pharmacies were more involved with adherence and cardiovascular and diabetes metrics than with other metrics. Depression metrics received the lowest overall involvement. For total cost of care, different approaches were used; 5 pharmacies used the dashboard to identify likely high-cost patients they could try to manage, and 4 pharmacies monitored adherence to avoid complications that could contribute to increased cost. For the survey response rate was 72.6% (n = 53). The mean perception of level of success was 53.06 ± 20.15 (mean ± SD). Activities with the highest priority were adherence (1.98 ± 0.97) and diabetes care (2.04 ± 0.83), and the activity with the lowest priority was depression care (3.60 ± 1.10). The most frequently mentioned challenge was time availability, and the most common improvement suggestion was better communication between the insurer and providers. CONCLUSION: In conclusion, this study found that community pharmacies were transforming their practices to be successful under a commercial value-based payment program. The pharmacies tended to build on care processes already established (e.g., medication adherence, patients with diabetes or cardiovascular conditions) and developed new processes to address emerging metrics and associated patient needs (e.g., collecting and documenting blood pressure and hemoglobin A1c levels). Future research is needed to identify best practices for patient care and pharmacy success under broad VBPPs such as the one studied here.
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Servicios Comunitarios de Farmacia , Farmacias , Mecanismo de Reembolso , Servicios Comunitarios de Farmacia/economía , Hemoglobina Glucada , Humanos , Cumplimiento de la Medicación , FarmacéuticosRESUMEN
Background Pharmacists are one of the most accessible but unoptimized healthcare providers in the community. They are medication experts and have authority to independently prescribe in Idaho. Through the provision of direct patient care services (i.e., those distinct from traditional prescription dispensing functions), pharmacists have a greater opportunity to impact chronic disease prevention and management across the state. This can be done by filling gaps in community care (e.g., prescribing recommended therapy) and directly managing and preventing chronic diseases. However, current practices surrounding pharmacist-provided direct patient care services are unknown. Objective To characterize direct patient care services provided by Idaho community and ambulatory care pharmacists as well as to assess individual pharmacists' and their work sites' capacity and barriers in providing and expanding services. Setting Community and ambulatory care pharmacists' work sites in Idaho. Method We administered a cross-sectional, electronic, 20-min survey to Idaho community and ambulatory care pharmacists. Main outcome measure The survey focused on collecting data on current practices, capacity, and barriers related to pharmacist-provided direct patient care services. Results The survey was completed by 280 eligible community and ambulatory care pharmacists with the majority of respondents (n = 250) offering pharmacist-provided direct patient care services. Pharmacists most often prescribed therapy for tobacco cessation (nicotine replacement, bupropion, varenicline), naloxone, and devices for patients with diabetes. Top barriers to individual pharmacists providing services were dispensing load and workload while top barriers to work sites (e.g., environment) were reimbursement/billing, number of available staff, and workflow. Conclusion Idaho community and ambulatory care pharmacists currently offer direct patient care services to patients across the state, but face barriers in providing and increasing services offered.
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Atención Ambulatoria , Servicios Comunitarios de Farmacia , Atención a la Salud , Diabetes Mellitus/terapia , Farmacéuticos , Rol Profesional , Cese del Hábito de Fumar , Atención Ambulatoria/economía , Servicios Comunitarios de Farmacia/economía , Estudios Transversales , Atención a la Salud/economía , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/economía , Encuestas de Atención de la Salud , Humanos , Idaho , Reembolso de Seguro de Salud , Seguro de Servicios Farmacéuticos , Farmacéuticos/economía , Cese del Hábito de Fumar/economía , Agentes para el Cese del Hábito de Fumar , Dispositivos para Dejar de Fumar Tabaco , Flujo de Trabajo , Carga de TrabajoRESUMEN
INTRODUCTION: Community retail pharmacies offer multiple public health services to meet the health care needs of medically underserved rural communities. Many rural residents are enrolled in Medicaid insurance, and it is important that pharmacies contract with Medicaid to meet the health care needs of these people. The objective of this study was to evaluate disparities in access to Medicaid-contracted pharmacies across the rural-urban continuum in Washington State. METHODS: We linked data on licensed community retail pharmacies in Washington State in 2017 to lists of state Medicaid-contracted pharmacies. We classified pharmacies as being located in small rural, large rural, suburban, and urban areas by using rural-urban commuting area (RUCA) codes. We evaluated the likelihood of zip code-level access to at least 1 pharmacy that was contracted with a Medicaid insurance plan across the rural-urban continuum by using descriptive statistics and modified Poisson regression models, adjusted for zip code-level community characteristics. RESULTS: Of 1,145 pharmacies in our study sample, 8.4% (n = 96) were not contracted with a Medicaid plan. Compared with urban core zip codes, small rural zip codes (adjusted relative risk [ARR] = 0.64; 95% CI, 0.46-0.91) and large rural zip codes (ARR = 0.68; 95% CI, 0.49-0.95) were significantly less likely to have access to a Medicaid-contracted pharmacy. Suburban zip codes did not differ significantly from urban core areas in their access to Medicaid-contracted pharmacies. CONCLUSION: In Washington State, the likelihood of access to a Medicaid-contracted pharmacy decreased significantly as rurality increased. Policy efforts should aim to improve access for Medicaid enrollees, especially those outside urban centers.
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Servicios Comunitarios de Farmacia/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud , Servicios Comunitarios de Farmacia/economía , Estudios Transversales , Humanos , Medicaid , Población Rural/estadística & datos numéricos , Estados Unidos , Población Urbana/estadística & datos numéricos , WashingtónRESUMEN
BACKGROUND: Improving the identification of depression in adults in primary care can produce clinical and economic benefits. Community Pharmacists may play a role in screening for depression. OBJECTIVE: To systematically review and evaluate the evidence for the feasibility, impact and cost-effectiveness of community pharmacists screening adults for depression. METHODS: An electronic literature search using the databases EMBASE, PubMed and CINAHL Complete from January 2000 to September 2019 was undertaken to identify studies involving community pharmacists screening for depression. Data relating to sample size, population demographics and medical conditions of adults screened were extracted. Details around the screening model, process-related outcomes, clinical outcomes and economic outcomes were also extracted. RESULTS: Ten studies using eight unique depression screening tools were identified. Ease of administration was the most common selection criterion (n = 4) while no reason was given in four studies. Seven studies reported that through screening, pharmacists could identify adults with undiagnosed depression. Pharmacists referred adults screening positive for assessment in seven studies and followed up participants in two studies. No study assessed the impact of screening on depressive symptoms or the cost-effectiveness of pharmacists screening for depression. CONCLUSION: Community pharmacists are able to use depression screening tools to identify undiagnosed adults having symptoms of depression. However, there is little evidence around the impact of this screening on clinical and economic outcomes. Larger, well-designed studies that use a highly accurate, easily administered screening tool and include patient referral and follow-up and pharmacist training are warranted to provide evidence on the impact of community pharmacists screening adults for depression.
Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Depresión/diagnóstico , Tamizaje Masivo/organización & administración , Farmacéuticos/organización & administración , Rol Profesional , Servicios Comunitarios de Farmacia/economía , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Análisis Costo-Beneficio/estadística & datos numéricos , Estudios de Factibilidad , Humanos , Tamizaje Masivo/economía , Tamizaje Masivo/estadística & datos numéricos , Derivación y Consulta/economía , Derivación y Consulta/organización & administración , Derivación y Consulta/estadística & datos numéricosRESUMEN
Management of intermittent allergic rhinitis (IAR) is suboptimal in the UK. An Australian community pharmacy-based intervention has been shown to help patients better self-manage their IAR. We conducted a pilot cluster RCT in 12 Scottish community pharmacies to assess transferability of the Australian intervention. Trained staff in intervention pharmacies delivered the intervention to eligible customers (n = 60). Non-intervention pharmacy participants (n = 65) received usual care. Outcome measures included effect size of change in the mini-Rhinoconjunctivitis Quality of Life Questionnaire (miniRQLQ) between baseline, 1-week and 6-week follow-up. Trial procedures were well received by pharmacy staff, and customer satisfaction with the intervention was high. The standardised effect size for miniRQLQ total score was -0.46 (95% CI, -1.05, 0.13) for all participants and -0.14 (95% CI,-0.86, 0.57) in the complete case analysis, suggesting a small overall treatment effect in the intervention group. A full-scale RCT is warranted to fully evaluate the effectiveness of this service.
Asunto(s)
Farmacéuticos , Rinitis Alérgica Estacional/terapia , Automanejo/métodos , Adulto , Servicios Comunitarios de Farmacia/economía , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Calidad de Vida , Rinitis Alérgica Estacional/economía , Automanejo/economía , Automanejo/educación , Encuestas y CuestionariosRESUMEN
DISCLOSURES: No funding supported the writing of this commentary. The author has nothing to disclose.
Asunto(s)
Servicios Comunitarios de Farmacia/organización & administración , Fuerza Laboral en Salud/estadística & datos numéricos , Farmacias/organización & administración , Farmacéuticos/organización & administración , Atención Primaria de Salud/organización & administración , Servicios Comunitarios de Farmacia/economía , Servicios Comunitarios de Farmacia/estadística & datos numéricos , Servicios Comunitarios de Farmacia/tendencias , Costos de los Medicamentos , Medicamentos Genéricos/economía , Educación en Farmacia/estadística & datos numéricos , Educación en Farmacia/tendencias , Fuerza Laboral en Salud/tendencias , Humanos , Farmacias/economía , Farmacias/estadística & datos numéricos , Farmacias/tendencias , Farmacéuticos/estadística & datos numéricos , Farmacéuticos/tendencias , Medicamentos bajo Prescripción/economía , Servicios Preventivos de Salud/economía , Servicios Preventivos de Salud/organización & administración , Servicios Preventivos de Salud/estadística & datos numéricos , Servicios Preventivos de Salud/tendencias , Atención Primaria de Salud/economía , Atención Primaria de Salud/estadística & datos numéricos , Atención Primaria de Salud/tendencias , Rol Profesional , Mecanismo de Reembolso , Estados UnidosRESUMEN
DISCLOSURES: No funding was received for the writing of this commentary. The author has nothing to disclose.
Asunto(s)
Organizaciones Responsables por la Atención/organización & administración , Servicios Comunitarios de Farmacia/organización & administración , Economía Farmacéutica/organización & administración , Farmacias/organización & administración , Organizaciones Responsables por la Atención/economía , Organizaciones Responsables por la Atención/tendencias , Servicios Comunitarios de Farmacia/economía , Servicios Comunitarios de Farmacia/tendencias , Economía Farmacéutica/tendencias , Farmacias/economía , Farmacias/tendencias , Estados UnidosRESUMEN
DISCLOSURES: No funding supported the writing of this article. The author is an employee of AmerisourceBergen and leads its Good Neighbor Pharmacy program, which supports independent community pharmacy customers.