RESUMO
BACKGROUND: Little is known about the use of technical assistance (TA) programs to facilitate the integration of pharmacist clinical services in primary care settings. OBJECTIVE: Design, implement, and evaluate a TA program to advance pharmacist integration and clinical services in primary care. PRACTICE DESCRIPTION: Structured TA program for developing new or enhancing current integrated pharmacist services was utilized in 4 primary care organizations (i.e., federally qualified health center, accountable care organization, and an academic and regional health system). PRACTICE INNOVATION: Holistic TA program with a logic model, organizational stages of pharmacist integration, project prioritization, and implementation plans. EVALUATION METHODS: A mixed-methods contextual inquiry approach for integration of pharmacist clinical services. Quantitative analysis was used for TA program activities, time spent, pilot project data, and a web-based survey for post-TA program assessment. Coincidence analysis was used to assess organizational commitment to TA services. Qualitative analysis was used for data collected through semi-structured key informant interviews and team meeting activity reports. RESULTS: TA program team spent 1872 hours over 11 months on program development, logistics, implementation, and project oversight. TA services included 88 onsite and virtual meetings, 11 onsite pharmacist coaching sessions, 6 workflow mapping sessions, and updating online learning resources. Primary care organizations that had already hired a pharmacist were more likely to uptake TA services. Most useful TA methods were webinar meetings (89%) and on-site pharmacist coaching (88%). TA project results were used for strategic planning (73%), pharmacist value/impact assessment (72%), pharmacist capacity modeling (68%), and workflow design (65%). A key learning from the TA program was the importance of a qualified pharmacist with clinical service experience in primary care settings and population health teams. CONCLUSION: TA program for the pharmacist clinical service integration has broad application to primary care organizations with diverse organizational structures, payer mixes, and practice settings.
Assuntos
Atenção à Saúde , Farmacêuticos , Humanos , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Atenção Primária à SaúdeRESUMO
BACKGROUND: While technical assistance (TA) has been utilized by primary care organizations (PCOs) for electronic health record installation and medical home recognition, little is known about PCOs' use of TA to optimize pharmacist clinical services and integration in team-based care or population health programs. In 2019, the Connecticut Office of Health Strategy's State Innovation Model Program funded a no-cost TA initiative for 9 PCOs to initiate and/or advance pharmacist clinical services. OBJECTIVE: To assess organizational, operational, and pharmacist factors that influenced PCO commitment to the TA program. METHODS: During the TA program, data were collected from multiple sources including PCO demographic data; discussions and meetings with PCO medical, pharmacy, and administrative leaders; on-site workflow observations; and pharmacist coaching sessions. Configurational comparative methods were applied using the data collected during the TA program. Candidate factors were identified and calibrated on the basis of the researchers' knowledge of the TA program, organizational readiness for change models, implementation science frameworks, and published literature. Each candidate factor was iteratively assessed until 13 factors were selected and calibrated by independently assigning each factor a dichotomous value across PCOs. Calibration differences between the researchers were discussed until consensus was reached. Solutions were modeled using the Coincidence Analysis (cna) package in R and RStudio (RStudio, PBC). RESULTS: Of the 9 PCOs, 4 committed to participating in the TA program. Only 1 factor, the presence of a hired pharmacist, consistently distinguished PCOs that committed from those that did not, with 100% coverage and 80% consistency. CONCLUSION: PCO commitment to participate in the TA program was best explained by the factor of already having hired a pharmacist. These results can inform future efforts to engage PCOs in TA, primary care policy initiatives, and future research to understand factors influencing PCO success with pharmacist clinical services integration.