Influence of patient-pharmacist relationship on willingness to accept pharmacist-provided services.

BACKGROUND: Willingness to accept various pharmacist-provided services such as health promotion and medication management is still considered low. Evidence suggests that patient experience and socio-demographics partially explain patient willingness to use pharmacy services. However, the influence of a patient's relationship with their pharmacist may provide additional explanatory power. OBJECTIVES: The aims of the study were to [1] explore the willingness to accept pharmacy services across patients' relationship with pharmacists and [2] evaluate the association between the patient-pharmacist relationship and patients' willingness to accept pharmacist-provided services. METHODS: A total of 1521 respondents' data on the types of patient-pharmacist relationships and willingness to accept dispensing, drug information, medication management, and health promotional services were collected from the 2021 National Consumer Survey on Medication Experience and Pharmacists' Role. Willingness scores across the groups were evaluated using chi-square and analysis of variance. Binary logistic regression was used to investigate the associations between patient-pharmacist relationships and willingness to accept pharmacist-provided services. RESULTS: More respondents were "definitely willing" to accept dispensing services (68.5%) and drug information (68.3%), while 56.5% and 50.1% were "definitely willing" to accept health promotion and medication management services, respectively. While respondents with "customer" and "client" archetype relationships were definitely willing to accept the 4 categories of pharmacy services, the highest proportion of respondents definitely willing to accept the services was observed among those with "partner" archetype relationships. Willingness scores increased significantly across the archetype relationships. Respondents with a "partner" archetype relationship had the highest and most significant odds ratio of accepting all the categories of pharmacist-provided services. CONCLUSION: Willingness to accept services from pharmacists increased as the level of the patient-pharmacist relationship grew. Patients in "partner" archetype relationship were significantly more likely to accept all categories of pharmacist-provided services. Pharmacists are encouraged to embrace the patient-pharmacist relationship continuum to optimize patient care.

Investigation of predictors influencing patient-pharmacist relationship establishment.

BACKGROUND: A strong patient-pharmacist relationship is tied to patients' trust and confidence in pharmacists and pharmacy services. While past research has described patient-pharmacist relationship archetypes (i.e., "customer," "client," "partner") with potential to help pharmacists initially understand patients' preferences and expectations of care and services, little is known about potential factors that underlie these preferences and expectations. OBJECTIVES: This study was aimed to [1] compare the prevalence of the current and desired patient-pharmacist relationships archetypes reported by patients and [2] identify the sociodemographic, health, and medication use and procurement factors predictive of the archetypes representing patients' current relationship with outpatient pharmacists. METHODS: Data from 1521 patients were collected via the 2021 National Consumer Survey on Medication Experience and Pharmacists' Role. Patient-pharmacist relationship distribution across patients' sociodemographic characteristics was explored using crosstabulations. Multinomial logistic regression was also used to investigate the association between patient sociodemographic characteristics and the current patient-pharmacist archetype relationships. RESULTS: The mean age of the patients was 53.9 years and 57.3% were married. Thirty-two percent of the patients reported currently having a "Customer" relationship, while 17.9% and 15.2% reported having a "Client" and "Partner" archetype relationship, respectively. "Client" (25.2%) and "Partner" (20.2%) relationships were the most commonly preferred archetypal relationships. The odds ratios (OR) of having "Client" or "Partner" relationships increased with the number of patients' health conditions and medications. Patients who visited independently owned and clinic pharmacies had a higher OR of building professional relationships with a pharmacist. CONCLUSION: The qualities of a patient-pharmacist relationship may be associated with key patient characteristics. Pharmacists can build relationships with patients informed by a continuum of patient preferences, expectations, and needs to optimize health outcomes.

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.

Reducing potentially preventable health events among patients with asthma through multi-state, multi-center quality improvement program.

INTRODUCTION: Enhancing Care for Patients with Asthma is a multi-state, multi-center quality improvement program developed to augment guideline-based practice among health care providers through Plan-Do-Study-Act cycle. This study examined the association between the implementation of the guideline-based quality improvement program and subsequent changes in asthma-related emergency room visits and hospitalizations. METHODS: This retrospective, interrupted time-series study used administrative claims data from a private insurer that provided coverage to patients receiving care from participating health centers (15 centers in New Mexico, Oklahoma, Texas, and Illinois). The 12-month implementation period started in January 2013 for centers in Cohort 1 and October 2013 for centers in Cohort 2. The claims of 1,828 patients with asthma from January 2012 to May 2015 were analyzed. The data included 12-month pre-program implementation, 12-month program implementation, and 5-month post-program completion periods. RESULTS: The average number of asthma-related emergency room visits and hospitalizations decreased from 2.22 to 1.38 and 1.97 to 1.04 per 100 patients per month, respectively, in the 12-month pre-implementation period as compared to 12-month implementation period. The results of three-level generalized linear mixed models found that during the 12-month implementation period, patients had 37.7% and 47.1% lower rates of emergency room visits and hospitalizations, respectively, compared to the 12-month pre-implementation period (p < 0.001 in both comparisons). CONCLUSIONS: Enhancing Care for Patients with Asthma is an effective quality improvement program that was successfully executed in diverse geographical states and associated with reductions in potentially preventable health events. The findings support the widespread use of the program in other settings.

Patient characteristics associated with the use of pharmacist-administered vaccination services and predictors of service utilization.

BACKGROUND: Data on the impact of pharmacists as vaccinators are available; however, research on understanding the characteristics of users of pharmacist-administered vaccinations is scarce. OBJECTIVES: This study aimed to identify the characteristics of the users of pharmacist-administered vaccinations and recognize predictors of utilizing these services. METHODS: Data were obtained from a cross-sectional online survey, and the sample size was 26,173 respondents from all over the United States. The outcome measure was the previous use of pharmacist-administered vaccination. Independent variables were demographic factors, health-related factors, and previous utilization of pharmacy products and services. Chi-square test and multivariable logistic regression analyses were conducted to examine the factors associated with the use of this service. P values, odds ratios (ORs), and 95% CIs were computed and reported. RESULTS: About 31% of respondents reported previous use of pharmacist-administered vaccination. The gender of respondents was mainly female (71.2%), and the race was mainly white (80.7%). Chi-square analysis showed a statistically significant association of service use with age, education, geographic region, use of other pharmacy services and products, type of pharmacy, and the number of chronic diseases (P < 0.05). Logistic regression analysis showed a statistically significant association with the number of chronic diseases (OR 1.085 [95% CI 1.049-1.122]), level of education (1.352 [1.35-1.28]), race (0.901 [0.840-0.969]), and proximity to pharmacy (0.995 [0.992-0.997]). Age, type of pharmacy, and previous use of other pharmacist-provided services and products also showed statistically significant associations (P < 0.05). CONCLUSION: The use of pharmacist-administered vaccination has been increasing over the past years. The service has many advantages compared with other vaccination service providers and associated with higher vaccination rates among people with older age, higher education, and a higher number of chronic diseases. With proper training and education, pharmacists are unique in improving vaccination services and public health in general.

An intersectional review of discrimination and harassment experiences in pharmacy: Findings from the 2019 National Pharmacist Workforce Survey.

BACKGROUND: Most pharmacists in the United States are women, and the profession is becoming more racially diverse. The recent increase in political and social movements in the United States has heightened our awareness of the importance of better understanding the experiences of underrepresented individuals and groups. Little is known about discrimination and harassment in the profession of pharmacy in the United States. OBJECTIVES: The purpose of this study was to provide evidence that discrimination and harassment exist in the pharmacy profession and explore differences in discrimination and harassment using the intersectionality of race and sex. METHODS: The 2019 National Pharmacist Workforce Survey (NPWS) utilized an electronic survey that was distributed using a 3-contact Dillman approach by email to a randomized sample of 96,110 licensed pharmacists from all 50 U.S. states using the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS included a new battery of questions to assess the prevalence of discrimination and harassment in pharmacy. RESULTS: The most common bases of discrimination experienced were based on age (31.2%), sex (29%), and race or ethnicity (16.6%). The most common type of harassment experienced was "hearing demeaning comments related to race or ethnicity" at 15.6%. The intersectionality analysis revealed different experiences among sex or race combinations. Black and Asian male pharmacists had the highest rate of "hearing demeaning comments about race or ethnicity." Nonwhite pharmacists were more likely to experience harassment from customers or patients compared with their white colleagues. Black female pharmacists had the highest rate of being "very unsatisfied" with the results of reporting discrimination and harassment to their employer. CONCLUSION: Discrimination, including harassment and sexual harassment, is illegal, immoral, and unjust. As the profession of pharmacy continues to become more diverse, there must be a conscious, systemic, and sustained effort to create and maintain workplaces that are safe, equitable, and free of discrimination.

Snapshot of unemployed pharmacists from the 2019 National Pharmacy Workforce Survey.

BACKGROUND: Prior national surveys have quantified unemployment in the pharmacy workforce, and recent surveys have occurred in a changing environment, with increased numbers of pharmacists in the labor market. OBJECTIVES: We sought to investigate the rate of unemployment and situations of unemployed pharmacists. METHODS: Data from the 2019 National Pharmacist Workforce Survey were analyzed, focusing on an initial question about employment status and follow-up questions for unemployed respondents about whether they were seeking a job, the reason they were unemployed, and how long they had been unemployed. RESULTS: Overall, 4.4% of the respondents were unemployed, with higher rates occurring for female pharmacists, older pharmacist cohorts, and respondents of color, with the highest rate occurring (9.3%) for Black pharmacists. Most (74.4%) of the unemployed pharmacists were seeking a job in pharmacy, but 16.6% were not seeking any job. Nearly two-thirds of the unemployed pharmacist respondents had left the workforce involuntarily, with men at higher rates than women. The youngest cohort of unemployed pharmacists was the least likely to be forced to leave and more likely to leave for workplace-related or personal reasons. Black pharmacists had the overall highest rate of leaving the workforce involuntarily. On average, the unemployed pharmacists had been out of work nearly 2 years (19.2 months), and the periods out of work ranged widely. Those seeking a job in pharmacy predominantly (75.7%) had been unemployed for 1 year or less. More than half of the pharmacists involuntarily unemployed had been unemployed for 6 months or less. CONCLUSION: An increased rate of unemployment and a higher proportion of those unemployed seeking work occurred in this most recent national survey of the pharmacist workforce. Differences in the extent of unemployment and whether leaving the workforce was voluntary or involuntary occurred in pharmacists of color and in some age cohorts.

Retail clinics colocated with pharmacies: A Delphi study of pharmacist impacts and recommendations for optimization.

OBJECTIVES: To identify workforce issues likely to affect pharmacists working in retail clinics (RCs) colocated with community pharmacies and to generate recommendations for optimizing health, cost, and operations outcomes. DESIGN AND PARTICIPANTS: A Delphi expert panel process using researchers with pharmacist workforce research experience was used. Panelists responded to 2 surveys of 3 rounds each. In survey 1, panelists used a 4-point linear numeric scale to rate the importance of 15 impact factors on pharmacists working in the RC/pharmacy setting. In survey 2, panelists used a 3-point linear numeric scale to rate the importance of recommendations for optimal outcomes. Recommendations were structured around elements from collaboration theory, a framework for evaluating critical areas for success in merged operations. MAIN OUTCOME MEASURES: Consensus was defined as ≥ 80% rating an impact "very" or "moderately" important (survey 1) and "very" important (survey 2). Impact factors were rank-ordered by ratings and numeric scoring. Selected comments about consensus items were reported. RESULTS: The 8-person panel had 100% response rates for both surveys. 12 of the 15 impact variables achieved consensus (survey 1). The highest ranking impacts were ability to establish collaborative relationships, relationships with coworkers, including nurse practitioners, and location of the RC relative to the pharmacy. Of 15 recommendations (survey 2), 5 achieved consensus and focused heavily on information sharing and early and ongoing collaboration among all stakeholders. CONCLUSION: Clinical, economic, health care quality, and patient preference data suggest that RCs colocated with pharmacies are likely to play a permanent role in U.S. health care. RCs can affect pharmacists and pharmacies positively or negatively. Positive impacts are most likely where establishing collaborative partnerships with all stakeholders, including patients, throughout planning, implementation, and operation are emphasized. With only about 3% of pharmacy operations colocated with RCs now, attention and resources should be devoted to developing and testing models based on collaboration principles.

Pharmacist and student pharmacist views of professional and personal well-being and resilience.

OBJECTIVES: To describe the views of pharmacists and student pharmacists regarding (1) aspects of life and experiences that provide professional and personal satisfaction and fulfillment, (2) causes of stress, and (3) needs related to maintaining satisfaction and fulfillment. DESIGN: A generic qualitative research design was used for collecting data from 380 pharmacists and 332 student pharmacists who wrote responses to an online survey hosted by the American Pharmacists Association (APhA) from November 17 to December 2, 2018, using standard data collection procedures applied by that organization. APhA uses its member and affiliate data files as its sampling frame and limits the number of contacts per year for each person in those files. De-identified responses from those who volunteered to write comments were sent to the research team for analysis. A conventional content analysis approach was applied for analysis of the text. Analysts convened to discuss emergent themes and develop operational descriptions. Key segments of text that best represented each theme were identified. Personal presuppositions were disclosed and were useful for developing group consensus for theme identification and description. Rigor was supported through assessment of credibility, confirmability, intercoder checking, transferability, inductive thematic saturation, and authenticity. SETTING AND PARTICIPANTS: Participants are in the design since data already collected. OUTCOME MEASURES: Not applicable. RESULTS: Findings showed that pharmacists and student pharmacists are able to recognize and pursue achievement, recognition, responsibility, advancement, relationship, esteem, self-actualization, meaning, and accomplishment in both their professional and personal lives. However, external factors such as "workism" and individual factors such as "moral distress" were identified as areas of improvement that are needed for well-being and resilience. CONCLUSION: Pharmacists' basic human needs are being met, but to improve well-being and resilience for pharmacists in both their professional and personal lives, there is a need for addressing both the external factors and individual factors that they encounter.

Enhancing guideline-based asthma care processes through a multi-state, multi-center quality improvement program.

OBJECTIVE: This study investigated the effectiveness of Enhancing Care for Patients with Asthma (ECPA)-a collaborative quality improvement program implemented in 65 community health centers that serve asthma patients in four states-on clinic-based asthma performance measures consistent with national guidelines. METHODS: This study utilized a pretest-posttest quasi-experimental design. Six clinic-based performance measures of each center were collected from a retrospective chart review at time points: before the ECPA implementation; at the end of the 12-month long ECPA program; and 6 months after program completion. The effectiveness of the ECPA was assessed using generalized linear mixed models with a Poisson distribution and log link by evaluating the change in each measure from baseline to program completion, from baseline to 6-month post-program completion and from program completion to 6-month post-program completion. RESULTS: The ECPA implementation was positively associated with improvement in all measures from baseline to program completion: documentation of asthma severity (rate ratio (RR) 1.314; 95% confidence interval (CI) 1.206, 1.432); Asthma Control Test (RR 3.625; 95% CI 3.185, 4.124); pulmonary function testing (RR 1.771; 95% CI 1.527, 2.054), asthma education (RR 2.246; 95% CI 2.018, 2.501), asthma action plan (RR 2.335; 95% CI 2.070, 2.634) and controller medication (RR 1.961; 95% CI 1.504,2.556). Improvement was sustained for all six measures at the 6-month post-program completion time point. CONCLUSION: This study demonstrated the favorable effect of the ECPA program on evidence-based asthma quality measures. This program could be considered a model worth replication on a broader scale.

Transforming community-based pharmacy practice through financially sustainable centers for health and personal care.

OBJECTIVES: To provide a case for transforming community-based pharmacy practice through financially sustainable centers for health and personal care. SUMMARY: Macro-level changes in health care laws, markets, technology, organizational systems, and professional education have increased the capacity for pharmacists to competently provide patient care and public health services that surpass the current workflow designs of most community pharmacies. Community-based pharmacy practices have an opportunity to fundamentally transform into financially sustainable centers for health and personal care. This would require changing our objective from connecting products with customers to one that connects practitioners to patients. Rather than inventory generating revenue, patient care generates revenue. Rather than success being measured by number of prescriptions filled, it would be measured by patient outcomes. Physical spaces would no longer be organized to display and sell products; they would be organized for patients to receive services. Finally, this would require that business would change from being sought through the generation of prescriptions to being sought through recruitment of patients. CONCLUSION: Community-based pharmacy practice can be transformed through the development of financially sustainable centers for health and personal care that would (1) be focused on optimizing care, (2) use patient care business models, and (3) be conducive to patients "receiving care" rather than "purchasing products."

Potentially Inappropriate Antidepressant Prescriptions Among Older Adults in Office-Based Outpatient Settings: National Trends from 2002 to 2012.

Using data from 2002 to 2012 National Ambulatory Medical Care Survey, we estimated that the prevalence of overall antidepressant prescriptions increased almost twofold from 5.2% in 2002 to 10.1% in 2012 in office-based outpatient visits made by older adults. In addition, older adults were exposed to the risk of potentially avoidable adverse drug events in approximately one in ten antidepressant-related visits, or 2.2 million visits annually. Amitriptyline and doxepin were the two most frequent disease-independent potentially inappropriate antidepressants. Racial/ethnic minorities, and Medicaid beneficiaries had higher odds of potentially inappropriate antidepressant prescriptions (P < 0.05). Efforts to minimize potentially inappropriate antidepressant prescriptions are needed.

Effects of depression screening on diagnosing and treating mood disorders among older adults in office-based primary care outpatient settings: An instrumental variable analysis.

Existing literature shows mixed findings regarding the efficacy and effectiveness of depression screening, and relatively little is known about the effectiveness of depression screening among older adults in primary care visits in the U.S. This study examines the effects of depression screening on the three following outcomes: mood disorder diagnoses, overall antidepressant prescriptions, and potentially inappropriate antidepressant prescriptions among older adults ages 65 or older in office-based outpatient primary care settings. We used data from 2010-2012 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based primary care outpatient visits among older adults (n=9,313 unweighted). We employed an instrumental variable approach to control for selection bias in our repeated cross-sectional population-based study. Injury prevention and stress management were selected as instrumental variables, as they were considered completely exogenous to outcomes of interests using conceptual and statistical criteria. We conducted multivariate bivariate probit (biprobit) regression analyses to investigate the effect of depression screening on each outcome, when controlled for other covariates. We found that depression screening was negatively associated with potentially inappropriate antidepressant prescriptions (ß=-2.17; 95% CI -2.80 to -1.53; p<0.001). However, no significant effect of depression screening on diagnosis of mood disorders and overall antidepressant prescriptions was found. Overall, depression screening had a negative effect on potentially inappropriate antidepressant prescriptions. Primary care physicians and other healthcare providers should actively utilize depression screening to minimize potentially inappropriate antidepressant prescriptions in older adult patients.

The certainty in consumers' willingness to accept pharmacist-provided medication therapy management services.

OBJECTIVES: To describe consumers' willingness to accept medication therapy management (MTM) services provided by a pharmacist. DESIGN: Cross-sectional Internet survey included questions about willingness to use 11 components of MTM services. PARTICIPANTS: The data of 8352 United States' adults who were on 3 or more medications were obtained from the 2015 National Consumer Survey on the Medication Experience and Pharmacists' Roles, which included 26,173 respondents. MAIN OUTCOME MEASURES: Respondents used a scale that ranged from "definitely would not accept" to "definitely would accept" to specify their willingness to use each of the MTM components. RESULTS: The mean age was 53.1 years, with an average of 1.9 health problems and 5.4 prescription medications. About 50% of respondents definitely would accept 6 or more MTM components. The services with the highest rates of "definitely would accept" were "Recommend the use of a generic drug to help save money" and "Provide advice in administering medications as prescribed" (65.4% and 64.2%, respectively). The next highest were "Performing a review of all medications to make sure they are effective, safe, and affordable" and "Recommendation of nonprescription medications to take care of mild ailments or discomforts" (57.0% and 56.4%, respectively). Those who definitely would accept MTM services, compared with those who would not, differed in terms of gender, education level, income, medication insurance coverage, ever having been a pharmacist, and number of health problems. CONCLUSION: The majority of United States' adults expressed a certain willingness to accept most of the components of MTM services. More research needs to be done to understand why certain groups were less willing to accept MTM services.

Consumers' characteristics associated with the use of mail pharmacy services in the United States: Findings from the 2015 National Consumer Survey on the Medication Experience.

OBJECTIVES: The purpose of this study was to describe current users of mail pharmacy services and to evaluate factors associated with the use of mail pharmacy services. DESIGN: Cross-sectional online survey-based study. SETTING AND PARTICIPANTS: The data were obtained from the 2015 National Consumer Survey on the Medication Experience, which included 26,173 adults from throughout the United States. OUTCOME MEASURES: Mail pharmacy utilization was based on participant self-report. Demographic variables included age, education, race, gender, insurance status, distance to nearest pharmacy, number of disease states, and income. Chi-square and t test analyses were conducted to assess the factors associated with mail pharmacy use. Multivariable logistic regressions were used to compute the odds ratios (ORs) and 95% confidence intervals for the predictors of mail pharmacy usage. RESULTS: Overall, 17% of respondents reported the use of mail pharmacy services. Based on chi-square analysis, use of mail pharmacy services was significantly associated with age, education, race, and region. In addition, distance to nearest pharmacy and the report of the presence of certain disease states were significantly associated with mail pharmacy use (P <0.001). Based on the results of logistic regression analysis, there was a significant association of mail pharmacy use by age, having chronic diseases, level of education, distance to nearest pharmacy, and other included variables (P <0.05). CONCLUSION: Mail pharmacy service users accounted for 17% of the respondents of this study. Advancing age, presence of chronic diseases, increasing level of education, and increasing distance to the nearest pharmacy were positively associated with the use of mail pharmacies. Further research is needed to better understand patient-specific reasons for choosing mail pharmacies or community pharmacies.

Exploring pharmacists' perceived job alternatives: Results from the 2014 National Pharmacist Workforce Survey.

OBJECTIVE: To examine the association between pharmacists' demographics, practice variables, worklife attitudes (e.g., work environment stress, control in the work environment, professional commitment, work-home conflict, and organizational commitment), and their perceived job alternatives. DESIGN: Cross-sectional descriptive study. SETTING: A representative nationwide sample of licensed pharmacists in the United States, 2014. PARTICIPANTS: A total of 1574 practicing pharmacists. MAIN OUTCOME MEASURES: A previously validated Likert-type scale was used to measure perceived job alternatives. Pharmacists reported their perception on how easy it would be to find a better job with the use of 17 common organizational characteristics. The higher the score, the easier they perceived it would be to find a new job. RESULTS: The perceived job alternatives scale manifested 4 constructs: environmental conditions, professional opportunities, compensation, and coworkers. Multivariate regression analysis showed that organizational commitment was the most influential worklife attitude and was negatively associated with all constructs except better compensation. The higher professional commitment and environmental stress, the easier pharmacists perceive it would be to find a new job with better environmental conditions, such as better professional treatment by management. Younger pharmacists indicated higher perceived levels of ease in finding a job with better environmental conditions and professional opportunities. Male pharmacists also reported a higher perceived level of ease in finding an alternate job with better professional opportunities. White pharmacists perceived it would be easier to find a new job with better environmental aspects and compensation. No statistical significance was observed in perceived job alternatives among pharmacists practicing in different primary work settings after adjusting for other variables. CONCLUSION: Demographics and worklife attitudes were found to affect perceived availability of job alternatives. Organizational commitment was the most important factor inversely associated with pharmacists' perceptions of better job alternatives. Employers may retain pharmacists by constantly maintaining pharmacists' sense of belonging to their organizations.

Influences on the frequency and type of community pharmacy services.

OBJECTIVES: To describe services provided by community pharmacies and to identify factors associated with services being provided in community pharmacies. DESIGN: Cross-sectional national mail survey. SETTING AND PARTICIPANTS: Pharmacists actively practicing in community pharmacies (independent, chain, mass merchandisers, and supermarkets). OUTCOME MEASURES: Frequency and type of pharmacy services available in a community pharmacy, including medication therapy management, immunization, adjusting medication therapy, medication reconciliation, disease state management, health screening or coaching, complex nonsterile compounding, and point-of-care testing. RESULTS: With a 48.4% response rate, the survey showed that community pharmacies offered on average 3 of the 8 services studied. Pharmacy chains and supermarket pharmacies reported providing significantly more services than did mass merchandise pharmacies. The number of pharmacy services provided was positively associated with involvement in an interprofessional care team, innovativeness, and perceived workload. The number of pharmacy services was negatively correlated with having 3.5 or more pharmacy technicians on duty. CONCLUSION: Pharmacy chains and supermarkets are providing the most pharmacy services among community pharmacy settings. The number of services provided was associated with innovativeness, technician staffing, and perceived workload. Also, involvement with an interprofessional care team supported greater service delivery. Community pharmacies vary in their provision of services beyond dispensing.

Trends in pharmacist participation in the workforce, 2009 to 2014.

OBJECTIVES: To examine changes from 2009 to 2014 in variables related to whether, how much, and where licensed pharmacists worked as pharmacists. Comparisons were made separately for men and women pharmacists. DESIGN: Data were obtained from 2 cross-sectional, descriptive surveys of licensed pharmacists and represented 1394 pharmacists in 2009 and 2446 pharmacists in 2014. The useable response rates to the surveys were 52.3% and 48.2%, respectively. SETTING: United States. MAIN OUTCOME MEASURES: We examined the work status, the work setting, work position, and age distribution of actively practicing pharmacists. We studied the proportion of pharmacists working part-time overall and by age group and determined full-time equivalents (FTEs) by age group. RESULTS: From 2009 to 2014, the proportion of licensed pharmacists that reported actively practicing pharmacy decreased for both men and women pharmacists. A significantly larger proportion of men pharmacists reported being retired in 2014 compared with 2009. In 2014, women represented a majority of actively practicing pharmacists and pharmacists in management positions. The proportion of actively practicing women pharmacists that worked part-time decreased from 2009 to 2014, and the FTE contribution of women pharmacists was approximately equal to men pharmacists in 2014. The proportion of pharmacists working in community practice settings decreased from 2009 to 2014. CONCLUSION: The period 2009 to 2014 appears to have been a time of great change in the pharmacist workforce and for work participation by pharmacists, reinforcing the need to continue to monitor changes that affect work participation by pharmacists.

Establishing pathways for access to pharmacist-provided patient care.

OBJECTIVE: To describe the pathways being established for access to pharmacist-provided patient care and supply recommendations for the next steps in this process. DATA SOURCES: A series of reports published by the American Pharmacists Association regarding pharmacist-provided patient care services. SUMMARY: Community pharmacies and integrated health organizations have emerged as the two predominant pathways for patient access to pharmacist-provided patient care. We view these two pathways as complementary in helping cover patients' entire medication therapy needs as they traverse acute and chronic health care services. However, gaps in access to pharmacist-provided care remain, especially during transitions in care. CONCLUSION: In further establishing pathways for access to pharmacist-provided patient care, we propose that the application of collaboration theory will help close gaps that currently exist between health care organizations. Such an approach carries risk and will require trust among participating organizations. This approach is also likely to require updating and contemporizing pharmacy practice acts and other statutes to allow pharmacists to practice at maximum capacity within new models of care. To perform their new roles and create sustainable business models to support these new functions, pharmacists will need to be paid for their services. To this end, changes will need to be made to payment and documentation systems, incentives, and contracting approaches to develop proper reimbursement and accounting for pharmacists' new roles.

Medication discrepancies associated with subsequent pharmacist-performed medication reconciliations in an ambulatory clinic.

OBJECTIVE: To describe the number of medication discrepancies associated with subsequent medication reconciliations by a clinical pharmacist in an ambulatory family medicine clinic and the proportion of subsequent medication reconciliation visits that were associated with hospital discharge, long-term anticoagulation management, or both. METHODS: Data on medication reconciliations were collected over a 2-year time period in an ambulatory family medicine clinic for patients taking 10 or more medications. RESULTS: Medication reconciliation was performed 752 times for 500 patients. A total of 5,046 discrepancies were identified, with more than one-half deemed clinically important. A mean (± SD) of 6.7 ± 4.6 discrepancies per visit (3.5 ± 3.2 clinically important) were identified. The findings showed that the distribution of total discrepancies identified by pharmacist-performed medication reconciliation was significantly different over the course of subsequent medication reconciliations. However, the distribution of clinically important discrepancies was not significantly different; important discrepancies were as likely to be found in later reconciliations as in earlier ones. As subsequent medication reconciliation visits were performed, an increasing proportion consisted of post-hospital discharge visits, long-term anticoagulation managed by a clinical pharmacist, or both. CONCLUSION: Patients with a recent hospital discharge, on long-term anticoagulation management, or both, were more likely to have multiple sessions with a clinical pharmacist for medication reconciliation. These findings can help identify patients for whom medication reconciliation is warranted.