Gender inequity: Enough talk, time for action.

While gender inequity has been shown to be an ongoing issue in the pharmacy profession, it has moved to the forefront due to increasing numbers of women in pharmacy. Two national organizations, American Pharmacists Association (APhA) and American Association of Colleges of Pharmacy (AACP) convened a joint Gender Equity Task Force to examine this matter among social and administrative sciences pharmacy faculty. The Task Force launched a survey and conducted interviews, as well as held several forums to solicit recommendations. This commentary provides recommendations for pharmacy constituents and stakeholders regarding: training and programming, leadership and mentoring, policy, and expansion. The goal is for organizations and leadership to incorporate recommendations with the goal of closing the gap in gender inequity.

A checklist for a consistent, comprehensive medication review.

INTRODUCTION: Medicare Advantage Part D plans and stand-alone Part D prescription drug plans are required by the Centers for Medicare and Medicaid Services to have qualified providers, including pharmacists, and offer annual comprehensive medication reviews (CMRs) for eligible Medicare beneficiaries. Although guidance on the components of a CMR is available, providers have flexibility in how to deliver the CMR to patients and which content to cover. With the variety of patient needs, CMR content is not always consistently delivered in practice. Our research group performed an extensive evaluation to create and test an ideal CMR content coverage checklist for CMR provision. CMR CONTENT CHECKLIST: The CMR Content Checklist can be used for quality improvement purposes to evaluate the comprehensiveness of pharmacist services-to assess either within pharmacist variation across patients or within organization variations between pharmacists or sites. INCORPORATING THE CMR CONTENT CHECKLIST INTO PRACTICE: Testing in a real-world setting demonstrated where gaps in service coverage existed. The CMR Content Checklist could be used as the first step for quality improvement given that it provides details on the key aspects of the service that can inform quality measure development.

Qualitative analysis of telephonic comprehensive medication review content and delivery.

BACKGROUND: Comprehensive medication reviews (CMRs) are offered to eligible Medicare beneficiaries to improve patient medication knowledge, identify, and address medication concerns, and empower medication self-management. However, the specific content of real-world CMRs is unclear. OBJECTIVE: To qualitatively assess CMR content and delivery among telephonic CMR providers. METHODS: This qualitative thematic analysis used transcriptions of audio-recorded patient interactions during CMRs from 3 telephonic medication therapy management provider organizations. Data were qualitatively analyzed using the inductive saturation model to code emergent themes by independent reviewers who met to agree themes through consensus. Intercoder reliability was calculated using Krippendorf alpha. RESULTS: Overall, 32 CMR transcripts from 3 organizations were analyzed in 13 rounds of coding. Intercoder reliability was >95%. A total of 21 themes were identified across 4 stages: call opening (4 themes), medication reconciliation (5 themes), clinical assessments and guidance (8 themes), and call closing (4 themes). The call opening stage included: service explanation; insurance coverage/cost; identity/privacy/recording; and patient's medication management. Medication reconciliation included: drug name, dose, frequency, and indication; medication deletion and addition; over-the-counter and vaccination assessment; drug efficacy assessment; and prescribing provider assessment. Clinical assessments and guidance included 4 core clinical assessments: allergy assessment; drug therapy problem assessment; drug-related adverse events; and medication modification; and 4 additional assessments: clinical/therapeutic guidance; cost savings guidance; diet/exercise/lifestyle guidance; and optional clinical and behavioral assessments. Call closing included: documentation; primary care provider confirmation; patient satisfaction; and call transfer. There were variations among organizations in the depth that CMR components were covered. CONCLUSION: These findings suggest provider organizations are including components that meet Centers for Medicare and Medicaid Services goals for CMRs. Yet, variations among organizations indicate a need for standardization and patient-centered measures to ensure appropriate CMR components are covered, while maintaining flexibility for pharmacists to provide patient-oriented CMRs that meet patients' clinical needs.

Gender equity perceptions among social and administrative science faculty: A qualitative evaluation.

BACKGROUND: Anecdotal evidence suggests that gender inequity persists in academic pharmacy. To date, there are limited published data about the perception of gender inequity in academic pharmacy. OBJECTIVE: The objective of this project was to determine themes associated with gender inequity perceptions in social and administrative science faculty from 2 national pharmacy organizations. METHODS: A gender equity task force comprising 13 members from Social and Administrative Sciences (SAS) sections of the American Pharmacists Association and the American Association of Colleges of Pharmacy was formed. The task force designed a semistructured interview guide comprising questions about demographics and core areas where inequities likely exist. When the survey invitation was sent to faculty members of the SAS sections via Qualtrics, faculty indicated whether they were willing to be interviewed. Interviews were conducted by 2 members of the task force via video conferencing application. The interviews were transcribed. Topic coding involving general categorization by theme followed by refinement to delineate subcategories was used. Coding was conducted independently by 3 coders followed by consensus when discrepancies were identified. RESULTS: A total of 21 faculty participated in the interviews. Respondents were primarily female (71%), were white (90%), had Doctor of Philosophy as their terminal degree (71%), and were in nontenure track positions (57%). Most respondents (90%) experienced gender inequity. A total of 52% reported experiencing gender inequity at all ranks from graduate student to full professor. Four major themes were identified: microaggression (57%), workload (86%), respect (76%), and opportunities (38%). Workload, respect, and opportunities included multiple subthemes. CONCLUSION: Faculty respondents perceive gender inequities in multiple areas of their work. Greater inequity perceptions were present in areas of workload and respect. The task force offers multiple recommendations to address these inequities.

Validation and Assessment of a Tool to Measure Psychosocial Readiness to Use Modern Contraceptives among Women in Tigray, Ethiopia.

Social norms, beliefs, and attitudes around modern contraception (MC) use can influence the decision to take up a method, but susceptibility to these factors varies between individuals. The effect of psychosocial readiness to use MC at the individual level is not established for women in Ethiopia. Data from 349 women were used for validity and reliability testing of a 12-item MC psychosocial readiness scale. A rating-scale Rasch model tested for unidimensionality, rating scale functioning, and construct and content validity. Multiple linear regression assessed the effect of respondent characteristics on MC psychosocial readiness scores. The psychometric properties of the univariate MC psychosocial readiness scale were satisfactory after the stepwise removal of two items. Prior MC use, socioeconomic status, geographic zone, and education were significantly associated with increased endorsement of MC psychosocial readiness. The 10-item scale measures the extent of endorsement of MC psychosocial readiness for childbearing women in Tigray, Ethiopia. Further research should qualitatively explore the identified influence of education on MC psychosocial readiness.

Improving and validating a rating scale to assess student pharmacists' perception of professional identity.

BACKGROUND: There are limited data on the psychometric properties of instruments evaluating professional identity (PI) among student pharmacists. OBJECTIVES: This study analyzed the psychometric properties of an instrument to assess student pharmacists' perception of their PI. METHODS: Data from a cross-sectional survey were used to establish validity and reliability evidence of student pharmacists' perception of PI using Rasch analysis. Linear regression was conducted to evaluate the association of students' characteristics with their perceived PI. Analyses were conducted in WINSTEPS (SWREG, Minnetonka, MN) and SAS (SAS, Cary, NC). RESULTS: The analysis included 118 student pharmacists. Primary analysis suggested inadequate scale functionality; thus, some response categories were merged. With modified item anchors and the removal of the most misfitting item, the data fit the model as measured by student and item infit and outfit mean-squared values. The item-person map showed appropriate distribution of item difficulty, identifying medicine adviser and entrepreneur being the easiest and hardest items to agree with, respectively. Students' abilities initially mismatched with item difficulty and exhibited a ceiling effect, requiring addition of items reflecting students' higher perceptions of PIs. Although students' reliability coefficient (RC) and separation index were 0.98 and 1.73, respectively, RC of the items was 0.94. Students who reported receiving formal PI training were 0.3 times more likely to have high perception of PI than those who did not report training. CONCLUSION: The instrument exhibited fair validity and reliability evidence for assessing the perception of PI among student pharmacists. Additional items to fill identified item gaps are needed to improve the instrument's content validity.

Comparison of the properties of the English and Spanish versions of the Patient Satisfaction with Pharmacist Services Questionnaire 2.0.

BACKGROUND: Pharmacists provide direct patient care services such as chronic disease management and medication therapy management services. Patient satisfaction measures are valuable tools to assess outcomes. Therefore, measuring patient satisfaction with pharmacist services, using tools such as the Patient Satisfaction with Pharmacist Services Questionnaire 2.0 (PSPSQ 2.0), is important to ensure service quality. OBJECTIVE: The objective of the study was to evaluate the descriptive properties and reliability of the original English and newly translated Spanish versions of the PSPSQ 2.0 in a larger sample. METHODS: This project evaluated the functioning of the Spanish translation of the PSPSQ 2.0 compared to the English version. Demographic characteristics were analyzed to determine whether the instrument functioned differently for English- and Spanish-speaking groups. Psychometric properties were analyzed. RESULTS: Completed data for both PSPSQ 2.0 versions were available for 337 patients (English, n = 187; Spanish, n = 150) enrolled. In the English data set, no items had a ceiling or a floor effect, while in the Spanish data set, all items had a ceiling effect, but no items had a floor effect. In both the English and Spanish versions, nearly all the items had a strong, positive correlation with one another (greater than 0.30), indicating the measure was unidimensional. The pattern of the estimated loading indicated the items were assigned as expected. The items functioned differently in the English and Spanish instruments, and there was a statistically significant difference in Wald values between the 2 versions (P > 0.05). CONCLUSION: The PSPSQ 2.0 demonstrated reliability for this setting and population. However, regarding demonstration of validity, the response categories in the instrument seem not to capture the views of the Spanish-speaking respondents. Further work may focus on uncovering the preferences for use of Likert scale response categories by Spanish speakers to ensure greater cultural fidelity in the translation.

Trends in telephonic comprehensive medication review in the United States from 2000 to present: a scoping literature review.

BACKGROUND: Although comprehensive medication review (CMR) services have been shown to provide value to patients and payers, the extent of uniformity in service delivery is unknown. A variety of standards and recommendations are available from academic and professional sources, but variation in service provision is an important consideration when attempting to measure or compare service quality nationally. OBJECTIVE: This study aimed to identify and summarize trends in the peer-reviewed and gray literature describing telephonic CMR delivery and content. METHODS: A scoping review of peer-reviewed and gray literature was conducted to quantify and qualify trends in CMR service. Two independent reviewers screened abstracts from 9 bibliographic databases and selected gray literature sources in accordance with the Joanna Briggs Institute guidelines and an internally developed protocol. Inclusion criteria for the review were English language; discussion of telephonic CMR service in the United States; research, legislation, or guidelines that describe CMR content coverage requirements for payment; and publication from the year 2000 to the present. Data relating to publication type, study design, setting, region, and themes of CMR content were collated into a Microsoft Excel data extraction form. Qualitative thematic analysis was conducted, and key findings and concepts were reported contextually. RESULTS: Of 374 identified documents screened, 15 were included in this scoping review and thematic analysis. The following characteristics of CMRs were identified: content, coverage, eligibility, frequency, process, and responsiveness. All published documents (n = 15, 100%) included a discussion of CMR content, and 14 sources (93%) addressed process elements of providing a CMR. Discussion of other themes varied in frequency across documents, ranging from 3 articles (20%) addressing organizational goals for CMR to 12 articles (80%) including elements of responsiveness. Within-theme variation was also observed for several CMR content areas. CMR process was the most heterogeneous theme with topics ranging from access to patient health records to pharmacist training. CONCLUSIONS: Assessment of telephonic CMR comprised a small but steadily increasing portion of the medication therapy management literature. Publications since 2015 have shown an increasing consensus of CMR content and purpose. Per the identified literature, there is an ongoing demand for higher-quality, more holistic CMRs, but there is no consensus on how to measure CMR quality. Future work should include engaging with CMR experts to understand variability in measures of CMR success.

Psychometric evaluation of a comprehensive medication management service experience instrument.

BACKGROUND: The Health-Systems Alliance for Integrated Medication Management (HAIMM) instrument was developed to estimate patient experience following pharmacist-delivered comprehensive medication management (CMM). OBJECTIVES: The objective of this paper was to assess the psychometric properties and factor structure of the HAIMM instrument. METHODS: Data were collected from 5 members of the HAIMM collaborative. A one-factor confirmatory factor analysis (CFA) model was used to assess instrument dimensionality. A partial-credit item response theory model was used to assess the psychometric properties of the ten-item HAIMM patient experience instrument, consisting of tests for rating scale functioning, person and item fit, and content validity. RESULTS: Among 516 respondents, there was a strong skew toward high satisfaction, including a strong ceiling effect. CFA results suggest a unidimensional construct. Item difficulty was spread across a low range and content redundancies were identified. The mean-square values for both infit and outfit all fell within the recommended range, whereas the z-standard fit was within the recommended range for most items. The 5-point Likert scale used in the HAIMM instrument did not distinguish between participants' level of experience following the pharmacist-delivered CMM service. CONCLUSION: The psychometric analysis showed the HAIMM survey tool does not cover all of the content that should be assessed to fully evaluate CMM experiences. In its current form, the HAIMM instrument should not be used to make comparisons about the quality of CMM services provided, although it may be useful to monitor patient satisfaction for quality improvement purposes. Further research is required to develop an improved instrument that contains expanded content coverage, response options, and aspects of CMM to be useful by health care providers, health systems, and other decision makers.

Key informant perspectives about telephonic comprehensive medication review services in the United States.

BACKGROUND: Comprehensive medication reviews (CMRs) are provided by providers such as pharmacists to eligible beneficiaries. Although CMRs have been shown to provide value to patients, little is known about the service uniformity, quality, and content of CMRs. OBJECTIVE: This study aimed to characterize the current state of CMR services from diverse stakeholder perspectives and describe variation in responses to content and delivery of telephonic CMR services. METHODS: Semistructured interviews were conducted with 10 key informants. The interview guide contained 6 key questions with additional probing questions. Transcripts were analyzed using the inductive saturation model and phenomenological approach to code emergent themes, which were iteratively refined until saturation was achieved. RESULTS: Key informants included CMR payers (n = 3), providers (n = 5), and standards-setting organizations (n = 2). Ten themes about CMRs emerged from qualitative analysis: (1) definition, (2) organizational goals, (3) content, (4) eligibility, (5) frequency, (6) acceptance and completion, (7) process and personnel, (8) quality assurance, (9) preparation, and (10) future directions. CMR content descriptions were consistent across perspectives. Key informants described scenarios appropriate for expanded CMR eligibility criteria, although none were consistently reported. Providers emphasized patient CMR acceptance rates whereas payers and standard-setting organizations emphasized completion rates. Completion rates and adherence to Centers for Medicare and Medicaid Services standards were characterized as core organizational goals (n = 8), whereas patient satisfaction was less frequently identified (n = 4). A lack of incentive for CMR providers to follow-up with patients was a barrier to expanded services. Overall, key informants were dissatisfied with the CMR completion rate measure and would prefer measures focused on service quality and outcomes. CONCLUSIONS: CMR services largely met perceived guidelines, with variation in value-added services. Key informants desired adoption of an actionable measure that is focused on quality rather than completion rate. To inform a quality measure, future research should analyze completed CMRs to determine the extent of variation in content and delivery.

Nationally Representative Health Care Expenditures of Community-Based Older Adults with Pain in the United States Prescribed Opioids vs Those Not Prescribed Opioids.

OBJECTIVE: To compare health care expenditures between older US adults (≥50 years) with pain who were prescribed opioid medications and those who were not. DESIGN: Cross-sectional. SETTING: Community-based adults in the 2015 Medical Expenditure Panel Survey (MEPS). SUBJECTS: Nationally representative sample of US adults alive for the calendar year, aged 50 years or older, who reported having pain in the past four weeks. METHODS: Older US adults (≥50 years) with pain in the 2015 MEPS data were identified. The key independent variable was opioid prescription status (prescribed opioid vs not prescribed opioid). Hierarchical linear regression models assessed health care expenditures (inpatient, outpatient, office-based, emergency room, prescription medications, other, and total) in US dollars for opioid prescription status from a community-dwelling US population perspective, adjusting for covariates. RESULTS: The 2015 study cohort provided a national estimate of 50,898,592 noninstitutionalized US adults aged ≥50 years with pain in the past four weeks (prescribed opioid N = 16,757,516 [32.9%], not prescribed opioid N = 34,141,076 [67.1%]). After adjusting for covariates, individuals prescribed an opioid had 61% greater outpatient (ß = 0.477, P < 0.0001), 69% greater office-based (ß = 0.524, P < 0.0001), 14% greater emergency room (ß = 0.131, P = 0.0045), 63% greater prescription medication (ß = 0.486, P < 0.0001), 29% greater other (ß = 0.251, P = 0.0002), and 105% greater total (ß = 0.718, P < 0.0001) health care expenditures. There was no difference in opioid prescription status for inpatient expenditures (P > 0.05). CONCLUSIONS: This study raises awareness of the economic impact associated with opioid use among US older adults with pain. Future research should investigate these variables in greater depth, over longer time periods, and in additional populations.

Validity and Reliability of the Student Refractive Error and Eyeglasses Questionnaire-Revised Version in Myopic Children.

SIGNIFICANCE: Multiple vision-related quality of life (VRQol) instruments exist, but questionnaires designed specifically for myopic children that are appropriate for assessing the impact of refractive error are rare. PURPOSE: This study aimed to assess the validity and reliability of the Student Refractive Error and Eyeglasses Questionnaire - Revised (SREEQ-R) in school-aged children with myopia in the United Kingdom. METHODS: Community optometrists in the United Kingdom invited children up to the age of 18 years presenting for an eye examination with current or previous reported use of eyeglasses for myopia to complete the SREEQ-R, which consists of 20 specific items divided into two sections each with three response categories. The "without glasses" section relates to perceptions of uncorrected vision/not wearing glasses, and the "with glasses" relates to corrected vision/wearing glasses. Rasch analysis was used to explore the psychometric performance (content, construct validity, and reliability) of the questionnaire items and scale using Winsteps software (Winsteps.com. Portland, OR). RESULTS: A total of 125 eligible children with a mean ± standard deviation age of 12.7 ± 2.9 years completed the SREEQ-R. All items fit the Rasch model and were retained, and the scale was found to be unidimensional. All children and item infit and outfit mean square statistics fell within the recommended fit criteria. As per the Rasch analysis, the person reliability coefficients were 0.84 and 0.91, whereas item reliabilities were 0.99 and 0.80 for the without glasses and with glasses sections, respectively. The internal consistency for the SREEQ-R was good; Cronbach α values were 0.84 for without glasses and 0.91 for with glasses. CONCLUSIONS: The SREEQ-R had satisfactory validity and reliability evidence. Construct validity of the scale was supported to measure the impact of uncorrected and corrected refractive error on vision-related quality of life in myopic school-aged children in the United Kingdom. The SREEQ-R could be used in future studies to evaluate vision-related quality of life in children with myopia.

A motivational factors assessment instrument for medication management center employees providing medication therapy management services: A Rasch analysis.

BACKGROUND: Telephonic medication management centers (MMCs) provide medication therapy management services to help alleviate medication-related issues and improve health outcomes. Motivation factors driving the performance of MMC personnel are key components in achieving these goals. Yet, published literature is limited on how motivation affects MMC personnel performance. OBJECTIVE: To assess validity and reliability of the employee motivation questionnaire (EMQ), a 19-item measure of barriers and facilitators to motivation associated with MMC employees' work performance. METHODS: Pharmacist, nurse, pharmacy technician, and intern employees (N = 534) from 5 telephonic-based U.S. MMCs were invited to complete the electronic EMQ. Rasch analysis was conducted in Winsteps software using a rating scale model. Construct and content validity and reliability were analyzed with employee and item separation index (SI) and reliability coefficient (RC). Linear regression was conducted to test the association of employee characteristics with individual work performance motivation. RESULTS: A total of 319 employees completed the EMQ, 59.7% response rate. Principal components analysis suggested a unidimensional construct. Employee and item infit and outfit mean squared values met recommended fit criteria (0.5-1.5), suggesting that the data fit the model. An item-person map identified items that were easiest (joy of helping patients) and most difficult (motivated to work harder if incentives were tied to goal achievements) to agree with. Mismatch of employee motivation and item difficulty level on the measurement continuum (-1 to 0.92 logits) indicated a need for additional items that employees perceive as more difficult to agree with. The employee RC was 0.81 and the SI was 2.04; whereas, the item RC was 0.97 and the SI was 5.94. None of the variables tested illustrated statistically significant associations with the person motivation measure. CONCLUSIONS: The EMQ illustrated reasonable content validity, good construct validity, and reliability evidence when used to measure motivation factors among MMC employees. Consideration of employee motivation factors may help to better meet MMC program goals and improve patient outcomes.

Analysis of medical tourism at the Andrade port of entry.

BACKGROUND: Medical tourism, a term used to describe the practice of traveling to obtain medical services or products, is known to occur along the U.S.-Mexico border and has for some time. Despite the ever-increasing number of local border crossings, there is little research or monitoring done on the prevalence of medical tourism or to show the products and services sought. OBJECTIVES: To identify which medications and services are most frequently obtained, the reasons for these instances of medical tourism, perceived efficacy or satisfaction of the medications and services, and the likelihood of continuing to receive health care in Mexico. METHODS: Using a cross-sectional survey design, participants were recruited to participate in an anonymous electronic 12-question survey at or near the U.S.-Mexico border at the Andrade port of entry. All participants were waiting to cross or had just crossed the border through this port. Data were analyzed using descriptive statistics. RESULTS: A total of 427 surveys were collected for analysis. The respondents reported traveling from 29 states within the United States, as well as from 3 other countries. The average age of the participants was 64.5 years, with a range of 19-93 years. Cost was reported by 92% (n = 394) as the major factor to participate in medical tourism, and the most common income bracket reported was between $25,001 and $50,000 annually (n = 103). Dental (n = 124) was the most common medical service, and antibiotics (n = 225) were the most common class of medications sought. Most of the participants expressed the intent to continue to participate in medical tourism (n = 404). CONCLUSION: Most survey respondents felt that Mexican health care services are of the same or better quality compared with those in the United States, for a lower cost, and plan to participate in medical tourism moving forward. Many opportunities for future research exist on this topic, including follow-up surveys and laboratory analyses to compare medication samples.

A conceptual framework for evaluation of community pharmacy pay-for-performance programs.

BACKGROUND: Recent interest in initiating pay-for-performance (P4P) programs indicates an underlying belief that economic incentives will have a direct impact on health care quality and efficiency. Evaluations of the impact of P4P programs on health care organizations and providers have been presented in the literature; however, none have focused on the impact of an incentive targeting community pharmacies. OBJECTIVE: To propose a theory-derived conceptual framework of how a financial incentive might work in a community pharmacy. METHODS: Studies from the fields of economics (agency theory), psychology (intrinsic and extrinsic motivators; expectancy theory), and organizational theory (ownership, institutional layers, organizational culture, and change management; quality improvement) were reviewed to inform the framework's components. This proposed conceptual framework also integrated and expanded on previous health care-related P4P models. RESULTS: P4P programs inherently use financial incentives to catalyze change; however, elements from psychology and organizational theories along with economic theory were identified as important considerations in how a financial incentive may operate when targeting a community pharmacy. Through the incorporation of these theories along with other P4P frameworks in health care, a conceptual framework was derived comprising 4 domains: incentive, pharmacy, other influencing factors, and P4P program measures. Hypothesized relationships among these domains were depicted. CONCLUSION: As focus on improving the quality of health care provision develops, opportunities for pharmacists to provide patient care services beyond dispensing will continue to advance, along with expanded reimbursement mechanisms extending beyond traditional product dispensing. The proposed theory-derived conceptual framework serves to depict how the integration of P4P and other factors may affect the pharmacy environment and subsequently affect a pharmacy's capability to perform well on medication-related quality measures. This framework may be used as a foundation on which to design studies to investigate the association between community pharmacy factors and performance in a P4P program.

Prescriber and pharmacist attitudes toward inclusion of diagnosis or clinical indication on prescription orders.

BACKGROUND: Pharmacy and medication safety organizations have long recommended that diagnosis or clinical indication be required on medication orders to improve the safety and effectiveness of care. OBJECTIVE: To assess attitudes of Arizona prescribers and pharmacists toward the inclusion of the clinical indication or the diagnosis on prescription orders and perceived barriers to its implementation in Arizona. METHODS: Data were obtained by questionnaires from pharmacists and primary care prescribers after a continuing pharmacy education presentation on the value of including a clinical indication or a diagnosis on prescription orders. The survey was distributed to licensed pharmacists who attended the Arizona Pharmacy Association's Southwest Clinical Pharmacy Seminar. The survey was distributed to primary care providers with active Arizona licenses who attended the Arizona Osteopathic Medical Association Annual Convention and to nurse practitioners after an Arizona Nurse Practitioner Council educational webinar. Prescriber and pharmacist responses were compared using the Mann-Whitney U test. An a priori alpha of 0.05 was used, and in the cases of multiple comparisons, a Bonferroni correction was employed. RESULTS: A total of 74 complete questionnaires were submitted by prescribers and 54 by pharmacists. Approximately 71% of the prescribers and 66% of the pharmacists agreed that they would support voluntary inclusion of a diagnosis or a clinical indication on prescription orders (P = 0.81). However, the 2 groups disagreed on whether the inclusion of the diagnosis or clinical indication should be a requirement (44% of prescribers agreed vs. 96% of pharmacists, P < 0.001). Two perceived barriers revealed statistically significant differences, with the prescribers being more concerned about possible insurance rejections than pharmacists (P = 0.005, whereas the pharmacists were more concerned about potential software transmission accuracy than prescribers (P < 0.001). CONCLUSION: Arizona prescribers and pharmacists in our convenience sample supported the voluntary inclusion of a diagnosis or a clinical indication on prescriptions orders but disagreed as to whether it should be required. Prescribers especially indicated they have a variety of concerns that need to be overcome before they could support a statewide mandate.

Evaluating the role and value of a clinical pharmacist in a concierge primary care clinic.

OBJECTIVE: To understand the perceived role and value of the clinical pharmacist in a southern Arizona concierge primary care practice (CPCP) by employees. METHODS: Semistructured face-to-face interviews were conducted with health care team members employed by the CPCP site in December 2019 and January 2020 for this study. The interviews were audio recorded, transcribed, and thematically analyzed using an inductive approach with ATLAS.ti (version 7). A qualitative assessment was performed by 2 independent reviewers to identify the themes, which included clinical, economic, and humanistic outcomes. RESULTS: Eleven CPCP employees were interviewed: physicians (n = 2), a nurse practitioner (n = 1), medical assistants (n = 4), and administrative staff (n = 4). The perceived role and value of the clinical pharmacist in this CPCP varied by employee position; yet, all expressed the pharmacist's positive impact on patient care. Five themes were identified. The most common pharmacist roles identified included providing medication knowledge to providers, preventing abuse of controlled substances, monitoring clinical response to medications and adverse drug events, aiding in prior authorizations, educating patients, and providing patient-centered care. CONCLUSION: These results demonstrate that the integration of a clinical pharmacist into a CPCP can be valuable. This study highlights that the pharmacist was positively received by the physicians and staff. This further supports the value of the pharmacist as a key interprofessional health care team member. Further study is warranted to assess the longitudinal impact of pharmacists' services in a CPCP.

Expanding pharmacists' roles: Pharmacists' perspectives on barriers and facilitators to collaborative practice.

OBJECTIVE: The pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists' perspectives of CPAs, including barriers and facilitators to CPA implementation. METHODS: Semistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes. RESULTS: Seventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients' health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process. CONCLUSIONS: The pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.

Evaluating provider acceptance of pharmacist interventions in the Discharge Companion Program and its association with readmission reduction.

OBJECTIVE: To evaluate provider acceptance of pharmacist interventions within the Discharge Companion Program (DCP) and its association with hospital readmissions. METHODS: This retrospective record review included patients referred to the DCP between January and October 2018. DCP pharmacists' interventions were assessed for provider acceptance on follow-up consultation or readmission. A chi-square test assessed the association between provider acceptance, communication modality, and technology used. A logistic regression model assessed the association between readmission risk and variables of interest. An a priori alpha level of 0.05 was used. RESULTS: Of the 197 patients referred to the DCP, 102 met inclusion criteria. DCP pharmacists made a total of 271 interventions; 185 (68.7%) required provider action. The most common intervention type was medication addition or discontinuation (n = 74, 40%); the communication mode was between DCP nurses and primary care provider offices or skilled nursing facilities (n = 56, 54.9%); and the preferred technology was the telephone (n = 58, 56.9%). Provider acceptance rate was 30.8% (n = 57) of actionable interventions, although it was not significantly associated with 30-day readmission reductions (P = 0.833) and did not differ significantly when interventions were communicated to other health care professionals (P = 0.53). The specific intervention communication mode (i.e., telephone, facsimile, or both) of pharmacist interventions did not significantly affect provider acceptance (P = 0.133). The overall readmission rate was 22.5% (n = 23), and the only significant predictor of 30-day readmission was the number of comorbidities (odds ratio 1.28 [95% CI 1.03-1.58], P = 0.024). CONCLUSION: Provider acceptance of pharmacists' interventions did not significantly affect 30-day readmission rates, regardless of communication mode (telephone or facsimile) or technology used. However, the DCP successfully identified numerous medication-related problems. Further study is warranted regarding provider acceptance of pharmacist recommendations on 30-day readmission reduction.

Exploring performance predictors among employees in a pharmacist-led medication management center.

OBJECTIVE: Health care companies are increasingly interested in developing and maintaining employee motivation. However, this can be challenging with different professions working together in delivering telephonic medication therapy management services. The purpose of the study is to assess employees' perceptions of performance metrics, strategies to achieve those metrics, motivational work factors, and barriers to achievement at a medication management center (MMC). DESIGN: Focus group using purposive sampling. SETTING: Six in-person focus groups were conducted with the MMC employees. PARTICIPANTS: Separate focus groups were conducted for pharmacists, student pharmacist interns, and pharmacy technicians. Each group consisted of approximately 5 participants, lasted roughly 1 hour, and was facilitated by trained qualitative researchers. OUTCOME MEASURES: The semistructured sessions involved participants responding to open-ended, predetermined questions introduced by a facilitator. The sessions were audio-recorded and transcribed for analysis. Two independent reviewers analyzed the transcripts; a third independent reviewer facilitated a consensus to resolve discrepancies. RESULTS: Thirty MMC employees, with an average age of 32.1 ± 10.5 years, participated; most of them (73.3%) were women and had worked at the MMC for an average of 2.8 ± 2.2 years. Six themes were identified: (1) awareness and understanding of performance measures; (2) perceptions of performance measures; (3) suggested changes to make the performance measures more reflective of their roles; (4) motivating factors to improve performance; (5) performance barriers; and (6) strategies to achieve performance goals. The intrinsic motivational factors included providing patient care, helping change patients' lives, and meeting work goals. The extrinsic motivational factors included remuneration, management, teamwork, work environment, and feedback. The performance barriers were unrealistic goals, lack of feedback, ineffective communication, and inconsistent operational procedures. CONCLUSIONS: These study findings contribute to a growing body of research surrounding employee motivation within organizations with diverse workforces. Future work is warranted to investigate employee motivation in similar pharmacy-related settings.