Abandonment of prescriptions in medically underserved areas: Primary medication non-adherence in community pharmacies in the delta region of the United States.

Background: In the U.S. alone, medication non-adherence is estimated to cause 1 in 10 hospitalizations, approximately 125,000 deaths annually, and cost the U.S. healthcare system just under $300 billion each year. Patients in medically underserved areas (MUAs) are particularly vulnerable to all forms of non-adherence and downstream morbidity and mortality; however, the extent to which primary medication non-adherence (i.e., prescription abandonment) affects the underserved is still largely unknown. Objectives: To assess the difference in rates of abandonment of quality measured prescriptions in areas that are medically underserved compared to areas that are not. The secondary objective is to assess the impact that the COVID-19 pandemic had on rates of prescription abandonment in both MUAs and those that are not. Methods: In this retrospective study, data on abandoned, quality measured prescriptions were collected and analyzed using Chi-Square analyses from one regional division of a large grocery-chain pharmacy containing ninety-one pharmacies located in Tennessee, Mississippi, Arkansas, Kentucky, and Missouri. The primary objective used 2019 data while the secondary objective used data from April - November of both 2019 and 2020. Results: Patients from MUAs abandoned quality measured prescriptions at a higher rate of 5.44% compared to 4.77% of those not living in these areas (P < 0.01). This study also discovered that during the COVID-19 pandemic, MUAs had a decrease in abandonment from 6.14% in 2019 to 6.02% in 2020 (P < 0.01). Those from non-MUAs had non-significant change in abandonment (P = 0.87). Conclusion: Patients in MUAs abandon quality measured prescriptions at a statistically significant higher rate when compared to patients who live in areas that are not considered to be medically underserved. Moreover, during the COVID-19 pandemic patients living in MUAs had a statistically significant decrease in prescription abandonment while those in non-MUAs did not statistically change.

Enhancing point-of-care testing through standardized training and redeployment of pharmacy technicians in the community setting.

Objectives: The primary objective of this study was to assess the impact of a standardized training model for technician-supported point-of-care testing (POCT) on the number of health screenings performed across two states in a large community chain pharmacy. Secondary objectives included the assessment of pharmacist and technician perceptions of advanced roles of the pharmacy technician in POCT service delivery. Practice description: Certified pharmacy technicians (CPhTs) across six regional divisions of a large community chain pharmacy in Tennessee and Ohio participated in a standardized training program prior to implementation of technician-supported POCT. Practice innovation: Standardized training consisted of pre-training assessments, online training modules, post-training assessments, followed by in-person skills-based assessments. CPhT participation was limited to technical tasks of POCT (e.g. sample collections, quality assurance). Evaluation methods: The study addressed its primary objective by comparing total number of health screenings for included pharmacies in 2019 as compared to 2020. Descriptive and inferential statistics were used. Perceptions were assessed using an electronic, Likert-type scale questionnaire. Results: Pharmacies with technician-supported POCT showed a 46% increase in the total number of health screenings performed vs. 2019. The survey found that 74% (106/144) of pharmacists and 83% (34/41) of CPhTs agreed or strongly agreed that technician-supported POCT is acceptable for their practice site. Most pharmacy personnel agreed or strongly agreed that the service was appropriate and feasible for their respective practice sites. Conclusion: This study provided supporting evidence that technician-supported POCT may positively impact the number of health screenings conducted in a community pharmacy setting. Standardization of training may allow for expansion of this service across additional states. Furthermore, pharmacy personnel perceptions were overall positive.

Evaluating advanced pharmacy technician roles in the provision of point-of-care testing.

OBJECTIVES: Assess the impact of pharmacy technician-supported point-of-care testing (POCT), including sample collection, on the number of cholesterol screenings performed in a community pharmacy setting. Secondary objectives include assessment of provider perceptions and patient satisfaction of POCT when executed by a technician. PRACTICE DESCRIPTION: Thirty-two community pharmacies in 1 regional division of a large community pharmacy chain in Tennessee; 16 participated in a certified pharmacy technician (CPhT) training program, and 16 did not. PRACTICE INNOVATION: CPhTs supported POCT service delivery limited to the nonprofessional, technical tasks (e.g., sample collection, quality assurance). EVALUATION: The primary objective was evaluated by comparing the total number of screenings for control and intervention sites. Descriptive and inferential statistics were used. Both secondary measures were assessed via anonymous, Likert-type scale questionnaires. RESULTS: Intervention pharmacies performed 358 screenings, whereas control pharmacies performed 255 screenings (16.8% difference). The patient perception survey found that 94% (149 of 159) of those who received screening with CPhT involvement agreed or strongly agreed that the service was valuable, and 70% (111 of 159) reported that they are likely to follow up with their primary care providers to discuss the results. Furthermore, most patients were in agreement that they were overall satisfied with the screening services provided by the CPhT (94%, 149 of 159), and the CPhT was professional while performing the screening (95%, 151 of 159). The provider perceptions survey on service implementation found that most pharmacy personnel agreed or strongly agreed that CPhTs performing POCT was feasible, appropriate, and acceptable. CONCLUSION: This study provided preliminary data that technician-supported POCT may positively impact the number of screenings provided. In addition, provider perceptions were positive, and patients felt satisfied with the studied technician model.

Exploring Pharmacy Technician Roles in the Implementation of an Appointment-Based Medication Synchronization Program.

The objective of this study was to qualitatively explore the role of pharmacy technicians in the implementation of an appointment-based model (ABM) medication synchronization program. The purposeful sampling of technicians working within six different locations of a supermarket chain pharmacy in Mississippi and Tennessee was carried out, and the technicians were interviewed between January and April 2018. A semi-structured interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR). Questions gathered information around pharmacy technician demographics and CFIR domains (process, inner setting, outer setting and intervention characteristics). Interviews were audiotaped and transcribed. Two members of the research team performed thematic content analysis. Six full-time, certified pharmacy technicians with 8.3 ± 2.7 years of experience were interviewed. Findings suggest that including hands-on experience with program software is needed during training to successfully implement ABM. A barrier to implementation was the time needed to complete ABM tasks as compared to other tasks. Although some barriers exist regarding implementation, technicians believe that overall, this program has positive benefits for patients. Results from this study signify that ABM implementation can be challenging. Better ABM portal integration with the pharmacy patient profile and appropriate workforce budgeting are key to continued success.

Exploring pharmacists' perceptions regarding influenza and streptococcal testing within a chain pharmacy.

OBJECTIVES: To assess pharmacists' perceptions of point-of-care testing (POCT) and treatment for influenza and streptococcus pharyngitis in a community pharmacy setting. A secondary objective was to explore the correlation between demographic data and survey responses. METHODS: An anonymous electronic Likert-type-scale questionnaire was sent to pharmacists in a division of a large national supermarket chain pharmacy in western Tennessee, Mississippi, and Arkansas. This survey was e-mailed with the use of Qualtrics Survey Software and administered from November 28, 2016, to December 31, 2016. It included questions that explored pharmacists' willingness to perform influenza and streptococcus pharyngitis POCT as well as to recommend and provide appropriate treatment. The survey also collected demographic information including age, education, and number of years practicing at current site. The survey was reviewed by a convenience sample of pharmacists in a large national supermarket chain and revised based on their feedback. Descriptive statistics were used to evaluate quantitative participant responses. RESULTS: The electronic survey was distributed to 379 pharmacists, and the response rate for the survey was 39% (146/379). This study found that 69% either strongly agreed or agreed to be willing to perform POCT in a community pharmacy setting, and 86% either strongly agreed or agreed to be willing to recommend appropriate treatment for influenza and streptococcal pharyngitis. Secondarily, the majority of participants either strongly agreed (27%) or agreed (52%) that they possessed the clinical knowledge to treat these infections. In addition, 32% strongly agreed and 52% agreed that their staff could be trained to assist with these services. Finally, 66% either strongly agreed or agreed there were barriers to implementing this service. CONCLUSION: This survey provided insight into pharmacists' perceptions of providing influenza and streptococcal pharyngitis POCT in their pharmacy and demonstrated that a majority were willing to provide treatment.

Patient Satisfaction With a Comprehensive Medication Review Provided by a Community Pharmacist.

Background: The comprehensive medication review (CMR) is one of the most commonly delivered medication therapy management services, and it is a required service to be provided to Medicare Part D beneficiaries. Despite the large body of evidence available on medication therapy management benefits, and the growing value placed on it by payers, there has been little research assessing patient satisfaction with these services. Objectives: The primary objective of this study was to determine patient satisfaction with a face-to-face or telephonic CMR provided by a chain community pharmacist. The study secondarily assessed patients' perceived value of the service while also collecting demographic information. Methods: A Likert-type satisfaction survey was distributed to patients on completion of a face-to-face or telephonic CMR in either Outcomes or Mirixa by members of a clinical team (7 clinical pharmacists and 4 residents) within a chain community pharmacy. Participants were asked to return the survey in a self-addressed stamped envelope within 1 week of the CMR. Results: The response rate for the survey was 33% (31 of 95 surveys returned). The study found that approximately 70% (21 of 31) strongly agreed with being overall satisfied with the CMR. Conclusion: This research study provided insight to patients' perceptions of a CMR provided by a community pharmacist. Patient views of the CMR were positive, with patients finding CMR delivery in a community pharmacy valuable. Further investigation of specific interventions and approaches during a medication review could help identify ways to increase patient satisfaction.