Enhancing adult immunization care by community pharmacists: A qualitative analysis of Project VACCINATE.

BACKGROUND: Project VACCINATE was a 1-year demonstration project conducted in 70 community pharmacies in Washington from September 1, 2016 to August 31, 2017 aimed at increasing adult vaccination and documentation in the state immunization information system (IIS). Key intervention features aligned with the Standards for Adult Immunization Practices and included incorporation of an immunization interface to facilitate proactive immunization screenings, patient engagement regarding vaccine needs, and vaccine documentation in the IIS as enhancements to the vaccination workflow. OBJECTIVE: The objective of this qualitative study, a subanalysis of Project VACCINATE, was to identify community pharmacy staff members' perceptions of work system factors that influenced the implementation of key intervention features. METHODS: Pharmacy staff at all Project VACCINATE locations were eligible to participate and were recruited by e-mail. Key informant interviews lasting 15-30 minutes were conducted by telephone using a semistructured interview guide. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work systems. RESULTS: A total of 7 interviews were conducted with pharmacists from different pharmacy locations from September to December 2017. Nine factors emerged across all domains of the SEIPS 2.0 model regarding the implementation of the key intervention features. These factors were pharmacist-patient relationships, team culture, individualized patient education, technician involvement, electronic access to vaccine records, pharmacy layout, staff training, immunization documentation in other care settings, and insurance coverage. CONCLUSIONS: Several key factors were identified that, when addressed, can enable the incorporation of proactive immunization screenings, patient engagement, and vaccine documentation as enhancements to the community pharmacy-based vaccination process. Community pharmacy organizations should consider incorporating the described factors into existing immunization programs when assessing the unique dynamics of their work system.

Integrating public health students into interprofessional education.

Recognizing the public health professional are critical members of interprofessional teams, the Council on Education for Public Health (CEPH) recently added a required Masters of Public Health (MPH) student competency focused on interprofessional education (IPE). A student-centered approach to the design and evaluation of an emergency preparedness-focused curricular program to meet the interprofessional needs of MPH students was used to meet this expectation at the University of Washington. Curriculum design was informed by two 80-minute listening sessions with MPH students to better understand their current interprofessional educational experiences and needs, and how an emergency preparedness-focused two-hour Interprofessional Active Learning Series (iPALS) session could help them develop interprofessional competency. The resultant iPALS session was assessed with a short, paper-based questionnaire. We found MPH students have an interest in participating in IPE, and that all students who participated in the emergency preparedness-focused iPALS session reported significant increases in their interprofessional and disaster response abilities based on their pre- and post-session evaluations. Student-centered IPE curriculum focused on emergency preparedness can enhance the self-reported ability of students across the health sciences to perform on interprofessional teams while engaging in a topic that has relevance to MPH students.

Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015.

PURPOSE AND OBJECTIVES: Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Although effective CRC screening tests exist, CRC screening is underused. Use of evidence-based interventions (EBIs) to increase CRC screening could save many lives. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) provides a unique opportunity to study EBI adoption, implementation, and maintenance. We assessed 1) the number of grantees implementing 5 EBIs during 2011 through 2015, 2) grantees' perceived ease of implementing each EBI, and 3) grantees' reasons for stopping EBI implementation. INTERVENTION APPROACH: CDC funded 25 states and 4 tribal entities to participate in the CRCCP. Grantees used CRCCP funds to 1) provide CRC screening to individuals who were uninsured and low-income, and 2) promote CRC screening at the population level. One component of the CRC screening promotion effort was implementing 1 or more of 5 EBIs to increase CRC screening rates. EVALUATION METHODS: We surveyed CRCCP grantees about EBI implementation with an online survey in 2011, 2012, 2013, and 2015. We conducted descriptive analyses of closed-ended items and coded open-text responses for themes related to barriers and facilitators to EBI implementation. RESULTS: Most grantees implemented small media (≥25) or client reminders (≥21) or both all program years. Although few grantees reported implementation of EBIs such as reducing structural barriers (n = 14) and provider reminders (n = 9) in 2011, implementation of these EBIs increased over time. Implementation of provider assessment and feedback increased over time, but was reported by the fewest grantees (n = 17) in 2015. Reasons for discontinuing EBIs included funding ending, competing priorities, or limited staff capacity. IMPLICATIONS FOR PUBLIC HEALTH: CRCCP grantees implemented EBIs across all years studied, yet implementation varied by EBI and did not get easier with time. Our findings can inform long-term planning for EBIs with state and tribal public health institutions and their partners.

Implementing a pharmacist-led in-home medication coaching service via community-based partnerships.

OBJECTIVES: To describe one independent pharmacy group's experience delivering and being reimbursed for in-home medication coaching, or home visits, to high-risk and high-complexity community-dwelling patients. SETTING: A nondispensing clinical division of an independent community pharmacy in Seattle, Washington. PRACTICE INNOVATION: A community pharmacist-led in-home medication coaching program delivered through partnerships with 3 community-based organizations for referrals and payment over a 4.5-year period. Community-based partners included a state comprehensive care management program, a local health system's cardiology clinic, and the local Area Agency on Aging. EVALUATION: A retrospective analysis of patient demographics, drug therapy problems, interventions, and pharmacy and technician time was conducted with the use of the pharmacy's internal patient care documentation and billing systems from January 1, 2012, to June 31, 2016. RESULTS: A total of 462 home visits (142 initial, 320 follow-up) were conducted with 142 patients. Patients averaged 13 disease states (range 3-31) and 16 medications (range 1-44) at their initial visit. Pharmacists identified an average of 11 drug therapy problems per patient (range 1-36) and performed an average of 13 interventions per patient (range 1-48). The most common drug therapy problem identified was nonadherence, and the most common intervention performed was education. The median pharmacist time in the home was 1.5 hours (range 0.67-2.75) for an initial visit and 1 hour (range 0.08-2.25) for a follow-up visit. CONCLUSION: Home visits can be successfully implemented by community pharmacists to provide care to high-risk and high-complexity community-dwelling patients. Our experience may inform other community pharmacy organizations looking to develop similar home visit services.

Whole Systems Within Whole Systems: The Oregon Health Plan's Expansion of Services for Back and Neck Pain.

OBJECTIVES: The authors employ a Whole Systems framework to explore implementation of new guidelines for back and neck pain in Oregon's Medicaid system. Whole Systems research is useful for understanding the relationship between complementary and integrative health care (CIH) and conventional health care systems in real-world clinical and practice settings. DESIGN: Preliminary results are from an observational study designed to evaluate state-wide implementation of CIH and other non-pharmacological treatments for neck and back pain among Oregon Medicaid patients. This natural experiment, even in early stages, provides insight into the challenges of integrating Whole Systems oriented therapies into Medicaid billing and treatment. METHODS: Qualitative data are drawn from: (1) semi-structured interviews with representatives of each of the 16 coordinated care organizations (CCOs) responsible for administering the Oregon's Medicaid insurance through the Oregon Health Plan (OHP); and (2) open-ended survey responses from acupuncturists in all 16 CCO areas. RESULTS: Implementation of the new policy guidelines poses logistical and epistemological challenges. Differences in worldview, inadequate reimbursement, and simple lack of awareness of CIH among medical providers are some of the factors that pose barriers to merging CIH therapies into conventional frameworks. CONCLUSIONS: In this article, we explore the potential for a Whole Systems perspective to better explain the complexity of integrating CIH and other non-pharmacological services into a state financed health care system. Oregon's expansion of services for back and neck pain presents an opportunity to explore challenges and successes in melding multiple approaches to health and pain management into a managed system such as the OHP.