Cost-effectiveness and budget impact of the management of uncomplicated urinary tract infection by community pharmacists.

BACKGROUND: Urinary tract infections (UTI) are one of the most common infections treated in primary care and the emergency department. The RxOUTMAP study demonstrated that management of uncomplicated UTI by community pharmacists resulted in high clinical cure rates similar to those reported in the literature and a high degree of patient satisfaction. The objective of this study was to assess the cost-effectiveness and budget impact of community pharmacist-initiated compared to family or emergency physician-initiated management of uncomplicated UTI. METHODS: A decision analytic model was used to compare costs and outcomes of community pharmacist-initiated management of uncomplicated UTI to family or emergency physician-initiated management. Cure rates and utilities were derived from published studies. Costs of antibiotic treatment and health services use were calculated based on cost data from Canada. We used a probabilistic analysis to evaluate the impact of treatment strategies on costs and quality-adjusted-life-months (QALMs). In addition, a budget impact analysis was conducted to evaluate the financial impact of community pharmacist-initiated uncomplicated UTI management in this target population. This study was conducted from the perspective of the public health care system of Canada. RESULTS: Pharmacist-initiated management was lower cost ($72.47) when compared to family and emergency physician-initiated management, $141.53 and $368.16, respectively. The QALMs gained were comparable across the management strategies. If even only 25% of Canadians with uncomplicated UTI were managed by community pharmacists over the next 5 years, the resulting net total savings was estimated at $51 million. CONCLUSION: From a Canadian public health care system perspective, community pharmacist-initiated management would likely be a cost-effective strategy for uncomplicated UTI. In an era of limited health care resources, expanded roles of community pharmacists or other non-physician community based prescribers are important mechanisms through which accessible, high-quality and cost-effective care may be achieved. Further studies to evaluate other conditions which can be managed in the community and their cost effectiveness are essential.

Extracorporeal cardiopulmonary resuscitation: A primer for pharmacists.

PURPOSE: To describe the use of mechanical circulatory support in the setting of cardiac arrest and summarize pharmacists' role in extracorporeal cardiopulmonary resuscitation (ECPR). SUMMARY: ECPR is increasingly used to reduce morbidity and improve mortality after cardiac arrest. ECPR employs venoarterial ECMO, which provides full circulatory perfusion and gas exchange in both adult and pediatric patients in cardiac arrest. After the emergency medicine team identifies potential candidates for ECPR, the ECMO team is consulted. If deemed a candidate for ECPR by the ECMO team, the patient is cannulated during ongoing standard cardiopulmonary resuscitation. A multidisciplinary team of physicians, nurses, perfusionists, pharmacists, and support staff is needed for successful ECPR. Pharmacists play a vital role in advanced cardiac life support (ACLS) prior to cannulation. Pharmacists intervene to make pharmacotherapy recommendations during ACLS, prepare medications, and administer medications as allowed by institutional and state regulations. Pharmacists also provide pharmacotherapy support in the selection of anticoagulation agents, ongoing vasopressor administration during ECMO cannulation, and the optimization of medication selection in the peri-ECPR period. CONCLUSION: With the growing use of ECPR, pharmacists should be aware of their role in medication optimization during ECPR.

Effect of a pharmacist-based toxicology consult service on appropriate use of intravenous N-acetylcysteine for acetaminophen toxicity: A retrospective cohort study.

Background: Incorporating clinical pharmacists on the medical team has been associated with fewer medication errors and increased error interception. Due to the logistical complexities of the intravenous (IV) N-acetylcysteine (NAC) regimen for acetaminophen toxicity, many opportunities for medication errors exist. A pharmacist-based toxicology consultation service was implemented at our institution, allowing pharmacists to formally aid in the management of toxicology patients throughout their hospital admission, including those with acetaminophen toxicity. The purpose of this study was to evaluate the effect of a house-wide pharmacist-based toxicology consult service on errors associated with IV NAC treatment for patients admitted with acetaminophen toxicity. Methods: A retrospective, pre-post cohort study was conducted on patients who received IV NAC for acetaminophen toxicity. The intervention evaluated was the implementation of a pharmacist-based toxicology consult service, known as the pharmacy toxicology team. The primary end point was the incidence of an error associated with IV NAC. An error was defined as the composite of inappropriate dose, administration rate, initiation, continuation, or discontinuation. Results: Eighty-four patients were included; 30 patients in the pregroup, and 54 patients in the postgroup. Fewer patients experienced an error in the postgroup compared to the pregroup (30% vs 63%, P = 0.003). Conclusion: The implementation of this unique pharmacist-based toxicology consult service was associated with fewer patients experiencing an error related to IV NAC therapy for acetaminophen toxicity. Application of this data may aid in the justification for development of clinical pharmacist-based toxicology consult services at other institutions.

Identifying Services Provided in Community Pharmacy Practice Settings.

Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.

Designing for health equity: A mixed method study exploring community experiences and perceptions of pharmacists' role in minor ailment care.

BACKGROUND: Minor ailments are self-limiting, easily diagnosable and treatable conditions. Funded pharmacist minor ailments services (PMAS) have been posited to improve medicines access equity and, despite ethnic minorities across the globe experiencing reduced access to medicines and health care, PMAS internationally have not explicitly centered ethnic equity in service design or outcome measurement. OBJECTIVE: To explore Maori experiences of minor ailments care and perceptions of the pharmacists' role. METHODS: This mixed methods study collected data through facilitated wananga (collaborative knowledge-sharing group discussions). Eligible participants (Maori, 18 years plus, obtained medicine from pharmacy in last 3 years) were recruited through local pharmacist networks using convenience sampling. Wananga included qualitative data collection through discussion using a topic guide and a quantitative questionnaire. Indigenous theory was applied within a general inductive approach to thematic development to analyze qualitative data. Quantitative data was reported using simple descriptive statistics. RESULTS: Thirteen wananga (3 in-person, 10 online) were conducted from September 2021-February 2022 with 62 participants from seven New Zealand regions. The minor ailments that participants were most likely to seek treatment from pharmacy first, instead of a doctor, were eczema (87.2%), coughs and colds (85.7%), headlice (85.7%), insect bites (83.9%), and hayfever (83.9%). Four themes were generated from the qualitative data: designing the right environment for minor ailment care; clinically and culturally safe care; moving from stigmatizing to strengths-based services; the benefits of PMAS. Participant-informed ideas for PMAS service development centered on Maori aspirations included: developing clinically and culturally safe pharmacy environments, enabling medicine supply outside of the physical pharmacy setting, avoiding stigmatizing language when promoting PMAS availability, and collaborative practice with other health providers. CONCLUSION: This study provides important recommendations when developing PMAS to increase the likelihood of delivering equitable care, and has international application across multiple pharmacy and health service settings.

Should Business Training Be a Significant Element of Pharmacy Training?

Because pharmacists cannot be reimbursed for their clinical services and are not listed as providers under the US Social Security Act, they often have difficulty finding ways to financially support their services. Specifically, because pharmacists are not listed as providers, there is not usually sufficient financial support through reimbursement to cover pharmacist labor costs. Further, pharmacists must show that they save more in labor costs through cost avoidance to be accessible to patients in particular health care settings. Business training may provide a foundation for pharmacists to create financially viable models of practice and allow for better communication with administrative decision-makers, thus increasing the accessibility of their clinical services.

A scoping study of the medication therapy related pharmacist services in the Western Pacific Region.

OBJECTIVES: To identify the preferred terminologies, nature of services, perceived benefits and barriers to medication therapy-related pharmacist services in the Western Pacific region to facilitate the development of a framework for medication therapy management. METHOD: A survey was completed by hospital and community pharmacists purposively selected by the national pharmacist associations. KEY FINDINGS: Pharmaceutical care was the preferred term with services predominantly related to medication safety and public health. The perceived barriers included lack of appropriate facility, time and funding. CONCLUSION: A broader pharmaceutical care framework is a preferred approach to delivery of Good Pharmacy Practice in the region.

An exploration of barriers, facilitators, and practical solutions for adopting medication synchronization into community pharmacies: A qualitative analysis.

Background: Community pharmacies across the nation have adopted medication synchronization (Med Sync) services with the aim of improving medication adherence. To help incorporate Med Sync into a pharmacy's workflow, pharmacy associations and organizations developed implementation guides for community pharmacies. However, considerable variability in the adoption of this service exists as pharmacies struggle to implement Med Sync into traditional workflow. Researchers identified early adopters of Med Sync who dispense majority of their prescriptions as part of a Med Sync program. An exploratory study was undertaken with the aim to reveal themes surrounding facilitators and barriers to adoption of Med Sync in community pharmacies. Objectives: The objective of this study was to explore the barriers and facilitators associated with Med Sync adoption in community pharmacies and generate practical solutions for service adoption. Methods Community pharmacies participating in the North Carolina's Community Pharmacy Enhanced Services Network (CPESNsm) who were early adopters of Med Sync and had greater than 50% of their prescription volume being dispensed as part of a Med Sync program were recruited to participate in semi-structured interviews. Interviews were conducted, recorded, and transcribed verbatim with representatives who led the adoption of Med Sync in their pharmacy. Inductive coding and summary analysis were used to analyze the interview data and determine themes associated with facilitators and barriers. Results: Analysis of the interviews revealed four key themes: program organization, staff engagement, patient engagement, and provider engagements for Med Sync adoption. Each of these themes had several sub-themes, contributing to facilitators and barriers to Med Sync adoption. Subthemes of program organization included having organizational infrastructure, including a pharmacy software system, a dedicated area, and a consistent enrollment process. Subthemes of staff engagement included having a team-based approach, job training, and staff incentives. Patient engagement's subthemes included communication, finances, health literacy, and transportation. Provider engagement resulted with subthemes including lack of communication and provider-pharmacist relationships. Conclusion: To ensure successful adoption of Med Sync into traditional workflow, community pharmacies should employ a multi-factorial approach that includes internal and external components to the community pharmacy. This study identified facilitators associated with successful Med Sync adoption such as adequate staff engagement and requisite program organization. Barriers hindering successful Med Sync adoption resulted from challenges with provider and patient engagement. This study also makes an important contribution by providing practical solutions to Med Sync adoption based on participant responses and identified themes and sub-themes.

Preferences for pharmacist services to enhance medication management among people with diabetes in Indonesia: A discrete choice experiment.

OBJECTIVES: To elicit patients' preferences for pharmacist services that can enhance medication management among people with diabetes in Indonesia. METHODS: A discrete choice experiment (DCE) among 833 respondents with diabetes in 57 community health centers (CHCs) and three hospitals in Surabaya, Indonesia. Consultation was the baseline service. Four attributes of consultation and two attributes of additional services were used in the DCE profiles based on literature and expert opinion. The DCE choice sets generated were partially balanced and partially without overlap. Random effect logistic regression was used in the analysis. RESULTS: Respondents preferred a shorter duration of consultation and flexible access to the pharmacist offering the consultation. A private consultation room and lower copayment (fee) for services were also preferred. Respondents with experience in getting medication information from pharmacists, preferred to make an appointment for the consultation. Total monthly income and experience with pharmacist services influenced preferences for copayments. CONCLUSION: Differences in patients' preferences identified in the study provide information on pharmacist services that meet patients' expectations and contribute to improve medication management among people with diabetes. PRACTICE IMPLICATION: This study provides insight into evaluating and designing pharmacist services in accordance with the preferences of people with diabetes in Indonesia.

Community Pharmacists' Experiences and Perception about Transitions of Care from Hospital to Home in a Midwestern Metropolis.

OBJECTIVES: (1) To describe the experiences of community pharmacists in transitions of care (TOC) from hospital to home in a Midwestern metropolis; and (2) to develop instruments to measure perceived importance of TOC activities. METHODS: Survey items were developed, including a six-item instrument to capture perceived importance of TOC activities. The items were piloted to examine face validity before dissemination to 310 community pharmacists. Descriptive statistics were reported. Principal component analysis and reliability analysis for the six-item instrument were performed to assess construct validity and Cronbach's alpha, respectively. RESULTS: The response rate was 37% (n = 118). The majority of community pharmacists estimated that they learned of a patient's discharge on less than 10% of the occasions. There were 76 cases in which the discharged patients experienced either a prescription- or medication-related problem. For the six-item measurement of perceived importance, one component was yielded and all items loaded on the component with high values, which confirmed construct validity. The Cronbach's alpha for these six items was 0.941, indicating high reliability. CONCLUSIONS: A large communication gap existed for community pharmacists to receive patient discharge information. The six-item instrument to measure perceived importance of TOC activities was valid and reliable.

Medication synchronization adoption and pharmacy performance.

BACKGROUND: While medication synchronization programs are becoming a staple in community pharmacies, a standard process needs to be identified to provide consistent positive outcomes. Many studies demonstrate how medication synchronization affects individual level patients but have not examined how medication synchronization affects the pharmacy's performance. Because community pharmacies are calibrated based on performance to adherence measures for all patients, it is important to understand whether resource-intensive interventions, such as medication synchronization, lead to improved performance. OBJECTIVES: The aims of this study were to 1) examine pharmacy characteristics associated with medication synchronization adoption and 2) examine whether medication synchronization is associated with pharmacy-level performance on select medication adherence and utilization measures. METHODS: This study used a cross-sectional design. Community pharmacies participating in the North Carolina Community Pharmacy Enhanced Services Network (NC CPESN℠) program were included in this study. Pharmacy performance was measured as summary score of pharmacy's performance on seven risk-adjusted measures which were used to measure pharmacy's performance in the program. Adoption of medication synchronization was measured as a binary variable capturing whether the pharmacy offered med sync at the time the survey was administered. RESULTS: Surveys were received from 160 out of 268 participating pharmacies (59.7% response rate) with a total of 155 pharmacies being included in the analytic sample. Pharmacies that adopted medication synchronization were more likely to have a clinical pharmacist on staff (c = 5.4, p = 0.019). Holding all else constant, medication synchronization adoption was not significantly associated with total medication adherence performance (p = 0.371). CONCLUSION: Medication synchronization has proven successful in improving individual patient level adherence but may not change a pharmacy's overall performance in adherence for all patients. Further research is needed to examine how effective implementation might contribute to whether a medication synchronization program leads to meaningful gains in adherence for all patients.

Medicines Optimisation for Respiratory Patients: The Establishment of a New Consultant Respiratory Pharmacist Role in Northern Ireland.

Medicines optimisation for those with respiratory conditions can have a significant impact on clinical outcomes and substantial efficiency gains for health care. Consultant pharmacists are experts working at the top of their specialism in four main pillars of practice, namely clinical care, leadership, education and training, and research and development. A consultant respiratory pharmacist has recently been appointed at a large Health and Social Care Trust in Northern Ireland to provide expert care and clinical leadership for the medicines optimisation agenda with regards to respiratory care in Northern Ireland. Alongside clinical practice, leadership, and service development, emphasis will be placed on monitoring and evaluating the work of the consultant respiratory pharmacist with a view to gathering the necessary evidence to support the case for further investment in such consultant pharmacist posts in the region. This short communication article outlines some of the clinical and economic factors associated with the decisions to invest in the consultant pharmacist model of care in Northern Ireland.

Impact of clinical pharmacist services on quality adjusted life years in head and neck cancer patients.

BackgroundThe role of clinical pharmacists in the provision of patient care is evolving in developing countries such as India. However, their acceptance in health care setups remains debatable. Objective This study aims to investigate the change in quality adjusted life-years after providing clinical pharmacist services in head and neck cancer patients. Setting Oncology speciality private centre in West India. Method It was a prospective, multi-centered pre-post study. Patients were recruited into the control group and intervention group. Clinical pharmacist services were provided only to the intervention group. The quality adjusted life-years was measured by incorporating the EQ-5D-5L instrument. Patients have been provided with the EQ-5D-5L questionnaire at the pre-determined intervals i.e. before beginning of each chemotherapy cycles till the completion of treatment. The analysis was carried out using descriptive analysis and student's t-test. Main outcome measures Change in quality adjusted life-years amongst control and intervention groups of head and neck patients. Results A total of 104 patients were recruited, out of which 50 patients were in control group and 54 patients in intervention group. Docetaxel, cisplatin, 5-fluorouracul regimen, paclitaxel-carboplatin regimen and weekly cisplatin were prescribed in majority of the head and neck patients (control group: 82%; intervention group: 74.1%). The majority of patients in the control group were facing medication-related problems such as irrational administration of chemotherapy (18.9%), lack of optimal supportive care (18.9), negligence of co-morbid conditions (16.1%), improper chemo-drug calculation (14.9%) and drug interaction (13.2%). The remedial action was provided by clinical pharmacist to overcome these medication-related problems in intervention group. The quality adjusted life-years significantly decreased in the control group from 0.012 to 0.005, however, it remained constant in the intervention group from 0.013 to 0.014 after the completion of 6 chemotherapy cycles. Conclusion The incorporation of clinical pharmacist services has helped us in identifying and understanding the various types of medication-related problems and their potential causes in patients suffering from head and neck cancer. Moreover, it helped to improve the quality adjusted life-years and decrease adverse drug reactions, reflecting positive impact on patient care.

Community Pharmacist-Provided Wellness and Monitoring Services in an Employee Wellness Program: A Four-Year Summary.

Objective: To assess the clinical outcomes of participants of an employee wellness program during four years of service implementation. Methods: A prospective cohort study was conducted at 15 independent community pharmacy chain locations in northwest and central Missouri. A total of 200 participants were enrolled in an employee wellness program, and the program included five monitoring groups-cholesterol, blood pressure, blood glucose, weight, and healthy participant groups. Participants selected a pharmacist wellness coordinator and wellness appointments were conducted, consisting of education, goal-setting, and monitoring through physical assessment and point of care testing. The primary outcome measures were total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), body mass index (BMI), and waist circumference (WC). The secondary outcome measures were the proportion of patients who achieved the clinical value goals at baseline versus 48 months. The primary outcome measures among data collection time points were compared using one-way analysis of variance (ANOVA) tests, and the secondary outcomes were compared between baseline and 48 months by Chi-square or Fisher's exact tests. One-way ANOVA post hoc tests were also performed using least significant difference, to further identify which time points differed from each other. Results: At baseline, there were 134 patients in the cholesterol monitoring group, 129 in the weight monitoring group, 117 in the blood pressure monitoring group, 46 in the blood glucose monitoring group, and 26 in the healthy participant monitoring group. For patients in the blood pressure monitoring group, compared with baseline, there was a significant decrease in DBP at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood pressure goals at 48 months. For patients in the blood glucose monitoring group, compared with baseline, there was a significant decrease in FBG at months 12, 24, 36, and 48, and a significant increase in the proportion of patients achieving blood glucose goals at 48 months. Conclusions: Pharmacist-led wellness visits provided to employee wellness patients in a community pharmacy may lead to improvements in BP and FBG values.

Pharmacist Services in the Opioid Crisis: Current Practices and Scope in the United States.

Introduction: Pharmacist roles promoting safe opioid use are recognized in literature and practice. Pharmacists can offer services such as counseling on opioid risks, naloxone dispensing, education on opioid storage and disposal, prescription drug monitoring program (PDMP) utilization, opioid deprescribing, and providing resources for addiction treatment to help mitigate the opioid crisis. Objective: This commentary seeks to describe current and potential roles for pharmacists to combat the United States opioid crisis and identify key factors affecting service provision. Methods: The paper summarizes evidence-based studies describing current pharmacist roles and services, factors affecting service implementation, and strategies to further improve pharmacist roles and services related to promoting safe opioid use for patients. Results: Pharmacists recognize their roles and responsibilities to counsel patients on opioid risks, dispense naloxone, educate on opioid storage and disposal, utilize prescription drug monitoring programs (PDMPs), offer opioid deprescribing, and provide resources for addiction treatment. However, pharmacists express low confidence, time, and training as barriers to service provision. This suggests a need for structured training, resources, and organizational support for pharmacists to improve confidence and participation in such services. Conclusions: Although pharmacists are aware of roles and responsibilities to help reduce the opioid crisis, more training, education, organizational support and resources are needed to increase their ability to embody these roles.

Building the Case: Changing Consumer Perceptions of the Value of Expanded Community Pharmacist Services.

BACKGROUND: The role of the community pharmacist has traditionally been a medication dispenser; however, community pharmacists' responsibilities must expand to include more direct patient care services in order to transform primary care practice. OBJECTIVES: Use case-based scenarios to (1) determine factors that contribute to positive and negative consumer perceptions of expanded community pharmacist patient care roles, (2) identify facilitators and barriers that contribute to consumer perceptions of the value of expanded community pharmacist patient care services, and (3) develop a successful approach and strategies for increasing consumer advocacy for the value of expanded community pharmacist patient care services. METHODS: Two consumer focus groups used scenario-based guided discussions and Likert scale questionnaires to elicit consumer reactions, facilitators, and barriers to expanded community pharmacist services. RESULTS: Convenience, timeliness, and accessibility were common positive reactions across all 3 scenarios. Team approach to care and trust were viewed as major facilitators. Participant concerns included uncertainty about pharmacist training and qualifications, privacy, pharmacists' limited bandwidth to accept new tasks, and potential increased patient costs. Common barriers to service uptake included a lack of insurance payment and physician preference to provide the services. CONCLUSION: Consumer unfamiliarity with non-traditional community pharmacist services is likely an influencer of consumers' hesitancy to utilize such services; therefore, an opportunity exists to engage consumers and advocacy organizations in supporting expanded community pharmacist roles. This study can inform consumers, advocates, community pharmacists, primary care providers, and community-based organizations on methods to shape consumer perceptions on the value of community pharmacist expanded services.

Innovative Partnership between a Rural Mental Health Center and Community Pharmacy: Integration of a Mental Health Pharmacist.

PURPOSE: The purpose of this article is to describe how an innovative partnership between a rural community mental health center, community independent pharmacy and College of Pharmacy and integration of a mental health pharmacist lead to identification of medication therapy problems (MTP's) and interprofessional team partnerships with center mental health professionals. METHODS: A contractual arrangement was initiated between Northern Pines Mental Health Center (NPMHC), GuidePoint Pharmacy Services GPS) and the University of Minnesota College of Pharmacy (UMN CoP) to place a PGY1 resident at NPMHC. The resident was assigned to work closely with the Chief Medical Officer and provide initial comprehensive medication management (CMM) services to individuals who were enrolled in Assertive Community Treatment (ACT). A retrospective chart review was conducted to evaluate the impact of services provided. Patient inclusion criteria included ACT enrollees 18 years or older, a diagnosis of SPMI, taking at least one psychotropic medication, and participation in at least one resident-led CMM visit. Additional findings included the relationship between the pharmacist, the psychiatric physician, and other members of the ACT team. Descriptive statistics were used to document the findings. FINDINGS: N = 30 met the inclusion criteria: 18 males and 12 females, age ranged from 24 - 69 with average of 44 years old. 110 MTPs were identified ranging from no MTPs to 10 MTPs per patient, with a mean of 4 MTPs/patient. There was an uneven distribution of MTPs between psychiatric and medical conditions, with a disproportionately high occurrence of "Needs Additional Drug Therapy" in medical conditions and "Adverse Drug Reaction" in psychiatric conditions. In addition, the services were valued by members on the ACT team. CONCLUSION: Rural residents with SPMI in intensive community treatment have complex medication needs that require the training and skills of a clinical pharmacist. Despite the inclusion of a medication list as part of the ACT fidelity standards MTPs may go unrecognized and unresolved without the services of a clinical pharmacist conducting CMM. The pharmacist and psychiatric physician formed a collaborative partnership to address medication issues. We conclude that there is a need for integrating clinical pharmacist services into rural mental health centers.

"It Made a Difference to Me": A Comparative Case Study of Community Pharmacists' Care Planning Services in Primary Health Care.

In some jurisdictions, governments and the public look to community pharmacies to provide expanded primary health care services, including care plans with follow-up. Care planning services, covered by the Compensation Plan in Alberta, Canada, require pharmacists to assess an eligible patient's health history, medication history, and drug-related problems to establish goals of treatment, interventions, and monitoring plan. Follow-up assessments are also covered by the Compensation Plan. A comparative case study method facilitated an in-depth investigation of care planning services provided by four community pharmacy sites. Data from 77 interviews, 61 site-specific documents, and 94 h of observation collected over 20 months were analyzed using an iterative constant comparative approach. Using a sociomaterial theoretical framework, the perceived value of care planning services was examined through an investigation of the relationships and interactions between people and information. Patients perceived the value of care planning as related to waiting time to access care and co-creating individualized plans. Physicians and other health care professionals valued collaboration, information sharing, and different perspectives on patient care. Pharmacists valued collaboration with patients and other health care professionals, which renewed their sense of responsibility, increased satisfaction, and gave meaning to their role.

Establishing a New Ambulatory Care Practice Site as a Pharmacy Practice Faculty.

There is an imminent need to identify and develop new ambulatory care practice sites with the increase in the number of colleges of pharmacy across the nation. This manuscript provides recommendations to help clinical faculty determine whether a potential pharmacy practice site will be able to provide adequate resources and support to establish a successful practice. This may be challenging to pharmacy practice faculty in settings where clinical pharmacy services have never been utilized. Topics include the pre-work needed prior to approaching a new practice site, assessing the need for physical requirements, meeting key personnel, marketing clinical skills and services, implementing, and evaluating practice site. Preparation includes having a clear vision of the pharmacist services, ensuring that stakeholders have an understanding of the pharmacy services inquiring the site support and resources for the pharmacist, and regularly communicating.

Pharmacist Involvement in a Community Paramedicine Team.

BACKGROUND: Hospital readmissions have recently gained scrutiny by health systems as a result of their high costs of care and potential for financial penalty in hospital reimbursement. Mobile-integrated health and community paramedicine (MIH-CP) programs have expanded to serve patients at high risk of hospital readmission. Pharmacists have also improved clinical outcomes for patients during in-home visits. However, pharmacists working with a MIH-CP program have not been previously described. This project utilized a novel multidisciplinary Community Paramedicine Team (CPT) consisting of a pharmacist, paramedic, and social worker to target patients with heart failure at high risk of readmission to assist with coordination of care and education. OBJECTIVES: This article describes the development of the CPT, delineation of CPT member responsibilities, and outcomes from pilot visits. METHODS: The CPT visited eligible patients in their homes to provide services. Patients with heart failure who were readmitted within 30 days were eligible for a home visit. RESULTS: A total of 6 patients were seen during the pilot, and 2 additional patients were seen after the pilot. CONCLUSION: Imbedding a pharmacist into a CPT provides a unique expansion of pharmacy services and a novel approach to address hospital readmissions.