Using the Pharmacists' Patient Care Process to address social determinants of health in patients with diabetes.

Owing to the accessibility of pharmacists and frequency of their patient encounters, pharmacists may be in the unique position to help recognize the impact that social determinants of health (SDOH) have on a patient's health. The American Pharmacists Association wants to provide practical tools and resources for pharmacists to assess and mitigate SDOH with their patients. Through the use of a diabetes patient case and the Pharmacists' Patient Care Process (PPCP), this article will highlight a few of the numerous items available to provide culturally and linguistically tailored disease management and health literate and numerate communication and to improve food security. Using tools and resources to address SDOH in the context of the PPCP allows pharmacists to develop an even more patient- and person-centered care plan with the goal of achieving optimal patient outcomes and reducing health disparities. As pharmacists gain comfort with using these tools and resources to address SDOH in their practices, they should continue to seek opportunities to learn about other SDOH and their impact on patients' chronic medical conditions, including diabetes.

Collaborating with pharmacists to advance health equity for patients with diabetes through communication.

Health disparities are closely linked with economic, social, or environmental disadvantage and are the differences observed between groups as related to disease morbidity and mortality, injury, or violence. U.S. Food and Drug Administration Office of Minority Health and Health Equity and the American Pharmacists Association are both committed to the advancement of health equity and to increasing education and awareness of diabetes-related health disparity issues. Pharmacists are strategically located within the health care system and have the knowledge and skills to support the reduction of health disparities in patients with diabetes. This article highlights some of the many approaches and resources pharmacists can use in addressing health disparities and describes culturally competent, health literate, and numerate techniques for providing education and communicating with patients who have diabetes.

Pharmacist-led telehealth tobacco cessation services compared with usual care in a community health center.

BACKGROUND: Previous studies regarding tobacco cessation services (TCS) concluded that pharmacist interventions lead to higher or similar quit rates compared with usual care; however, little is known about patient satisfaction with these services. OBJECTIVES: This study assessed 30-day point prevalence abstinence and patient satisfaction of TCS provided by pharmacists compared with primary care providers (PCPs) in a community health center. Secondary objectives assessed the number of encounters and time spent counseling and medications prescribed at each visit. METHODS: Patients at the age of 18 years or older with tobacco use disorder and a new quit attempt were invited to complete a 9-question survey via e-mail, phone, and mail 7 months after their initial tobacco cessation visit. The survey assessed 30-day point prevalence abstinence and patient satisfaction. Chart reviews were conducted to assess time spent counseling and prescribing patterns. RESULTS: The response rate was 38.8% (50/129) overall, 43.9% in the pharmacist group and 36.3% in the PCP group. A 30-day point prevalence abstinence was reached by 22.2% (4/18) in the pharmacist group and 9.4% (3/32) in the PCP group (P = 0.23). Patient satisfaction was significantly higher in the pharmacist group with regard to discussion around medications used to quit smoking (100% vs. 65.6%, P = 0.004), understanding how to properly use the medications (100% vs. 62.5%, P = 0.002), identifying behavioral changes to assist with quitting (94.4% vs. 65.6%, P = 0.036), and frequent follow-up visits (83.3% vs. 46.9%, P = 0.016). Pharmacists spent more time counseling patients and were more likely to prescribe dual nicotine replacement therapy and prescription medications. CONCLUSIONS: There was not a statistically significant difference in abstinence rates, and patient satisfaction with TCS provided by pharmacists and PCPs was high. Pharmacists provide a more intensive service by spending more time counseling patients and providing more follow-ups and are more likely to diversify medications prescribed to quit smoking.

A team-led remote ambulatory care rotation: Creating efficiency without sacrificing quality.

BACKGROUND AND PURPOSE: Advanced pharmacy practice experiences (APPEs) are a highly anticipated part of the doctor of pharmacy program. Traditionally, these rotations are offered as full-time, onsite experiences. However, there are situations in which geography, transportation, and housing requirements limit the accessibility of these experiences. Additionally, unexpected changes in rotation schedules or resource limitations may leave students in a difficult situation when completing their rotation hours. Having the ability to provide a remote APPE that results in similar student learning outcomes provides flexibility to experiential directors and ensures students' continued progression towards graduation. EDUCATIONAL ACTIVITY AND SETTING: A group of faculty members and post-graduate trainees collaborated to create a remote, one-month ambulatory care experience for 18 students over three months. Students had access to the electronic health record (EHR) from their homes through a partnership with a local federally qualified health center. Access to the EHR enabled the students to participate in telehealth visits and have meaningful interactions with patients as if they were on-site. Students were also able to participate in topic discussions, answer drug information questions, complete a literature evaluation series, and work on projects remotely through this rotation. FINDINGS AND SUMMARY: This remote rotation allowed preceptors to meet the educational needs of students while allowing them to provide patient care through telehealth. Data from summative student evaluations, student evaluations of preceptor and site, and a supplemental survey demonstrate that this remote rotation is a meaningful learning experience for students and is comparable to similar in-person rotations.

Pharmacist Provided Spirometry Services: A Scoping Review.

PURPOSE: Despite international guidelines' recommendations, spirometry is underutilized in the diagnosis and management of asthma and COPD. Spirometry may be an opportunity for trained pharmacists to meet the needs of patients with suspected or diagnosed lung conditions. The aim of this scoping review is to describe the literature including pharmacist provided spirometry services, specifically to identify: 1) the models of pharmacist provided spirometry services, and additional services commonly offered alongside spirometry, 2) pharmacist training and capability to obtain quality results, and (3) pharmacist, physician, and patient perspectives. METHODS: In September 2020, a comprehensive literature search in PubMed and EMBASE was conducted to identify all relevant literature on the topic of pharmacist provided spirometry services using the search term: "pharmacist or pharmacy" and "spirometry or pulmonary function test or lung function test." Literature was screened using inclusion/exclusion criteria and selected articles were charted and analyzed using the themes above. RESULTS: A total of 27 records were included. The scoping review found that pharmacist provided spirometry has been conducted around the world in community pharmacies and clinic settings. Community pharmacists may increase access to spirometry screening; the lack of communication with primary care providers and remuneration are barriers that need to be overcome to optimize the utility of the service. Clinic-based services are interprofessional and collaborative, allowing a patient to receive the test, results, diagnosis, and medication changes in one visit. Following comprehensive training, pharmacists felt confident in their ability to perform spirometry and met quality standards at acceptable rates. CONCLUSION: Spirometry is an opportunity for pharmacists to improve evidence-based practice for screening and diagnosing lung conditions along with providing comprehensive services to complement testing. Data around provider and patient perspectives is limited and should be further investigated to determine if providers and patients would value and collaborate with pharmacists providing spirometry services.

Pharmacist-Driven Spirometry Screening to Target High-Risk Patients in a Primary Care Setting.

Objectives: The primary objective of this study is to determine the effect of proactive pharmacist identification of high-risk patients eligible for diagnostic spirometry testing on the percentage of appropriate spirometry referrals ordered and the percentage of spirometry tests completed in those that qualify. Methods: This prospective study compares spirometry referrals ordered and tests completed between an intervention site and control site within a federally qualified health center (FQHC) where pharmacists provide spirometry services. At both sites, all patients who had a primary care provider (PCP) appointment and qualified for spirometry screening on the designated intervention dates during a 12-week period were included in this study. At the intervention site, the pharmacist recommended a spirometry screening to the PCP prior to identified high-risk patients' appointments. At both sites, a chart review was completed to determine if referrals were ordered and tests were completed for patients who qualified. Results: The number of patients eligible for diagnostic spirometry testing at the intervention and control sites was 190 (n = 125 vs n = 65, respectively). Among eligible patients, the percentage of referrals ordered was significantly higher at the intervention site (47.2% vs 7.7%, P < .001). Among patients who qualified, completion of spirometry testing was significantly higher in the intervention site (23.2% vs 3.1%, P < .001). Conclusion: Results of this study suggest that pharmacists proactively identifying high-risk patients for spirometry screenings within an FQHC increases appropriate referrals ordered by PCPs and tests completed by high-risk patients. Pharmacists in the primary care setting can aid the PCP in the management of chronic obstructive pulmonary disease through significantly increased spirometry referrals and therapeutic clinical assessments and recommendations. They also can provide face-to-face motivational counseling for smoking cessation, inhaler education, and vaccine recommendations. This population health approach to spirometry testing represents an emerging role for pharmacists and could be adopted in other primary care settings.

A team-based learning approach to interprofessional education of medical and pharmacy students.

BACKGROUND: As collaborative team-based healthcare expands, there is a need for effective interprofessional education (IPE). Although the desired outcomes of IPE are defined by the Interprofessional Education Collaborative (IPEC), resources often limit IPE implementation. The purpose of this study is to assess the effectiveness of a novel interprofessional activity in improving health professions students' interprofessional competencies using team-based learning (TBL). INTERPROFESSIONAL EDUCATION ACTIVITY: Teams of second year pharmacy and medical students participated in a novel IPE session targeting roles and responsibilities. This activity was designed and implemented by a small number of faculty and used TBL to educate a large number of students using limited resources. Class averages for individual and team readiness assurance test (iRAT/tRAT) scores were collected, and students were invited to complete the Interprofessional Collaborative Competencies Attainment Survey (ICCAS) to evaluate the effectiveness of the activity. DISCUSSION: On average, tRAT scores were 20% higher than iRAT scores. While there was significant improvement for all items on the ICCAS, questions within the roles and responsibilities domain of the ICCAS were most affected. IMPLICATIONS: This novel IPE activity was successful in teaching a large group of professional students in the targeted domain of roles and responsibilities in a single session. This activity was a rich experience in which students learned together using limited resources which can be easily replicated at other institutions to help professional students gain proficiency in interprofessional competencies.

An Ambulatory Care Clinic and Community Pharmacy Collaboration to Address Prescription Abandonment.

PURPOSE: The purpose of this research is to evaluate a collaborative workflow aimed at decreasing prescription abandonment. SETTING: A federally qualified health center and a 340B contracted grocery store-based community pharmacy. PRACTICE WORKFLOW: An ambulatory care clinic with an established partnership with a community pharmacy chain identified a need to decrease prescription abandonment rates. A process was developed whereby an ambulatory care pharmacy technician received a report from the pharmacy of prescriptions filled for at least 7 days since the initial fill date and at risk for abandonment at the community pharmacy. The pharmacy technician identified health-system barriers, attempted to remedy any identified barriers, and conducted patient reminder phone calls. Health-system barriers were classified by the following categories: incorrect contact information at the community pharmacy, incorrect 340B copayment, incorrect insurance information at the community pharmacy, and need for prior authorization. EVALUATION: A prospective cohort study was conducted from February 2016 to April 2016 in order to evaluate the effectiveness of this workflow. RESULTS: 551 prescriptions and 350 patients were included in this cohort. Of the 551 prescriptions, 362 had at least one identified barrier that may have led to prescription abandonment. There were 111 health-system identified barriers, and 96 of these barriers were acted upon. Additionally, there were 459 patient identified barriers, and 179 of these barriers were acted upon. When a pharmacy technician was able to identify and act upon at least one barrier, 106 prescriptions (46.9%) were picked-up from the pharmacy. CONCLUSION: From the information gathered in this quality improvement project, operational changes have been implemented at the ambulatory care clinic and community pharmacy as a means to further decrease modifiable health-system barriers that may lead to prescription abandonment.

Impact of a Pharmacist-Provided Spirometry Service on Access to Results in a Primary Care Setting.

OBJECTIVES: The primary objective of this study was to determine the effect of a pharmacist-provided spirometry service within a federally qualified health center on the percentage of spirometry referrals completed with results reviewed by the ordering provider. Secondary objectives evaluated differences between internal and external referrals, medication recommendations made by the pharmacist, and revenue brought in by the service. METHODS: Chart reviews were completed to determine the referral completion rates between patients who received a spirometry referral before (December 2014-September 2015) and after (January 2016-October 2016) the implementation of the pharmacy-provided spirometry service. Chart reviews were also used to determine the number and completion rate among referrals for internal and external services in the postimplementation time frame. Chart reviews also assessed medication recommendations made by the pharmacist. RESULTS: The results demonstrate an increase in referral completion rate from 38.1% to 47.0% ( P = .08) between the pre- and postimplementation time frames. In the postimplementation time frame, there was a statistically significant difference in the percentage of referrals completed between in-house referrals and external referrals (70.0% and 40.9%, respectively, P = .0004). Comparing clinics with and without the spirometry service, there was a statistically significant difference in the total number of spirometry referrals (1.13% and 0.59%, respectively, P < .0001) and the percent of referrals completed (0.55% and 0.27%, respectively, P = .0002). CONCLUSION: The results suggest that offering spirometry within the primary care setting helps to increase the rate of completed spirometry tests with results available to the primary care provider. Additionally, the results show that there is an increased completion rate in patients who receive an internal spirometry referral, which may be due to reduced barriers in obtaining this testing. Overall, these results demonstrate that providing spirometry in the primary care setting helps to increase spirometry results obtained and could be beneficial in other primary care settings.