Impact of outpatient pharmacist dispensing in an opioid use disorder clinic.

BACKGROUND: Medications for opioid use disorder are effective in reducing opioid deaths, but access can be an issue. Relocating an outpatient pharmacist for weekly buprenorphine dispensing in an outpatient clinic may facilitate coverage for buprenorphine and mitigate access and counseling barriers. OBJECTIVES: This study aimed to evaluate whether staffing an outpatient resident pharmacist to dispense in the buprenorphine clinic had a positive impact on (1) mean cost per prescription charged to charity care and (2) basic elements of patient satisfaction with the on-site pharmacist. METHODS: Patient demographics, buprenorphine formulation, insurance type, and uncovered costs were abstracted from dispensing records in the 16 weeks before the pharmacist clinic presence and 16 weeks with the pharmacist present. The difference in insurance types across the 2 periods was tested using a chi-square test, and the mean uncovered prescription costs charged to charity care for the 2 periods was compared using an independent-samples t test. A brief survey was administered while the pharmacist was on-site to evaluate satisfaction, which was analyzed with frequencies of "yes" responses and free-text comments. RESULTS: A total of 38 patients received buprenorphine during both the pre- and postperiods. Once the pharmacist was on-site, more patients used Medicaid or private insurance, decreasing the mean uncovered cost per prescription from $55.00 (SD 68.7) to $36.97 (SD 60.1) (P = 0.002). Patients reported high levels of satisfaction with most reporting they were more likely to ask questions, pick up their prescriptions, and take their medicine with the pharmacist in the clinic. CONCLUSIONS: The pharmacist successfully transitioned a portion of prescriptions previously covered by charity care to Medicaid or private insurance. This shift led to a decrease in charity care costs by $2950.20 and a reduction in the average uncovered cost per prescription. The pharmacist's presence in the clinic seemed to reduce barriers especially related to inconvenience.

Reprint of: Impact of outpatient pharmacist dispensing in an opioid use disorder clinic.

BACKGROUND: Medications for opioid use disorder are effective in reducing opioid deaths, but access can be an issue. Relocating an outpatient pharmacist for weekly buprenorphine dispensing in an outpatient clinic may facilitate coverage for buprenorphine and mitigate access and counseling barriers. OBJECTIVES: This study aimed to evaluate whether staffing an outpatient resident pharmacist to dispense in the buprenorphine clinic had a positive impact on (1) mean cost per prescription charged to charity care and (2) basic elements of patient satisfaction with the on-site pharmacist. METHODS: Patient demographics, buprenorphine formulation, insurance type, and uncovered costs were abstracted from dispensing records in the 16 weeks before the pharmacist clinic presence and 16 weeks with the pharmacist present. The difference in insurance types across the 2 periods was tested using a chi-square test, and the mean uncovered prescription costs charged to charity care for the 2 periods was compared using an independent-samples t test. A brief survey was administered while the pharmacist was on-site to evaluate satisfaction, which was analyzed with frequencies of "yes" responses and free-text comments. RESULTS: A total of 38 patients received buprenorphine during both the pre- and postperiods. Once the pharmacist was on-site, more patients used Medicaid or private insurance, decreasing the mean uncovered cost per prescription from $55.00 (SD 68.7) to $36.97 (SD 60.1) (P = 0.002). Patients reported high levels of satisfaction with most reporting they were more likely to ask questions, pick up their prescriptions, and take their medicine with the pharmacist in the clinic. CONCLUSIONS: The pharmacist successfully transitioned a portion of prescriptions previously covered by charity care to Medicaid or private insurance. This shift led to a decrease in charity care costs by $2950.20 and a reduction in the average uncovered cost per prescription. The pharmacist's presence in the clinic seemed to reduce barriers especially related to inconvenience.

Nurse judgements of hospitalized patients' safety concerns are affected by patient, nurse and event characteristics: A factorial survey experiment.

AIM: To test the influences of patient, safety event and nurse characteristics on nurse judgements of credibility, importance and intent to report patients' safety concerns. DESIGN: Factorial survey experiment. METHODS: A total of 240 nurses were recruited and completed an online survey including demographic information and responses to eight factorial vignettes consisting of unique combinations of eight patient and event factors. Hierarchical multivariate analysis was used to test influences of vignette factors and nurse characteristics on nurse judgements. RESULTS: The intraclass coefficients for nurse judgements suggest that the variation among nurses exceeded the influence of contextual vignette factors. Several significant sources of nurse variation were identified, including race/ethnicity, suggesting a complex relationship between nurses' characteristics and their potential biases, and the influence of personal and patient factors on nurses' judgements, including the decision to report safety concerns. CONCLUSION: Nurses are key players in the system to manage patient safety concerns. Variation among nurses and how they respond to scenarios of patient safety concerns highlight the need for nurse-level intervention. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE: Complex factors influence nurses' judgement, interpretation and reporting of patients' safety concerns. IMPACT: Understanding nurse judgement regarding patient-expressed safety concerns is critical for designing processes and systems that promote reporting. Multiple event and patient characteristics (type of event and apparent harm, and patient gender, race/ethnicity, socioeconomic status, and communication approach) as well as participant characteristics (race/ethnicity, gender, years of experience and primary hospital area) impacted participants' judgements of credibility, degree of concern and intent to report. These findings will help guide patient safety nurse education and training. REPORTING METHOD: STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION: Members of the public, including patient advocates, were involved in content validation of the vignette scenarios, norming photographs used in the factorial survey and testing the survey functionality.

Community pharmacist encounters with patients displaying suicide warning signs: a cross-sectional survey.

BACKGROUND: Mental health is a prominent public health issue exacerbated by the coronavirus disease 2019 pandemic. Community pharmacists are positioned to contribute. OBJECTIVES: This study aimed to describe Iowa community pharmacists' encounters, confidence, behaviors, and training needs related to patients with suicide warning signs and explore relationships between demographics and previous training with encounter frequency, confidence, and behaviors. METHODS: A cross-sectional survey was mailed to a sample of community pharmacists in Iowa. Three contacts were made between May and June 2022 including a prenotification letter, survey with a paid return envelope, and reminder postcard, each with a QR code for optional online completion. The survey included demographics, suicide warning sign encounter types, confidence, suicide prevention behaviors, and suicide prevention training history and needs. Analysis of variance and t tests compared differences between demographics and previous training with encounter frequency, confidence, and behaviors. RESULTS: The response rate was 18.3% with 161 survey completions. Pharmacists reported encounters with patients who appeared distressed (96.3%), made concerning statements related to suicide (23.8%), and disclosed suicidal thoughts (8.8%). A minority of pharmacists had asked patients about suicide (21.1%) or referred them to crisis resources in the past year (17.4%). A third had previous suicide prevention training (37.9%), which was associated with higher levels of confidence (P < 0.001) and intervention behaviors (P < 0.05). Respondents expressed interest in training, particularly on intervention and referral. CONCLUSIONS: This sample of community pharmacists encountered patients with suicide warning signs. Providing more pharmacists with training and support in understanding local mental health resources and referrals may increase their confidence and engagement in suicide prevention.

A qualitative exploration of patient preferences for Medicare Part D consultation services offered in a community pharmacy setting.

BACKGROUND: Community pharmacies currently offer Medicare Part D consultation services to help eligible beneficiaries select prescription medication insurance. Despite these service offerings, there is a paucity of information on patient preferences for these service offerings and optimal service delivery from the patient perspective. OBJECTIVES: The objectives of this study were to (1) evaluate patient expectations of and willingness-to-pay (WTP) for community pharmacy Medicare Part D consultation services, (2) identify components of Medicare Part D consultation services associated with service quality, and (3) explore differences in preferences and service expectations between services-experienced and service-naive patients. METHODS: This was a qualitative exploratory study, with data collected using interviews and a follow-up supplemental survey with participants recruited from 5 community pharmacies across the state of Iowa participating in the Community Pharmacy Enhanced Services Network. A total of 17 patients contacted the research team for participation. Interviews were recorded and transcribed, with qualitative data analysis performed using template analysis guided by the SERVQUAL framework. Interview participants were invited to complete a supplemental survey. Descriptive statistics and frequencies were generated for survey items. Service-experienced and service-naive survey responses Pearson chi-square and Welch t tests were used to determine significant differences between service-experienced and service-naive responses for categorical and continuous variables, respectively. RESULTS: In total, all 17 patients who contacted the research team agreed to participate in interviews, with 8 service-experienced and 9 service-naive interviews completed. Template analysis identified 14 subdomains across the SERVQUAL domains. Similarities and differences in service preferences between groups were identified, focusing on patient-pharmacist trust, past service experience, and WTP. All interview participants completed supplemental surveys, with no statistically significant differences between service-experienced and service-naive participant characteristics identified. CONCLUSIONS: Service-experienced patients emphasized components of the service that contribute to service quality and generally reported higher WTP values. Many service-naive patients were unaware community pharmacies provided consultation services, suggesting that pharmacists may benefit from considering how services are offered to patients based on the specific preferences and expectations and consider ways to increase awareness of service offerings.

Hepatitis C screening in a community pharmacy setting: Patient perspective.

BACKGROUND: Hepatitis C virus (HCV) is an infection of the liver, which contributes to over 15,000 deaths in the United States annually. When treated, HCV has a 90% or greater cure rate, however testing for HCV remains low. OBJECTIVES: To assess patient perspectives on HCV screenings in the community pharmacy setting including awareness of screening, willingness to be screened, barriers to screening, and willingness to pay for HCV screening. METHODS: This study used a cross-sectional survey design. The surveys were distributed by staff at an independent community pharmacy participating in an HCV screening initiative through the state department of public health. Eligible patients were born between 1945 and 1965. Descriptive statistics were calculated for survey variables. Open-ended responses were analyzed for additional context. RESULTS: Fifty-seven surveys were returned and analyzed. The majority of the respondents were White (94%), female (56%), and had some college education (26%). Only 7% were aware that a finger-stick point-of-care test was available and 67% were unaware of the Centers for Disease Control and Prevention (CDC) recommendation for testing. The most frequently reported barrier or hesitation to screening was the patient not thinking they were at risk (29%) followed by uncertainty about cost (14%). Over half of respondents (63%) were either somewhat interested or very interested in testing in a community pharmacy, however, the majority (71%) were not willing to pay or only willing to pay less than $20. CONCLUSIONS: Survey respondents were largely unaware of the recommendations and availability of finger-stick HCV screenings at community pharmacies but many were willing to be tested if low-cost. Providing patient education on the importance of HCV screenings and CDC recommendations may bolster interest in screening.

Leadership aspiration: An intersectional analysis of racial and gender equity in pharmacy.

BACKGROUND: The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes. OBJECTIVES: The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership. METHODS: The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics. RESULTS: Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898). CONCLUSION: Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions.

Barriers to Increasing Prescription Drug Monitoring Program Use: A Multidisciplinary Perspective.

Prescription drug monitoring programs are implemented through individual state policies and are one solution to curb the opioid crisis. The objectives of this study are to: (1) describe the multidisciplinary experiences using this program in practice; (2) identify limitations of the program and the desired features for improvement; and (3) characterize expectations for improved access when prescription drug monitoring programs are embedded in the electronic health record. A qualitative descriptive study design used semistructured interviews of 15 multidisciplinary healthcare providers. Textual data were analyzed using content analysis. Results showed the prescription drug monitoring program was helpful to decision-making processes related to opioid prescribing and referral to treatment; there were barriers limiting healthcare providers' use of the prescription drug monitoring program; preferences were delineated for integrating prescription drug monitoring program into electronic health record; and recommendations were provided to improve the program and increase use. In conclusion, the prescription drug monitoring program was viewed as useful in making strides to reduce the impact of inappropriate opioid prescribing in our country. By engaging a multidisciplinary group of healthcare providers, solutions were offered to improve the interface and function of the prescription drug monitoring program to assist in increasing use.

An intersectional review of discrimination and harassment experiences in pharmacy: Findings from the 2019 National Pharmacist Workforce Survey.

BACKGROUND: Most pharmacists in the United States are women, and the profession is becoming more racially diverse. The recent increase in political and social movements in the United States has heightened our awareness of the importance of better understanding the experiences of underrepresented individuals and groups. Little is known about discrimination and harassment in the profession of pharmacy in the United States. OBJECTIVES: The purpose of this study was to provide evidence that discrimination and harassment exist in the pharmacy profession and explore differences in discrimination and harassment using the intersectionality of race and sex. METHODS: The 2019 National Pharmacist Workforce Survey (NPWS) utilized an electronic survey that was distributed using a 3-contact Dillman approach by email to a randomized sample of 96,110 licensed pharmacists from all 50 U.S. states using the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS included a new battery of questions to assess the prevalence of discrimination and harassment in pharmacy. RESULTS: The most common bases of discrimination experienced were based on age (31.2%), sex (29%), and race or ethnicity (16.6%). The most common type of harassment experienced was "hearing demeaning comments related to race or ethnicity" at 15.6%. The intersectionality analysis revealed different experiences among sex or race combinations. Black and Asian male pharmacists had the highest rate of "hearing demeaning comments about race or ethnicity." Nonwhite pharmacists were more likely to experience harassment from customers or patients compared with their white colleagues. Black female pharmacists had the highest rate of being "very unsatisfied" with the results of reporting discrimination and harassment to their employer. CONCLUSION: Discrimination, including harassment and sexual harassment, is illegal, immoral, and unjust. As the profession of pharmacy continues to become more diverse, there must be a conscious, systemic, and sustained effort to create and maintain workplaces that are safe, equitable, and free of discrimination.

Snapshot of unemployed pharmacists from the 2019 National Pharmacy Workforce Survey.

BACKGROUND: Prior national surveys have quantified unemployment in the pharmacy workforce, and recent surveys have occurred in a changing environment, with increased numbers of pharmacists in the labor market. OBJECTIVES: We sought to investigate the rate of unemployment and situations of unemployed pharmacists. METHODS: Data from the 2019 National Pharmacist Workforce Survey were analyzed, focusing on an initial question about employment status and follow-up questions for unemployed respondents about whether they were seeking a job, the reason they were unemployed, and how long they had been unemployed. RESULTS: Overall, 4.4% of the respondents were unemployed, with higher rates occurring for female pharmacists, older pharmacist cohorts, and respondents of color, with the highest rate occurring (9.3%) for Black pharmacists. Most (74.4%) of the unemployed pharmacists were seeking a job in pharmacy, but 16.6% were not seeking any job. Nearly two-thirds of the unemployed pharmacist respondents had left the workforce involuntarily, with men at higher rates than women. The youngest cohort of unemployed pharmacists was the least likely to be forced to leave and more likely to leave for workplace-related or personal reasons. Black pharmacists had the overall highest rate of leaving the workforce involuntarily. On average, the unemployed pharmacists had been out of work nearly 2 years (19.2 months), and the periods out of work ranged widely. Those seeking a job in pharmacy predominantly (75.7%) had been unemployed for 1 year or less. More than half of the pharmacists involuntarily unemployed had been unemployed for 6 months or less. CONCLUSION: An increased rate of unemployment and a higher proportion of those unemployed seeking work occurred in this most recent national survey of the pharmacist workforce. Differences in the extent of unemployment and whether leaving the workforce was voluntary or involuntary occurred in pharmacists of color and in some age cohorts.

Factors Influencing Judgments to Consult Prescription Monitoring Programs: A Factorial Survey Experiment.

BACKGROUND: Prescription monitoring programs (PMPs) can provide health care professionals with valuable information. However, few studies have explored providers' decision making for accessing PMPs. AIMS: This study aimed to identify provider characteristics and situational factors most influencing perceived importance of consulting the PMP for patients in a simulated context. DESIGN: The study used a cross-sectional factorial survey. SETTINGS: The survey was administered electronically. PARTICIPANTS/SUBJECTS: Community pharmacists, advanced practice registered nurses (APRNs), and physicians in Iowa. METHODS: Participants were recruited by mail which included a link to the online survey. The survey consisted of demographic questions, eight randomly generated vignettes, and one ranked item. The vignettes described a hypothetical prescription using eight experimental variables whose levels were randomly varied. Respondents evaluated each vignette for importance to access the PMP. Analyses used linear mixed-effects models in R (Version 3.5.0). RESULTS: A total of 138 responses were available for multilevel analysis. Women, physicians, and APRNs rated it more important to consult the PMP for a given prescription compared with men and pharmacists. Accessing a PMP was perceived as more important with cash payments, quantity dispensed, suspicion for misuse, hydromorphone and oxycodone prescriptions, and headache. Advancing age, postoperative pain, and anxiety or sleep indications were associated with less importance. CONCLUSIONS: Age, indication for prescribing, misuse, and payment mode each independently had greater importance to providers in accessing the PMP. This was the first study to isolate the influence of different controlled substances on how important it was to consult the PMP.

Use of a fall risk evaluation in a community-based pharmacy.

BACKGROUND: Falls in older adults are a serious public health concern. They increase health care expenditure and account for more than $30 billion in direct medical costs. Medication-related problems can contribute to fall risk, and community-based pharmacists are well positioned to intervene, given their role in monitoring ongoing medications. OBJECTIVES: To evaluate the integration of a fall risk screening assessment (i.e., Stopping Elderly Accidents, Deaths, and Injuries [STEADI]) into community pharmacy practice and to report on the targeted medication management interventions that pharmacists made for patients aged 50 years or older with a fall risk potential. PRACTICE DESCRIPTION: A service-oriented independent pharmacy in the Midwest United States that uses an in-house clinical software program to perform a prospective drug utilization review and document clinical interventions. PRACTICE INNOVATION: A 3-item STEADI fall risk screening assessment was administered from October 15, 2018, to January 31, 2019, to 311 pharmacy patrons aged 50 years or older taking high-risk medications. EVALUATION: For those with a positive screen for fall risk, the 12-item STEADI fall risk assessment was administered. A pharmacist performed a comprehensive medication review (CMR) for these patients. Education and medication recommendations were provided. RESULTS: Fifty-three patients (17%) responded "Yes" to at least 1 prescreening question. The mean total STEADI fall risk score was 5.7 out of 12. The most commonly reported STEADI item was a worry regarding falling (75.5%) and sometimes feeling unsteady when walking (67.9%). Education regarding falls was provided to all the patients who received the study CMR, but only 6 medication changes were made to the prescribers, of which 4 were accepted. CONCLUSION: The STEADI assessment was useful in identifying patients who were potentially at a risk of falls. More work pertaining to deprescribing high-risk medications for at-risk patients seems to be needed.

The developing role of community pharmacists in facilitating care transitions: A systematic review.

BACKGROUND: The impact of multidisciplinary interventions to support patients moving from hospital to home have generally demonstrated a benefit. However, the role of community pharmacists is still being defined. OBJECTIVES: To review, with the use of the Coleman Care Transitions Intervention (CTI) pillars, the interventions performed by community and ambulatory-care pharmacists for patients undergoing care transitions. DATA SOURCES: The following databases were searched for manuscripts published from 1997 to 2017: Pubmed, Cochrane Database, Cinahl, and Embase. DATA EXTRACTION: Two authors screened manuscripts for relevancy. Studies were included if they evaluated patient care processes by community or ambulatory-care pharmacists as part of care transitions beyond receiving a discharge summary. Data were abstracted by one author and reviewed by the other. RESULTS: Twelve studies were included in the review, 8 of which were from the community setting. Each CTI pillar was represented, although to differing degrees. Pharmacists applied their experience in reviewing medications, identifying and resolving drug therapy problems, and providing education to this new context. Better mechanisms are needed to notify pharmacists of patients undergoing transition, grant access to medical records, and provide appropriate reimbursement. The CTI pillars of assisting patients with personal health records and discussing condition red flags were infrequently used, suggesting an area for exploration. CONCLUSION: Although there are important structural barriers to address, community pharmacists are increasingly positioned to contribute to care transitions, and there are numerous interventions that can be combined when creating new programs.

A community pharmacist-led service to facilitate care transitions and reduce hospital readmissions.

OBJECTIVES: To assess the impact of a community pharmacist-delivered care transition intervention on 30-day hospital readmissions. SETTING: A single private 263-bed hospital in the Midwest United States and 12 partnering community pharmacies, 1 serving as primary pharmacy. PRACTICE INNOVATION: Adult general medicine inpatients were evaluated by nursing staff with the use of a worksheet based on the Better Outcomes by Optimizing Safe Transitions (BOOST) readmission risk toolkit. The highest-risk patients were enrolled in a 3-contact intervention. First, a pharmacist from the primary community pharmacy delivered an in-room work-up. The pharmacist focused on medication education, problem identification, and verifying medication access following discharge. A pharmacist visited the hospital for approximately 4 hours most weekdays, during which the pharmacist saw 3-4 patients. A community pharmacist telephoned these patients 8 and 25 days after discharge. EVALUATION: The intervention was provided to 555 patients who had a mean readmission risk worksheet score of 1.90 (SD 1.13) and not provided to 430 patients with lower readmission risk worksheet scores, which averaged 0.68 (SD 0.86; P < 0.001). Thirty-day readmissions to the study hospital were lower for intervention patients (8.1%) versus comparison patients (21.4%; P < 0.001). Thirty-day readmissions to any hospital were calculated for a subsample of 129 intervention patients and 103 comparison patients with Medicare Fee for Service insurance for which claims were available, but the difference (10.9% and 15.5%, respectively) did not reach statistical significance (P = 0.328). PRACTICE IMPLICATION: A community pharmacy was successful in partnering with a hospital and other community pharmacies to lead a care transitions intervention associated with reduced 30-day same-hospital readmissions. CONCLUSION: A community pharmacist-led intervention delivered to higher-risk patients showed a significant decrease in readmission rate to the same hospital compared with lower-risk patients hospitalized in the same unit but not receiving the intervention. This supports the community pharmacists' role in care transitions.

Evaluation of community pharmacist-provided telephone interventions to improve adherence to hypertension and diabetes medications.

OBJECTIVES: To 1) identify specific patient barriers and pharmacist interventions to medication adherence by means of the Drug Adherence Work-Up (DRAW) tool; and 2) measure patient adherence to antihypertensive and antidiabetic medications by calculating proportion of days covered (PDC) before and after pharmacist telephone adherence interview. DESIGN: This prospective quality-improvement study consisted of telephonic interviews and targeted interventions to increase medication adherence based on patient-specific barriers. The baseline PDC was electronically calculated for each patient, and postintervention PDCs were manually calculated at 90 days and 180 days after baseline. The measurement period in each PDC calculation was 180 days. SETTING AND PATIENTS: This study was conducted in a small-chain independent pharmacy in rural Midwest United States. Patients taking an antihypertensive or oral antidiabetic medication were identified through an online platform and contacted if they had a PDC of less than 80% during the previous 180 days. OUTCOME MEASURES: Baseline and postinterview PDC were calculated for each patient who received an adherence interview. Frequency of specific barriers and pharmacist interventions were identified and analyzed. RESULTS: Ninety-seven eligible patients were identified. Fifty-six patients participated in an interview. Of these, a total of 66 barriers to adherence were identified. Pharmacists implemented 76 interventions for these patients, and 43 patients were included in final PDC calculations. From baseline, 69.0% of patients with hypertension and 64.3% of patients with diabetes reached a PDC of greater than 80% within 3 months. The most frequently identified barrier was forgetfulness on routine days, and the most common interventions were patient education, deactivated drug, and recommend or start medication synchronization program. CONCLUSION: Using pharmacists to identify and address patient barriers to adherence resulted in a significant increase in PDC among patients with hypertension and diabetes. The DRAW tool can be used in a community pharmacist-delivered telephonic intervention to improve medication adherence.

Any questions? Yes, do pharmacists monitor medications at refill?

OBJECTIVES: To describe pharmacists' self-reported refill monitoring activities and test for demographic and work setting differences that contribute to variation. METHODS: This study used a cross-sectional survey design. A 4-contact survey was mailed to 599 community pharmacists randomly selected from a list provided by the state board of pharmacy. Surveys were mailed in June and July 2013. Descriptive statistics and analysis of variance were used to characterize these data. RESULTS: Of the 599 surveys mailed, 269 complete responses were received for a 44.9% response rate. Pharmacists reported reviewing the patient's medication profile for 40% of refills. Of the 29% of refills handed off, pharmacists asked 70% of patients if they had any questions and 23% a specific question about drug therapy. Pharmacists at mass merchandisers and those in smaller towns were least likely to examine the profile, whereas pharmacists working at independent stores, owners, and pharmacists with a BS Pharm degree were most likely to hand off refills to patients. Demographic and work-setting characteristics factors were not associated with the rate of asking specific questions about the patient's drug therapy, although pharmacists with a BS Pharm, at an independent store, or working in the smallest towns were least likely to ask "Any questions?" when handing off the prescription. CONCLUSION: Pharmacists reported reviewing patient profiles, handing off prescriptions, and asking medication-specific questions to fewer than one-half of patients picking up refills. Pharmacists were more likely to inquire if patients had any questions than to ask specific questions, and other researchers have reported that the former phrasing may inadvertently serve to reduce patient engagement.

Community pharmacists, medication monitoring, and the routine nature of refills: a qualitative study.

OBJECTIVE: To describe the attitudes, contextual factors, and behaviors associated with medication monitoring in the dispensing process by community pharmacists. DESIGN: Descriptive qualitative research with semistructured interviews. SETTING: Midwestern community pharmacies or telephone. PARTICIPANTS: 12 licensed community pharmacists from chain, independent, and grocery pharmacies. INTERVENTION: 45-minute, semistructured interviews were conducted to gather detailed live experiences and perspectives pertinent to the study objective. MAIN OUTCOME MEASURES: Transcripts were coded descriptively and interpretively, originating with the input and monitoring process domains of the Health Collaboration Model. RESULTS: A thematic dichotomy was interpreted in the analysis. All participants discussed both (1) the technical and routine nature of their work, and (2) the problem-solving and relational aspects of practice. More specifically, medication monitoring was constrained by busyness, lack of patient interest, and the routine nature of refills, although to varying extents. Some predominantly responded to unique circumstances such as patient question-asking, prior memory of a patient interaction or service utilization, or technical issues such as medication cost. Others added unprompted questions of varying specificity when handing off the prescription to understand patient medication experiences. Pharmacists felt challenged by nonadherence monitoring because workflows made this information difficult to access and late refills were prevalent. CONCLUSION: Community pharmacies seeking to increase medication monitoring in the dispensing process may target the routine nature of refills and the availability of monitoring information.

An Exploratory Qualitative Study of Student Pharmacist Perspectives on Leadership.

OBJECTIVES: The objectives of this study were to (1) explore student pharmacists' knowledge and perceptions of leadership characteristics and behaviors, and (2) identify where students have opportunities to observe and exhibit leadership. METHODS: Data were collected from 32 students participating in a pharmacy leadership elective. Students submitted reflections about leadership definitions, characteristics, observations of leadership, and times when they felt like a leader. An inductive constant comparative analysis was used to code and categorize text segments from the reflections using NVivo 1.7.1 (Lumivero; Denver, CO). Holistic consideration of the reflections was used to identify an overarching theme. RESULTS: Three categories were specified to organize the data from the qualitative analysis: (1) Leader Characteristics, (2) Leading Behaviors, and (3) Leadership Contexts. One overarching theme was proposed encompassing the categories and sub-categories: Leadership Contradictions. The theme is based on the finding that students seemed able to identify leadership characteristics but emphasized descriptions like holding titles and completing managerial or task-focused duties, suggesting contradictions between conceptual understanding of leadership and leadership behaviors. CONCLUSION: The contradictions between students' conceptual understanding of leadership and what they offered as examples of how and where leadership was observed or applied to practice suggest additional activities and experiences may be warranted to help students appreciate that leadership extends beyond formal roles and demonstrates the ability to influence and support the achievement of shared goals of a team. Additionally, a multi-modal approach may enhance leadership assessment.

Medicare Part D plan-selection experience: qualitative findings from a national cross-sectional survey.

Background: A variety of services exit to assist eligible beneficiaries select Medicare Part D insurance plans; however, selecting an optimal plan remains a challenge. While patients would benefit from evaluating and switching their Medicare Part D plan on a yearly basis, few choose to do so. Objective: The objective of this study was to describe the Medicare Part D plan selection experience across all US states. Methods: This was a qualitative analysis using data from a cross-sectional Qualtrics panel survey administered in January 2022. Descriptive statistics were generated for demographic and patient-specific items for individuals who provided open-ended survey item responses. Open-coding and content analysis were used to analyze responses to the open-ended survey item. Results: Overall, 540 responses were received, with the largest number of responses from Florida (11%, 61). A total of 101 respondents (18.7%) of survey respondents provided open-ended comments. Qualitative analysis identified four response categories: Benefit design, Plan information and selection assistance, Plan Switching, and Plan-selection experience. Conclusions: Overall, participants expressed frustrations with high costs and plan restrictions. Many participants needed plan-selection assistance, with some individuals switching plans each year. Recent legislation may address difficulties related to medication costs; however, additional focus on resources and educational interventions may improve the Medicare Part D experience.

The association between cost sharing, prior authorization, and specialty drug utilization: A systematic review.

BACKGROUND: Specialty drugs are identified by high monthly costs and complexity of administration. Payers use utilization management strategies, including prior authorization and separate tiers with higher cost sharing, to control spending. These strategies can negatively impact patients' health outcomes through treatment initiation delays, medication abandonment, and nonadherence. OBJECTIVE: To examine the effect of patient cost sharing on specialty drug utilization and the effect of prior authorization on treatment delay and specialty drug utilization. METHODS: We conducted a literature search in the period between February 2021 and April 2022 using PubMed for articles published in English without restriction on date of publication. We included research papers with prior authorization and cost sharing for specialty drugs as exposure variables and specialty drug utilization as the outcome variable. Studies were reviewed by 2 independent reviewers and relevant information from eligible studies was extracted using a standardized form and approved by 2 reviewers. Review papers, opinion pieces, and projects without data were excluded. RESULTS: Forty-four studies were included in this review after screening and exclusions, 9 on prior authorization and 35 on cost sharing. Patients with lower cost sharing via patient support programs experienced higher adherence, fewer days to fill prescriptions, and lower discontinuation rates. Similar outcomes were noted for patients on low-income subsidy programs. Increasing cost sharing above $100 was associated with up to 75% abandonment rate for certain specialty drugs. This increased level of cost sharing was also associated with higher discontinuation rates and odds. At the same time, decreasing out-of-pocket costs increased initiation of specialty drugs. However, inconsistent results on impact of cost sharing on medication possession ratio (MPR) and proportion of days covered (PDC) were reported. Some studies reported a negative association between higher costs and MPR and PDC; however, MPR and PDC of cancer specialty drugs did not decrease with higher costs. Significant delays in prescription initiation were reported when prior authorization was needed. CONCLUSIONS: Higher levels of patient cost sharing reduce specialty drug use by increasing medication abandonment while generally decreasing initiation and persistence. Similarly, programs that reduce patient cost sharing increase initiation and persistence. In contrast, cost sharing had an inconsistent and bidirectional effect on MPR and PDC. Prior authorization caused treatment delays, but its effects on specialty drug use varied. More research is needed to examine the effect of cost sharing and prior authorization on long-term health outcomes.