Exploration of Network Facilitator Experiences Implementing Payer-Partner Programs within a Nationwide Clinically Integrated Network.

BACKGROUND: The Community Pharmacy Enhanced Services Network (CPESN) is a clinically integrated network (CIN) of approximately 3,500 community-based pharmacies in 48 local networks across the United States. CPESN USA promotes expansion of innovative programs within community-based pharmacies including value-based contracting for patient care services. As opportunities grow, it is important to define strategies and tools needed to implement payer-partner programs. OBJECTIVE: To explore strategies and resources utilized when implementing payer-partner programs within a CIN. METHODS: This cross-sectional electronic survey was emailed to forty-eight MNFs representing forty-eight local CPESN networks across the United States. An electronic survey was emailed to the MNF of each local CPESN network. Fourteen questions collected the MNFs experience with (1) opportunities at the local network, (2) resources found helpful for implementing payer-partner programs, (3) barriers to implementing payer-partner programs, (4) confidence with tasks related to payer-partner program implementation, and (5) reporting what types of teammates they work with or manage when implementing a payer-partner program. The survey was open for data collection for 65 days. Data was analyzed using descriptive statistics. RESULTS: 42 completed surveys were returned (response rate 87.5%). MNFs ranked the barriers most frequently experienced as buy-in effect (n=16, 41.0%) and management of pharmacy/network follow-through (n = 11, 28.2%). MNFs reported helpful resources for program implementation as peer-to-peer guidance (n=31, 79.5%) and program handouts/guides (n=30, 76.9%). MNFs reported additional resources needed as subject matter experts (n=23, 59.0%) and templated communications (n=22, 56.4%). MNFs expressed their highest levels of confidence in tasks related to leadership management (n=30, 76.9%) and implementing programs (n=28, 71.8%). CONCLUSION: Barriers to payer-partner program implementation within the clinically integrated network were buy-in effect, management of pharmacy/network follow-through, management of peers, and management of pharmacy/network implementation. Leaders within the CIN reported desires for a toolkit which iterates successful strategies and education on building community and accountability within local networks. Development of tailored support and resources can enhance the capacity of network leaders to scale payer-partner programs within community-based pharmacies.

Evaluation of a hybrid medication synchronization training module for pharmacy technicians.

BACKGROUND: Medication synchronization involves coordinating a patient's medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared with automatic refill-processing programs. Patients are 2-6 times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service. OBJECTIVE: This study aimed to develop a training program for pharmacy technicians regarding medication synchronization and assess changes in knowledge and confidence before and after implementing a training program. PRACTICE DESCRIPTION: An independent community pharmacy in North Carolina. Pharmacists provide medication therapy management, reimbursed clinical services, medication synchronization, and immunizations. PRACTICE INNOVATION: The training program included medication synchronization basics, patient enrollment process, processing a synced patient, and a hands-on practice session. EVALUATION METHODS: Technicians took a pre-training survey assessing knowledge and confidence before immediately completing a one-on-one pharmacist-led training session with a hands-on component regarding medication synchronization. Technicians took the same post-training survey 2 weeks after completing the training session and using medication synchronization in daily workflow. Pre- and post-training scores were assessed using a paired samples t test. RESULTS: Ten technicians completed the training program; 40% of the technicians were certified and 30% were enrolled in a PharmD program. The mean pre-training knowledge score was 78% (7.1 of 9 points), the mean post-training knowledge score was 92% (8.3 of 9 points), and the mean difference between the pre- and post-training knowledge scores was 13.4% (1.2 points), with a statistically significant difference (P = 0.0026). Confidence with conducting a medication synchronization call increased from 7.2 to 9.6 on a 10-point Likert scale, and confidence scores increased regarding incorporating medication synchronization into workflow from 6.9 to 8.7. CONCLUSION: The standardized technician training program increased knowledge and confidence in technicians regarding managing a medication synchronization program.

Incorporating social determinants of health into patient care workflows within a health-system specialty pharmacy.

BACKGROUND: The influence of adverse factors on social determinants of health (SDOH) and their impact on patient outcomes is widely recognized. Pharmacists, as accessible healthcare professionals, can play a pivotal role in identifying and addressing SDOH concerns. Health-system specialty pharmacies have consistently assisted patients in accessing expensive specialty medications and ensuring adherence to therapy. As such, they are uniquely positioned to address SDOH concerns of patients. OBJECTIVE: To assess the effectiveness of incorporating standardized SDOH screening and referral methods into the patient care workflows of a health-system specialty pharmacy. PRACTICE DESCRIPTION: The University of North Carolina Health Care (UNC Health) Specialty and Home Delivery Pharmacy is a health-system owned specialty pharmacy serving patients in North Carolina, South Carolina, and Virginia. It holds accreditations from the Utilization Review Accreditation Commission and Accreditation Commission for Health Care. PRACTICE INNOVATION: A standardized SDOH screening and referral method were integrated into patient care workflows of a health-system specialty pharmacy. If SDOH concerns were identified upon screening by a specialty pharmacist, patients were referred to an entity within the health-system responsible for connecting patients to local community resources to address their SDOH concerns. EVALUATION METHODS: The types of SDOH concerns, frequency of SDOH referrals, referral turnaround time, outcomes of the referrals, and patient demographics were evaluated to determine the impact of this project. Descriptive statistics were used to analyze results. RESULTS: Sixty-nine patients were included (female: n = 38, 55.1%; age (mean±SD: 48.9 ± 16.3). Eighty-seven SDOH concerns were reported, 54 patients (78.3%) were connected to local resources upon referral, and the average turnaround time of referrals was 2.2 business days. CONCLUSION: The findings of this pilot study highlight the effectiveness of incorporating SDOH screening and referral methods into specialty pharmacy workflows. Specialty pharmacies can successfully identify and address nonmedical factors impacting patients.

Impact of health information exchange access on medication management recommendations in a community-based pharmacy setting.

BACKGROUND: Community-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a health information exchange (HIE) on pharmacist recommendations during a medication management encounter. OBJECTIVE: The objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE. PRACTICE DESCRIPTION: Moose Pharmacy is one of few community pharmacies in North Carolina with access to a large health-system HIE. PRACTICE INNOVATION: This cohort study reviewed data over 4 months. Patients were identified for medication management based on filling eligible medications for atherosclerotic cardiovascular disease (ASCVD), hypertension, diabetes, dyslipidemia, or heart disease. Pharmacy personnel used the HIE to acquire laboratory test results. At the medication management appointment, the pharmacist collected blood pressure (BP), assessed smoking history, and medication or disease concerns. ASCVD risk score, statin therapy, A1c, and BP were assessed. Follow-up with the patient or provider was determined, if needed, and documented. EVALUATION METHODS: Collected records were reviewed to quantify the number and type of clinical recommendations made by the pharmacist, and their acceptance status by the prescriber. Descriptive analyses were used to analyze results. RESULTS: Thirty-four encounters were included. Most participants had diabetes (n = 21, 62%) and hypertension (n = 31, 91%). Nearly one-third of encounters (n = 11, 32%) resulted in a pharmacist recommendation. Recommendations were for BP dose adjustments (n = 4, 36%), diabetes medication changes (n = 3, 27%), and statin initiations/escalations (n = 4, 36%). Four recommendations (36%) were accepted, with 1 requiring modifications from the provider; 3 recommendations (27%) were declined; and 3 recommendations (27%) were unanswered. CONCLUSION: Access to progress notes and laboratory values using an HIE enhanced the pharmacist's ability to provide enhanced patient care recommendations during medication management consultations.

Reprint of: Evaluation of a community-based pharmacy resident-led continuous glucose monitoring program within a family medicine clinic.

BACKGROUND: Pharmacist-driven continuous glucose monitoring (CGM) is associated with reduced hemoglobin A1c (HbA1c) and achievement of daily glycemic goals. Community-based pharmacists are well-positioned to improve CGM uptake among patients with diabetes due to their accessibility and expertise. However, little data exist evaluating the outcomes of CGM services led by a community-based pharmacist. OBJECTIVE: To evaluate the impact of a community-based pharmacy resident-driven CGM service on HbA1c, revenue, and patient satisfaction. PRACTICE DESCRIPTION: Independent community pharmacy sharing a clinical services agreement with a primary care clinic for Postgraduate Year One (PGY1) Community-based Pharmacy Residents to provide patient care under general supervision of the physician. PRACTICE INNOVATION: Patients were offered CGM services if they were 18+ years with an HbA1c > 7.0% and had insurance coverage for CGM. Enrolled patients engaged in three months of pharmacist-led appointments for CGM application, data interpretation, diabetes education, and lifestyle management. Current Procedural Terminology (CPT) codes 99211, 95250, or 95251 were billed based on each encounter. HbA1c values were collected at program enrollment and conclusion. Patients completed a satisfaction survey at program conclusion. EVALUATION METHODS: Demographics and billed CPT codes were collected from the electronic health record. Descriptive statistics were used to analyze data. RESULTS: Eighteen patients were included. A mean reduction of 1.2% occurred in HbA1c (n = 12; 9.7%-8.5%). Forty CPT codes were billed, generating $3671.40 of revenue. Satisfaction surveys were collected for 50% of participants (n = 9). Most were satisfied with the CGM service and its individual components (n = 8, 89%). Most were willing to continue using CGM devices and receive diabetes education from a pharmacist (n = 8, 89%). CONCLUSION: A community-based pharmacist-led CGM service demonstrated a reduction in HbA1c and generated revenue for the clinic. Patients reported satisfaction and willingness to continue the service.

Evaluation of a community-based pharmacy resident-led continuous glucose monitoring program within a family medicine clinic.

BACKGROUND: Pharmacist-driven continuous glucose monitoring (CGM) is associated with reduced hemoglobin A1c (HbA1c) and achievement of daily glycemic goals. Community-based pharmacists are well-positioned to improve CGM uptake among patients with diabetes due to their accessibility and expertise. However, little data exists evaluating the outcomes of CGM services led by a community-based pharmacist. OBJECTIVE: To evaluate the impact of a community-based pharmacy resident-driven CGM service on HbA1c, revenue, and patient satisfaction. PRACTICE DESCRIPTION: Independent community pharmacy sharing a clinical services agreement with a primary care clinic for Postgraduate Year One (PGY1) Community-based Pharmacy Residents to provide patient care under general supervision of the physician. PRACTICE INNOVATION: Patients were offered CGM services if they were 18+ years with an HbA1c > 7.0% and had insurance coverage for CGM. Enrolled patients engaged in three months of pharmacist-led appointments for CGM application, data interpretation, diabetes education, and lifestyle management. Current Procedural Terminology (CPT) codes 99211, 95250, or 95251 were billed based on each encounter. HbA1c values were collected at program enrollment and conclusion. Patients completed a satisfaction survey at program conclusion. EVALUATION METHODS: Demographics and billed CPT codes were collected from the electronic health record. Descriptive statistics were used to analyze data. RESULTS: Eighteen patients were included. A mean reduction of 1.2% occurred in HbA1c (n = 12; 9.7%-8.5%). Forty CPT codes were billed, generating $3671.40 of revenue. Satisfaction surveys were collected for 50% of participants (n = 9). Most were satisfied with the CGM service and its individual components (n = 8, 89%). Most were willing to continue using CGM devices and receive diabetes education from a pharmacist (n = 8, 89%). CONCLUSION: A community-based pharmacist-led CGM service demonstrated a reduction in HbA1c and generated revenue for the clinic. Patients reported satisfaction and willingness to continue the service.

College student perceptions of pharmacist-provided hormonal contraception.

BACKGROUND: North Carolina immunizing pharmacists are authorized to provide oral and transdermal hormonal contraception to eligible patients. In March 2022, implementation of this enhanced patient care service began statewide, after approval of standing orders and published training from the North Carolina Association of Pharmacists. Two pharmacy locations on a college campus began offering pharmacist-provided hormonal contraception shortly after approval. OBJECTIVE: The objective of this study was to assess the willingness of students to seek pharmacist-provided hormonal contraception and the willingness of students to pay for this service. METHODS: This cross-sectional study was conducted on the campus of a public, research-intensive university. To be included, individuals must have been 18 years of age or older, enrolled as a student or postdoc at the university, and must have used prescribed hormonal oral contraception within the last year. Individuals who declined consent or surveys that were not at least 90% complete were excluded. The survey was administered via Qualtrics and distributed via e-mail and printed flyers with a QR code. The survey opened February 10, 2023, and closed April 24, 2023. RESULTS: In total, 170 survey responses were analyzed. Almost three-fourths of participants (72.9%) were not aware that pharmacists could provide hormonal contraception in North Carolina. All participants identified at least one benefit to pharmacist-provided contraception, with the most common responses being "I believe it would save time" (85.3%) and "appointment not needed" (89.4%). Almost two-thirds of participants (65.3%) identified at least one barrier that would prevent them from seeking pharmacist-provided contraception. The most common barrier identified was privacy at the pharmacy (20.0%). Most participants (81.8%) reported that they are willing to pay for this service, with the majority willing to pay up to $29. CONCLUSION: Students on this campus seem to have a receptive attitude toward pharmacist-provided hormonal contraception and are willing to pay for a consultation.

Navigating the journey as a peer reviewer: A roadmap to success.

Peer review is an essential step in scientific progress and clinical improvement, providing opportunity for research to be critically evaluated and improved by one's colleagues. Pharmacists from all job settings are called to serve as peer reviewers in the ever-growing publication landscape of the profession. Despite challenges to engagement such as time and compensation, peer review provides considerable professional development for both authors and reviewers alike. This article will serve as a practical guide for peer reviewers, discussing best practices as well as the handling of different situations that may arise during the process.

Barriers and best practices related to documentation of electronic care plans: A survey of community-based pharmacies in 4 states.

BACKGROUND: The provision of enhanced services within community-based pharmacy is increasing. However, an opportunity remains to improve efficient documentation of services, and barriers to implementation exist. Electronic care (eCare) planning is the act of using health information technology to submit a pharmacist eCare plan for a patient encounter, similar to a Subjective, Objective, Assessment, Plan note. OBJECTIVE: The primary objective was to identify barriers and best practices related to documentation of eCare plans within community-based pharmacies participating in 4 Community Pharmacy Enhanced Services Networks (CPESN). METHODS: One of two 24-question electronic surveys was distributed to pharmacies in CPESN Florida, Georgia, Mississippi, and Ohio. Pharmacies submitting fewer than 10 eCare plans in the previous quarter received a survey to assess barriers to implementation; pharmacies submitting 10 or more eCare plans received a survey to assess best practices for implementation. Surveys remained open for 14 days, with a reminder sent on days 7 and 12. Data were analyzed using descriptive statistics. An independent-samples t test assessed for between-group differences in the overall knowledge. RESULTS: A total of 63 responses were received (Barriers = 19; Best Practices = 44). Best Practices pharmacies earned a higher overall knowledge score than Barriers pharmacies (9.26 vs. 7.26 out of 13 points, P = 0.001). Frequently reported barriers were staffing resources (n = 11, 57.9%), perceived time commitment (n = 8, 42.1%), and lack of payment (n = 8, 42.1%). Most Best Practices pharmacies agreed or strongly agreed that they involve pharmacists (n = 36, 81.8%) and student pharmacists (n = 33, 75.5%) in eCare planning processes. Common foci of eCare plans by Best Practice pharmacies were medication synchronization (n = 35, 79.5%), drug therapy problems (n = 29, 65.9%), adherence assessment (n = 28, 63.6%). CONCLUSIONS: A difference in knowledge and perceptions exists between pharmacies who regularly eCare plan and those who do not. Observed trends in knowledge, perceptions, barriers, and best practices should be used to create a training to increase eCare planning quality and consistency.

Analysis of provider-generated revenue and impact on medication reconciliation from a pharmacist-led chronic care management service.

BACKGROUND: Published data on pharmacist-provided chronic care management (CCM) services is limited, particularly for programs led by community-based pharmacists. OBJECTIVE: The objective was to quantify the total revenue generated from a community pharmacist-led CCM service, including CCM billing and appointment referrals. A second objective was to identify the types and frequencies of medication discrepancies identified during medication reconciliation. PRACTICE DESCRIPTION: Realo Drugs is a group of 18 independent community pharmacies serving eastern North Carolina. PRACTICE INNOVATION: Exploration of revenue generated from a community pharmacist-led CCM service. EVALUATION METHODS: This retrospective analysis assessed interventions completed by pharmacists between April 1, 2018 through June 30, 2019. Data was extracted from the electronic health record (EHR), including revenue generated from CCM billing codes, appointment referrals made by the pharmacist resulting in a completed in-office appointment, and which patients received medication reconciliation. The types and frequencies of medication discrepancies were documented, including medication no longer being used by the patient, medication omission, and strength or dose mismatch. Descriptive statistics were used to analyze data. RESULTS: Over 15 months with a total of 112 patients, a total of $26,148 was generated from CCM services, representing an average of $15.56 per patient per month. The majority (approximately 80%) of the revenue was generated from noncomplex patient encounters. Of the 239 medication reconciliations completed, 609 medication discrepancies were identified. The majority of medication discrepancies (67%) were categorized as "patient no longer takes medication listed on EHR medication list." The second most common discrepancy was "patient takes medication not listed on the EHR medication list" (22%), followed by "strength/dose mismatch" (10%). CONCLUSION: These data can demonstrate to provider partners the sources of revenue that can be provided through CCM services. In addition to revenue, pharmacists can positively impact patient care through identification of medication discrepancies through medication reconciliation.

Implementation of a community-based pharmacist-run attention deficit hyperactivity disorder clinic in a college health center.

BACKGROUND: Published evidence is lacking to describe the pharmacist's role in medication management within an attention deficit hyperactivity disorder (ADHD) specialty clinic. OBJECTIVES: The objectives were (1) to measure the growth of an ADHD clinic in a college health center after the integration of clinical pharmacists and (2) to evaluate provider adherence to clinic policies and procedures before and after pharmacist integration. PRACTICE DESCRIPTION: In 2017, a pharmacist-run ADHD clinic was established at a college campus. PRACTICE INNOVATION: Pharmacists conducted collaborative initial visits with psychiatrists and independently provided follow-up appointments for patients with ADHD. EVALUATION METHODS: Data were extracted from the electronic health record for patients aged 18 years or older with an ADHD diagnosis who completed a medication evaluation or medication follow-up visit from July 1, 2016 to June 30, 2019. Data were excluded if it was for another visit type, was a non-ADHD clinic provider visit, or if the visit note was classified. Data before the pharmacist integration (July 1, 2016-June 30, 2017) were compared with data after the pharmacist integration (July 1, 2017-June 30, 2019). Chi-square tests of independence evaluated differences in blood pressure monitoring, heart rate monitoring, and stimulant medication contract signature between psychiatrist- and pharmacist-run appointments. RESULTS: Pharmacist presence in the ADHD clinic increased from 0 full-time equivalent (FTE) to 0.2 FTE over 3 years. The number of appointments increased by 1003% (from 26 to 287). Compared with psychiatrist-run appointments, pharmacist-run appointments were more adherent to monitoring blood pressure (11% vs. 77%, P < 0.001) and heart rate (6% vs. 75%, P < 0.001), as well as clinic policy requiring a patient's signature on a stimulant medication contract (64% vs. 75%, P = 0.019). CONCLUSION: Pharmacists can assist psychiatrists in medication management of ADHD in the college health setting. A pharmacist-psychiatrist collaboration increased quality of care and monitoring of medication adverse effects.

Analysis of prior authorization success and timeliness at a community-based specialty care pharmacy.

BACKGROUND: Specialty medications may require a prior authorization (PA) before a patient can access the medication. Providers often identify PA approval as a burden for the practice. Pharmacists can facilitate the completion of the PA process. OBJECTIVE: The primary objective was to evaluate the time to first PA decision (approval or denial) for dermatologic medications dispensed by a community-based specialty pharmacy. A secondary objective was to compare PA timeliness (time to PA approval and time to first medication fill) between a community-based specialty pharmacy and a dermatology provider office. PRACTICE DESCRIPTION: Realo Specialty Care is a community-based independent specialty pharmacy that provides comprehensive care to patients with complex and chronic conditions such as plaque psoriasis, hidradenitis suppurativa, and atopic dermatitis. Pharmacy services include PA assistance, comprehensive medication management, patient education, and adherence monitoring. PRACTICE INNOVATION: Pharmacy dispensing system data were used to conduct a retrospective analysis of the effectiveness at resolving PA requests. PAs are traditionally completed by a provider's practice, and data are documented within the pharmacy system as a PA task. EVALUATION METHODS: Data included PA tasks for dermatology prescriptions for patients aged 18 years or older between January 1, 2017, and June 30, 2019. Initial receipt of the prescription, PA decision, and PA decision date were noted in the PA task and confirmed via fax documentation. The date of first fill was confirmed by prescription data. RESULTS: The pharmacy completed 677 PA tasks with a mean time to PA decision of 1.9 days, whereas the provider's office averaged 20.9 days (P < 0.001). The pharmacy demonstrated a mean time to first fill of 6.6 days, whereas the provider's office averaged 16.2 days (P < 0.001). CONCLUSION: Pharmacies can effectively complete PAs to expedite the filling process for patients and increase medication access. Provider practices could benefit from delegating these tasks to a partnered pharmacy.

Community-based pharmacy use of the Pharmacist eCare Plan: A retrospective review.

BACKGROUND: Pharmacists in community-based settings document patient care using the Pharmacist eCare Plan (PeCP). OBJECTIVE: To conduct a pilot evaluation of the PeCP use and documentation of Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes within select community-based pharmacies. PRACTICE DESCRIPTION: Moose Pharmacy operates 7 locations in rural North Carolina that are part of the Community Pharmacy Enhanced Services Network (CPESN). The Moose Pharmacy Medication Adherence Program (MooseMAP) targets patients with a chronic condition who would benefit from medication synchronization, adherence packaging, and monthly calls. PRACTICE INNOVATION: CPESN pharmacies use the PeCP to track a patient's concerns, goals, interventions, and medication-related information. The PeCP standard requires pharmacies to detail a patient's current medication regimen and health concerns as well as the pharmacy's interventions and patient's health over time. EVALUATION METHODS: Data were included if the patient was enrolled in MooseMAP and had a free-text note in the eCare Plan. Data were excluded if the medication-related problem (MRP) or intervention was a general health problem without a valid SNOMED CT code. Data were categorized into MRPs, medication interventions, education, and referrals. The International SNOMED CT browser and pharmacy health information technology (PHIT) value sets were searched; data sets without existing codes were submitted to the appropriate oversight authorities for future inclusion. Data were analyzed using descriptive statistics. RESULTS: Emerging codes were identified that resulted in 91 recommendations to PHIT for development of new SNOMED CT codes and 113 recommendations to PHIT for inclusion in the PHIT value sets. In total, 66% of MRPs did not have a valid SNOMED CT code, and 78% of MRPs were not included in a PHIT value set. The most prevalent gap in MRP or intervention documentation related to medication use issues. CONCLUSION: Incorporating emerging codes into documentation systems should enable the profession to better communicate value to health care stakeholders.

Using pharmacy technicians to maximize pharmacist intervention with home health service patients.

OBJECTIVES: The objectives of this study were to assess 30- and 60-day hospitalizations and to determine the number of medication therapy problems (MTPs) identified during pharmacy technician-driven medication reconciliation for high- to very high-risk home health patients. SETTING: The study was conducted in 8 independent community pharmacy locations. PRACTICE DESCRIPTION: Realo Discount Drugs is a group of 16 independent community pharmacies serving eastern North Carolina. PRACTICE INNOVATION: Realo Discount Drugs partnered with Well Care Home Health to provide medication reconciliation services to high- and very high-risk patients. A pharmacy technician contacts the patient to obtain an accurate medication list and complete a falls risk assessment and depression screening. The technician updates the medication list, allergies, and vaccination status in the electronic health record (EHR). The pharmacist reviews the medication list for completeness; assesses for falls risk, depression, and medication interactions; and generates communication to the provider for clarifications or recommendations, if needed. Additional counseling points that need to be conveyed to the patient by the home health nurse are documented in the EHR. EVALUATION: Thirty- and 60-day hospitalizations for enrolled patients were manually pulled from documented transfers in the EHR and compared with data from a third-party administrator. MTPs were categorized by the pharmacist and documented. Descriptive statistics were used to evaluate the data collected. RESULTS: At 30 days from the start of care, 13.4% (93/695) of patients who received pharmacy services were hospitalized compared with 26.8% (143/534) of patients who did not receive pharmacy services (P < 0.01). At 60 days from the start of care, 20.9% (145/695) of patients who received pharmacy services were hospitalized compared with 33.3% (178/534) of patients who did not receive pharmacy services (P < 0.01). CONCLUSION: A technician-driven medication reconciliation process led to a reduction in hospitalizations and identified MTPs in home health patients.

Impact of quality measures performed through pharmacist collaboration with a primary care clinic.

OBJECTIVE: The objective was to assess the clinical and financial impact of a pharmacist integrated within a primary care practice on quality measures of the merit-based incentive payment system (MIPS). SETTING: The study was conducted in a multidisciplinary primary care practice in Charlotte, NC. PRACTICE DESCRIPTION: A collaborating pharmacist from an independent community pharmacy is integrated within clinic workflow. In this team-based model, pharmacists work alongside providers to furnish comprehensive care, focusing on MIPS quality measure improvement through Medicare annual wellness visits (AWVs) and chronic care management (CCM). PRACTICE INNOVATION: Quality measure achievement was assessed from completed face-to-face AWVs, phone call CCM, or both. EVALUATION: From January 1, 2017, to December 31, 2018, 403 patients in 2017 and 565 patients in 2018 were eligible to be seen by the collaborating pharmacist for either an AWV, CCM, or both services. Measure achievement was characterized using descriptive statistics. Billing reports were used to determine the average monthly dollar amount of Medicare Part B claims submitted. RESULTS: The percentage of patients achieving quality measures increased for 3 measures, decreased for 2 measures, and was neutral for 1 measure. The percentage of patients achieving quality measures resulted in a MIPS quality performance score of 60 of 60 points, which contributed to a final MIPS score of 100 of 100 points and a positive (+) 1.88% payment adjustment in 2019. Extrapolating from previous volume, the provider's total MIPS payment adjustment may result in an additional $16,920 in annual reimbursement. CONCLUSION: Pharmacist-provided collaborative clinical services in the primary care setting appear to ensure achievement of MIPS quality measure benchmarks, potentially increasing the practice's annual MIPS reimbursement by $16,920.

Development of a process to improve medication adherence in patients with rheumatoid arthritis in the specialty pharmacy setting.

OBJECTIVE: To develop a disease-specific patient questionnaire to be used during monthly follow-up telephone calls ("refill calls") for patients with rheumatoid arthritis receiving a noninfused biologic medication. SETTING: Independent specialty community pharmacy in North Carolina. PRACTICE DESCRIPTION: Realo Specialty Care was formed to provide a patient-centered care approach to patients with complex, chronic conditions such as HIV/AIDS, hepatitis, rheumatoid arthritis, and plaque psoriasis. The services include medication therapy management, patient education, prior authorization assistance, adverse drug reaction monitoring, and an adherence program. PRACTICE INNOVATION: Using national guidelines, an 8-item questionnaire that addressed overall health, adherence, and adverse medication events for noninfused biologic medications for rheumatoid arthritis was developed. When an eligible patient was identified, a notification was added within the pharmacy's dispensing software. The pharmacist or technician was prompted to use the newly developed questionnaire during the monthly refill call. EVALUATION: Patients' responses were archived in their profiles within the pharmacy's dispensing software. The change in adherence was assessed by the mean medication possession ratio (MPR) before the intervention (July 2018 to September 2018) and monthly after the intervention (November 2018 to February 2019). RESULTS: A total of 29 patients were eligible on the basis of an MPR less than 90%; data from 18 patients were used. The mean MPR increased from 71% preintervention (September 2018) to 75% in the first month after the start of the intervention (November 2018). The mean MPR reached a high of 81% in the fourth month after the start of the intervention (February 2019), representing a 10% increase in the MPR. CONCLUSION: The specialty pharmacy team successfully developed and used the rheumatoid arthritis questionnaire during the monthly refill calls. The implementation of the disease-specific questionnaire led to increased medication adherence and enhanced communication with patients with regard to their health and outcome of therapy.

Effect of a standardized module for training pharmacy technicians to assist with chronic care management services.

OBJECTIVE: To measure the change in knowledge of a certified pharmacy technician (CPhT) after completing a standardized educational module highlighting key information required to complete chronic care management services. SETTING: Seven independent community pharmacy locations. PRACTICE DESCRIPTION: Realo Discount Drugs is a group of 19 independent community pharmacies serving eastern North Carolina. PRACTICE INNOVATION: Three modules were created to educate CPhTs: (1) basics of chronic care management, (2) medication and vaccination reconciliation and screening tools, and (3) assessing chronic diseases and setting goals. Each module averaged 10 minutes and was in the form of voice-over Microsoft PowerPoint (Microsoft Corporation, Redmond, WA) slides. EVALUATION: The CPhTs anonymously took a computerized 20-question pretest before viewing the modules. The CPhTs were asked to view the modules within 7 days of completing the pretest. After at least 14 days of module completion, the CPhTs anonymously took the same computerized 20-question posttest and a 3-question survey. Pre- and posttest scores were compared using a paired t-test. RESULTS: A total of 12 participants completed the study. The mean pretest score was 60% (12/20 points), the mean posttest score was 75% (15/20 points), the mean difference between pre- and posttest scores was an increase of 15% (3 points), and this difference was statistically significant (P = 0.004). There were 10 CPhTs who had an increase in score from pre- to posttest. Most of the CPhTs found the modules to be informative and to have value in increasing their abilities and responsibilities in performing as CPhTs. Some of the CPhTs reported using the learned information daily. CONCLUSION: These standardized modules were effective in increasing clinical knowledge of the CPhTs for completing chronic care management services. New topics can be added in the future, as well as following up with CPhTs on missed questions and knowledge application.

The effect of community pharmacist-led health coaching on clinical outcomes.

OBJECTIVE: To evaluate the impact of a community pharmacist-driven health coaching program on clinical outcomes from baseline to 1 year. SETTING: Independent community pharmacy in western North Carolina. PRACTICE DESCRIPTION: Sona Pharmacy + Clinic is an independent community pharmacy offering enhanced clinical services such as medication synchronization, adherence packaging, and free delivery. Sona Benefits offers pharmacy benefit manager (PBM) services to self-funded plans in western North Carolina. PRACTICE INNOVATION: Sona Health Management Program is a disease management program offered to Sona Benefits PBM clients; the services began in October 2016. EVALUATION: Change in clinical outcome measures (total number of medications, blood pressure, hemoglobin A1c, weight, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], patient health questionnaire [PHQ-9] scores, and asthma control test [ACT] scores) were assessed for members who participated in the program for a minimum of 12 months for at least 2 of the following conditions: hypertension, hyperlipidemia, diabetes, depression, and asthma. RESULTS: Health coaching was provided to 42 members (mean age of 55.9 years and 2.7 qualifying disease states). The mean number of medications per patient significantly decreased from 7.2 to 6.2 (P = 0.02). Systolic and diastolic blood pressures were significantly reduced from 130.8 mm Hg to 125.7 mm Hg (P = 0.04) and 76.9 mm Hg to 73.7 mm Hg (P = 0.04), respectively. Other clinical outcome measures evaluated, such as hemoglobin A1c, weight, LDL-C, HDL-C, TG, and PHQ-9 and ACT scores, were improved but did not reach significance. CONCLUSION: These results suggest that community pharmacists can have a positive impact on patients with multiple chronic conditions through health coaching services. This project suggests a potential model of pharmacist health coaching through pharmacist-run PBM services.

A standardized team-based approach for identifying naloxone-eligible patients in a grocery store pharmacy.

OBJECTIVES: To define a standardized team-based approach to identify naloxone-eligible patients in a community pharmacy and to evaluate the impact of the approach on the number of naloxone orders dispensed. SETTING: Two locations within one district of a chain pharmacy. PRACTICE DESCRIPTION: Kroger is a national grocery store pharmacy. PRACTICE INNOVATION: A standardized team-based approach was implemented from November 2017 to February 2018 into the dispensing workflow to identify naloxone-eligible patients. Training was provided to team members (e.g., pharmacist, student pharmacist, technician) at the intervention store. Persons age 18 years and older who met more than 1 of the following criteria were included: greater than or equal to 50 morphine milligram equivalents per day, concurrent benzodiazepine and opioid use, fentanyl patch greater than or equal to 25 µg/h, and documented or verbal history of overdose or substance use disorder. Persons were excluded if they were younger than 18 years, did not speak English, or received an opioid prescription of less than 5 days' duration and no opioid exposure during the previous 30 days. EVALUATION: If inclusion criteria were met, a clinical flag was placed in the dispensing system, alerting the pharmacist to speak with the patient at pick-up. The pharmacist educated the patient on the risks of opioid medications and the benefits of naloxone and then offered to dispense naloxone. The control store followed standard of practice. Data were evaluated using descriptive statistics. RESULTS: The intervention and control store each dispensed 3 naloxone orders from November 2016 to February 2017. During the study period, 39 persons were identified as eligible for naloxone, and 11 naloxone orders were dispensed at the intervention store (28.2%); 2 naloxone orders were dispensed at the control store. A standardized team-based approach resulted in dispensing 8 additional naloxone orders at the intervention store, representing a 367% increase compared with the prior year, when this approach was not used. CONCLUSION: A standardized team-based approach was successfully implemented in a grocery store pharmacy and resulted in increased naloxone dispensing to naloxone-eligible patients.

Assessing care team perspectives on integration of a community pharmacist into an ambulatory care practice.

OBJECTIVES: The objective was to advance the integration of a community pharmacist within an accountable care organization (ACO) by assessing the desired roles of a pharmacist within the care team, satisfaction with the current arrangement of a pharmacist's involvement, and willingness to learn more about the roles of a community pharmacist. SETTING: A community pharmacist from Realo Discount Drugs was embedded within 3 clinics associated with Coastal Carolina Quality Care, an ACO. PRACTICE DESCRIPTION: An independent community pharmacy established a partnership with an ACO that has multiple group practices and shares an electronic health record. PRACTICE INNOVATION: Care managers referred patients to the pharmacist. The goal of community pharmacist involvement within the clinic was to provide transitions-of-care services to recently hospitalized patients, reconciling medications and dosing after discharge. EVALUATION: A 12-item online survey was conducted to evaluate the partnership. Health care team members were included; staff without expected involvement with the patient or pharmacist were excluded. Questionnaire items addressed provider type, desired role of the pharmacist, satisfaction with pharmacist involvement, and willingness to learn about or desire for more pharmacist involvement. The survey was open for 30 days with a reminder sent on day 15. Responses were thematically categorized, and content analysis was used to analyze results. RESULTS: Sixteen survey responses were received. The care team most frequently requested that the community pharmacist provide medication reconciliation (50%), medication education (44%), cost-reduction strategies (44%), and drug-interaction evaluation (38%). Care team satisfaction was positive; no respondents were unsatisfied. One-third (37%) of respondents were unaware of the pharmacist's involvement, had not referred patients to the pharmacist, or desired more interaction with the pharmacist. CONCLUSION: Survey findings were used to advance community pharmacist integration within an ACO, resulting in meaningful changes to pharmacist-provided services within clinic workflow.