Evaluation of Patient Adherence to Vaccine and Screening Recommendations during Community Pharmacist-led Medicare Annual Wellness Visits in a Family Medicine Clinic.

Background: The Centers for Medicare and Medicaid Services initiated annual wellness visits (AWV) to reduce healthcare costs and improve preventive healthcare for beneficiaries. Provider time constraints and varying preferences to perform AWVs have limited its clinical implementation in some areas, affording pharmacists an opportunity to expand their role. Objective: To evaluate patient adherence to pharmacist recommendations for vaccinations and preventive screenings in an annual wellness visit service at a family medicine clinic in northeast Mississippi. Methods: This study included patients receiving at least one vaccination or screening recommendation during an AWV. Investigators provided vaccination (influenza, pneumococcal and herpes zoster) and screening (mammograms, DEXA, and colorectal cancer) recommendations based on current guidelines. For services not provided in-clinic, investigators contacted outside facilities 45 days post-visit to confirm adherence to recommendations. Primary endpoints included the composite adherence rate of all recommendations and percentage of patients achieving the 60% goal composite adherence rate. Secondary endpoints included individual vaccination and screening adherence rates. Results: Investigators recommended 715 interventions to a total of 254 patients, of which 239 were completed within 45 days for a 33.4 percent composite adherence rate. 20.1 percent of all participants achieved the goal composite adherence rate (60%). Overall, participants were 30.5 and 41 percent adherent to all vaccinations and preventive screening recommendations, respectively. Conclusion: Pharmacists providing AWVs increased patient access to preventive health recommendations. Although, adherence to recommendations remains a challenge and warrants further study. The findings and limitations observed in this study have identified opportunities for future research to evaluate pharmacist-led AWV services.

Pharmacists' perceptions of pharmacy technician occupational values.

Background: Pharmacy technician scope of practice has expanded in recent years to attempt to alleviate the responsibility burden placed on pharmacists in some states. However, little research has examined the ways in which pharmacists attempt to persuade technicians to take on additional roles. Management literature has identified the importance of understanding employee values in crafting persuasive role expansion messaging. Objectives: Identify the occupational values which pharmacists believe are the most important to pharmacy technicians when attempting to craft messages aimed at increasing technician involvement in advanced roles. Methods: Semi-structured interviews were conducted with pharmacists across multiple practice settings to identify how important they believe nine selected occupational values are to pharmacy technicians. Average scores for each of the nine values were calculated and examined to identify potential differences between the two overarching types of occupational values: intrinsic and extrinsic. Results: Pharmacists indicated that they believed that technicians are more extrinsically motivated than intrinsically motivated. Pharmacists believed that technicians had higher levels of extrinsic occupational values as opposed to intrinsic occupational values (3.920 vs. 3.113). The most important values to technicians as perceived by pharmacists were the income of the job and the hours of the jobs (average score of 4.85 and 4.75, respectively). The chance to be helpful to others and society was the only intrinsic value with an average score >3.5. Additionally, pharmacists indicated that technicians were not properly compensated for their work, which furthered illustrated the perceived importance of extrinsic motivators. Finally, when it came to crafting messaging around role expansion, pharmacists believed it was important to tailor their messaging to the technician they were speaking to. Conclusion: Pharmacists looking to craft role expansion messaging to their technicians are more likely to utilize extrinsic occupational values as motivators instead of using intrinsic values.

The impact of pharmacy benefit managers on community pharmacy: A scoping review.

Introduction: The introduction of pharmacy benefit managers (PBMs) within the United States healthcare system occurred with the aim to decrease costs and increase quality. News media and legislation have painted a picture of decreased pharmacy competition and potential negative impacts on patients and their access to affordable medications. Objective: The objective of this scoping review was to evaluate the current research literature examining the impact of PBMs on the finances of community pharmacies. Methods: Scientific journal articles published between 2010 and 2022 were included if they met the predefined objective. Results: This scoping review identified four articles that met inclusion criteria. None of the identified articles independently quantified the financial impact of PBMs on community pharmacies. Conclusions: Additional research should be completed to specifically understand the financial impact on community pharmacies to help ensure the viability of community pharmacy as an integral access point for patients.

College student behaviors and preferences in community pharmacies.

Objective: The primary goal of conducting this research was to gain insight into what characteristics of a community pharmacy college students may find appealing and how community pharmacies can tailor their services toward college students. Participants: The survey was distributed to 3,000 college students at The University of Mississippi from various schools and majors across campus. A total of 188 students participated by completing questions from the survey. Methods: The research was performed by using a cross-sectional online survey, and basic descriptive statistics, including frequency counts were used to characterize the findings. Statistical analyses, including crosstabs and chi-square analyses, were used to determine if there were any significant (p < 0.05) associations between characteristics such as pharmacy preferences and other variables. Results: Results of this survey indicated that the majority of respondents have used a community pharmacy in the past six months, and a small number of participants are interested in using a pharmacy for more than the sole reason of filling a prescription. Results also showed that insurance and convenience were the two most influential factors in choosing a community pharmacy. Conclusion: The findings presented in this study show a number of opportunities for community pharmacies to improve the health of college students and their communities.

Pharmacy Technician Efficacies and Workforce Planning: A Consensus Building Study on Expanded Pharmacy Technician Roles.

The expansion of pharmacy technician scope of practice in recent years, though remaining somewhat contentious, has afforded multiple opportunities for pharmacy technicians to provide additional assistance within the pharmacy. However, much of the research examining this growth has focused on specific tasks, which were determined by either the researchers themselves or the respective state boards of pharmacy. This study aimed to gain a better understanding of what expanded tasks pharmacists believe technicians should have an increased role in performing. A consensus-building research methodology was used to survey practicing pharmacists to determine which tasks those pharmacists believed technicians should take an increased role in performing. This study used modified Delphi techniques to build consensus among panels of both hospital and community pharmacists regarding 20 setting-specific technician tasks. Results of our study indicated that both hospital and community pharmacists believed technicians should have an increased involvement in performing tasks which are more related to the operations of the pharmacy rather than tasks which are more clinical in nature. This finding illustrates a belief among a segment of pharmacists that expanded roles for technicians should do more to alleviate the managerial and operational burden placed on pharmacists, potentially allowing pharmacists to take on increased clinical roles.

The Impact of Leadership Program Formatting on Perceived Development Within Pharmacy Cohorts.

Objective. To assess the impact of variable leadership development program formats on perceived participant growth.Methods. In 2020, the Phi Lambda Sigma national office began offering national Leader Academies to members, while University of South Florida Health Taneja College of Pharmacy simultaneously offered a Leader Academy program to its Phi Lambda Sigma students. Both programs used virtual leadership development tools from GiANT Worldwide, but differed in meeting frequency, content focus, and participant diversity. A 17-question pre- and postsurvey was developed from the Emotional Intelligence Leadership Inventory. Descriptive and inferential statistics were used to compare the cohorts.Results. Twenty-two respondents in the national cohort (66.7% response rate) and 15 in the single-institution cohort (100% response rate) were included. There was more diversity in age, ethnicity, and previous education in the national cohort. Significant improvements in perceived growth were noted in almost all areas. The only decrease noted was the national cohort response to "I strive to improve myself." The overall change in mean response values was generally higher for the single-institution cohort. Qualitative data supported these results and showed more notable references to emotional intelligence in the national cohorts (∼50%) as compared to the single-institution cohort (<25%).Conclusion. Study results suggest that participation in a longitudinal leadership development program, regardless of cohort format, leads to perceived participant improvement in three categories. However, perceived benefit within each of these categories may vary depending on the cohort. Future studies are needed to further evaluate specific leadership arenas and validate the leadership assessment tool.

The Report of the 2021-2022 Professional Affairs Standing Committee: Resource Guide for the Integration of Clinical Pharmacy Faculty in Professional Practice Settings.

The 2021-22 Professional Affairs Committee was charged to (1) Develop a resource guide for member institutions and faculty regarding payment for the practice-related activities of pharmacy faculty; (2) Nominate at least one person for an elected AACP or Council Office; and (3) Consider ways that AACP can improve its financial health. This report describes the methodology and content utilized for the development of an online resource guide for member institutions, faculty, and practice sites regarding the integration of clinical faculties' patient care services into patient care settings, including models for payment and value-based payment structures that can be utilized to support the practice-related activities of faculty. The committee offers a revision to a current association policy statement, a proposed policy statement as well as recommendations to AACP and suggestions to colleges and schools of pharmacy pertaining to the committee charges.

Change in Student Pharmacists' Perceptions and Confidence of Pediatric Related Topics After Participation in Pediatric Pharmacy-Focused Skills Laboratory.

OBJECTIVE: The objective of this study was to assess the impact of a pediatric pharmacy-focused skills laboratory on student pharmacist confidence and comfort with pediatric topics. METHODS: This study compared student responses on a questionnaire completed both pre- and post-lab. The lab activities included pre-readings, a pre-lab lecture, and a 2-hour laboratory session. The questionnaire assessed perceptions related to counseling pediatric patients and confidence in communicating with children and caregivers. Wilcoxon rank sum tests compared the differences in the preand post-lab questionnaire results. The McNemar test was used to test for conversion. RESULTS: A total of 187 of 221 pharmacy students completed the pre-lab questionnaire (85% response rate) and 116 completed the post-lab questionnaire (52% response rate). Significantly higher confidence levels were reported in the post-lab questionnaire for 5 of the 7 questionnaire items. Specifically, concerning level of confidence in measuring oral solutions, 17.5% of students' pre-lab, compared with 42.6% post-lab felt completely confident in being able to determine the appropriate measuring devices for liquid medications. No statistically significant differences were noted regarding comfort level or knowledge. CONCLUSIONS: Although an increase in confidence was seen in several areas, some students still lacked confidence after the lab session, suggesting that more pediatric-focused activities may be needed in the curriculum to reinforce pediatric concepts.

Insurance Adjudication Simulation Across Multiple Institutions and Levels of Learners.

Objective. A virtual educational innovation was designed and implemented to have student pharmacists simulate insurance processing. This article describes the impact of this third-party payer simulation on student knowledge and confidence and reports student perceptions of the activity.Methods. First-, second-, and third-year pharmacy students (P1, P2, and P3 students, respectively) at four institutions completed the self-paced simulation. Knowledge was assessed by comparing results of multiple-choice questions on the pre- and post-assessments and evaluated by the Wilcoxon signed rank test. Confidence was assessed by students' change in self-reported confidence scale measurements and compared using the chi-square test.Results. The simulation had a significant impact on student knowledge. The largest improvement was in P1 students, with a pre- to post-assessment average score difference (scale 0-100) of 16.6 compared to 7.2 for P2 and 10.2 for P3 students. Significant improvement was seen on most of the knowledge questions, with variations for certain questions between groups. All groups had significantly improved self-rated confidence in their abilities. Most students agreed that they would recommend this activity to other students (91.7%) and that it encouraged them to think about the material in a new way (85%).Conclusions. Through an innovative simulation on prescription insurance processing, positive results were seen across all three levels of learners. Knowledge assessments significantly improved, and student confidence increased across all groups and all confidence items. Participants would recommend this activity to other students and felt it was an effective way to learn about insurance adjudication.

Overcoming Past Perceptions and a Profession-Wide Identity Crisis to Reflect Pharmacy's Future.

The profession of pharmacy has come to encompass myriad identities, including apothecary, dispenser, merchandiser, expert advisor, and health care provider. While these identities have changed over time, the responsibilities and scope of practice have not evolved to keep up with the goals of the profession and the level of education of practicing pharmacists in the United States. By assuming that the roles of the aforementioned identities involve both product-centric and patient-centric responsibilities, our true professional identity is unclear, which can be linked to the prevalence of the impostor phenomenon within the profession. For pharmacy to truly move forward, a unified definition for the profession is needed by either letting go of past identities or separating these identities from each other by altering standards within professional degree programs and practice models. Without substantial changes to the way we approach this challenge as a profession, the problems described will only persist and deepen.

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.

A Modified Delphi Involving Laboratory Faculty to Define Essential Skills for Pharmacy Graduates.

Objective. To define essential skills for Doctor of Pharmacy (PharmD) graduates that are needed in the four most common sectors of pharmacy practice as determined by expert faculty who instruct within pharmacy skills laboratories.Methods. A three-round Delphi method was used to establish consensus. In the first round, participants were asked what skills were needed by students at entry to practice in community, health-system, ambulatory care, and managed care pharmacy settings. In rounds two and three, participants were asked to rate each skill with a level of importance using a 10-point Likert scale (1=not important to 10=very important).Results. In round one, participants produced a collective list of 289 essential skills. These skill statements were sent to participants in rounds two and three to assign a level of importance. After the third round, participants reached consensus using a mean level of importance for a final list of 69 community pharmacy skills, 47 health-system, 60 ambulatory care, and 15 managed care skills. These skills were then mapped to entrustable professional activities domains for schools and colleges pharmacy to use as a resource when assessing core competency development in the curriculum.Conclusion. The Delphi technique was used successfully with expert pharmacy skills laboratory faculty to identify laboratory-focused essential skills that recent PharmD graduates should have prior to entering community, health-system, ambulatory care, or managed care pharmacy practice. These essential skills can be used to guide curriculum development, develop milestone markers, and help ensure students are practice ready.

Public perceptions of naloxone use in the outpatient setting.

INTRODUCTION: Naloxone has become an important component of preventing deaths from opioid overdose. Although studies have confirmed its cost-effectiveness, naloxone is rarely prescribed proactively in case of accidental overdose. The perception still exists that a reversal agent may enable patients with opioid use disorder to continue abusing opioids without fear of death from overdose. This study was designed to determine the general public's knowledge of naloxone and their perceptions about receiving a naloxone prescription with opioid use. METHODS: Participants were recruited through Amazon Mechanical Turk (MTurk), where a link directed participants to an electronic survey. Participants were included if they were 18 years of age or greater and currently living in the United States. Participants were paid $0.10 USD via Amazon MTurk upon completing the survey. RESULTS: Four hundred five participants successfully completed the survey, and 61% were aware that there is a medication available to treat opioid overdose. The majority of participants responded positively to the idea of acquiring naloxone. Responses were evenly split for agreeing and disagreeing with the statement "naloxone is only necessary for people who abuse opioids." Although 51% of respondents believed that having naloxone available enables people who abuse opioids, 88% agreed that naloxone is beneficial for people who accidentally overdose on opioids. A majority believed that naloxone should be made available upon request to anyone concerned about opioid overdose. DISCUSSION: Participants were generally aware of the availability of an opioid reversal agent and responded positively to 3 different methods of acquiring naloxone through their prescriber or pharmacist.

First Responder knowledge, perception and confidence in administering naloxone: Impact of a pharmacist-provided educational program in rural Mississippi.

OBJECTIVE: In July 2017, Mississippi passed House Bill 996, which permitted first responders to carry naloxone and required training before administration. There is no standard training offered in Mississippi for first responders. The purpose was to evaluate the change in first responder knowledge, perceptions, and confidence in administering naloxone after pharmacist training. SETTING: The study was conducted at an independent community pharmacy in Holly Springs, Mississippi, with a longstanding presence in Marshall county. Participants included firefighters and law enforcement. PRACTICE DESCRIPTION: Participants provided informed consent and attended a 1-hour training class taught by a pharmacist. Participants were recruited by telephone to the local police and fire chiefs, who agreed to have their departments trained by the pharmacy. PRACTICE EVALUATION: The survey consisted of 12 questions and covered topics including, knowledge and perception of the opioid crisis, overdose symptoms, reversal agents, and confidence to perform correct administration. The first outcome was change in participants' knowledge of opioid overdose symptoms and was gathered with multiple choice questions. The second and third outcomes included change in perception and confidence in ability to administer reversal agents and were measured using a Likert-type scale ranging from strongly disagree to strongly agree. Fifty-seven participants completed the training, and the majority had more than 21 years of experience. The pre- and post-training survey responses demonstrated a statistically significant change in the first outcome where the average score of the knowledge assessment increased from 35% to 56% (P < 0.001). The perception and confidence outcomes had a statistically significant improvement in 5 of the 8 questions. CONCLUSION: Providing opioid education to law enforcement and firefighters increased their knowledge of overdose symptoms and improved administration technique, perception, and confidence to administer naloxone correctly.

Development of a medication synchronization common language for community pharmacies.

OBJECTIVES: To develop a common language for the medication synchronization process in community pharmacies. METHODS: A systematic and iterative process was used to create and refine a common language for medication synchronization. First, a review of all available medication synchronization-related documents was completed. Second, a systematic scoping literature review was conducted to determine what core components of medication synchronization have been implemented by community pharmacies. Third, semistructured interviews were conducted with community pharmacists and key stakeholders to identify principles and successful practices. Findings from the document review, systematic scoping review, and semistructured interviews were integrated to develop a medication synchronization common language. Finally, researchers and key stakeholders refined the initial draft by means of a systematic process. RESULTS: This process generated a medication synchronization common language that includes common language for the philosophy and values of medication synchronization. This profile also includes descriptions of core components with activities to be conducted for each of the identified 5 core components. The 5 core components are: 1) identification and enrollment of patients; 2) completion of a medication review and patient assessment; 3) alignment of medication refills; 4) preparation for medication delivery; and 5) delivery of medication and other services. CONCLUSION: The development of a common language for medication synchronization will allow for the promotion of consistency in implementation and operation of these programs across community pharmacies. Consistency in implementation will allow for better interpretation of patient outcomes such as adherence and other clinical measures.