Evaluation of a Diabetes Coaching Program on Clinical Outcomes in a Self-Insured Grocery Chain.

Background: Diabetes is among the most prevalent and costly disease states to treat. Many self-insured employers offer employee wellness programs to decrease healthcare expenditures for chronic illnesses, such as diabetes. Existing literature demonstrates that pharmacists can positively impact treatment of patients with diabetes and assist in lowering costs of care, but no current literature examines pharmacist intervention within an employee wellness program over a prolonged period of time. Objectives: To quantify the hemoglobin A1c (HbA1c) lowering achieved through participation in a pharmacist-led diabetes coaching program within a self-insured company. Methods: A retrospective chart review was conducted at a self-insured grocery store chain in the Kansas City area with an employee wellness program called Start Now. Patients who enrolled in the Start Now Program for Diabetes Care (SN-DM) between July 1, 2008 and July 1, 2021 with at least two documented HbA1c measurements were included in the analysis. Results: A total of 355 charts were included in the analysis. The average HbA1c reduction observed in program patients was 0.61% (P < .001). At baseline, 40% of program patients were considered to have controlled diabetes (A1c <7%) compared with 60% of patients at most recent HbA1c (P < .001). There was no correlation between HbA1c lowering and number of pharmacist coaching visits; however, greater HbA1c lowering was observed in patients with a higher baseline HbA1c. Conclusion: Patients who participated in the SN-DM program achieved a significant decrease in mean HbA1c. More patients were considered controlled at last or most recent HbA1c according to the American Diabetes Association guidelines.

Marketing Two Immunization Services at a Regional Supermarket Chain Pharmacy.

Background: Personal selling of immunization services includes starting a dialogue with patients, utilizing effective questioning and listening skills to identify their vaccination needs, and recommending appropriate vaccines accordingly. The study objectives were (1) to integrate personal selling into the dispensing workflow to promote pneumococcal polysaccharide vaccine (PPSV23), and (2) to evaluate the impact of personal selling and automated telephone calls to promote herpes zoster vaccine (ZVL). Methods: For the first study objective, a pilot project was conducted at one out of 19 affiliated supermarket pharmacies. Dispensing records were used to target patients with diabetes mellitus for PPSV23, and personal selling was implemented over a 3-month period. For the second study objective, a full study was conducted among the nineteen pharmacies, with five in the study group and 14 in the control group. Personal selling was implemented over a 9-month period, and automated telephone calls were placed and tracked over a 6-week period. Mann-Whitney U tests were used to compare vaccine delivery rates between the study and control groups. Results: In the pilot project, 47 patients needed PPSV23, but none received it from the pharmacy. In the full study, 900 ZVL vaccines were given, with 459 given for 15.5% of the eligible patients in the study group. During the time when 2087 automated telephone calls were placed and tracked, 85 vaccines were given across all pharmacies, with 48 given for 1.6% of the eligible patients in the study group. During both the 9-month and 6-week periods, the mean ranks of vaccine delivery rates in the study group were higher than the control group (p < 0.05). Conclusions: The pilot project incorporated personal selling into the dispensing workflow and, although no vaccines were given, provided valuable lessons. The full study demonstrated that personal selling alone and personal selling combined with automated telephone calls were associated with higher vaccine delivery rates.

Evaluating pediatric weight-based antibiotic dosing in a community pharmacy.

BACKGROUND: Owing to pharmacokinetic variations in pediatric patients, many antibiotics require weight-based dosing to ensure medication safety and antimicrobial stewardship. Despite the need for weight-based dosing, prescribers are not legally required to include the weight or diagnosis code on pediatric prescriptions that are necessary components to verify appropriateness. Clinical decision support system (CDSS) can help clinicians improve dosing appropriateness, but little is known about CDSS in a community pharmacy setting. To determine the impact of implementing CDSS in this setting, baseline information is necessary. OBJECTIVES: This study aimed to determine both the percentage of pediatric antibiotic prescriptions without optimal patient information required to evaluate weight-based dosing and the baseline percentage of prescriptions dosed outside of guideline recommendations. METHODS: A retrospective chart review was conducted at a locally owned community pharmacy in rural Southeast Missouri. Prescriptions written for patients less than 18 years old for guideline recommended antibiotics used for acute otitis media or acute pharyngitis dispensed between October 1, 2020, and May 10, 2021, were included in the analysis. Prescriptions were considered optimal if they included both patient weight and diagnosis code. Optimal prescriptions were evaluated for adherence to guideline recommended dosing. The primary outcomes included percentage of prescriptions without patient weight, diagnosis code, or both and the percentage of optimal prescriptions prescribed outside of guideline recommended dosing for the specified condition. RESULTS: Of the 115 included prescriptions, 45 were missing a patient weight, diagnosis code, or both. Seventy prescriptions were considered optimal, and of those, 42 (60%) were prescribed outside of guideline recommended dosing. CONCLUSION: Prescriptions were identified as missing important information at the time of dispensing. Of the optimal prescriptions, the majority were prescribed outside of current guideline recommended dosing, with subtherapeutic dosing being the most common.

Implementation of a self-measured blood pressure program in a community pharmacy: A pilot study.

BACKGROUND: Hypertension is a leading cause of cardiovascular disease in the United States and is costing the health care system billions of dollars annually. A health program that combines education, empowerment, and monitoring has shown to improve clinical outcomes and decrease overall health care costs. OBJECTIVE: To describe the implementation and effectiveness of a self-measured blood pressure (SMBP) program in a community pharmacy. PRACTICE DESCRIPTION: An independent community pharmacy located within rural Southeast Missouri. On-site community pharmacists provide medication therapy management, adherence monitoring, immunizations, and reimbursed clinical services. PRACTICE INNOVATION: Patients were eligible if they were older than 18 years of age and fell into one of the following categories: self-reported a new hypertension diagnosis, self-reported a desire to SMBP, were referred by a provider, or had a medication change within the 3 months before enrollment. The program consisted of 4 patient sessions. The first session obtained an initial blood pressure and provided patient education and behavior counseling. Follow-up sessions obtained average SMBP readings and reinforced previously learned concepts. EVALUATION METHODS: Implementation was evaluated using time and patient satisfaction. Effectiveness was evaluated using number and type of clinical problems identified, BP measurements, and test scores. RESULTS: A total of 20 patients enrolled and completed the study. The program took 63 minutes (SD ± 18) of staff time per patient for recruitment, sessions, reminder calls, and documentation. All patients received education and monitoring and 11 additional clinical problems were documented. Systolic BP decreased an average of 17 mm Hg (P = 0.002), and diastolic BP decreased an average of 12 mm Hg (P < 0.001). Patient confidence scores increased by 14%, and 7 more patients correctly answered the post-test knowledge question. All patients reported overall satisfaction with the program as "satisfied" or "very satisfied." CONCLUSION: This standardized SMBP program effectively improved hypertension control and patient confidence in managing BP.

Prediabetes screening intervention used to promote a lifestyle change program.

BACKGROUND: According to the 2020 Centers for Disease Control and Prevention (CDC) report on diabetes in the United States, an estimated 88 million Americans have prediabetes. A study found that those who were aware that they had prediabetes were more likely to engage in diabetes risk-reducing behaviors. There is no current literature supporting methods to promote a lifestyle change program (LCP), which were proven effective at lowering the risk of prediabetes. We theorized that the results of this study may be used to justify the screening intervention to promote this LCP. OBJECTIVE: The objective of this study was to describe the impact of a prediabetes risk-screening intervention on (1) increasing awareness of participants' risk of prediabetes and (2) enrollment in the LCP. METHODS: The screening intervention consisted of informed consent, preintervention survey, intervention, and postintervention survey. The intervention included the CDC Prediabetes Screening Test, body mass index calculation, and brief risk counseling. Participants who had a CDC Prediabetes Screening Test score lower than 9 were released from counseling and the postintervention survey. Eligible participants were offered enrollment in the LCP. Preintervention and postintervention survey scores were compared using paired t tests, with significance set at P ≤ 0.05. RESULTS: Of the 53 total participants, 46 screened positive on the CDC Prediabetes Screening Test. Of these 46 participants, 33 met the CDC eligibility requirements for the LCP. Of these 33 participants, 12 enrolled in the LCP, which was the same number as a previous pilot study. Mean survey scores increased from 9.41 to 9.65 out of 10 (P = 0.002). Overall, 89.1% (N = 46) of participants reported that the intervention increased their awareness of the risk of prediabetes. CONCLUSION: The prediabetes screening intervention successfully increased awareness of risk of prediabetes, both quantitatively and according to participant report. The intervention led to equivalent enrollment in the LCP as the previous pilot year.

Quantification of admission diagnoses in an employer-based transitions of care program.

BACKGROUND: Transitions of care (TOC) are critical times for patients, and if not conducted effectively, can lead to adverse events, preventable treatment, and costly readmissions. TOC programs are implemented to improve patient care, prevent hospital readmissions, and lower financial penalties associated with readmissions. Medicare's hospital readmission reduction program (HRRP), a value-based care model, targets specific conditions and procedures. Although many TOC programs focus on HRRP conditions, there are few studies looking at prevalence of disease states seen in TOC programs embedded within an employer-based insurance program in which financial ramifications exist for all hospitalizations. There is a need to better understand the potential missed opportunities for employer-based programs solely addressing HRRP conditions. OBJECTIVE: To quantify admission diagnoses in a nontargeted employer-based TOC program. METHODS: We conducted a descriptive study of patients enrolled in a TOC program conducted by a self-insured grocery store chain. We included all patients enrolled in this TOC program who experienced a hospital admission between January 1, 2017 and August 31, 2019. Each admission diagnosis was categorized into the appropriate anatomic and physiological groups using the 2020 ICD-10-CM categories. Data were reported using descriptive statistics. RESULTS: We identified 180 eligible patients with 328 hospital admissions. The mean (± SD) age of the study population was 53.6 ± 14.4 years. The most common admission diagnoses were those in the digestive category (n = 61, 18.6% of admissions); elective total hip or knee replacement was the most prevalent HRRP condition (n = 30, 9.1% of admissions). Overall, HRRP conditions accounted for 58 (17.7%) of eligible admissions. CONCLUSION: Most of the patients seen by an employer-based TOC program were for conditions not targeted by the HRRP. By including patients beyond those covered by the HRRP, such TOC programs may realize greater improvements in financial and clinical outcomes. These benefits, however, need to be confirmed in future studies.

RETRACTED: Beyond the PGY-1 community pharmacy residency: Characterizing career pathways of residency graduates.

This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal). This article was retracted by the authors because of data errors discovered after publication.

Beyond the PGY-1 community pharmacy residency: Characterizing career pathways of residency graduates.

OBJECTIVE: To characterize positions obtained upon graduation from Community Pharmacy Residency Programs (CPRPs). DESIGN: Descriptive nonexperimental study; online cross-sectional survey. SETTING: United States, February to April 2016. PARTICIPANTS: One hundred thirty-three community pharmacy residency program alumni. INTERVENTION: CPRP alumni identified by past program directors were surveyed using 3 contact attempts. MAIN OUTCOME MEASURES: Descriptive measures of demographics and information regarding post-CPRP employment including sex, region, degree status, number of positions offered, and further specialization were determined. Skills developed during CPRPs, such as research, teaching, management, advocacy, and clinical service provision during employment, were reported. RESULTS: E-mails were sent to 216 potential participants, and 133 useable survey responses were gathered from CPRP alumni. When asked how many positions were offered upon residency graduation, 57% were offered 2 positions and 26% were offered 3 positions. Of those employed, 50% of respondents indicated employment at the practice site at which they completed their CPRP. The amount of time spent on traditional dispensing decreased from the initial post-residency position to the current position. The time CPRP graduates spent in roles involving research, management, and advocacy activities in their current position was increased. CONCLUSION: Graduates of CPRPs spend approximately 34% of their time dispensing, which is less than the national average reported by the National Pharmacist Workforce Survey. A contributing factor to the expansion of CPRPs largely depends on the ability of employment opportunities that embrace the value this unique skill set brings. CPRPs foster clinical innovation and leadership in the community setting, thus creating additional opportunities for pharmacists to demonstrate their value to the health care system.