Exploring the early phase of implementation of a vaccine-based clinical decision support system in the community pharmacy.

OBJECTIVE: To explore the implementation strategy of a recombinant zoster vaccine (RZV) clinical decision support (CDS) intervention in community pharmacy workflow to increase second-dose vaccination rates. SETTING: The level of analysis was the unit (e.g., pharmacy). The participants were selected from across approximately 2200 pharmacies in 37 states on the basis of criteria believed to affect implementation success (e.g., size, location) using a sampling matrix. PRACTICE DESCRIPTION: Large supermarket pharmacy chain. PRACTICE INNOVATION: Vaccine-based CDS intervention in community pharmacy workflow. EVALUATION: A mixed-methods contextual inquiry approach explored the implementation of a new RZV CDS workflow intervention. Data collection involved key informant, semistructured interviews and an electronic, Web-based survey. The survey was based on a validated instrument and was made available to all pharmacists nationwide within the study organization to assess views of the implementation's appropriateness, acceptability, and feasibility during early implementation. Afterward, a series of semistructured, in-depth interviews were conducted until a point of saturation was reached. The interview guide was based on selected constructs of the Consolidated Framework for Implementation Research. RESULTS: A total of 1128 survey responses were collected. Survey respondents agreed or strongly agreed that the implementation was acceptable (78.34%), appropriate (79.92%), and feasible (80.53%). Twelve pharmacist participants were interviewed via telephone. Five themes emerged from the interviews, revealing facilitators and barriers that affected implementation of the intervention: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. CONCLUSION: The implementation of the RZV CDS "nudge" intervention was welcomed, suitable, and operable in the community pharmacy setting to meet the needs of the organization, employees, and patients. The contextual factors identified during the implementation process of this CDS intervention in a community pharmacy setting may be used in scaling this and future CDS interventions for public health initiatives aimed at pharmacists in this setting.

The impact of a pharmacist-extender training program to improve pneumococcal vaccination rates within a community chain pharmacy.

OBJECTIVES: Evaluate the impact of a targeted training program for pharmacist-extenders (technicians and pharmacy interns) on vaccine screening role expansion within pharmacy workflow on pneumococcal vaccination rates. Secondary objectives include measuring changes in pharmacist-extenders' role perceptions surrounding vaccination services before and after training and exploring the implementation of vaccine screening role expansion of pharmacist-extenders using semistructured interviews founded in the Consolidated Framework for Implementation Research constructs. DESIGN: This study used a mixed methods sequential explanatory design from November 2017 to April 2018. SETTING AND PARTICIPANTS: The study occurred in 20 pharmacies in a division of a national supermarket, community pharmacy in Tennessee. Pharmacist-extenders, who worked in participating pharmacies and who completed the vaccination training program, before or after online survey or interview were included in this study. OUTCOME MEASURES: Pharmacist-extenders accessed a training program webinar. Onsite training focused on identifying eligible patients for pneumococcal vaccines based on patient age and comorbidities. The vaccine screening program used a train-the-trainer model. Pneumococcal vaccination rates were collected and analyzed from January 2018 to March 2018 and compared during the same time period from the previous year. Descriptive and inferential statistics evaluated pneumococcal vaccination rates and survey responses. An anonymous electronic Likert-type scale questionnaire was e-mailed to participating pharmacies before and after the training program. An explanatory qualitative arm was added post-hoc to provide insights into the primary endpoint. Six semistructured interviews were conducted using Consolidated Framework for Implementation Research domains. RESULTS: Pneumococcal vaccination rates improved compared with the previous year during the same time period (P > 0.05). Subgroup analysis identified outlier pharmacies prompting the explanatory qualitative arm. No statistically significant changes were identified in the surveys. Seven themes were identified from participant interviews. CONCLUSION: Pneumococcal vaccination rate data showed varying trends toward pharmacist-extenders having a positive impact on pneumococcal vaccination rates through role expansion; however, these improvements varied by pharmacy and were dependent on program implementation differences.

Rescheduling hydrocodone combination products: Impact on patients receiving long-term HCP therapy in a large chain pharmacy-A statewide assessment.

OBJECTIVE: This study aimed to evaluate the rescheduling of hydrocodone combination products (HCPs) from schedule III (CIII) to schedule II (CII) in patients receiving chronic HCP therapy. METHODS: This study was a retrospective cohort analysis of administrative pharmacy data from 118 statewide pharmacies from a retail chain in Tennessee. HCP filling histories were analyzed on patients meeting enrollment criteria from July 1, 2014, to October 1, 2015. The average number of tablets dispensed, daily average of the number of tablets dispensed, and monthly average of morphine milligram equivalents (MME) dispensed were compared for the periods of July 1, 2014, to October 5, 2014 (enrollment period before schedule change) and October 6, 2014, to October 1, 2015 (period following schedule change) using a pooled t test. RESULTS: A total of 4536 patients met the inclusion criteria. Of these 4536 patients, 60.6% were female, and 40.4% were male, with an average age of 58 years (patients included in this study were between the ages of 18 and 99 years). The total number of hydrocodone tablets dispensed in the 12 periods after the schedule change dropped from 467,217 to 259,327, a 45.5% reduction (P < 0.001). Total MME decreased from 4.11 to 2.29 million, a 45.3% reduction (P < 0.001). The number of study participants still receiving an HCP at the end of the study decreased to an average of 2736 across the 12 periods following the schedule change, a 40% reduction. CONCLUSION: HCP dispensing and use decreased among patients receiving chronic opioid treatment from a large corporate statewide community pharmacy in Tennessee after a schedule change from CIII to CII. Monthly sums of total tablets dispensed, average daily tablets dispensed, MME, and average daily MME calculated from July 1, 2014, to October 1, 2015, all experienced statistically significant reductions.

Targeting adaptability to improve Medication Therapy Management (MTM) implementation in community pharmacy.

OBJECTIVES: (1) To develop an adaptation framework for MTM delivery for pharmacists (the MTM Adaptability Framework), (2) to examine the impact of an educational intervention informed by the MTM Adaptability Framework on MTM completion rates over a 2-year period, and (3) to explore pharmacists' perceptions regarding knowledge and beliefs about MTM and MTM implementation self-efficacy pre- and post-intervention. METHODS: This study is a prospective, mixed-methods research study including a quasi-experimental, one-group pretest-posttest quantitative study with a sequential explanatory qualitative study arm featuring semi-structured key informant interviews. US supermarket pharmacy chain setting included 93 community pharmacy sites located in Tennessee, Kentucky, and Alabama. MTM completion rates are reported as percentage of completed comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) and pharmacist perceptions. RESULTS: An 11.4% absolute increase in MTM completion rates was seen after the educational intervention targeting adaptation of MTM in the community pharmacy setting. This was found to be significant (46.92% vs. 58.3%; p < 0.001). Responses to the semi-structured interviews were mapped against CFIR and included themes: "knowledge and beliefs about MTM (pre-intervention)," "self-efficacy for MTM implementation (pre-intervention)," "knowledge and beliefs about MTM (post-intervention)," and "self-efficacy for MTM implementation (post-intervention)." Data convergence was found across these methodologies and suggested that targeting adaptability of MTM delivery increases MTM completion rates (quantitative data) and positively changes perceptions of MTM feasibility and self-efficacy (interviews). CONCLUSION: The use of an educational intervention about adaptation of MTM to influence adaptation of MTM to a chain community pharmacy setting part of an implementation strategy improved MTM completion rates significantly. Future research should investigate combined implementation strategies and their impact on MTM implementation success.