Implementing community pharmacy-based influenza point-of-care test-and-treat under collaborative practice agreement.

BACKGROUND: Early and accessible testing for influenza with point-of-care testing (POCT) can be a critical factor for deciding to begin antiviral treatment. More than 10,000 pharmacies across the USA offer Clinical Laboratory Improvement Amendments-waived POCT for infectious diseases, such as influenza A/B. Knowledge of barriers and facilitators to large-scale POCT implementation may be useful in scaling POCT for influenza test-and-treat services (Flu POCT). The objective of this study was to explore the experiences of pharmacists who were early adopters of Flu POCT and treatment under collaborative practice agreement in community pharmacy settings. METHODS: Qualitative research design with in-depth, semi-structured virtual video interviews of licensed US community pharmacists. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR). Interviewees were selected via a purposeful sampling of pharmacists who were enrolled in a nationwide clinical trial involving pharmacy-based influenza test-and-treat under a collaborative agreement. Interviews were recorded and transcribed. A deductive analytic approach was used via constructs from the CFIR. RESULTS: Six pharmacists were interviewed. Interviews ranged from 28 to 70 min, with an average length of 46 min. Four broad themes emerged from the data, and each had corresponding subthemes and supporting quotes: influence of the Flu POCT service characteristics on pharmacy implementation, influence of factors outside of the pharmacy setting in Flu POCT implementation, factors within the pharmacy setting influencing implementation, and process of implementing Flu POCT. A novel pharmacy-based Flu POCT implementation framework is presented. CONCLUSIONS: Implementation of community pharmacy-based Flu POCT services is feasible; but, a thorough understanding of both barriers and facilitators to their implementation is needed to increase the spread and scale of these programs. Specifically, pharmacy stakeholders should focus efforts on increasing patient and provider awareness, pharmacist acceptance, leadership support, and support of health providers external to the pharmacy to improve implementation success.

Design of a disaster preparedness escape room for first and second-year pharmacy students.

BACKGROUND AND PURPOSE: Educational escape rooms assist students with the development of teamwork, augmentation of problem-solving skills, and reinforcement of key course concepts. In this report, we examined the feasibility of creating a bioterror preparedness escape room in a small enrollment pharmacy public health elective course. EDUCATIONAL ACTIVITY AND SETTING: A bioterror preparedness escape room was developed for pharmacy students in a health elective course. The instructional objectives of training students in disaster preparedness were assessed via group readiness assessment tests in the scenario and individual readiness assessment tests after the completion of the activity. FINDINGS: Twenty-eight students participated in the escape room activity in groups of 6 to 8 students (n = 4 observations) and all groups escaped. Student performance was higher on the initial attempts of three group readiness assessment tests (88 ± 16.0%, 82 ± 7.1%, 78 ± 12.0%) than in the final individual readiness assessment test (73.4 ± 20.4%). Students indicated that they found the educational escape room to be enjoyable (95.7%) and felt that all members of the team were involved in solving the problems (86.9%). SUMMARY: A disaster preparedness educational escape room was designed and implemented in a public health elective for pharmacy students. Findings indicate that the educational escape room format is an effective method for reinforcing course content, however additional improvements could be made to the instructional design to enhance individual student knowledge retention.

Community pharmacist-physician collaborative streptococcal pharyngitis management program.

OBJECTIVES: To describe patient outcomes associated with a community pharmacy-based, collaborative physician-pharmacist group A Streptococcus (GAS) management program. SETTING: Fifty-five chain and independent community pharmacies in Michigan, Minnesota, and Nebraska. PRACTICE INNOVATION: Pharmacists screened clinically stable adult patients who presented with signs and symptoms consistent with GAS pharyngitis from October 1, 2013, to August 1, 2014, by means of Centor criteria, and performed a physical assessment followed by a rapid antigen detection test (RADT) for eligible patients. Patients were treated according to a collaborative practice agreement (CPA) with a licensed prescriber or a physician consult site model. Pharmacists followed up with patients 24-48 hours after the encounter to assess patient status and possible need for further intervention. EVALUATION: Number of patients screened, tested, and treated, and health care utilization. RESULTS: Of 316 patients screened, 43 (13.6%) were excluded and referred for care. Of 273 patients (86.4%) eligible for testing, 48 (17.6%) had positive test results and 46 (16.8%) received amoxicillin or azithromycin per the CPA. Of those tested, 43.2% had no primary provider and 43.9% visited the pharmacy outside of traditional clinic office hours. CONCLUSION: Pharmacists demonstrated the ability and capacity to provide care for patients seeking treatment for pharyngitis. The number of patients without a primary care provider and seen at the pharmacy outside of normal office hours highlights the improved access that community pharmacy-based care offers.

Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness.

OBJECTIVES: To examine the effectiveness of collaborative physician-community pharmacist programs to treat influenza-like illness (ILI) with respect to clinical outcomes and health care utilization. DESIGN: Prospective multicenter cohort study. SETTING: Fifty-five pharmacies in Michigan, Minnesota, and Nebraska. PATIENTS: Adult patients presenting to the pharmacy with ILI during the 2013-14 influenza season (October 1, 2013 to May 30, 2014). INTERVENTION: Pharmacists screened adult patients presenting with ILI, completed a brief physical assessment, performed a point-of-care rapid influenza diagnostic test (RIDT), and provided appropriate referral or treatment per an established collaborative practice agreement (CPA) with a licensed prescriber. Pharmacists followed-up with patients 24 to 48 hours after the encounter to assess patient status and possible need for further intervention. MAIN OUTCOME MEASURES: Number of patients screened, tested, and treated for influenza. RESULTS: Of the 121 patients screened, 45 (37%) were excluded and referred to their primary care provider or an urgent care facility for management. Of the 75 patients (62%) eligible for participation, 8 (11%) had a positive RIDT and were managed according to the CPA. Of the patients tested, 34.6% had no primary care physician and 38.7% visited the pharmacy outside of normal office hours. Only 3% of patients reported feeling worse at follow-up. CONCLUSION: This study describes a physician-pharmacist collaborative model for treating ILI. Using an evidence-based CPA, pharmacists were able to provide timely treatment to patients with and without influenza.

Consumer interest in community pharmacy HIV screening services.

OBJECTIVE: To evaluate consumers' interest in pharmacist-provided human immunodeficiency virus (HIV) screening and to evaluate potential barriers and facilitators to HIV screening in the community pharmacy setting. METHODS: Cross-sectional survey of adult patients who presented to one of five community (chain and independent) pharmacies from November 2010 to August 2011. RESULTS: Based on 380 usable surveys, 135 (35.8%) participants were interested in pharmacy-based HIV screening. Independent predictors of interest in HIV screening identified in multivariate analysis (reference groups: ages 30 to 49 years old and white, non-Hispanic race) included younger age (18 to 29 years old) (odds ratio [OR], 2.48; 95% confidence interval [CI], 1.31 to 4.71); black, non-Hispanic race (OR, 2.37; CI, 1.40 to 4.03); and other race (OR, 4.58; CI, 1.63 to 12.87). Lack of perceived risk for HIV was the most commonly cited barrier to HIV screening; and free, rapid, or confidential HIV testing were identified as potential facilitators. CONCLUSION: Interest in pharmacy-based HIV screening was high among participants representing age and race groups disproportionately affected by HIV. Expansion of HIV screening efforts to community pharmacies warrants further consideration.

Pharmacist-provided rapid HIV testing in two community pharmacies.

OBJECTIVE: To evaluate the acceptability and feasibility of pharmacist-provided rapid testing for human immunodeficiency virus (HIV) infection in community pharmacies. PRACTICE DESCRIPTION: A pharmacist-provided HIV testing model-including rapid HIV testing, counseling, and linkage to confirmatory HIV testing services-was developed and implemented. SETTING: Two independent pharmacies located in Michigan cities of different size and with different prevalence of HIV infection. MAIN OUTCOME MEASURES: Number of HIV tests performed, time required for HIV testing services, description of participants who received an HIV test, and pharmacist and participant perception of the HIV testing experience. RESULTS: From October 2011 to March 2013, pharmacists provided HIV tests to 69 participants. One (1.5%) participant had a reactive HIV test and was immediately referred to an appropriate health care provider for confirmatory testing. HIV testing services required a median time of 30 (range, 20-90) minutes. Participants had a median age of 23 (range, 18-61) years and were diverse by gender (59.4% women) and race (46.4% black; 39.1% white). This was the first HIV test for 42% of participants, many of whom reported high-risk behaviors in the prior 6 months. Participants and pharmacists reported favorable perceptions of the HIV testing experience. CONCLUSIONS: This project demonstrates the acceptability and feasibility of pharmacist-provided rapid HIV testing in two community pharmacies with distinct characteristics. Further development of HIV testing services in this practice setting is warranted.