Pharmacy professionals' preparedness to use Mental Health First Aid (MHFA) behaviors.

BACKGROUND: There is a need to train healthcare professionals to provide first aid to people experiencing a mental health crisis. Research testing the association between Mental Health First Aid (MHFA) training and the use of MHFA behaviors could provide evidence of program effectiveness in the pharmacy setting. OBJECTIVES: The objectives of this study were to measure the preparedness of pharmacy professionals to function in a MHFA role, and compare preparedness and the use of MHFA behaviors based on demographic characteristics. METHODS: Pharmacists and student pharmacists attended MHFA training under a multi-state pharmacy initiative in 2018. An anonymous electronic survey was administered to 227 participants using 4 contacts in May to June, 2019. The survey evaluated if participants had recommended MHFA to others, their preparedness to engage in MHFA behaviors (13 items), and their frequency of performing a set of MHFA behaviors (7 items). Descriptive statistics, bivariate analysis, and ANOVA were used to describe the sample and compare these variables across groups. RESULTS: The analysis was based on 96 responses (42.3%). Almost all respondents (96%) had recommended MHFA training to others. Respondents reported that the training program prepared them to provide a range of MHFA behaviors for multiple mental health conditions, particularly for depression and anxiety. Participants most often reported asking about a distressed mood and listening non-judgmentally. Almost half of participants had asked someone if they were considering suicide and a similar percent had referred someone considering suicide to resources. Those reporting the highest levels of preparedness engaged in significantly more MHFA behaviors than those with lower levels of preparedness (p=0.017). Preparedness and use of MHFA behaviors were not significantly associated with respondent demographic characteristics. CONCLUSION: These data suggest that pharmacy professionals who had MHFA training felt prepared to engage in MHFA and many used behaviors like asking about suicide and making referrals since being trained in MHFA. Research is warranted to better understand what makes someone feel maximally prepared to use MHFA behaviors compared to lower feelings of preparedness.

Pharmacy professionals' preparedness to use Mental Health First Aid (MHFA) behaviors

BACKGROUND: There is a need to train healthcare professionals to provide first aid to people experiencing a mental health crisis. Research testing the association between Mental Health First Aid (MHFA) training and the use of MHFA behaviors could provide evidence of program effectiveness in the pharmacy setting. OBJECTIVES: The objectives of this study were to measure the preparedness of pharmacy professionals to function in a MHFA role, and compare preparedness and the use of MHFA behaviors based on demographic characteristics. METHODS: Pharmacists and student pharmacists attended MHFA training under a multi-state pharmacy initiative in 2018. An anonymous electronic survey was administered to 227 participants using 4 contacts in May to June, 2019. The survey evaluated if participants had recommended MHFA to others, their preparedness to engage in MHFA behaviors (13 items), and their frequency of performing a set of MHFA behaviors (7 items). Descriptive statistics, bivariate analysis, and ANOVA were used to describe the sample and compare these variables across groups. RESULTS: The analysis was based on 96 responses (42.3%). Almost all respondents (96%) had recommended MHFA training to others. Respondents reported that the training program prepared them to provide a range of MHFA behaviors for multiple mental health conditions, particularly for depression and anxiety. Participants most often reported asking about a distressed mood and listening non-judgmentally. Almost half of participants had asked someone if they were considering suicide and a similar percent had referred someone considering suicide to resources. Those reporting the highest levels of preparedness engaged in significantly more MHFA behaviors than those with lower levels of preparedness (p = 0.017). Preparedness and use of MHFA behaviors were not significantly associated with respondent demographic characteristics. CONCLUSION: These data suggest that pharmacy professionals who had MHFA training felt prepared to engage in MHFA and many used behaviors like asking about suicide and making referrals since being trained in MHFA. Research is warranted to better understand what makes someone feel maximally prepared to use MHFA behaviors compared to lower feelings of preparedness

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An evaluation of community pharmacies' actions under value-based payment.

OBJECTIVE: To determine actions taken by community pharmacies to be successful under a value-based pharmacy program (VBPP). METHOD: An exploratory sequential mixed methods approach was used to evaluate pharmacies participating in the VBPP, with qualitative data collected and analyzed in the first phase, followed by quantitative measurement through a 30-item survey instrument in the second phase. RESULTS: The qualitative data showed that participating pharmacies were more involved with adherence and cardiovascular and diabetes metrics than with other metrics. Depression metrics received the lowest overall involvement. For total cost of care, different approaches were used; 5 pharmacies used the dashboard to identify likely high-cost patients they could try to manage, and 4 pharmacies monitored adherence to avoid complications that could contribute to increased cost. For the survey response rate was 72.6% (n = 53). The mean perception of level of success was 53.06 ± 20.15 (mean ± SD). Activities with the highest priority were adherence (1.98 ± 0.97) and diabetes care (2.04 ± 0.83), and the activity with the lowest priority was depression care (3.60 ± 1.10). The most frequently mentioned challenge was time availability, and the most common improvement suggestion was better communication between the insurer and providers. CONCLUSION: In conclusion, this study found that community pharmacies were transforming their practices to be successful under a commercial value-based payment program. The pharmacies tended to build on care processes already established (e.g., medication adherence, patients with diabetes or cardiovascular conditions) and developed new processes to address emerging metrics and associated patient needs (e.g., collecting and documenting blood pressure and hemoglobin A1c levels). Future research is needed to identify best practices for patient care and pharmacy success under broad VBPPs such as the one studied here.

Evaluation of participant reluctance, confidence, and self-reported behaviors since being trained in a pharmacy Mental Health First Aid initiative.

In the U.S., an estimated one in five individuals experience a mental illness annually which contribute to significant human and economic cost. Pharmacists serving in a public health capacity are positioned to provide first aid level intervention to people experiencing a mental health crisis. Research on pharmacy professionals (pharmacists, technicians, students) undergoing training in Mental Health First Aid (MHFA) can provide evidence of the potential benefits of such training. The objectives of this study were to 1) describe the reluctance and confidence to intervene in mental health crises of pharmacy professionals previously trained in MHFA, 2) describe their self-reported use of MHFA behaviors since becoming trained, and 3) describe participant open-ended feedback on their MHFA training. MATERIALS AND METHODS: An electronic survey was disseminated in May and June, 2019 using a four-email sequence to pharmacy professionals who had completed MHFA training from one of five pharmacist MHFA trainers throughout 2018. Domains included demographics, six Likert-type reluctance items, seven Likert-type confidence items for performing MHFA skills, and frequency of using a set of nine MHFA skills since being trained. Prompts collected open-ended feedback related to MHFA experiences and training. Descriptive statistics were used for scaled and multiple-choice items and a basic content analysis was performed on the open-ended items to group them into similar topics. RESULTS: Ninety-eight out of 227 participants responded to the survey yielding a response rate of 44%. Participants reported high levels of disagreement to a set of reluctance items for intervening and overall high levels of confidence in performing a range of MHFA skills. Participant self-reported use of a set of MHFA skills ranged from 19% to 82% since being trained in MHFA. Almost half (44%) of participants had asked someone if they were considering suicide. A majority (61%) also had referred someone to resources because of a mental health crisis. Open-ended responses included positive experiences alongside important challenges to using MHFA in practice and recommendations including additional training focused on the pharmacy setting. CONCLUSIONS: Pharmacy professionals in this evaluation reported little reluctance and high confidence related to using MHFA training and reported use of MHFA skills since being trained.

Patient Experiences at Enhanced-Service Pharmacies in Iowa.

OBJECTIVES: As payment systems are evolving, the role of community pharmacists has expanded from simply dispensing prescriptions to actively providing care to patients. Little is known about patients' experiences with enhanced pharmacy services under the pay-forperformance model. In Iowa, Wellmark implemented its Value-Based Pharmacy Program (VBPP) where pharmacists receive capitation for performance on a set of quality measurements. Therefore, the objective of this study was to evaluate the quality of services and pharmacies from patients' perspective in VBPP. A structured interview guide developed from the service quality model was used for this study. METHODS: We conducted telephone interviews with patients from 6 community pharmacies participating in VBPP between December 2017 and January 2018. Patients who were aged between 21 and 90 years, had Wellmark prescription drug coverage, were currently on at least three medications with one or more of the medications for a chronic condition and had received enhanced pharmacy services were invited for the study. The semi-structured interview transcripts were coded and analyzed using an inductive approach of thematic analysis. RESULTS: Interviews were completed by 25 patients. Most of them were female and the average age was 59. More than half of the patients were taking at least five medications for chronic conditions. A majority of the patients received medication synchronization and immunization. A total of 13 themes across the service quality dimensions were identified. Patients thought their pharmacists were reliable, responsive, knowledgeable and trustworthy when they provided services. Pharmacy services were accessible and perceived as high quality. Privacy was not a big concern for most patients. Patients had a somewhat limited view regarding how pharmacists helped them maintain health. CONCLUSION: Patients' perceptions of enhanced pharmacy services and pharmacies were generally positive while their understanding of pharmacists' clinical role was limited.

The Iowa new practice model: Advancing technician roles to increase pharmacists' time to provide patient care services.

OBJECTIVES: Determine the effects of an 18-month pilot project using tech-check-tech in 7 community pharmacies on 1) rate of dispensing errors not identified during refill prescription final product verification; 2) pharmacist workday task composition; and 3) amount of patient care services provided and the reimbursement status of those services. DESIGN: Pretest-posttest quasi-experimental study where baseline and study periods were compared. SETTING AND PARTICIPANTS: Pharmacists and pharmacy technicians in 7 community pharmacies in Iowa. OUTCOME MEASURES: The outcome measures were 1) percentage of technician verified refill prescriptions where dispensing errors were not identified on final product verification; 2) percentage of time spent by pharmacists in dispensing, management, patient care, practice development, and other activities; 3) the number of pharmacist patient care services provided per pharmacist hours worked; and 4) percentage of time that technician product verification was used. RESULTS: There was no significant difference in overall errors (0.2729% vs. 0.5124%, P = 0.513), patient safety errors (0.0525% vs. 0.0651%, P = 0.837), or administrative errors (0.2204% vs. 0.4784%, P = 0.411). Pharmacist's time in dispensing significantly decreased (67.3% vs. 49.06%, P = 0.005), and time in direct patient care (19.96% vs. 34.72%, P = 0.003), increased significantly. Time in other activities did not significantly change. Reimbursable services per pharmacist hour (0.11 vs. 0.30, P = 0.129), did not significantly change. Non-reimbursable services increased significantly (2.77 vs. 4.80, P = 0.042). Total services significantly increased (2.88 vs. 5.16, P = 0.044). CONCLUSION: Pharmacy technician product verification of refill prescriptions preserved dispensing safety while significantly increasing the time spent in delivery of pharmacist provided patient care services. The total number of pharmacist services provided per hour also increased significantly, driven primarily by a significant increase in the number of non-reimbursed services. This was mostly likely due to the increased time available to provide patient care. Reimbursed services per hour did not increase significantly mostly likely due to lack of payers.