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1.
Res Social Adm Pharm ; 2020 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-32414658

RESUMEN

Pharmacists are increasingly asked to incorporate new and greater amounts of clinical services into their traditional medication distribution responsibilities, but many barriers exist. Given the demanding pharmacy practice environment, improved time management may improve implementation rates. One area not previously explored within this area is the clinical skill of "prioritization" of medication related problems (MRPs). Prioritization is vital as the workload demand for pharmacist time exceeds time available; however, the underdeveloped skills of prioritizing is a concern in the field of pharmacy practice, as it also is across professions in healthcare. Previous research has suggested that pharmacists and student pharmacists inexperienced in implementing clinical services struggle knowing where to begin when providing direct patient care, given the complex patient care regimens, a complex pharmacy practice workload, and the numerous preventative care interventions possible for a given patient. This paper provides a review of theory and science of prioritization in patient care service delivery, including Multicriteria Decision Analysis (MCDA), Lean Six Sigma (LSS), and Jaen's Competing Demands framework. A case study is shared which emphasizes both the need for and potential impact of a renewed focus on workload management skills, such as prioritization.

2.
Artículo en Inglés | MEDLINE | ID: mdl-32389555

RESUMEN

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.

3.
Artículo en Inglés | MEDLINE | ID: mdl-32217084

RESUMEN

OBJECTIVES: Assess the impact of pharmacy technician-supported point-of-care testing (POCT), including sample collection, on the number of cholesterol screenings performed in a community pharmacy setting. Secondary objectives include assessment of provider perceptions and patient satisfaction of POCT when executed by a technician. PRACTICE DESCRIPTION: Thirty-two community pharmacies in 1 regional division of a large community pharmacy chain in Tennessee; 16 participated in a certified pharmacy technician (CPhT) training program, and 16 did not. PRACTICE INNOVATION: CPhTs supported POCT service delivery limited to the nonprofessional, technical tasks (e.g., sample collection, quality assurance). EVALUATION: The primary objective was evaluated by comparing the total number of screenings for control and intervention sites. Descriptive and inferential statistics were used. Both secondary measures were assessed via anonymous, Likert-type scale questionnaires. RESULTS: Intervention pharmacies performed 358 screenings, whereas control pharmacies performed 255 screenings (16.8% difference). The patient perception survey found that 94% (149 of 159) of those who received screening with CPhT involvement agreed or strongly agreed that the service was valuable, and 70% (111 of 159) reported that they are likely to follow up with their primary care providers to discuss the results. Furthermore, most patients were in agreement that they were overall satisfied with the screening services provided by the CPhT (94%, 149 of 159), and the CPhT was professional while performing the screening (95%, 151 of 159). The provider perceptions survey on service implementation found that most pharmacy personnel agreed or strongly agreed that CPhTs performing POCT was feasible, appropriate, and acceptable. CONCLUSION: This study provided preliminary data that technician-supported POCT may positively impact the number of screenings provided. In addition, provider perceptions were positive, and patients felt satisfied with the studied technician model.

4.
Am J Health Syst Pharm ; 77(6): 457-465, 2020 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-31965172

RESUMEN

PURPOSE: To gather rich details about the value of technician certification from diverse groups of pharmacists of various practice settings and levels of experience. METHODS: Focus groups of pharmacists were conducted using a semistructured interview guide in 4 states (California, Idaho, Tennessee, and Washington) varying in pharmacy technician scope of practice, regulation, and education and/or training environment. Participant pharmacists came from health-system, clinic, and community pharmacy environments. The focus groups took the unique approach of an organizational behavior perspective to contextualize technician readiness for practice change and employer fit. The sessions were audio-recorded and transcribed verbatim. Rapid-based qualitative analysis was used to code the data, with summary templates completed by 2 of the researchers for each of the 4 sessions. RESULTS: There were a total of 33 focus group participants, including 13 male and 20 female pharmacists ranging in age from 27 to 68 years. The 4 major themes yielded by the data were (1) impact of certification, (2) context of certification, (3) organizational culture considerations, and (4) future credentialing. Certification was deemed to have a greater impact on technician maturation, professional socialization, and career commitment than on actual job skills, even while job knowledge was also deemed to be enhanced. In fact, the certification process was also deemed beneficial in that it meshes with on-the-job training. Participants indicated preferences for technician certification examinations to incorporate more content in "soft skills" and also for development of more specialty and/or differentiated certification products. CONCLUSION: Pharmacists from 4 states saw value in certification but agreed that certification is but one component of readying technicians for future practice. Suggestions for furthering the value of certification were shared.

5.
J Am Pharm Assoc (2003) ; 60(1): 39-46, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31669416

RESUMEN

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.

6.
Res Social Adm Pharm ; 2019 Dec 06.
Artículo en Inglés | MEDLINE | ID: mdl-31822390

RESUMEN

BACKGROUND: With the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers. OBJECTIVES: The aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs). METHODS: Using a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory. RESULTS: Employers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management). CONCLUSIONS: New emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification.

7.
Res Social Adm Pharm ; 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31732384

RESUMEN

BACKGROUND: National pharmacy technician certification in the U.S. is believed to hold a valuable place in promoting technician competence, but the views of pharmacists from varying settings and positions could help further clarify how certification could be optimized. OBJECTIVE: The aims of this study were to determine differences among pharmacists in how they view certification, the level of value they ascribe to certification, and how they might make further improvements in the certification process. METHODS: A self-administered survey was constructed and delivered in QualitricsXM in spring of 2019 to a random sample of pharmacists in 4 U S. states chosen for high proportions of both certified and non-certified pharmacy technicians and for their differences in technician regulation and scope of practice. Analysis employed a host of bivariate tests then summative backward elimination regression analyses in consideration of Type I error and in that the approach taken was to acquire a "gestalt" of events rather than test individual hypotheses. RESULTS: Pharmacists' opinions on the impact of certification varied by their job position, their practice setting, and sometimes their sex and work status. Pharmacists in clinical and in supervisory positions saw the positive impact of certification in different ways than did staff pharmacists. Certain groups would like to see more support for certification from their employers, while others aim for more support from certification vendors, and some pharmacists would like to see more content on "soft skills" in the certification process. Certification is seen as most beneficial to technicians in the hospital setting. CONCLUSIONS: The results of this study suggest differences among pharmacists in their perceptions of the value of certification and what might be done to further enhance that value. The results of this study will hopefully provide some clarification and direction for certification vendors, policymakers, educators, and pharmacy leaders.

8.
Pharmacy (Basel) ; 7(4)2019 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-31694189

RESUMEN

The purposes of this study were: (1) to determine pharmacists' perceptions of the impact of certification on competence in specific job skills, its impact in combination with job experience, and its impact in combination with other types of vocational education/training; (2) to identify elements that could potentially enhance the value, or impact of national certification; and (3) to determine how pharmacists view certification in light of various personnel management and organizational behavior phenomena. A self-administered survey was constructed and delivered in spring of 2019 to a random sample of four U.S. states chosen for their geographic diversity and relatively high proportions of both certified and non-certified pharmacy technicians. Following multiple reminders, a response rate of 19.3% was obtained. The 326 responding pharmacists saw certification being less impactful alone than when combined with other types of education/training and previous job experiences. They saw the need for more skills-related and "soft skills" content on the certification examination and agreed that certification is a factor in hiring decisions and that it should be required for designation for advanced practice status. Taken together, respondents saw the need for pharmacy leaders to integrate certification with other aspects of preparation to make for a more competent and professional workforce support team.

9.
Implement Sci ; 14(1): 99, 2019 11 27.
Artículo en Inglés | MEDLINE | ID: mdl-31775801

RESUMEN

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.

10.
J Am Pharm Assoc (2003) ; 59(6): 880-885, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31474528

RESUMEN

OBJECTIVES: To explore initial outcomes of the Optimizing Care Model's impact on patient care through technician product verification after the first 3 months of implementation, including the model's impact on pharmacist workday composition, rates of patient care services delivered, and rates of product selection errors not identified during final product verification. SETTING: Fourteen chain and independent community pharmacies licensed and located in Tennessee. INNOVATION: The Optimizing Care Model is an innovative approach to community pharmacy practice aiming to foster a new patient-centered care delivery model that expands clinical service delivery through task delegation to pharmacist extenders. EVALUATION: A quasiexperimental 1-group pretest-posttest design was used. Study sites self-reported data from 3 months before and 3 months after implementation of the intervention. RESULTS: Overall pharmacist time spent delivering patient care services increased significantly on implementation of the Optimizing Care Model (25% vs. 43%; P < 0.001), and time spent performing dispensing-related activities decreased significantly (63% vs. 37%; P = 0.02). There was a total increase in quantity of clinical services delivered to patients from baseline, but data from initial study outcomes did not reach statistical significance. At least 1 new clinical service provided under a collaborative practice agreement had been implemented by all 14 sites (100%) as of Spring 2018. Total undetected error rates were significantly less in the Optimizing Care Model phase compared to the traditional model (0.063% vs. 0.085%; P < 0.001). CONCLUSION: Initial results of the Optimizing Care Model demonstrate improved patient care through increased clinical service delivery versus the traditional model. Undetected error detection rates were low in both models, but lower in the Optimizing Care Model. The Optimizing Care Model may represent a novel approach to improving care for patients while creating efficiencies through a staff delegation model, providing pharmacists the opportunity to further evolve their practice and advance clinical care for patients.

11.
Res Social Adm Pharm ; 2019 May 24.
Artículo en Inglés | MEDLINE | ID: mdl-31151919

RESUMEN

BACKGROUND: Pharmacist-led medication therapy management (MTM) programs are considered evidence-based and have clearly defined core components. Despite this, MTM programs are often implemented without fidelity due to notable implementation barriers, such as physician-pharmacist relationships and pharmacist access to patient medical records. To improve MTM implementation, the Tennessee Medicaid program developed a MTM intervention that incorporates implementation strategies to address some of the known barriers to implementation (e.g., formalizing pharmacist-physician relationships through collaborative practice agreements, ensuring pharmacists' access to medical records). OBJECTIVES: The purpose of this hybrid type 2 effectiveness-implementation study is to (1) assess the effectiveness of the MTM pilot program in Tennessee (e.g., medication adherence, healthcare utilization, quality and cost of care) and (2) assess the implementation of the MTM pilot program (e.g., feasibility, appropriateness, acceptability, penetration). METHODS: The Tennessee MTM pilot program is being assessed as a hybrid type 2 effectiveness-implementation study with a quasi-experimental design. A mixed methods approach (QUAN + QUAL) for the purpose of complementarity (e.g., answering related research questions). Data will include surveys, interviews, MTM platform encounter information, and medical and pharmacy claims. Initial analyses will include data between January 2018 and December 2019. CONCLUSION: The study will further add to the evidence base of MTM interventions by testing an intervention that addresses known barriers to implementation and simultaneously collecting data on effectiveness and implementation to speed up MTM translation. The Tennessee MTM program is expected to serve as a guide to other states seeking to expand pharmacist-delivered clinical services to their Medicaid members, particularly those intending to incorporate MTM into programs seeking to improve primary care delivery. Further, by improving the implementation of MTM, the pilot program is expected to improve the reliability of MTM program benefits including healthcare quality and cost and patient outcomes.

12.
J Am Pharm Assoc (2003) ; 59(4): 570-574, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30979577

RESUMEN

OBJECTIVES: To determine the economic feasibility of implementing community pharmacy-based tech-check-tech compared with other common community pharmacy practice models. METHODS: A decision tree analysis compared 4 community pharmacy practice models: (1) historical (pharmacist or technician fills prescriptions and pharmacist gives immunizations); (2) historical with tech-check-tech (technician or certified technician fills prescriptions and pharmacist gives vaccinations); (3) modern (historical model plus medication therapy management [MTM] services); and (4) modern with tech-check-tech (modern model but a technician or certified technician handles all fills). A series of summed Markov models with a 1-year time horizon compared strategies on gross profit with the use of cycles of 1 hour of work attributed to either filling prescriptions, giving vaccinations, or conducting MTM. RESULTS: Based on current MTM volume, the splitting of pharmacist time across all services (modern model) was the most profitable strategy, resulting in approximately $1700 more than the next most profitable approach (historical model). Models incorporating tech-check-tech need significant time to be filled by MTM services, vaccinations, or other billable services to make up for the investment made into pharmacists' time. For these models, the likelihood of conducting a comprehensive medication review (CMR) in a given hour needs to exceed 47% for allocating all pharmacist time to nonfilling functions to be more profitable. Performing targeted medication reviews alone (without the chance of a CMR) was not sufficient to make tech-check-tech a profitable strategy. At the current inputs, billable services of exceeding approximately $18 and $20 per hour are needed for tech-check-tech to be the most profitable model with and without MTM services, respectively. CONCLUSION: Tech-check-tech implementation in the community setting has the potential to be profitable if pharmacist time is adequately scheduled with other billable services. Future research in this area should increase the number of pharmacies included and expand analyses to encompass chain-based community pharmacies.

13.
J Am Pharm Assoc (2003) ; 59(3): 310-318, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30940516

RESUMEN

OBJECTIVES: The primary objective of this study was to identify and summarize the perspectives of managers, pharmacists, and pharmacy technicians regarding the implementation of the Optimizing Care Model and corresponding task delegation of final product verification to pharmacy technicians in the community pharmacy. A secondary objective was to better understand successes and concerns in implementing the model. DESIGN: This qualitative research study employed the use of semistructured interviews. The authors served as coders and analyzed the transcripts with the use of inductive and deductive thematic analysis. SETTING AND PARTICIPANTS: Key informants included managers, pharmacists, and pharmacy technicians participating in the Optimizing Care Model in community pharmacies across both chain and independent pharmacy settings in Iowa, Tennessee, and Wisconsin. Interviews were conducted via telephone. RESULTS: The research team interviewed 14 participants. Six themes were identified: The Optimizing Care Model catalyzes patient care service delivery expansion in the community pharmacy setting, effectiveness is driven by "freed-up" pharmacist time compared with the traditional model, the model positively affects roles and job satisfaction of pharmacy personnel, technician engagement and ownership have a strong impact on the success and ramifications of the model, significant changes to pharmacy operations are necessary for successful implementation, and there are several factors ensuring successful implementation and sustaining of the Optimizing Care Model. CONCLUSION: Various participants (pharmacists, managers, technicians) in a technician product verification program known as the Optimizing Care Model agreed that patient care delivery can be enhanced through the task delegation of final product verification to pharmacy technicians. Additional positive impacts on organizational and individual level outcomes were found, which included quality of work life, engagement, and commitment.

14.
Pharmacy (Basel) ; 7(1)2019 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-30717311

RESUMEN

The purpose of this pilot study was to explore the impact of pharmacist-provided recommendations to general practitioners (GPs) of patients living in assisted living facilities (ALFs). A secondary objective of this study was to explore prescriber and ALF staff perceptions. This was a mixed-method, quasi experimental 1-group pre/post-test study with an explanatory qualitative arm using in-depth semi-structured interviews at five regional ALFs and one independent community pharmacy in East Tennessee. Residents older than 65 years of age, with confirmed diagnosis of Type II diabetes in the pharmacy's medical record, taking anti-diabetic medication for at least 14 days and resident of affiliated ALF for at least past 30 days were enrolled. Phase 1 demonstrated a 35.1% (13/37 recommendations) acceptance rate of pharmacist recommendations. Phase 2 demonstrated a similar 31.3% acceptance rate of pharmacist recommendations (5/16 recommendations). The mean pre⁻post difference in average 30-day FBG was greater in the accepted group than the rejected recommendation group (-9.1 vs. -2.3 mg/dL). Pharmacist⁻GP collaboration in the ALF population was feasible and may improve the quality of patient care of these residents.

15.
J Am Pharm Assoc (2003) ; 59(3): 369-374.e2, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30745189

RESUMEN

OBJECTIVES: To compare viewpoints of nationally certified and noncertified technicians and explore the perceived value of technician certification in the job performance domains of medication safety, skills and abilities, experience, engagement and satisfaction, and productivity. METHODS: A cross-sectional survey of pharmacy technicians, from 6 states representing 4 regions of the United States, was conducted. Technician mailing lists were purchased from Boards of Pharmacy, and randomly selected technicians were sent survey invitations. Surveys were completed via Qualtrics and analyzed with the use of SAS. RESULTS: Six hundred seventy-six technicians (547 certified, 103 noncertified, and 26 previously certified) responded to the survey (9.4% response rate). Certified technicians reported significantly higher confidence rating for desire to take on new responsibilities (P < 0.01; Cohen d 0.45) and plans to remain in the pharmacy field (P = 0.01, Cohen d 0.35), lower rating for leaving the job in the next 12 months (P < 0.01; Cohen d 0.35), and perceived lower rate of medication errors (P < 0.01; Cohen d 0.35) compared with other technicians in the work setting. The majority of respondents stated confidence in performing the "final check" on another technician's preparation of a new or refill medication if allowed. Both certified and noncertified technicians noted dissatisfaction with pay. The majority of respondents reported that they spent none of or less than 10% of their workday assisting pharmacists with medication therapy management (MTM) sessions, immunizations, or point-of-care tests; however, 71 respondents specifically described how they assist pharmacists with MTM. CONCLUSION: Results from our survey sample indicate that certified technicians have a stronger organizational and career commitment and desire to take on new roles. A majority of respondents noted dissatisfaction with pay but feel a sense of pride in their work. Both groups were confident in their abilities needed for tech-check-tech product verification.

16.
J Am Pharm Assoc (2003) ; 59(2): 187-194, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30679031

RESUMEN

OBJECTIVES: To explore the current roles of the pharmacy technician in the provision of medication therapy management (MTM) and their relation to organizational behavior at "high-performing" community pharmacies within a nationwide supermarket chain. DESIGN: Qualitative research study using methodologic triangulation with the use of semistructured interviews of key informants, direct observation at "high-performing" pharmacy sites, and respondent journals. SETTING AND PARTICIPANTS: High-performing pharmacy sites within a large supermarket pharmacy chain in Tennessee. A high-performing site was defined as a pharmacy that has successfully implemented MTM into its pharmacy workflow. MAIN OUTCOME MEASURES: Themes related to pharmacy technician roles in the delivery of direct patient care services. RESULTS: A total of 28 key informants were interviewed from May 2015 to May 2016. Key informants included 10 certified technicians, 5 noncertified technicians, and 13 pharmacists across 8 pharmacies in central and eastern Tennessee. Three themes were identified. At high-performing sites, pharmacy technicians were engaged in both clinical support activities as well as nonclinical support activities with the goal of improving clinical service implementation. Several barriers and facilitators were revealed. CONCLUSION: Within high-performing teams, expanded technician roles to support patient care service delivery were associated with successful clinical service implementation. Future studies should further explore these expanded technician duties, as well as the role of organizational culture, climate, and team dynamics, in the delivery of patient care and clinical services across a heterogeneous pharmacy setting.

17.
J Am Pharm Assoc (2003) ; 59(2S): S21-S24, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30448025

RESUMEN

OBJECTIVE: To describe opportunities for pharmacists to use mobile messaging and real-time monitoring to engage with patients taking long-term medications. SUMMARY: The proliferation of mobile phone use across the United States has been met with increased application of these devices by the medical community. However, beyond simple text messages and app-based functions, use of these devices by pharmacies and pharmacists has not been leveraged to improve patient outcomes, such as medication adherence. Resources now exist that can facilitate more advanced mobile communication between patients and pharmacists, which can be managed and informed by data available in most pharmacies. Such tailored messaging can be personalized further by being reactive to patient behavior using real-time medication use monitoring tools, facilitating low-cost, high-reach interventions for patients in need of ongoing guidance. CONCLUSION: Mechanisms now exist for pharmacies to engage patients more proactively with their prescribed therapy using mobile communication and devices. By facilitating such engagement, pharmacists can remain connected with patients throughout their care, better interpret their needs, navigate adherence-related issues, and more holistically counsel patients based on observed behaviors. Community pharmacy leadership should pursue the use of these advanced mobile messaging techniques as another tool in their arsenal to improve patient outcomes.

18.
Am J Pharm Educ ; 82(1): 6190, 2018 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-29491501

RESUMEN

Objective. To explore third-year pharmacy (P3) student perceptions of medication therapy management (MTM) after an introduction to the various levels of MTM services within an MTM course. Methods. A qualitative survey was conducted of 158 P3 students. Open-ended questions were used to explore students' thoughts, feelings, and perceptions related to the pharmacist's approach in MTM following a lecture establishing differences in roles and responsibilities between the varying levels of MTM. Emphasis was placed on the pharmacist's role when providing comprehensive medication management (CMM). CMM is a higher-level direct patient care service with a whole-patient focus that goes beyond medication or disease specific focuses of either a comprehensive medication review (CMR) or targeted medication review (TMR). Thematic analysis was performed and an inductive approach to data analysis was used. Results. The following five themes were identified: misperceptions entering the course, efficient delivery of MTM depends on understanding the differences between services, doctor of pharmacy education is a factor in confused MTM role expectations, role limitations exist and referrals to other providers, and the CMR meets unmet needs. Conclusion. Students noted initial confusion between their roles and responsibilities during a CMM versus a CMR. Pharmacy educators should address the varying roles and responsibility differences across MTM services within their curriculum.


Asunto(s)
Educación en Farmacia/métodos , Administración del Tratamiento Farmacológico/educación , Percepción , Farmacéuticos/psicología , Estudiantes de Farmacia/psicología , Encuestas y Cuestionarios , Curriculum , Femenino , Humanos , Masculino
19.
Res Social Adm Pharm ; 14(4): 360-366, 2018 04.
Artículo en Inglés | MEDLINE | ID: mdl-28457907

RESUMEN

BACKGROUND: Point-of-care testing (POCT) is a specialty of laboratory medicine that occurs at the bedside or near the patient when receiving health services. Despite its clinical utility, POCT implementation in the community pharmacy setting is slow due to uncertainty about the market for this novel service and remuneration for services rendered. OBJECTIVE: To identify 1) demographics and 2) willingness-to-pay preferences of the market niche of consumers who prefer to receive POCT services in the community pharmacy. METHODS: A sample of 188 participants matched to the U.S. population were surveyed in February of 2016 utilizing a self-explicated conjoint analysis survey model. RESULTS: Age groups differed between the community pharmacy consumer niche and the entire sample. The largest age group of the pharmacy niche consumer group were between 20 and 34 years old. Of those who preferred the community pharmacy setting to receive POCT services, 75% indicated they would be willing to pay $50 or more compared to 79% of the entire sample who preferred to pay $50 or less. CONCLUSIONS: There exists a latent and niche group of consumers interested in community pharmacy provided POCT services. This market niche is younger, and in general willing-to-pay more than the general population for these tests.


Asunto(s)
Servicios Comunitarios de Farmacia , Comportamiento del Consumidor , Pruebas en el Punto de Atención , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Percepción , Adulto Joven
20.
Curr Pharm Teach Learn ; 9(3): 473-478, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-29233287

RESUMEN

BACKGROUND AND PURPOSE: To explore students' perceptions (self-assessment) of their preparedness to develop collaborative practice agreements (CPAs) before and after delivery of one CPA-focused classroom lectures and 2) a CPA development student project in partnership with a local community-based pharmacy. EDUCATIONAL ACTIVITY AND SETTING: A CPA-focused didactic lecture and subsequent project were given to second-year (P2) pharmacy students enrolled in a community pharmacy elective course at the University of Tennessee College of Pharmacy. Pre- and post-surveys were administered using an online survey platform to assess student perceptions. Responses for each survey question were summarized using frequencies, and chi-square analysis was conducted to assess the association between pre- and post-scores on each question. FINDINGS: Students were significantly more likely to rate themselves as prepared or completely prepared to develop a CPA in a community pharmacy setting (χ2=61.21, p<0.01) after the course and project. Students also noted that they felt they were prepared or very prepared to work within a team to develop and implement a CPA in a community pharmacy setting (χ2=37.60, p<0.01). SUMMARY: This study demonstrated that a didactic classroom lecture series followed by a student project partnered with a local community pharmacy improved perceived knowledge, preparedness, and ability to implement CPAs in a community pharmacy. Through intentional exposure of students to scope-of-practice expanding opportunities like CPAs, pharmacy educators can potentially accelerate the evolution of community pharmacy practice.


Asunto(s)
Servicios Comunitarios de Farmacia/legislación & jurisprudencia , Educación en Farmacia/métodos , Farmacéuticos/legislación & jurisprudencia , Médicos/legislación & jurisprudencia , Estudiantes de Farmacia , Contratos , Conducta Cooperativa , Prestación de Atención de Salud , Humanos , Autoeficacia , Encuestas y Cuestionarios
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