Preparing community pharmacy teams for health information exchange (HIE).

BACKGROUND: Health information exchanges (HIEs) facilitate health care professionals' electronic sharing of patient information across different organizations. When community pharmacists have access to HIE, they can further contribute to improved patient outcomes. However, several implementation challenges are noted, which impede sustained pharmacist access to HIE. To our knowledge, no bidirectional HIE interface design and pharmacy team-informed implementation process has been documented. In response, our research team designed and developed an HIE interface prototype for use specifically by community pharmacy teams to access local HIE data through their pharmacy dispensing software. OBJECTIVES: To 1) identify barriers, facilitators, and recommendations for using HIE data in community pharmacies and 2) create a curated list of resources addressing identified implementation needs to aid future implementation of a fully functional, bidirectional HIE interface by community pharmacy teams. METHODS: Pharmacists, pharmacy technicians, and patients from three pharmacy sites within the Community Pharmacy Enhanced Services Network of Indiana participated in individual semi-structured interviews. Interview questions were mapped to select constructs across all domains of the Consolidated Framework for Implementation Research. Interview transcripts were deductively coded. A subset of participants participated in Evidence-Based Quality Improvement sessions to iteratively update planned resource items needed to support future HIE implementation. RESULTS: We interviewed 23 total participants: 8 pharmacists, 8 pharmacy technicians, and 7 patients. Five facilitators, four barriers, and two recommendations were identified. These were further characterized into four key implementation needs: instruction on how to use HIE; guidance on workflow and team roles; resources that are patient-facing; and resources that are provider-facing, resulting in 16 planned implementation resources. CONCLUSION: Our study provides the first-of-its-kind list of pharmacy team-informed resources to facilitate sustainability and scalability of HIE implementation in community pharmacies.

Usability Evaluation of a Community Pharmacy Health Information Exchange Interface Prototype.

OBJECTIVE: Few community pharmacies have access to health information exchange (HIE) data. We conducted a first-of-its-kind usability evaluation of an HIE interface prototype (referred to throughout as the "HIE-Pioneer mock-up") developed with pharmacists and pharmacy technicians to aid future implementation in community pharmacies. METHODS: Community pharmacists and pharmacy technicians were recruited to complete usability evaluations with the HIE-Pioneer mock-up. Each usability evaluation lasted up to 60 minutes. System usability scale (SUS) scores were collected from each participant following each usability evaluation session and summarized with descriptive statistics. Usability evaluation videos were reviewed for common usability attributes, such as the impact of identified usability problems, learnability, and efficiency. Time on task, task success rates, and prototype utilization were also recorded. RESULTS: Sixteen total participants completed usability testing across three community pharmacies. The average SUS score was 69.7 (scale 0-100, where 100 is the best), with pharmacists on average reporting higher satisfaction than technicians (74.1 vs. 65.3, respectively). Altogether, we identified 23 distinct usability problems. Key problems identified included needed clarification in tool label names and accessibility of HIE links within the existing workflow. Overall, the usability of the HIE-Pioneer mock-up generally fostered pharmacy professionals' ease of learning and efficiency. CONCLUSION: Our study identified key areas, and potential solutions, to improve the usability of the HIE-Pioneer mock-up. Overall, pharmacy professionals viewed the HIE-Pioneer mock-up positively, with good satisfaction ratings. The HIE-Pioneer mock-up provides a blueprint for future HIE implementation in community pharmacy settings, which would increase community pharmacy teams' access to HIE data nationwide. Community pharmacy access to bi-directional HIE is expected to improve communication among more health care professionals involved in patient care and equip pharmacy professionals with needed information for improved clinical decision-making.

Strengths and limitations of a novel "Flip the Pharmacy" practice transformation coach advanced pharmacy practice experience.

BACKGROUND AND PURPOSE: Flip the Pharmacy (FtP) helps community pharmacies "flip" from dispensing- to patient-centered care models with assistance from practice transformation coaches ("coaches"). Purdue University College of Pharmacy created a novel advanced pharmacy practice experience (APPE) positioning students to serve as FtP coaches with oversight from four faculty coaches. This communication describes the APPE's design, characterizes preliminary student coaching outcomes, and identifies the APPE's strengths and limitations. EDUCATIONAL ACTIVITY AND SETTING: Twelve pharmacies were coached by APPE students. The APPE was designed to enhance student knowledge and skills in the scaled implementation of advanced patient care services through structured weekly activities: Week 1, student orientation and training; Week 2, preparing for pharmacy visits; and Weeks 3 and 4, conducting pharmacy visits. Students also performed recurring tasks each week, including managing social media accounts. FINDINGS: Twenty-eight students completed the APPE. Students conducted 81 in-person and 105 virtual visits. Faculty coaches were estimated to need 40 to 50  hours each month for coaching-related activities; involving student coaches reduced faculty coach time by approximately 50%, with faculty spending 20  hours on average per month vs. students spending 50.84  hours. APPE strengths included intentional weekly structuring and oversight and careful student transitions; limitations included minimal pharmacy vendor knowledge and limited rapport-building with pharmacies. SUMMARY: Early experiences demonstrated several benefits, including optimized faculty coach time and student exposure to practice transformation. Future endeavors to implement similar APPEs should incorporate strategies to enhance pharmacy vendor knowledge and strengthen relationship-building with participating pharmacies.

Pharmacist-led hormonal contraceptive prescribing service in a Federally Qualified Health Center: Initial implementation outcomes.

BACKGROUND: The United States has a higher rate of unintended pregnancy than many other developed countries, and Indiana's unintended pregnancy rate is above the national average. Unintended pregnancy rates are highest among low-income women. Federally Qualified Health Centers (FQHC) provide care for the underserved and uninsured patient population. OBJECTIVE: To determine the acceptability, adoption, appropriateness, and feasibility of a pharmacist-led hormonal contraception prescribing service within a FQHC through a collaborative drug therapy management protocol. METHODS: An explanatory mixed methods analysis included surveys followed by semistructured interviews. A survey was created and distributed to all patients who received the service and all providers (physicians and nurse practitioners) employed at the FQHC during service implementation. Semistructured interviews were conducted with a subset of patients and providers. RESULTS: A total of 11 patients and 8 providers completed the survey between January 1, 2022 and June 10, 2022. Of these participants, 4 patients and 4 providers completed an interview between May 1, 2022 and June 30, 2022. Both patients and providers perceived the service as acceptable and appropriate, and providers perceived implementation of the service within clinic as feasible. Ten patients received a prescription from the pharmacist; 1 patient was referred to a provider as the pharmacist was unable to prescribe the medication requested. CONCLUSION: Implementation of pharmacist prescribed hormonal contraception was perceived as acceptable, appropriate, and feasible by patients and providers. Pharmacists are perceived by patients and providers as an additional resource for hormonal contraception prescribing within a FQHC due to their clinical knowledge, efficiency, and attention paid to patients' concerns.

The Impact of COVID-19 on Pharmacy Student Stress During High-Stakes, Performance-Based Assessments in Skills-Based Courses.

Objective. To compare stress levels of pharmacy students in high-stakes, performance-based assessments administered during skills-based laboratory courses in normal classroom environments versus pandemic classroom environments impacted by COVID-19.Methods. In 2019, prior to the start of the COVID-19 pandemic, Doctor of Pharmacy (PharmD) students' stress levels were assessed via a voluntary, paper-based survey before and after performance-based assessments. Students were given a modified version of this survey in 2020 during the pandemic. The 2019 and 2020 survey responses were compared using Wilcoxon rank sum tests.Results. Pharmacy students reported higher perceived stress levels before performance-based assessments (3.8 vs 3.5) and after performance-based assessments (2.8 vs 2.5) prior to the pandemic compared to during the pandemic. Students identified stress as negatively impacting their performance-based assessment performance in both years (3.4 vs 3.1). Students had similar interest in wellness activities in both phases.Conclusion. Colleges of pharmacy should consider implementing stress relief programs around high-stakes assessments as well as prioritizing wellness initiatives within curricula.

Planning for health information exchange: Perspectives of community pharmacists in the Community Pharmacy Enhanced Services Network of Indiana.

BACKGROUND: Community pharmacists are one of the most accessible health professionals and provide many different services. However, lack of access to complete patient information is a barrier to making meaningful patient interventions. OBJECTIVES: To determine (1) current and desired health information access among community pharmacists in the Community Pharmacy Enhanced Services Network (CPESN) of Indiana and (2) design considerations for a health information exchange tool for use by community pharmacists. METHODS: This voluntary study was conducted over an 8-day survey period in which 40 pharmacies within the CPESN Indiana network were contacted during regular business hours and asked to take part in a 15-minute telephone survey. Questions asked were informed by the following Consolidated Framework for Implementation Research intervention characteristics domain constructs: relative advantage, evidence strength and quality, adaptability, trialability, complexity, costs, and design quality and packaging. RESULTS: Of the 40 contacted pharmacies, 32 (80%) completed the survey. Most pharmacies reported access to immunization registry data; no other routine access was reported by any pharmacy. In questions assessing the relative advantage of Health Information Exchange (HIE) access compared with their current information access, at least 84.4% said that they agreed or strongly agreed with all statements. When choosing the data element most desirable to have access to via HIE in a community pharmacy, the most frequently selected choices were updated medication orders (n = 18, 56.3%), progress notes (n = 5, 15.6%), and laboratory tests (n = 4, 12.5%). Suggestions to improve ease of implementation included integration within dispensing software and clinical decision-making support features, such as alerts for pertinent lab values. CONCLUSION: Integrating HIE data into community pharmacies would provide community pharmacists with access to important patient data, and pharmacists believed that this would improve their practice. Future research should explore whether implementation of this type of tool leads to better patient outcomes and improved pharmacist job satisfaction.