Expanding scope: Impact and preferred implementation strategies for statewide test and treat protocols.

BACKGROUND: Arkansas Act 503 allows pharmacists to test and treat health conditions performed with waived tests using a statewide protocol. To guide development and implementation of these protocols, this study was conducted after enactment of Act 503 and before protocols were published. OBJECTIVES: The objectives were to determine pharmacy leaderships' perceived impact on point-of-care testing (POCT) services in Arkansas and preferred implementation strategies for expanding scope of practice. METHODS: A cross-sectional electronic survey of pharmacies holding a Clinical Laboratory Improvement Amendments certificate of waiver in Arkansas was conducted. The primary point of contact of 292 pharmacies was invited by e-mail. Chain, regional, or multi-independent pharmacies of the same company completed one survey on behalf of their organization. The questions assessed perceptions of Act 503 on POCT services and preferred implementation strategies. Study data were collected using REDCap and analyzed using descriptive statistics. RESULTS: One hundred and twenty-five invitations were e-mailed to pharmacy owners or representatives with a response rate of 64.8% (n = 81 surveys). This represented 238 of 292 invited pharmacies (81.5%). In 2021, 82.6% of pharmacies provided POCT services, specifically 27% influenza, 26% streptococcus, and 47% coronavirus disease 2019. Ninety pharmacies (37.9%) reported they are certain or almost certain they will prescribe using the protocol. More pharmacies (63%) reported the youngest age they would prescribe treatment is 6 to 12 years. Most pharmacies (82.2%) do not anticipate or are unsure about increasing their fee once the protocol is adopted. Most pharmacies (> 95%) reported virtual training, online modules, central contact, and a one-page resource with key protocol information would be most helpful in implementing new statewide protocols. CONCLUSION: Arkansas pharmacies are willing to use a protocol for 6 years and older and did not anticipate increasing fees to support the expanded service. Pharmacists indicated virtual training and one-page resources would be most helpful. This work highlights implementation strategies that could be most useful as pharmacy scope expands in other states.

A taxonomy for community pharmacy patient care services reported in Pharmacist eCare Plans.

BACKGROUND: Pharmacies belonging to the Community Pharmacy Enhanced Service Networks (CPESN) are transforming their practices with support of the Flip the Pharmacy initiative. These pharmacies are submitting eCare plans that describe care that they have provided to patients. OBJECTIVES: The objectives of this study were (1) To develop a taxonomy for services reported by community pharmacies participating in year 1 of the Flip the Pharmacy initiative and (2) to illustrate the use of the taxonomy for hypertension-related services. METHODS: A retrospective observational study design was used. The analyzed data were extracted from eCare plans submitted by participating pharmacies during the first year of the Flip the Pharmacy initiative (October 1, 2019-September 30, 2020). Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) codes submitted for encounter reason and for procedures were sorted into categories based on similarity of terminology in the SNOMED-CT code labels. All SNOMED-CT codes in the encounter reasons that had blood pressure or hypertension in their labels were mapped to taxonomy categories. Descriptive statistics were calculated for all variables. RESULTS: A total of 368,297 eCare plans reporting 1,049,061 SNOMED-CT procedures were submitted for 133,210 patients by 526 pharmacies. Seven categories of community pharmacy patient care services were identified: medication synchronization, medication review, monitoring, immunizations, patient education, adherence, and recommendations. Over half of the encounter reasons (63.5%) and procedures (56.2%) were for medication synchronization. Both medication review and monitoring accounted for about 10% of the encounters, and medication review made up over 30% of procedures. A total of 18,307 encounters were related to hypertension. Of these, monitoring was the most frequent, with 11,285 encounters (61.6%) encounters, followed by patient education, with 5173 encounters (28.3%). CONCLUSION: CPESN pharmacies are delivering a wide range of patient care services. This taxonomy provides a concise way to organize and report services being delivered by community pharmacies.

Evaluation of an accredited training program on implementation of point-of-care testing in community pharmacies.

OBJECTIVES: The primary objective of this study was to evaluate the National Association of Chain Drugstores' point-of-care testing (POCT) training program's effect on the implementation of pharmacy POCT services in Arkansas and barriers that may have prevented or slowed implementation. The secondary objective was to evaluate the quality of the training program by asking participants to report their feelings of preparedness at the conclusion of the training and once they began implementing POCT services independently. METHODS: In July 2019, 57 pharmacists in Arkansas were invited by e-mail to participate in a survey project to evaluate the effectiveness of the POCT training program. The responses were captured using the REDCap survey platform. The survey was available for approximately 5 weeks. The data were interpreted using descriptive analysis. RESULTS: A total of 25 pharmacists responded to the survey. Eight e-mail contacts were determined to be inactive or ineligible to participate for a usable response rate of 46.9%. Approximately 48% of the respondents stated that their pharmacy offered POCT services. The most common barrier to implementation identified by the respondents was determining how to obtain treatment for patients who tested positive. Most of the respondents also reported feeling at least "very prepared" at the conclusion of the training program. Once they began implementing POCT services on their own, 6 respondents reported a decrease in preparedness, 2 respondents reported an increase in preparedness, and the remainder felt equally prepared in both scenarios. More than half of the respondents (52.2%) requested additional resources outside of what is currently provided. CONCLUSION: The implementation rates and effectiveness of the training program discussed in this study will potentially help improve the training and expand POCT services. As pharmacies add additional services outside of dispensing products, training programs and other resources will become increasingly important.

Development and implementation of a collaboration between a patient-centered medical home and community pharmacy.

OBJECTIVES: This study aimed to describe the development and implementation strategies used in the collaboration between a patient-centered medical home (PCMH) and a grocery pharmacy chain and to evaluate the effectiveness of a community pharmacist's clinical integration in reducing hemoglobin A1c levels at clinic and patient levels. SETTING: The Kroger Co and Catholic Health Initiative St. Vincent. PRACTICE DESCRIPTION: The Kroger Co is a large grocery store that operates 27 pharmacies in the state of Arkansas, with 20 locations in the central Arkansas area. PCMH is part of a large health system in central Arkansas with 10 primary-care clinics in the area. PRACTICE INNOVATION: With the transition to value-based payment models, pharmacists are being utilized in settings outside of the pharmacy. This project demonstrates a partnership between a community pharmacy and PCMH. The community pharmacist spent 20 h/week in the PCMH providing medication therapy and disease state management services. Services were focused on patients with uncontrolled diabetes. EVALUATION: Descriptive statistics were used to describe the distribution of the pharmacists' time. A patient-level pre-post analysis of the mean changes in hemoglobin A1c (HbA1c) was conducted for patients who interacted directly with the pharmacist. A clinic-level analysis was conducted to evaluate changes in HbA1c compared to that in a nonequivalent control group using a standard quality measure. RESULTS: In total, 312 individual patients interacted with the pharmacist. Of those patients, 228 had diabetes. A total of 111 patients underwent pre-post HbA1c analysis. In those patients, there was a statistically significant reduction in mean HbA1c . There was no difference in clinic-level results between the intervention and control locations. CONCLUSION: Collaboration between a community pharmacy and PCMH is feasible and may improve patient care. Future research should include pharmacy-based visits and development of a process for improved communication.

Implementation of technician-driven medication therapy management program in community pharmacies.

OBJECTIVES: Pharmacists have reported barriers in implementing medication therapy management (MTM) services into community pharmacy workflow. A community pharmacy grocery chain created an MTM training program with detailed workflow manual and templates intended as a turnkey operation for MTM implementation. To expand the use of this program, 20 community pharmacies were trained in January 2017. The objective of this study was to evaluate the adoption or actual implementation of the program's workflow and to determine barriers to implementation. SETTING: Pharmacists and technicians who participated in the program were from 20 community pharmacies, including a chain pharmacy, multiple-independent pharmacies, and single-independent pharmacies, in Arkansas. PRACTICE INNOVATION: The training program used a standardized process with documentation templates to implement a technician-driven workflow. The program required 1 pharmacist and 1 technician per pharmacy to attend an 8-hour live training session. EVALUATION: Qualitative cross-sectional study using semistructured interviews with pharmacists and technicians 1 year after training session. One pharmacist and 1 technician from 12 pharmacies were invited. The interview guide included questions on how the program was implemented at their respective pharmacies and barriers to implementing the program. The interviews were recorded and transcribed, and transcripts were coded for common themes. RESULTS: Seven pharmacists and 6 pharmacy technicians agreed to participate. The program was implemented without difficulty in all 7 pharmacies. Pharmacists and technicians reported that the program provided streamlined MTM workflow, expanded technicians' role, and improved confidence in providing services. Barriers to providing MTM services, despite the new workflow, included competing priorities and staffing. CONCLUSION: The training program resulted in a variety of community pharmacies to successfully implement MTM services. Future studies should further explore sustainability and impact on financial and patient outcomes.

Physician-reported factors that encourage collaboration with community pharmacists.

OBJECTIVE: To determine factors that encourage physicians to establish collaborative practice agreements with community pharmacists. METHODS: A 20-item cross-sectional survey was mailed to a random sample of 1000 family medicine physicians practicing in North Carolina. Two weeks after the initial mailing, a reminder was sent to physicians. Physicians were entered into a drawing to receive a gift card as an incentive for survey completion. The questionnaire collected demographic information, factors important to physicians for collaboration with a community pharmacist, and physician perceptions of pharmacist qualifications. Descriptive statistics were used to analyze patterns in the Likert scale survey responses. RESULTS: Of the 1000 mailed surveys, 67 were returned as undeliverable, resulting in a final sample size of 933 surveys. One hundred forty-six family medicine physicians responded to the survey, yielding a 15.6% response rate. Respondents were 58% male, 73% had been practicing longer than 10 years, and 60% had an academic affiliation. Our results indicate that an established relationship with a community pharmacist is the most important factor when considering a collaborative practice agreement. At least 90% of physicians reported that the most important pharmacist contributions were drug therapy adverse effect management, drug interaction management, medication access assistance, prescription counseling, and medication adherence. A majority of physicians reported that community pharmacists improve quality outcomes and metrics (74% and 72%, respectively). CONCLUSION: Physicians in North Carolina recognize the value of the services a pharmacist can provide to their patients. Developing relationships between community pharmacists and physicians and describing the value of additional credentialing in the provision of patient care will be integral in establishing collaborative practice agreements in the community setting.

Implementing an integrated care management program in community pharmacies: A focus on medication management services.

OBJECTIVES: To describe the initiation of a community pharmacy medication management service within a statewide integrated care management program. SETTING: One hundred twenty-three community and community health center pharmacies in 58 counties of North Carolina. PRACTICE DESCRIPTION: Independent and community health center pharmacies offering medication management as part of an integrated care management program to Medicaid, Medicare, dually eligible Medicare-Medicaid, and NC Health Choice beneficiaries in North Carolina. PRACTICE INNOVATION: Community pharmacies joined an enhanced service network created by Community Care of North Carolina to provide medication management services as part of an integrated care management program. EVALUATION: During the first 3 months of the program, 41% of pharmacies consistently documented the medication management services. Interviews were conducted with pharmacists from the inconsistent pharmacies to drive program improvements. RESULTS: Pharmacists at 73 community and community health center pharmacies were interviewed. The majority of pharmacists reported that challenges in "initiating services" and "documenting" were due to increased intensity of service and documentation compared with Medicare Part D medication therapy management requirements. Program changes to improve participation included revision of documentation requirements, authorization of technicians to transcribe pharmacists' interventions, additional documentation templates, workflow consultations, and feedback on documentation quality. CONCLUSION: Community pharmacies are capable of providing medication management integrated with care management. Some pharmacies have more difficulty initiating new services in the current workflow landscape. To facilitate implementation, it is important to minimize administrative burden and provide mechanisms for direct feedback. Pharmacy owners, managers, and leaders in pharmacy policy can use these findings to aid implementation of new services in community pharmacies.

Pharmacy characteristics associated with the provision of medication management services within an integrated care management program.

OBJECTIVES: To examine pharmacy operational and personnel characteristics that influence engagement in providing a community pharmacy medication management service within a statewide integrated care management program. METHODS: Before the program launch, all of the pharmacies were surveyed to collect demographic, operational, and personnel characteristics such as weekly prescription volume and number of staff, respectively. Those data were then compared with engagement in the program. Engagement was defined as providing initial comprehensive medication review as part of the medication management service. Three months after program launch, pharmacies were dichotomized as consistently engaged or inconsistently engaged. Data were analyzed with the use of descriptive statistics and chi-square and t tests to test for statistical significance between consistent and inconsistent engagement groups. RESULTS: A baseline survey was collected for all 123 pharmacies who joined the integrated care management program. After the first 3 months, 50 pharmacies were consistently engaged in the program. Compared with inconsistently engaged pharmacies, consistently engaged pharmacies employed more full-time pharmacists (mean 2.1 vs. 1.8; P = 0.05) and more full-time technicians (mean 4.0 vs. 3.0; P <0.01), allocated more nondispensing hours for pharmacists (88% vs 60%; P <0.01), were more likely to employ a dedicated clinical pharmacist (20% vs 5%; P = 0.013), and hosted more pharmacy residents (78% vs 22%; P = 0.02). Years of pharmacy operation (P = 0.05) and pharmacy store type (P = 0.05) also were significantly associated with level of engagement. Neither prescription volume dispensed per week, number of hours of pharmacist overlap, nor hosting pharmacy students was statistically different between consistent and inconsistent pharmacies. CONCLUSION: Engagement in clinical activities in community pharmacy appears to improve with adequate staffing, availability of time for nondispensing activities, and having 1 or more pharmacists dedicated to clinical activities.

Fellowships in community pharmacy research: Experiences of five schools and colleges of pharmacy.

OBJECTIVE: To describe common facilitators, challenges, and lessons learned in 5 schools and colleges of pharmacy in establishing community pharmacy research fellowships. SETTING: Five schools and colleges of pharmacy in the United States. PRACTICE DESCRIPTION: Schools and colleges of pharmacy with existing community partnerships identified a need and ability to develop opportunities for pharmacists to engage in advanced research training. PRACTICE INNOVATION: Community pharmacy fellowships, each structured as 2 years long and in combination with graduate coursework, have been established at the University of Pittsburgh, Purdue University, East Tennessee State University, University of North Carolina at Chapel Hill, and The Ohio State University. EVALUATION: Program directors from each of the 5 community pharmacy research fellowships identified common themes pertaining to program structure, outcomes, and lessons learned to assist others planning similar programs. RESULTS: Common characteristics across the programs include length of training, prerequisites, graduate coursework, mentoring structure, and immersion into a pharmacist patient care practice. Common facilitators have been the existence of strong community pharmacy partnerships, creating a fellowship advisory team, and networking. A common challenge has been recruitment, with many programs experiencing at least one year without filling the fellowship position. All program graduates (n = 4) have been successful in securing pharmacy faculty positions. CONCLUSION: Five schools and colleges of pharmacy share similar experiences in implementing community pharmacy research fellowships. Early outcomes show promise for this training pathway in growing future pharmacist-scientists focused on community pharmacy practice.

Using Instagram Stories to supplement a required self-care pharmacy course.

BACKGROUND AND PURPOSE: Social media is widely used among Americans, with Instagram being especially popular in adults under age 30. There are few examples of the use of Instagram in pharmacy education and no reports of student perspectives on using Instagram to supplement self-care pharmacy coursework. This article describes the design, implementation, and evaluation of a teaching innovation using Instagram Stories to supplement a required self-care course. EDUCATIONAL ACTIVITY AND SETTING: The instructors of Self-Care Therapeutics created an Instagram account to share content as an optional supplement to course topics. The account shares stories featuring real-time questions from friends and family of the instructors, product and device demonstrations, and discussion of current events or news related to over-the-counter products. An anonymous survey was sent to all students at the semester conclusion to gain student perceptions of the posted content. A focus group was conducted to further interpret the survey data. FINDINGS: Of the 89 students enrolled, 51 completed the survey and 30 students followed the course account. Students agreed that the account was helpful for reinforcing information from class and provided information beyond what was discussed in class, but they had mixed perceptions of its utility for exam preparation and application to real life. SUMMARY: Use of Instagram Stories as an alternative method to supplement content in a required self-care course is feasible and received well by students. Use of social media could improve perceived relevance of course topics to students.

Identification and Characterization of Workflow Models for Medication Therapy Management in Community Pharmacies.

Community pharmacists providing medication therapy management (MTM) services report difficulty incorporating MTM services with dispensing and other pharmacy services. A variety of approaches exist due to a lack of an ideal standard for service integration. This study seeks to identify and characterize MTM workflow models in pharmacies of one geographic area of a large community pharmacy chain. Thirteen semi-structured interviews were conducted with pharmacists from thirteen different pharmacies. Interviews were audio-recorded, transcribed, and analyzed for common themes using an inductive qualitative approach. We did not find a high level of MTM task integration into the dispensing workflow in this setting. However, three main strategies used to delegate work of MTM activities were identified and defined: shared teamwork, delegated teamwork, and single delegation. Few MTM tasks were integrated into the dispensing workflow among interviewed pharmacies; most tasks were performed outside of workflow. The most common integration was performing patient interviews at pick up. There were no trends identified among high performing or low performing pharmacies. This work may provide a basis to define workflow models for further research to test implementation strategies within community pharmacies.

Rural Community Pharmacists' Perceptions of Implementing Mental Health Interventions to Reach Underserved Populations.

Mental illness and suicide are significant public health problems. Limited resources put individuals at greater risk, particularly in rural areas with fewer health providers. Community pharmacists are the most accessible health professionals in rural communities and are interested in addressing mental health concerns. Research is limited on how to implement mental health interventions in community pharmacy settings. The objectives of this study were to assess community pharmacists' perceptions of mental health interventions and barriers and facilitators to implementation and prioritize interventions to be pilot tested. Qualitative interviews were conducted with community pharmacists (N=17). Interviews focused on perceptions of mental health interventions in pharmacy settings. Data were analyzed using template analysis. A stakeholder meeting reviewed data and prioritized interventions to be pilot tested. Pharmacists viewed implementing mental health interventions positively. Barriers included lack of mental health knowledge, time, diagnosis, and concerns about workflow. Facilitators included accessible settings, knowing the community, and seeing patients frequently. The most common needs for implementation were education and payment. Pharmacists preferred progress monitoring in collaboration with a prescriber and mental health first aid training. Further research is needed to gather feedback from prescribers to inform implementation.

The Report of the 2022-2023 AACP Professional Affairs Standing Committee: Focused Integration of Community-Based Pharmacy Practice Within the AACP Transformation Center.

The 2022-2023 Professional Affairs Committee was charged to (1) Devise a framework and 3-year workplan for the Academia-Community Pharmacy Transformation Pharmacy Collaborative to be integrated within the American Association of Colleges of Pharmacy (AACP) Transformation Center. This plan should include the focus area(s) to be continued and developed by the Center, potential milestone dates or events, and necessary resources; and (2) Provide recommendations on focus areas and/or potential questions for the Pharmacy Workforce Center to consider for the 2024 National Pharmacist Workforce Study. This report provides the background and methodology utilized to develop the framework and 3-year workplan focused on (1) community-based pharmacy pipeline development for recruitment, programming, and retention, (2) programming and resources for community-based pharmacy practice, and (3) research areas for community-based pharmacy practice. The Committee offers suggested revisions for 5 current AACP policy statements, 7 recommendations pertaining to the first charge, and 9 recommendations pertaining to the second charge.

Redefining 'advanced': Supporting and promoting practice change through community advanced pharmacy practice experiences.

INTRODUCTION: Community pharmacy practice in the United States (US) has faced several external pressures, threatening traditional practice models. Schools and colleges of pharmacy (S/COP), particularly through experiential rotations, are perfectly poised to help these practices create new sustainable business models. The purpose of this article is to highlight demonstrated, reproducible successes of community advanced pharmacy practice experience (APPE) advancement initiatives. PERSPECTIVE: Despite community pharmacists being highly-trained health care providers with roughly equivalent educational backgrounds, community-based practices in the US are not all the same. Student pharmacists can contribute to the design and implementation of revenue-generating services helping individual pharmacies elevate their practice. Doing so involves new models for staffing, workflow, billing, and documentation. Students can help support practice change by focusing on implementation and sustainability. Example APPE integrations focused on community pharmacy practice transformation are described in detail from the University of Arkansas for Medical Sciences College of Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Idaho State University. IMPLICATIONS: Establishing intentional connections that focus on new sustainable community business models is a responsibility for S/COP. The examples provided serve to demonstrate the feasibility of these partnerships. Training students on innovative practice models and utilizing them is critical in moving community practice forward. As academicians, we must prepare students to be agents of change for the profession and intentionally integrate them into a systematic plan to help promote and change practice activities wherever possible, but especially in community practice.

Advanced pharmacy practice experience students at the intersection of education and practice transformation.

BACKGROUND AND PURPOSE: Community pharmacy practice is transforming from traditional dispensing roles, and advanced pharmacy practice experiences (APPEs) could be a viable mechanism to assist pharmacies during transformation. A new type of APPE is described and the design, outcomes, and feedback from the first students and pharmacies piloting this rotation are discussed. EDUCATIONAL ACTIVITY AND SETTING: A four-week elective APPE was designed to position fourth-year students as facilitators for community pharmacy transformation activities. The first transformation activity was clinical documentation using electronic care plans (eCare plans). Students spent a majority of the rotation in the pharmacy with only the first week and one day a week thereafter at the college of pharmacy. Students assessed current pharmacy workflow, developed an implementation plan, trained pharmacy staff, and created protocols and resources. FINDINGS: Four student pharmacists completed the rotation during May, June, and August 2019. Student knowledge was assessed through a 12-question pre- and post-quiz on implementation science and the pharmacist eCare plan. Following orientation activities, students' scores increased from an average 44% to 86%. Course evaluations showed students learned about pharmacy business management and recognized challenges in teaching staff new concepts. All students indicated appreciation for innovative activity involvement and helping a pharmacy advance its practice. SUMMARY: Early findings from this elective indicate a successful learning experience for students and pharmacy owners. The students gained skills in teaching, facilitation, and practice management, while pharmacy owners benefitted from staff training and implementation resources.

Positive Impact of Technician-Driven MTM Program on Performance Measures.

OBJECTIVE: To determine the effect of using a technician-driven medication therapy management (MTM) program on quality performance measures for a community pharmacy chain. METHODS: A technician-driven MTM program was incorporated in 35 stores of a regional supermarket pharmacy chain. The overall chain percentage score for the 4 quality measures used in Medicare Part D Star Ratings-proportion of days covered (PDC) for cholesterol, diabetes, renin-angiotensin system antagonists (RASA), and high-risk medication use-was compared pre- and postimplementation of the technician-driven MTM program. Data were collected from Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) platform and t tests were used to analyze 1 year pre- and postimplementation. RESULTS: The PDC for RASA, high cholesterol medications, and diabetes medications significantly increased pre- to postimplementation for each drug class (P < .001, P = .011, P = .001, respectively). The combined overall mean PDC score for RASA, cholesterol medications, and diabetes medication classes significantly increased by 5.6% from 2015 to 2016 (74.2% vs 79.8%, P < .001); there was also a nonsignificant decrease in high-risk medication use for the entire chain. CONCLUSIONS: This technician-driven MTM program can positively affect pharmacy quality performance and potentially improve patient outcomes.

Development of Community Pharmacy Characteristics Questionnaire: Application of Cognitive Interviewing.

BACKGROUND: A questionnaire specific to community pharmacy characteristics, such as staffing models for clinical activities and business operations, does not exist. As community pharmacy practice expands, it is important to characterize how pharmacies are changing for outcomes research. The aim of this study was to conduct cognitive interviewing with community pharmacists to gain feedback on the formatting, readability, and content of items measuring community pharmacy characteristics to develop such a questionnaire. METHODS: National surveys and previously developed survey work were reviewed to identify the following question categories: business operations, human resource management, division of clinical responsibilities, technology, and enhanced services. Questions for each domain were drafted and assessed for applicability across different states and level of importance by researchers in 3 different states. Using the "think aloud" method of cognitive interviewing to evaluate clarity in instructions, question items and response entry, an iterative process was established that included 3 rounds of interviews with discussion and modifications made by the research team between each round. RESULTS: A total of thirteen cognitive interviews across 3 rounds were conducted via telephone and lasted between 30 and 60 minutes. Time for participant pharmacists to complete the questionnaire ranged from 12 minutes to 30 minutes. The interviews revealed areas of ambiguity, and missing response options for the variety of business structures. The question categories with the most problematic items were business operations, human resource management, and division of clinical responsibilities. CONCLUSION: Using cognitive interviewing, a community pharmacy questionnaire focusing on operational characteristics was developed. Future research is warranted to test the organizational characteristics defined in this paper with a larger sample size representing multiple states.

A model to inform community pharmacy's collaboration in outpatient care.

Value-driven health care and team-based care are gaining momentum from policymakers, payers, and providers. An important facet to examine is the health care team, especially in outpatient care. Community pharmacy is a significant aspect of the patient's health experience and a valuable component of outpatient care. An in-depth look into how community pharmacy can participate in the outpatient care team is described. To function as a team, it is crucial to address collaboration among outpatient practices, while making it easier for patients to navigate the outpatient health system. Previously published characteristics, principles, and values of effective health care teams within primary care can aid in establishing teams across practice settings including community pharmacy.

Early Introduction to Professional and Ethical Dilemmas in a Pharmaceutical Care Laboratory Course.

OBJECTIVE: To study the effects of an early professional development series in a pharmaceutical care laboratory (PCL) course on first-year pharmacy students' perceptions of the importance of professional attitudes and action. DESIGN: Three hundred thirty-four first-year students enrolled in a PCL course participated in a new required learning activity centered on development of professional attitudes and behaviors. Students discussed situational dilemmas in pharmacy practice in small groups, highlighting application of the Oath of a Pharmacist and the Pharmacists' Code of Ethics. ASSESSMENT: Students completed an optional questionnaire at the beginning and end of the semester to assess change in their attitudes and behaviors related to professionalism in pharmacy practice. CONCLUSION: While students entered their training with a strong appreciation for professionalism, they felt more confident in applying the Oath of a Pharmacist and the Pharmacists Code of Ethics to dilemmas in practice following the new learning activity.