Community pharmacist intervention to close statin gaps in diabetes care: The GuIDE-S study.

BACKGROUND: Statin therapy is recommended for people with type 2 diabetes (T2D) to lower cardiovascular risk; however, evidence suggests that significant gaps in statin therapy exist. OBJECTIVE: To evaluate (1) the impact of a community pharmacist-led model for initiating statin therapy in people with type 2 diabetes (T2D) on statin initiation and (2) pharmacists' self-reported perceptions of the intervention feasibility and fidelity to the intervention. METHODS: This was a type 1 hybrid effectiveness-implementation study of 9 intervention and 18 control pharmacies within a community pharmacy chain. Pharmacy staff proactively identified patients with T2D not taking a statin and prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from the patient's preferred prescriber. The eligible population included patients aged 18-84 years with T2D, who had filled ≥60 days' supply of one, noninsulin, diabetes medication in a rolling 6-month period, and who had not filled a statin during the same period. A Cox proportional hazards model was used to compare time to statin initiation. Pharmacists at intervention pharmacies completed a survey at 6 and 12 months after implementation (March and August 2019, respectively) to assess intervention feasibility and fidelity. RESULTS: For the statin initiation analysis, 1670 intervention patients were matched to 3358 control patients. Overall, 26.3% (n=442) of intervention patients and 25.4% (n=854) of control patients initiated a statin within 12 months of their index date. There was no difference in statin initiation likelihood between intervention and control patients (hazard ratio: 1.00; 95% CI: 0.83, 1.21). Fifteen pharmacists completed the 6-month survey (33% response rate), and 12 completed the 12-month survey (26%). The intervention's feasibility score was 4.0 at 6 months and 4.2 at 12 months, indicating an increase in perceived feasibility. Fidelity decreased from 6 to 12 months. CONCLUSION: The community pharmacist-led intervention resulted in more patients initiating statin therapy as compared to usual care; however, the differences were not statistically significant. Pharmacists perceived the intervention to be feasible; however, fidelity decreased over time.

Community pharmacist intervention to optimize statin adherence in diabetes care: The GuIDE-S study.

BACKGROUND: Statin use in people with type 2 diabetes (T2D) reduces cardiovascular events, yet adherence remains suboptimal. OBJECTIVE: This study evaluated the impact of a community pharmacist intervention on statin adherence in new users with T2D. METHODS: As part of a quasi-experimental study, community pharmacy staff proactively identified adult patients with T2D who were not prescribed a statin. When appropriate, the pharmacist prescribed a statin via a collaborative practice agreement or facilitated acquisition of a prescription from another prescriber. Patients received individualized education and follow-up and monitoring for 1 year. Adherence was defined as the proportion of days covered (PDC) by a statin over 12 months. Linear and logistic regression were used to compare the effect of the intervention on continuous and a binary adherence threshold, defined as PDC ≥ 80%, respectively. RESULTS: Overall, 185 patients started statin therapy and were matched to 370 control patients for analysis. Adjusted average PDC was 3.1% higher in the intervention group (95% CI -0.037 to 0.098). Patients in the intervention group were 21.2% more likely to have PDC ≥ 80% (95% CI 0.828-1.774). CONCLUSION: The intervention resulted in higher statin adherence than usual care; however, the differences were not statistically significant.

Pharmacists' Role in Chronic Disease Management from Physicians' Perspective.

OBJECTIVE: The objective of this research was to gather physicians' perception of pharmacists providing chronic disease management and identify trends in physicians' characteristics that could potentially impact their comfort level collaborating with pharmacists. METHOD: Physicians practicing in the outpatient setting in the state of Washington were invited to participate in a voluntary, anonymous survey. Physicians practicing in a large multidisciplinary outpatient clinic in the Southwest Washington and Seattle areas were included. For Likert scale questions, median values were reported. Physicians' characteristics were also correlated with their willingness to collaborate with pharmacists in the provision of clinical services. RESULTS: Results were analyzed using descriptive statistics to summarize the data collected to determine which pharmacist provided clinical services physicians would like to collaborate on. Physicians were most comfortable with pharmacists reviewing patients' medications followed by pharmacist provision of disease state education and least comfortable with pharmacists initiating therapy. Physicians that have worked with pharmacists in the past were more likely to collaborate with pharmacists compared to physicians that have never worked with a pharmacist. Furthermore, pharmacists' ability to bill patients' medical insurance did not influence physicians' likelihood to collaborate with pharmacists. CONCLUSION: This information will be used to aid in the determination of future directions for the implementation of additional clinical services within the community pharmacy setting. Additionally, it is anticipated that pharmacists will be able to utilize this information to initiate conversations with physicians in an effort to collaborate on new pharmacist provided clinical services as well as improve patient outcomes by increasing access to healthcare providers, including pharmacists.

Assessing Readiness of Community Pharmacists to Perform and Document Medically Billed Clinical Services.

OBJECTIVES: To assess the readiness of community pharmacists in documenting and performing medically billed clinical services. Additionally, the preferred training method of community pharmacists was evaluated. METHODS: This study surveyed practicing pharmacists in a chain community pharmacy in Washington State via a voluntary, anonymous online survey through Qualtrics. Data collected in the survey measured each pharmacist's self-perceived ability to perform examinations and to gather and document patient subjective and objective information compliant with medical billing requirements. In addition, questions evaluated the training methods pharmacists preferred in the community setting. The data was aggregated and analyzed utilizing descriptive statistics to assess pharmacists' self-perceived baseline understanding regarding documenting and performing medically billed clinical services as well training preferences of the pharmacists surveyed. RESULTS: Pharmacists in the study had a generally higher perceived ability in performing past medical history, medical decision-making and clinical documentation of a medical visit. In contrast, pharmacists in the community setting had a lower perceived ability performing physical assessment criteria in a medically billed clinical visit. This study indicated that pharmacists in the community setting preferred live small-group training on future medical billing. CONCLUSION: Pharmacists have some of the skills necessary to perform and bill clinical visits; however, there is room for improvement in particular areas where pharmacists have a lack of training and experience.