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.

Pharmacist-provided services and community pharmacist integration into a patient-centered medical home: A qualitative study of primary care clinic staff perceptions.

OBJECTIVES: To describe patient-centered medical home (PCMH) staff members' views toward community pharmacist involvement in patient care within the PCMH and to identify areas in which pharmacist-provided services can improve the quality of care in their clinics. DESIGN: Qualitative semistructured interview study. SETTING: One primary care clinic. PARTICIPANTS: Multidisciplinary clinic staff members. OUTCOME MEASURES: Views of staff toward implementing a community pharmacist into their clinic and top pharmacist services to help improve medication management within the clinic. RESULTS: A total of 14 staff members of the clinic participated in the study. Participants included physicians, clinical staff members such as registered nurse assistants, licensed practical nurses, and medical assistants, and clinic management. Key themes included the following: the clinic was open to implementing pharmacy services; the providers would be very receptive to pharmacist recommendations; the clinic is willing to try different pharmacist integration models to see what works best within the workflow; the pharmacist must be readily available for consultation; the pharmacist should hold an introductory meeting with the clinic; opinions vary on the best timing of pharmacist appointments with patients; and ideas vary about the best location for pharmacist consultations. The top 5 pharmacist services mentioned by participants included chronic condition management, medication reconciliation training, Beers List education, diabetes education, and adherence counseling. CONCLUSION: Primary care clinic staff support the integration of pharmacy services. Further research is needed to apply the results to other clinics and to identify barriers and opportunities in the implementation process.

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.

Prior Pharmacy Work Experience as a Predictor of Clinical and Didactic Performance for Admissions Committees.

OBJECTIVE: To investigate prior pharmacy work experience (PPWE) in admissions to predict clinical and didactic performance. METHODS: In this retrospective study, data from 3 cohorts, classes of 2020-2022, were collected. Multivariate regressions were conducted to determine the impact of PPWE on performance in first-year pharmacy (P1) Community Introductory Pharmacy Practice Experience (IPPEs), second-year pharmacy (P2) institutional IPPEs, P2 & third-year pharmacy (P3) Observed Structured Clinical Examinations (OSCEs), Drug Information class and P1, P2, P3 grade point averages (GPAs). RESULTS: Of 329 students, those who had PPWE (n = 210) worked as pharmacy technicians (78%), clerks, cashiers, drivers (10%), or other (12%). The majority worked in community settings (86%) and worked an average of 24 h weekly. PPWE was not associated with any pharmacy school GPAs. Those with PPWE scored 2.17 out of 100% points higher in Drug Information than those who did not. They also scored higher on P1 IPPE performance in communication and pharmacy operations skills; however, these notable differences did not continue in P2 IPPEs or OSCEs. Total hours worked in higher quartiles were also associated with increased scores in P1 IPPE communications skills, P1 IPPE pharmacy operations skills, and Drug Information course scores. CONCLUSION: Prior pharmacy work experience modestly improved pharmacy school performance in selected areas in the P1 year, but the effect did not continue in later years. Students who had PPWE performed better in Drug Information and P1 IPPE communication and pharmacy operations skills.

Using an Algorithm to Assess Vaccination Among Patients Who Attended a Pharmacy Student-Driven Statewide Free Health Screening.

BACKGROUND: National vaccination rates remain below goals. Given the geographic availability of community pharmacies, pharmacists are uniquely positioned to provide immunizations. However, many pharmacists may not be proactively recommending vaccinations to patients. OBJECTIVE: The objective of this project was to assess recommendation acceptance rates among patients who attended a pharmacy student-driven statewide free health screening. METHODS: A brief algorithm addressing 4 routine adult vaccinations was created for use by student pharmacists to initiate conversations regarding potentially indicated vaccines with patients. This algorithm was employed at statewide screenings in 2014 and 2015 with expert users available for further discussion. Follow-up to determine recommendation acceptance and identify barriers to immunization occurred 3 to 12 months after screening. The primary end point of change in immunization recommendation acceptance rates between 2014 and 2015 was analyzed using a chi-square test; secondary objectives included changes in consent rates and thematic analysis of reported barriers. RESULTS: A total of 1016 patients were screened. Of these, 403 (39.7%) patients gave consent for student pharmacists to follow-up on vaccine recommendations. The overall recommendation acceptance rate was 27%, with approximately 46% of patients accepting at least 1 recommendation. Acceptance rates significantly decreased in the second year (36.5% vs 23.5%, P < .001), while consent for follow-up significantly increased (20% vs 64%, P < .001). Commonly reported barriers to immunization included resistance to vaccines, forgetfulness, and cost. CONCLUSION: This algorithm provided a method for novice users to initiate conversations with patients about immunizations and may allow novices to act as pharmacist extenders to improve immunization rates.

A communications module to reinforce motivational interviewing concepts.

BACKGROUND AND PURPOSE: Motivational interviewing (MI) is a patient-centered method of communicating that can be used to improve medication adherence. However, it can be difficult to teach and learn. This paper describes the creation of a stand-alone introductory MI module for second-year pharmacy students and its transformation to a module intended to reinforce content after the addition of a new MI-based course in the first year. It compares student competence in MI skills between the two modules (introductory versus reinforcement). EDUCATIONAL ACTIVITY AND SETTING: In 2012 and 2013, an introductory MI module was delivered to second year pharmacy students. In 2014, a course grounded in MI principles was introduced in the first year of the curriculum, with the module in the second year modified to reinforce those principles. All second-year students' MI skills were assessed with an objective structured clinical examination (OSCE) case. Overall case scores and individual item scores were compared before and after the addition of the course using assessment data from two years before and after the change. FINDINGS: Overall case scores (81.9% vs. 86.9%, p = 0.001) significantly improved after the introduction of the new course. Items related to MI skills also improved significantly. Scores for general communication items were not different. SUMMARY: After the introduction of the new MI-based first-year course, students performed better on items specifically related to MI in an OSCE case. This model can serve as a useful example of how to introduce MI skills and reinforce these skills later in the curriculum.

Emergency contraception counseling in a retail pharmacy setting: a pilot study.

INTRODUCTION: Nonprescription emergency contraception (EC) is now available for purchase without age restrictions. This is a great opportunity for pharmacists to provide counseling to ensure that customers use EC correctly. OBJECTIVE: This pilot study explored the impact of student pharmacist counseling on customer knowledge of EC in a retail pharmacy setting and assessed customer satisfaction with the counseling. METHODS: Counseling was performed at 2 retail pharmacies during June and July 2012. Participants completed a 12-question pretest that measured baseline knowledge of EC prior to a 5- to 10-minute education session, followed by the same 12-question posttest. A follow-up test was conducted via telephone within 1 to 3 months after the counseling. RESULTS: Eighty-seven women participated with a mean age of 30.2 (standard deviation = 7.2) years. The average posttest score was significantly higher than the pretest score (11.5 ± 1.0 vs 8.5 ± 2.5; P < .001). The mean follow-up score (9.9 ± 1.1) was significantly higher than the pretest score (P = .014), which indicated retained knowledge. Participants reported being highly satisfied with the counseling session and strongly agreed that the counseling would help them use EC correctly. CONCLUSION: Student pharmacist-provided EC counseling increased participants' EC knowledge both immediate and long term. This study suggests that EC counseling is feasible and valued by customers.