Chain Pharmacies Research Articles

Методический подход к маркетинговой оценке эффективности онлайн-позиционирования аптечных сетей в Уральском федеральном округе

Методический подход к маркетинговой оценке эффективности онлайн-позиционирования аптечных сетей в Уральском федеральном округе

A qualitative case study exploring the implementation of pharmacist care planning services in community pharmacies

ObjectivesTo describe the comprehensive annual care plan (CACP) process and to conceptualize how remunerated CACP services were implemented by community pharmacists. DesignA comparative, multiple case study approach with data comprising document review, observation, and semistructured interviews. Setting and participantsPharmacists, pharmacy technicians and staff, and student pharmacists from 4 different community pharmacy sites in Alberta, Canada, including independent, franchise, and corporate chain pharmacies. In addition, patients and other health care providers were included in the interviews. Outcome measuresConstructivist grounded theory was used to understand how care planning services were implemented in the real-world context of community pharmacies and how pharmacists provided CACPs within their practice. ResultsBetween May 2016 and January 2018, a total of 77 interviews and 94 hours of observations were completed at the 4 pharmacy sites, and 61 documents were collected. The CACP service required adaptation of the workflow at each of the sites. However, pharmacists and other pharmacy staff recognized benefits of the service with respect to pharmacists’ role expansion. The overarching grounded theory concept was changing the status quo. The following 4 themes emerged representing how the service was implemented: engaging patients, professional development and learning from experience, creating a supportive environment, and building community connections. ConclusionThis study found that practice change or changing the status quo was needed to implement remunerated care planning services in community pharmacies. The results of this study may be of interest to community pharmacists, pharmacy managers, and policy makers who are implementing remunerated care planning services in other jurisdictions.

The Impact of Pharmacist Vaccination Privilege during a Nation-Wide Measles Outbreak.

The 2019 measles outbreak was the worst since the USA eliminated measles in 2000. This paper presents the vaccination trends for a large chain-pharmacy, Walgreens, and examines the estimated vaccination capacity and impact of pharmacist privilege policies across states. Specifically, we estimated the number of people who could have been vaccinated in eight states with reduced or no measles, mumps, and rubella (MMR) vaccination privilege during the study period January–June, 2019. During the study period, Walgreens pharmacists administered MMR vaccines to 62,526 patients, a 231.9% increase. If pharmacists had been permitted to vaccinate against measles in the eight states investigated, Walgreens pharmacies would have administered between 12,404 and 36,551 additional vaccinations during that time. We also estimated all chain pharmacies’ capacity to vaccinate in one state that was severely impacted by the measles outbreak, New York, using a range from normal pharmacy operating conditions to maximum capacity. Assuming sufficient demand, it was estimated that chain pharmacies in New York State would have the capacity to vaccinate between 47,688 and 174,856 patients daily, achieving MMR vaccination (first dose) of the measles-susceptible population within 8–28 days. Overall, this study demonstrates the public health value of pharmacist vaccination privilege during a nation-wide outbreak of measles.

Naloxone availability and dispensing in Indiana pharmacies 2 years after the implementation of a statewide standing order

ObjectivesThis study examined changes in rates of pharmacy naloxone stocking and dispensing in Indiana between 2016 and 2018 and explored supplemental variables and factors that may have affected observed differences. MethodsResearchers used data from 2 existing datasets that were collected from managing pharmacists who responded to statewide pharmacy censuses in 2016 and 2018. After identifying all cases in which a pharmacy’s managing pharmacist responded in both 2016 and 2018 censuses, researchers conducted a nonparametric statistical comparison of naloxone stocking and dispensing rates in 107 Indiana pharmacies. Additional descriptive data regarding naloxone-related pharmacy policies and educational programs during those years were collected in 2019 from pharmacy corporations operating food stores or chain pharmacies in Indiana and from the Indiana Pharmacists Association. ResultsPharmacy stocking and dispensing in Indiana increased from 2016 to 2018. In 2016, 57% of pharmacies reported stocking naloxone compared with 92.5% in 2018 (P < 0.001). Similarly, 23.4% of pharmacies reported dispensing naloxone in 2016 compared with 76.6% of pharmacies in 2018 (P < 0.001). All responding pharmacy corporations and the state pharmacy association reported offering self-directed volunteer-training programs regarding naloxone since 2016. In addition, they reported that company policy and procedures regarding naloxone were put into place in response to the 2016 statewide standing order. ConclusionPharmacy naloxone stocking and dispensing increased in the 2 years after the statewide standing order was issued. The effect of the order itself was likely moderated or mediated by corporate responses to the law. Research examining the impact of naloxone-availability policies on pharmacy practice and patient incomes should longitudinally examine data after policy implementation and with covariates that include type of pharmacy (e.g., chain or independent), location, and opioid overdose–associated mortality rates.

Community pharmacy and primary health care in Sweden - at a crossroads.

The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.

Маркетинг лікарських препаратів у контексті державного регулювання фармацевтичного ринку

The study is aimed at determining the characteristics of the activities of representatives of the pharmaceutical industry in the context of compliance with the requirements of international standards in order to provide the population with high-quality, affordable and effective drugs in the context of the COVID-19 coronavirus pandemic. It is substantiated that the marketing activities of pharmaceutical companies and pharmacy chains should comply with the principles of socially responsible marketing and be subject to state regulation in terms of protecting and ensuring public health. The use of individual tools of the marketing complex is not able to solve the problem of reforming relations in the system of providing pharmaceutical care as a whole, since it is necessary to take into account the social orientation of the activities of pharmaceutical companies and the restrictions that exist in the system of informing consumers about the consumer properties of medicines. The theoretical foundations of state regulation of the pharmaceutical market in the direction of creating a legal basis for the functioning of the subjects of the pharmaceutical system by establishing legal and effective relationships between manufacturers, suppliers and consumers of medicines on the principles of implementing socially responsible marketing, compliance with legislative and ethical norms in terms of ensuring the health of citizens of Ukraine have been developed. The social orientation of the activities of representatives of the pharmaceutical sector is focused on providing the population with affordable and effective medicines by improving the pricing system for medicines, producing safe medicines, providing complete and reliable information about the consumer properties of medicines. With the help of generalization and system analysis methods, theoretical and methodological recommendations have been formed for improving the directions of state regulation of the pharmaceutical market in terms of adhering to the principles of socially responsible marketing, the implementation of which will allow government bodies to develop an effective mechanism for state regulation of the pharmaceutical market.

LEGAL MEANS OF ENSURING COMPETITION IN PHARMACY

The aim: To research the consequences of pharmacy chains monopolization and establishment of legal means of neutralization of such consequences. Materials and methods: The study is based on acts of the European Union, the United States, and Ukraine and international regulations and documents on health care. The study's materials were the results of a questionnaire survey of managers and specialists in a pharmacy on marketing contracts. The views of scientists on the above issue were also studied. The study analyzes generalized information from scientific journals using scientific, legal methods. Among the main research methods are systematic approach, analytical, statistical, comparative, dialectical, graphical, and a questionnaire survey of respondents. Results: Consolidation of massive pharmacy chains leads to an artificial increase in drug prices by almost 50 percent, which significantly reduces their availability to patients, and in many cases, makes treatment impossible due to lack of funds. Conclusions: As a result of further monopolization of the pharmacy market, the pharmaceutical industry, small pharmacy enterprises, and the complete distribution of medicines will be destroyed.

Survey to assess management of abdominal pain and cramping in South African pharmacy chains

Background: Most consumers with abdominal cramps and pain choose to treat them with over-the-counter (OTC) medication. Currently there are no data evaluating the approach of South African pharmacy staff to abdominal cramps and pain. The purpose of this survey was to evaluate the approach of pharmacy healthcare providers (HCPs) to abdominal pain and cramping and attitudes towards Buscopan (hyoscine butyl bromide) for treatment of abdominal cramps. Method: An online and face-to-face survey was conducted with 142 pharmacists and 82 pharmacist’s assistants from two major retail pharmacy chains. The study was commissioned by an independent research company. Results: Pharmacists and pharmacist’s assistants reported providing advice to an average of 13 patients with abdominal cramps weekly. The majority of HCPs recommended treatment based on symptoms, potential for drug interactions and safety. Only approximately half of consumers always followed the advice of the HCP. HCPs commonly saw patients who had taken inappropriate medication for their abdominal pain and cramping, including nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol and codeine-containing preparations. Overall, 85% of pharmacists recommended Buscopan for the treatment of abdominal pain and cramping, based on perceptions of efficacy, tolerability and improvement in quality of life. Conclusions: Consumers don’t always select an appropriate medication for abdominal pain and cramping, and require advice from a pharmacy HCP. Fostering trust and confidence is essential to ensure that the patient follows the advice given. Most South African pharmacy HCPs within these two major retail chain pharmacies recommend Buscopan as first line for treatment of abdominal cramps.

Scenario-based optimisation of a two-tier distribution network with a simplified route construction

The paper deals with an optimisation of a distribution network design (DND) problem combined with a location routing problem (LRP). A combinatorial model of a two-tier distribution network (DN) is proposed, where the objective function cumulates costs of transport, handling and facilities. A generic mathematical model (GMM) of the problem is constructed, where a function of simplified route construction (FSRC) is suggested to linearize a problem formulation. Additionally, a set of business-oriented constraints is proposed, including facility relocations, regularity changes, time limits of deliveries, and vehicle’s capacity changes. It helps to define several scenario-based extensions of GMM and each scenario is a combination of these constraints. The problem is iteratively solved with exact algorithms. This methodology has been experimentally applied to optimise the DN of drugstore chain, where five alternative scenarios of DN configuration have been tested. Each of them has been optimised and the results have ranged from 7% increase to 30% reduction of objective function, referred to a current state. A recommended scenario assuming 12% cost reduction has been implemented in practice and the expected result has been proved.

Provably Efficient Reinforcement Learning for Episodic Stochastic Inventory Control Models

Motivated by a long-standing gap between inventory theory and practice, we study online inventory models with unknown cyclic demand distributions. We design provably efficient reinforcement learning (RL) algorithms that leverage the structure of inventory problems. We apply the standard performance measure in online learning literature, regret, which is defined as the difference between the total expected cost of our policy and the total expected cost of the clairvoyant optimal policy that has full knowledge of the demand distributions a priori. This paper analyzes, in the presence of unknown cyclic demands, the lost-sales model with zero lead time, and the multi-product backlogging model with positive lead times, fixed joint-ordering costs and order limits. For both models, we first introduce episodic models where inventory is discarded at the end of every cycle, and then build upon these results to analyze non-discarding models. Our RL policies HQL and FQL achieve ~O(T^(1/2)) regret for the episodic lost-sales model and the episodic multi-product backlogging model, matching the regret lower bound that we prove in this paper. For the non-discarding models, we construct a bandit learning algorithm on top of the previous RL algorithms, named Meta-HQL. Meta-HQL achieves ~O(T^(1/2)) regret for the non-discarding lost-sales model with zero lead time, again matching the regret lower bound. For the non-discarding multi-product backlogging model, our policy Mimic-QL achieves ~O(T^(5/6)) regret bound. Our policies remove the regret dependence on the cardinality of the state-action space for inventory problems, which is an improvement over existing RL algorithms. We conducted experiments with a real sales dataset from Rossmann, one of the largest drugstore chains in Europe, and also with a synthetic dataset. For both sets of experiments, our policy converges rapidly to the optimal policy and dramatically outperforms the best policy that models demand as i.i.d. instead of cyclic.

Силиконовая малина. Рейтинг российских аптечных сетей по итогам 2019 года

Силиконовая малина. Рейтинг российских аптечных сетей по итогам 2019 года

Серверное сияние. Рейтинг российских аптечных сетей по итогам I квартала 2020 года

Серверное сияние. Рейтинг российских аптечных сетей по итогам I квартала 2020 года

Estimating the Effect of a National Pharmacy-Led Influenza Vaccination Voucher Program on Morbidity, Mortality, and Costs.

Influenza (also known as "flu") is estimated to cause between 12,000 and 79,000 deaths annually. Vaccinations are beneficial in preventing influenza cases and reducing the likelihood of severe outcomes. Unfortunately, vaccination coverage is low among uninsured populations. Removing the cost barrier can help increase vaccination coverage in this group, averting flu cases and related morbidity and costs. To model the potential effect of providing no-cost flu vaccinations to uninsured individuals on influenza-related morbidity, mortality, and costs. In collaboration with the Department of Health and Human Services and local agencies, Walgreens pharmacies provided free flu vaccinations through a nationwide voucher distribution program. We calculated the redemption rate, potentially averted cases, and estimated cost savings for the 2015-2016 and 2016-2017 flu seasons. Using incidence and vaccine effectiveness estimates from the Centers for Disease Control and Prevention, we calculated the rate of influenza in the general population and the estimated cases averted based on the number of redeemed vouchers. We applied patient age along with parameters from published studies to estimate averted ambulatory care visits, hospitalizations, mortality, productively losses, and overall related costs. During the 2015-2016 flu season, the pharmacy chain distributed 600,000 vouchers with a redemption rate of 52.3%, resulting in 314,033 flu vaccinations. Improvements were subsequently made to the distribution process to increase utilization rates. There were 400,000 vouchers distributed during the 2016-2017 season with a higher redemption rate of 87.2%, resulting in 348,924 flu vaccinations. The estimated number of potentially averted cases was higher during the 2016-2017 season (13,347) than the 2015-2016 season (11,537) due to a higher redemption rate and increased flu activity. Taken together, we estimated that 8,621 ambulatory care visits, 314 hospitalizations, and 15 deaths were averted due to the flu voucher program. Averted health care costs totaled $937,494 in ambulatory care visits and $3,510,055 in hospitalizations. Averted productivity losses ranged from $4,473,509 to $14,613,502. This study demonstrates the effectiveness of a pharmacy-led partnership with local community-based organizations to promote flu vaccinations among uninsured individuals. Our model found that a no-cost flu voucher program has the potential to reduce influenza-related morbidity, mortality, and costs. This study was funded by Walgreen Co. All authors are employees of Walgreen Co. and affiliated with Walgreens Center for Health and Wellbeing Research. Findings from this study were presented as a podium presentation at the Academy of Managed Care Pharmacy Nexus 2018; October 22-25, 2018; Orlando, FL.

Primary health care policy and vision for community pharmacy and pharmacists in Spain.

From a political and governance perspective Spain is a decentralized country with 17 states [comunidades autónomas] resulting in a governmental structure similar to a federal state. The various state regional health services organizational and management structures are focused on caring for acute illnesses and are dominated by hospitals and technology. In a review by the Interstate Council, a body for intercommunication and cooperation between the state health care services and national government, there is a move to improve health care through an integrative approach between specialized care and primary care at the state level. Community pharmacy does not appear to have a major role in this review. Primary health care is becoming more important and leading the change to improve the roles of the health care teams. Primary care pharmacists as the rest of public health professionals are employed by the respective states and are considered public servants. Total health care expenditure is 9.0% of its GDP with the public health sector accounting for the 71% and the private sector 29% of this expenditure. Community pharmacy contracts with each state health administration for the supply and dispensing of medicines and a very limited number of services. There are approximately 22,000 community pharmacies and 52,000 community pharmacists for a population of 47 million people. All community pharmacies are privately owned with only pharmacists owning a single pharmacy. Pharmacy chain stores are not legally permitted. Community pharmacy practice is based on dispensing of medications and dealing with consumer minor symptoms and requests for nonprescription medications although extensive philosophical deep debates on the conceptual and practical development of new clinical services have resulted in national consensually agreed classifications, definitions and protocolized services. There are a few remunerated services in Spain and these are funded at state, provincial or municipal level. There are no health services approved or funded at a national level. Although the profession promulgates a patient orientated community pharmacy it appears to be reluctant to advocate for a change in the remuneration model. The profession as a whole should reflect on the role of community pharmacy and advocate for a change to practice that is patient orientated alongside the maintenance of its stance on being a medication supplier. The future strategic position of community pharmacy in Spain as a primary health care partner with government would then be enhanced.

Advantages and Disadvantages of Flexible Forms of Employment in the Opinion of Employees

Flexibility of the labour market and employment in atypical forms has been indicated for years as a potential source of more effective competition. However, both types of flexibility constitute important changes for employees that cause concern in terms of employment security. In this con-text, the aim of the research was to determine opinions about the advantages and disadvantages of employment in atypical forms. The research was carried out in a chain of pharmacies and among paramedics, i.e. in entities where flexible employment constitutes the basic employment relation-ship. In the respondents’ opinion, there are more disadvantages than advantages of employment in flexible forms, and the main disadvantage of atypical work is employment insecurity.

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

ObjectivesThis 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. SettingThe Kroger Co and Catholic Health Initiative St. Vincent. Practice descriptionThe 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 innovationWith 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. EvaluationDescriptive 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. ResultsIn 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. ConclusionCollaboration 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.

Assessment of naloxone availability in Georgia community pharmacies

ObjectivesTo examine the availability of naloxone in community pharmacies and examine differences in naloxone availability across pharmacy location, pharmacy type, and areas of greater opioid overdose mortality. MethodsA cross-sectional design was used to conduct a telephone survey of community pharmacists. A list of community pharmacies was obtained from the Georgia Board of Pharmacy; 25% were randomly selected, stratified across the National Center for Health Statistics rural-urban codes. The primary outcome was pharmacist-reported naloxone stock status. Predictor variables included urban and rural location, pharmacy type, and opioid related mortality rates. Descriptive statistics and multivariable logistic regression were performed using StataCorp. 2017 Stata Statistical Software: Release 15. ResultsOf the 600 pharmacies randomly selected, 166 pharmacies were not called because they were not open to the public or had known corporate policy prohibiting the release of stock information, or because of undisclosed reasons. Of the 434 called, 330 (76%) answered and agreed to participate and were included in the analysis. The majority were metropolitan (66%) and chain pharmacies with 4 or more locations (62%). Only 31% reported that naloxone was available for same-day purchase, 65% did not carry naloxone and 3% indicated that it was out of stock. Chain community pharmacies (CVS, Walgreens, etc.), were more likely than independent pharmacies to have naloxone for same-day purchase (45% vs 24%; OR = 2.106, 95% CI 1.124–3.943), and areas with high opioid mortality rates were more likely to have naloxone than areas with low mortality rates (38% vs. 24%; odds ratio 1.866 [95% CI 1.059–3.290]). ConclusionPatients in Georgia face barriers accessing the potentially life-saving medication naloxone. Most community pharmacies (69%) did not have naloxone stocked. Naloxone was less likely to be available from independent pharmacies and in areas of lower than average opioid mortality rates. Additional strategies are needed to increase access to naloxone in an effort to combat the opioid epidemic.

Community pharmacists' attitudes, barriers, knowledge and counseling practice with regard to preconception, pregnancy and lactation.

Although preferably avoided, pregnant and lactating women often use medicines, including potentially inappropriate products. Pregnant women also commonly search for online information on medication. This underscores the need for appropriate counseling by healthcare professionals, including community pharmacists. However, little is known about pharmacists' perceptions and barriers towards this role, nor about their knowledge and counseling practice. To explore licensed pharmacists' attitudes, barriers, knowledge and counseling practice regarding pharmaceutical care during preconception, pregnancy and lactation. All pharmacists employed in 40 randomly selected pharmacies of a Belgian pharmacy chain ('Surplus Network') were asked to complete an online survey between September 2018-February 2019. The survey assessed pharmacists' attitudes and current practice regarding their role, as well as barriers and knowledge. Additionally, the 40 pharmacies were visited twice in December 2017 by simulated patients. The scenarios included a request for a pregnancy test and for an over-the-counter (OTC) product to treat pregnancy-related nausea. All 63 invited pharmacists completed the survey. For all attitude-related statements, at least 80% agreed that pharmacists should take up the presented roles. However, for only 1 in 5 statements did at least 80% report currently taking up these roles for all or most patients. Most commonly reported barriers related to difficulties identifying the woman's status (71%) and lack of education (67%). The median score for the knowledge test was 23/45 (range: 6-36). The mystery shopping showed inadequate questioning and insufficient counseling. Only in 10% of cases was folic acid intake spontaneously discussed; in 39% of cases, incorrect advice about the dispensed OTC-product was given. Pharmacists acknowledged having an important role during preconception, pregnancy and lactation, but currently do not provide pharmaceutical care in this area to most patients. Educational programs are urgently needed to improve licensed pharmacists' knowledge and counseling regarding this topic.

Targeting adaptability to improve Medication Therapy Management (MTM) implementation in community pharmacy

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.MethodsThis 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.ResultsAn 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).ConclusionThe 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.

Rescheduling hydrocodone combination products: Impact on patients receiving long-term HCP therapy in a large chain pharmacy—A statewide assessment

ObjectiveThis study aimed to evaluate the rescheduling of hydrocodone combination products (HCPs) from schedule III (CIII) to schedule II (CII) in patients receiving chronic HCP therapy. MethodsThis study was a retrospective cohort analysis of administrative pharmacy data from 118 statewide pharmacies from a retail chain in Tennessee. HCP filling histories were analyzed on patients meeting enrollment criteria from July 1, 2014, to October 1, 2015. The average number of tablets dispensed, daily average of the number of tablets dispensed, and monthly average of morphine milligram equivalents (MME) dispensed were compared for the periods of July 1, 2014, to October 5, 2014 (enrollment period before schedule change) and October 6, 2014, to October 1, 2015 (period following schedule change) using a pooled t test. ResultsA total of 4536 patients met the inclusion criteria. Of these 4536 patients, 60.6% were female, and 40.4% were male, with an average age of 58 years (patients included in this study were between the ages of 18 and 99 years). The total number of hydrocodone tablets dispensed in the 12 periods after the schedule change dropped from 467,217 to 259,327, a 45.5% reduction (P < 0.001). Total MME decreased from 4.11 to 2.29 million, a 45.3% reduction (P < 0.001). The number of study participants still receiving an HCP at the end of the study decreased to an average of 2736 across the 12 periods following the schedule change, a 40% reduction. ConclusionHCP dispensing and use decreased among patients receiving chronic opioid treatment from a large corporate statewide community pharmacy in Tennessee after a schedule change from CIII to CII. Monthly sums of total tablets dispensed, average daily tablets dispensed, MME, and average daily MME calculated from July 1, 2014, to October 1, 2015, all experienced statistically significant reductions.