Community Pharmacy Chain Research Articles

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

BackgroundStatin therapy is recommended for people with type 2 diabetes (T2D) to lower cardiovascular risk; however, evidence suggests that significant gaps in statin therapy exist. ObjectiveTo 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. MethodsThis 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. ResultsFor 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. ConclusionThe 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.

Effect of text message communication on patient presentation for an influenza vaccination in a community-based pharmacy setting

BackgroundCommunity pharmacies use text message communications for information regarding approaching refills and fill status. Patients can also be notified regarding annual influenza vaccine availability and schedule an appointment for the vaccine. ObjectivesThis study aimed to evaluate whether text message communications affected patient presentation and resulted in a percent increase of patients receiving an influenza vaccine compared with previous vaccine season and to determine whether additional vaccines are administered upon presentation. MethodsAmbidirectional study retrospectively analyzed the impact, nationally, of a new text message communication on influenza vaccinations at a large community pharmacy chain and prospectively surveyed patients receiving an influenza vaccine at 2 geographically similar pharmacies of the chain in Southwest Virginia. Text message communications regarding vaccine and appointment availability were sent to patients at the age of 18 years and older who opted in to text message communications and received an influenza vaccine with the chain during the 2019-2020 influenza season. Vaccine data from consecutive seasons were compared. Eligible patients in Southwest Virginia were surveyed about how they were informed about availability, previous intent to receive an influenza vaccine, applicability to other vaccines, and effect of the coronavirus disease 2019 pandemic on vaccination. Results were analyzed using bivariate and multivariate analyses. ResultsNationally, influenza vaccines administered increased by 17.45% in patients who permitted text message communication and overall by 13.22% after implementation. Decreases in co-administered pneumococcal vaccines and tetanus, diphtheria, and pertussis vaccines and an increase in co-administered zoster vaccines were observed. A total of 111 patients were surveyed; 4% presented owing to text message communication. A majority were intent on receiving the vaccine before being notified and reported that the pandemic did not affect presentation. Notably, 45.05% of patients were likely to receive routine vaccines if notified by text message. ConclusionText message communications are another viable way to increase vaccinations, but further studies should be conducted outside of a pandemic setting.

Which factors may influence the implementation of drug dispensing in community pharmacies? A qualitative study.

Implementation of clinical pharmacy services, such as drug dispensing, is a complex process. It is necessary to understand the challenges associated with this practice from the perspective of the actors involved to help ensure optimal service provision. Thus, this study aimed to understand the factors that may influence the implementation of drug dispensing in community pharmacies, according to the perceptions of pharmacists. This qualitative study was based on semistructured, face-to-face interviews. The participants were pharmacists who worked in a chain of community pharmacies in Brazil, selected based on their direct participation in the implementation process. The interview recordings were transcribed full verbatim and were independently analyzed using thematic analysis, followed by consensus meetings between researchers. The factors identified by the participants were classified according to the Apoteca framework. This study was approved by the Committee of Ethics in Research and all participants signed an informed consent form. We conducted 18 interviews, with 47 factors that may influence the implementation of drug dispensing in community pharmacies being identified. These factors were allocated to seven categories: support from community pharmacy chain (4), pharmacy infrastructure (11), characteristics of the pharmacy, medicines and other health products (4), pharmacist (16), dispensing work process (2), pharmacy team (2)and patient (8). The classification of factors according to the Apoteca framework allocated most of them to administrative (14) and technical (15) domains, followed by attitudinal (13) and political (5) domains. This study identified several factors that can influence the implementation of drug dispensing and classified them according to the domains of the Apoteca framework, highlighting the multifactorial nature of the implementation process. The results of this study can guide the planning of strategies aimed at providing efficient drug dispensing in community pharmacies.

Clinical Nudge Impact on Herpes Zoster Vaccine Series Completion in Pharmacies

A new recombinant herpes zoster vaccine has advanced efforts to prevent shingles, but its multidose regimen introduces potential barriers to full protection that must be managed by community pharmacies. To address this potential patient management challenge, a pharmacy records clinical support tool was implemented to assist pharmacy staff in managing herpes zoster vaccine dose completion. Beginning in November 2018, a large community pharmacy chain (operating in 36 states) implemented a provider nudge within its clinical decision support tool across all locations that fit seamlessly into the existing workflow, alerting the pharmacy staff of the need for a patient's second dose. Initial and second doses were followed over 2 overlapping, 10-month periods before and after system launch. Differences in vaccine completion rates before and after the system was operational were assessed by chi-square tests and predictors of completion, controlling for store- and patient-level characteristics, and were analyzed by multivariable logistic regression and generalized linear models throughout 2021. Across 2,271 pharmacies, 71,459 and 41,982 initial doses of the herpes zoster vaccine were given in the baseline and intervention period, respectively. The proportion of patients completing both doses increased slightly after system implementation (before: 71.9%, after: 75.2%; p<0.0001). However, dramatic improvements in time to dose completion were observed (before: 109.8 days, after: 93.3 days; p<0.001), and changes were significant in stores in all but 4 states. Results suggest that the use of a clinical nudge improved the occurrence of and time to herpes zoster vaccine dose completion in adults across the U.S.

Effect of community pharmacist-provided patient education of partial fill availability for acute opioid prescriptions

BackgroundMore than 191 million opioid prescriptions were filled in the United States during 2017, and studies have shown that patients often have leftover medication. ObjectivesTo (1) measure the percentage filled as partial quantities and the percentage subsequently filled to completion; (2) determine which medications are filled as partial, completion, and full fills; and (3) identify patient reasons and demographics for partial, completion, and full fills. Practice descriptionTwo pharmacies of a national community pharmacy chain in Richmond, VA. Practice innovationVirginia law allows prescriptions to be filled in partial quantities as long as the total quantity does not exceed the written quantity and the remaining portions are filled within 30 days of the written date. Pharmacists developed an intervention to educate patients about the option to fill opioid prescriptions as a partial quantity. Evaluation methodsRetrospective analysis of drug utilization reports to identify the impact of the pharmacist intervention for acute, nonmaintenance opioid prescriptions filled as partial, completion, or full fill during a 5-month period. Patient demographics and reasons for choosing a partial or full fill were collected using surveys completed at prescription pickup. ResultsA total of 25.6% of included prescriptions were partially filled, and of these, only 31.9% were filled to completion. Hydrocodone-acetaminophen was the most common prescription, 35.8% full, 28.3% partial, and 36.4% completion fills. Patients’ motivation was driven by the pharmacist’s suggestion (48.5%) for partial fill and desire to have the medication if needed (36.6%) for full fill. ConclusionPharmacist offer of partial filling of acute opioid prescriptions may lead patients to partially fill prescriptions, and patients cited the pharmacist suggestion as a motivator.

Pharmacist engagement in a community pharmacy hypertension management program in collaboration with an academic medical center.

To explore the perceptions of pharmacists and administrators who had an integral role in designing and operationalizing an integrated community pharmacist hypertension management program with collaboration between an academic medical center and a regional chain community pharmacy. Community pharmacists (n = 3), ambulatory care pharmacists (n = 2), medical directors (n = 2), and health-system (n = 1) and pharmacy (n = 1) administrators reported positive experiences engaging with the hypertension management program. Strengths of the program included comprehensive training by the ambulatory care pharmacists, community pharmacist access to the electronic health record (EHR), and primary care providers who were receptive to referring patients and accepting recommendations from the community pharmacists. All participants felt that the program had a positive outlook and saw opportunity for expansion, such as extended hours of operation, new locations, and additional pharmacists. Pharmacists are well positioned to extend hypertension management programs from primary care clinics into local pharmacies if they have appropriate training, access to the EHR, and ongoing support from collaborating primary care offices. Additional research using implementation science methods is needed to further test the scalability and replicability of the program among different patient populations, community pharmacies, and health systems.

Assessing the Availability of Foreign and American Sign Language Interpreting Services in Community Pharmacies.

Objective To determine community pharmacists' experience with foreign language and American Sign Language (ASL) interpretation services. Design A survey was drafted to gather information about pharmacists' familiarity with ASL and foreign language interpreting services as well as the frequency with which pharmacists encountered patients who needed these services. Setting Independent and chain community pharmacies in Spokane County, Washington, USA. Participants Fifty-two community pharmacies were identified using a provider-credential search. Fifty-one pharmacists (98%) agreed to participate and completed the survey. Interventions Surveys were initially conducted in person, but after the COVID-19 pandemic began data collection was halted and restarted via phone in accordance with the Washington State University Office of Research Support and Operations. Results Four out of 51 pharmacists surveyed (7.84%) indicated that they were fluent in a language besides English. Pharmacists reported encountering patients who spoke Spanish (31%), Russian (31%), ASL (8%), Arabic (5%), Mandarin Chinese (5%), Vietnamese (5%), Marshallese (5%), and Ukrainian (2%). Some pharmacists (8%) reported not encountering patients who spoke other languages besides English. Most pharmacists (72.5%) indicated their company offered interpreting services for foreign languages, but less than half of pharmacists surveyed (43.1%) had experience using these services. Forty-five percent of pharmacists surveyed did not know whether their company offered an interpreting service for ASL, and only 23.5% indicated that they had experience using ASL interpreting services. Conclusion Pharmacists are less familiar with services for patients who speak ASL and are less likely to have experience with ASL interpretation services than they are to have assisted foreign-language-speaking patients.

Predictors of job satisfaction among pharmacists: A regional workforce survey

BackgroundJob satisfaction affects organizational outcomes including performance and retention. The pharmacy job satisfaction literature points to several predictors of job satisfaction, but educational debt and various work settings have not been previously examined. ObjectivesTo identify predictors of Virginia pharmacists' job satisfaction. MethodsThis cross-sectional study used data from the 2018 Virginia Pharmacist Workforce Survey. Of 15,424 registered pharmacists, 13,962 (90.5%) completed the survey. Pharmacists who reported being employed and working in Virginia in the previous year (2017) were included in the analysis (n = 6042). Data were summarized using descriptive statistics. Multiple logistic regression identified predictors of job satisfaction. ResultsRespondents were primarily female (66.3%), Pharm.D. degree holders (65.5%), with a 14.8-year average work experience. Most pharmacists (86%) reported being very/somewhat satisfied with their job. Educational debt was not significantly associated with job satisfaction. Significant predictors of job satisfaction included: being female (aOR = 1.28, 95% CI 1.08, 1.52); working <30 (aOR = 1.80, 95% CI 1.14, 2.84), 30–39 (aOR = 1.47, 95% CI 1.02, 2.11), or 40–49 (aOR = 1.42, 95% CI 1.02, 1.98) versus ≥50 h per week; earning an annual income of <$50,000 (aOR = 0.60, 95% CI 0.38, 0.94) or ≥ $150,000 (aOR = 2.05, 95% CI 1.30, 3.23) versus $100,000–$149,999; working in an independent community pharmacy (aOR = 3.72, 95% CI 2.54, 5.44), health system (aOR = 3.81, 95% CI 2.78, 5.22), clinic-based pharmacy (aOR = 4.39, 95% CI 2.18, 8.83), academia (aOR = 5.20, 95% CI 1.97, 13.73), benefits administration (aOR = 3.64, 95% CI 1.71, 7.74), long-term home and home health/infusion (aOR = 1.71, 95% CI 1.10, 2.67), mass merchandiser community (aOR = 0.79, 95% CI 0.62, 0.99), or manufacturer and wholesale distributor (aOR = 3.46, 95% CI 1.97, 6.08) versus chain community pharmacy. ConclusionsOverall, Virginia pharmacists reported high job satisfaction. Pharmacists working in chain community pharmacy reported lower satisfaction relative to other settings. Being female, having a high annual income, and working for less hours was associated with improved job satisfaction.

The Relation between Information Technology Adoption and the Pharmacist Job Satisfaction in the Chain Community Pharmacy in Amman

The Relation between Information Technology Adoption and the Pharmacist Job Satisfaction in the Chain Community Pharmacy in Amman

The relation between information technology adoption and the pharmacists' job satisfaction in the chain community pharmacy in Amman

This study aims to investigate the significance of the relationship between information technology adoption and the pharmacists' job satisfaction in the chain pharmacies in Amman. Data were collected from 73 pharmacists who work in Amman branches of one chain pharmacy in Jordan (Dawacom). The questionnaire is made of two parts: IT adoption and job satisfaction. Four dimensions represented IT technology: the ability of the organisation to utilise IT; the impact of IT on business processes; communication: e-business and social network; and IT knowledge and training. The results of this study show that the satisfaction of the pharmacists is statistically correlated to the ability of the organisation to utilise IT, and the impact of IT on business processes. However, the relationship between the other two dimensions and job satisfaction was found insignificant.

The evaluation of mandatory alerts on long-acting opioid prescriptions and the use of a community pharmacy naloxone protocol

BackgroundOpioid overdose deaths accounted for approximately 69.5% of the total drug overdoses in the United States in 2018. In the same year, the Centers for Disease Control and Prevention estimates that around 9 million opportunities to dispense naloxone to high-risk patients were missed. Community pharmacists are equipped to help all patients obtain naloxone to prevent opioid-related overdoses. ObjectivesThe purpose of this study was to determine the impact of mandatory alerts on the dispensing of naloxone by pharmacists using a physician-approved protocol. The primary objective of this study was to evaluate the change in the number of dispensed naloxone prescriptions via physician-approved protocol compared with the same time period in the previous year. The secondary objective was to evaluate the pharmacists’ knowledge and confidence dispensing naloxone via physician-approved protocol. Practice descriptionA system-generated mandatory alert that prompted pharmacists to assess the need for naloxone and initiate and dispense as appropriate via a physician-approved protocol was implemented in 5 pharmacies of a large community pharmacy chain between June and July 2020. Practice innovationA technology enhancement was designed that automatically created a mandatory alert in the pharmacy management system for all patients who were dispensed a long-acting opioid medication to prompt pharmacists to initiate and dispense naloxone as appropriate. Evaluation methodsThe impact of the mandatory alert was evaluated by assessing patients’ medication fill history in the pharmacy management system to determine the change in naloxone prescriptions dispensed. ResultsDuring the intervention period, pharmacists initiated and dispensed 34 incremental naloxone prescriptions via a physician-approved protocol compared with the same time period in the previous year. ConclusionThe results illustrated that system-generated mandatory alerts prompting pharmacist intervention can effectively increase pharmacist utilization of a physician-approved protocol, resulting in increased naloxone prescriptions dispensed to high-risk patients.

Determination of potential drug-drug interactions in prescription orders dispensed in a community pharmacy setting using Micromedex® and Lexicomp®: a retrospective observational study.

Background Community pharmacists have a role in identifying drug-drug interactions (DDIs) when processing prescription orders and dispensing medications to patients. The harmful effects of DDIs can be prevented or minimized by using an electronic DDI checker to screen for potential DDIs (pDDIs). However, different DDI checkers have variable rates of detecting pDDIs. Aim To estimate the prevalence of pDDIs in prescriptions dispensedina community pharmacy setting using two electronic DDI databases and to evaluate the association between thepDDIs and contributory factors. Method Eligible prescription orders dispensed by a community pharmacy chain in Qatar from January to July 2020 were included in this retrospective observational study. For each prescription, Micromedex® and Lexicomp® were simultaneously used to identify pDDIs, and the interactions categorized based on severity and risk rating. Results Seven hundred-twenty prescriptions met the inclusion criteria, of which Micromedex® and Lexicomp® respectively identified 125 prescriptions (17.4%) and 230 prescriptions (31.9%) as having at least one pDDI. Moderate strength of agreement was found between Lexicomp® and Micromedex® in identifying pDDIs (Cohen's Kappa = 0.546). Micromedex® classified 61.6% of DDIs as major severity, while Lexicomp® classified 30.8% as major severity. The number of concurrent medications per prescription was significantly and positively associated with pDDI. Conclusion This study demonstrates a high prevalence of pDDIs among prescriptions dispensed in a community pharmacy setting.It is advisable that community pharmacists in Qatar, who typically do not have access to computerized patient profiles, use these DDIcheckers to ensure all pDDIs are communicated to respective prescribers for appropriate action.

Analysis of naloxone access and primary medication nonadherence in a community pharmacy setting

BackgroundAccess to naloxone is a primary public health strategy to prevent opioid overdose death. Factors associated with primary medication nonadherence (PMN) to naloxone are underreported in the literature. ObjectiveThe objective of this study was to evaluate naloxone dispensing trends and PMN in a community pharmacy setting. MethodsThis retrospective analysis included patients of a community pharmacy chain in Maine and New Hampshire (57 and 29 pharmacy locations, respectively) for whom a claim for a naloxone prescription was billed between January 1, 2019, and July 31, 2020. ResultsA total of 2152 patients associated with 2606 naloxone claims were identified for analysis. A majority of the subjects were women (52.7%) and the mean age of all the subjects was 46.4 ± 16.0 years. Of the 2606 naloxone claims, 565 prescriptions were returned to stock and never dispensed to the patient for a PMN rate of 21.7%. Gender and age were not associated with naloxone PMN. Factors associated with naloxone PMN were urban location [x2(1) = 12.49, P = 0.0004], concomitant opioid analgesic [x2(1) = 4.56, P = 0.0328], and payment method [x2(4) = 251.07, P < 0.0001]. Regarding payment method, nonadherence was higher among cash (138 of 386, 35.8%) and private insurance (191 of 455, 42.0%) transactions whereas lower among Medicare (132 of 681, 19.4%) and Medicaid (89 of 899, 9.9%) transactions. Concomitant buprenorphine [x2(1) = 44.57, P < 0.0001] and the use of a naloxone standing order [x2(1) = 4.79, P = 0.0162] were associated with primary adherence to take-home naloxone. ConclusionA notable portion of naloxone prescribed and filled in the community pharmacy setting was never obtained by the patient. Factors associated with PMN in this study included geographic location, use of a standing order, concomitant prescriptions for buprenorphine or opioid analgesic medications, and payment method. Underlying causes of PMN must be addressed (e.g., removing financial barriers and optimizing the use of standing orders) to increase naloxone access for persons at risk of opioid overdose.

Strategies for implementing the Appointment-Based Model at a rural independent chain of community pharmacies

BackgroundThe Appointment-Based Model (ABM) is a care model that helps community pharmacists streamline their medication dispensing workflow while simultaneously integrating patient care into the medication preparation process through medication synchronization. Implementation of the ABM has varied across community pharmacies. Further studies that identify tailored implementation approaches are needed to support broad adoption of the ABM in practice. Objectives(1) To determine facilitators and barriers to ongoing adoption and implementation of the ABM at a small chain of rural independent pharmacies where adoption has stalled and (2) to identify implementation strategies to support further adoption of the ABM at these pharmacies MethodsThis project was an exploratory, mid-implementation study. Semistructured interviews were conducted with pharmacy staff who participated in the ongoing implementation and use of the ABM at the pharmacies. Interviews elicited stakeholder-centered perspectives on (1) experiences with the ABM to date, (2) processes and roles for the ABM, and (3) opinions on how implementation of the ABM could be improved at the pharmacies. Rapid qualitative assessment methodology was used for analysis to identify facilitators and barriers and to select implementation strategies. ResultsThirty-one pharmacy personnel were interviewed: pharmacists (n = 10), pharmacy technicians (n = 7), and fill clerks (n = 14). The research team identified 6 facilitators and 4 barriers to the implementation of the ABM at the pharmacies. Five implementation strategies were selected based on the facilitators and barriers: (1) capture and share local knowledge across pharmacy sites, (2) conduct educational outreach visits, (3) conduct ongoing training, (4) prepare patients to be active participants in the ABM, and (5) organize clinician implementation team meetings. ConclusionsDevelopment of a stakeholder-driven implementation approach may support further implementation and adoption of the ABM in practice.

The Impact of a Digital Vaccine Consent Form in a Large Community Pharmacy Chain.

Background: A large community pharmacy chain implemented a new digital platform to eliminate the need for patients to fill out a traditional vaccine consent form in the pharmacy. The new digital vaccine consent form allowed patients to complete the form online, where it was transmitted directly to the pharmacy's network. Objectives: To identify the characteristics of patients who used an online digital vaccine consent form to receive vaccinations and to evaluate patient satisfaction and confidence in utilizing the digital vaccine consent form to receive pharmacy services. Methods: This three-month prospective study was conducted in the Mid-Atlantic division of a large community pharmacy chain. A 16-question survey was developed using information from the literature to collect demographic information and patient confidence and satisfaction with the digital vaccine consent form. An email was sent to pharmacy staff containing instructions on the procedure for posting a recruitment flyer, distributing the survey post-vaccination, and how to return completed surveys. Univariate and bi-variate analysis were conducted. Results: Thirty-six participants responded to the survey, majority of participants were female (56%). Two patients used the digital vaccine consent form; both used because it was more convenient and were likely to use the form again. For those who did not use the digital vaccine consent form, 32% feel somewhat unconfident in using digital technologies for pharmacy services. A majority of patients prefer to be notified about new online services by email (39%) or advertisements in the pharmacy (31%). When asked the likelihood of using the digital vaccine consent form in the future, majority stated unlikely (34%) or neutral (25%). Conclusions: Most participants did not utilize the new digital vaccine form. This provides an opportunity to further engage patients on the availability and use of the digital vaccine consent form in order to advance digital technologies for pharmacy services.

Enhancing point-of-care testing through standardized training and redeployment of pharmacy technicians in the community setting

ObjectivesThe primary objective of this study was to assess the impact of a standardized training model for technician-supported point-of-care testing (POCT) on the number of health screenings performed across two states in a large community chain pharmacy. Secondary objectives included the assessment of pharmacist and technician perceptions of advanced roles of the pharmacy technician in POCT service delivery. Practice descriptionCertified pharmacy technicians (CPhTs) across six regional divisions of a large community chain pharmacy in Tennessee and Ohio participated in a standardized training program prior to implementation of technician-supported POCT. Practice innovationStandardized training consisted of pre-training assessments, online training modules, post-training assessments, followed by in-person skills-based assessments. CPhT participation was limited to technical tasks of POCT (e.g. sample collections, quality assurance). Evaluation methodsThe study addressed its primary objective by comparing total number of health screenings for included pharmacies in 2019 as compared to 2020. Descriptive and inferential statistics were used. Perceptions were assessed using an electronic, Likert-type scale questionnaire. ResultsPharmacies with technician-supported POCT showed a 46% increase in the total number of health screenings performed vs. 2019. The survey found that 74% (106/144) of pharmacists and 83% (34/41) of CPhTs agreed or strongly agreed that technician-supported POCT is acceptable for their practice site. Most pharmacy personnel agreed or strongly agreed that the service was appropriate and feasible for their respective practice sites. ConclusionThis study provided supporting evidence that technician-supported POCT may positively impact the number of health screenings conducted in a community pharmacy setting. Standardization of training may allow for expansion of this service across additional states. Furthermore, pharmacy personnel perceptions were overall positive.

An analysis of pharmacists' workplace patient safety perceptions across practice setting and role characteristics

BackgroundLay press investigations have been published that describe pharmacist errors and the workplace environment in the community pharmacy setting. However, recent studies that explore pharmacists' perceptions of patient safety in the workplace are limited. Objectives1) To describe pharmacists' perceptions of workplace patient safety; 2) To compare pharmacists' perceptions of workplace patient safety across practice setting type, pharmacist roles, average hours worked per shift, and average hours worked per week. MethodsActively licensed Tennessee pharmacists were recruited from January 1 and June 30, 2019 to complete a 13-item survey of workplace patient safety perceptions (N=1391). Descriptive statistics were calculated, and nonparametric statistical tests employed to compare differences in perceptions across practice setting type, pharmacist roles, and hours worked per shift and per week. ResultsStatistically significant differences in workplace patient safety perceptions were noted across practice setting type (p values <.001) and pharmacist roles (p values <.001). The extent to which pharmacists agreed/strongly agreed that their employer provides a work environment that allows for safe patient care ranged from 29.7% of chain community pharmacists to 85% of compounding pharmacists. Fifty-two percent of staff pharmacists, 56.5% of relief pharmacists, and 58.5% of managers/pharmacists in charge agreed or strongly agreed that their employer provides a work environment that allows for safe patient care, whereas 89.3% of regional managers/directors/vice-presidents and 72.5% of clinical/specialty pharmacists indicated the same. Average hours per shift was inversely correlated with perceptions of workplace patient safety (p values <.001). ConclusionTennessee pharmacists' perceptions of workplace patient safety varied widely across practice setting type and pharmacist roles. Perceptions of safety were notably lower in the chain community pharmacy setting. Additional research is warranted to better understand the relationship between pharmacist perceptions and quantifiable patient safety metrics, particularly in the chain community pharmacy setting.

Scaling technician product verification: Contextual analysis for developing an implementation strategy for a large community pharmacy chain

ObjectiveTo identify facilitators and barriers of early implementation of a technician product verification (TPV) program in a large community pharmacy chain. MethodsA mixed-methods (surveys, semistructured interviews, and nondisguised direct observation) approach was used to ascertain facilitators and barriers to implementation and to subsequently develop a scalable implementation strategy with the aim to accelerate TPV scalability across a large community pharmacy chain in states where it is permitted. One-on-one staff interviews and observations provided qualitative data to identify facilitators and barriers to TPV. A Web-based survey was used to gather perceptions on a variety of implementation strategies that would make use of identified facilitators and work to overcome identified barriers. ResultsDuring the mixed-method study, 3 key themes emerged: TPV is a complex intervention whose implementation is facilitated by both adaptability and trialability and is highly dependent on state practice regulations; the implementation climate of the pharmacy organization serves as a facilitator to TPV; and individual beliefs about TPV change over time as implementation experience increases. ConclusionTPV is an expansion of the technician role that allows the profession of pharmacy to increase the provision of clinical activities by delegation of a nonclinical-based task. Early adopters of TPV recognize that verification is a task that is increasingly automated by mail-order pharmacies and that verification may no longer be considered a pharmacist task. Pharmacies in this study tended to revert to comfortable, traditional workflow at the first sign of distress. To be successful in the future, TPV should be thought of as the primary workflow procedure and not as an option. TPV is a service that will require staff buy-in, patience, and championship.

Perceptions and Attitudes of Pharmacogenomics Through the Lens of Community Pharmacists and Patients

Background Pharmacists represent some of the most accessible healthcare workers and are in an opportune position to spearhead new clinical initiatives, such as pharmacogenomics (PGx) services. It is important that we understand the perceptions and attitudes both pharmacists and patients have regarding PGx and potential barriers of implementing it into routine clinical practice. Methods A cross-sectional survey study was conducted across one regional division of a large community pharmacy chain to assess the perceptions and attitudes of pharmacists and patients regarding PGx in California. A secondary aim was to determine perceived barriers to PGx implementation into community pharmacies. Results The majority (67%) of pharmacists agreed or strongly agreed to understanding PGx compared to 35% of patients being aware of PGx (p&lt;0.001). More patients (62%) preferred their pharmacist compared to pharmacists (43%) preferring themselves as a provider to manage patients' medications based on their PGx results (p&lt;0.01). Many patients (88%) expressed interest in participating in a PGx test; both pharmacists (84%) and patients (85%) were unlikely to have participated or know someone who has participated in PGx testing. Pharmacists and patients expressed similar concerns about privacy of their PGx data by employers (p=0.287) and insurers (p=0.953), a potential barrier to PGx implementation. Conclusion Pharmacists are well positioned to spearhead PGx consultations and patients are interested in pharmacists using PGx to help manage their medications; however, various barriers were identified that must be overcome for PGx to become incorporated in routine practice.

Facilitating pneumococcal vaccination among high-risk adults: Impact of an assertive communication training program for community pharmacists

BackgroundCommunity pharmacies are vital access points to provide a range of vaccines to adults, including pneumococcal vaccines; however, despite a growth in the number of vaccines given at these sites, the most recent rates of adults being immunized against pneumococcal disease remain below the goals set by Health People 2020. Low patient awareness is a leading reason for suboptimal vaccination rates, suggesting that a need exists to improve provider communication in recommending pneumococcal vaccination in high-risk adults. ObjectivesTo evaluate the impact of a communication training program to improve pharmacist promotion of the pneumococcal vaccine among high-risk adults in Tennessee. MethodsA multiphase training program was initiated in partnership with 2 regions of a nationwide community pharmacy chain (n = 100) focusing on improving evidence-based, presumptive recommendations related to pneumococcal vaccination. All locations were randomized to one of 3 arms on the basis of training intensity: (1) no training; (2) online training only; and (3) online and in-person simulation training. The program focused on improving evidence-based, pharmacist vaccine recommendations using health behavior theories, sales techniques, and improvisation provided through online and in-person simulation training. Changes in vaccinations (compared with the same 6-month period in the previous year) and provider self-efficacy were evaluated by Mann-Whitney U tests, chi-square tests, and general linear models. ResultsCompleting the full training program led to nominal changes in pharmacist self-efficacy across the 6 items measured (P > 0.05). Overall counts of all pneumococcal vaccines were lower (−11.3%) across all stores in the period after training; however, a small increase (2.1%) was observed in the stores that underwent the full training, versus changes of −22.0% (P = 0.084) and −9.4% (P = 0.199) in control and online-only training comparisons, respectively. ConclusionsPharmacists’ vaccine-related self-efficacy may be improved through an evidence-based communication training program, but a more holistic focus on all recommended adult vaccines may be necessary to realize meaningful improvements.