Independent Pharmacy Owners Research Articles

Independent community pharmacies’ provision of enhanced services: A mixed methods approach

BackgroundThe pharmacy profession continues to broaden toward a patient-centered care practice. Pharmacy members of formal enhanced services networks are embracing this practice. However, descriptions of how pharmacies adopt a patient-centered care practice by providing enhanced services are not widely known. ObjectivesTo explore the pharmacy services of Nebraska independent community pharmacists within the context of the pharmacy profession’s transition toward patient-centered care and determine if pharmacy participation in a formal enhanced pharmacy services network is associated with the provision of enhanced services. MethodsA mixed methods approach was used by first conducting a cross-sectional quantitative survey, followed by a small qualitative study to further explain the survey findings. The survey of 193 Nebraska independent community pharmacies included members and nonmembers of the Nebraska Enhanced Services Pharmacies (NESP) network. Data were collected on the enhanced services offered. Survey analyses used descriptive and inferential statistics. Qualitative data on reasons for offering enhanced services and their profitability were subsequently collected using a focus group of 3 independent community pharmacy owners. The interview transcript analysis used coding to generate major themes. ResultsThe survey response rate was 59%. Across all respondents, the average number of enhanced services offered was 17.3 out of 47 services studied. NESP members provided more enhanced services (x¯ = 20) than non-NESP members (x¯ = 16), P = 0.003. NESP membership was associated with the opinion that offering enhanced services increases profits, P = 0.016. The major themes were “NESP members have always been taking care of people” and “Profitability from enhanced services is key for sustainability of independent community pharmacies.” ConclusionIndependent community pharmacies provide a range of enhanced services. NESP members provided more enhanced services than non-NESP members and focused on taking care of people by providing enhanced services. NESP membership may provide opportunities for pharmacies to offer more enhanced services to patients with the intent to improve patient-centered care.

Design and effect of performance-based pharmacy payment models.

BACKGROUND: Community pharmacy participation in performance-based payment models has increased in recent years. Despite this, there has been neither much research done to evaluate the effect of these models on health care quality and spending nor is there extensive literature on the design of these models. OBJECTIVES: To (a) describe the types of measures used in performance-based pharmacy payment models (PBPPMs); (b) describe the financial impact of PBPPMs on pharmacies; (3) explore pharmacy owners' perceptions of PBPPMs; and (4) describe any practice changes made in response to PBPPMs. METHODS: This is a cross-sectional study that surveyed independent community pharmacy owners between November 2019 and January 2020. The survey included 45 items split into 5 sections that covered respondent characteristics and the 4 domain objectives. Descriptive statistics were used for quantitative responses, and free-text responses were assessed for themes. RESULTS: Of the 68 individuals who responded to the survey, 42 were community pharmacy owners who met the study eligibility criteria, and 30 responded to most survey items. Owners expressed frustration at the design of PBPPMs, with 90% stating that they did not feel that the actions necessary to meet or exceed performance standards were within their control, and 90% also reported a loss of revenue because of these models. In addition, large numbers of respondents felt that they did not have enough information on how performance measures were computed (76.7%) or how cut-points were determined (86.7%). Despite negative feelings, most owners reported implementing changes in service offerings as a result of these models. CONCLUSIONS: PBPPMs appear to be commonplace and put substantial financial burden on community pharmacies. Study results suggest that greater education by payers could improve pharmacist engagement, as could involvement of pharmacies in the design and maintenance of PBPPMs. DISCLOSURES: This work was supported by a grant from the American Association of Colleges of Pharmacy, which was not involved in the collection, analysis, and interpretation of data; writing of the report; or the decision to submit this article for publication. Urick reports consulting fees from Pharmacy Quality Solutions. The other authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Impact of implementing a comprehensive patient management solution in a regional community pharmacy chain

The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions.To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures.Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator.A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings.TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting.

Pharmacy and provider partnership to reduce use of high risk medications in the elderly

The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions.To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures.Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator.A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings.TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting.

After the storm, Houston pharmacists pitch in as volunteers.

The grim televised images of Hurricane Harvey and its aftermath don’t really do justice to the reality on the ground, says Anjanette Wyatt, founder of the Texas Association of Independent Pharmacy Owners and chief executive officer of Clinical Care Pharmacy, LLC. “It’s unbelievable,

Implementation of a reimbursed medication review program: Corporate and pharmacy level strategies.

In 2006, the Ontario drug plan greatly reduced community pharmacy reimbursement for generic drugs. In exchange, a fee-for-service medication review program was introduced to help patients better understand their medication therapy and ensure that medications were taken as prescribed. A qualitative study of community pharmacy implementation strategies was undertaken to inform a mixed methods evaluation of the program. To describe strategies used by community pharmacies to implement a government-funded medication review service. Key informant interviews were conducted with pharmacy corporate executives and managers, as well as independent pharmacy owners. All pharmacy corporations in the province were approached; owners were purposively sampled from the registry of the pharmacist licensing body to obtain diversity in pharmacy attributes; and pharmacy managers were identified through a mix of snowball and registry sampling. Thematic qualitative coding and analysis were applied to interview transcripts. 42 key informants, including 14 executives, 15 managers/franchisees, and 11 owners, participated. The most common implementation strategy was software adaptation to flag eligible patients and to document the service. Human resource management (task shifting to technicians and increasing the technician complement), staff training, and patient identification and recruitment processes were widely mentioned. Motivational strategies including service targets and financial incentives were less frequent but controversial. Strategies typically unfolded over time, and became multifaceted. Apart from the use of targets in chain pharmacies only, strategies were similar across pharmacy ownership types. Ontario community pharmacies appeared to have done little preplanning of implementation strategies. Strategies focused on service efficiency and quantity, rather than quality. Unlike other jurisdictions, many managers supported the use of targets as motivators, and very few reported feeling pressured. This detailed account of a range of implementation strategies may be of practical value to community pharmacy decision makers.

The use of think-aloud protocols to identify a decision-making process of community pharmacists aimed at improving CMS Star Ratings scores.

The Center for Medicare and Medicaid Services (CMS) created the Star Rating system based on multiple measures that indicate the overall quality of health plans. Community pharmacists can impact certain Star Ratings measure scores through medication adherence and patient safety interventions. To explore methods, needs, and workflow issues of community pharmacists to improve CMS Star Ratings measures. Think-aloud protocols (TAPs) were conducted with active community retail pharmacists in Oklahoma. Each TAP was audio recorded and transcribed to documents for analysis. Analysts agreed on common themes, illuminated differences in findings, and saturation of the data gathered. Methods, needs, and workflow themes of community pharmacists associated with improving Star Ratings measures were compiled and organized to exhibit a decision-making process. Five TAPs were performed among three independent pharmacy owners, one multi-store owner, and one chain-store administrator. A thematically common 4-step process to monitor and improve CMS Star Ratings scores among participants was identified. To improve Star Ratings measures, pharmacists: 1) used technology to access scores, 2) analyzed data to strategically set goals, 3) assessed individual patient information for comprehensive assessment, and 4) decided on interventions to best impact Star Ratings scores. Participants also shared common needs, workflow issues, and benefits associated with methods used in improving Star Ratings. TAPs were useful in exploring processes of pharmacists who improve CMS Star Ratings scores. Pharmacists demonstrated and verbalized their methods, workflow issues, needs, and benefits related to performing the task. The themes and decision-making process identified to improving CMS Star Ratings scores will assist in the development of training and education programs for pharmacists in the community setting.

Analysis of costs to dispense prescriptions in independently owned, closed-door long-term care pharmacies.

The need for accurate calculation of long-term care (LTC) pharmacies' costs to dispense (CTD) has become more important as payers have moved toward reimbursement models based on pharmacies' actual acquisition cost for drug products and the Centers for Medicare Medicaid Services (CMS) has implemented requirements that LTC pharmacies must dispense prescriptions for certain branded drugs in 14-day-or-less quantities. To (a) calculate the average cost that the typical independently owned, closed-door LTC pharmacy currently incurs to dispense and deliver a prescription to the resident of a client LTC facility and (b) estimate how CMS-mandated changes to a 14-day-or-less dispensing cycle would affect the typical LTC pharmacy's average CTD. The data requirements and measurement model were developed by academic researchers in consultation with an industry advisory committee of independent LTC pharmacy owners. A survey instrument was constructed to collect financial and operating data required to calculate the CTD. Surveys were distributed via 3 dissemination channels to approximately 1,000 independently owned, closed-door LTC pharmacies. The National Community Pharmacists Association mailed surveys to their LTC members; 3 major national wholesalers distributed surveys to their LTC customers through their newsletters; and 3 LTC group purchasing organizations distributed the surveys to their members through emails, newsletters, mailings, and/or regional meetings. Each pharmacy's CTD was calculated by dividing total LTC dispensing-related costs by the total number of prescriptions dispensed. Dispensing-related costs included costs incurred to physically dispense and deliver prescriptions (e.g., dispensing pharmacists' and technicians' salaries and costs of medication containers) and costs incurred to support the dispensing function (e.g., salaries of delivery and medical records personnel). A model based on dispensing-related fixed, variable, and semivariable costs was developed to examine the impact of shorter dispensing cycles on LTC pharmacies' CTD. A prescription volume increase of 19% was assumed based on converting only solid oral branded drugs to short-cycle dispensing. A diverse sample of 64 closed-door LTC pharmacies returned usable surveys. Sales from dispensing to LTC facilities accounted for more than 98% of total sales. Respondents indicated that they currently dispensed 23% of total doses in 14-day-or-less cycles and 76% in 28-31 day cycles. Most pharmacies used automated medication packaging technology, heat and cold package sealers, bar code systems, sterile compounding hoods, LTC printers or labelers, and electronic prescribing. The median CTD was $13.54 with an interquartile range (25th to 75th percentiles) of $10.51 to $17.66. More than half of dispensing-related costs were from personnel expense, of which pharmacists and managers accounted for more than 40%. The results of the fixed and variable cost modeling suggested that converting solid oral brand-name drugs from 30-day to 14-day dispensing cycles would lower the median per prescription CTD to between $11.63 and $12.54, depending on the assumptions made about the effects of semivariable costs. However, this decrease in per prescription dispensing cost is dwarfed by an increase in total dispensing cost incurred by pharmacies that results from doubling the monthly volume of short-cycle prescriptions that must be dispensed. The result is that the typical LTC pharmacy in our sample incurred a CTD of $13.54 if the medication is dispensed in a 30-day cycle or $23.26 if the medication is dispensed in two 14-day cycles (at a cost of $11.63 for each cycle dispensed). Our results indicated a median CTD of $13.54 for the typical independently owned, closed-door LTC pharmacy. Moving to a shorter cycle would reduce pharmacies' average per-prescription CTD but would increase the number of prescriptions dispensed per month. Our results indicated that transitioning solid oral branded products to 14-day cycles would reduce the median CTD to a minimum of $11.63 but would increase total dispensing costs because each sold oral branded prescription would require twice the number of monthly dispensing events.

Existing arrangements for monitoring community pharmacies in England: Can they have a role in the revalidation of pharmacists?

BackgroundMaintaining and regulating professional competence in health care is a growing concern. Tasked with developing a system of revalidation for pharmacy professionals, the pharmacy regulator in Great Britain commissioned a series of studies to evaluate existing sources of evidence as potential contributors to the revalidation process. ObjectivesTo explore the utility of existing regulatory inspections and service commissioners' contract monitoring processes in the community pharmacy sector as sources of evidence of the fitness to practice of pharmacists in England. MethodsThirteen semistructured telephone interviews conducted with representatives of the regulatory Inspectorate and community pharmacy commissioners. ResultsInterviewees described current processes for inspecting and monitoring community pharmacy premises and the services they provided. Their focus was primarily on the pharmacy and not on the pharmacist. Views were given as to how the roles of the Inspectorate and service commissioners might be developed to incorporate aspects of revalidation. Particular issues were raised in relation to the revalidation of self-employed locum and independent owner pharmacists. ConclusionsExisting inspection and contract monitoring processes have little utility in providing evidence of the fitness to practice of individual community pharmacists in England. However, there may be potential for the Inspectorate and service commissioners to develop a role in revalidation, particularly for locum pharmacists and/or independent pharmacy owners. Moreover, they may take a role in providing the infrastructure required to support the process of revalidation for community pharmacists. Current financial pressures and restructuring in the National Health Service, however, are obstacles to the development of revalidation processes.

Strategic planning to ensure future practice success

As the end of 2012 approached, I had two interesting conversations that helped me focus on my practice and what I ultimately want to achieve. The fi rst was with a colleague who was starting an independent practice in a physician clinic and asked about my policy and procedure manual, as he needed to create one to be compliant with his pharmacy contracts. The second was with a friend of mine who asked me what my 5-year plan was for my practice and business.

Controlled Substance Prescriptions after the New e-Prescription Regulations

The Drug Enforcement Administration (DEA) issued regulations authorizing electronic prescriptions (e-prescriptions) for controlled substances; the regulations first became effective on June 1, 2010. Overshadowed by the health care reform legislation enacted by Congress earlier that year, these groundbreaking regulations have been overlooked by many in the health care community. To focus attention on these new regulations, this article first describes e-prescribing costs and benefits that are expected to accrue, not only to the pharmacist, but also to the DEA, prescribers, and the general public. This information will allow independent pharmacy owners and supervising pharmacists at institutions to make more informed decisions as to whether to implement e-prescriptions for controlled substances. In addition, this article explains how the new e-prescription rules are integrated into the preexisting controlled substance regulations, providing a comprehensive overview of the pharmacist's obligations when presented with any type of controlled substance prescription. This approach is intended to make these new regulations more accessible to all pharmacists, but especially to those who are new to the profession.

Factors associated with independent pharmacy owners' satisfaction with Medicare Part D contracts

Background As Medicare Part D contracts apply pressure on the profitability of independent pharmacies, there is concern about their owners' willingness to sign such contracts. Identifying factors affecting independent pharmacy owners' satisfaction with Medicare Part D contracts could inform policy makers in managing Medicare Part D. Objectives (1) To identify influences on independent pharmacy owners' satisfaction with Medicare Part D contracts and (2) to characterize comments made by independent pharmacy owners about Medicare Part D. Methods This cross-sectional study used a mail survey of independent pharmacy owners in 15 states comprising 6 Medicare regions to collect information on their most- and least-favorable Medicare Part D contracts, including satisfaction, contract management activities, market position, pharmacy operation, and specific payment levels on brand and generic drugs. Results Of the 1649 surveys mailed, 296 surveys were analyzed. The regression models for satisfaction with both the least and the most-favorable Part D contracts were significant ( P < 0.05). A different set of significant influences on satisfaction was identified for each regression model. For the most-favorable contract, influences were contending and equity. For the least-favorable contract, influences were negotiation, equity, generic rate bonus, and medication therapy management (MTM) payment. About one-third of the survey respondents made at least 1 comment. The most frequent themes in the comments were that Medicare Part D reimbursement rate is too low (28%) and that contracts are offered without negotiation in a “take it or leave it” manner (20%). Conclusion Equity, contending, negotiation, generic rate bonus, and MTM payments were identified as the influences of independent pharmacy owners' satisfaction toward Medicare Part D contracts. Generic rate bonus and MTM payment provide additional financial incentives to less financially favorable contracts and, in turn, contribute to independent pharmacy owner's satisfaction toward these contracts.

Logistics or patient care: Which features do independent Finnish pharmacy owners prioritize in a strategic plan for future information technology systems?

ObjectiveTo determine Finnish community pharmacy owners's requirements for the next generation of software systems. DesignDescriptive, nonexperimental, cross-sectional study. SettingFinland during December 2006. Participants308 independent pharmacy owners. InterventionSurvey listing 126 features that could potentially be included in the new information technology (IT) system. The list was grouped into five categories: (1) drug information and patient counseling, (2) medication safety, (3) interprofessional collaboration, (4) pharmacy services, and (5) pharmacy internal processes. Main outcome measurePerceived value of potential features for a new IT system. ResultsThe survey was mailed to all independent pharmacy owners in Finland (n = 580; response rate 53% [n = 308]). Respondents gave priority to logistical functions and functions related to drug information and patient care. The highest rated individual features were tracking product expiry (rated as very or quite important by 100% of respondents), computerized drug–drug interaction screening (99%), an electronic version of the national pharmaceutical reference book (97%), and a checklist-type drug information database to assist patient counseling (95%). ConclusionIn addition to the high ranking for logistical features, Finnish pharmacy owners put a priority on support for cognitive pharmaceutical services in the next IT system. Although the importance of logistical functions is understandable, the owners demonstrated a commitment to strategic health policy goals when planning their business IT system.

Patient-centered care in the community-based compounding practice setting

ObjectiveTo identify patient-centered care (PCC) functions delivered with compounded medications in the community pharmacy setting. DesignCross-sectional study. SettingUnited States during August to November 2007. Participants163 community pharmacist members of the International Academy of Compounding Pharmacists. InterventionWeb-based questionnaire. Main outcome measuresPharmacists' self-reported implementation and perceptions of the PCC process. ResultsRespondents were predominantly men (78.4%), independent pharmacy owners (84.0%), held a BPharm degree (78.5%), and dispensed an average of 746.6 prescriptions per week, including an average of 209.1 compounded medications. Respondents perceived a greater responsibility to provide PCC when dispensing a compounded medication compared with a manufactured product. Compounding pharmacists provided input into the prescribing process via frequent physician-initiated consultation. Respondents reported greater follow-up with patients and physicians regarding therapy with compounded medications than manufactured products. ConclusionPCC is characterized by maintenance and frequent updating of detailed patient health records, routine counseling of patients on new and continuing drug therapies, monitoring of patient therapeutic outcomes, and participation in the prescribing process. Patients are drawn into a stronger relationship with pharmacists who provide these services. Provision of PCC services is associated with greater perceived quality of patient care and pharmacist professional satisfaction.

Pharmaceutical Care in Community Pharmacies: Practice and Research in the US

To describe the state of community pharmacy, including patient care services, in the US. Chain pharmacies, including traditional chains, mass merchandisers, and supermarkets, comprise more than 50% of community pharmacies in the US. Dispensing of drugs remains the primary focus, yet the incidence of patients being counseled on medications appears to be increasing. More than 25% of independent community pharmacy owners report providing some patient clinical care services, such as medication counseling and chronic disease management. Most insurance programs pay pharmacists only for dispensing services, yet there are a growing number of public and private initiatives that reimburse pharmacists for cognitive services. Clinical care opportunities exist in the new Medicare prescription drug benefit plan, as it requires medication therapy management services for specific enrollees. The private market approach to healthcare delivery in the US, including pharmacy services, precludes national and statewide strategies to change the basic business model. To date, most pharmacies remain focused on dispensing prescriptions. With lower dispensing fees and higher operating costs, community pharmacies are focused on increasing productivity and efficiency through technology and technicians. Pharmacists remain challenged to establish the value of their nondispensing-related pharmaceutical care services in the private sector. As the cost of suboptimal drug therapy becomes more evident, medication therapy management may become a required pharmacy benefit in private drug insurance plans. Pharmacy school curricula, as well as national and state pharmacy associations, continually work to train and promote community pharmacists for these roles. Practice research is driven primarily by interested academics and, to a lesser degree, by pharmacy associations. Efficient dispensing of prescriptions is the primary focus of community pharmacies in the US. Some well designed practice-based research has been conducted, but there is no national research agenda or infrastructure. Reimbursement for cognitive services remains an infrequent, but growing, activity.

Career commitment: a mediator of the effects of job stress on pharmacists' work-related attitudes.

The hypothesis for this study was that career commitment mediates the effects of job stress on several work-related attitudes of pharmacists. The effects of job stress, career commitment, met expectations, job satisfaction, and organizational commitment on job turnover intention were also investigated. Cross-sectional mail survey. Nationwide sample of licensed pharmacy practitioners in the United States. 1,088 respondents (full- or part-time chain, independent, or hospital pharmacists) to a previous study. Rating scales measured each of the study variables. Demographic information was also collected. Data analyses included descriptive statistics, confirmatory factor analysis, and structural equation modeling with latent variables. None. Responses were received from 653 pharmacists out of 921 contacted (71%). The effects of job stress on job turnover intention were mediated through career commitment, met expectations, organizational commitment, and job satisfaction. Career commitment positively affected met expectations (beta = 0.35), and met expectations positively affected organizational commitment (beta = 0.66) and job satisfaction (beta = 0.78). An increase in the mean level of job satisfaction and organizational commitment decreased the likelihood of job turnover intention. Independent pharmacy owners tended to have the most positive attitudes toward work. Strategies should be developed to increase the career commitment of pharmacists. Increased commitment can reduce the negative effects of job stress and improve work-related attitudes.

Pharmacists' Decision Making in the Selection of Generic Pharmaceuticals

Criteria that influence pharmacists' decisions to stock generic pharmaceuticals and criteria that influence pharmacists' decisions to recommend generic pharmaceuticals to patients were examined. The sample consisted of 298 Ohio independent community pharmacy owners or managers. Data were collected by mail questionnaires. Questions pertained to background information about each participating pharmacy and respondent, criteria used in stocking generic pharmaceuticals, and criieria used in recommending generic pharmaceuticals to patients. Economic considerations, the of generic pharmaceuticals, the generic distributor and the manufacturer, and the therapeutic class of the brand-name product influenced pharmacists' decisions to stock generic pharmaceuticals. Third-party programs, physicians, and patients influenced pharmacists' decisions to recommend generic pharmaceuticals to patients.