Supermarket Pharmacy Research Articles

Vaccine administration by pharmacy technicians: Impact on vaccination volume, pharmacy workflow and job satisfaction

BackgroundImmunizing pharmacy technicians (IPTs) have become more prevalent in recent years, but their impact on community pharmacy practice has yet to be determined. ObjectivesDetermine the impact of implementing IPTs on vaccination volume in a community pharmacy chain and assess pharmacy staff's perspectives on the clinical abilities of IPTs and their impact on pharmacy workflow and job satisfaction. MethodsRetrospective data analysis comparing the number of vaccines administered in a supermarket pharmacy chain from September to March 2019–2020 and 2020–2021 in pharmacies with IPT(s) versus those without IPT(s). For the secondary objective, investigators developed and deployed two role-based mixed quantitative/qualitative surveys among pharmacy staff. ResultsPharmacies with IPT(s) observed a greater mean increase in vaccination volume from 2019–2020 to 2020–2021 versus those without IPTs (+159.35 vs. +104.57, p = 0.011). Among IPT survey respondents, 50/75 (66.7%) felt more satisfied with their job after receiving immunization training. Among pharmacist respondents, 80/119 (67.3%) felt that IPTs positively impacted their job satisfaction and 61.7% felt that pharmacist clinical services were either somewhat positively affected, or positively affected. ConclusionImplementing IPTs can increase the volume of vaccines administered in a chain pharmacy and may positively affect job satisfaction and pharmacy workflow.

Scaling the optimizing care model in community pharmacy using implementation mapping and COM-B theoretical frameworks

BackgroundThere has been increasing evidence that “task shifting,” when a provider entrusting specific responsibilities to another member of their team, can increase care access and may lead to better patient care outcomes. This has been particularly underscored in underserved communities throughout the world where task shifting has led to increased health care access in areas of provider shortages. Within the profession of pharmacy, pharmacy technicians are the primary pharmacist assistants and recipients of pharmacist-delegated tasks. Recently, such task delegation has placed the pharmacist in more direct patient care responsibilities beyond medication dispensing—and one such model with a growing evidence base is the optimizing care model. The optimizing care model is an novel approach to community pharmacy practice centered on expanded clinical service delivery by means of task delegation. Through task shifting, the optimizing care model has been shown to reduce medication errors and increase the quantity of patient care services offered by the pharmacist. However, means to spread and scale the model have yet to be reported in the literature. MethodsThis article describes the development of a package of implementation strategies designed to facilitate implementation of the optimizing care model in a single division of nationwide supermarket pharmacy chain. The implementation mapping approach was used to systematically develop strategies. In this approach, a protocol is prospectively developed to guide the implementation of a novel evidence-based interventions into a given setting, including the development of implementation strategies. ResultsThe application of the 5 steps of implementation mapping is described in detail. Implementation objectives, models, and strategies are outlined, as well as the final implementation protocol. There was an overall increase in weeks meeting the 10% optimizing care model threshold—33% at baseline to 83% after the intervention. ConclusionsThe implementation mapping process led to development of multifaceted implementation strategy for implementing the optimizing care model into community pharmacy practice. The strategy improved optimizing care model implementation. Further research is needed to understand which strategies were most impactful.

Identifying Services Provided in Community Pharmacy Practice Settings.

Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.

Marketing Two Immunization Services at a Regional Supermarket Chain Pharmacy.

Background: Personal selling of immunization services includes starting a dialogue with patients, utilizing effective questioning and listening skills to identify their vaccination needs, and recommending appropriate vaccines accordingly. The study objectives were (1) to integrate personal selling into the dispensing workflow to promote pneumococcal polysaccharide vaccine (PPSV23), and (2) to evaluate the impact of personal selling and automated telephone calls to promote herpes zoster vaccine (ZVL). Methods: For the first study objective, a pilot project was conducted at one out of 19 affiliated supermarket pharmacies. Dispensing records were used to target patients with diabetes mellitus for PPSV23, and personal selling was implemented over a 3-month period. For the second study objective, a full study was conducted among the nineteen pharmacies, with five in the study group and 14 in the control group. Personal selling was implemented over a 9-month period, and automated telephone calls were placed and tracked over a 6-week period. Mann-Whitney U tests were used to compare vaccine delivery rates between the study and control groups. Results: In the pilot project, 47 patients needed PPSV23, but none received it from the pharmacy. In the full study, 900 ZVL vaccines were given, with 459 given for 15.5% of the eligible patients in the study group. During the time when 2087 automated telephone calls were placed and tracked, 85 vaccines were given across all pharmacies, with 48 given for 1.6% of the eligible patients in the study group. During both the 9-month and 6-week periods, the mean ranks of vaccine delivery rates in the study group were higher than the control group (p < 0.05). Conclusions: The pilot project incorporated personal selling into the dispensing workflow and, although no vaccines were given, provided valuable lessons. The full study demonstrated that personal selling alone and personal selling combined with automated telephone calls were associated with higher vaccine delivery rates.

Supermarket pharmacy closures: a watershed moment?

Supermarket pharmacy closures: a watershed moment?

Opioid overdose counseling and prescribing of naloxone in rural community pharmacies: A pilot study

IntroductionFatal overdoses from opioids increased four-fold from 1999 to 2009, and they are now the leading cause of death among Americans under 50. Legislation has been passed by every state to increase access to naloxone but dispensing by community pharmacies remains low. ObjectivesThe objective of this study was to pilot test a proactive opioid overdose counseling intervention and a passive naloxone intervention, and the implementation strategies developed to support their delivery, in rural community pharmacies on relevant implementation outcomes. MethodsThe interventions, implementation strategies, and the overall pilot study approach were developed in a collaborative partnership with a regional supermarket pharmacy chain. They selected 2 rural pharmacies to participate in the pilot study and 2 non-intervention pharmacies to serve as comparison sites. Two interventions were pilot tested in the 2 intervention pharmacies: 1) a proactive opioid overdose counseling intervention and 2) a passive naloxone intervention. An explanatory sequential mixed-methods design was utilized to evaluate adoption, feasibility, acceptability, and appropriateness outcomes after the 3-month observation period. ResultsBetween the 2 intervention pharmacies, 130 patients received the opioid overdose counseling intervention. 44 (33.8%) were prescribed and dispensed naloxone. Zero naloxone prescriptions were written or dispensed at the comparison pharmacies. Interviews with pharmacy staff found the interventions to be feasible, acceptable, and appropriate in their settings. ConclusionThis small scale pilot study in partnership with a regional supermarket pharmacy chain had positive results with a third of patients who received the opioid overdose counseling intervention being dispensed naloxone. However, the majority of patients did not receive naloxone indicating additional revisions to the intervention components and/or implementation strategies are needed to improve the overall impact of the interventions.

Predisposing, Enabling, and Need Factors Associated with the Choice of Pharmacy Type in the US: Findings from the 2015/2016 National Consumer Survey on the Medication Experience and Pharmacists' Roles.

Background: Knowing the type of pharmacy used by the patient is meaningful to the pharmacist. Previous studies have assessed different factors predicting the kind of pharmacy selection and reached inconsistent findings. Objectives: To identify patient and health-related factors associated with pharmacy type selection. Methods: The Andersen Behavioral Model of Health Service Use was used to organize the selection of patient characteristics and categorize them as predisposing, enabling, and need factors. The dependent variable was the type of pharmacy used. Logistic regression was used to predict the association between patient-related characteristics and the type of pharmacy used. Results: Older age respondents were less likely to use independent pharmacies (OR = 0.992) and more likely to use mail pharmacy services (OR = 1.026). Highly educated people showed higher use of chain and mail pharmacies (OR = 1.272, 1.185, respectively) and less tendency to use the independent, supermarket, and prescription-only pharmacy types. Men were less likely to use chain pharmacies (OR = 0.932) and more likely to use supermarket pharmacies than women. Patients who use Medication Therapy Management (MTM) services had higher odds of using independent and supermarket pharmacies (OR = 2.808, 1.689, respectively). Patients with a higher number of chronic diseases and experienced side effects of medications were more likely to use independent pharmacies (OR for number of disease = 1.097 and for side effects = 1.095). Conclusions: This study’s findings identify characteristics associated with selecting certain pharmacy settings and direct future research to include other predictors encompassing beliefs, attitudes, and other social factors.

Retrospective evaluation of preconception care opportunities in a chain community pharmacy setting

ObjectivesCertain prescription medications should be avoided during pregnancy to reduce the risk of fetal harm. Identification of these medications to minimize exposure may be achieved through the integration of preconception care recommendations into medication therapy management (MTM) services. The primary objective of this study was to identify missed opportunities for pharmacists to provide preconception care support related to medications associated with adverse pregnancy outcomes for reproductive-aged women who received MTM consultations at a regional supermarket pharmacy chain. Secondary objectives examined the concurrent use of prenatal vitamins, folic acid, or hormonal contraception in patients receiving medications associated with adverse pregnancy outcomes. MethodsThe study examined all MTM and prescription drug claims submitted by a regional chain of supermarket pharmacies from January 1, 2018 to June 30, 2019, to identify female patients aged 15-45 years who received MTM services. Prescription claims were cross-referenced to determine which of these patients also received medications associated with adverse pregnancy outcomes. To identify patients with long-term use of opioids and nonsteroidal anti-inflammatory drugs, a restriction based on days supplied was then applied. ResultsOf the 2020 female patients who received MTM services and filled at least 1 prescription during the study period, 731 (36.2%) were found to have received at least 1 medication associated with adverse pregnancy outcomes for the minimal days’ threshold. Of these, 509 (69.6%) lacked evidence of concurrent prescription contraception, and 74 (10.1%) had a concurrent prescription for folic acid or prenatal vitamins. ConclusionThe use of medications associated with adverse pregnancy outcomes was widespread in this sample of reproductive-aged women. The findings of this study indicate the need for additional research to investigate the implementation of targeted MTM interventions to build standard workflow processes and facilitate pharmacists’ management of this critical clinical issue.

A conceptual value-based incentivization model of adult immunization for community pharmacists

ObjectiveTo design a value-based payment model to incentivize pharmacists for increased administration of influenza, herpes zoster, pertussis-containing, and pneumococcal vaccines to adults at community pharmacies. DesignA modified delphi technique was used to create a concept for a value-based payment model through consensus of expert opinion. Settingand participants: Experts were recruited from a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution to participate in 4 electronic surveys and 1 in-person meeting. Outcome measuresConsensus on model design by means of a modified delphi technique. ResultsA panel of 11 experts participated in a series of electronic surveys and 1 in-person meeting. The final value-based payment model addressed how and when pharmacists would receive an incentive for meeting specific vaccination goals. The final value-based payment model also addressed the following concepts: estimated cost avoidance, vaccine effectiveness, and community protection. A 3-tiered incentive model was agreed on by the participants to tie increased vaccination rates with increased payment. Vaccination goals for each tier were defined as the percent increase in vaccination rates from the year immediately preceding. Incentives were defined as a percentage of estimated direct medical costs avoided to be shared between the payer and pharmacy. ConclusionA conceptual value-based payment model to incentivize pharmacists for increased delivery of adult vaccinations at community pharmacies was designed and agreed on by experts representing a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution. Consensus was achieved by aligning the interests of both payers and pharmacies. The final model included 3 tiers of bundled incentives to reward percent increases in adult vaccination from historical baselines. This model may be used as an example for community pharmacies and health care payers to design future value-based immunization programs.

Exploring the early phase of implementation of a vaccine-based clinical decision support system in the community pharmacy

ObjectiveTo explore the implementation strategy of a recombinant zoster vaccine (RZV) clinical decision support (CDS) intervention in community pharmacy workflow to increase second-dose vaccination rates. SettingThe level of analysis was the unit (e.g., pharmacy). The participants were selected from across approximately 2200 pharmacies in 37 states on the basis of criteria believed to affect implementation success (e.g., size, location) using a sampling matrix. Practice descriptionLarge supermarket pharmacy chain. Practice innovationVaccine-based CDS intervention in community pharmacy workflow. EvaluationA mixed-methods contextual inquiry approach explored the implementation of a new RZV CDS workflow intervention. Data collection involved key informant, semistructured interviews and an electronic, Web-based survey. The survey was based on a validated instrument and was made available to all pharmacists nationwide within the study organization to assess views of the implementation’s appropriateness, acceptability, and feasibility during early implementation. Afterward, a series of semistructured, in-depth interviews were conducted until a point of saturation was reached. The interview guide was based on selected constructs of the Consolidated Framework for Implementation Research. ResultsA total of 1128 survey responses were collected. Survey respondents agreed or strongly agreed that the implementation was acceptable (78.34%), appropriate (79.92%), and feasible (80.53%). Twelve pharmacist participants were interviewed via telephone. Five themes emerged from the interviews, revealing facilitators and barriers that affected implementation of the intervention: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process. ConclusionThe implementation of the RZV CDS “nudge” intervention was welcomed, suitable, and operable in the community pharmacy setting to meet the needs of the organization, employees, and patients. The contextual factors identified during the implementation process of this CDS intervention in a community pharmacy setting may be used in scaling this and future CDS interventions for public health initiatives aimed at pharmacists in this setting.

Supermarket pharmacy delivers flu vaccines to GP patients as practices face shortages

Supermarket pharmacy delivers flu vaccines to GP patients as practices face shortages

Implementation of comprehensive medication management at supermarket pharmacies in a pharmacy network

ObjectiveTo garner experience with the early implementation of pharmacist-provided comprehensive medication management at a regional supermarket pharmacy during the initial launch of a statewide community pharmacy enhanced services network payer contract. MethodsA series of key informant interviews were conducted with pharmacists at Giant Eagle Pharmacy locations in Pennsylvania. To be eligible to participate, pharmacists must have been trained by the Pennsylvania Pharmacists Care Network to deliver contracted comprehensive medication management services and willing to participate in audio recorded, telephonic interviews every 2 weeks. Interviews concluded when each pharmacist completed a total of 6 interviews or when the project period ended. A semistructured interview guide was developed by the investigators to elicit the pharmacists’ experience providing contracted services. Interviews were transcribed and coded by 2 independent investigators. Coding discrepancies were resolved. The final coded transcripts were presented back to the project team to identify and finalize major themes. Illustrative quotes were selected to represent each theme. ResultsInterviews from 10 pharmacists were included in the analysis. Five themes emerged as keys of successful early implementation: (1) promote commitment of the pharmacy team, (2) use effective whole-team patient engagement strategies, (3) personalize patient encounters by providing patient-centered care and practicing interpersonal skills, (4) make workflow and staffing resources easily accessible, and (5) make clinical patient care tools readily available. ConclusionThese results highlight thematic trends for how pharmacists can successfully engage their patients in contracted comprehensive medication management services. Understanding the success of early implementation at a regional supermarket pharmacy can serve as a framework for other participants in community pharmacy enhanced services networks to replicate and scale contracted patient care services.

Improving care transitions through medication therapy management: A community partnership to reduce readmissions in multiple health-systems

ObjectivesThe primary objective was to measure the impact of a pharmacist-provided medication therapy management program on 30-day postdischarge readmission rates. The secondary study objectives were to characterize the number and types of pharmacist interventions, to determine the impact of the intervention on primary and secondary medication nonadherence, and to measure patient satisfaction with the intervention. DesignRandomized, clinical trial. SettingSix hospitals and a supermarket pharmacy chain with 60 pharmacies. ParticipantsFour hundred patients discharged from a participating hospital with acute myocardial infarction, pneumonia, congestive heart failure, chronic obstructive pulmonary disease, or diabetes. Main outcome measuresPrimary outcome measure was 30-day readmission rate. Secondary outcomes were pharmacist interventions, primary and secondary medication nonadherence, and patient satisfaction. ResultsFour hundred patients were enrolled. There was not a significant difference in 30-day readmission rates between intervention and control groups (11.3% vs. 10.7%; P = 0.49). A large portion of patients randomized to the intervention did not attend their appointment. In a per protocol (PP) analysis, which included the 62 intervention patients who attended their appointment and the 187 patients in the control group, there was a significant difference in 30-day readmission rates (1.6% vs. 10.7%; P = 0.02). In the PP analysis, controlling for baseline differences, patients in the intervention group were significantly less likely to experience a readmission (odds ratio, 0.126; 95% confidence interval, 0.016-0.968; P = 0.046). In the PP analysis, the percentage of prescriptions not picked up in the intervention group compared with the control group was reduced by 2.5%, (6.4% vs. 8.9%; P = 0.59). Pharmacists identified many interventions, averaging 6 per patient. ConclusionThis study successfully implemented a large-scale transition of care program between multiple health systems and community pharmacies that reduced hospital readmissions. Pharmacists identified many interventions for patients. The transmission of patient information from the inpatient setting to the community pharmacy is key to transitioning patients successfully.

Exploring the expanded role of the pharmacy technician in medication therapy management service implementation in the community pharmacy

ObjectivesTo explore the current roles of the pharmacy technician in the provision of medication therapy management (MTM) and their relation to organizational behavior at “high-performing” community pharmacies within a nationwide supermarket chain. DesignQualitative research study using methodologic triangulation with the use of semistructured interviews of key informants, direct observation at “high-performing” pharmacy sites, and respondent journals. Setting and participantsHigh-performing pharmacy sites within a large supermarket pharmacy chain in Tennessee. A high-performing site was defined as a pharmacy that has successfully implemented MTM into its pharmacy workflow. Main outcome measuresThemes related to pharmacy technician roles in the delivery of direct patient care services. ResultsA total of 28 key informants were interviewed from May 2015 to May 2016. Key informants included 10 certified technicians, 5 noncertified technicians, and 13 pharmacists across 8 pharmacies in central and eastern Tennessee. Three themes were identified. At high-performing sites, pharmacy technicians were engaged in both clinical support activities as well as nonclinical support activities with the goal of improving clinical service implementation. Several barriers and facilitators were revealed. ConclusionWithin high-performing teams, expanded technician roles to support patient care service delivery were associated with successful clinical service implementation. Future studies should further explore these expanded technician duties, as well as the role of organizational culture, climate, and team dynamics, in the delivery of patient care and clinical services across a heterogeneous pharmacy setting.

Positive Impact of Technician-Driven MTM Program on Performance Measures

Objective: To determine the effect of using a technician-driven medication therapy management (MTM) program on quality performance measures for a community pharmacy chain. Methods: A technician-driven MTM program was incorporated in 35 stores of a regional supermarket pharmacy chain. The overall chain percentage score for the 4 quality measures used in Medicare Part D Star Ratings—proportion of days covered (PDC) for cholesterol, diabetes, renin–angiotensin system antagonists (RASA), and high-risk medication use—was compared pre- and postimplementation of the technician-driven MTM program. Data were collected from Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) platform and t tests were used to analyze 1 year pre- and postimplementation. Results: The PDC for RASA, high cholesterol medications, and diabetes medications significantly increased pre- to postimplementation for each drug class (P < .001, P = .011, P = .001, respectively). The combined overall mean PDC score for RASA, cholesterol medications, and diabetes medication classes significantly increased by 5.6% from 2015 to 2016 (74.2% vs 79.8%, P < .001); there was also a nonsignificant decrease in high-risk medication use for the entire chain. Conclusions This technician-driven MTM program can positively affect pharmacy quality performance and potentially improve patient outcomes.

Scripted Surge Pharmacy Pandemic Exercise: Testing Vaccine Administration and Antiviral Dispensing

In 2015, the Centers for Disease Control and Prevention (CDC) collaborated with the National Association of County and City Health Officials (NACCHO) to develop and conduct the Scripted Surge Pharmacy Pandemic Exercise to assess the capacity of pharmacies to administer vaccines and dispense medications during a severe influenza pandemic and to evaluate their various approaches to this activity. A mass merchant pharmacy and a supermarket pharmacy were recruited in 2 different states. At each pharmacy, 2 consecutive 90-minute exercise runs were completed in which actors, simulating patients, presented themselves to the pharmacy counter and requested a vaccine and/or prescription(s). Each run was slightly different in terms of patient flow, staffing, and physical configuration. Individual plays were timed, and a quality assessment was conducted as each patient left the store. Despite the complexities of the pandemic scenario, the number of vaccines administered and prescriptions dispensed surpassed what that pharmacy could typically accomplish during current peak hours of operation. Furthermore, the number of requests successfully processed increased between the first and second runs at each site, suggesting that processing efficiency improved with practice and experience. Few unexpected outcomes were observed, most of which were attributable to exercise artificialities, and they were judged unlikely to occur under real-world scenarios and routine pharmacy practice. The experience gained from this exercise indicates that pharmacies can likely play an important role in improving access to vaccinations and medications during a future pandemic.

Training and retaining community pharmacy leaders: Career pathways after completing a PGY1 community pharmacy residency affiliated with a large supermarket chain

ObjectiveTo determine pharmacist career paths and resident perceptions after completion of a PGY1 community pharmacy residency with a national supermarket pharmacy chain. MethodsCross-sectional nationwide survey. ResultsOverall, 65% (n = 24) of residents who responded accepted a position with Kroger immediately after graduation. When asked about the degree of value the residency had on obtaining the resident’s ideal position, 29 (76%) reported that it was “very valuable” and the remaining 9 (24%) reported that it was “somewhat valuable.” Positions that these pharmacists held immediately after residency completion were: clinical pharmacist (clinical coordinators, patient care specialists, or patient care managers; 54%), staff pharmacist (21%), split/mixed (mixed clinical and staffing components; 21%), and pharmacy manager (4%). ConclusionResidency trained pharmacists were retained by the pharmacy chain where they practiced, and the majority of those pharmacists held split or full-time clinical pharmacist roles within the chain supermarket pharmacy.

Influences on the frequency and type of community pharmacy services

ObjectivesTo describe services provided by community pharmacies and to identify factors associated with services being provided in community pharmacies. DesignCross-sectional national mail survey. Setting and participantsPharmacists actively practicing in community pharmacies (independent, chain, mass merchandisers, and supermarkets). Outcome measuresFrequency and type of pharmacy services available in a community pharmacy, including medication therapy management, immunization, adjusting medication therapy, medication reconciliation, disease state management, health screening or coaching, complex nonsterile compounding, and point-of-care testing. ResultsWith a 48.4% response rate, the survey showed that community pharmacies offered on average 3 of the 8 services studied. Pharmacy chains and supermarket pharmacies reported providing significantly more services than did mass merchandise pharmacies. The number of pharmacy services provided was positively associated with involvement in an interprofessional care team, innovativeness, and perceived workload. The number of pharmacy services was negatively correlated with having 3.5 or more pharmacy technicians on duty. ConclusionPharmacy chains and supermarkets are providing the most pharmacy services among community pharmacy settings. The number of services provided was associated with innovativeness, technician staffing, and perceived workload. Also, involvement with an interprofessional care team supported greater service delivery. Community pharmacies vary in their provision of services beyond dispensing.

The promise of point-of-care testing: Hy-Vee's Kingston shows how it works

A the counter at Hy-Vee Pharmacy in Omaha, NE, “Tom” complained of a sore throat. Describing his symptoms, he asked Alison Kingston, PharmD, whether he should try an OTC remedy or schedule a visit with his primary care provider. But pharmacists at Hy-Vee Inc. now have a new tool in their toolkit. In less than 15 minutes, Kingston could administer a strep test right there at the pharmacy. Depending on the results, Tom could walk away with a prescription for strep or an OTC product.

Impact of a Transitions of Care Training Module on Community Pharmacists' Knowledge and Attitudes.

Background: Community pharmacists' accessibility to patient histories and personal patient relationships situates them to have a potentially significant impact on transitions of care. Recent literature has demonstrated that improved patient outcomes and an overall reduction in health care costs occur when pharmacists are involved in medication reconciliation during transitions of care. Objective: To develop a transitions of care training module for community pharmacists. To assess the training module's impact on pharmacists' transition of care knowledge and their attitude toward actively participating in the transitions of care for their patients. Methods: Community pharmacists practicing in a supermarket pharmacy chain participated in this study. A pretest and posttest were administered around a 30-minute transitions of care training module. The attitude assessment consisted of a 5-point Likert-type scale, while the knowledge-based assessment consisted of true/false and multiple-choice questions. SPSS version 21.0 was used to generate descriptive and nonparametric statistical analyses. The study was approved by the University of Toledo Social, Behavioral, and Educational Institutional Review Board. Results: Thirty-six pharmacists (72%) successfully completed the pre-post survey. The average pharmacist posttest knowledge survey score improved from the pretest score, 73% to 99%. A paired Student's t test demonstrated the posttest percentage of correct questions on the knowledge-based survey improved from the baseline knowledge. Pharmacists' average posttest attitudes regarding participation in patients' transitions of care statistically improved compared to their pretest attitudes. Conclusion: Community pharmacists' transitions of care knowledge and attitudes can be improved through a training module.