Traditional Pharmacy Services Research Articles

Patient perspectives of antiretroviral pharmacy services: A cross-sectional cohort study.

Adherence to antiretroviral therapy (ART) remains the main predictor of sustained HIV virologic suppression for people with HIV (PWH). Mail-order pharmacy services are often offered to patients as an alternative option to traditional pharmacy services. Some payers mandate ART to be dispensed from specific mail-order pharmacies regardless of patient choice complicating ART adherence for patients affected by social disparities. Yet, little is known about patient perspectives regarding mail-order mandates. Eligible patients of the HIV program at University of Nebraska Medical Center with experience receiving ART from both a local and mail-order pharmacy were invited to complete a 20-question survey with three core sections: experiences/perspectives on local and mail-order pharmacy settings; pharmacy attributes rankings; and pharmacy preference. Paired t-tests and Mann-Whitney tests were used to compare the agreement scores of pharmacy attributes. Sixty patients (N = 146; 41.1%) responded to the survey. Mean age was 52 years. Most were male (93%) and White (83%). The majority of participants were on ART for HIV treatment (90%) and 60% were using mail-order pharmacies for their prescription services. Significant scoring differences (p<0.05) were observed for all pharmacy attributes favoring local pharmacies. Refilling ease was the most important attribute noted. More respondents (68%) preferred local pharmacies versus mail-order pharmacies. Payer associated mail-order pharmacy mandates were experienced by 78% with half believing the mandates impacted their medical care negatively. In this cohort study, respondents preferred local pharmacies compared to mail-order pharmacy for ART prescription services and noted ease of refilling as the most important pharmacy attribute. Two-thirds of respondents believed mail-order pharmacy mandates negatively affected their health. Insurance payers should consider the removal of mail-order pharmacy mandates to allow patient choice of pharmacy, which may help remove barriers to ART adherence and improve long-term health outcomes.

Factors Facilitating and Hindering Development of a Medication Use Review Service in Eastern Europe and Iran-Cross-Sectional Exploratory Study.

Polypharmacy is a common issue in patients with chronic diseases. Eastern-European countries and Iran are exploring possibilities for implementing the Medication Use Review (MUR) as a measure for optimizing medication use and ensuring medication safety in polypharmacy patients. The aim of this study was to gain insights into the development of the community pharmacy sector and map facilitators and barriers of MUR in Eastern Europe and Iran. The representatives of the framework countries received a questionnaire on community pharmacy sector indicators, current and future developments of pharmacies, and factors encouraging and hindering MUR. To answer the questionnaire, all representatives performed document analysis, literature review, and qualitative interviews with key stakeholders. The socio-ecological model was used for inductive thematic analysis of the identified factors. Current community pharmacist competencies in framework countries were more related to traditional pharmacy services. Main facilitators of MUR were increase in polypharmacy and pharmaceutical waste, and access to patients’ electronic list of medications by pharmacists. Main barriers included the service being unfamiliar, lack of funding and private consultation areas. Pharmacists in the framework countries are well-placed to provide MUR, however, the service needs more introduction and barriers mostly on organizational and public policy levels must be addressed.

Evaluation of a Pharmacist-Led Remote Warfarin Management Model Using a Smartphone Application (Yixing) in Improving Patients' Knowledge and Outcomes of Anticoagulation Therapy.

Background: The management of warfarin-treated patients has been recognized as a challenge due to narrow therapeutic range and food and drug interactions in warfarin therapy. We aim to evaluate the effect of a pharmacist-led remote warfarin management model using a smartphone application (app) on anticoagulation therapy. Methods: Eligible patients who had received warfarin therapy after mechanical heart valve replacement were enrolled. The intervention group was offered a pharmacist-led remote warfarin management model using the app named Yixing. Yixing incorporates functions including automatic daily reminder, personal health record, educational program, and online counseling. The control group received traditional pharmacy services without Yixing. Co-primary outcomes were patients’ awareness score of warfarin therapy obtained from questionnaire, the medication adherence measured by the percentage of the correct-warfarin-taken days in the monitored period, the fraction of time in therapeutic range (FTTR), and the incidence of anticoagulation-related complications. The needed information of the patients was acquired via electronic medical records from the hospital, Yixing system and telephone follow-up when necessary. Results: 64 and 66 patients were initially in the intervention and control groups respectively. After propensity score matching, 50 patients were assigned in each group. The intervention group had a median age of 51.0 years, in which 27 (54%) were male. The control group had a median age of 50.5 years, in which 28 (56%) were male. Patient awareness score in the intervention group was 8.00 (2.00), which was higher than that in the control group, with score at 6.50 (2.50) (p = 0.001). No significant difference was found in the percentage of the correct-warfarin-taken days between the two groups (p = 0.520). The median (interquartile range) value of FTTR was 80.3% (21.9%) and 72.1% (17.7%) in the intervention and control groups respectively (p = 0.033), and no significant differences in the incidence of anticoagulation-related complications were observed (p = 0.514). Conclusion: The pharmacist-led remote warfarin management model using Yixing improves patients’ awareness of warfarin therapy and increases FTTR, but may not have significant improvements on medication adherence and safety.

Bridging the Gap: Community Pharmacists’ Burgeoning Role as Point-Of-Care Providers During the COVID-19 Pandemic Through the Integration of Emerging Technologies

Community pharmacies are an under-utilized setting for the provision of primary and preventative care measures, especially the provision of clinical dietary care. The SARS-CoV-2 pandemic presented a unique opportunity to study pharmacist-based nutritional counseling in the absence of ready access to primary nutritional care. In the present interventional pilot study, we analyzed the efficacy of a Clinical Decision Support System (CDSS) for community pharmacy integration on patient weight management, monitoring, and goal setting over a 4-week period. 57 Greek adult patients (16 males and 41 females) of a community pharmacy in the greater Athens area were enrolled in the intervention and subsequently assigned a hypo- or iso-caloric diet according to baseline anthropometric measurements, total daily energy expenditure, medical history, and drug treatment status as assessed by the CDSS. At the end of the intervention period participant weight (kg) and corresponding Body Mass Index (BMI) (kg/ m2) calculations were recorded to gauge sample diet and CDSS recommendation efficacy. Among patients who remained diet compliant to study completion, body weight and BMI were significantly decreased in the hypo-caloric diet group compared to baseline (n=13) (mean difference = -2.685 kg, p = 0.004; mean difference = -1.112 kg/m2, p = 0.004, respectively). No significant change in body weight nor BMI from baseline of isocaloric diet compliant patients was registered (n=9) (p=0.273; p=0.320, respectively), succeeding in the purported goal of weight maintenance. This study provides preliminary evidence for the efficacy of a CDSS in assisting pharmacists with nutritional assessment, screening, and sample diet counselling concordant with patient dietary and weight-loss requirements. This trial also builds on emerging research into the broadening purview of traditional pharmacy services in primary care settings.

Virtual pharmacist interventions on abuse of over-the-counter medications during COVID-19 versus traditional pharmacist interventions

ObjectivesThis study aimed to investigate the frequency, nature, and clinical significance of pharmacist interventions on over-the-counter (OTC) medicines with abuse potential across community pharmacies with and without virtual care. MethodsIn this prospective observational study, a trained research team observed the dispensary teams of 12 community pharmacies in the United Arab Emirates (UAE), 6 of which were operating virtual pharmacy care. A standardized data collection form was used to include information about dispensing of OTC medicines and pharmacist interventions on those with abuse/misuse potential. The clinical significance of the interventions was evaluated by a multidisciplinary committee. ResultsThe frequency of pharmacist interventions on OTC medicines with abuse potential across pharmacies with and without virtual services was 83.2% versus 91.0%, respectively, whereas the frequency of pharmacist interventions on OTC medicines with misuse potential across pharmacies with and without virtual services was 79.8% versus 41.2%, respectively. The proportions of clinically significant interventions across pharmacies with and without virtual services were 19.7% versus 10.5%, respectively. Cough medicines were dispensed significantly more across pharmacies with virtual care than across pharmacies without virtual care (25.6% vs. 9.7%, respectively; P = 0.04). Asking the patient to seek the advice of an addiction specialist (adjusted odds ratio = 4.11; P = 0.001) versus refusing to sell the drug was more likely to be associated with pharmacies with virtual services than with pharmacies operating traditional pharmacy services. ConclusionVirtual pharmaceutical care is a potential approach to reduce the abuse/misuse of OTC medicines but needs some improvements regarding detection of these cases. The UAE is the first country in the region to implement and regulate virtual pharmacy practice.

Patient preferences for healthcare delivery through community pharmacy settings in the USA: A discrete choice study.

In order to improve public health, it is necessary to facilitate patients' easy access to affordable high-quality primary health care, and one enhanced approach to do so may be to provide primary healthcare services in the community pharmacy setting. Discrete choice experiments to evaluate patient demand for services in pharmacy are relatively limited and have been hampered by a focus on only a few service alternatives, most focusing on changes in more traditional pharmacy services. The study aim was to gauge patient preferences explicitly for primary healthcare services that could be delivered through community pharmacy settings in the USA, using a very large sample to accommodate multiple service delivery options. An online survey was administered to a total of 9202 adult patients from the general population. A subsequent online survey was administered to 50 payer reimbursement decision-makers. The patient survey included a discrete choice experiment (DCE) which showed competing scenarios describing primary care service offerings. The respondents chose which scenario would be most likely to induce them to switch from their current pharmacy, and an optimal patient primary care service model was derived. The likelihood this model would be reimbursed was then determined in the payer survey. The final optimal service configuration that would maximize patient preference included the pharmacy: offering appointments to see a healthcare provider in the pharmacy, having access to their full medical record, provide point-of-care diagnostic testing, offer health preventive screening, provide limited physical examinations such as measuring vital signs, and drug prescribing in the pharmacy. The optimal model had the pharmacist as the provider; however, little change in demand was evident if the provider was a nurse-practitioner or physician's assistant. The demand for this optimal model was 2-fold higher (25.5%; 95% Bayesian precision interval (BPI) 23.5%-27.0%) than for a base pharmacy offering minimal primary care services (12.6%; 95% BPI 12.2%-13.2%), and was highest among Hispanic (30.6%; 95% BPI: 25.7%-34.3%) and African American patients (30.7%; 95% BPI: 27.1%-35.2%). In the second reimbursement decision-maker survey, the majority (66%) indicated their organization would be likely to reimburse the services described in the optimal patient model if provided in the pharmacy setting. This United States national study provides empirical support for a model of providing primary care services through community pharmacy settings that would increase access, with the potential to improve the public health.

Interprofessional Approach to Increase Billable Care-Events in a Rural Community

Objectives: The study was designed to build a financially stable, replicable, and interprofessional program around a Center of Excellence (COE) model exclusively in a community pharmacy setting. This involved creating a separate pharmacy-based clinic within the community pharmacy with recognized rendering providers by payers allowing pharmacists to bill incident to for services and increase the quality of patient clinical outcomes.&#x0D; Setting: Apple Discount drugs in Salisbury, MD is a multi-site independent community pharmacy setting offering traditional pharmacy services along with several pharmacist run clinical programs.&#x0D; Practice Innovation: The pharmacy developed an interprofessional team around a Center of Excellence (COE) model as a separate medical clinic within the community pharmacy as a subsidiary of the parent company that was staffed with healthcare providers that are recognized by payers to bill for services.&#x0D; Main Outcome Measures: Outcomes of the study included analysis of the number of patients seen, the ability to obtain reimbursement for the clinical services offered, and changes in A1C and BMI to support the clinical value of pharmacist intervention.&#x0D; Results: A total of 309 patients with diabetes were seen over a 16 month period, including 120 patients who completed the 10 hour diabetes training program. Clinical outcomes showed an improvement in A1C from 9.1 pre enrollment to 7.5 post intervention, and a drop in BMI from 35.7 pre enrollment to 32.4 post intervention. The pharmacy was also able to increase the amount of reimbursement for services provided.&#x0D; Conclusions: The development of a pharmacy based clinic business model inside of a community pharmacy has increased the amount of clinically billed services for the pharmacy. Improvements in clinical outcomes led to an acceptance of the pharmacist as a member of the patient’s care team by patients, local physician’s offices, and third party payers.&#x0D; Funding: This work was supported by the Community Pharmacy Foundation [grant #143 , 2015]&#x0D; &#x0D; Type: Commentary

Interprofessional Approach to Increase Billable Care-Events in a Rural Community

Objectives: The study was designed to build a financially stable, replicable, and interprofessional program around a Center of Excellence (COE) model exclusively in a community pharmacy setting. This involved creating a separate pharmacy-based clinic within the community pharmacy with recognized rendering providers by payers allowing pharmacists to bill incident to for services and increase the quality of patient clinical outcomes. Setting: Apple Discount drugs in Salisbury, MD is a multi-site independent community pharmacy setting offering traditional pharmacy services along with several pharmacist run clinical programs. Practice Innovation: The pharmacy developed an interprofessional team around a Center of Excellence (COE) model as a separate medical clinic within the community pharmacy as a subsidiary of the parent company that was staffed with healthcare providers that are recognized by payers to bill for services. Main Outcome Measures: Outcomes of the study included analysis of the number of patients seen, the ability to obtain reimbursement for the clinical services offered, and changes in A1C and BMI to support the clinical value of pharmacist intervention. Results: A total of 309 patients with diabetes were seen over a 16 month period, including 120 patients who completed the 10 hour diabetes training program. Clinical outcomes showed an improvement in A1C from 9.1 pre enrollment to 7.5 post intervention, and a drop in BMI from 35.7 pre enrollment to 32.4 post intervention. The pharmacy was also able to increase the amount of reimbursement for services provided. Conclusions: The development of a pharmacy based clinic business model inside of a community pharmacy has increased the amount of clinically billed services for the pharmacy. Improvements in clinical outcomes led to an acceptance of the pharmacist as a member of the patient’s care team by patients, local physician’s offices, and third party payers. Funding: This work was supported by the Community Pharmacy Foundation [grant #143 , 2015] Type: Commentary

Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine. A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5-81.2%) and patient education (57.9%; CI 51.2-63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8-62.4%). Most physicians (62.4%; CI 56.8-69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0-39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2-81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2-16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems. The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

A pharmacy's journey toward the patient-centered medical home

To describe the integration of a clinic pharmacy with a patient-centered medical home (PCMH). Primary care clinic in Monroe, WA, from 1981 to January 2011. Pharmacists and physicians with a previous working relationship in a family practice residency program established colocated practices in 1981. In addition to traditional pharmacy services, collaborative practice agreements were developed and clinical pharmacy services expanded over time. Reimbursement challenges for clinical pharmacy services existed in the fee-for-service environment. The acquisition of the clinic and pharmacy by Providence Health and Services created a new financial alignment with additional opportunities for collaboration. An internally funded grant established a PCMH pilot that included pharmacist participation. PCMH pharmacists and the care provider team identified areas to improve physician and clinic efficiencies and to enhance patient care. Clinical pharmacy services expanded under the PCMH model. Pharmacist activities included value-added refill authorization services, coordinated patient visits with the PCMH pharmacist and physicians, medication therapy management, diabetes and anticoagulation services, hospital discharge medication reconciliation, and participation in the shared medical appointment. Clinical pharmacy services are woven into the PCMH fabric of this clinic. New pharmacists will be challenged and rewarded in this evolving health care model.

Perceptions, experiences, and expectations of physicians in hospital settings in Jordan regarding the role of the pharmacist

Background To initiate a collaborative working relationship (CWR) between physicians and pharmacists, current physicians' perceptions, expectations, and experiences with pharmacists should be determined. Objective The purpose of this study was to investigate physicians' perceptions, expectations, and their actual experiences with pharmacists in hospital settings in Jordan. Methods A self-administered questionnaire was delivered to 284 physicians selected randomly from 4 main hospitals in northern Jordan. The questionnaire was composed of 4 parts investigating physicians' expectations, experiences, and perceptions of the pharmacists. Results Two hundred and forty-five questionnaires were completed (response rate, 86.3%). More than half of the physicians were comfortable with pharmacists providing patient education. Similarly, just fewer than half (48.2%) were uncomfortable with pharmacists suggesting the use of prescription medications to patients. Most physicians (62.5%) expect the pharmacist to educate their patients about safe and appropriate use of drugs; however, approximately one third (33.9%) of them do not expect the pharmacist to be available for consultation during rounds. Approximately, 54% of the physicians agreed that pharmacists were always a reliable source of information. Nevertheless, only 28.2% agreed that pharmacists frequently inform them that their patients have experienced some problem with their medications. Conclusions Physicians in hospitals in Jordan were more likely to accept or recognize traditional pharmacy services than newer clinical services. Increasing physician awareness of these clinical pharmacy skills will be an important step in developing CWRs.

Drug Utilization Review in an Extended Care Facility

Clinical pharmacy has expanded the scope of pharmaceutical services and one of the newer areas of involvement is the extended care facility. The author discusses the need, because of a limited budget, for better financial control of drug usage in Lions Gate Hospital's new 170 bed extended care unit. A need for pharmacy involvement in geriatrics because of the rising population of elderly people in extended care facilities and nursing homes and the complexities of using drugs in the elderly is discussed. The new extended care unit was provided with traditional pharmacy services and a pharmacist to participate in a patient review committee. This pharmacist monitored the patients' drug usage and made recommendations to the committee where applicable. The lowered costs of drug therapy in the extended care unit and the more efficacious use of certain medications are discussed in terms of pharmacy involvement. The author concludes that the pharmacist can make a significant contribution to the more economical use of drugs in extended care facilities and has a potential valuable role in improving patient care in this area.

Provision of pharmacy services in community health centers and migrant health centers.

To assess the frequency with which pharmacy services are provided in community health centers (CHCs) and migrant health centers (MHCs), the importance of these services in these settings, and pharmacists' preparedness to provide these services and to determine whether pharmacist- and site-specific characteristics are related to the provision of pharmacy services. A self-administered mail survey was used to collect information on the provision of traditional pharmacy services and on the provision of pharmaceutical care services in four domains: collecting, organizing, and evaluating information; formulating a course of action; providing medications and counseling patients; and monitoring and managing patient outcomes. Data were also gathered on pharmacist- and site-specific characteristics. Descriptive and inferential statistics were calculated. Surveys were mailed to a sample of 1,260 contact persons (medical/executive directors and pharmacists). Pharmacist-reported frequency of the provision of pharmacy services, respondents' perceptions regarding the importance of the provision of pharmacy services, and respondents' perceived level of preparedness to provide pharmacy services. Pharmacists in CHCs and MHCs provided traditional services very often, felt that the services were important, and felt very prepared to provide the services. Although frequency and perceived importance and preparedness varied across and within the four pharmaceutical care domains, pharmacists most often reported collecting, organizing, and evaluating information and providing medications and counseling patients. Least often reported was formulating a course of action, followed by monitoring and managing patient outcomes. Similarly, pharmacists felt least prepared to provide these services. Pharmacists who had received additional education and training reported that they provided pharmacy services significantly more often (P < .05) and felt significantly more prepared to provide the services. Additional pharmacy-related education and training may be helpful in preparing pharmacists in CHCs and MHCs to increase their provision of pharmaceutical care services.

A Comparison of Satisfaction with Mail versus Traditional Pharmacy Services

OBJECTIVE: To determine the level of satisfaction with pharmacy services among enrollees of a managed care organization and to compare the level of satisfaction between mail pharmacy and traditional pharmacy patrons. DESIGN: Data were collected via telephone interviews with 1,362 enrollees of a large managed care organization with recent prescription claims. Scores were calculated for various hypothesized multi-item dimensions of satisfaction of pharmacy services. With one exception, internal-consistency reliability coefficients for the scales exceeded 0.50. Health status was also measured, using the physical and mental health composite scores of the 12-ltem Short Form (SF-12) Health Survey. Satisfaction with pharmacy services was compared between patron groups using tests and analysis of covariance (AN COVA) models. RESULTS: Mail pharmacy patrons were more satisfied than traditional pharmacy patrons with their pharmacy services in general (77.6 vs. 72.8, P=0.002), and specifically with the financial aspects and technical quality of those services. After adjusting for general satisfaction with medical care, health status, and select demographic variables, mail pharmacy patrons still had greater levels of general satisfaction with pharmacy services (P=0.036). Respondents with depressive symptoms were less satisfied with aspects of traditional pharmacy services than with mail services, and subjects with airway disease were less satisfied with the turnaround time for mailed prescriptions than for traditional services. CONCLUSION: The difference in satisfaction between the patron groups was not large and may not be of practical significance. However, variations in observed satisfaction scores between respondents with and without specific comorbid conditions may be useful from a policy and planning perspective.

Impact of a clinical pharmacist's emphasis on patient communication on the patient's attitude toward pharmacy.

This study sought to determine if the provision of a clinical pharmacist with increased patient communication to a given population would result in that population having a subsequent improvement in its attitude toward pharmacy. A before and after experimental-control group (pretest-posttest) research design with randomization was employed. Questionnaires were mailed to 200 families in the control and experimental rural towns the day the model practice with increased patient communication opened. Identical questionnaires were again mailed to pretest respondents after the practice had been in operation for approximately one- and two-year periods. Analysis of covariance revealed that consumers in the town exposed to increased patient communication experienced an improvement in attitude toward pharmacy which was significantly greater than that experienced by consumers in the control town which retained traditional pharmacy services during the same time period. The final posttest measurement indicated that consumers in the experimental town had an attitude level significantly higher than consumers in the control town. Relatively strong support is given to the hypothesis that increased patient communication about drug therapy can result in improved consumer attitudes toward pharmacy.

Cost Comparison of Decentralized Unit Dose and Traditional Pharmacy Services in a 600-bed Community Hospital

Cost Comparison of Decentralized Unit Dose and Traditional Pharmacy Services in a 600-bed Community Hospital