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

Comparing South Dakota Pharmacist Perspectives of Pharmacy Services in Rural versus Urban settings

Background

Access to healthcare services is a major barrier to residents of the rural state of South Dakota. As a highly accessible member of the healthcare team, outpatient pharmacists can play a key role in a patient's healthcare journey. There is a need to identify the unique barriers and facilitators pharmacists in both rural and urban areas face to maximize the impact of their role.

Objective

The objective of this work was to compare perceptions of rural and urban pharmacists regarding the facilitators and barriers to providing patient care in South Dakota.

Methods

This qualitative project highlights results from interviews and focus group sessions with a convenience sample of South Dakota pharmacists. Participants were recruited using a referral word-of-mouth system, contracts with healthcare market research agencies, newspaper advertisements, and posters displayed in public locations in South Dakota. Practice location was characterized as rural or urban based on United States Department of Agriculture definitions. Findings from interviews and focus group sessions were coded and analyzed using content analysis by two student researchers.

Results

Participants included 12 rural-practicing and 21 urban-practicing pharmacists in South Dakota. In both rural and urban areas, key barriers included communication with providers (50% rural; 50% urban), lack of electronic health record access (25% rural; 14% urban), not enough staff (22% rural; 20% urban), and patient misunderstanding the scope of pharmacy (22% rural; 40% urban). Barriers specific to rural areas included time to provide services (22%), having smaller facilities (27%) and provider hesitation regarding collaborative practice agreements (29%). There were no urban-specific barriers. Facilitators specific to urban areas included frequent communication with patients (6.1%) and good quality support staff (9.1%). There were no rural-specific facilitators.

Conclusions

Next steps include increasing awareness of pharmacy-based patient care services, researching further to identify the extent to which facilitators and barriers influence the ability to initiate and sustain pharmacy services in rural and urban areas, and providing support to pharmacies to overcome barriers and leverage facilitators.

Could pharmacy technicians play a role in supporting the appropriate and safe use of traditional and complementary medicines?

Across the world traditional and complementary medicine (T&CM) product use is prevalent with some countries reporting greater than 50% of the population using these products. T&CM products are primarily self-selected through retail outlets including pharmacies. Pharmacists across the world generally agree they should play a role in ensuring the appropriate and safe use of T&CM products but report being time and resource poor to do so. In this commentary, it is proposed that pharmacy technicians as members of the pharmacy workforce, who with adequate education, and supportive technologies could support pharmacists in providing guidance to consumers and patients about the appropriate and safe use of T&CM products. Pharmacy technicians play a crucial role in the pharmacy workforce, serving as integral members of healthcare teams fulfilling a wide array of tasks essential for the efficient functioning of pharmacies and ensuring the safe dispensation of medications. They have been described by pharmacists as the "the face of the pharmacy" in the community setting and relied on not only for mitigating and triaging problems, but also be primarily responsible for developing rapport, eliciting trust and even loyalty from pharmacy patrons. As such, there is a momentous opportunity for pharmacy technicians to play a role in providing T&CM advice and triaging the need for pharmacists' intervention where harm, or risk of is identified.

Pharmacists' perceptions of pharmacy technician occupational values

Background

Pharmacy technician scope of practice has expanded in recent years to attempt to alleviate the responsibility burden placed on pharmacists in some states. However, little research has examined the ways in which pharmacists attempt to persuade technicians to take on additional roles. Management literature has identified the importance of understanding employee values in crafting persuasive role expansion messaging. Objectives: Identify the occupational values which pharmacists believe are the most important to pharmacy technicians when attempting to craft messages aimed at increasing technician involvement in advanced roles.

Methods

Semi-structured interviews were conducted with pharmacists across multiple practice settings to identify how important they believe nine selected occupational values are to pharmacy technicians. Average scores for each of the nine values were calculated and examined to identify potential differences between the two overarching types of occupational values: intrinsic and extrinsic.

Results

Pharmacists indicated that they believed that technicians are more extrinsically motivated than intrinsically motivated. Pharmacists believed that technicians had higher levels of extrinsic occupational values as opposed to intrinsic occupational values (3.920 vs. 3.113). The most important values to technicians as perceived by pharmacists were the income of the job and the hours of the jobs (average score of 4.85 and 4.75, respectively). The chance to be helpful to others and society was the only intrinsic value with an average score >3.5. Additionally, pharmacists indicated that technicians were not properly compensated for their work, which furthered illustrated the perceived importance of extrinsic motivators. Finally, when it came to crafting messaging around role expansion, pharmacists believed it was important to tailor their messaging to the technician they were speaking to.

Conclusion

Pharmacists looking to craft role expansion messaging to their technicians are more likely to utilize extrinsic occupational values as motivators instead of using intrinsic values.

Organizational Readiness to Implement Community Pharmacy-Based Opioid Counseling and Naloxone Services: A Scoping Review of Current Practice Models and Opportunities

The purpose of this study was to explore existing practice models and opportunities surrounding community pharmacist-delivered opioid counseling and naloxone (OCN) services in the U.S., with the goal of enhancing organizational readiness and improving patient access. A scoping literature review was conducted. English-language articles published in peer-reviewed journals from January 2012-July 2022 were sought via PubMed, CINAHL, IPA, and Google Scholar using permutations of terms such as "pharmacist/pharmacy", "opioid/opiate", "naloxone", "counseling", and "implement/implementation". Original articles reporting the resources/inputs (personnel; pharmacist full-time equivalents; facilities and expenses; in-house versus outsourced personnel), implementation processes (legal source of pharmacist authority; patient identification strategies; intervention procedures; workflow strategies; business operations), and programmatic outcomes (uptake and delivery; interventions made; economic impact; patient or provider satisfaction) of pharmacist-delivered OCN services in community (retail) settings were retained. Twelve articles describing ten unique studies were included. The studies primarily used quasi-experimental designs and were published from 2017 to 2021. The articles described seven broad program elements/themes: interprofessional collaboration (n = 2); patient education format including one-on-one patient education (n = 12) and group education sessions (n = 1); non-pharmacist provider education (n = 2); pharmacy staff education (n = 8); opioid misuse screening tools (n = 7); naloxone recommendation/dispensing (n = 12); and opioid therapy and pain management (n = 1). Pharmacists screened/counseled 11-2716 patients and provided 11-430 doses of naloxone. Limited implementation costs, patient/provider satisfaction, or economic impact measures were reported. This review may serve as a guide for community pharmacists in implementing OCN services in their own practices. Future studies should clarify OCN program implementation costs, patient/provider satisfaction, and the economic impact.

Pharmacy Technician Efficacies and Workforce Planning: A Consensus Building Study on Expanded Pharmacy Technician Roles

The expansion of pharmacy technician scope of practice in recent years, though remaining somewhat contentious, has afforded multiple opportunities for pharmacy technicians to provide additional assistance within the pharmacy. However, much of the research examining this growth has focused on specific tasks, which were determined by either the researchers themselves or the respective state boards of pharmacy. This study aimed to gain a better understanding of what expanded tasks pharmacists believe technicians should have an increased role in performing. A consensus-building research methodology was used to survey practicing pharmacists to determine which tasks those pharmacists believed technicians should take an increased role in performing. This study used modified Delphi techniques to build consensus among panels of both hospital and community pharmacists regarding 20 setting-specific technician tasks. Results of our study indicated that both hospital and community pharmacists believed technicians should have an increased involvement in performing tasks which are more related to the operations of the pharmacy rather than tasks which are more clinical in nature. This finding illustrates a belief among a segment of pharmacists that expanded roles for technicians should do more to alleviate the managerial and operational burden placed on pharmacists, potentially allowing pharmacists to take on increased clinical roles.

Role of community pharmacy professionals in child health service provision in Ethiopia: a cross-sectional survey in six cities of Amhara regional state

BACKGROUND

Community pharmacy professionals have great potential to deliver various public health services aimed at improving service access, particularly in countries with a shortage of health professionals. However, little is known about their involvement in child health service provision in Ethiopia.

OBJECTIVE

The purpose of this study was to evaluate the level of involvement of community pharmacy professionals in child health service provision within Ethiopia.

METHODS

A multi-center cross-sectional survey was conducted among 238 community pharmacy professionals from March to July 2020 in Amhara regional state of Ethiopia. Independent samples t-test and one way Analysis of Variance (ANOVA) was used to test the mean difference.

RESULTS

Most community pharmacy professionals were 'involved' in providing child health services related to 'advice about vitamins/supplements' (46.6%), 'advice about infant milk/formulas' (47.1%) and 'responding to minor symptoms' (50.8%) for children. The survey revealed that, community pharmacy professionals were less frequently involved in providing childhood 'vaccination' services. Further, level of involvement of community pharmacy professionals differed according to participants' licensure level, setting type, responsibility in the facility and previous training experience in child health services.

CONCLUSION

Community pharmacy professionals have been delivering various levels of child health services, demonstrating ability and capacity in improving access to child health services in Ethiopia. However, there is a need for training and government support to optimize pharmacist engagement and contribution to service delivery.

The Tennessee Medicaid medication therapy management program: early stage contextual factors and implementation outcomes

BACKGROUND

First investigated in the 1990s, medication therapy management (MTM) is an evidence-based practice offered by pharmacists to ensure a patient's medication regimen is individualized to include the safest and most effective medications. MTM has been shown to a) improve quality of patient care, b) reduces health care costs, and c) lead to fewer medication-related adverse effects. However, there has been limited testing of evidence-based, a-priori implementation strategies that support MTM implementation on a large scale.

METHODS

The study has two objectives assessed at the organizational and individual level: 1) to determine the adoption, feasibility, acceptability and appropriateness of a multi-faceted implementation strategy to support the MTM pilot program in Tennessee; and 2) to report on the contextual factors associated with program implementation based on the Consolidated Framework for Implementation Research (CFIR). The overall design of the study was a hybrid type 2 effectiveness-implementation study reporting outcomes of Tennessee state Medicaid's (TennCare) MTM Pilot program. This paper presents early stage implementation outcomes (e.g., adoption, feasibility, acceptability, appropriateness) and explores implementation barriers and facilitators using the CFIR. The study was assessed at the (a) organizational and (b) individual level. A mixed-methods approach was used including surveys, claims data, and semi-structured interviews. Interview data underwent initial, rapid qualitative analysis to provide real time feedback to TennCare leadership on project barriers and facilitators.

RESULTS

The total reach of the program from July 2018 through June 2020 was 2033 MTM sessions provided by 17 Medicaid credentialed pharmacists. Preliminary findings suggest participants agreed that MTM was acceptable (μ = 16.22, SD = 0.28), appropriate (μ = 15.33, SD = 0.03), and feasible (μ = 14.72, SD = 0.46). Each of the scales had an excellent level of internal (> 0.70) consistency (feasibility, α = 0.91; acceptability, α = 0.96; appropriateness, α = 0.98;). Eight program participants were interviewed and were mapped to the following CFIR constructs: Process, Characteristics of Individuals, Intervention Characteristics, and Inner Setting. Rapid data analysis of the contextual inquiry allowed TennCare to alter initial implementation strategies during project rollout.

CONCLUSION

The early stage implementation of a multi-faceted implementation strategy to support delivery of Tennessee Medicaid's MTM program was found to be well accepted and appropriate across multiple stakeholders including providers, administrators, and pharmacists. However, as the early stage of implementation progressed, barriers related to relative priority, characteristics of the intervention (e.g., complexity), and workflow impeded adoption. Programmatic changes to the MTM Pilot based on early stage contextual analysis and implementation outcomes had a positive impact on adoption.

Identifying key roles of the pharmacy technician in primary care settings

DISCLAIMER

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

PURPOSE

As the pharmacist's role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist's professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature.

METHODS

The duties of primary care pharmacist technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians.

RESULTS

Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects.

CONCLUSION

Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

Positive deviants for medication therapy management: A mixed-methods comparative case study of community pharmacy practices

BACKGROUND

To optimize medication use in older adults, the Centers for Medicare & Medicaid Services (CMS) launched Medication Therapy Management (MTM) services as part of Medicare Part D policy; however, strategies for achieving high quality MTM outcomes are not well understood.

OBJECTIVE

The objective of this study was to generate hypotheses for strategies contributing to community pharmacies' high performance on policy-relevant MTM quality measures.

METHODS

This mixed-methods comparative case study was guided by the Positive Deviance approach and Chronic Care Model. The study population consisted of pharmacy staff employed by a Midwestern division of a national supermarket-community pharmacy chain. Data consisted of demographics and qualitative data from semi-structured interviews. Qualitative and quantitative data were analyzed deductively and inductively or using descriptive statistics, respectively. MTM quality measures used to evaluate participant pharmacies' MTM performance mirrored select 2017 Medicare Part D Plans' Star Rating measures.

RESULTS

Thirteen of 18 selected case pharmacies (72.2%) participated in this study, of which 5 were categorized as high performers, 4 moderate performers, and 4 low performers. Eleven pharmacists, 11 technicians, and 3 student interns participated in interviews. Eight strategies were hypothesized as contributing to MTM performance: Strong pharmacy staff-provider relationships and trust, Inability to address patients' social determinants of health (negatively contributing), Technician involvement in MTM, Providing comprehensive medication reviews in person vs. phone alone, Placing high priority on MTM, Using available clinical information systems to identify eligible patients, Technicians using clinical information systems to collect/document information for pharmacists, Faxing prescribers adherence medication therapy problems (MTPs) and calling on indication MTPs.

CONCLUSIONS

Eight strategies were hypothesized as contributing to community pharmacies' performance on MTM quality measures. Findings from this work can inform MTM practice and Medicare Part D MTM policy changes to positively influence patient outcomes. Future research should test hypotheses in a larger representative sample of pharmacies.

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

OBJECTIVE

To identify facilitators and barriers of early implementation of a technician product verification (TPV) program in a large community pharmacy chain.

METHODS

A mixed-methods (surveys, semistructured interviews, and nondisguised direct observation) approach was used to ascertain facilitators and barriers to implementation and to subsequently develop a scalable implementation strategy with the aim to accelerate TPV scalability across a large community pharmacy chain in states where it is permitted. One-on-one staff interviews and observations provided qualitative data to identify facilitators and barriers to TPV. A Web-based survey was used to gather perceptions on a variety of implementation strategies that would make use of identified facilitators and work to overcome identified barriers.

RESULTS

During the mixed-method study, 3 key themes emerged: TPV is a complex intervention whose implementation is facilitated by both adaptability and trialability and is highly dependent on state practice regulations; the implementation climate of the pharmacy organization serves as a facilitator to TPV; and individual beliefs about TPV change over time as implementation experience increases.

CONCLUSION

TPV is an expansion of the technician role that allows the profession of pharmacy to increase the provision of clinical activities by delegation of a nonclinical-based task. Early adopters of TPV recognize that verification is a task that is increasingly automated by mail-order pharmacies and that verification may no longer be considered a pharmacist task. Pharmacies in this study tended to revert to comfortable, traditional workflow at the first sign of distress. To be successful in the future, TPV should be thought of as the primary workflow procedure and not as an option. TPV is a service that will require staff buy-in, patience, and championship.

Community chain pharmacists' perceptions of increased technicians' involvement in the immunization process

BACKGROUND

Over the past 2 decades, pharmacists have positioned immunization services as an important aspect of their expanding role in patient care.

OBJECTIVES

To examine how community chain pharmacists view time spent on immunization, available in-store resources and barriers, and pharmacy technician involvement in the context of their views about the achievement of key National Vaccine Advisory Committee (NVAC) Standards of Adult Immunization Practice in their workplace.

METHODS

A representative, nationwide survey was administered electronically to chain community pharmacists over a 4-week period. Community pharmacists offering year-round immunization in retail chain, supermarket, and mass-merchant settings, randomly sampled from a database maintained by the American Pharmacists Association. We examined several sets of interrelated relationships regarding pharmacists' perceived achievement of 3 key NVAC standards (assessment, recommendation and administration), time spent on the overall immunization process, the effectiveness of available in-store resources, immunization impediments, and the endorsement of increased technician involvement in community pharmacy-based immunization service (PBIS) delivery.

RESULTS

A sample of 590 survey responses was obtained from 9717 e-mails delivered, with 489 deemed eligible (5% response rate). Sizeable numbers of pharmacists acknowledged that several activities integral to achieving optimal immunization levels were not being addressed. Although pharmacists accepted that appropriately trained pharmacy technicians should be able to ask (77%) and assess (66%) patients, only 24% agreed that technicians should be able to administer vaccine doses. Pharmacists satisfied with in-store immunization resources and technicians' involvement were more likely to report achieving the 3 key NVAC standards. Paradoxically, how pharmacists viewed their immunization time expenditures was unrelated to whether they agreed that pharmacy technicians should have an expanded role in asking, assessing, or administering vaccines to their patients.

CONCLUSION

Overall, community pharmacies would likely better meet national immunization goals by achieving all 3 key NVAC standards and incorporating expanded roles for appropriately trained and supervised technicians in PBIS.

Community pharmacist perceptions of increased technician responsibility

BACKGROUND

Pharmacists have struggled to find time to spend on clinical tasks. As such, regulatory steps have been taken by some states to expand the scope of practice for community pharmacy technicians.

OBJECTIVE

The objective of this study was to determine what settings and characteristics predict pharmacists' comfort levels with technicians giving or receiving verbal prescriptions, performing nonclinical medication therapy management tasks, administering vaccinations, and verifying prescriptions.

METHODS

This study employed a national Internet-based survey of community pharmacists using a health care marketing research panel. The Consolidated Framework for Implementation Research (CFIR) was used as a theoretical basis for inquiry, particularly the CFIR domains of "outer setting," "inner setting," and "individual characteristics." As the outcome variable of this study, the respondents were asked to report their comfort levels with technicians performing the 4 advanced tasks. Four multivariable linear regression models identified statistically significant predictors of pharmacists' comfort with each task. Repeated measures analysis of variance (ANOVA) was used to compare the pharmacists' comfort levels among tasks.

RESULTS

For all 4 tasks, pharmacists who believed that technicians had the ability to complete each task were more comfortable with technicians completing those tasks. In addition, pharmacists with perceptions of stronger technician interest in advanced tasks were found to be more comfortable with technicians taking on more responsibility for all tasks except vaccine administration. Repeated measures ANOVA found that pharmacists' comfort levels differed on all 4 tasks.

CONCLUSION

This study found that the CFIR domains of inner setting (pharmacy location) and individual characteristics (perceptions of technicians and pharmacist education) affect pharmacists' level of comfort with technicians taking on additional responsibilities, but outer setting variables such as regulations do not. This suggests that pharmacist characteristics may affect the expansion of technician task responsibilities, no matter what state regulations allow.

The influence of intervention complexity on barriers and facilitators in the implementation of professional pharmacy services - A systematic review

BACKGROUND

Community pharmacies increasingly offer professional pharmacy services, whose implementation is often influenced by facilitating or obstructive implementation factors. The occurrence and composition of implementation factors vary among different services with discrete characteristics and complexity of the intervention, making it difficult to foresee potential barriers in implementation.

OBJECTIVE(S)

This paper investigates potential associations between intervention complexity and occurring implementation factors.

METHODS

A systematic literature search on the implementation factors and intervention complexity of professional pharmacy services in the community setting was carried out in electronic databases (PubMed, CINAHL, and PsycINFO) throughout December 2018. Implementation factors were extracted from semi-structured interviews, focus groups, and surveys with community pharmacists and categorized using the Consolidated Framework for Implementation Research (CFIR). The complexity of each service was assessed using the following complexity parameters: (I) number of involved healthcare professions, (II) number of service components such as recruiting of patients, screening intervention, and follow-up, (III) frequency of the service, (IV) expenditure of time per patient (encounter), and (V) workflow distortion, i.e. booking appointments for intervention with the patient. Finally, the association between implementation factors and intervention complexity was analyzed by quantifying implementation factors and by relating them to specific intervention characteristics using Fisher's exact test.

RESULTS

15 studies covering a broad spectrum of professional pharmacy services were included. There was a trend that in services with higher complexity more implementation factors occurred (p = 0.094). Single key complexity parameters can trigger specific implementation factors. For instance, general practitioner and pharmacy technician involvement were significantly associated with interprofessional communication and leadership engagement, respectively.

CONCLUSION

Key implementation factors and associated complexity parameters seem to be of similar or more importance than the total number of implementation factors with regard to successful implementation. By assessing various complexity parameters of an intervention, potential key barriers could be identified and subsequently addressed prior to implementation.

The need to prioritize "prioritization" in clinical pharmacy service practice and implementation

Pharmacists are increasingly asked to incorporate new and greater amounts of clinical services into their traditional medication distribution responsibilities, but many barriers exist. Given the demanding pharmacy practice environment, improved time management may improve implementation rates. One area not previously explored within this area is the clinical skill of "prioritization" of medication related problems (MRPs). Prioritization is vital as the workload demand for pharmacist time exceeds time available; however, the underdeveloped skills of prioritizing is a concern in the field of pharmacy practice, as it also is across professions in healthcare. Previous research has suggested that pharmacists and student pharmacists inexperienced in implementing clinical services struggle knowing where to begin when providing direct patient care, given the complex patient care regimens, a complex pharmacy practice workload, and the numerous preventative care interventions possible for a given patient. This paper provides a review of theory and science of prioritization in patient care service delivery, including Multicriteria Decision Analysis (MCDA), Lean Six Sigma (LSS), and Jaen's Competing Demands framework. A case study is shared which emphasizes both the need for and potential impact of a renewed focus on workload management skills, such as prioritization.

Perceived Benefit of Immunization-Trained Technicians in the Pharmacy Workflow

Clinical community pharmacists have continually restructured their workflow to serve the community by optimizing patient care outcomes. Defining the perceived benefits of having an immunizing pharmacy technician in the workflow can help to redefine the way community pharmacists operate during patient immunization. The purpose of this study is to share the opinions of supervising pharmacists that have an immunizing technician within their workflow model and highlight their contributions. Pharmacists involved in this novel workflow model were interviewed two times, once in 2017 and then in 2020, to gauge opinions over time. Findings in the results of this study included such themes as: (1) Pharmacists’ perceived improvement in workflow flexibility; (2) The choice of the correct technician to immunize within the pharmacy; (3) Pharmacists’ perceived improved workflow time prioritization; (4) Limited available training as a barrier to implementation; and (5) The initial apprehension and later acceptance of pharmacists with respect to the innovation. As technician immunization administration spreads beyond early adopter states, further research into the impact on pharmacy workflow is needed.

Medication Therapy Management: Current Challenges

Medication therapy management (MTM) services have evolved as a means for pharmacists and other providers to assist patients and caregivers in improving therapeutic outcomes and reducing health care expenditures. More than a decade has passed since the Medicare Modernization Act of 2003 provided pharmacists with the opportunity to deliver MTM services to Medicare beneficiaries. MTM continues to offer pharmacists the opportunity to use their knowledge; yet, pharmacists have reported challenges with service delivery. Identifying the challenges that affect MTM services in pharmacy practice is necessary in order to seek improvement to MTM delivery. This narrative review explores the current challenges pharmacists face with MTM delivery, summarizes potential solutions for addressing challenges, and seeks to incite further debate, service reconfiguration, and ultimately service improvement of pharmacist-provided MTM services.

Evaluating advanced pharmacy technician roles in the provision of point-of-care testing

OBJECTIVES

Assess the impact of pharmacy technician-supported point-of-care testing (POCT), including sample collection, on the number of cholesterol screenings performed in a community pharmacy setting. Secondary objectives include assessment of provider perceptions and patient satisfaction of POCT when executed by a technician.

PRACTICE DESCRIPTION

Thirty-two community pharmacies in 1 regional division of a large community pharmacy chain in Tennessee; 16 participated in a certified pharmacy technician (CPhT) training program, and 16 did not.

PRACTICE INNOVATION

CPhTs supported POCT service delivery limited to the nonprofessional, technical tasks (e.g., sample collection, quality assurance).

EVALUATION

The primary objective was evaluated by comparing the total number of screenings for control and intervention sites. Descriptive and inferential statistics were used. Both secondary measures were assessed via anonymous, Likert-type scale questionnaires.

RESULTS

Intervention pharmacies performed 358 screenings, whereas control pharmacies performed 255 screenings (16.8% difference). The patient perception survey found that 94% (149 of 159) of those who received screening with CPhT involvement agreed or strongly agreed that the service was valuable, and 70% (111 of 159) reported that they are likely to follow up with their primary care providers to discuss the results. Furthermore, most patients were in agreement that they were overall satisfied with the screening services provided by the CPhT (94%, 149 of 159), and the CPhT was professional while performing the screening (95%, 151 of 159). The provider perceptions survey on service implementation found that most pharmacy personnel agreed or strongly agreed that CPhTs performing POCT was feasible, appropriate, and acceptable.

CONCLUSION

This study provided preliminary data that technician-supported POCT may positively impact the number of screenings provided. In addition, provider perceptions were positive, and patients felt satisfied with the studied technician model.

Pharmacists ascribing value of technician certification using an organizational behavior framework

PURPOSE

To gather rich details about the value of technician certification from diverse groups of pharmacists of various practice settings and levels of experience.

METHODS

Focus groups of pharmacists were conducted using a semistructured interview guide in 4 states (California, Idaho, Tennessee, and Washington) varying in pharmacy technician scope of practice, regulation, and education and/or training environment. Participant pharmacists came from health-system, clinic, and community pharmacy environments. The focus groups took the unique approach of an organizational behavior perspective to contextualize technician readiness for practice change and employer fit. The sessions were audio-recorded and transcribed verbatim. Rapid-based qualitative analysis was used to code the data, with summary templates completed by 2 of the researchers for each of the 4 sessions.

RESULTS

There were a total of 33 focus group participants, including 13 male and 20 female pharmacists ranging in age from 27 to 68 years. The 4 major themes yielded by the data were (1) impact of certification, (2) context of certification, (3) organizational culture considerations, and (4) future credentialing. Certification was deemed to have a greater impact on technician maturation, professional socialization, and career commitment than on actual job skills, even while job knowledge was also deemed to be enhanced. In fact, the certification process was also deemed beneficial in that it meshes with on-the-job training. Participants indicated preferences for technician certification examinations to incorporate more content in "soft skills" and also for development of more specialty and/or differentiated certification products.

CONCLUSION

Pharmacists from 4 states saw value in certification but agreed that certification is but one component of readying technicians for future practice. Suggestions for furthering the value of certification were shared.

Exploring Pharmacy Technician Roles in the Implementation of an Appointment-Based Medication Synchronization Program

The objective of this study was to qualitatively explore the role of pharmacy technicians in the implementation of an appointment-based model (ABM) medication synchronization program. The purposeful sampling of technicians working within six different locations of a supermarket chain pharmacy in Mississippi and Tennessee was carried out, and the technicians were interviewed between January and April 2018. A semi-structured interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR). Questions gathered information around pharmacy technician demographics and CFIR domains (process, inner setting, outer setting and intervention characteristics). Interviews were audiotaped and transcribed. Two members of the research team performed thematic content analysis. Six full-time, certified pharmacy technicians with 8.3 ± 2.7 years of experience were interviewed. Findings suggest that including hands-on experience with program software is needed during training to successfully implement ABM. A barrier to implementation was the time needed to complete ABM tasks as compared to other tasks. Although some barriers exist regarding implementation, technicians believe that overall, this program has positive benefits for patients. Results from this study signify that ABM implementation can be challenging. Better ABM portal integration with the pharmacy patient profile and appropriate workforce budgeting are key to continued success.

Care coordination and follow-up practices in the community pharmacy setting: A mixed methods study

OBJECTIVES

This mixed methods study had 2 aims: (1) to describe the frequency of care coordination between pharmacists, prescribers, and care managers and (2) to identify pharmacists' strategies for care coordination and follow-up in a community pharmacy setting.

DESIGN

This study used a mixed methods design.

SETTING AND PARTICIPANTS

Pharmacists who were responsible for implementing North Carolina community pharmacy enhanced services network (NC CPESN®) activities in their pharmacy during the first or second year of the 3-year program (September 2014-August 2016).

OUTCOME MEASURES

A survey was administered to gather data on care coordination in community pharmacies and for follow-up. In-depth interviews were conducted to expand on the findings from the quantitative data. Descriptive statistics were calculated for survey data. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

RESULTS

Surveys were received from 101 pharmacies (82.1% response rate). Fourteen pharmacies with missing responses were removed, resulting in 87 pharmacies being included in the analysis. The majority of pharmacies were single, independent pharmacies (46.5%), and approximately one-third of pharmacies had a clinical pharmacist on the staff (31.1%). To communicate with prescribers, pharmacists most frequently used facsimile (fax) (82.1%) or phone (65.5%). A total of 12 pharmacists participated in the semistructured interviews. Pharmacists defined care coordination as interdisciplinary collaboration and communication among the members of the health care team to provide the best possible patient-centered care. All pharmacists agreed that good health care provider (i.e., care manager and prescriber) relationships are crucial to the success of patient care; however, participants mentioned that building these relationships has been or is currently difficult to establish.

CONCLUSION

Care coordination among pharmacists, prescribers, and care managers is important for improving patients' medication management and overall outcomes. To our knowledge, this is the first study to quantify care coordination between pharmacists, prescribers, and care managers and to identify strategies to facilitate care coordination. Results from this study have the potential to inform how care coordination and longitudinal follow-up are best implemented within the community pharmacy setting.

Revisiting the Role of Physicians in Assisted Living and Residential Care Settings

As the United States population ages, a higher share of adults is likely to use long-term services and supports. This change increases physicians' need for information about assisted living and residential care (AL/RC) settings, which provide supportive care and housing to older adults. Unlike skilled nursing facilities, states regulate AL/RC settings through varying licensure requirements enforced by state agencies, resulting in differences in the availability of medical and nursing services. Where some settings provide limited skilled nursing care, in others, residents rely on resident care coordinators, or their own physicians to oversee chronic conditions, medications, and treatments. The following narrative review describes key processes of care where physicians may interact with AL/RC operators, staff, and residents, including care planning, managing Alzheimer's disease and related conditions, medication management, and end-of-life planning. Communication and collaboration between physicians and AL/RC operators are a crucial component of care management.

Exploring employer perceptions of pharmacy technician certification in the community pharmacy setting

BACKGROUND

With the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers.

OBJECTIVES

The aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs).

METHODS

Using a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory.

RESULTS

Employers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management).

CONCLUSIONS

New emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification.

Implementation process for comprehensive medication review in the community pharmacy setting

OBJECTIVES

To (1) describe the implementation process for comprehensive medication reviews (CMRs) among community pharmacies (e.g., processes for prioritizing patients, staffing, and information collection) and (2) examine factors associated with community pharmacies' CMR information collection process.

METHODS

A survey was administered to the pharmacist responsible for implementation of CMRs (i.e., the lead pharmacist) in the community pharmacy (n = 87). The survey included questions about pharmacy characteristics, satisfaction with the NC community pharmacy enhanced services network (NC-CPESN) program, and implementation of CMRs. Frequencies and means were calculated to describe the sample characteristics and pharmacies' CMR implementation process. A multiple linear regression was conducted to examine which characteristics were associated with the CMR information collection process.

RESULTS

The majority of pharmacies in the sample were either independently owned single stores (46.5%) or multiple stores under the same independent ownership (41.6%). Most pharmacies used pharmacists (97.7%) or pharmacy technicians (65.5%) for patient outreach for CMRs. A small percentage of pharmacies used administrative staff to conduct patient outreach for CMRs (9.2%). Information for prescription medications (89.5%), indication (80%), and medication adherence (81.1%) was routinely collected. Information such as date of last dose for prescription medications (48.4%) and lifestyle factors, such as physical activity (21.1%), diet (29.5%), and alcohol (31.6%), was collected less routinely. Having a clinical pharmacist (P = 0.025) and pharmacist overlap hours (P = 0.009) significantly improved the CMR information collection process.

CONCLUSION

Although CMRs are important interventions for improving patient outcomes, more guidance is needed on how to effectively implement them. This would allow the process to be efficient and assure implementation with fidelity across all community pharmacies. In addition, staffing appears to influence the quality of CMR information collection. Future research is warranted on CMR implementation to develop efficient staffing models and standardize the process of information collection.