Reimbursement for pharmacist-provided health care services: A multistate review

Strategies to Improve Access to Care for Patients With Opioid Use Disorder

Treatment of opioid use disorder (OUD) faces several challenges, including restricted access to medications, geographical and logistical barriers, and variability in treatment availability across different communities. This article outlines several strategies aimed at improving access to medications. Pharmacy-based care could potentially extend access to medications but would require regulatory changes to empower pharmacists. In addition, telemedicine has shown promise in improving access by mitigating geographic and transportation barriers. Mobile health clinics also offer a direct approach to delivering medication-based treatments to underserved communities. Furthermore, integrating OUD treatment into primary care settings could facilitate early detection and treatment. Policy changes have increased access to take-home medications and buprenorphine initiation at home. Community engagement would be crucial for tackling the social determinants of health to offer equitable care for patients. The implementation of these strategies has the potential to significantly enhance the accessibility and delivery of effective, timely and equitable treatment to patients with OUD.

The role of community pharmacists in point-of-care testing and treatment for influenza and Group A Streptococcus -a narrative review using Ecological Systems Theory

BACKGROUND

Point-of-care testing (POCT) is a valuable diagnostic approach for identifying pathogens such as Group A Streptococcus (GAS) and influenza. Early detection through POCT allows for timely initiation of appropriate treatments improving public health outcomes and minimizing antibiotic misuse. Community pharmacists are well positioned to offer POCT and treatment, but they face significant system level barriers to widespread implementation and reach.

METHODS

This narrative review employs Ecological Systems Theory to examine the role of community pharmacists in the implementation of POCT and subsequent treatment for respiratory infections and synthesize findings from a range of studies at different levels of the system. Medline was used to identify articles with MESH headings of rapid diagnostic tests and community pharmacists. Articles were reviewed and used to inform the synthesis. Additional articles were identified using free-text search to fill gaps in the domains.

RESULTS

The review indicates that community pharmacists are well-positioned to provide POCT for respiratory infections, addressing barriers such as appointment availability, scheduling difficulties, and distance to primary care facilities. The accessibility of neighborhood pharmacies can significantly reduce health disparities by offering timely testing and treatment options. Studies demonstrate that early intervention facilitated by POCT in pharmacies leads to better health outcomes and more efficient use of antibiotics and antivirals.

CONCLUSIONS

Community pharmacists play a crucial role in expanding access to POCT and treatment for respiratory infections, particularly in underserved areas. Their involvement can lead to improved public health outcomes by ensuring early and appropriate treatment. Future research should focus on overcoming barriers to POCT implementation in pharmacies and further quantifying the impact on health disparities and treatment efficacy. The integration of POCT services in community pharmacies represents a significant advancement in public health strategy, enhancing the overall healthcare delivery system.

Community pharmacy-based buprenorphine programs and pharmacists' roles, knowledge, attitudes, and barriers to providing buprenorphine-related services: A systematic review

BACKGROUND

Buprenorphine is an effective medication for treating opioid use disorder (OUD) and reducing opioid-related overdose deaths. Community pharmacies are key access points for buprenorphine, with pharmacists well-positioned to dispense and counsel patients on appropriate use. Recent evidence has identified pharmacists' growing engagement in buprenorphine services; yet, access to buprenorphine and related services in community pharmacies remains limited.

OBJECTIVES

This systematic review aimed to investigate and synthesize evidence from existing literature on pharmacy-based buprenorphine programs for OUD, including stocking/dispensing patterns, and pharmacists' knowledge, attitudes, and barriers (KAB) to providing buprenorphine services.

METHODS

Searches were performed across 4 databases: PubMed, Web of Science, CINAHL, and Google Scholar. Eligible articles included U.S.-based, peer-reviewed original research conducted between 2002 and 2024, focusing on pharmacy-based buprenorphine programs for OUD and community pharmacists' KAB related to buprenorphine. PRISMA guidelines were followed.

RESULTS

Search retrieved a total of 488 articles with 38 meeting the criteria for inclusion. Community pharmacy-based buprenorphine programs for OUD included physician-pharmacist collaborative care models, established dispensing agreements, and reinforced counseling. Buprenorphine stocking/availability varied across pharmacy types, with independent pharmacies less likely to stock and dispense the medication than chain pharmacies. Pharmacists appeared to exhibit limited knowledge and a cautious willingness to dispense buprenorphine. Barriers included concerns about perceived Drug Enforcement Administration (DEA) "caps"/investigations, wholesaler flags, diversion risks, inadequate knowledge, and insufficient communication with clinicians.

CONCLUSION

This study found that community pharmacist involvement in buprenorphine programs has the potential to improve access to OUD treatment. However, wider adoption of these initiatives requires rigorous evaluation through randomized controlled trials and longitudinal studies to demonstrate their effectiveness. Barriers, including perceived DEA investigations and wholesaler restrictions, may limit pharmacist engagement in providing buprenorphine. Policy reforms addressing these concerns are needed, alongside efforts to increase pharmacists' knowledge and foster better communication/collaboration between clinicians and pharmacists to enhance buprenorphine access and utilization.

Provision of Mental and Behavioral Health Supports and Services by Pharmacists in Washington State

Pharmacists are highly accessible healthcare professionals with presence in communities, hospitals, and clinics. They are well positioned to expand their roles in supporting individuals with mental health challenges. A cross-sectional study was conducted to identify trends in how pharmacists assess, monitor, identify, and care for patients with mental health challenges. The survey was distributed to licensed pharmacists in Washington State (n = 8,082) in 2023. Questions addressed the provision of mental health supports and services provided by pharmacists, respondents' self-assessed preparedness in delivering services, and professional and personal demographics. Data were analyzed using descriptive statistics and logistic regression. A total of 856 responses were received (10.6%) and 810 were included in the final dataset. Most respondents held a PharmD degree (74%). Common practice environments included community (37%), hospital (27%), and clinic (21%) settings. Less than 1% were board-certified psychiatric pharmacists. The most common mental health services provided involved medication-related services, including talking to patients regarding psychiatric medication (51%), consulting with physicians (47%), and assessing side effects (45%). Over 60% of pharmacists reported being prepared to deliver these services. Less than 30% of pharmacists indicated they were prepared to conduct mental health screenings or make referrals, and provision of these services was low. A statistically significant association was found between preparedness and providing supports and services (p < 0.001). Overall, pharmacists indicated they were more prepared and frequently delivered services related to medication use for mental health indications, while preparedness and offerings for non-medication activities was low, highlighting opportunities for further professional development.

Cost-effectiveness of a pharmacist-led medication therapy management clinic for management of type 2 diabetes

BACKGROUND

Diabetes imposes a substantial public health burden. Involvement of clinical pharmacists in diabetes disease management can improve health outcomes while managing expenditure.

OBJECTIVE

This study aimed to evaluate the lifetime cost-effectiveness of a pharmacist-led medication therapy management clinic (MTMC) compared to usual care for individuals with type 2 diabetes mellitus, from a U.S. payer perspective.

METHODS

A cohort simulation Markov model was developed to simulate the occurrence of major complications of diabetes. Transition probabilities, MTMC treatment effects, health state costs, and utilities were based on data from electronic health records and published literature. Outcomes evaluated were lifetime costs, quality-adjusted life years (QALYs), and incremental cost-effective ratio (ICER). Sensitivity analyses were conducted on all model inputs; scenario analyses assessed the impact of preventing additional diabetes complications on economic outcomes, and of reduced MTMC visit frequency.

RESULTS

Over a lifetime, MTMC resulted in $160,145 total costs and 6.73 QALYs; usual care resulted in $152,806 total costs and 6.65 QALYs. The ICER for MTMC compared to usual care was $93,375 per QALY gained, indicating cost-effectiveness at a willingness-to-pay threshold of $100,000 per QALY gained. Scenario analyses showed that modeling additional complications or reduced visit frequency lowered the ICER. The results were most sensitive to MTMC costs, and hazard ratios for occurrence of stroke, myocardial infarction, and renal failure.

CONCLUSION

The study demonstrates the potential cost-effectiveness of integrating clinical pharmacy services into comprehensive care strategies. Findings support the broader coverage and reimbursement of such services to optimize clinical outcomes and reduce long-term health care costs.

Complexity of patient encounters within a clinically integrated community pharmacy network Medicaid payer program

BACKGROUND

Community pharmacists frequently care for patients with complex medical and social needs; however, specific evidence on pharmacist perceptions of what makes a patient encounter complex has not been clearly characterized. There is a need to better understand specific factors that contribute to patient encounter complexity and demonstrate how pharmacists in community settings care for these individuals.

OBJECTIVES

The objectives of this programmatic case study were to: (1) elucidate factors that contributed to patient encounter complexity as a part of a Medicaid Managed Care Organization comprehensive medication management payer program in community pharmacies and (2) curate a series of patient case vignettes that provide evidence of pharmacists care for patients with complex medical and social needs within community pharmacies.

METHODS

This qualitative programmatic case study utilized data from semi-structured interviews with community pharmacists who provided comprehensive medication management services to Medicaid patients in Pennsylvania. Pharmacists described their most complex patient encounter. Interviews were transcribed and independently coded by 2 investigators. The coded texts were grouped into categories, and a cross-case inductive thematic analysis was performed to identify complexity factors.

RESULTS

Thirty pharmacists provided 48 patient case vignettes and 3 complexity factors emerged: (1) care coordination; (2) behavioral health support; and (3) social determinants of health. Representative patient case vignettes were selected to illustrate these factors.

CONCLUSION

Pharmacists, who participated in a community pharmacy Medicaid Managed Care Organization payer program, provided care to patients with complex health needs. In addition to medication-related problems, specific factors that increased pharmacist perception of encounter complexity were care coordination with other health care providers, behavioral health support, and addressing social determinants of health.

Act for the future of community pharmacy

Community pharmacies serve as a vital gateway to primary care and public health, offering face-to-face pharmacist expert care to assure safe and effective medication use. However, they are disappearing at an alarming rate, with 20%-30% of all community pharmacy locations projected to close within the next year. The objective of this commentary is to highlight the critical need for systemic reforms and collective action within our profession to address the unique challenges faced by community pharmacies, ensuring their sustainability and continued role in providing essential health care services for patients. Key issues and evidence are provided to help pharmacy professionals better articulate why pharmacy closures are happening now and how we can work toward a transformed future. Pharmacy closures stem from an unsustainable business model characterized by declining reimbursement for prescription medications, opaque and anticompetitive pricing practices of pharmacy benefit managers, and limited reimbursement for clinical services. Among these challenges, our profession has the opportunity to create a future for community pharmacy where every person has local access to pharmacist expert care and medications through sustainable, integrated community pharmacy practice. Our profession must embrace community pharmacy teams' role in patient care, champion opportunities to integrate community pharmacists and their support staff as members of the health care team, and advocate for payment transparency and transformation. Creating this future will take all pharmacists and all pharmacy professionals.

Exploring the need and potential of ambulatory pharmacy practice for empowering patient and care delivery in India

In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care.

Factors influencing the uptake of public health interventions delivery by community pharmacists: A systematic review of global evidence

BACKGROUND

Community pharmacies are the first point of contact for most people seeking treatment for minor illnesses globally. In recent years, the role of community pharmacists has evolved, and they play a significant role in the delivery of public health interventions (PHIs) aimed at health promotion and prevention such as smoking cessation services, weight management services, HIV prevention, and vaccination. This review aims to explore the evidence on the factors that influence community pharmacists to take up the role of delivery of such interventions.

METHODS

Three electronic databases namely, Embase (1947-December 2023), Medline (1975-December 2023), and Scopus (1823-December 2023) were searched for relevant literature from the inception of the database to December 2023. Reference lists of included articles were also searched for relevant articles. A total of 22 articles were included in the review based on our inclusion and exclusion criteria. The data were analyzed and synthesized using a thematic approach to identify the factors that influence the community pharmacist's decision to take up the role of PHI delivery. Reporting of the findings was done according to the PRISMA checklist.

FINDINGS

The search identified 10,927 articles of which 22 were included in the review. The main factors that drive the delivery of PHIs by community pharmacists were identified as; training and continuous education, remuneration and collaboration with other healthcare professionals. Other factors included structural and workflow adjustments and support from the government and regulatory bodies.

CONCLUSIONS

Evidence from this review indicates that the decision to expand the scope of practice of community pharmacists is influenced by various factors. Incorporating these factors into the design of policies and public health programs is critical for the successful integration of community pharmacists in the delivery of broader public health to meet the rising demand for health care across health systems.

Evaluating trends in pharmacist e-prescribing: 2019-2022

BACKGROUND

Pharmacists have some prescriptive authority in all fifty states through dependent and independent prescribing. Data describing the volume and characteristics of pharmacist prescribing are not widely available, and these insights are critical to gauge the impact of regulations supporting pharmacist prescriptive authority.

OBJECTIVE

To identify trends in pharmacist prescribing and compare them to primary care provider (PCP) prescribing trends by analyzing e-prescriptions initiated from electronic health records systems from 2019 through 2022.

METHODS

This cross-sectional study used e-prescriptions from a national health information network to identify e-prescriptions ordered by pharmacists and PCPs from January 7, 2019, to January 1, 2023. E-prescriptions ordered by pharmacists and PCPs were analyzed to identify annual volume by prescriber type and most prescribed therapeutic classes. States with the highest volume of e-prescriptions ordered by pharmacists were identified.

RESULTS

The number of e-prescriptions prescribed by a pharmacist increased 47% from 2019 (n = 814,726) to 2022 (n = 1,199,601). The number of pharmacists prescribing in 2019 was 1650, and this increased by 122% to 3664 in 2022. The number of e-prescriptions prescribed by PCPs increased by 4% from 2019 (n = 927,890,123) to 2022 (n = 965,803,376) while the number of PCPs prescribing increased by 8% from 2019 (n = 364,995) to 2022 (n = 394,753).

CONCLUSION

Pharmacist e-prescribing increased across the 4 years studied while PCP e-prescribing modestly increased. Factors like access to technology, such as electronic health records, state regulations, and reimbursement impact a pharmacist's ability to prescribe.

Locations and characteristics of pharmacy deserts in the United States: a geospatial study

Pharmacies are important health care access points, but no national map currently exists of where pharmacy deserts are located. This cross-sectional study used pharmacy address data and Census Bureau surveys to define pharmacy deserts at the census tract level in all 50 US states and the District of Columbia. We also compared sociodemographic characteristics of pharmacy desert vs non-pharmacy desert communities. Nationally, 15.8 million (4.7%) of all people in the United States live in pharmacy deserts, spanning urban and rural settings in all 50 states. On average, communities that are pharmacy deserts have a higher proportion of people who have a high school education or less, have no health insurance, have low self-reported English ability, have an ambulatory disability, and identify as a racial or ethnic minority. While, on average, pharmacies are the most accessible health care setting in the United States, many people still do not have access to them. Further, the people living in pharmacy deserts are often marginalized groups who have historically faced structural barriers to health care. This study demonstrates a need to improve access to pharmacies and pharmacy services to advance health equity.

An Implementation-Focused Qualitative Exploration of Pharmacist Needs Regarding an Opioid Use Disorder Screening and Brief Intervention

BACKGROUND

Screening and brief interventions (SBI) can help identify opioid safety risks and healthcare professionals can accordingly intervene without a significant increase in workload. Pharmacists, one of the most accessible healthcare professionals, are uniquely positioned to offer SBI. To design an effective intervention with high potential for implementation, we explored pharmacist needs and barriers regarding SBI for opioid use disorders.

METHODS

Using the Consolidated Framework for Implementation Research (CFIR), we conducted 11 semi-structured 60-minute interviews with community pharmacists. We used a purposeful sample of English-speaking pharmacists practicing in varied pharmacies (small independent, large-chain, specialty-retail) and positions (managers, owners, full-time/part-time pharmacists). Transcriptions were analyzed using deductive content analysis based on CFIR constructs, followed by inductive open coding. Utilizing a theoretical framework for data collection and analysis, a diverse sample of pharmacist roles, peer debriefing, and 2 independent coders for each transcript, altogether increased the credibility and transferability of our research. Data collection and analysis continued until data saturation was achieved.

RESULTS

Pharmacists described good working relationships with colleagues, organization cultures that were open to new initiatives, and believed the SBI to be compatible with their organization goals and pharmacy structure, which are facilitators for future SBI implementation. Pharmacists were motivated by improved patient outcomes, more patient interaction and clinical roles, representing facilitators at the individual level. They also described stigma toward patients, mixed need for change, and lack of knowledge regarding SBI, which are potential barriers to be addressed. Pharmacists believed that the SBI model was adaptable, not complicated, and benefits outweighed implementation costs.

CONCLUSIONS

We addressed current SBI literature gaps-mainly lack of focus on implementation and contextual data, through rigorous implementation-focused qualitative research. Our exploratory findings have direct implications on future pharmacy-based SBI implementation.

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy

In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.

Community Pharmacy Credentialing for Medical Insurance to Facilitate Sustainability in COVID-19 Testing

Background: In April 2020, pharmacists were added as medical providers under Idaho Medicaid in response to recent scope expansion for pharmacists and to increase beneficiaries' access to coronavirus disease 2019 (COVID-19) testing and services. The COVID-19 pandemic prompted expedited Medicaid enrollment for pharmacists but did not address coverage of medical services provided to privately insured individuals for pharmacy-based testing services. Objective: This study aimed to describe processes used by independently owned, community-based pharmacies in Idaho to credential with private insurers and report outcomes. Methods: Relevant information and forms required to credential with the four major payers in the state of Idaho were collected. Packets were obtained via medical insurers' websites and by direct contact. Questions that arose from community pharmacists during the submission process were collected and answered on a shared spreadsheet, and insurance representatives were contacted directly to resolve questions. Results: Eight out of 13 participating pharmacies submitted an average of three credentialing packets for their facilities. Thirty-five pharmacists also submitted an average of four credentialing packets for themselves. As of mid-May 2021, nearly 20 weeks after submission, only 67 out of 129 pharmacists had received word regarding the status of their applications. Less than half of all pharmacist applications were approved (after their first attempt). Conclusion: Efforts to support the education of both pharmacists and medical insurers may streamline the credentialing processes in the future.

Hepatitis C screening in a community pharmacy setting: Patient perspective

BACKGROUND

Hepatitis C virus (HCV) is an infection of the liver, which contributes to over 15,000 deaths in the United States annually. When treated, HCV has a 90% or greater cure rate, however testing for HCV remains low.

OBJECTIVES

To assess patient perspectives on HCV screenings in the community pharmacy setting including awareness of screening, willingness to be screened, barriers to screening, and willingness to pay for HCV screening.

METHODS

This study used a cross-sectional survey design. The surveys were distributed by staff at an independent community pharmacy participating in an HCV screening initiative through the state department of public health. Eligible patients were born between 1945 and 1965. Descriptive statistics were calculated for survey variables. Open-ended responses were analyzed for additional context.

RESULTS

Fifty-seven surveys were returned and analyzed. The majority of the respondents were White (94%), female (56%), and had some college education (26%). Only 7% were aware that a finger-stick point-of-care test was available and 67% were unaware of the Centers for Disease Control and Prevention (CDC) recommendation for testing. The most frequently reported barrier or hesitation to screening was the patient not thinking they were at risk (29%) followed by uncertainty about cost (14%). Over half of respondents (63%) were either somewhat interested or very interested in testing in a community pharmacy, however, the majority (71%) were not willing to pay or only willing to pay less than $20.

CONCLUSIONS

Survey respondents were largely unaware of the recommendations and availability of finger-stick HCV screenings at community pharmacies but many were willing to be tested if low-cost. Providing patient education on the importance of HCV screenings and CDC recommendations may bolster interest in screening.

Pharmacist roles in the medication use process: Perceptions of patients, physicians, and pharmacists

OBJECTIVES

It is uncertain whether stakeholder perceptions of pharmacist roles in the medication use process (MUP) have evolved alongside pharmacist advanced scope of practice. This study aimed to examine patient, pharmacist, and physician perceptions of pharmacist roles in the MUP.

DESIGN

This IRB-approved study used a cross-sectional design with online panels of patients, pharmacists, and physicians.

SETTING AND PARTICIPANTS

A Qualtrics panel of 1,004 patients, 205 pharmacists, and 200 physicians completed the surveys between August-November 2021.

OUTCOME MEASURES

Using role theory as framework, 12-item surveys were developed to examine perceptions regarding effectiveness of and best choice for improving each MUP step. Data analysis included descriptive statistics, correlations, and comparisons.

RESULTS

Majority of the physician, pharmacist, and patient samples believed that physicians prescribe the best possible medications (93.5%, 83.4%, 89.0% respectively), prescriptions are filled accurately (59.0%, 61.4%, 92.6% respectively) and timely (86.0%, 68.8, 90.2% respectively). Majority of physicians (78.5%) opined prescriptions are generally error free and patients are monitored (71%); fewer pharmacists agreed (42.9%, 51%; p<0.05). Most patients (92.4%) reported taking medications as directed; only 60% professionals agreed (p<0.05). Physicians selected 'pharmacists' as top choice for reducing dispensing errors, providing counseling, and helping patients take medications as directed. Patients wanted pharmacists to help manage their medications (87.0%) and 'someone' to periodically check on their health (100%). All 3 groups agreed physician-pharmacist collaboration was important to improve patient care and outcomes (90.0%-97.1%); however, 24% of physicians were uninterested in collaboration. Both professionals reported lack of time, appropriate setup, and interprofessional communication as challenges to collaboration.

CONCLUSION

Pharmacists believe their roles have evolved to align with expanded opportunities. Patients perceived pharmacists play comprehensive roles in medication management through counseling and monitoring. Physicians recognized pharmacist roles in dispensing and counseling, but not in prescribing or monitoring. Clarity in role expectations amongst these stakeholders is critical to optimizing pharmacist roles and patient outcomes.

Flip the Pharmacy's impact on comprehensive medication management performance

BACKGROUND

Clinically integrated networks of community pharmacies are expanding partnerships with health care payers for sustainable provision of patient care services. The Pennsylvania Pharmacists Care Network (PPCN), a part of CPESN USA, launched its first payer program in 2017 with a Medicaid managed care organization for comprehensive medication management (CMM). Some PPCN pharmacy teams have participated in Flip the Pharmacy, a national practice transformation initiative.

OBJECTIVES

This study aimed to determine whether pharmacy participation in Flip the Pharmacy was associated with a greater rate of CMM encounters than in nonparticipating pharmacies within a statewide clinically integrated network.

METHODS

This project was a retrospective quantitative study. CMM encounter data including total number of encounters and total number of eligible members were extracted from monthly reports. Generalized estimating equations were used to assess the association between Flip the Pharmacy participation and CMM encounter rates.

RESULTS

Of 103 pharmacies that participated in the CMM program in 2019 and 2020, 77.7% of pharmacies (n = 80) were included in analyses. Of these, 31.3% (n = 25) participated in Flip the Pharmacy. Overall, 80 pharmacies documented 8460 patient encounters through the CMM program. On average, pharmacies participating in Flip the Pharmacy recorded 1.67 times the rate of encounters compared with non-Flip the Pharmacy pharmacies (95% CI 1.10-2.54), controlling for single versus multiple pharmacy sites and weekend hours. On average, pharmacies participating in Flip the Pharmacy recorded 1.18 times the rate of initial encounters (95% CI 0.84-1.59) and 2.06 times the rate of follow-up encounters (95% CI 1.22-3.48) compared with non-Flip the Pharmacy pharmacies.

CONCLUSION

Participation in Flip the Pharmacy in Pennsylvania was associated with greater engagement and completion of encounters within a payer program for CMM. Continued practice transformation efforts are needed to ensure the sustainability of community pharmacy practice as it continues to expand into payment for patient care services.

Pharmacists' facilitators and barriers to implementing and billing for patient care services: Interviews from the Ohio Medicaid Project

BACKGROUND

In the past several decades, a growing body of literature is recognizing the benefits of pharmacist-led health care services in improving clinical and economic outcomes. Despite this evidence, pharmacists are not recognized on a federal level as health care providers in the United States. Ohio Medicaid managed care plans began partnering with local pharmacies in 2020 to launch initial programs for implementing pharmacist-provided clinical services.

OBJECTIVES

This study aimed to identify barriers and facilitators to implementing and billing for pharmacist-provided services in Ohio Medicaid managed care plan programs.

METHODS

This qualitative study interviewed pharmacists involved in the initial programs using a semistructured interview based on the Consolidated Framework for Implementation Research (CFIR). Interview transcripts were coded for thematic analysis. Identified themes were mapped to the CFIR domains.

RESULTS

Four Medicaid payors partnered with 12 pharmacy organizations, representing 16 unique sites of care. Interviews were conducted with 11 participants. The thematic analysis found data fit within the 5 domains with 32 total themes. Pharmacists described the implementation process of their services. The primary themes for improvement of implementation process were system integration, payor rule clarity, and patient eligibility and access. The 3 themes that emerged as key facilitators were communication between payors and pharmacists, communication between pharmacist and care teams, and the perceived value of the service.

CONCLUSIONS

Payors and pharmacists can work collaboratively to improve patient care opportunities by increasing access with sustainable reimbursement, clear guidelines, and open communication. Continued improvement is needed in system integration, payor rule clarity, and patient eligibility and access.

Willingness to Pay for Clinical Pharmacy Services Among People With Diabetes in Nigerian Community Pharmacies

OBJECTIVES

This study aimed to assess willingness to pay (WTP) for clinical pharmacy services among people with diabetes and to determine the factors affecting WTP for these services.

METHODS

This was a cross-sectional exit survey of 450 people with diabetes visiting 15 community pharmacies in Uyo metropolis, Akwa Ibom State, Nigeria, between August and September 2021. Self-reported questionnaires were administered to eligible patients just before leaving the community pharmacy. Data were analyzed using SPSS (version 25.0). Statistical significance was set at P < .05.

RESULTS

Response rate was 87.3%. Two hundred respondents (50.9%) were willing to pay an average amount of US$2.83 (minimum-maximum, US$0.12-US$24.27) for clinical pharmacy services. The two most often cited reasons for those who were unwilling to pay were their inability to pay and their opposition to paying for any healthcare services. Employment status (P < .001), personal monthly income (P < .001), satisfaction with income (P < .001), household monthly income (P < .001), health insurance coverage (P < .001), insulin use (P < .001), perception of the pharmacist's relevance in healthcare (P = .013) and in diabetes care (P < .001), and satisfaction with the pharmacist's services (P < .001) significantly affected WTP choices. None of the patient characteristics predicted the maximum amounts patients were willing to pay.

CONCLUSIONS

Many of the people with diabetes assessed were willing to pay for clinical services at a reasonable price. Although most patient variables affected their WTP choices, none of the variables predicted the maximum amount they were willing to pay. For possible remuneration for clinical services, community pharmacists should continue to grow their practices and stay current with patient care.

Pharmacy deserts and COVID-19 risk at the census tract level in the State of Washington

Community pharmacies are a crucial component of healthcare infrastructure, including for COVID-19 pandemic prevention services like testing and vaccination. Communities that are "pharmacy deserts," experience healthcare inequities. However, little research has characterized where these communities are, making it difficult for local leaders to prioritize resources for them. This study identifies pharmacy deserts at the census tract level in Washington state for the first time and explores their association with COVID-19 risk. Out of 1,441 tracts, 127 were pharmacy deserts, comprising approximately 454,000 adults, or 8% of the state's adult population. Among those tracts identified as pharmacy deserts, 67% were considered high risk for COVID-19. Solutions are needed to expand equitable access to pharmacy services in these communities. The methods and data presented herein provide healthcare leaders with information to address this pharmacy access gap in Washington and could be similarly applied to other settings. Three categories of policy changes could address health inequities found in our study: 1) improve financial incentives for pharmacists to practice in underserved areas, 2) prevent pharmacy closures, and 3) deploy innovative care delivery methods such as telehealth services.

Update and recommendations: Pharmacists' prescriptive authority for tobacco cessation medications in the United States

To characterize state laws in the United States regarding the expansion of pharmacists' prescriptive authority for tobacco cessation medications, compare key components across different models, and discuss important considerations for states that are considering similar legislation or policies. Legislative language was reviewed and summarized for all states with pharmacist prescriptive authority for tobacco cessation medications, and state boards of pharmacy were contacted to determine the number of registered complaints or safety concerns received as a result of pharmacists' prescribing under these authorities. As of June 2022, 17 states have enacted laws for pharmacists' prescriptive authority for tobacco cessation medications; most (N = 16) have implemented procedures, and 1 is in the process of adopting a similar prescribing model. Of 16 states with fully delineated protocols, 8 (Colorado, Idaho, Indiana, New Mexico, North Dakota, Oregon, Utah, Vermont) include all medications approved by the U.S. Food and Drug Administration for smoking cessation, and 8 (Arizona, Arkansas, California, Iowa, Maine, Minnesota, Missouri, North Carolina) include nicotine replacement therapy medications only. Most protocols specify minimum cessation education requirements for pharmacists and define required intervention elements (e.g., screening, cessation intervention components, follow-up, and documentation requirements). Personal communications with state boards of pharmacy revealed no complaints or safety concerns regarding pharmacists' prescribing for cessation medications since these authorities were first implemented, in New Mexico, in 2004. The number of states with pharmacists' prescriptive authority for tobacco cessation medications has increased substantially in recent years. There have been no registered complaints or safety concerns since the inception of this expanded scope of practice. Although the profession has made meaningful progress, there are inconsistencies across states with respect to medications that are included and requirements for implementing tobacco cessation services, which may impede broader adoption.

Improving the Pharmacists’ Response to Public Health Emergencies—Documentary Research on Online Resources Provided by National Pharmacists’ Associations

Objectives: Given the expanding role of pharmacists during COVID-19 pandemic, we aimed to investigate the approach of professional associations to supporting their practice and to find ways to improve their response to public health emergencies.

Methods: We conducted documentary research on websites of seven national pharmacists’ associations, submitted the findings to a comparative thematic analysis, and made proposals of specific good practices.

Results: Many great resources were provided by pharmacists’ associations in Australia, France, Spain, and the US. The similarities include scientific information on COVID-19 tests, treatments and vaccines, legal issues, and wellbeing management. The main differences were in developing medication management programs, supporting hospital pharmacists, helping families, or advocating for an equitable vaccination. In Finland, Hungary and Romania, the focus was on updating emerging information. Considering the need for better managing public health emergencies at organizational level, we suggested good practices regarding training and communication.

Conclusion: Professional associations should develop preparedness and response plans for public health emergencies. Practical training and effective communication could improve the resilience of pharmacists and patients during pandemics, which could save lives.

Stakeholder perceptions of community pharmacist population health management of people living with epilepsy

OBJECTIVE

To identify the predisposing, enabling, and reinforcing factors influencing the integration of community pharmacists in population health approaches to epilepsy care.

METHODS

Key informant interviews were conducted with 32 stakeholders, including five people living with epilepsy (PWE), ten caregivers of PWE, seven epileptologists, one neurologist, one epilepsy nurse, and eight community pharmacists in Washington State and Oregon from September 2019 to February 2020. Interviews were audio recorded, transcribed, and analyzed using a rapid content analysis approach guided by the PRECEDE-PROCEED Model to identify predisposing, enabling, and reinforcing factors influencing integration of community pharmacists in population health approaches to epilepsy care.

RESULTS

Four predisposing, four enabling, three positive reinforcing factors, and two negative reinforcing factors emerged as influencing integration of community pharmacists in a population health approach to epilepsy care across all stakeholder groups. Predisposing factors included patient advocacy, medication adherence, medication monitoring, and medication education. Enabling factors were a shared vision, collaboration structure, efficient communication, and pharmacist attributes (knowledge, experience, and attitude). Positive reinforcing factors included a team approach, easy to access support, and medication adherence. Negative reinforcing factors were duplicate or conflicting care and limited time and resources.

SIGNIFICANCE

This study identified several predisposing, enabling, and reinforcing factors influencing integration of community pharmacists in population health approaches to epilepsy care based on stakeholder perceptions. Community pharmacists may consider these factors when implementing services for patients with epilepsy.

Patient Satisfaction with Pharmacist-Provided Health-Related Services in a Primary Care Clinic

(1) Background: Patient satisfaction plays an important role in the perceived value, sustained utilization, and coverage of healthcare services by payers and clinics. (2) Methods: A 33-question survey was designed to assess patient satisfaction and perceived value for healthcare services provided by a clinical pharmacist in a single primary care facility. It included general items from validated patient satisfaction surveys (i.e., PROMIS^®, CAHPS) and pharmacist-specific items identified in selected literature. It was offered to all patients who were presenting for a new, unique visit with the clinical pharmacist at the medical clinic between May 2019 and April 2020. (3) Results: A total of 66 patients agreed to take the survey (RR = 100%), and the responses were overwhelmingly positive. However, men were more likely than women to report higher satisfaction (X2(1, n = 920) = 0.67, p = 0.027), and new patients reported higher satisfaction than existing patients (X2(1, n = 1211) = 1.698, p = 0.037). (4) Conclusions: The findings of this study indicate a high degree of patient satisfaction with pharmacist-provided healthcare services in the primary care setting.

Assessing Pharmacists' Views and Barriers to Providing and Billing for Pharmacist-Provided Health Care Services

Background: The role of Idaho and Alaska pharmacists in providing health care services has steadily broadened over recent years. With many new pharmacist-provided health care service possibilities, this study assessed the impact of these advancements on community pharmacies. Objective: The objective of this study was to identify current pharmacist-provided health care services and pharmacist-perceived barriers to providing and billing for these services in Idaho and Alaska community pharmacies. Methods: A questionnaire was developed focusing on 2 areas: providing services and billing for services. Pharmacy students on experiential rotations administered the questionnaires to pharmacists at their rotation sites. Pharmacists at community pharmacy practice sites in Idaho and Alaska completed the questionnaire in an interview format conducted by students. Likert-type scale data were analyzed using descriptive statistics. Because the study did not include a comparator group, no power calculation was conducted. All open-response answers were analyzed independently by 2 researchers and discrepancies in coding open-ended questions were resolved by discussion with a group of 4 researchers. Results: Most pharmacists reported that they already provide non-dispensing services, desired to implement new services, and had confidence in their team's ability to handle new services. Time and resources were the most cited barriers to providing new services; compensation, company support, and education were the most cited barriers to billing for services. Conclusions: Community pharmacists already provide non-dispensing services and many are looking to provide more services, but barriers of time, resources, compensation, company support, and education will need to be overcome to move forward.

Establishment of a Framework to Support Multi-Faceted Initiatives for Pharmacy-Practice Transformation: Lessons Learned

We describe the first two years of a multifaceted, five-year program to support sustainable pharmacist-provided health services in Alaska. In 2018, the Alaska Pharmacists Association funded the Sustainable Education and Training Model under Pharmacist as Providers (SETMuPP) to train and support pharmacists to navigate the insurance medical billing process for nondispensing healthcare services. The SETMuPP employed a three-pillar implementation approach: (1) training and practice support infrastructure, (2) PharmD curriculum augmentation, and (3) advocacy and legislative support. The first two years have demonstrated the effectiveness of triad partnerships between professional associations, state policy makers, and academic centers to catalyze meaningful practice transformation.

Pharmacist-led interventions to improve medication adherence in older adults: A meta-analysis

BACKGROUND/OBJECTIVE

As pharmacists work to ensure reimbursement for chronic disease management services on the national level, evidence of their impact on important health metrics, such as medication adherence, is needed. However, summative evidence is lacking on the effectiveness of pharmacists to improve medication adherence in older adults. The objective was to assess the effectiveness of pharmacist-led interventions on medication adherence in older adults (65+ years).

DESIGN/SETTING/PARTICIPANTS

Using a systematic review and meta-analytic approach, a comprehensive search of publications in PubMed, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Google Scholar was conducted through April 2, 2020 for randomized clinical trials of pharmacist-led interventions to improve medication adherence in older adults. A standardized mean difference effect size (Cohen's d) was calculated for medication adherence in each study. Study effect sizes were pooled using a random-effects model, with effect sizes weighted by inverse of its total variance.

MEASUREMENTS

Medication adherence using any method of measurement.

RESULTS

Among 40 unique randomized trials of pharmacist-led interventions with data from 8822 unique patients (mean age, range: 65-85 years), the mean effect size was 0.57 (k = 40; 95% Confidence Interval [CI]: 0.38-0.76). When two outlier studies were excluded from the analysis, the mean effect size reduced to 0.41 (k = 38; 95% CI: 0.27-0.54). A sensitivity analysis of medication adherence outcome by time point resulted in a mean effect size of 0.64 at 3 months (k = 12; 95% CI: 0.32-0.97), 0.30 at 6 months (k = 13; 95% CI: 0.11-0.48), 0.22 at 12 months (k = 12; 95% CI: 0.08-0.37), and 0.36 for outcome time points beyond 12 months (k = 5; 95% CI: 0.02-0.70).

CONCLUSION

This meta-analysis found a significant improvement in medication adherence among older adults receiving pharmacist-led interventions. Implementation of pharmacist-led interventions supported by Medicare reimbursement could ensure older adults' access to effective medication adherence support.

The impact of the COVID-19 pandemic on addressing common barriers to pharmacy-based point-of-care testing

Introduction: Pharmacy-based point-of-care testing has long had the potential to improve patient access to timely care, but adoption has been slowed by financial and regulatory barriers. The COVID-19 pandemic reduced or temporarily eliminated many of the barriers to pharmacy-based testing. This review examines how the changes brought on by may impact pharmacy-based testing after the pandemic.Areas covered: This review searched peer-reviewed, lay, and regulatory literature to explore the implementation of pharmacy-based COVID-19 testing. This includes a review of regulatory and financial changes that removed barriers to testing. Additionally, it reviews the literature related to the growth of pharmacy-based testing.Expert opinion: It is clear that the COVID-19 pandemic created an awareness and opportunity for pharmacy-based point-of-care testing. The changes made in response to the pandemic have the potential to increase the role of pharmacy-based testing, but additional regulatory changes and wider pharmacy adoption are still needed to maximize the value of such services.