The role of network ties to support implementation of a community pharmacy enhanced services network

Using Single-Case Experimental Design and Patient-Reported Outcome Measures to Evaluate the Treatment of Cancer-Related Cognitive Impairment in Clinical Practice

Cancer-related cognitive impairment (CRCI) affects a large proportion of cancer survivors and has significant negative effects on survivor function and quality of life (QOL). Treatments for CRCI are being developed and evaluated. Memory and attention adaptation training (MAAT) is a cognitive-behavioral therapy (CBT) demonstrated to improve CRCI symptoms and QOL in previous research. The aim of this article is to describe a single-case experimental design (SCED) approach to evaluate interventions for CRCI in clinical practice with patient-reported outcome measures (PROs). We illustrate the use of contemporary SCED methods as a means of evaluating MAAT, or any CRCI treatment, once clinically deployed. With the anticipated growth of cancer survivorship and concurrent growth in the number of survivors with CRCI, the treatment implementation and evaluation methods described here can be one way to assess and continually improve CRCI rehabilitative services.

Coaching strategies for the Flip the Pharmacy practice transformation initiative in Pennsylvania independent community pharmacies

BACKGROUND

Flip the Pharmacy (FtP) is a nationwide initiative to scale practice transformation in community pharmacies. Participating pharmacies are coached through monthly practice transformation initiatives and document their patient-care activities through Pharmacist electronic Care (eCare) Plans.

OBJECTIVES

The objective of this study was to identify peer coaching strategies to facilitate practice transformation in Pennsylvania community pharmacies.

METHODS

This was a qualitative study using semistructured interviews with practice transformation coaches and pharmacy champions participating in Pennsylvania's FtP program. The interview guide was informed by the Consolidated Framework for Implementation Research and elicited information using the intervention characteristics, inner setting, characteristics of individuals, and process domains. Interviews were conducted in person or via telephone over a 3-month period. An inductive qualitative thematic analysis was performed to identify coaching strategies.

RESULTS

A total of 18 key informants were interviewed: 6 pharmacy champions and 12 practice transformation coaches. The following 5 coaching strategies emerged: (1) learn to use the pharmacy's specific Pharmacist eCare Plan software, (2) build a trusting relationship with the pharmacy, (3) engage all pharmacy team members in practice transformation, (4) adapt communication strategies to the pharmacy's preference, and (5) tailor goals to the pharmacy's stage of practice transformation.

CONCLUSION

This study elicited 5 peer coaching strategies to support community pharmacy practice transformation initiatives. These findings can be used to further practice transformation efforts in community pharmacies through FtP and other initiatives aimed at expansion of community pharmacy patient care services.

Integrating the Public Health Services Model into Age-Friendly Pharmacies: A Case Study on the Pharmacies in Taiwan

Taiwan is expected to become a superaged society by 2026. Community pharmacies have recently joined Taiwan's primary care system; they have great potential to provide professional healthcare services. This study examined whether the services provided by community pharmacists enhance medication adherence, enable the identification and solution of drug therapy problems, and are accepted by community residents. The Department of Public Health, Taoyuan City, collaborated with the Taoyuan Pharmacist Association over 11 months in 2018 in enabling pharmacists to dispense prescriptions and provide medication adherence consultations, cognitive services, and home and institutional medical care services. This study designed four satisfaction questionnaires to assess the feasibility and performance of these services. Regarding the services related to medication knowledge and adherence, 92.10% of the patients reported overall satisfaction, and all understanding and ability scores were improved in more than 95% of patients. The number of patients highly cooperative regarding their medication had risen from 14 to 234 after the intervention, and the number with low medication adherence had dropped from 533 to 33. More than 90% of respondents indicated that the institutional medical care services had significantly improved their medication knowledge and behaviors. The feasibility of the incorporation of integrated the public health services model into age-friendly pharmacies was confirmed by this study.

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.

A community-based partnership collaborative practice agreement project to disseminate and implement evidence-based practices in community pharmacy

BACKGROUND AND PURPOSE

The objective of this study is to explore the impact of an educational intervention including (1) collaborative practice agreement (CPA)-focused lecture and (2) a student project in partnership with a community-based pharmacy on dissemination and implementation of CPAs in community pharmacy practice.

EDUCATIONAL ACTIVITY AND SETTING

A CPA-focused classroom lecture and related project were given to five sequential years of second-year pharmacy students enrolled in a community pharmacy elective course. Community pharmacist feedback provided at the completion of the project was compared to present-day data collected via telephone survey. Responses for each survey question were summarized using frequencies, and chi-square analysis was conducted to assess the association between pharmacist perceptions at the time of the project vs. the present day.

FINDINGS

Forty-seven projects representing 47 unique CPAs were completed over five sequential years of the course. The most commonly targeted disease states by CPAs were influenza/streptococcus pharyngitis (25.5%), therapeutic interchange (6.4%), oral contraceptives (6.4%), and tobacco cessation (6.4%). Pharmacists noted that students facilitated their progress toward CPA implementation by serving as a means for CPA law education (23.4%) and by saving time in CPA development (12.8%).

SUMMARY

This study demonstrated that a student project partnering with a local community pharmacy improved knowledge dissemination but did not have any direct impact on implementation of CPAs in a community pharmacy. However, students may have a role in dissemination and implementation of evidence-based practices, such as CPAs, when appropriately matched to setting-specific implementation barriers.

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

BACKGROUND

The pharmacy profession continues to broaden toward a patient-centered care practice. Pharmacy members of formal enhanced services networks are embracing this practice. However, descriptions of how pharmacies adopt a patient-centered care practice by providing enhanced services are not widely known.

OBJECTIVES

To explore the pharmacy services of Nebraska independent community pharmacists within the context of the pharmacy profession's transition toward patient-centered care and determine if pharmacy participation in a formal enhanced pharmacy services network is associated with the provision of enhanced services.

METHODS

A mixed methods approach was used by first conducting a cross-sectional quantitative survey, followed by a small qualitative study to further explain the survey findings. The survey of 193 Nebraska independent community pharmacies included members and nonmembers of the Nebraska Enhanced Services Pharmacies (NESP) network. Data were collected on the enhanced services offered. Survey analyses used descriptive and inferential statistics. Qualitative data on reasons for offering enhanced services and their profitability were subsequently collected using a focus group of 3 independent community pharmacy owners. The interview transcript analysis used coding to generate major themes.

RESULTS

The survey response rate was 59%. Across all respondents, the average number of enhanced services offered was 17.3 out of 47 services studied. NESP members provided more enhanced services (x¯ = 20) than non-NESP members (x¯ = 16), P = 0.003. NESP membership was associated with the opinion that offering enhanced services increases profits, P = 0.016. The major themes were "NESP members have always been taking care of people" and "Profitability from enhanced services is key for sustainability of independent community pharmacies."

CONCLUSION

Independent community pharmacies provide a range of enhanced services. NESP members provided more enhanced services than non-NESP members and focused on taking care of people by providing enhanced services. NESP membership may provide opportunities for pharmacies to offer more enhanced services to patients with the intent to improve patient-centered care.

Role of Pharmacists in the Interprofessional Care Team for Patients with Chronic Diseases

Chronic diseases are a major health problem and cause of death worldwide. Patients with chronic diseases should be managed by an interprofessional care team consisting of general practitioners, medical specialists, nurses, and pharmacists. However, the roles of pharmacists in this interprofessional care team have not been fully explored. This study, therefore, examined their roles as members of the interprofessional care team in managing patients with chronic diseases. A search in PubMed, Google Scholar, EBSCO, Scopus, and Cochrane Library databases was conducted for research articles that discussed pharmacists, interprofessional healthcare, and chronic diseases. From initial 420 identified articles, a total of 27 articles were included in this study. The interprofessional healthcare team should have a sense of tolerance and belonging among its members, which is reflected in five dimensions: partnership, coordination, cooperation, decision-making, and therapeutic outcomes. The five dimensions are closely related because they support each other in the success of the therapy. The presence of pharmacists in an interprofessional healthcare team has been proven to help facilitate access to primary care and improve patient outcomes. Pharmacists can assist in managing chronic disease conditions by providing drug information to patients and other healthcare providers and by acting as a consultant for treatment-related issues. The pharmacist’s role as part of an interprofessional care team reinforces the importance of a collaborative healthcare team in providing clinical services to patients with chronic diseases.

Sustainable Business Models in Hybrids: A Conceptual Framework for Community Pharmacies’ Business Owners

Community pharmacies have recently been asked to contribute to sustainable healthcare systems through active participation in an integrated model of care and by playing a major educational role for environmental conservation. Therefore, dramatic changes in their institutional context have led to increasing competition in the drugs retail sector and a shift toward a service-oriented business. These factors urge rethinking of the business model of these hybrid organizations, which combine a profit-oriented, social, and more recently addressed, environmental identity. This paper aims at discussing a sustainable business model (SBM) that could allow community pharmacies to contribute to public health through pharmacists’ current role and development of that role. The effects of the COVID-19 pandemic suggest that human health should be at the center of the sustainable development agenda; the pandemic raises questions about the traditional role of community pharmacies, such as extending patient-oriented services. The SBM for community pharmacies represents an opportunity to enhance their role among the healthcare workforce, especially in a time of global pandemics. In addition, the SBM can support community pharmacies to integrate sustainability in day-to-day pharmacy practice, although it should be customized based on the contextual characteristics of the business and on differences between countries, such as health policies and regulations.

Community Pharmacists' Perceptions of Patient Care Services within an Enhanced Service Network

Background: Pharmacists are positioned as an accessible source of patient care services (PCS). Despite the adversity community pharmacies continue to face, the expanding opportunity of offering PCS continues to be a pathway forward. Objective: To identify community pharmacists’ perceptions to deliver PCS within an enhanced service network. Methods: One-on-one semi-structured phone interviews were conducted as part of a mixed-methods approach. Interview transcripts were analyzed using a consensus codebook to draft thematic findings. Participants were recruited from an electronic survey targeting community pharmacists from the New York chapters of the Community Pharmacy Enhanced Services Network (CPESN). Results: Twelve pharmacists were interviewed with four main themes identified. The majority of study participants were pharmacy owners (92%) devoting an average of 15 h/week to PCS and 8 h/week addressing social barriers. The main themes identified include: (1) perceptions of pharmacy profession, (2) reimbursement models and sustainability of PCS, (3) provision of patient care services, and (4) how PCS address social determinants of health. Conclusions: Offering PCS opportunities for patients is a direction many community pharmacists have embraced and are working to succeed. Ongoing research is needed focusing on community pharmacists’ self-perceptions of the clinical impact and role they hold in an evolving healthcare system.

Self-organisation, adaptability, organisational networks and inter-organisational coordination: empirical evidence from humanitarian organisations in Uganda

Purpose

To coordinate humanitarian organisations with different mandates that flock the scenes of disasters to save lives and respond to varied needs arising from the increased number of victims is not easy. Therefore, the level at which organisations self-organise, network and adapt to the dynamic operational environment may be related to inter-organisational coordination. The authors studied self-organisation, organisational networks and adaptability as important and often overlooked organisational factors hypothesised to be related to inter-organisational coordination in the context of humanitarian organisations.

Design/methodology/approach

The study’s sample consisted of 101 humanitarian organisations with 315 respondents. To decrease the problem of common method variance, the authors split the samples within each humanitarian organisation into two subsamples: one subsample was used for the measurement of self-organisation, organisational network and adaptability, while the other was for the measurement of inter-organisational coordination.

Findings

The partial least square structural equation modelling (PLS-SEM) analysis using SmartPLS 3.2.8 indicated that self-organisation is related to inter-organisational coordination. Organisational network and adaptability were found to be mediators for the relationship between self-organisation and inter-organisational coordination and all combined accounted for 57.8% variance in inter-organisational coordination.

Research limitations/implications

The study was cross sectional, hence imposing a limitation on changes in perceptions over time. Perhaps, a longitudinal study in future is desirable. Data were collected only from humanitarian organisations that had delivered relief to refugees in the stated camps by 2018. Above all, this study considered self-organisation, adaptability and organisational networks in the explanation of inter-organisational coordination, although there are other factors that could still be explored.

Practical implications

A potential implication is that humanitarian organisations which need to coordinate with others in emergency situations may need to examine their ability to self-organise, network and adapt.

Social implications

Social transformation is a function of active social entities that cannot work in isolation. Hence, for each to be able to make a contribution to meaningful social change, there is need to develop organisational networks with sister organisations so as to secure rare resources that facilitate change efforts coupled with the ability to reorganise themselves and adapt to changing environmental circumstances.

Originality/value

The paper examines (1) the extent to which self-organisation, adaptability and organisational networks influence inter-organisational coordination; (2) the mediating role of both adaptability and organisational networks between self-organisation and inter-organisational coordination in the context of humanitarian organisations against the backdrop of complex adaptive system (CAS) theory.

A Student Pharmacist Quality Engagement Team to Support Initial Implementation of Comprehensive Medication Management within Independent Community Pharmacies

In 2017, the Pennsylvania Pharmacists Care Network (PPCN), an enhanced pharmacy services network, and STRAND Clinical Technologies partnered to launch a payor contract with a Pennsylvania Medicaid Managed Care Organization for the provision of comprehensive medication management (CMM) at PPCN pharmacies. PPCN and the Community Leadership and Innovation in Practice Center at the University of Pittsburgh School of Pharmacy partnered to create the Quality Engagement Team (QET), a group of student pharmacists formed with the intent to support the initial implementation of this contract. The QET supported the pharmacies through biweekly phone calls, which led to increased pharmacist engagement and produced impactful patient encounter stories that were then reported back to the payor. We utilized Active Implementation Frameworks and select implementation strategies from the Expert Recommendations for Implementing Change project throughout the implementation period. The QET supported the successful implementation of this payor contract, which saw an increase in CMM encounters completed by the pharmacists during each month of the four-month contract period. Students, pharmacists and the payor each derived meaningful benefits from this initiative. Student pharmacists can be a powerful asset in the implementation of payor programs within an enhanced pharmacy services network, resulting in the mutually beneficial and sustainable support of the network.

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.

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.

Impact of pharmacist care provision in value-based care settings: How are we measuring value-added services?

OBJECTIVES

To discuss the current state of measuring value-added services in emerging value-based payment practice models and their impact on the pharmacy profession.

SUMMARY

Value-based care models require a focus on population health. In value-based care settings, providers are held accountable for risk that goes beyond the clinic encounter, and payment is tied to quality measures that reflect clinical and humanistic outcomes across the health care spectrum. This creates opportunities for pharmacist integration into value-based care settings through addressing gaps in care, optimizing medication use, and developing physician-pharmacist team-based care practice models.

CONCLUSION

Scalable and sustainable pharmacist integration into value-based care settings should involve expansion of preventive care into the community. The need for measurement of the value added by pharmacy services is a priority.