Obstacles to the Implementation of Pharmaceutical Care in the Community Setting

Role of community pharmacists in educating asthmatic patients: A multi-centered cross-sectional study in Ethiopia

Background:

Effective asthma management requires a multidisciplinary approach that includes; the physician, the patient, and the patient’s family.

Objectives:

The current study aimed to assess the roles played by community pharmacists toward asthma control together with the barriers hindering their practice and possible strategies to overcome those barriers.

Methods:

A multi-centered cross-sectional study was conducted. Data was collected using a structured, self-administered questionnaire adapted from previously conducted studies and customized to fit with the current study setup. The collected data was cleaned, coded, and entered into Statistical Package for Social Sciences (SPSS) version 21 for analysis. Descriptive analysis of the collected data was conducted and the results were presented using frequency tables and graphs.

Results:

A total of 122 community pharmacy professionals; 63 from Gondar, 26 from Bahir Dar, 15 from Debre Markos, 14 from Woldia, and 4 from Debre birhan participated in the study. About 96 (78.7%) of the participants reported that they teach their patients the basic facts about asthma. More than two-thirds of the participants 85 (69.7%) also reported that they were able to identify and manage the triggering factors of asthma for their patients. Lack of pharmacist time was reported by 78 (63.9%) of the study participants as a major reason for the inadequacy of the counseling service provided.

Conclusion:

It appears evident that there is a need for continuing professional education and pharmacists to receive additional training to improve their ability to go beyond identifying a problem and suggesting therapeutic options.

Barriers to Community Pharmacists' Provision of Diabetes Care Services in Iowa

Background:

Pharmacists are in a unique position to provide valuable patient care services to patients with diabetes. Even though many pharmacists have developed their diabetes care knowledge base and obtained credentials, they do not provide diabetes care on a regular basis, suggesting the existence of barriers to care other than knowledge and skills.

Objective:

To determine the barriers limiting the provision of diabetes care services in community pharmacy settings.

Methods:

Community pharmacists (N = 1,337) in Iowa were surveyed regarding (1) the types of diabetes care services provided, (2) reimbursement for services provided, (3) educational needs, (4) perceived barriers to providing diabetes services, and (5) demographics. A 46 item questionnaire was developed and mailed to participants with an addressed, stamped envelope. Nonrespondents were contacted by email or phone and asked to complete the questionnaire. Respondents' perceived barriers to diabetes care were compared based on their demographic characteristics.

Results:

Response rate to the questionnaire was 59.2%. Approximately 30% of respondents provided at least one diabetes care service. Of those respondents, 98% offered blood glucose meter training to their patients, and 64.7% offered patient education on diabetes topics. Issues pertaining to reimbursement, workload, and available time were the most limiting barriers to providing diabetes care services to their patients. Previously documented barriers such as patient attitudes, cultural/language barriers, store layout and patient privacy, and inadequate resources and start-up funds were not considered to be limiting by the respondents in this study.

Conclusions:

Provision of diabetes care services is higher than reported in earlier studies. While some barriers may no longer be as limiting as they were in the past decade, inadequate reimbursement, large workload, and lack of time continue to persist as the primary barriers cited by pharmacists who are charged with providing diabetes care.

Does hospitalization influence patients' medication adherence and community pharmacists' interventions?

BACKGROUND

Medication adherence reduces disease morbidity. Data regarding changes in a patient's adherence before and after hospitalization and how this hospitalization influences a pharmacist's interventions are scarce.

OBJECTIVE

To assess changes in adherence to cardiovascular and respiratory medications in the year preceding and following a hospitalization; explore patients' perceptions about medication adherence and the pharmacist's role; and describe pharmacists' interventions regarding medication adherence.

METHODS

This cohort study included patients hospitalized for acute coronary syndrome, acute worsening of heart failure, or acute COPD exacerbations. Adherence to cardiovascular and respiratory medications was measured by calculating the proportion of days covered (PDC) from prescription refills. Patient interviews were completed to explore their perceptions about medication adherence and the role of the pharmacist. Community pharmacists were invited to complete an online survey and to participate in focus groups to discuss interventions to improve medication adherence.

RESULTS

Medication adherence was assessed for 61 patients; the mean PDC was 69.8% 12 months before hospitalization and 72.4% 12 months following hospitalization. Patients reported that they felt the need to take their medications to prevent worsening of their disease. They were satisfied with current pharmaceutical services. A total of 136 questionnaires completed by pharmacists were analyzed and 9 participants attended the focus groups. Most pharmacists reported monitoring prescription renewals to assess adherence, with no significant influence from the hospitalization itself. The patient's interest was reported to be an important facilitator, whereas a lack of time and face-to-face interaction with patients who had their medication delivered to their home was reported a main barrier to interventions. This study was limited by a small sample size.

CONCLUSIONS

Patient medication adherence did not significantly change following hospitalization. Hospitalization does not appear to significantly influence patient and pharmacist behavior towards medication adherence.

Pharmacy students' attitudes toward pharmaceutical care in Riyadh region Saudi Arabia

AIM OF THE STUDY

The objectives of the study were to investigate and describe the attitude of Saudi pharmacy students toward pharmaceutical care.

METHOD

A survey of pharmacy students (8th-10th educational levels) was conducted from September to December 2006, in college of pharmacy King Saud University, Riyadh. The students completed a self-administered questionnaire designed to test the study objectives. The instrument (Standard Pharmaceutical Care Attitudes Survey, PCAS) used in the questionnaire was developed and revalidated in USA. Descriptive statistics on the sample characteristics and questionnaire items include means, standard deviation and frequency distribution. Student's t test and one-way ANOVA were used for inferential statistics.

RESULTS

A total of 214 students (85.6% response rate) completed the questionnaire. The Cronbach alpha was found to be 0.792. Of the respondents, 95.2% felt that pharmaceutical care movement will improve patient health, 94.9% thought that the practice of pharmaceutical care is valuable, 85% "strongly agree" or "agree" that all pharmacists should perform pharmaceutical care, whereas, about two third (64.5%) "strongly agree" or "agree" that students should perform pharmaceutical care during their clerkships. The rated scores and factor loading, which are used to determine items that belong to the group responses, were reported. Determination of communalities revealed no item had loading factor of <0.4 and therefore, the mean total score was computed to be 56.17 +/- 0.29019. Females had significantly higher positive attitudes than their male counterparts, and this were also associated with age and marital status.

CONCLUSION

Saudi pharmacy students in the study indicated favorable positive attitudes toward pharmaceutical care, and the attitude ratings were associated with age, sex and marital status. A nationwide survey including all pharmacy faculties would provide further evidence. The validity of PCAS needs cross validation in Saudi Arabia.

Factors Influencing a Community Pharmacist's Interventions in Asthma Care

Background:

Little is known about current pharmacists' interventions related to drug counselling and monitoring in asthma, along with the barriers and facilitators to these, in the province of Quebec.

Objectives:

To identify and explore organizational, relational and professional factors that influence community pharmacists' interventions in asthma care and propose solutions to overcome the barriers to these interventions.

Methods:

In 2006, a survey and an invitation to participate in a focus group were sent to community pharmacists in Quebec. Three focus groups were held to discuss the results of the survey about community pharmacists' interventions in asthma and the factors influencing these interventions, along with solutions to identified barriers. Each focus group lasted for approximately 120 minutes and was moderated by 2 investigators.

Results:

Seventeen community pharmacists participated in the study. One focus group was held with pharmacy owners, 1 with salaried pharmacists who graduated before 1990 and 1 with salaried pharmacists who graduated after 1996. Owners and salaried pharmacists of different years of graduation generally made the same comments. Most pharmacists reported intervening with asthma patients, especially when initial prescriptions were filled. Lack of time and unclear definition of tasks were reported as barriers. Solutions were proposed to resolve barriers, such as clearly defining tasks and ensuring quick access to support materials for patient education and drug monitoring.

Conclusion:

Community pharmacists report intervening in asthma care mostly when patients fill their initial prescription. Several barriers to follow-up interventions were identified.

Ontario Family Physician Readiness to Collaborate with Community Pharmacists on Drug Therapy Management: Lessons for Pharmacists

Background/Objective:

Collaboration between community pharmacists and physicians with respect to drug therapy management occurs relatively infrequently. There has been little research on physicians' views about such collaboration. The primary objective of this study was to assess Ontario family physicians' attitudes and readiness to collaborate with community pharmacists on drug therapy management.

Methods:

A 3-page survey instrument inquiring about 3 collaborative behaviours was distributed by fax or mail to a random sample of 848 family physicians and general practitioners across Ontario. Nonrespondents received 2 reminders.

Results:

The survey response rate was 36%. Most physicians reported conversing with a community pharmacist about a patient's drug therapy management 5 or fewer times per week, and very few said they used pharmacists as their primary source of medication information. Eighty-four percent reported that they regularly took community pharmacists' phone calls, while 78% reported that they sometimes sought pharmacists' recommendations regarding patient drug therapy. Only 28% reported that they sometimes referred their patients to community pharmacists for medication reviews, with 44% being unaware that such a service existed. Most comments were favourable, typically providing positive examples of collaboration with pharmacists. The most important identified advantage of collaborating with community pharmacists was more accurate medication lists. The main disadvantage identified was that pharmacists are constrained by not having access to key patient information (e.g., diagnosis, lab results, consultant reports). Additional barriers to collaboration reported by physicians included rotating pharmacists and perceived pharmacist interference with physicians' drug therapy plans.

Conclusion:

Overall, Ontario family physicians were engaged in limited collaboration with community pharmacists. By making an effort to increase the frequency of their direct professional interactions with physicians, pharmacists can enhance physician awareness of their willingness to provide patient-oriented services, thus facilitating collaboration.

Community pharmacists' interventions in asthma care: a descriptive study

BACKGROUND

Factors influencing community pharmacists' interventions have been identified, but little information is available regarding these factors in asthma care.

OBJECTIVE

To describe the type and frequency of pharmacists' asthma care interventions and to identify factors influencing those interventions.

METHODS

A pretested, self-administered questionnaire was mailed to all community pharmacists registered with the Ordre des pharmaciens du Québec in 2006. The form included questions about the pharmacists' interventions in asthma care in the community setting (21 questions), factors influencing the provision of those interventions (13 questions), and the responders' characteristics (17 questions).

RESULTS

A total of 4587 questionnaires were sent; 917 pharmacists returned the questionnaires (response rate 20%), and 877 were eligible for analysis. Overall, community pharmacists who completed the questionnaire appeared to intervene frequently when the initial prescription for asthma medication was filled. About 98% of responders reported providing verbal information always or often on new asthma medication prescriptions. Furthermore, checking for overuse of rescue medication and underuse of maintenance therapy always or often was reported by 91% and 85.8% of responders, respectively. Other interventions at follow-up were not as frequently reported. For example, only 8.4% of pharmacists reported reassessing inhalation technique always or often. Lack of time was reported to be an important barrier to the type and frequency of intervention, while interest on the part of the patient appeared to be a significant facilitator. About 99% of pharmacists agreed with the statement that they have an important role in asthma care.

CONCLUSIONS

Community pharmacists appear to intervene with patients with asthma mostly at the initiation of treatment, but some interventions at follow-up are not frequently done, which could be attributed to organizational factors.

Impact of a continuing education program on community pharmacists' interventions and asthma medication use: a pilot study

BACKGROUND

By upgrading the pharmacists' knowledge and skill set through continuing education (CE) programs, they could be better suited to contribute to the enhancement of the management of asthma.

OBJECTIVE

To assess the impact of an asthma CE program provided to community pharmacists on their knowledge, intervention frequency, and the appropriateness of asthma medication use.

METHODS

Community pharmacists were invited to participate in a CE program on asthma. Those who displayed an interest in the program were assigned to either a control or experimental group. Participants in the first group were not offered the CE program until the study was completed; the second group participated in the CE program at the onset of the study period. The knowledge on asthma of both groups of pharmacists was assessed using a questionnaire before the CE program, and the knowledge of the experimental group was reassessed after the CE program. Pharmacists were asked to document their interventions in the study log book over 6 months following the CE program. The appropriateness of asthma medication use was estimated by reviewing the prescription claims for a subgroup of patients covered by Québec's Public Prescription Drug Insurance Plan.

RESULTS

Pharmacists' knowledge improved after the CE program; however, the number of interventions reported during the 6 month period following the program was low and did not differ significantly between the groups, with an average of 3.04 per pharmacy in the experimental group versus 3.26 in the control group. The appropriateness of asthma medication use did not improve once the CE program had been completed.

CONCLUSIONS

Our CE program had little impact on the number of interventions by community pharmacists and the appropriateness of asthma medication use.

Community and ambulatory pharmacy: evaluation of patient care services and billing patterns before implementation of Medicare part D

OBJECTIVE

To provide a summary of community and ambulatory pharmacy practice and billing patterns for medication therapy management services before implementation of Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA).

DESIGN

Cross-sectional survey.

SETTING

Ambulatory care and community pharmacy practice settings in the United States in January 2004.

PARTICIPANTS

Members of the American College of Clinical Pharmacy Ambulatory Practice and Research Network, preceptors of the American Pharmacists Association (APhA) Community Pharmacy Residency Programs, and participants in the APhA Immunizing Pharmacist listserv.

INTERVENTIONS

E-mail invitations to participate in a Web-based survey.

MAIN OUTCOME MEASURES

Practice setting; pharmacy services performed; whether pharmacists were billing for pharmacy services; if billing, the billing technique used; if not billing, the reason for not billing.

RESULTS

Of 349 respondents, 127 (36.4%) were practicing within a physician office, while 121 (34.7%) were practicing in community pharmacies. Diabetes, anticoagulation, dyslipidemia, hypertension, and smoking cessation management services were performed significantly more often in physician offices. Immunization delivery and diabetes, dyslipidemia, and osteoporosis screenings were performed significantly more often in community settings. A total of 190 (54.5%) pharmacists stated that they were billing for pharmacy services. More community pharmacists were billing for services compared with other combined practice settings (69.2% versus 46.7%, P < .001). Top reasons identified for not billing for services were salaried position, indigent population, and discomfort with the billing process.

CONCLUSION

Valuable baseline data are provided regarding pharmacy services that have been successfully implemented in ambulatory and community practice settings and which billing techniques were used to receive reimbursement before the implementation of MMA.

Role theory: literature review and implications for patient-pharmacist interactions

BACKGROUND

There is a need to describe how role theory has been used by researchers to describe various phenomena in pharmacy so as to identify gaps in knowledge and future research priorities.

OBJECTIVE

The primary purpose of this article is to review how role theory has been used in the community pharmacy literature. Secondary objectives are to (1) examine the use of role theory over the evolution of the profession of pharmacy, (2) determine what role theory perspectives have been used, (3) explore the implications of role theory for patient-pharmacist interactions, and (4) explore implications for future pharmacy research using role theory.

METHODS

A literature search of Web of Knowledge and International Pharmaceutical Abstracts was conducted. Articles were included if they examined some aspect of role theory in community pharmacy and were categorized based on their role theory perspective and "era" of pharmacy in which they were published.

RESULTS

Thirty research articles were identified spanning from 1956 to 2004 with the majority (19 studies) using mail surveys. Articles used functionalist (9 studies), organizational (7), functional and organization (4), cognitive (10), and symbolic interactionist (1) perspectives to role theory. The number of articles using role theory has been increasing over time. The functional and symbolic interactionist perspectives provide rich descriptions of the multiple pharmacy roles and allow for a clearer understanding of the barriers affecting actors' experience. Using an organization perspective, role stressors such as role conflict, ambiguity, and overload were found to impact pharmacists' worklife. Cognitive role theory research has clearly shown that pharmacists' and patients' expectations for the encounter shape interaction.

CONCLUSIONS

The use of role theory informs both researchers and practitioners about the practice of pharmacy and patient interactions. Still, there is much work to be done in role theory and pharmacy research. Experimental designs, longitudinal studies, and qualitative research methodologies may warrant greater use and attention. Role change should be identified as a priority, and research is needed to elucidate what interventions change patients' and pharmacists' expectations of the patient-pharmacist interaction.

Attitudes of Nigerian pharmacists towards pharmaceutical care

OBJECTIVE

To explore Nigerian pharmacists' attitudes towards pharmaceutical care, and determine significant attitudinal differences in different practice settings.

METHOD

A 25-item self-completion pre-tested and validated questionnaire was administered to a convenience sample of 1500 pharmacists in Nigeria. Data were gathered on a Likert-type rating scale. Descriptive statistics including frequencies and mean scores, and significant attitudinal differences on sample characteristics were computed.

MAIN OUTCOME MEASURE

Pharmacists' opinions on multi-item pharmaceutical care attitudinal scale.

RESULT

The national survey achieved 67% response rate. About three-quarters (76%, n = 1005) of the respondents indicated willingness to embrace pharmaceutical care. Nearly all the pharmacists (96%) believed pharmaceutical care would enhance patients' appreciation of the pharmacist and 84% reported their intention to practice pharmaceutical care even if there is no additional income. An overwhelming 93% said that they would participate in any training program to enable them to practice pharmaceutical care, while less than a quarter (20%) claimed their pharmacy layout was suited for patient-centered practice. Three quarters (75%) of the respondents indicated positive attitude towards pharmaceutical care. Both male and female genders, all age groups, different levels of professional experience, and pharmacists in hospital, community, industrial and administrative practice settings had similar positive attitude scores. Only pharmacists' professional experience appeared to have a significant influence on attitude scores (F = 5.267; P = 0.001), with scores varying with the level of professional experience.

CONCLUSION

The study has shown that the attitudes of Nigerian pharmacists towards pharmaceutical care are favorably high irrespective of the practice settings. The attitude ratings vary with the levels of professional experience, with pharmacists having less experience showing more positive attitude. Nigerian pharmacists indicated willingness to implement pharmaceutical care but expressed major concerns about their knowledge, professional skills, and pharmacy layout. Gradual introduction of pharmaceutical care would be logical.

Using buzz marketing to promote ideas, services, and products

OBJECTIVE

To (1) discuss buzz marketing, contrast it with traditional forms of promotional communications, and provide guidelines for use and (2) describe a successful buzz-marketing program used by Sentara Healthcare to decrease overuse and inappropriate use of antibiotic medications.

DATA SOURCES

An English-language-only literature search of ABI Inform, Lexus-Nexus, InfoTrac, and university library databases from 1980 to the present using the keywords buzz, word of mouth, opinion leader, and thought leader. Articles and books were cross referenced for other works of interest.

STUDY SELECTION

Performed by the author for their contribution to an exploratory analysis of this topic.

DATA EXTRACTION

Performed by the author.

DATA SYNTHESIS

Buzz marketing is an indirect communications method that has been used successfully in the promotion of a wide variety of products, services, and ideas. By identifying and cultivating nonmedia opinion leaders, the technique generates word-of-mouth communications between these early adopters of products and services and the early and late majority of people who tend to follow their lead. Opinion leaders can be categorized as ordinary or extraordinary, technical or social, and specialist or generalist, depending on the nature of their communications, expertise, and range of knowledge. Buzz marketing is most useful for ideas that are memorable, produce small changes in behavior that have big effects over time, and have the potential to reach a "tipping point" in terms of momentum among a target population. Pharmacists can use buzz marketing for promoting innovative services such as pharmaceutical care. A case study is presented on the use of buzz marketing by a health system for decreasing antibiotic resistance through lessening of public demand for antibiotics and support of physicians in prescribing the agents appropriately.

CONCLUSION

Buzz marketing is a potent force in the promotion of pharmaceuticals and can be used by pharmacists. It works best when patients perceive the benefits of innovations. Providing samples and demonstrations of the innovation will foster positive perceptions. Innovations also spread better when they are compatible with the needs, desires, and preferences of individuals and can be adapted to the unique situation of the adopter.

Pharmacist Compensation for Cognitive Services: Focus on the Physician Office and Community Pharmacy

We provide a stepwise approach for the clinical pharmacy practitioner in the physician clinic or community pharmacy setting to secure compensation for cognitive services. How to establish compensation for pharmacist services is explored, including evaluating the payer mix, developing a relationship with the first- or third-party payer, becoming credentialed with a third-party payer, and creating a fee structure. We detail the physical process of billing, which involves completing appropriate billing forms, appropriately using billing codes, documenting cognitive services in the patient record, and obtaining the proper waivers and/or approvals to provide specific services such as laboratory services and immunizations. This comprehensive review of compensation for cognitive services available in the community pharmacy and physician office environment is designed to be a template for pharmacists to further develop specific strategies, implement fee structures, and obtain compensation in their pharmacy environment and payer mix. Exploration into these innovative markets will enable pharmacists to increase revenue as they enhance and expand their cognitive services for patients.

Pharmaceutical care in chain pharmacies: beliefs and attitudes of pharmacists and patients

OBJECTIVE

To discuss with pharmacists and patients with reactive airways disease their beliefs about pharmaceutical care and the pharmacist's role in health care, obstacles to providing pharmaceutical care in community pharmacies, and strategies to overcome these obstacles.

DESIGN

Two focus groups of patients, two focus groups of pharmacists.

PARTICIPANTS

Thirteen patients with reactive airways disease and 11 chain pharmacists.

MAIN OUTCOME MEASURES

Qualitative reports on the pharmacist's role in health care delivery and obstacles to implementing pharmaceutical care programs.

RESULTS

Pharmacists wished to provide pharmaceutical care, and patients were supportive of pharmacists' involvement in their health care. Both viewed counseling as an important role for pharmacists and believed that pharmacists should work with patients' physicians. Reported obstacles included lack of time, inadequate privacy, and pharmacists' lack of direct access to patients' physicians. Pharmacists and patients believed pharmacists should have access to patient-specific clinical data.

CONCLUSION

Focus groups provided valuable information for designing pragmatic pharmaceutical care. The obstacles and possible solutions identified through the discussions represent fertile ground for designing innovative pharmaceutical care programs.

Pharmacists' understanding of patient education on metered-dose inhaler technique

OBJECTIVE

To assess pharmacists' attitudes, beliefs, and knowledge about assessing and educating patients regarding metered-dose inhaler (MDI) technique; to determine frequency of MDI assessment and teaching behavior; and to assess the effect of an asthma pharmaceutical care educational program on the same variables six months later.

DESIGN

Questionnaire completed before and six months after the educational intervention.

SETTING

Pharmacies based in clinics owned by a healthcare system located in communities of a large metropolitan area.

MAIN OUTCOMES MEASURES

Pharmacists' self-reported frequency of assessment and education; attitudes and beliefs about assessing and educating patients using MDIs; and knowledge of MDI technique.

RESULTS

The survey response rate was 53.7% (n = 39) for baseline and 43% (n = 32) for follow-up. Most pharmacists (85.4% at baseline, 87.5% at follow-up; p = 0.79) indicated that they educate patients receiving new MDI prescriptions. In addition, 47.4% at baseline and 68.8% at follow-up indicated they educate patients using inhalers for three months (p = 0.07). Only 21.1% at baseline and 18.8% at follow-up (p = 0.81) indicated that they follow up with long-term users. The mean +/- SD MDI technique knowledge score (steps correct out of 9 possible) at baseline was 7.2 +/- 1.1 and 7.5 +/- 1.3 at follow-up (p = 0.29). Significant changes in level of agreement with some beliefs/attitudes were observed, including the importance of frequently assessing/educating patients, confidence and comfort when assessing/educating patients, and that assessing/educating patients is not the role of only the physician. Respondents continued to acknowledge that MDI education and assessment are important to improving and maintaining control of disease. However, the respondents thought that barriers exist that inhibit this activity, such as not enough time for education and assessment.

CONCLUSIONS

Pharmacists reported they frequently educate patients and assess MDI technique for new prescriptions but not very often for patients recently started, as well as for long-term users. Six months after an educational program, attitudes and beliefs toward this activity were either not changed or, in some, improved. Pharmacists perceive that there is not enough time to assess and educate patients who use MDIs.

Patients' willingness to pay for pharmaceutical care

OBJECTIVE

To determine the level at which patients receive pharmaceutical care services and their willingness to pay for comprehensive pharmaceutical care services.

DESIGN

A mail survey was sent to 2,500 adults in the United States.

SETTING

Surveys were mailed to subjects' homes.

PATIENTS OR OTHER PARTICIPANTS

Subjects were randomly selected from a marketing database that included representation from each of the 50 states of the United States.

INTERVENTION(S)

The survey provided a description of comprehensive pharmaceutical care, and survey items asked about the level of care subjects were receiving and their willingness to pay for these services.

MAIN OUTCOME MEASURES

Level of various pharmacy services subjects reported receiving, and the dollar amount subjects were willing to pay for comprehensive pharmaceutical care.

RESULTS

The majority of the subjects were not receiving pharmaceutical care services. The average amount all respondents were willing to pay for these services was $13 for a one-time consultation and $28 for this plus 1 year of monitoring. Looking only at those respondents willing to pay (56%), the means rise to $23 and $50, respectively.

CONCLUSION

A majority of patients are willing to pay for pharmaceutical care services, even if they are not now receiving this level of care. Direct payment from patients who recognize the therapeutic benefits of pharmaceutical care may be a more viable option than is generally believed, at least until the profession can prove pharmaceutical care's utility and cost-effectiveness to third party payers.

An exploratory study of community pharmacy practice change

OBJECTIVES

(1) To compare the resources and practitioner activities in community pharmacies that have changed practice with those in pharmacies that have not changed; and (2) in pharmacies that have changed practice, to identify factors affecting a pharmacy's ability to support pharmacy practice change.

DESIGN

Multiple-case design, in which six pharmacies were studied in depth.

SETTING

Six independent community pharmacies in Iowa.

PARTICIPANTS

Pharmacy owners.

INTERVENTION

A mail survey and an on-site personal interview were used to collect information about the pharmacy's practice changes and influences on the practice change process.

MAIN OUTCOME MEASURES

14 criteria of pharmacy practice change and 5 types of influences on change (environmental variables, organizational variables, owner/manager characteristics, strategy-making features, attributes of change).

RESULTS

Three pharmacies had made considerable change, one had made some change, and two had made little or no change. After a broad set of initial changes, subsequent changes tended to be made incrementally. A variety of factors were identified that support pharmacy practice change. Most of the factors were associated with improving resources, such as upgraded staff skills, involvement in demonstration projects, regular environmental scanning, and regular interaction with advocates for pharmacy practice change (e.g., college of pharmacy, pharmacy associations, innovative practitioners). Also, experienced owners who looked to the future and actively addressed constraints were associated with making pharmacy practice change.

CONCLUSION

Practitioners and other interested parties should consider a broad array of activities when trying to facilitate pharmacy practice change. Researchers can use these findings to develop studies that will provide stronger scientific evidence that can contribute to a model of pharmacy practice change. The continued study of pharmacy practice change can assist pharmacists working to translate a philosophy of pharmaceutical care into daily practice.

Pharmacy service alliances: a tool to reduce uncertainty and create new revenue streams

OBJECTIVES

(1) Present conceptual support for a type of pharmacy network, a pharmacy service alliance (PSA), (2) describe the development of a PSA in eastern Iowa, and (3) discuss how other types of PSAs can be developed.

DESIGN AND PARTICIPANTS

12 independent pharmacies in eastern Iowa.

SETTING

Community pharmacy practice.

MAIN OUTCOME MEASURES

Formation of a PSA.

RESULTS

Pharmacy members of the Certified Pharmaceutical Care Network, a PSA, have jointly developed new pharmacy services. Collaborative efforts have involved disease state management programs, group marketing activities, and a quality improvement process.

CONCLUSION

PSAs offer an organizational model that pharmacies could use to successfully develop new pharmacy services.

Characteristics of pharmacies and pharmacists associated with the provision of cognitive services in the community setting

OBJECTIVE

To determine the influence of payment, pharmacy setting characteristics, pharmacist demographics, practice setting, and attitudinal characteristics on whether cognitive services (CS) were performed by pharmacists, and the volume of CS performed.

DESIGN

Prospective randomized trial. Community pharmacies were randomized to a documentation-and-payment group (study group) and a documentation-only group (control). Participating pharmacies and pharmacists were surveyed by mail, and responses were linked to a documented CS database.

SETTING

Community pharmacies serving ambulatory Medicaid patients in the state of Washington, excluding health maintenance organization pharmacies and pharmacies predominantly serving long-term care residents.

PARTICIPANTS

200 community pharmacies and their pharmacists (110 study, 90 control) participating in the Washington State Cognitive Activities and Reimbursement Effectiveness (CARE) Project.

INTERVENTION

Payment for CS. All participants documented CS. Study group pharmacies billed Medicaid for services performed in identifying and resolving drug therapy-related problems.

MAIN OUTCOME MEASURE

Documentation of CS.

RESULTS

Documentation of CS was more likely if the pharmacist was an owner or manager, if documentation was not perceived as burdensome, and if the pharmacy had a low ratio of prescription to total sales. Higher documentation rates were associated with study group status, lower pharmacy prescription volume as a percentage of total sales, and a higher percentage of prescriptions billed to Medicaid. Among pharmacists, two setting variables--medical center location and rural location--were associated with higher documentation rates.

CONCLUSION

Performance of CS was strongly affected by payment and other situational factors, including practice setting and volume of prescriptions dispensed. Pharmacies and pharmacists were also more likely to perform CS if the target patient population represented a relatively large percentage of that pharmacy's patient clientele.

Michigan Medicaid recipients' perceptions of medication counseling as required by OBRA '90

OBJECTIVE

To assess pharmacist counseling under OBRA '90 from the Medicaid recipient's perspective. Specifically, the study was designed to (1) assess pharmacists' compliance with counseling requirements, (2) assess recipients' level of satisfaction with the information provided during counseling and whether the information provided increased their comfort level in taking medication correctly, and (3) determine relationships between variables associated with pharmacist counseling and recipient satisfaction and comfort level.

DESIGN

Cross-sectional telephone survey of Medicaid recipients. Medicaid recipient or caregiver was the unit of measure.

SETTING

Michigan.

PATIENTS

408 recipients who received new prescriptions during a one-week period in November 1995.

INTERVENTIONS

Telephone survey.

MAIN OUTCOME MEASURE

Recipients' perception of whether an offer to counsel was made.

RESULTS

Only 104 (25.5%) recipients indicated that someone offered counseling for their new prescription, and only 62 (15.2%) recipients indicated they knew of the requirement; 163 (40.0%) indicated someone offered counseled them. Counseled recipients were satisfied with the amount, quality, and way the information was presented, and were more likely to assign a higher level of importance to pharmacist counseling. The majority of respondents indicated high levels of comfort in using their medications safely, with those who were counseled expressing a higher level of comfort.

CONCLUSION

From the perspective of the Medicaid recipient, pharmacies are failing to offer counseling for most new prescriptions. The results indicate that counseling improves measures of recipient comfort in using medications safely and enhances the level of importance patients assign to pharmacist counseling.