Browsing by Subject "Community pharmacy"

Now showing 1 - 8 of 8
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    Community Pharmacist-Provided Opioid Intervention Frequencies and Barriers
    (Elsevier, 2023) Nichols, Molly A.; Kepley, Kristen L.; Rosko, Kylee S.; Suchanek Hudmon, Karen; Curran, Geoffrey M.; Ott, Carol A.; Snyder, Margie E.; Miller, Monica L.; Medicine, School of Medicine
    Background: Community pharmacists are well-positioned to engage in opioid-related harm reduction activities (i.e., opioid interventions). However, several barriers to providing these interventions have been identified. Comparing the frequencies of opioid interventions and identifying which barriers are perceived to have the highest impact in providing interventions will yield valuable information for increasing opioid use disorder (OUD) care access within pharmacies. Objectives: To (1) characterize the frequency of 9 opioid interventions in community practice settings and (2) assess community pharmacists' perceptions of what impact 15 key barriers have on providing opioid interventions. Methods: This was a multi-state, cross-sectional, and descriptive survey study. Opioid interventions evaluated included prevention (e.g., OUD screening) and treatment (e.g., OUD resource referral); barriers encompassed confidence and knowledge, work environment, provider interactions, and patient interactions. Respondents were recruited from 3 community pharmacy practice-based research networks in the Midwest and South regions of the US. Recruitment and telephone survey administration occurred between December 2021 and March 2022. Descriptive statistics were computed and open-ended items were reviewed to identify common themes. Results: Sixty-nine of 559 pharmacists contacted (12.3%) completed the survey. All opioid interventions were reported to be provided less frequently than indicated in practice. Screening and referral interventions were provided least frequently, at 1.2 and 1.6 times on average, respectively, to the last 10 patients for which respondents felt each intervention was needed. Patient refusal, minimal or no reimbursement, inadequate staffing and time, and negative patient reactions were identified as the highest-impact barriers to providing opioid interventions. Approximately 26% of respondents agreed or strongly agreed that pharmacy school adequately prepared them to provide opioid interventions in practice. Conclusion: Prioritizing the resolution of pharmacy work environment barriers will support pharmacists in routinely providing opioid interventions. Changes in Doctor of Pharmacy curricula and continuing education are also indicated to further prepare pharmacists to engage in opioid-related harm reduction.
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    Community Pharmacy Technicians’ Engagement in the Delivery of Brief Tobacco Cessation Interventions: Results of a Randomized Trial
    (Elsevier, 2022) Corelli, Robin L.; Merchant, Kyle R.; Ellis Hilts, Katy; Kroon, Lisa A.; Vatanka, Parisa; Hille, Brian T.; Suchanek Hudmon, Karen; School of Nursing
    Background: In recent years, the role of community pharmacy technicians has expanded to include involvement in the provision of brief tobacco cessation interventions. While technicians appear to be a key component in this service, their level of engagement and associated perceptions of this new role have not been described. Objective: To compare pharmacy technicians' frequency of involvement in brief tobacco cessation interventions delivered in a community pharmacy setting, as a function of training approach, and to characterize their perceptions of this expanded role, including barriers to implementation. Methods: Twenty California-based grocery store chain pharmacies were randomized to receive (a) written training materials-only [minimal] or (b) written training materials plus live training with coaching and active monitoring by pharmacy management [intensive]. After written materials were distributed to the sites, tobacco cessation interventions were documented prospectively for 12 weeks post-training. Results: Over the 12-week study, technicians (n = 50) documented their involvement in 524 interventions (57.7% of 908 total), with the minimal group accounting for 56.1% and the intensive group accounting for 43.9% (p < 0.001). The number of individual technicians who reported at least one intervention was 16 (of 26; 61.5%) in the minimal group and 24 (of 24; 100%) in the intensive group (p < 0.001). At the conclusion of the study, 100% of technicians in the intensive group self-rated their ability to interact with patients about quitting smoking as good, very good, or excellent compared to 73.9% in the minimal group (p = 0.10). Conclusion: In both study arms, technicians documented high numbers of tobacco cessation interventions. The higher proportion of technicians providing one or more interventions in the intensive group suggests a greater overall engagement in the process, relative to those receiving minimal training. Technicians can play a key role in the delivery of tobacco cessation interventions in community pharmacies.
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    An Evaluation of the Spread and Scale of PatientToc™ from Primary Care to Community Pharmacy Practice for the Collection of Patient-Reported Outcomes: A Study Protocol
    (Elsevier, 2021) Snyder, Margie E.; Chewning, Betty; Kreling, David; Perkins, Susan M.; Knox, Lyndee M.; Adeoye-Olatunde, Omolola A.; Jaynes, Heather A.; Schommer, Jon C.; Murawski, Matthew M.; Sangasubana, Nisaratana; Hillman, Lisa A.; Curran, Geoffrey M.; Biostatistics and Health Data Science, School of Medicine
    Background: Medication non-adherence is a problem of critical importance, affecting approximately 50% of all persons taking at least one regularly scheduled prescription medication and costing the United States more than $100 billion annually. Traditional data sources for identifying and resolving medication non-adherence in community pharmacies include prescription fill histories. However, medication possession does not necessarily mean patients are taking their medications as prescribed. Patient-reported outcomes (PROs), measuring adherence challenges pertaining to both remembering and intention to take medication, offer a rich data source for pharmacists and prescribers to use to resolve medication non-adherence. PatientToc™ is a PROs collection software developed to facilitate collection of PROs data from low-literacy and non-English speaking patients in Los Angeles. Objectives: This study will evaluate the spread and scale of PatientToc™ from primary care to community pharmacies for the collection and use of PROs data pertaining to medication adherence. Methods: The following implementation and evaluation steps will be conducted: 1) a pre-implementation developmental formative evaluation to determine community pharmacy workflow and current practices for identifying and resolving medication non-adherence, potential barriers and facilitators to PatientToc™ implementation, and to create a draft implementation toolkit, 2) two plan-do-study-act cycles to refine an implementation toolkit for spreading and scaling implementation of PatientToc™ in community pharmacies, and 3) a comprehensive, theory-driven evaluation of the quality of care, implementation, and patient health outcomes of spreading and scaling PatientToc™ to community pharmacies. Expected impact: This research will inform long-term collection and use of PROs data pertaining to medication adherence in community pharmacies.
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    Implementing Brief Tobacco Cessation Interventions in Community Pharmacies: An Application of Rogers’ Diffusion of Innovations Theory
    (MDPI, 2022-05-30) Hilts, Katy Ellis; Corelli, Robin L.; Prokhorov, Alexander V.; Zbikowski, Susan M.; Zillich, Alan J.; Hudmon, Karen Suchanek; Health Policy and Management, School of Public Health
    Pharmacists, as highly accessible members of the healthcare team, have considerable potential to address tobacco use among patients. However, while published data suggest that pharmacists are effective in helping patients quit, barriers exist to routine implementation of cessation services in community pharmacy settings. Within the context of a randomized trial (n = 64 pharmacies), surveys were administered over a period of 6 months to assess pharmacists' perceptions of factors associated with the implementation of "Ask-Advise-Refer", a brief intervention approach that facilitates patient referrals to the tobacco quitline. Study measures, grounded in Rogers' Diffusion of Innovations Theory, assessed pharmacists' perceptions of implementation facilitators and barriers, perceptions of intervention materials provided, and perceived efforts and personal success in implementing Ask-Advise-Refer at 6-months follow-up. Findings indicate that while the brief intervention approach was not difficult to understand or implement, integration into normal workflows presents greater challenges and is associated with overall confidence and implementation success. Lack of time was the most significant barrier to routine implementation. Most (90.6%) believed that community pharmacies should be active in promoting tobacco quitlines. Study results can inform future development of systems-based approaches that lead to broad-scale adoption of brief interventions, including but not limited to tobacco cessation, in pharmacy settings.
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    Improving over-the-counter medication safety for older adults: A study protocol for a demonstration and dissemination study
    (Elsevier, 2017-09) Chui, Michelle A.; Stone, Jamie A.; Holden, Richard; Medicine, School of Medicine
    BACKGROUND: Adverse drug events (ADEs) associated with over-the-counter (OTC) medications cause 178,000 hospitalizations each year. Older adults, aged 65 and older, are particularly vulnerable to ADEs. Of the 2.2 million older adults considered at risk for a major ADE, more than 50% are at risk due to concurrent use of an OTC and prescription medication. OBJECTIVES: To refine the intervention and implementation strategy through diagnostic and formative evaluation; to evaluate the effectiveness of the intervention for preventing misuse of high-risk OTC medications by older adults; and to evaluate the implementation of the intervention in community pharmacies. METHODS: A system redesign intervention to decrease high-risk OTC medication misuse will be tested to reduce misuse by improving communication between older adults and community pharmacists via the following features: a redesign of the physical environment to sensitize older adults to high-risk OTC medications, and the implementation of a clinical decision tool to support the pharmacist when critically evaluating the older adult's health status. The study will be conducted in three phases: a participatory design phase, a beta phase, and a test phase. The test phase will be conducted in three mass-merchandise stores. A total of 144 older adults will be recruited. A pre (control)/post (intervention) test will determine the effectiveness of the intervention. The primary outcome will be a comparison of proportion of older adults who misuse OTC medication from baseline to post-intervention. The process of implementation in the community pharmacy setting will be evaluated using the taxonomy proposed by Proctor et al. The participatory design phase has been approved by the institution's IRB (2016-0743). PROJECTED IMPACT: It is anticipated that this project, which focuses on achieving systems-based improvement in an underemphasized area of the medication use process, will reduce ADEs associated with inappropriate OTC medication use in older adults.
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    Preparing for the spread of patient-reported outcome (PRO) data collection from primary care to community pharmacy: a mixed-methods study
    (BMC, 2022-03-14) Adeoye‑Olatunde, Omolola A.; Curran, Geoffrey M.; Jaynes, Heather A.; Hillman, Lisa A.; Sangasubana, Nisarata; Chewning, Betty A.; Kreling, David H.; Schommer, Jon C.; Murawski, Matthew M.; Perkins, Susan M.; Snyder, Margie E.; Medicine, School of Medicine
    Background: Medication non-adherence is a significant public health problem. Patient-reported outcomes (PROs) offer a rich data source to facilitate resolution of medication non-adherence. PatientToc™ is an electronic PRO data collection software originally implemented at primary care practices in California, United States (US). Currently, the use of standardized PRO data collection systems in US community pharmacies is limited. Thus, we are conducting a two-phase evaluation of the spread and scale of PatientToc™ to US Midwestern community pharmacies. This report focuses on the first phase of the evaluation. The objective of this phase was to prepare for implementation of PatientToc™ in community pharmacies by conducting a pre-implementation developmental formative evaluation to (1) identify potential barriers, facilitators, and actionable recommendations to PatientToc™ implementation and (2) create a draft implementation toolkit. Methods: Data collection consisted of demographics, observations, audio-recorded contextual inquiries, and semi-structured interviews with staff (e.g., primary care providers, pharmacists, pharmacy technicians) and patients during 1-day site visits to a purposive sample of (1) primary care practices currently using PatientToc™ and (2) community pharmacies in Indiana, Wisconsin, and Minnesota interested in the future use of PatientToc™. Post-visit site observation debriefs were also audio-recorded. Verbatim transcripts of all recordings were coded using deductive/inductive approaches and intra-/inter-site summaries were produced identifying potential barriers, facilitators, and actionable recommendations mapped to the Consolidated Framework for Implementation Research constructs. A stakeholder advisory panel engaged in an Evidence-Based Quality Improvement (EBQI) implementation process. This included "member checking" and prioritizing findings, and feedback on the adapted PatientToc™ application, implementation strategies, and accompanying toolkit for community pharmacy implementation. Results: Two primary care practices, nine pharmacies, and 89 individuals participated. Eight major themes (four barriers and four facilitators) and 14 recommendations were identified. Throughout the four EBQI sessions, the panel (1) confirmed findings; (2) designated high priority recommendations: (a) explain PatientToc™ and its benefits clearly and simply to patients, (b) ensure patients can complete questionnaires within 10 min, and (c) provide hands-on training/resources for pharmacy teams; and (3) provided feedback on the adapted PatientToc™ application and finalized toolkit items for initial community pharmacy implementation. Conclusions: Adoption of electronically captured PROs in community pharmacies is warranted. The implementation strategies systematically developed in this study can serve as a model for implementation of technology-driven health information patient care services, in the understudied context of community pharmacies.
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    Promoting pharmacy-based referrals to the tobacco quitline: a pilot study of academic detailing administered by pharmacy students
    (Sage, 2015) Wahl, Kimberly R.; Woolf, Brittany L.; Hoch, Matthew A.; Zillich, Alan J.; Suchanek Hudmon, Karen; Medicine, School of Medicine
    Objective: To conduct a pilot study of a student-delivered academic detailing initiative to promote brief, pharmacy-based tobacco cessation interventions, and referrals to the tobacco quitline. Methods: Pharmacy students (n = 11) received training and delivered academic detailing sessions for promoting brief tobacco cessation interventions at community pharmacies (n = 37). Six months after the session, a survey was faxed to each pharmacy to assess (1) the quality and acceptance of the academic detailing session and the materials provided during the session and (2) tobacco cessation counseling perceptions and practices. Results: Pharmacists from 30 (81%) sites responded to the survey; of these, 37% reported that they increased the number of patients asked about smoking since the academic detailing session, 70% reported an increase in the number of participants advised to quit smoking, 57% reported an increase in the number of patients counseled, and 50% reported routinely providing referrals to the tobacco quitline. Conclusion: pharmacy students are capable of providing academic detailing for brief tobacco cessation interventions in community pharmacies. Results of this pilot study suggest a positive impact of this service on pharmacists' counseling behavior for tobacco cessation.
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    Role of the community pharmacist in emergency contraception counseling and delivery in the United States: current trends and future prospects
    (Dove Press, 2017-03-23) Rafie, Sally; Stone, Rebecca H.; Wilkinson, Tracey A.; Borgelt, Laura M.; El-Ibiary, Shareen Y.; Ragland, Denise; Pediatrics, School of Medicine
    Women and couples continue to experience unintended pregnancies at high rates. In the US, 45% of all pregnancies are either mistimed or unwanted. Mishaps with contraceptives, such as condom breakage, missed pills, incorrect timing of patch or vaginal ring application, contraceptive nonuse, forced intercourse, and other circumstances, place women at risk of unintended pregnancy. There is a critical role for emergency contraception (EC) in preventing those pregnancies. There are currently three methods of EC available in the US. Levonorgestrel EC pills have been available with a prescription for over 15 years and over-the-counter since 2013. In 2010, ulipristal acetate EC pills became available with a prescription. Finally, the copper intrauterine device remains the most effective form of EC. Use of EC is increasing over time, due to wider availability and accessibility of EC methods. One strategy to expand access for both prescription and nonprescription EC products is to include pharmacies as a point of access and allow pharmacist prescribing. In eight states, pharmacists are able to prescribe and provide EC directly to women: levonorgestrel EC in eight states and ulipristal acetate in seven states. In addition to access with a prescription written by a pharmacist or other health care provider, levonorgestrel EC is available over-the-counter in pharmacies and grocery stores. Pharmacists play a critical role in access to EC in community pharmacies by ensuring product availability in the inventory, up-to-date knowledge, and comprehensive patient counseling. Looking to the future, there are opportunities to expand access to EC in pharmacies further by implementing legislation expanding the pharmacist scope of practice, ensuring third-party reimbursement for clinical services delivered by pharmacists, and including EC in pharmacy education and training.