INNOVATIONS in pharmacy (Iip - E-Journal)
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Criteria-based Certification and Validation of Online Pharmacies: Opportunities for Improved Quality and Safety
Get PDFObjectives: The objective of this study was to explore the conformity of online sites with established quality standards.
Methods: Online pharmacies with the NABP Verified Internet Pharmacy Practice Sites (VIPPS) designation were scrutinized for their conformity with select criteria established by the National Association of Board of Pharmacies (NABP) and FDA consumer guidelines.
Results: 36 VIPPS certified online pharmacy sites were included in the study. The sites were examined against VIPPS and FDA standards. The criteria related to the design and content of the web site and to the pharmaceutical services being offered through the site. Lack of clear terminological distinction between “online pharmacy” (a business) and “online site” (a tool for a business) was problematic. Sites did not adhere to uniform design principles. The scope and availability of pharmaceutical services for online consumers were not readily apparent.
Conclusion: The very legitimacy of existing criteria for online pharmacies remains to be established. Significant opportunities exist to improve the quality and scope of policies and to tie them more closely to longstanding best-practices in areas such as web usability and pharmaceutical care. Revision recommendations for VIPPS criteria are discussed.
Type: Original Researc
Integration of Rural Community Pharmacies into a Rural Family Medicine Practice-Based Research Network: A Descriptive Analysis
Get PDFPurpose: Practice-based research networks (PBRN) seek to shorten the gap between research and application in primary patient care settings. Inclusion of community pharmacies in primary care PBRNs is relatively unexplored. Such a PBRN model could improve care coordination and community-based research, especially in rural and underserved areas. The objectives of this study were to: 1) evaluate rural Appalachian community pharmacy key informants’ perceptions of PBRNs and practice-based research; 2) explore key informants’ perceptions of perceived applicability of practice-based research domains; and 3) explore pharmacy key informant interest in PBRN participation.
Methods: The sample consisted of community pharmacies within city limits of all Appalachian Research Network (AppNET) PBRN communities in South Central Appalachia. A descriptive, cross-sectional, questionnaire-based study was conducted from November 2013 to February 2014. Bivariate and multivariate analyses were conducted to examine associations between key informant and practice characteristics, and PBRN interest and perceptions.
Findings: A 47.8% response rate was obtained. Most key informants (88%) were very or somewhat interested in participating in AppNET. Enrichment of patient care (82.8%), improved relationships with providers in the community (75.9%), and professional development opportunities (69.0%) were perceived by more than two-thirds of respondents to be very beneficial outcomes of PBRN participation. Respondents ranked time constraints (63%) and workflow disruptions (20%) as the biggest barriers to PBRN participation.
Conclusion: Key informants in rural Appalachian community pharmacies indicated interest in PBRN participation. Integration of community pharmacies into existing rural PBRNs could advance community level care coordination and promote improved health outcomes in rural and underserved areas.
Type: Original Researc
Exploring Accessibility of Community Pharmacy Services
Get PDFObjective: To use selected literature to describe strengths and opportunities for improvement related to accessibility of health services in the community pharmacy setting.
Summary: Pharmacists have been described as one of the most accessible health care professionals, particularly as nearly 90% of Americans live within 5 miles of a community pharmacy. However, geography alone does not provide access to health services. Individuals must be able to gain entry into the health care system, access a health care location where needed services are provided, and find a health care provider with whom the patient can communicate and trust. Current and potential opportunities for community pharmacists to increase access via each step are described.
Conclusion: Community pharmacists are highly accessible health care professionals who are trusted by patients. Opportunities exist to further increase access to dispensing and non-dispensing services in order to better meet the needs of the public.
Type: Commentar
Reducing Health Care Costs and Improving Clinical Outcomes Using an Improved Asheville Project Model
Get PDFThis study was designed to add to the body of knowledge gained through the original Asheville Project studies, and to address some of the limitations of the earlier studies. Scalability. Since the original Asheville Project publications there have been some successful replications, however, there is a need to broaden the geographic scope and increase the size of the study population. Study Design. Previous studies were limited to pre-post, self-as-control design. We added a control group. Model improvement. We were able to incorporate an electronic record of care. This allows incorporation of medical and prescription claims, ease of documentation, improved data capture, reporting, standardization of care, identification of deficiencies in care, and communication with other health care providers. This enhancement may be worthy of more comment than we devoted to it , however, we didn’t want to detract from the main goal of the study, and we wanted to avoid any hint of commercialization on the part of the organization that provided the electronic record. Relevance to profession. We sincerely hope the relevance goes beyond the profession of pharmacy and that it reinforces the message that the profession of pharmacy offers real solutions to rising health care costs in the U.S.
Type: Original Researc
Enhancing Personal Health Record Adoption Through the Community Pharmacy Network: A Service Project
Get PDFPersonal Health Records, or PHRs, are designed to be created, maintained and securely managed by patients themselves. PHRs can reduce medical errors and increase quality of care in the health care system through efficiency and improving accessibility of health information. Adoption of PHRs has been disappointingly low. In this paper a project is described—essentially a call for action—whereby the skills, expertise, and accessibility of the community pharmacist is utilized to address the problem of poor PHR adoption. The objective of this proposed project is to promote the expansion of PHR adoption directly at the consumer level by utilizing the existing infrastructure of community pharmacies. The ADDIE model can provide the framework for PHR adoption in community pharmacies. ADDIE is an acronym that stands for the 5 phases contained in the model: 1) Analysis, 2) Design, 3) Development, 4) Implementation, and 5) Evaluation. ADDIE is a versatile educational model used for creating instructional materials, and has found utility as a guidance model for managing projects of all types. By bringing together these concepts: the highly accessible infrastructure of community pharmacies with the educational resources to inform consumers on the proper use of PHRs, the quality of care for patients will be greatly enhanced.
Type: Idea Pape
Health Literacy Based Communication by Illinois Pharmacists
Get PDFObjectives: Health literacy has received attention as an important issue for pharmacists to consider when interacting with patients. Yet, there is little information about methods pharmacists use to communicate with patients and their extent of use of health literacy based interventions during patient interactions. The purpose of this study was to examine methods of communication and types of health literacy based interventions that practicing pharmacists use in Illinois.
Methods: A survey instrument addressing the study purpose was designed along with other items that were part of a larger study. Eleven items in the survey referred to pharmacist-patient communication. The instrument was pilot tested before administering to a random sample of 1457 pharmacists from the Illinois Pharmacists Association. Data were primarily collected via a mailed survey using Dillman’s five step total design method (TDM). Two reminder letters were mailed at two week intervals to non-respondents.
Results: Usable responses were obtained from 701 respondents (48.1% response rate). Using simple words (96%) and asking patients open-ended questions to determine comprehension (85%) were the most frequent methods that pharmacists used to communicate with patients. Only 18% of respondents always asked patients to repeat medication instructions to confirm understanding. The various recommended types of health literacy interventions were “always” performed by only 8 to 33% of the respondents. More than 50% of respondents indicated that they rarely or never had access to an interpreter (51%), or employed bilingual pharmacists (59%). Only 11% of pharmacists said that they rarely/never pay attention to nonverbal cues that may suggest low health literacy.
Conclusions: Pharmacists infrequently use action oriented health literacy interventions such as using visual aids, having interpreter access, medication calendars, etc. Additional training on health literacy, its scope, and related interventions coupled with system redesign and compensation for time spent counseling are essential to encourage health literacy tailored communication with patients.
Type: Original Researc
Integrating a Patient Care Development Model to Enhance Community Pharmacy Residency Programs
Get PDFPurpose: The purpose of this paper is to describe integration of a community-based patient care service development model, Partner for Promotion (PFP), within five community pharmacy residency programs (CPRPs) across the United States and provide insights and examples of methods for optimizing community pharmacy resident experiences, developing new patient care services, and achieving residency accreditation standards.
Summary: Five community pharmacy residency programs have integrated PFP that affiliated with Midwestern University – Glendale, Northeast Ohio Medical University, Ohio State University, University of Utah, and West Virginia University. Each college and residency program has identified different strategies through which PFP enhances their residency training and service development including completion of training modules, reflections and discussion on application of the PFP service development model to practice, research, and teaching, use of assignments to guide service creation, and mentoring of PFP student-pharmacist teams. All five sites directly link these activities to objectives required in PGY1 CPRP accreditation standards. PFP has resulted in resident-facilitated service development of a variety of patient care programs.
Conclusion: PFP applied to CPRPs enhances training on service development, builds new services within residency training sites, and assists programs with meeting residency accreditation standards. The experiences of five community pharmacy residency programs across the U.S. that have adopted the program has been positive, with creation of new services and residency sites, integration of novel teaching, practice, research, and learning opportunities for residents, and direct links from the PFP experience to achievement of residency objectives.
Type: Idea Pape
Examining the Effect of a Medication Synchronization or an Education Program on Health Outcomes of Hypertensive Patients in a Community Pharmacy Setting
Get PDFObjective: To examine the effect of a medication synchronization or education program on hypertensive health outcomes.
Methods: This study used a design of randomized controlled trial lasting four months taking place within a family-owned community pharmacy chain in a U.S. Midwestern state. A total of 302 hypertensive patients were randomized into 3 study groups - control, medication synchronization, and education. Interventions included management of medication refills through a medication synchronization program for the medication synchronization group, and monthly hypertension (HTN) education for the education group. Outcome measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), percentage of patients at blood pressure (BP) goal, self-rated change in medication adherence, and patients' HTN knowledge.
Results: All groups had significant decline of SBP from baseline; however the final analysis showed no significant SBP differences among study groups. The proportion of patients achieving BP goals in both the control (p=0.005) and education (p=0.019) groups increased at Month 4. Changes in self-reported adherence were not significant for any groups. All groups showed positive changes on HTN knowledge questions with the education group showing the greatest change.
Conclusion: Compared to the control group, there was no difference in the primary outcomes. However, this study demonstrated that educational materials written at an appropriate level and presented by community pharmacists to patients may have been associated with an increase in HTN knowledge and a significant increase in the proportion of patients achieving their BP goal. These educational interventions had a greater impact on helping patients achieve their blood pressure goals than medication synchronization. This may indicate that further intervention is needed to impact adherence aside from ensuring that patients have their medication on hand. Taking the time to educate patients about hypertension led to self-reported positive change with being more careful about taking medications and with not forgetting to take medications when they felt better.
Type: Original Researc
Medication Therapy Management and Preconception Care: Opportunities for Pharmacist Intervention
Get PDFAs medication therapy management (MTM) continues to grow in the profession of pharmacy, careful consideration as to areas for positive patient impact is warranted. Given the current gaps in preconception care in the United States, and the accessibility and expertise of the pharmacist, MTM interventions related to preconception care may be valuable. This paper describes potential for pharmacist intervention in several different areas of preconception care. Notably, targeted medication reviews may be appropriate for interventions such as folic acid recommendations, teratogenic/category X medication management, immunizations, and disease state management. Comprehensive medication reviews may be warranted for selected disease states due to complexity of interventions, such the management of diabetes. Comprehensive medication reviews may also be warranted if several targeted interventions are necessary, or if there are a several medications or disease states requiring intervention. Pharmacists also have important roles in screening, support, and referrals needed for preconception care in the context of MTM. Patients may benefit substantially from pharmacist-directed MTM services related to preconception care. In addition, depending on clinical pharmacy service contracts and billing opportunities, pharmacists may be reimbursed for providing these services, generating sustainable revenue while fulfilling an important public health need.
Type: Idea Pape