INNOVATIONS in pharmacy (Iip - E-Journal)
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Pharmacist Perspectives on Medication Costs and Affordability: A Pilot Study
Get PDFBackground- Research on pharmacist provided care and services has rarely focused on medication cost and affordability. This study aims to bridge the gap by examining pharmacists' perspectives of medication costs and affordability.
Objective- To explore pharmacists' perceptions about medication cost burden for patients, their communication with patients about i) ability to afford medications, ii) price, and iii) ways to reduce medication cost burden, their perceptions about ways to help improve affordability of medications and the barriers to communication.
Method- A cross sectional exploratory study design was utilized. A convenience sample of pharmacists working in community pharmacies in Brooklyn was approached and asked to complete a survey. The survey questions examined the extent to which pharmacists: 1) perceived medication cost to be a burden, 2) initiated discussion about i) ability to afford medications, ii) price of medications, iii) ways to reduce cost burden. Pharmacists were also asked to opine on how to improve affordability of medications and their perceived barriers for such communication with the patients. Questions were formulated to differentiate pharmacists' perceptions and behaviors in regards to dealing with patients with (PWI) and without insurance (PWOI). Data was analyzed using SPSS version 17.0.
Result- A total of twenty-six pharmacists out of 54 approached participated in the study. Majority of the pharmacists reported the cost of medication to be extremely/very burdensome for PWOI (73%) than PWI (23%). In contrast, more pharmacists reported initiating a discussion very often/always about affordability with PWI (35%) than PWOI (20%). Discussions about price of medications were more common than discussions about affordability and ways to reduce medication burden. On an average, 33% of the pharmacists suggested generics as a way to improve affordability of the medications for PWI and PWOI.
Conclusion- Patient-pharmacist communication on affordability and ways to reduce cost burden occurs very infrequently. Understanding the perspectives on patient-pharmacist communication on medication cost may help in developing effective strategies and may help reduce cost-related medication non-adherence.
Type: Student Projec
Addressing Clinical Faculty Need: Creating a Process and Evaluation for Peer Review of Practice
Get PDFObjectives: To describe the evolving process and evaluate the perceived value of peer review for clinical faculty.
Methods: Using a 5-point Likert scale, clinical faculty rated the value of an electronic peer review process by completing an electronic 30 item survey across six areas of clinical faculty practice-related activity. Based on feedback, modifications were made and faculty were re-surveyed the following year.
Results: Initially, 78% of faculty found peer review to be beneficial, mostly in the area of practice development and portions of practice dissemination. After modifications, 45% found peer review to be beneficial.
Conclusions: Clinical faculty are challenged to leverage their practice into teaching and scholarly activities; however, clinical faculty often need feedback to accomplish this. Although the peer review process was designed to address perceived needs of clinical faculty, the process is dynamic and needs further refinement. Overall, clinical faculty find value in a peer review process. This evaluation of peer review illustrates the challenges to provide feedback across six key areas of clinical faculty activity.
Type: Original Researc
Promoting Scholarly Lines of Inquiry in Pharmacy Education Through Idea Papers and Case Study Reports
Get PDFType: Invitatio
Case Study: Developing, Implementing, and Evaluating a One-Day Leadership Conference to Foster Women's Leadership in Healthcare
Get PDFDespite women increasingly entering the healthcare field, they still face barriers to advancing in leadership ranks within healthcare. To address the need for leadership development among women in healthcare, the Center for Leading Healthcare Change (CLHC) at the University of Minnesota College of Pharmacy piloted a one-day conference in November 2012 entitled "Women Impacting Healthcare: Decide to Make a Difference." This conference utilized an interactive agenda: each speaker's presentation was followed by hands-on leadership activities during which attendees developed their own personal leadership visions. Specific leadership activities were designed to build upon one another and help design a leadership pathway. All activities were consistent as they included personal reflection and interaction with others. Attendees were asked to complete two evaluations, one immediately at the conclusion of the conference, and another two-weeks post. The conference committee achieved the goal of delivering the conference objectives. As the Women Impacting Healthcare committee continues to look for ways to develop leaders in healthcare, the focus of future conferences will also evolve to include the needs of women currently in leadership roles, as well as ways women can grow into leadership roles.
Type: Case Stud
Value of Online Medication Therapy Management Resources: Community Pharmacist Perspectives
Get PDFObjectives: To describe pharmacists' attitudes toward and satisfaction with on-line training modules on MTM tools and tips for pharmacists and to characterize how useful the tools and concepts in the modules were to pharmacists when delivering MTM services.
Methods: Researchers distributed a web-based survey to pharmacists who had viewed the training modules that had been posted onto the training web site of OutcomesMTM. The majority of survey questions consisted of a 6-point Likert scale. Questions assessed pharmacists' opinions on the use of the tools. Information also was collected on implementing MTM tips, pharmacist demographics, and practice site characteristics.
Results: Respondents rated the Tool to Improve Medications in the Elderly via Review (TIMER) and DRug Adherence Work-up (DRAW) tools favorably across multiple items. Many pharmacists integrated the MTM tips into their practices, and reported increased efficiency in their delivery of MTM services.
Conclusion: Pharmacist training and tools such as the TIMER and DRAW tools plus MTM practice tips can assist pharmacists in providing MTM services to patients.
Type: Original Researc
Immunization Tour: Preparing for Mass Immunization through Pharmacy and Nursing Interprofessional Student-led Service-learning
Get PDFPharmacy and nursing students piloted a collaborative student initiative to administer mass influenza immunizations to a large university campus. Through the support of the School of Nursing, College of Pharmacy, and University Health Service this project later turned into a unique service-learning interprofessional one credit elective course promoting public health philosophy and principles, emergency preparedness strategies, clinical skills, and interprofessional team competencies centered around influenza immunizations. Including lessons learned, this article will describe the evolution of this innovative student-led project.
Type: Case Stud
Assessment of Asthma Inhaler Technique in Two Community Pharmacies
Get PDFObjectives: To 1) assess inhaler technique in patients with asthma who present to a community pharmacy and 2) determine if patients find it desirable to have further inhaler education from pharmacists.
Methods: Participants were recruited when picking up their inhalers at either one chain or one independent pharmacy from May 2012 to December 2012. Any person 18 years of age or older, diagnosed with asthma, and currently prescribed an inhaler was eligible for inclusion in the study. Those who voluntarily agreed to participate were provided a written survey to evaluate current inhaler usage and past education from pharmacists. Participants were then asked to demonstrate how they currently operate their inhalers and observations regarding technique were recorded. Participants were then educated on what improvements could be made in their technique, if applicable.
Results: A total of 31 surveys were completed for this study, of which only 3(9.6%) of the respondents were observed to be using their inhalers properly; however 18(58%) rated their technique as a 5 out of 5 on a Likert scale with 5 being the best. Almost all respondents (96.7%) classified their inhalers as "easy" or "very easy" to use, and 13 (41.9%) would prefer more education from pharmacists regarding their inhalers.
Conclusion: The results of this study identified a significant need for patients to be educated on proper inhaler technique. It also revealed a high patient preference for pharmacists to offer additional education to patients using asthma inhalers upon initiation of inhaler therapy and with inhaler refills.
Type: Student Projec
Evaluation of provider documentation of medication management in a Patient-Centered Medical Home (PCMH)
Get PDFPurpose: The National Committee for Quality Assurance (NCQA) has standards for recognizing Patient-Centered Medical Homes (PCMH) including one for medication management. Study objectives were to identify if and how providers within a PCMH recognized under the 2008 guidelines were documenting components of medication management to meet NCQA's 2011 requirements including: 1) providing information about new prescriptions to >80% of patients; 2) assessing understanding of medications for >50% of patients; and 3) assessing response and barriers to medication adherence for >50% of patients.
Methods: Physician and pharmacist-led patient visits from a family medicine office, from February 1 to August 1, 2012 were assessed. Patients over 18 years old taking at least one medication were included. A retrospective chart review was performed to assess documented components of medication management. Descriptive statistics were used to analyze data.
Results: A systematic sampling of 450 physician-led and 195 pharmacist-led patient visits, demonstrated providers did not meet documentation goals for providing patients information on new prescriptions (65% pharmacist, 24% physician, 36% of total provider notes) or for assessment of patients' understanding of medications (9% pharmacist 12% physician, 11% of total provider notes). Individually each type of provider did not meet the goal of assessing patient response and barriers to adherence to medication, but with combined intervention by the pharmacists and the physicians, the site was able to surpass NCQA's percentage goal (57% and 58%).
Conclusions: No components of medication management are well documented. Using the electronic medical record, pharmacists may be able to develop documentation tools and assist sites to meet NCQA's goals for medication management.
Type: Original Researc
The Development of a Community-Based, Pharmacist-Provided Falls Prevention MTM Intervention for Older Adults: Relationship Building, Methods, and Rationale
Get PDFThe objectives of this article are to discuss the process of community engagement experienced to plan and implement a pilot study of a pharmacist-provided MTM intervention focused on reducing the use of medications associated with falling, and to present the research methods that emerged from the community engagement process to evaluate the feasibility, acceptance, and preliminary impact of the intervention. Key lessons learned from the community engagement process also are presented and discussed. The relationship building and planning process took twelve months. The RE-AIM framework broadly guided the planning process since an overarching goal for the community partners was developing a program that could be implemented and sustained in the future. The planning phase focused on identifying research questions that were of most interest to the community partners, the population to study, the capacity of partners to perform activities, and process evaluation. Much of the planning phase was accomplished with face-to-face meetings. After all study processes, study materials, and data collection tools were developed, a focus group of older adults who represented the likely targets of the MTM intervention provided feedback related to the concept and process of the intervention. Nine key lessons were identified from the community engagement process. One key to successful community engagement is partners taking the time to educate each other about experiences, processes, and successes and failures. Additionally, partners must actively listen to each other to better understand barriers and facilitators that likely will impact the planning and implementation processes. Successful community engagement will be important to develop both formative and summative evaluation processes that will help to produce valid evidence about the effectiveness of pharmacists in modifying drug therapy and preventing falls as well as to promote the adoption and implementation of the intervention in other communities.
Type: Original Researc
Time and Motion Study of Influenza Diagnostic Testing in a Community Pharmacy
Get PDFBackground: It has been shown that use of rapid diagnostic tests (RDTs) is able to reduce costs and improve the prescribing practice of antivirals (i.e. oseltamivir) among patients with influenza-like illnesses (ILIs). Using existing Clinical Laboratory Improvement Amendment (CLIA)-waived RDTs and collaborative practice agreements, similar to those used to allow pharmacists to administer vaccines, it is possible for patients to seek point-of-care treatment for influenza or flu-like symptoms at a local pharmacy. Following a review of the patient's symptoms by a trained pharmacist, the qualified patient is offered an RDT to determine if the influenza virus is the cause of the symptoms. Based on the results of the RDT, the patient is provided with the appropriate treatment as defined by an approved practice agreement.
Objective: The aim of this study was to evaluate the feasibility of incorporating an RDT for influenza into community pharmacy practice.
Methods: This time and motion study was conducted at three community pharmacy locations, and a total of eight simulated patient visits were completed utilizing a standardized patient. In addition to determining a total time of the encounter, each simulation was divided into nine timed sub-categories. For data analysis, the time spent in each of the nine sub-categories was assigned to the pharmacist, pharmacy technician, or patient. Time and motion methodologies were used to estimate the total time required to provide the RDT service, to determine the amount of active time required of the pharmacist and pharmacy technician, and to evaluate the ability of the staff to provide the service within its existing workflow.
Results: The average total time to complete the entire patient encounter for an influenza assessment utilizing an RDT was 35.5 minutes (± 3.1 minutes). On average, the pharmacist spent 9.4 minutes (± 3 minutes) per encounter or about 26.5% of the entire encounter. When the pharmacy technician collected the vital signs, the pharmacist-required time was reduced to 4.95 minutes (± 2.7 minutes), which was about a 48% reduction.
Conclusions: The results indicate that an RDT program for influenza assessment required no more than a modest amount of pharmacist time and could be successfully incorporated into regular workflow with little to no disruption of other activities. As such, this approach to influenza management may be a feasible service for community pharmacies to offer patients. This was especially true if the pharmacy had well-trained technicians on staff that could support the service with collection of patient histories and vital signs.
Type: Original Researc