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Curran G, Mosley C, Gamble A, Painter J, Ounpraseuth S, Brewer NT, Teeter B, Smith M, Halladay J, Hughes T, Shepherd JG, Hastings T, Simpson K, Carpenter D. Addressing COVID-19 vaccine hesitancy in rural community pharmacies: a protocol for a stepped wedge randomized clinical trial. Implement Sci 2023; 18:72. [PMID: 38110979 PMCID: PMC10726603 DOI: 10.1186/s13012-023-01327-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Uptake of COVID-19 vaccines remains problematically low in the USA, especially in rural areas. COVID-19 vaccine hesitancy is associated with lower uptake, which translates to higher susceptibility to SARS-CoV-2 variants in communities where vaccination coverage is low. Because community pharmacists are among the most accessible and trusted health professionals in rural areas, this randomized clinical trial will examine implementation strategies to support rural pharmacists in delivering an adapted evidence-based intervention to reduce COVID-19 vaccine hesitancy. METHODS We will use an incomplete stepped wedge trial design in which we will randomize 30 rural pharmacies (unit of analysis) to determine the effectiveness and incremental cost-effectiveness of a standard implementation approach (consisting of online training that describes the vaccine hesitancy intervention, live webinar, and resource website) compared to adding on a virtual facilitation approach (provided by a trained facilitator in support of the delivery of the vaccine hesitancy counseling intervention by pharmacists). The intervention (ASORT) has been adapted from an evidence-based vaccine communication intervention for HPV vaccines through a partnership with rural pharmacies in a practice-based research network in seven southern US states. ASORT teaches pharmacists how to identify persons eligible for COVID-19 vaccination (including a booster), solicit and address vaccine concerns in a non-confrontational way, recommend the vaccine, and repeat the steps later if needed. The primary trial outcome is fidelity to the ASORT intervention, which will be determined through ratings of recordings of pharmacists delivering the intervention. The secondary outcome is the effectiveness of the intervention, determined by rates of patients who agree to be vaccinated after receiving the intervention. Other secondary outcomes include feasibility, acceptability, adoption, reach, and cost. Cost-effectiveness and budget impact analyses will be conducted to maximize the potential for future dissemination and sustainability. Mixed methods will provide triangulation, expansion, and explanation of quantitative findings. DISCUSSION This trial contributes to a growing evidence base on vaccine hesitancy interventions and virtual-only facilitation of evidenced-based practices in community health settings. The trial will provide the first estimate of the relative value of different implementation strategies in pharmacy settings. TRIAL REGISTRATION NCT05926544 (clinicaltrials.gov); 07/03/2023.
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Affiliation(s)
- Geoffrey Curran
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Cynthia Mosley
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abigail Gamble
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Jacob Painter
- Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ben Teeter
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megan Smith
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jacquie Halladay
- Department of Family Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Tamera Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - J Greene Shepherd
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Tessa Hastings
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Kit Simpson
- Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Delesha Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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Facciolo F, Siracuse MV, Galt KA, Fuji KT, Bramble JD. Independent community pharmacies' provision of enhanced services: A mixed methods approach. J Am Pharm Assoc (2003) 2021; 61:819-828.e1. [PMID: 34332888 DOI: 10.1016/j.japh.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/17/2021] [Accepted: 07/08/2021] [Indexed: 10/20/2022]
Abstract
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.
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Urick BY, Pathak S, Hughes TD, Ferreri SP. Design and effect of performance-based pharmacy payment models. J Manag Care Spec Pharm 2021; 27:306-315. [PMID: 33645246 PMCID: PMC10391031 DOI: 10.18553/jmcp.2021.27.3.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Community pharmacy participation in performance-based payment models has increased in recent years. Despite this, there has been neither much research done to evaluate the effect of these models on health care quality and spending nor is there extensive literature on the design of these models. OBJECTIVES: To (a) describe the types of measures used in performance-based pharmacy payment models (PBPPMs); (b) describe the financial impact of PBPPMs on pharmacies; (3) explore pharmacy owners' perceptions of PBPPMs; and (4) describe any practice changes made in response to PBPPMs. METHODS: This is a cross-sectional study that surveyed independent community pharmacy owners between November 2019 and January 2020. The survey included 45 items split into 5 sections that covered respondent characteristics and the 4 domain objectives. Descriptive statistics were used for quantitative responses, and free-text responses were assessed for themes. RESULTS: Of the 68 individuals who responded to the survey, 42 were community pharmacy owners who met the study eligibility criteria, and 30 responded to most survey items. Owners expressed frustration at the design of PBPPMs, with 90% stating that they did not feel that the actions necessary to meet or exceed performance standards were within their control, and 90% also reported a loss of revenue because of these models. In addition, large numbers of respondents felt that they did not have enough information on how performance measures were computed (76.7%) or how cut-points were determined (86.7%). Despite negative feelings, most owners reported implementing changes in service offerings as a result of these models. CONCLUSIONS: PBPPMs appear to be commonplace and put substantial financial burden on community pharmacies. Study results suggest that greater education by payers could improve pharmacist engagement, as could involvement of pharmacies in the design and maintenance of PBPPMs. DISCLOSURES: This work was supported by a grant from the American Association of Colleges of Pharmacy, which was not involved in the collection, analysis, and interpretation of data; writing of the report; or the decision to submit this article for publication. Urick reports consulting fees from Pharmacy Quality Solutions. The other authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.
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Affiliation(s)
- Benjamin Y Urick
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Shweta Pathak
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Tamera D Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
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Carpenter DM, Roberts CA, Farley JF. Measuring patient perspectives on community pharmacy quality: psychometric evaluation of a brief survey. J Manag Care Spec Pharm 2020; 27:105-111. [PMID: 33377440 PMCID: PMC10391284 DOI: 10.18553/jmcp.2021.27.1.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Measuring patient perspectives of the quality of health care delivery is an essential component of building a patient-centered model of care, which has garnered increasing emphasis under value-based payment models. Although measurements of patient perspectives of physician practices are common, few validated measures are currently available to assess patient perspectives of pharmacy quality. OBJECTIVE: To assess the reliability and validity of a brief measure that assesses patient experiences with the quality of community pharmacy services, referred to as the "patient experience" measure. METHODS: This article focuses on the second phase of a 2-phase survey development study. In the second phase, a convenience sample of 400 adult patients with chronic health conditions completed the final 7-item version of the patient experience measure via an online survey. An exploratory factor analysis was performed to determine the number of factors underlying the patient experience measure. Internal consistency reliability was assessed with Cronbach's alpha, and construct validity was evaluated by examining relationships between the patient experience measure, a quality of pharmacy services item, and patient demographic variables. RESULTS: Eigenvalues and scree plots suggested a 1-factor solution, with this single factor explaining 64% of the variance in the patient experience measure. Cronbach's alpha indicated excellent reliability (α = 0.90). Individuals with more positive patient experience scores rated the quality of their pharmacies' services significantly higher (Pearson r = 0.73, P < 0.001). Mean patient experience scores for those who had gone to their pharmacies for 7-11 months (mean = 3.66) were significantly lower than for those who had been going to their pharmacies for 5 or more years (mean = 4.22). CONCLUSIONS: The patient experience measure demonstrated excellent reliability and was correlated with patient perceptions of pharmacy quality. The measure also differentiated between individuals based on the length of time they had been going to their pharmacies. The scale could be used to quickly assess patient experience with community pharmacy services. DISCLOSURES: This work was supported by the National Community Pharmacists Association Innovation Center through a grant from the Community Pharmacy Foundation. Farley reports an unrelated grant from AstraZeneca and fees from Takeda for expert testimony. The other authors have nothing to disclose. This work was presented as a virtual poster at the American Pharmacists Association (APhA) Annual Meeting & Exposition, March 2020, Washington, DC.
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Affiliation(s)
- Delesha M Carpenter
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville
| | - Courtney A Roberts
- Division of Pharmaceutical Outcomes and Policy, University of North Carolina Eshelman School of Pharmacy, Asheville
| | - Joel F Farley
- Department of Pharmaceutical Care and Health Systems, University of Minnesota College of Pharmacy, Minneapolis
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Renfro CP, Turner K, Seeto J, Ferreri SP. Medication synchronization adoption and pharmacy performance. Res Social Adm Pharm 2020; 17:1496-1500. [PMID: 33234452 DOI: 10.1016/j.sapharm.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/05/2020] [Accepted: 11/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND While medication synchronization programs are becoming a staple in community pharmacies, a standard process needs to be identified to provide consistent positive outcomes. Many studies demonstrate how medication synchronization affects individual level patients but have not examined how medication synchronization affects the pharmacy's performance. Because community pharmacies are calibrated based on performance to adherence measures for all patients, it is important to understand whether resource-intensive interventions, such as medication synchronization, lead to improved performance. OBJECTIVES The aims of this study were to 1) examine pharmacy characteristics associated with medication synchronization adoption and 2) examine whether medication synchronization is associated with pharmacy-level performance on select medication adherence and utilization measures. METHODS This study used a cross-sectional design. Community pharmacies participating in the North Carolina Community Pharmacy Enhanced Services Network (NC CPESN℠) program were included in this study. Pharmacy performance was measured as summary score of pharmacy's performance on seven risk-adjusted measures which were used to measure pharmacy's performance in the program. Adoption of medication synchronization was measured as a binary variable capturing whether the pharmacy offered med sync at the time the survey was administered. RESULTS Surveys were received from 160 out of 268 participating pharmacies (59.7% response rate) with a total of 155 pharmacies being included in the analytic sample. Pharmacies that adopted medication synchronization were more likely to have a clinical pharmacist on staff (c = 5.4, p = 0.019). Holding all else constant, medication synchronization adoption was not significantly associated with total medication adherence performance (p = 0.371). CONCLUSION Medication synchronization has proven successful in improving individual patient level adherence but may not change a pharmacy's overall performance in adherence for all patients. Further research is needed to examine how effective implementation might contribute to whether a medication synchronization program leads to meaningful gains in adherence for all patients.
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Affiliation(s)
- Chelsea P Renfro
- Department Clinical Pharmacy and Translational Science at the University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Kea Turner
- Assistant Member at Moffitt Cancer Center and an Assistant Professor at the University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Joshua Seeto
- University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, USA.
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Patient outcomes from implementing an enhanced services pharmacy network. J Am Pharm Assoc (2003) 2020; 60:843-852.e15. [PMID: 32680782 DOI: 10.1016/j.japh.2020.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/06/2020] [Accepted: 05/10/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the effect of implementing a network of community pharmacies on medication adherence, health service utilization, and health care spending. DESIGN Quasi-experimental difference-in-difference analysis with a nonequivalent control group. SETTING AND PARTICIPANTS Eligible Medicaid-enrolled patients in North Carolina were attributed to intervention pharmacies between March 2015 and December 2016. A control group was propensity score-matched. Interventions consisted of enhanced services and a more intensive, comprehensive initial pharmacy assessment (CIPA). OUTCOME MEASURES Outcomes included hospitalizations; emergency department (ED) visits; health care spending for total medical, inpatient, outpatient, and ED services; and adherence to renin-angiotensin system antagonists (RASA), statins, noninsulin diabetes medications (NIDM), and multiple medications for chronic conditions (MMCC). RESULTS There were 31,509 patients who met eligibility criteria and were attributed to a participating pharmacy. Of these, 3897 received a CIPA. Before matching, patients attributed to participating pharmacies had greater Medicaid enrollment through aged, blind, or disabled status (49.2% vs. 31.5%, P < 0.001); greater case management (10.3% vs. 7%, P < 0.001); and worse rates of chronic disease (P < 0.001). Successful matching removed these differences. Adherence to RASA medications and MMCC increased by 9.5% and 10.3% (P < 0.05), respectively. Adherence did not change for statins and NIDM. The analysis also revealed a slower decline in average total medical spending of 5.7% (P < 0.01) relative to the control group over the same period, owed to a 9.6% (P < 0.001) slower decline in outpatient spending. ED utilization also decreased more slowly relative to controls by 4.8% (P < 0.05) following the intervention. CONCLUSION The pharmacy intervention resulted in a statistically significant improvement in medication adherence to RASA and multiple chronic medications, but did not change or may have worsened utilization and spending outcomes. More research is needed to explore patient selection and variation in implementation and heterogeneity of treatment effects when evaluating pharmacy interventions.
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Urick BY, Bhosle M, Farley JF. Patient Medication Adherence Among Pharmacies Participating in a North Carolina Enhanced Services Network. J Manag Care Spec Pharm 2020; 26:718-722. [PMID: 32463769 PMCID: PMC10391204 DOI: 10.18553/jmcp.2020.26.6.718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Improving medication adherence can reduce health care spending, and studies have demonstrated community pharmacists can positively affect adherence through the provision of enhanced services. The North Carolina (NC) Community Pharmacy Enhanced Services Network (CPESN) was formed in early 2014 with the goal of enhancing the care provided through its network pharmacies. OBJECTIVE To evaluate differences in medication adherence performance scores between pharmacies that participated in the NC-CPESN and control pharmacies in NC that did not. METHODS Medication adherence performance data for statins, renin-angiotensin system antagonists, oral diabetes medications, and a custom multiple chronic medication measure were gathered from quarterly reports between December 2014 and September 2016. Data for these quarterly reports were derived from NC Medicaid claims. These data were combined with pharmacy demographics and service offerings data from the National Council on Prescription Drug Plans dataQ database. Descriptive statistics were used to evaluate differences in demographics and service offerings between study cohorts. Generalized estimating equations were used to evaluate the relationship between medication adherence and pharmacy cohorts, demographics, and service offerings. RESULTS There were 267 enhanced services pharmacies and 1,872 control pharmacies included in this analysis. Enhanced services pharmacies were much more likely to be independent pharmacies, located in rural counties, offer multidose compliance packaging, and offer delivery services, but were less likely to offer 24-hour emergency services. Persistently higher adherences scores were observed for enhanced services pharmacies, with differences across measures ranging from 3.0% to 7.2% (P < 0.001). In multivariable models, the difference between enhanced services and control pharmacies was explained by differences in offerings of multidose compliance packaging and delivery services, which were associated with 3.4%-8.2% and 3.3%-4.0% improvements in adherence, respectively (P < 0.001). CONCLUSIONS This study found that enhanced services pharmacies had greater adherence performance scores for the NC Medicaid population. These differences appear to be due to CPESN enhanced services pharmacies' offering of multidose compliance packaging and delivery. Future work is needed to expand this analysis to other populations, as well as to explore the relationship between delivery and adherence. DISCLOSURES The project described was supported by Funding Opportunity Number 1C12013003897 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Ulrick reports consulting fees from Pharmacy Quality Solutions, unrelated to this work. Bhosle is an employee of Community Care of North Carolina, the not-for-profit company that sponsored the North Carolina enhanced services pharmacy network, and CPESN USA, a for-profit company that developed out of the original grant-funded project. Farley has nothing to disclose.
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Affiliation(s)
| | | | - Joel F. Farley
- University of Minnesota College of Pharmacy, Minneapolis
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Renfro CP, Urick BY, Mansour MA, Ferreri SP. Pharmacy characteristics correlating to performance in a community pharmacy network. J Am Pharm Assoc (2003) 2020; 59:275-279. [PMID: 30827530 DOI: 10.1016/j.japh.2018.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 11/06/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the correlation between pharmacy characteristics and a broad set of performance measures used to support a community pharmacy network. METHODS Baseline characteristics regarding demographics, services provided, technology, and staffing were collected via a 68-item survey for 123 pharmacies participating in the North Carolina community pharmacy enhanced services network. Performance metric data were collected, and scores were calculated for each pharmacy. Outcome measures for this study comprised of 4 adherence measures, a risk-adjusted hospitalization measure, a risk-adjusted emergency department visit measure, a total cost of medical care measure, and a composite pharmacy performance measure. Generalized estimating equations (GEE) were used to create multivariable statistical models measuring the correlation between pharmacy characteristics and performance measures. RESULTS After inclusion criteria were applied, 115 pharmacies remained in the analysis. These pharmacies were primarily single and multiple independent pharmacies, at 36.5% and 59.1%, respectively. Five characteristics were significantly associated with 3 measures, and none were associated with 4 or more. Having pharmacists in non dispensing roles was positively associated with total score, diabetes adherence, and chronic medication adherence. Home visits were positively associated with hypertension adherence, ED visit rate, and total score. Offering a smoking cessation program was positively associated with chronic medication, hypertension, and statin adherence. Offering free home delivery was positively associated with diabetes adherence but negatively associated with total medical spending and ED visit rate. Using dispensing automation was negatively associated with adherence to chronic medications, renin-angiotensin system antagonists, and statins. CONCLUSION No pharmacy characteristics were associated with a majority of performance measures chosen. Additional research is needed to identify structural variables that can be used as minimum participation criteria for high-performing pharmacy networks.
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Ferreri SP, Hughes TD, Snyder ME. Medication Therapy Management: Current Challenges. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2020; 9:71-81. [PMID: 32309200 PMCID: PMC7136570 DOI: 10.2147/iprp.s179628] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Stefanie P Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Tamera D Hughes
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7574, USA
| | - Margie E Snyder
- College of Pharmacy, Purdue University, Indianapolis, IN 46202, USA
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Farley JF, Kumar A, Urick BY. Measuring Adherence: A Proof of Concept Study for Multiple Medications for Chronic Conditions in Alternative Payment Models. PHARMACY 2019; 7:pharmacy7030081. [PMID: 31269735 PMCID: PMC6789652 DOI: 10.3390/pharmacy7030081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 06/26/2019] [Accepted: 06/28/2019] [Indexed: 02/04/2023] Open
Abstract
Adherence to renin angiotensin system antagonists (RASA), non-insulin diabetes medications (NIDM) and statins has been included in the Medicare Star Ratings program since 2012. The long-term use of these measures emphasizes adherence to a limited number of chronic medications and may present opportunities for Part D plan sponsors to misuse the measures to influence their Medicare Part D Star Rating. It also does not capture the adherence needs of high-risk patients with multiple chronic conditions. The objective of this study was to describe the development of a new measure to capture adherence to multiple medications for chronic conditions (MMCC). The MMCC measure captures adherence to 71 different therapeutic categories of medication and was constructed using North Carolina Medicaid prescription claims data from 2015 to 2017. This measure was validated against the existing RASA, NIDM and statin adherence measures. This new measure was highly correlated with Star Rating measures, captured a greater number of eligible patients than these existing measures and had a lower proportion of patients meet the adherence threshold than the existing Star Ratings adherence measures. There is an opportunity to develop new measures, which include adherence to multiple medications in populations with multiple chronic conditions.
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Affiliation(s)
- Joel F Farley
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA.
| | - Arun Kumar
- Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, MN 55455, USA
| | - Benjamin Y Urick
- Center for Medication Optimization, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
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Urick BY, Ferreri SP, Shasky C, Pfeiffenberger T, Trygstad T, Farley JF. Lessons Learned from Using Global Outcome Measures to Assess Community Pharmacy Performance. J Manag Care Spec Pharm 2018; 24:1278-1283. [PMID: 30479196 PMCID: PMC10397585 DOI: 10.18553/jmcp.2018.24.12.1278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION As value-based and alternative payment models proliferate, there is growing interest in measuring pharmacy performance. However, little research has explored the development and implementation of systems to measure pharmacy performance. Additionally, systems that currently exist rely on process and surrogate outcome measures that are not always relevant to patients and payers. PROGRAM DESCRIPTION This article describes the process used to design and implement a performance measurement program for a group of enhanced services pharmacies in North Carolina. This program was successful in measuring quality based on medication adherence, hospitalizations, emergency department visits, and total cost of medical care for nearly all North Carolina pharmacies. Measures were scored and combined into a single 11-point composite pharmacy performance score. To demonstrate the measures, we compared performance scores for enhanced services pharmacies (n = 119) to other North Carolina pharmacies (n = 1,616) during the baseline measurement period (March 1, 2015-May 31, 2015). Adherence measure scores for enhanced services pharmacies exceeded those of other pharmacies (P values < 0.0001-0.003), but total scores were not significantly different, with enhanced services pharmacy mean total scores of 6.54 vs. 6.29 for all other pharmacies (P = 0.115). OBSERVATIONS The program described provides an example of a composite performance measurement system that can be used to support alternative pharmacy payment models and shows that case-mix adjustment is possible for broad outcomes such as those used in this program. The measures used for the program depend on timely feeds of medical claims. Payers and pharmacy networks implementing a similar program may need to explore alternative structure or process measures. IMPLICATIONS As pharmacy payment models evolve, there may be value in collaboration between academics, pharmacists, and payers to bring different areas of expertise and perspectives into the performance measurement process. This program demonstrates that global outcome measurement is possible over a broad set of pharmacies and invites additional research to explore the validity of this and other methods to measure pharmacy quality and performance. DISCLOSURES The program described in this article was supported by Funding Opportunity Number 1C12013003897 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Community Care of North Carolina received the grant and subcontracted with the UNC Eshelman School of Pharmacy to carry out this project. Shasky, Pfeiffenberger, and Trygstad are employed by Community Care of North Carolina. Urick and Ferreri are employed by the UNC Eshelman School of Pharmacy. Farley was employed by the UNC Eshelman School of Pharmacy during data collection for this project and reports consulting fees from UCB Pharmaceutical Company unrelated to this project. Pfeiffenberger reports membership on the Pharmacy Quality Alliance (PQA) task force on pharmacy level measures; Trygstad is a PQA board member; Urick is a member of a scientific advisory committee for PQA.
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Affiliation(s)
- Benjamin Y Urick
- 1 University of North Carolina Eshelman School of Pharmacy, Chapel Hill
| | | | | | | | | | - Joel F Farley
- 3 University of Minnesota College of Pharmacy, Minneapolis
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Smith MG, Ferreri SP, Stafford R, Teeter B, Turner K, Veach S, Shea CM. Development of Community Pharmacy Characteristics Questionnaire: Application of Cognitive Interviewing. Innov Pharm 2018; 9:1-7. [PMID: 34007714 DOI: 10.24926/iip.v9i3.1349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background A questionnaire specific to community pharmacy characteristics, such as staffing models for clinical activities and business operations, does not exist. As community pharmacy practice expands, it is important to characterize how pharmacies are changing for outcomes research. The aim of this study was to conduct cognitive interviewing with community pharmacists to gain feedback on the formatting, readability, and content of items measuring community pharmacy characteristics to develop such a questionnaire. Methods National surveys and previously developed survey work were reviewed to identify the following question categories: business operations, human resource management, division of clinical responsibilities, technology, and enhanced services. Questions for each domain were drafted and assessed for applicability across different states and level of importance by researchers in 3 different states. Using the "think aloud" method of cognitive interviewing to evaluate clarity in instructions, question items and response entry, an iterative process was established that included 3 rounds of interviews with discussion and modifications made by the research team between each round. Results A total of thirteen cognitive interviews across 3 rounds were conducted via telephone and lasted between 30 and 60 minutes. Time for participant pharmacists to complete the questionnaire ranged from 12 minutes to 30 minutes. The interviews revealed areas of ambiguity, and missing response options for the variety of business structures. The question categories with the most problematic items were business operations, human resource management, and division of clinical responsibilities. Conclusion Using cognitive interviewing, a community pharmacy questionnaire focusing on operational characteristics was developed. Future research is warranted to test the organizational characteristics defined in this paper with a larger sample size representing multiple states.
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Affiliation(s)
- Megan G Smith
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, Chapel Hill, NC
| | - Rachel Stafford
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ben Teeter
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - Kea Turner
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Stevie Veach
- University of Iowa College of Pharmacy, Iowa City, IA
| | - Christopher M Shea
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC
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Renfro CP, Patti M, Ballou JM, Ferreri SP. Development of a medication synchronization common language for community pharmacies. J Am Pharm Assoc (2003) 2018; 58:515-521.e1. [PMID: 29980447 DOI: 10.1016/j.japh.2018.04.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To develop a common language for the medication synchronization process in community pharmacies. METHODS A systematic and iterative process was used to create and refine a common language for medication synchronization. First, a review of all available medication synchronization-related documents was completed. Second, a systematic scoping literature review was conducted to determine what core components of medication synchronization have been implemented by community pharmacies. Third, semistructured interviews were conducted with community pharmacists and key stakeholders to identify principles and successful practices. Findings from the document review, systematic scoping review, and semistructured interviews were integrated to develop a medication synchronization common language. Finally, researchers and key stakeholders refined the initial draft by means of a systematic process. RESULTS This process generated a medication synchronization common language that includes common language for the philosophy and values of medication synchronization. This profile also includes descriptions of core components with activities to be conducted for each of the identified 5 core components. The 5 core components are: 1) identification and enrollment of patients; 2) completion of a medication review and patient assessment; 3) alignment of medication refills; 4) preparation for medication delivery; and 5) delivery of medication and other services. CONCLUSION The development of a common language for medication synchronization will allow for the promotion of consistency in implementation and operation of these programs across community pharmacies. Consistency in implementation will allow for better interpretation of patient outcomes such as adherence and other clinical measures.
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