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Abdellatife OE, Makowsky MJ. Factors influencing Implementation of point-of-care testing for acute respiratory infectious diseases in community pharmacies: A scoping review using the Consolidated Framework for Implementation research. Res Social Adm Pharm 2024; 20:1-24. [PMID: 38431516 DOI: 10.1016/j.sapharm.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Emerging evidence suggests pharmacy-based point-of-care (POC) testing for acute respiratory infectious diseases is beneficial, but not widely implemented. A theory-informed review to understand the factors influencing service Implementation is lacking. OBJECTIVE To examine the extent, range, and nature of research available on enablers and barriers to POC testing Implementation for infectious respiratory diseases in community pharmacies and identify their underpinning theoretical constructs using the Consolidated Framework for Implementation Research (CFIR). METHODS Scoping review guided by the JBI Manual for Evidence Synthesis. A comprehensive search from inception to June 28th, 2022 was conducted using Medline, Embase, CINAHL, Cochrane Library, and ProQuest dissertations without date or language restriction. Eligible articles investigated barriers and/or facilitators to strep throat, influenza, C-reactive protein, and COVID-19 POC testing in community pharmacies. Two reviewers independently performed title & abstract screening, full-text screening, and data extraction. Content analysis was conducted according to a pre-established Framework and concepts were mapped to the CFIR. RESULTS Forty-three studies were included. Most originated from the USA (n = 24; 56%) and investigated strep throat. The majority were testing/initial Implementation projects (n = 23; 54%) conducted in urban centers (n = 17; 40%). Thirty-six (84%) studies used quantitative methodology, while 6 (14%) were qualitative. Only four studies (9%) used theory to guide their inquiry. The 124 identified Implementation factors mapped onto 21 CFIR constructs, covering all 5 domains. The domain "Outer setting" (n = 35/43; 81%) was most prevalent as were the constructs "Patient needs and resources," (n = 21/43; 49%) "External policy & incentives," (n = 17/43; 40%) and "Relative advantage" (n = 17/43; 40%). CONCLUSION A large volume of research explores factors influencing the Implementation of pharmacy-based respiratory infectious disease POC testing services, but few studies use qualitative or theory-informed methods. Knowledge of the wide range of facilitators and barriers identified can help pharmacy managers and researchers design strategies to support successful service Implementation.
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Affiliation(s)
- Omar E Abdellatife
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9
| | - Mark J Makowsky
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9.
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Ngwu RO, Lindeau R, Bielecki LM, Daly CJ. Assessing Community Pharmacists' Perception on Readiness to Initiate Point-of-Care Testing for SARS-CoV-2 in New York State During the Pandemic. J Pharm Pract 2024; 37:324-334. [PMID: 36242519 DOI: 10.1177/08971900221134642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Pursuant to the COVID-19 pandemic, an executive order issued by the New York State (NYS) governor allowed pharmacists to act as laboratory directors for a limited-service laboratory (LSL) to order and perform Food and Drug Administration (FDA) and Emergency Use Authorization (EUA) Clinical Laboratory Improvement Amendment (CLIA)-waived COVID-19 point-of-care testing (POCT). Objectives: To (i) assess the status of NYS community pharmacists with POCT in the early stages of the COVID-19 pandemic, (ii) assess the readiness and willingness of community pharmacists to incorporate COVID-19 POCT into their workflow during a pandemic, and (iii) assess community pharmacists' perception of the barrier to initiating COVID-19 POCT. Methods: This is a prospective cross-sectional study conducted from February 4 to February 21, 2021. An electronic survey consisting of 66 Likert-type questions, select all that apply, and fill-in-style questions were emailed to 250 Community Pharmacy Enhanced Service Network (CPESN) NY pharmacies, with a follow-up email sent halfway into the data collection period. The data were analyzed using descriptive statistics. Results: The result indicated that most participants (median = 5) demonstrated readiness and willingness to offer COVID-19 testing. Barriers to COVID-19 POCT were identified: impact on pharmacy workflow (59%), lack of payment mechanism (55%) and lack of sufficient training (21%). Most participants expressed interest in continuing POCT beyond the pandemic (86.1%). Conclusion: Community pharmacists in NYS reported willingness to initiate COVID-19 POCT. Addressing the identified barriers, such as workflow disruption and reimbursement challenges, will enable pharmacies to be better prepared to provide patient care, including POCT.
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Affiliation(s)
- Ruth O Ngwu
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
- Middleport Family Health Center, Middleport, NY, USA
| | - Ryan Lindeau
- Primary care of Western New York, Buffalo, NY, USA
| | | | - Christopher J Daly
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
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Hohmeier KC, McKeirnan K, Akers J, Klepser M, Klepser SA, Chen C, Klepser DG. Implementing community pharmacy-based influenza point-of-care test-and-treat under collaborative practice agreement. Implement Sci Commun 2022; 3:77. [PMID: 35842688 PMCID: PMC9287716 DOI: 10.1186/s43058-022-00324-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Early and accessible testing for influenza with point-of-care testing (POCT) can be a critical factor for deciding to begin antiviral treatment. More than 10,000 pharmacies across the USA offer Clinical Laboratory Improvement Amendments-waived POCT for infectious diseases, such as influenza A/B. Knowledge of barriers and facilitators to large-scale POCT implementation may be useful in scaling POCT for influenza test-and-treat services (Flu POCT). The objective of this study was to explore the experiences of pharmacists who were early adopters of Flu POCT and treatment under collaborative practice agreement in community pharmacy settings. Methods Qualitative research design with in-depth, semi-structured virtual video interviews of licensed US community pharmacists. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR). Interviewees were selected via a purposeful sampling of pharmacists who were enrolled in a nationwide clinical trial involving pharmacy-based influenza test-and-treat under a collaborative agreement. Interviews were recorded and transcribed. A deductive analytic approach was used via constructs from the CFIR. Results Six pharmacists were interviewed. Interviews ranged from 28 to 70 min, with an average length of 46 min. Four broad themes emerged from the data, and each had corresponding subthemes and supporting quotes: influence of the Flu POCT service characteristics on pharmacy implementation, influence of factors outside of the pharmacy setting in Flu POCT implementation, factors within the pharmacy setting influencing implementation, and process of implementing Flu POCT. A novel pharmacy-based Flu POCT implementation framework is presented. Conclusions Implementation of community pharmacy-based Flu POCT services is feasible; but, a thorough understanding of both barriers and facilitators to their implementation is needed to increase the spread and scale of these programs. Specifically, pharmacy stakeholders should focus efforts on increasing patient and provider awareness, pharmacist acceptance, leadership support, and support of health providers external to the pharmacy to improve implementation success. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00324-z.
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Tigges C, Doucette WR, Veach S, McDonough RP, Kent K, Wolff K, Witry MJ. Evaluation of patient perspective of point of care testing and medication: Dispensing by community pharmacists for Streptococcus pyogenes and influenza. J Am Pharm Assoc (2003) 2022. [DOI: 10.1016/j.japh.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hohmeier KC, Sain A, Garst A, Shell L, Desselle S, Gatwood J, Cost M. The Optimizing Care Model: Final findings of a novel community pharmacy practice model to enhance patient care delivery using technician product verification. J Am Pharm Assoc (2003) 2021; 62:112-119. [PMID: 34711522 DOI: 10.1016/j.japh.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/09/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The community pharmacy represents a convenient health care access point for patients and is increasingly used to deliver direct patient care services; however, several barriers exist that hinder widespread patient service implementation and scalability. Such barriers include scope of practice restrictions, a dearth of sustainable payment models, lack of pharmacist capacity given other responsibilities, and workflow models developed for dispensing medications rather than clinical care. In an effort to overcome the lack of pharmacist time and capacity, further task delegation to pharmacy technicians has been suggested. OBJECTIVES The primary objective of this study was to present the final outcomes of the Optimizing Care Model's impact. The model's impact on pharmacist patient care, workday composition, and rates of product selection errors not identified during final product verification are reported. METHODS The Optimizing Care Model is an innovative approach to community pharmacy practice aiming to foster a new patient-centered care delivery model that expands clinical service delivery and fosters collaboration across health care settings through task delegation, primarily through technician product verification (TPV). To investigate the impact of its sustained implementation, a quasi-experimental, 1-group pretest-posttest design was used. Outcomes assessed included medication errors, clinical activities, and workday composition. RESULTS Six chain and 3 independent pharmacies completed the final, continuation phase of the study. Overall pharmacist time spent delivering patient care services increased significantly upon implementation of the Optimizing Care Model (21% vs. 43%; P < 0.05), whereas pharmacist time spent performing dispensing-related activities decreased significantly (67% vs. 37%; P < 0.05). Total undetected error rates were significantly less in the Optimizing Care Model phase compared with the traditional model (0.05% vs. 0.01%; P < 0.001). CONCLUSION This study presented the final results of a 2-year assessment of the Optimizing Care Model. Results reaffirmed initial published findings that the model and its use of TPV increase the array and frequency of direct patient care services rendered while resulting in lower undetected error rates. Final project results of the Optimizing Care Model demonstrate increased clinical service delivery versus the traditional model, while also improving patient safety with lower rates of undetected dispensing errors within the Optimizing Care Model. The Optimizing Care Model continues to show promise as a future practice model for community pharmacies.
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Essack S, Bell J, Burgoyne D, Tongrod W, Duerden M, Sessa A, Altiner A, Shephard A. Point-of-Care Testing for Pharyngitis in the Pharmacy. Antibiotics (Basel) 2020; 9:E743. [PMID: 33126412 PMCID: PMC7693205 DOI: 10.3390/antibiotics9110743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is therefore an important step in effective antibiotic stewardship. Point-of-care (POC) tests, where results are available within minutes, can distinguish between viral and GAS pharyngitis and can therefore guide treatment in primary healthcare settings such as community pharmacies, which are often the first point of contact with the healthcare system. In this opinion article, the evidence for the use of POC testing in the community pharmacy has been discussed. Evidence suggests that pharmacy POC testing can promote appropriate antibiotic use and reduce the need for general practitioner consultations. Challenges to implementation include cost, training and 'who prescribes', with country and regional differences presenting a particular issue. Despite these challenges, POC testing for pharyngitis has become widely available in pharmacies in some countries and may represent a strategy to contain antibiotic resistance and contribute to antimicrobial stewardship.
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Affiliation(s)
- Sabiha Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - John Bell
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Douglas Burgoyne
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA;
| | - Wirat Tongrod
- Faculty of Pharmaceutical Sciences, Huachiew Chalermprakiet University, Samut Prakan 10540, Thailand;
| | - Martin Duerden
- School of Medicine, Centre for Medical Education, Cardiff University, Cardiff CF14 4XN, UK;
| | - Aurelio Sessa
- Italian College of General Practitioners and Primary Care (SIMG, Società Italiana di Medicina Generale delle Cure Primarie), 50142 Florence, Italy;
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany;
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Risøy AJ, Skeide Kjome RL, Svensberg K, Råheim M, Sølvik UØ. Pharmacists' experience of a diabetes risk-assessment service and analytical quality control in community pharmacies - A focus-group study. Res Social Adm Pharm 2020; 17:1259-1266. [PMID: 34155978 DOI: 10.1016/j.sapharm.2020.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Healthcare services such as diabetes risk-assessment are increasingly common in community pharmacies. Knowledge of community pharmacists' experiences of such services could ease the implementation of a larger-scale service. OBJECTIVES To explore Norwegian pharmacists' experience of a diabetes risk-assessment service, including analytical quality control, in a community-pharmacy setting. METHODS Three focus-group interviews were conducted in Norway between August and September 2017. Systematic text condensation was used, an analytic approach well suited for thematic content analysis across interview data. Fourteen pharmacists took part, recruited from a project offering a diabetes risk-assessment service, including measurements of Glycated hemoglobin A1c (HbA1c), in Norwegian community pharmacies. RESULTS The pharmacists emphasized the importance of using their knowledge and skills to promote good health. They considered offering this service as being compatible with their role as pharmacists. As communication is an essential part of their work, the pharmacists evaluated their communication skills as being good. Nevertheless, how to communicate the offering of this service was seen as a challenge, for instance recruiting participants and communicating in an understandable and professional way. Inclusion of the whole pharmacy staff as a team was experienced as an important success factor for implementation of a risk-assessment service. Analytical quality control was perceived as being a natural part of their job and a manageable task. CONCLUSIONS Offering a diabetes risk-assessment service is in line with the way a selected group of Norwegian community pharmacists perceived their professional role. However, they were uncomfortable recruiting participants, and expressed the wish for more support from the pharmacy chain. Our results add performance of analytical quality control as part of the ongoing development involving expansion of pharmacists' professional role. Future implementation studies may also benefit from giving both the pharmacy staff and customers sufficient time to familiarize themselves with the new service before measuring effects.
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Affiliation(s)
- Aslaug Johanne Risøy
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, PO Box 7804, N-5020, Bergen, Norway; Centre for Pharmacy, Faculty of Medicine, University of Bergen, PO Box 780, N-5007, Bergen, Norway; Norwegian Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, PO Box 6165, N-5892, Bergen, Norway.
| | - Reidun Lisbet Skeide Kjome
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, PO Box 7804, N-5020, Bergen, Norway; Centre for Pharmacy, Faculty of Medicine, University of Bergen, PO Box 780, N-5007, Bergen, Norway.
| | - Karin Svensberg
- Section for Pharmaceutics and Social Pharmacy, PharmaSafe Research Group, Department of Pharmacy, University of Oslo, PO Box 1068, Blindern, N-0316, Oslo, Norway; Department of Life Sciences and Health, Faculty of Health Sciences, Oslo Metropolitan University, PO Box 4, St. Olavs Plass, NO-0130, Oslo, Norway.
| | - Målfrid Råheim
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, PO Box 7804, N-5020, Bergen, Norway; Institute of Health and Social Sciences, Molde University College, PO Box 2110, NO-6402, Molde, Norway.
| | - Una Ørvim Sølvik
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, PO Box 7804, N-5020, Bergen, Norway.
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Kirby J, Mousa N. Evaluating the impact of influenza and streptococcus point-of-care testing and collaborative practice prescribing in a community pharmacy setting. J Am Pharm Assoc (2003) 2020; 60:S70-S75. [PMID: 32253085 DOI: 10.1016/j.japh.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if a difference in the use of point-of-care (POC) testing and treatment under a collaborative pharmacy practice agreement exists between insured and uninsured patients and also between patients established with a primary care provider (PCP) and those who are not established. A secondary objective was to assess patient satisfaction with a new, pharmacist-provided service. SETTING Two independent community pharmacies. PRACTICE DESCRIPTION Perkins Drugs is an independent community pharmacy practice that operates 2 sites in Gallatin, Tennessee. PRACTICE INNOVATION This practice innovation was pharmacist-provided POC influenza and group A Streptococcus (GAS) pharyngitis testing and associated treatment when appropriate. Pharmacists entered into a collaborative pharmacy practice agreement with a physician at a nearby primary care clinic, which allowed for the testing and prescribing of medication under a predetermined decision tree. EVALUATION Patient demographics and satisfaction levels with the service were collected. The service, while continuing, was implemented in December 2018, and cumulative data were collected until April 2019. RESULTS Pharmacists tested a total of 73 patients for influenza or GAS. Of the total, 24 patients (33%) did not have an established PCP, and 31 (42.5%) were uninsured. No significant difference was found in the use of the service when comparing the insured and uninsured groups, and participants were more likely to have an established PCP than not have. Of the patients who were contacted for follow-up, 98% reported satisfaction with the delivery of the service stating they would use it again. CONCLUSION Community pharmacy-based POC testing provides access to urgent care services for patients regardless of insurance status. In our experience, the service was well liked by patients and provided a nondispensing source of revenue. This service could potentially be duplicated, as state-based pharmacist scope of practice allows, to provide both a needed service to patients and elevate the pharmacist's role within the health care system.
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Hohmeier KC, Garst A, Adkins L, Yu X, Desselle SP, Cost M. The Optimizing Care Model: A novel community pharmacy approach to enhance patient care delivery by leveraging the technician workforce through technician product verification. J Am Pharm Assoc (2003) 2019; 59:880-885. [DOI: 10.1016/j.japh.2019.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/12/2019] [Accepted: 07/16/2019] [Indexed: 11/17/2022]
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Hohmeier KC, Desselle SP. Exploring the implementation of a novel optimizing care model in the community pharmacy setting. J Am Pharm Assoc (2003) 2019; 59:310-318. [DOI: 10.1016/j.japh.2019.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/25/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
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Klepser ME, Adams AJ. Pharmacy-based management of influenza: lessons learned from research. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:573-578. [PMID: 30265414 DOI: 10.1111/ijpp.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/17/2018] [Indexed: 01/13/2023]
Abstract
Recently, several jurisdictions have pursued legislative and regulatory changes to allow pharmacy-based influenza management models in which pharmacists can initiate appropriate antiviral therapy in community pharmacy settings. While studies have been published in Canada, Japan, New Zealand, Norway and the United States, concerns have been expressed over pharmacist training, the accuracy of rapid influenza diagnostic tests, and the potential impact on antimicrobial resistance, among others. Studies have demonstrated that pharmacists provide safe and effective influenza management, with high rates of patient satisfaction, while maintaining or improving antimicrobial stewardship.
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