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Lin Q, Mathers A, Tilli T, Baker J, Bhaidani S, Grootendorst P, Cadarette SM, Dolovich L. Implementation of the appointment-based model in community pharmacies: An analysis of refills and adherence. Res Social Adm Pharm 2023; 19:1286-1291. [PMID: 37286385 DOI: 10.1016/j.sapharm.2023.05.011] [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: 12/07/2022] [Revised: 02/22/2023] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Traditionally, much of community pharmacy practice relies on patients to request their own medication refills. These refills are often not aligned, which has been shown to decrease adherence and workflow efficiencies. The appointment-based model (ABM) is designed to proactively synchronize refills and schedule patient-pharmacist appointments. OBJECTIVES To describe the characteristics of patients enrolled in the ABM; and to compare the number of distinct refill dates, number of refills, and adherence for antihypertensives, oral antihyperglycemics, and statins 6-months and 12-months pre-post ABM implementation. METHODS In September 2017, the ABM was implemented across independent community pharmacies within a pharmacy banner in Ontario, Canada. In December 2018, a convenience sample of three pharmacies was extracted. Demographic and clinical characteristics were collected on program enrollment (index) date for individual patients and their medication fill histories were used to investigate adherence measures including distinct number of refill dates, number of refills, and proportion of days covered. Descriptive statistics were analyzed using StataCorp. RESULTS Analysis of 131 patients (48.9% male; mean age 70.8 years ± 10.5 SD) filled on average 5.1 ± 2.7 medications with 73 (55.7%) experiencing polypharmacy. Patients had a significant reduction in mean number of refill dates (6.8 ± 3.8 SD six-months pre-enrollment, 4.9 ± 3.1 SD six-months post-enrollment, p < 0.0001). Adherence to chronic medications remained high (PDC ≥95%). CONCLUSION The ABM was implemented for a cohort of established users, already highly adherent to their chronic medications. Results demonstrate reduced filling complexity and fewer refill dates while also sustaining the high baseline adherence across all chronic medications studied. Future studies should investigate patient perspectives and potential clinical benefits of the ABM.
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Affiliation(s)
- Qiqi Lin
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Annalise Mathers
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Tiana Tilli
- WholeHealth Pharmacy Partners, Markham, Ontario, Canada
| | - Jen Baker
- WholeHealth Pharmacy Partners, Markham, Ontario, Canada
| | | | - Paul Grootendorst
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne M Cadarette
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Eshelman School of Pharmacy, University of North Carolina, North Carolina, United States
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
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Waghmare PH, Huang CY, Jaynes HA, Green WM, Snyder ME, Adeoye-Olatunde OA, Coe AB, Farley JF, Zillich AJ. Disparities in Medicare beneficiaries' receiving medication synchronization. J Am Pharm Assoc (2003) 2023; 63:538-546.e2. [PMID: 36463009 DOI: 10.1016/j.japh.2022.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/21/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medication synchronization (med-sync) aligns patients' monthly or quarterly chronic medications to a predetermined single pickup date at a community pharmacy. The study objective was to examine med-sync enrollment disparities based on Medicare beneficiaries' predisposing, enabling, and need characteristics. METHODS This was a retrospective cohort study using a Medicare dataset of beneficiaries receiving medications from pharmacies that self-identified as providing med-sync. Medicare beneficiaries who were continuously enrolled in fee-for-service medical and pharmacy benefits during the study period (2014-2016) were included. Study cohorts (med-sync and non-med-sync patients) were defined, and bivariate and multivariable logistic regression analyses were performed. Andersen's Health Services Utilization Model guided our inclusion of predisposing, enabling, and need characteristics to examine for association with med-sync enrollment. RESULTS A total of 170,180 beneficiaries were included, of which 13,193 comprised the med-sync cohort and 156,987 comprised the non-med-sync cohort. Bivariate logistic regression analysis revealed statistically significant differences (P < 0.05) in cohorts based on age, geographic region, type of residence, number of unique chronic medications, comorbidities, outpatient visits, and inpatient hospitalizations. Beneficiaries had higher odds of being enrolled in med-sync with increasing age (adjusted odds ratio [AOR] 1.003 [95% CI 1.001-1.005]) and if they resided in the Northeast (AOR 1.094 [95% CI 1.018-1.175]), South (AOR 1.109 [95% CI 1.035-1.188]), and West (AOR 1.113 [95% CI 1.020-1.215]) than those in the Midwest. Beneficiaries residing in nonmetro areas had lower odds of enrollment (AOR 0.914 [95% CI 0.863-0.969]) than those in metro areas. Beneficiaries with previous fewer inpatient hospitalizations (AOR 0.945 [95% CI 0.914-0.977]) were more likely to be enrolled, and those with more outpatient visits (AOR 1.003 [95% CI 1.001-1.004]) were more likely to be enrolled. Those taking a higher number of oral chronic medications (AOR 1.005 [95% CI 1.002-1.008]) had greater odds of enrollment in med-sync. CONCLUSIONS Med-sync program expansion opportunities exist to address potential enrollment disparities based on age, geographic region, metropolitan area, and prior health utilization. Further studies are needed to develop and examine strategies among pharmacies to improve med-sync enrollment outreach to these subgroups of patients.
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Cheng A, Hughes TD, Chen HH, Ozawa S, Ferreri SP. Beyond refill alignment: Evaluating the impact of appointment-based model. Res Social Adm Pharm 2022; 18:3751-3757. [DOI: 10.1016/j.sapharm.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 04/20/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
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Hughes TD, Cutrell S, Minshew LM, Brown P, Ferreri SP. An exploration of barriers, facilitators, and practical solutions for adopting medication synchronization into community pharmacies: A qualitative analysis. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100111. [PMID: 35478527 PMCID: PMC9030300 DOI: 10.1016/j.rcsop.2022.100111] [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: 03/04/2021] [Revised: 01/12/2022] [Accepted: 01/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Community pharmacies across the nation have adopted medication synchronization (Med Sync) services with the aim of improving medication adherence. To help incorporate Med Sync into a pharmacy's workflow, pharmacy associations and organizations developed implementation guides for community pharmacies. However, considerable variability in the adoption of this service exists as pharmacies struggle to implement Med Sync into traditional workflow. Researchers identified early adopters of Med Sync who dispense majority of their prescriptions as part of a Med Sync program. An exploratory study was undertaken with the aim to reveal themes surrounding facilitators and barriers to adoption of Med Sync in community pharmacies. Objectives The objective of this study was to explore the barriers and facilitators associated with Med Sync adoption in community pharmacies and generate practical solutions for service adoption. Methods Community pharmacies participating in the North Carolina's Community Pharmacy Enhanced Services Network (CPESNsm) who were early adopters of Med Sync and had greater than 50% of their prescription volume being dispensed as part of a Med Sync program were recruited to participate in semi-structured interviews. Interviews were conducted, recorded, and transcribed verbatim with representatives who led the adoption of Med Sync in their pharmacy. Inductive coding and summary analysis were used to analyze the interview data and determine themes associated with facilitators and barriers. Results Analysis of the interviews revealed four key themes: program organization, staff engagement, patient engagement, and provider engagements for Med Sync adoption. Each of these themes had several sub-themes, contributing to facilitators and barriers to Med Sync adoption. Subthemes of program organization included having organizational infrastructure, including a pharmacy software system, a dedicated area, and a consistent enrollment process. Subthemes of staff engagement included having a team-based approach, job training, and staff incentives. Patient engagement's subthemes included communication, finances, health literacy, and transportation. Provider engagement resulted with subthemes including lack of communication and provider-pharmacist relationships. Conclusion To ensure successful adoption of Med Sync into traditional workflow, community pharmacies should employ a multi-factorial approach that includes internal and external components to the community pharmacy. This study identified facilitators associated with successful Med Sync adoption such as adequate staff engagement and requisite program organization. Barriers hindering successful Med Sync adoption resulted from challenges with provider and patient engagement. This study also makes an important contribution by providing practical solutions to Med Sync adoption based on participant responses and identified themes and sub-themes.
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Renfro CP, Smith K, Wilson CA, Overshine K, Hohmeier KC. Use of value stream mapping to improve the medication synchronization process. J Am Pharm Assoc (2003) 2021; 62:740-749.e3. [PMID: 35012893 DOI: 10.1016/j.japh.2021.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/10/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lean methodology, specifically value stream mapping, can be used to identify and reduce inefficiencies in the medication synchronization process. OBJECTIVES The objectives of this study were to (1) evaluate potential medication synchronization process improvements to reduce nonvalue-added actions, (2) assess fidelity to the medication synchronization core components, and (3) identify the best process for medication synchronization for an independent community pharmacy with multiple locations. METHODS This study used an observational, cross-sectional design. A value stream map was created to provide a detailed illustration of each step in the medication synchronization process. Time for each step of the medication synchronization process was observed on site on different days and times as well as the time required to process, package, and verify prescription medications. These steps were conducted before interventions were made to the process and after to compare the difference. The organizational readiness for change tool was administered to employees of the independent pharmacy before interventions to determine their perspective of the medication synchronization process and assess their readiness for change. RESULTS Owing to various interventions made to the medication synchronization process, 2 steps in the process were eliminated. This resulted in a decrease in adherence packaging time workflow by 69.4%. Staff (n = 9) rated the medication synchronization process on 4 components: acceptability of the current process (13.8 ± 3.6), intervention appropriateness (13.7 ± 3.7), feasibility of a new medication synchronization process (17.1 ± 2.3), and organizational level of support (21.8 ± 4.1). CONCLUSION Value stream mapping proved to be a valuable tool in identifying inefficiencies in the medication synchronization process and reducing nonvalue-added waste. The result was a decrease in time required for adherence packaging workflow and a more standardized medication synchronization process across multiple independent pharmacy locations. This more standardized process can play a key role in improving the continuity of patient care, increasing medication adherence, and in turn decreasing the number of hospital admissions.
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Herbert SMC, Heck LA, Vogel AN, Coley KC, Somma McGivney MA, Maher RL, Carroll JC. Strategies for implementing the Appointment-Based Model at a rural independent chain of community pharmacies. J Am Pharm Assoc (2003) 2021; 62:104-111.e2. [PMID: 34702646 DOI: 10.1016/j.japh.2021.09.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Appointment-Based Model (ABM) is a care model that helps community pharmacists streamline their medication dispensing workflow while simultaneously integrating patient care into the medication preparation process through medication synchronization. Implementation of the ABM has varied across community pharmacies. Further studies that identify tailored implementation approaches are needed to support broad adoption of the ABM in practice. OBJECTIVES (1) To determine facilitators and barriers to ongoing adoption and implementation of the ABM at a small chain of rural independent pharmacies where adoption has stalled and (2) to identify implementation strategies to support further adoption of the ABM at these pharmacies METHODS: This project was an exploratory, mid-implementation study. Semistructured interviews were conducted with pharmacy staff who participated in the ongoing implementation and use of the ABM at the pharmacies. Interviews elicited stakeholder-centered perspectives on (1) experiences with the ABM to date, (2) processes and roles for the ABM, and (3) opinions on how implementation of the ABM could be improved at the pharmacies. Rapid qualitative assessment methodology was used for analysis to identify facilitators and barriers and to select implementation strategies. RESULTS Thirty-one pharmacy personnel were interviewed: pharmacists (n = 10), pharmacy technicians (n = 7), and fill clerks (n = 14). The research team identified 6 facilitators and 4 barriers to the implementation of the ABM at the pharmacies. Five implementation strategies were selected based on the facilitators and barriers: (1) capture and share local knowledge across pharmacy sites, (2) conduct educational outreach visits, (3) conduct ongoing training, (4) prepare patients to be active participants in the ABM, and (5) organize clinician implementation team meetings. CONCLUSIONS Development of a stakeholder-driven implementation approach may support further implementation and adoption of the ABM in practice.
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Pham JN, Robertson AD, Melton BL, Rohling BJ, Newell BJ. Pilot Evaluation of Pharmacists' and Pharmacy Technicians' Knowledge and Understanding of a Medication Synchronization Program. J Pharm Pract 2021; 36:315-321. [PMID: 34583548 DOI: 10.1177/08971900211048306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Medication synchronization (MS) improves adherence by allowing patients to pick up all medications at the same time. Pharmacy staff need training to utilize a MS program effectively. Objective: Evaluate the impact of a video tutorial with decreased extraneous and intrinsic load on pharmacists' and pharmacy technicians' knowledge and understanding of a MS program. Study Method: Participants completed a prequestionnaire to assess knowledge and understanding of the MS process. They then watched a step-by-step video tutorial and were reassessed by a postquestionnaire 2 weeks later. Study participants included pharmacists and pharmacy technicians employed at 1 of 2 pharmacies in 1 regional division of a large community-based chain pharmacy. Participants were eligible if they were registered and in good standing with the Kansas Board of Pharmacy and employed for greater than 30 days since July 1, 2018. Results: Twenty participants were included in the final analysis. The median age was 36 years, 14 (70%) were female, 13 (65%) were pharmacy technicians, and each study site had equal representation. Most participants, 15 (75%), had previously completed the standard MS training. There was a significant improvement in number of correct responses after the intervention with a prequestionnaire score of 61.3% to postquestionnaire score of 70% (P=.002). Significant improvement in knowledge was seen in participants who completed the previous training as well as first-time learners of the MS process. Conclusion: Optimizing training on MS processes by decreasing extraneous and intrinsic load improved the pharmacy team's knowledge and understanding of the MS process.
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Affiliation(s)
- Janet N Pham
- Dillons Pharmacy, A Kroger Company, Wichita, KS, USA
| | - Amy D Robertson
- Department of Pharmacy Practice, University of Arkansas for Medical Sciences College of Pharmacy, Fayetteville, AR, USA
| | - Brittany L Melton
- Department of Pharmacy Practice, University of Kansas School of Pharmacy, Kansas City, KS, USA
| | | | - Bradley J Newell
- Department of Pharmacy Practice, University of Kansas School of Pharmacy, Wichita, KS, USA
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The impact of medication synchronization programs on medication adherence: A meta-analysis. J Am Pharm Assoc (2003) 2021; 61:e202-e211. [PMID: 33741277 DOI: 10.1016/j.japh.2021.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/15/2021] [Accepted: 02/12/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Medication nonadherence is associated with more than $100 billion in preventable medical costs each year in the United States. Medication synchronization (med sync) programs have emerged as a potential solution to addressing nonadherence. OBJECTIVES To assess the impact of med sync programs on adherence in adults on chronic medications through a meta-analysis. METHODS A comprehensive literature search was conducted for studies of med sync and adherence in adults published in English from database inception to May 2020. Studies were included if they provided a description of the med sync program, reported a quantitative measure of medication adherence using the proportion of days covered metric, and were conducted in the United States. The search terms included "medication synchronization," "med sync," "adherence," and "PDC." Pooled odds ratios (ORs) and 95% CIs using random-effects models were calculated to assess overall impact and subgroup analyses. The risk of bias of individual studies was assessed using the Downs and Black checklist. RESULTS Nine studies reporting 30 effect sizes were included in the meta-analysis. On the basis of the Downs and Black checklist, the methodological quality of the studies was fair (mean [SD] 17.6 [1.7]). Med sync was associated with greater odds of adherence (pooled OR 2.29 [95% CI 1.99-2.64], I2 = 93.3%, τ2 = 1.11). In addition, the type of med sync program influenced the variation in effect sizes (Cochran Q statistic [Qbetween] = 45.4, P < 0.001), with appointment-based med sync programs having the largest impact on adherence (3.14 [95% CI 2.72-3.63]). CONCLUSION In this meta-analysis of the impact of med sync on adherence, med sync was associated with statistically significant improvement in adherence. Policy makers and payers should consider reimbursement to pharmacies to support med sync programs in efforts to combat medication nonadherence and improve health outcomes.
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Morbitzer KA, McLaughlin JE, Ozawa S, Beechinor R, Dumond J, Pomykal C, Bush A, Zhang Q, Carpenter D, Lee CR. Implementation and Initial Evaluation of a Research and Scholarship Training Pathway in a Doctor of Pharmacy Curriculum. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2021; 85:8079. [PMID: 34281819 PMCID: PMC7829690 DOI: 10.5688/ajpe8079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 09/14/2020] [Indexed: 05/03/2023]
Abstract
Objective. To design, implement, and assess the initial impact of a pharmacy student research and scholarship training pathway.Methods. The Research and Scholarship in Pharmacy (RASP) pathway was designed to create a longitudinal, elective pathway within a Doctor of Pharmacy (PharmD) curriculum at a single institution. The pathway consisted of three elective courses built around a faculty-mentored scholarly project where students framed an answerable question, generated and interpreted relevant data, and communicated their findings in oral and written form. Following implementation, a retrospective, multi-method analysis was conducted to evaluate the impact of the program on the initial two student cohorts that completed it and assess their perceptions of the value of the pathway.Results. Fifty students (25 in each of two cohorts) completed the three-course sequence. Students were supported by 33 distinct faculty mentors. Thirty-eight (76%) students presented an abstract derived from their project at a national meeting. The first cohort exit survey (96% response rate) revealed positive student perceptions regarding the value of and satisfaction with the research pathway. Twenty-three (96%) students were satisfied with their research experience, 21 (88%) were satisfied with their faculty mentor, and 24 (100%) were satisfied with their development of project management skills. In the first cohort, 10 (40%) students published an original research manuscript within one year of graduation.Conclusion. The Research and Scholarship in Pharmacy pathway feasibly and effectively provided a mechanism for students to engage in a faculty-mentored longitudinal research experience within a PharmD curriculum that promoted skill development and opportunities for scholarship. Initial implementation demonstrated high rates of student satisfaction, low rates of student attrition, and high rates of scholarly output.
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Affiliation(s)
- Kathryn A Morbitzer
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Jacqueline E McLaughlin
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Sachiko Ozawa
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Ryan Beechinor
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Julie Dumond
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Christina Pomykal
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Antonio Bush
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Qisheng Zhang
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Delesha Carpenter
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Craig R Lee
- University of North Carolina at Chapel Hill, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
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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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Gernant SA, Bacci JL, Upton C, Ferreri SP, McGrath S, Chui MA, Rickles NM, Smith M. Three opportunities for standardization: A literature review of the variation among pharmacists' patient care services terminology. Res Social Adm Pharm 2020; 16:766-775. [PMID: 31836468 PMCID: PMC7784038 DOI: 10.1016/j.sapharm.2019.08.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Variation describing pharmacists' patient care services exist, and this variation contributes to the prevalent misunderstanding of pharmacists' roles. In contrast, standard phraseology is a critical practice among highly reliable organizations and a way to reduce variation and confusion. OBJECTIVE This work aims to identify and define pharmacists' patient care service terms to identify redundancies and opportunities for standardization. METHODS Between May to August 2018, terms and definitions were searched via PubMed, Google Scholar and statements/policies of professional pharmacy organizations. Two references per term were sought to provide an "early definition" and a "contemporary definition." Only literature published in English was included, and data gathered from each citation included the date published, the term's definition, and characterization of the reference's source as either a regulatory or professional body. A five-person expert panel used an iterative technique to revise and verify the list of included terms and subsequent literature review results. Terms were then searched in the National Library of Medicine's Medical Subject Heading Database (MeSH) in July, 2019. RESULTS There are fifteen commonly misunderstood terms that refer to the patient care services provided by pharmacists. The appearance of these terms in the literature spanned nearly five decades. Nearly half of terms appeared first in regulatory, law or policy documents; of these, two terms had contemporary definitions appearing in the professional literature that differed from their early regulatory definition. Three opportunities to improve standardization include: (1) Implementation of standardized phraseology systems similar to nursing's Clinical Care Classification System; (2) Academics' adherence to standardized MeSH terms; and (3) Clarification of pharmacy education accreditation standards. CONCLUSION Numerous terms are used to describe pharmacists' patient care services, with many definitions of terms overlapping in several key components. The profession has made concerted efforts to consolidate and standardize terminology in the past, but more opportunities exist.
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Affiliation(s)
- Stephanie A Gernant
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
| | - Jennifer L Bacci
- University of Washington School of Pharmacy, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Charlie Upton
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
| | - Stefanie P Ferreri
- Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, CB 7475, Chapel Hill, NC, USA.
| | - Stephanie McGrath
- Pennsylvania Pharmacists Care Network, 5587 Baum Blvd, Floor 3, Pittsburgh, PA, 15206, USA.
| | - Michelle A Chui
- Sonderegger Research Center for Improved Medication Outcomes, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI, 53713, USA.
| | - Nathaniel M Rickles
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
| | - Marie Smith
- University of Connecticut School of Pharmacy, 69 North Eagleville Road, Storrs, CT, 06269-3092, USA.
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Renfro C, Coulter D, Ly L, Fisher C, Cardosi L, Wasson M, Hohmeier KC. Exploring Pharmacy Technician Roles in the Implementation of an Appointment-Based Medication Synchronization Program. PHARMACY 2020; 8:E28. [PMID: 32138328 PMCID: PMC7151672 DOI: 10.3390/pharmacy8010028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/19/2020] [Accepted: 02/25/2020] [Indexed: 02/04/2023] Open
Abstract
The objective of this study was to qualitatively explore the role of pharmacy technicians in the implementation of an appointment-based model (ABM) medication synchronization program. The purposeful sampling of technicians working within six different locations of a supermarket chain pharmacy in Mississippi and Tennessee was carried out, and the technicians were interviewed between January and April 2018. A semi-structured interview guide was developed based on the Consolidated Framework for Implementation Research (CFIR). Questions gathered information around pharmacy technician demographics and CFIR domains (process, inner setting, outer setting and intervention characteristics). Interviews were audiotaped and transcribed. Two members of the research team performed thematic content analysis. Six full-time, certified pharmacy technicians with 8.3 ± 2.7 years of experience were interviewed. Findings suggest that including hands-on experience with program software is needed during training to successfully implement ABM. A barrier to implementation was the time needed to complete ABM tasks as compared to other tasks. Although some barriers exist regarding implementation, technicians believe that overall, this program has positive benefits for patients. Results from this study signify that ABM implementation can be challenging. Better ABM portal integration with the pharmacy patient profile and appropriate workforce budgeting are key to continued success.
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Affiliation(s)
- Chelsea Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA; (C.R.); (D.C.); (L.L.)
| | - Davis Coulter
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA; (C.R.); (D.C.); (L.L.)
| | - Lan Ly
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN 38163, USA; (C.R.); (D.C.); (L.L.)
| | - Cindy Fisher
- Kroger Pharmacy, Memphis, TN 38103, USA; (C.F.); (M.W.)
| | - Lindsay Cardosi
- Methodist South Bedside Delivery Program, Memphis, TN 38116, USA;
| | - Mike Wasson
- Kroger Pharmacy, Memphis, TN 38103, USA; (C.F.); (M.W.)
| | - Kenneth C. Hohmeier
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Nashville, TN 37211, USA
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13
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Fitzpatrick RM, Witry MJ, Doucette WR, Kent K, Deninger MJ, Mcdonough RP, Veach S. Retrospective analysis of drug therapy problems identified with a telephonic appointment-based model of medication synchronization. Pharm Pract (Granada) 2019; 17:1373. [PMID: 31275491 PMCID: PMC6594433 DOI: 10.18549/pharmpract.2019.2.1373] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 04/08/2019] [Indexed: 02/07/2023] Open
Abstract
Objectives: To describe the drug therapy problems (DTPs) identified for patients enrolled in an Appointment Based Model (ABM) for medication synchronization, describe the pharmacist-delivered clinical interventions, and assess what patient characteristics are associated with the number of DTPs identified. Methods: A cross-sectional chart review of 1 month of pharmacist notes for telephone ABM encounters at one independent community pharmacy in the Midwest U.S. was performed for a systematic random sample of patients active in the program during September 2017. Included patients were 18 years and older and took one or more synchronized medications. Data included months in the program, gender, age, insurance type, refill interval, medications (synchronized and total), DTP category, and intervention category. Descriptive statistics were calculated, and a multiple linear regression tested the association between patient characteristics and the number of DTPs identified. Results: The study involved 209 subjects, 54% women, with a mean age of 69.5 years and. The average number of medications synchronized was 4.7, the mean total number of medications was 6.3, and mean length of time in the program was 20 months. The DTPs (n=334) identified included needs additional drug therapy (43.1%), inappropriate adherence (31.4%), unnecessary drug therapy (15.0%), and adverse drug reaction (9.6%). The regression showed age and number of medications was positively associated with number of DTPs identified, but months enrolled was not. Conclusions: This ABM approach identified several hundred DTPs with corresponding interventions within a one-month period, suggesting that ABMs have a significant potential to improve patient care. The data also suggest that pharmacist interventions within an ABM program are valuable beyond the first few fills as patients move into maintenance use of their medications, especially for patients of advancing age and polypharmacy.
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Affiliation(s)
- Rebecca M Fitzpatrick
- Hartig Drug, Dubuque, IA (United States). [At time of study, was PGY1 Community Pharmacy Resident at The College of Pharmacy, University of Iowa, Iowa City, IA (United States)].
| | - Matthew J Witry
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa. Iowa City, IA (United States).
| | - William R Doucette
- Division Head and Veale Professor in Healthcare Policy, Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa. Iowa City, IA (United States).
| | - Kelly Kent
- Director of Clinical Services. Towncrest Pharmacy. Iowa City, IA (United States).
| | | | | | - Stevie Veach
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa. Iowa City, IA (United States).
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14
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Witry M, Ernzen M, Pape A, Viyyuri BR. Pilot and Feasibility of Combining a Medication Adherence Intervention and Group Diabetes Education for Patients with Type-2 Diabetes. PHARMACY 2019; 7:E76. [PMID: 31261613 PMCID: PMC6789893 DOI: 10.3390/pharmacy7030076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/18/2019] [Accepted: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
Introduction: Controlling diabetes typically requires self-management and medications. Community pharmacists are positioned to support patients with both. Methods: This study assessed the feasibility and potential benefit of combining pharmacist-provided group diabetes education (up to eight sessions) and medication synchronization using a three-group design. Data were collected using pre-post paper surveys and electronic health record data. One group received both education and synchronization services, another group received medication synchronization only, and a third served as control. Results: Of 300 contacted patients, eighteen patients participated in group diabetes education, 14 had medication synchronization only, and 12 comprised a control group. There was little change in HbA1c over the study period. Medication adherence appeared to be positively aided by medication synchronization, although all groups started with high adherence. Some medication beliefs and self-care activities may have been positively impacted by group diabetes education. Both groups receiving medication synchronization were satisfied. Conclusions: Participants strongly agreed they would recommend group diabetes education from the study pharmacy to a friend and were satisfied with medication synchronization; however, it was difficult to tell if there was a synergistic effect by combining the two services. Reimbursement for diabetes education was not obtained despite multiple attempts, hindering sustainability.
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Affiliation(s)
- Matthew Witry
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA.
| | | | | | - Brahmendra Reddy Viyyuri
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, Iowa City, IA 52242, USA
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15
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Patti M, Renfro CP, Posey R, Wu G, Turner K, Ferreri SP. Systematic review of medication synchronization in community pharmacy practice. Res Social Adm Pharm 2018; 15:1281-1288. [PMID: 30482457 DOI: 10.1016/j.sapharm.2018.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/05/2018] [Accepted: 11/11/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Medication non-adherence costs more than 100 billion dollars in avoidable hospitalizations yearly. As a result, community pharmacies have implemented medication synchronization programs to improve adherence. One function of most medication synchronization programs is the alignment of all of a patient's medications to refill on a single date. While aligning refills is a standard aspect of most programs, other features vary making it difficult to identify which program components lead to improved adherence. OBJECTIVE To review available literature and identify core components of medication synchronization and associated implementation techniques in community pharmacy. METHODS A systematic review was performed by searching electronic databases for studies, reviews, and other sources for grey literature discussing medication synchronization in community pharmacy settings. Studies were eligible for inclusion if they documented the operation of medication synchronization program in a community pharmacy. A framework analysis identified common themes present in the literature. RESULTS Twenty-six studies met criteria for final inclusion in this review. The majority of studies were retrospective cohorts, commentaries, and implementation guides. A wide variety of core components were included as part of medication synchronization program descriptions in the available literature. Several core components were identified as consistent throughout most of the published literature. These components were the identification and enrollment of patients, inclusion of a medication review and patient assessment, the alignment of refills, a formal process for preparation of medications, and the delivery of medications and other services. CONCLUSIONS This review identified several common themes of medication synchronization in the literature, which could help standardize medication synchronization within community pharmacy and facilitate future research. Themes found in this review provide the foundation upon which a consensus definition of medication synchronization can be built.
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Affiliation(s)
- Michael Patti
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| | - Chelsea Phillips Renfro
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center College of Pharmacy, Memphis, TN, USA
| | - Rachael Posey
- Health Sciences Library, University of North Carolina at Chapel Hill, William Rand Kenan Jr. Library of Veterinary Medicine at North Carolina State University, USA
| | - Gabrielle Wu
- UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA
| | - Kea Turner
- University of California, San Diego School of Medicine, USA
| | - Stefanie P Ferreri
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, USA.
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