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Waters AR, Meehan K, Atkins DL, Ittes AH, Ferrari RM, Rohweder CL, Wangen M, Ceballos RM, Issaka RB, Reuland DS, Wheeler SB, Brenner AT, Shah PD. How pharmacists would design and implement a community pharmacy-based colorectal cancer screening program. PREVENTIVE ONCOLOGY & EPIDEMIOLOGY 2024; 2:10.1080/28322134.2024.2332264. [PMID: 38881823 PMCID: PMC11177275 DOI: 10.1080/28322134.2024.2332264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Distributing CRC screening through pharmacies, a highly accessible health service, may create opportunities for more equitable access to CRC screening. However, providing CRC screening in a new context introduces a substantial implementation challenge. Methods We conducted 23 semi-structured interviews with community pharmacists practicing in Washington state and North Carolina about distributing fecal immunochemical tests (FIT) to patients in the pharmacy. The Consolidated Framework for Implementation Research (CFIR) was used to guide analysis. Results Pharmacists believed that delivering FITs was highly compatible with their environment, workflow, and scope of practice. While knowledge about FIT eligibility criteria varied, pharmacists felt comfortable screening patients. They identified standardized eligibility criteria, patient-facing educational materials, and continuing education as essential design features. Pharmacists proposed adapting existing pharmacy electronic health record systems for patient reminders/prompts to facilitate FIT completion. While pharmacists felt confident that they could discuss test results with patients, they also expressed a need for stronger communication and care coordination with primary care providers. Discussion When designing a pharmacy-based CRC screening program, pharmacists desired programmatic procedures to fit their current knowledge and context. Findings indicate that if proper attention is given to multi-level factors, FIT delivery can be extended to pharmacies.
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Affiliation(s)
- Austin R Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Katherine Meehan
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA 98109, USA
| | - Dana L Atkins
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98109, USA
| | - Annika H Ittes
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Rachel M Ceballos
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Rachel B Issaka
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine. Seattle, WA, 98195, USA
| | - Daniel S Reuland
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Alison T Brenner
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Parth D Shah
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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Skoy E, Frenzel O, Pajunen H, Eukel H. Implementation of a Pharmacy Follow-Up Program for Dispensed Opioid Medications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6628. [PMID: 37681768 PMCID: PMC10487139 DOI: 10.3390/ijerph20176628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There have been multiple reported pharmacy initiatives to reduce opioid misuse and accidental overdose to address our nation's public health crisis. To date, there has not been a description in the literature of a community pharmacy follow-up initiative for dispensed opioids. METHODS A follow-up program was designed and implemented in community pharmacies as part of a previously developed opioid overdose and misuse prevention program (ONE Program). Five to twelve days after the dispensing of an opioid, pharmacy technicians called the patient to follow up on opioid safety topics. Pharmacy technicians used a questionnaire to inquire about medication disposal plans, if the patient was taking the medication more than prescribed, medication side effects, and if the patient needed a pharmacist consultation. The results from that questionnaire were documented. RESULTS During the first 18 months of the follow-up program, 1789 phone calls were completed. Of those contacted, 40% were still using their opioid medication, and over 10% were experiencing side effects which triggered a pharmacist consult. Patients were reminded of proper medication disposal methods, and most patients (78%) desired to dispose of unused medication at the pharmacy medication disposal box. CONCLUSIONS Follow-up phone calls post-opioid medication dispensing were shown to add value to a previously established opioid misuse and accidental overdose prevention program and allowed for the fulfillment of the Pharmacist Patient Care Process.
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Affiliation(s)
- Elizabeth Skoy
- Department of Pharmacy Practice, School of Pharmacy, North Dakota State University, Dept 2660, Fargo, ND 58108, USA; (O.F.); (H.P.); (H.E.)
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Gatwood J, Brookhart A, Kinney O, Hagemann T, Chiu CY, Ramachandran S, Hohmeier KC. Clinical Nudge Impact on Herpes Zoster Vaccine Series Completion in Pharmacies. Am J Prev Med 2022; 63:582-591. [PMID: 35705425 DOI: 10.1016/j.amepre.2022.04.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A new recombinant herpes zoster vaccine has advanced efforts to prevent shingles, but its multidose regimen introduces potential barriers to full protection that must be managed by community pharmacies. To address this potential patient management challenge, a pharmacy records clinical support tool was implemented to assist pharmacy staff in managing herpes zoster vaccine dose completion. METHODS Beginning in November 2018, a large community pharmacy chain (operating in 36 states) implemented a provider nudge within its clinical decision support tool across all locations that fit seamlessly into the existing workflow, alerting the pharmacy staff of the need for a patient's second dose. Initial and second doses were followed over 2 overlapping, 10-month periods before and after system launch. Differences in vaccine completion rates before and after the system was operational were assessed by chi-square tests and predictors of completion, controlling for store- and patient-level characteristics, and were analyzed by multivariable logistic regression and generalized linear models throughout 2021. RESULTS Across 2,271 pharmacies, 71,459 and 41,982 initial doses of the herpes zoster vaccine were given in the baseline and intervention period, respectively. The proportion of patients completing both doses increased slightly after system implementation (before: 71.9%, after: 75.2%; p<0.0001). However, dramatic improvements in time to dose completion were observed (before: 109.8 days, after: 93.3 days; p<0.001), and changes were significant in stores in all but 4 states. CONCLUSIONS Results suggest that the use of a clinical nudge improved the occurrence of and time to herpes zoster vaccine dose completion in adults across the U.S.
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Affiliation(s)
- Justin Gatwood
- Department of Clinical and Translational Sciences, College of Pharmacy, The University of Tennessee Health Science Center, Nashville, Tennessee.
| | | | | | - Tracy Hagemann
- Department of Clinical and Translational Sciences, College of Pharmacy, The University of Tennessee Health Science Center, Nashville, Tennessee
| | - Chi-Yang Chiu
- Department of Preventive Medicine, College of Medicine, The University of Tennessee Health Science Center, Memphis, Tennessee
| | - Sujith Ramachandran
- Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi, Oxford, Mississippi
| | - Kenneth C Hohmeier
- Department of Clinical and Translational Sciences, College of Pharmacy, The University of Tennessee Health Science Center, Nashville, Tennessee
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Haga SB, Mills R, Moaddeb J, Liu Y, Voora D. Independent Community Pharmacists' Experience in Offering Pharmacogenetic Testing. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2021; 14:877-886. [PMID: 34290521 PMCID: PMC8289463 DOI: 10.2147/pgpm.s314972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/22/2021] [Indexed: 12/16/2022]
Abstract
Objective This study assessed pharmacist experiences with delivering pharmacogenetic (PGx) testing in independent community pharmacies. Methods We conducted a cluster randomized trial of independent community pharmacies in North Carolina randomized to provide either PGx testing as a standalone service or integrated into medication therapy management (MTM) services. Surveys and pharmacist data about the delivery of PGx testing were collected. Semi-structured interviews were also conducted. Results A total of 36 pharmacists participated in the study from 22 pharmacies. Sixteen pharmacists completed the pre-study and post-study surveys, and four pharmacists completed the semi-structured interviews. Thirty-one percent (11/36) of pharmacists had had some education in personalized medicine or PGx prior to the study. The only outcome that differed by study arm was the use of educational resources, with significantly higher utilization in the PGx testing only arm (p=0.007). Overall, compared to the pre-study assessment, pharmacists' knowledge about PGx significantly improved post-study (p=0.018). In the post-study survey, almost all pharmacists indicated that they felt qualified/able to provide PGx testing at their pharmacy. While 75% of pharmacists indicated that they may continue to provide PGx testing at their pharmacy after the study, the major concerns were lack of reimbursement for PGx counseling and consultation given the necessary time required. Conclusion Our findings demonstrated a positive experience with delivering PGx testing in the community pharmacy setting with little difference in pharmacists' experiences in providing PGx testing with or without MTM. Pharmacists were confident in their ability to provide PGx testing and were interested in continuing to offer testing, though sustained delivery may be challenged by lack of prescribing provider engagement and reimbursement.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Durham, NC, 27708, USA
| | - Rachel Mills
- Center for Applied Genomics & Precision Medicine, Durham, NC, 27708, USA
| | - Jivan Moaddeb
- Center for Applied Genomics & Precision Medicine, Durham, NC, 27708, USA
| | - Yiling Liu
- Center for Applied Genomics & Precision Medicine, Durham, NC, 27708, USA
| | - Deepak Voora
- Center for Applied Genomics & Precision Medicine, Durham, NC, 27708, USA
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