Implementation strategies from deployment of the National Diabetes Prevention Program in Pennsylvania community pharmacies

Coaching strategies for the Flip the Pharmacy practice transformation initiative in Pennsylvania independent community pharmacies

BACKGROUND

Flip the Pharmacy (FtP) is a nationwide initiative to scale practice transformation in community pharmacies. Participating pharmacies are coached through monthly practice transformation initiatives and document their patient-care activities through Pharmacist electronic Care (eCare) Plans.

OBJECTIVES

The objective of this study was to identify peer coaching strategies to facilitate practice transformation in Pennsylvania community pharmacies.

METHODS

This was a qualitative study using semistructured interviews with practice transformation coaches and pharmacy champions participating in Pennsylvania's FtP program. The interview guide was informed by the Consolidated Framework for Implementation Research and elicited information using the intervention characteristics, inner setting, characteristics of individuals, and process domains. Interviews were conducted in person or via telephone over a 3-month period. An inductive qualitative thematic analysis was performed to identify coaching strategies.

RESULTS

A total of 18 key informants were interviewed: 6 pharmacy champions and 12 practice transformation coaches. The following 5 coaching strategies emerged: (1) learn to use the pharmacy's specific Pharmacist eCare Plan software, (2) build a trusting relationship with the pharmacy, (3) engage all pharmacy team members in practice transformation, (4) adapt communication strategies to the pharmacy's preference, and (5) tailor goals to the pharmacy's stage of practice transformation.

CONCLUSION

This study elicited 5 peer coaching strategies to support community pharmacy practice transformation initiatives. These findings can be used to further practice transformation efforts in community pharmacies through FtP and other initiatives aimed at expansion of community pharmacy patient care services.

Exploring barriers and facilitators to pharmacist-provided diabetes self-management education and support

BACKGROUND

Pharmacists have the necessary clinical experience and medication knowledge to effectively provide diabetes self-management education and support (DSMES); however, barriers exist to DSMES implementation by community pharmacists.

OBJECTIVE

The aim of this study is to explore DSMES from the community pharmacists' perspectives, identify barriers and facilitators to pharmacist DSMES implementation, and guide development of pharmacist-provided DSMES programs in Idaho.

METHODS

Implementation climate, the theoretical framework for this project, is focused on how community pharmacists in Idaho perceive they will be supported by patients, health care providers, and insurers in DSMES implementation. Pharmacist investigators with qualitative research experience conducted semistructured interviews with 6 licensed community pharmacists from Idaho via Zoom between March and June 2020. Recordings were transcribed verbatim and analyzed using HyperRESEARCH 4.5.1. Themes, patterns, and dominant concepts that emerged from respondents' about DSMES were explored, labeled, and categorized into modifiable and nonmodifiable barriers and facilitators. This study was granted expedited approval by the Idaho State University Investigational Review Board.

RESULTS

Relevant themes included current scope of practice, barriers, and facilitators. Subthemes related to the current scope of pharmacy practice included unclear roles and responsibilities and legislative constraints to practice. For barriers, subthemes included cost of set-up, billing and coding education, and the sustainability of services based on current reimbursement models. For facilitators, subthemes included the need for additional collaborations (external and internal), technology access, and trained pharmacy staff.

CONCLUSION

Pharmacists are underutilized health care providers, capable of providing DSMES services if provided the necessary resources. This work identifies barriers and facilitators to pharmacist-led DSMES that can be considered by others when implementing DSMES or other disease management services.

An ounce of prevention is worth a pound of cure: considerations for pharmacists delivering the National Diabetes Prevention Program

Prediabetes is highly prevalent in the United States affecting over 88 million adults. In 2010, the Centers for Disease Control and Prevention (CDC) established the National Diabetes Prevention Program (NDPP), an intensive lifestyle program consisting of a 16-lesson curriculum focused on diet, exercise, and behavior modification, with the ultimate goal to reduce progression from prediabetes to diabetes. Despite tens of millions of adults potentially qualifying to participate in the program, the uptake of the NDPP has been exceedingly low. As a result, the CDC has focused its efforts on engaging with local health departments and community partners, including community pharmacies, across the United States to scale-up enrollment in the NDPP. In this commentary we discuss factors affecting implementation of the NDPP in community pharmacies and other settings where pharmacists practice, including training, space, personnel, recruitment and enrollment, retention, and sustainability.

How community pharmacists envision using pharmacogenomic data: A qualitative analysis

BACKGROUND

Nearly 300 medications contain pharmacogenomic information in their labeling approved by the U.S. Food and Drug Administration. As this number continues to grow, community pharmacists will be called on to use available pharmacogenomic data at the point of dispensing.

OBJECTIVE

This qualitative study aimed to describe how pharmacists envision the integration of pharmacogenomic data into the current workflows of community pharmacy practice.

METHODS

Community pharmacists from a regional supermarket chain pharmacy in the greater Pittsburgh area were interviewed using a semistructured interview guide. Participating pharmacists were presented with 3 clinical scenarios, followed by questions, to gain insight into how they envisioned the integration of pharmacogenomic data into community pharmacy workflow. The interview transcriptions were transcribed and coded. The content was analyzed to deduce the final themes. Supporting quotes were selected to illustrate each theme.

RESULTS

Ten community pharmacists from 3 different pharmacy locations participated in the study. A thematic analysis produced 6 themes: (1) integrating pharmacogenomic data into the dispensing software, (2) receiving an alert for pharmacogenomic information within the dispensing software, (3) accessing pharmacogenomic clinical guidelines to guide drug-decision-making, (4) contacting the prescriber by adding a task to the call queue, (5) placing a mandatory counseling alert on medications that were adjusted using pharmacogenomic data, and (6) counseling the patient on the first refill of a medication that was adjusted using pharmacogenomic data.

CONCLUSION

This study describes how pharmacists envisioned the integration of pharmacogenomic data into community pharmacy workflow. The participants sought the integration of pharmacogenomic data into existing dispensing software, alerts for actionable prescribing changes using patient-specific pharmacogenomic data when available, and access to clinical decision support. In addition, the participants preferred to engage prescribers and receive alerts to counsel patients at prescription pick-up. These findings are key to integrating pharmacogenomic data into community pharmacy practice.