Patient-Centered Care preferences & expectations in outpatient pharmacist practice: A three archetype heuristic

Comparison of clinical pharmacist practitioners' headache care roles across clinical contexts within the Veterans Health Administration: Optimizing pharmacist integration

BACKGROUND

Studies show interdisciplinary treatment is highly effective for addressing chronic pain syndromes, including headache disorders. Increasingly, advanced practice pharmacists work collaboratively with physicians to apply their unique skills to enhance patient outcomes.

OBJECTIVE

This qualitative study aimed to elucidate the potential in the Veterans Health Administration (VHA) for increased roles of clinical pharmacist practitioners (CPPs)-advanced practice pharmacists with a scope of practice-in collaborative, interdisciplinary headache care teams. Our research question was: How do CPPs integrate with interdisciplinary headache care teams in Headache Centers of Excellence (HCoE) and non-HCoE VHA facilities, and how can their roles be configured to optimize headache specialty care services?

METHODS

This cross-sectional qualitative study used purposive sampling to recruit CPPs providing headache care within HCoEs and in non-HCoE VHA facilities for virtual, recorded, individual interviews. Multi-stage qualitative data analysis entailed: team discussions; immersion/crystallization for close reading of transcripts to identify emerging patterns of HCoE/non-HCoE comparison of CPPs' experiences; team data sorting using spreadsheets; and further immersion into sorted data for final identification of comparisons and interpretation of the data.

RESULTS

A total of 15 CPPs involved in headache care were interviewed, with about half working in HCoEs and half in non-HCoE VHA facilities across the United States. CPPs' roles within and outside HCoEs have considerable overlap as both groups co-manage patients with headache with physicians. CPPs have independent and collaborative responsibilities as they extend headache specialists' services by providing direct patient care and referring to additional providers for headache treatment. When their roles differ within and outside HCoEs it is largely due to level of integration on interdisciplinary headache or pain teams. CPPs in HCoEs collaborate with headache neurologists and interdisciplinary teams; some outside HCoEs do as well, while others work with primary care. CPPs' weekly time dedicated specifically to headache tends to be greater in HCoEs. Nevertheless, most interviewees in both groups stated patient need exceeds CPP availability at their facilities for conducting detailed chart reviews, initial visits to understand the context of patients' headache, and scheduled follow-ups over time to monitor and adjust treatment. CPPs also consult with and educate physicians on headache pharmacy, particularly regarding appropriate use of non-formulary medications.

CONCLUSION

Findings from this study suggest that CPPs' roles in headache care are valuable to clinical colleagues and their patients and should be leveraged and expanded within HCoEs and non-HCoE VHA facilities. When substantively integrated into interdisciplinary headache care teams, CPPs offer unique knowledge, headache management and patient behavior change skills, extend headache specialists' services, and provide both patient and physician education. These combined responsibilities contribute to enhancing patient outcomes and facilitating ongoing access to high quality, evidence-based headache care.

Training Student Pharmacists How to Mitigate Racial or Ethnic Microaggressions in Patient Encounters

The experience of interfacing with the health care system is a taxing one for racially or ethnically marginalized patients (REMPs). The seemingly inevitable occurrence of encountering microaggressions is reason enough to avoid the interaction for many resulting in worse health outcomes. Microaggressions result in conflict, loss to follow-up, and reinforcing the unwelcome atmosphere of the health care system to REMPs. Teaching antimicroaggressive content in doctor of pharmacy curricula is critical for reducing strain on the fragile relationship between REMPs and the health care system. Whether it is gathering a patient history, devising a patient-centered care plan, or counseling patients, there is an opportunity for an interaction that could sever the patient's trust in the health care system. Teaching each of these skills-based learning activities should be combined with didactic lessons in nonjudgmental and nonmicroaggressive communication approaches. In addition, lessons regarding the impact of microaggressions on REMPs should also be present so that learners may appreciate the impact of a clinician's actions on REMPs in this regard. To establish evidence-based best practices, more research on teaching antimicroaggressive didactic and skills-based content to student pharmacists is needed.

Patient preferences and willingness-to-pay for community pharmacy-led Medicare Part D consultation services: A discrete choice experiment

INTRODUCTION

Community pharmacies currently offer Medicare Part D consultation services, often at no-cost. Despite facilitating plan-switching behavior, identifying potential cost-savings, and increasing medication adherence, patient uptake of these services remains low.

OBJECTIVES

To investigate patient preferences for specific service-offering attributes and marginal willingness-to-pay (mWTP) for an enhanced community pharmacy Medicare Part D consultation service.

METHODS

A discrete choice experiment (DCE) guided by the SERVQUAL framework was developed and administered using a national online survey panel. Study participants were English-speaking adults (≥65 years) residing in the United States enrolled in a Medicare Part D or Medicare Advantage plan and had filled a prescription at a community pharmacy within the last 12 months. An orthogonal design resulted in 120 paired-choice tasks distributed equally across 10 survey blocks. Data were analyzed using mixed logit and latent class models.

RESULTS

In total, 540 responses were collected, with the average age of respondents being 71 years. The majority of respondents were females (60%) and reported taking four or more prescription medication (51%). Service attribute levels with the highest utility were: 15-min intervention duration (0.392), discussion of services + a follow-up phone call (0.069), in-person at the pharmacy (0.328), provided by a pharmacist the patient knew (0.578), and no-cost (3.382). The attribute with the largest mWTP value was a service provided by a pharmacist the participant knew ($8.42). Latent class analysis revealed that patient preferences for service attributes significantly differed by gender and difficulty affording prescription medications.

CONCLUSIONS

Quantifying patient preference using discrete choice methodology provides pharmacies with information needed to design service offerings that balance patient preference and sustainability. Pharmacies may consider providing interventions at no-cost to subsets of patients placing high importance on a service cost attribute. Further, patient preference for 15-min interventions may inform Medicare Part D service delivery and facilitate service sustainability.

Enhancing the service quality of community pharmacies for non-prescription medicines based on the perspectives of pharmacists and patients: a qualitative study

BACKGROUND

Pharmacies in several countries are encountering a fierce competition from both local and international rivals, resulting in significant challenges in maintaining competitiveness and market share. Pharmacies are important locations for those seeking non-prescription medicines and are equipped to manage a wide variety of ailments. However, despite the large number of previous qualitative studies on the service quality of community pharmacies, very few studies have explored the service quality dimensions, specifically for non-prescription medications. In this study, we aimed to explore pharmacists' and patients' perception of potential pharmacy service quality for dispensing non-prescription medicines.

METHOD

Purposive and snowball sampling techniques were used to recruit and select qualified pharmacists and patients in the major cities of Thailand. Multiple face-to-face and telephone interviews were recorded, transcribed, and analysed systematically using the interpretive method of content analysis.

RESULTS

The participants reported several service attributes for dispensing of non-prescription medicines by community pharmacies. An analysis of the interviews revealed competence, communication, rapport, patient-centredness, and physical environment as the main themes related to service quality dimensions. Specifically, physical environment was categorized into two sub-themes, namely, hygiene and ambience.

CONCLUSIONS

Service quality dimensions of community pharmacies for non-prescription medications were supported by dyadic perspectives - pharmacist and patient perspectives. The findings of the study contribute to community pharmacy research by focusing on the potential dimensions of service quality, especially for non-prescription medicines.

Item development for patient-centered care preferences using a three-archetype heuristic: An exploratory study

Background

Patient-centered care is at the center of the Pharmacists' Patient Care Process; however, little is known about patient-centered care preferences and expectations for pharmacist care.

Objective

To develop and test items exploring the applicability of a proposed three-archetype heuristic for patient-centered care preferences and expectations in pharmacist care in a population of older adults using community pharmacies that provided enhanced and integrated services.

Methods

This was an exploratory analysis of a cross-sectional survey developed and distributed by postal mail to 17 Medicare-eligible patients at five Community Pharmacy Enhanced Service Network (CPESN) pharmacies in Iowa between November 2021 and January 2022. A total of 15 Likert-type archetype survey items were developed with an item developed for each of five constructs (Nature of Relationship and Locus of Control, Care Customization, Care Longevity, Intent of Communication, and Source of Value) for three archetypes ("Partner," "Client," and "Customer").Items were grouped by archetype to yield three, five-item scales, intended to reflect each archetype. Cronbach alphas (α) were calculated for each scale, measuring internal consistency. K-means clustering with silhouette analysis was performed using a group of archetype items with high internal consistency to identify clusters. Kruskal Wallis and Fisher's exact tests used to determine statistical significance for response means and frequencies between clusters, when appropriate.

Results

In total, 17 participants completed the survey (100% response rate). Cronbach alphas for the five-item scales reflecting "Partner," "Client," and "Customer" archetypes were 0.66, 0.33, and - 0.03, respectively. K-means clustering identified two clusters, labeled: "Independent Partner" and "Collaborative Partner." There were significant (p-value <0.05) differences between clusters for four of the 15 Likert-type items, suggesting the "Independent Partner" more autonomous, seek pharmacist expertise less frequently, and value pharmacist collaboration less compared to the "Collaborative Partner."

Conclusions

The items comprising the "Partner" archetype scale had a reasonably strong level of internal consistency. Older adults may desire highly tailored, co-created experience created from long-standing relationships with a particular pharmacist.

Investigation of predictors influencing patient-pharmacist relationship establishment

BACKGROUND

A strong patient-pharmacist relationship is tied to patients' trust and confidence in pharmacists and pharmacy services. While past research has described patient-pharmacist relationship archetypes (i.e., "customer," "client," "partner") with potential to help pharmacists initially understand patients' preferences and expectations of care and services, little is known about potential factors that underlie these preferences and expectations.

OBJECTIVES

This study was aimed to [1] compare the prevalence of the current and desired patient-pharmacist relationships archetypes reported by patients and [2] identify the sociodemographic, health, and medication use and procurement factors predictive of the archetypes representing patients' current relationship with outpatient pharmacists.

METHODS

Data from 1521 patients were collected via the 2021 National Consumer Survey on Medication Experience and Pharmacists' Role. Patient-pharmacist relationship distribution across patients' sociodemographic characteristics was explored using crosstabulations. Multinomial logistic regression was also used to investigate the association between patient sociodemographic characteristics and the current patient-pharmacist archetype relationships.

RESULTS

The mean age of the patients was 53.9 years and 57.3% were married. Thirty-two percent of the patients reported currently having a "Customer" relationship, while 17.9% and 15.2% reported having a "Client" and "Partner" archetype relationship, respectively. "Client" (25.2%) and "Partner" (20.2%) relationships were the most commonly preferred archetypal relationships. The odds ratios (OR) of having "Client" or "Partner" relationships increased with the number of patients' health conditions and medications. Patients who visited independently owned and clinic pharmacies had a higher OR of building professional relationships with a pharmacist.

CONCLUSION

The qualities of a patient-pharmacist relationship may be associated with key patient characteristics. Pharmacists can build relationships with patients informed by a continuum of patient preferences, expectations, and needs to optimize health outcomes.

Experience of Patients with COPD of Pharmacists' Provided Care: A Qualitative Study

Chronic obstructive pulmonary disease (COPD) is associated with high global morbidity and mortality. Pharmacists are uniquely positioned to provide services which may reduce the burden of this disease on the health system, patients, and their families. The study aimed to understand the perceptions and experiences of patients living with COPD with pharmacists’ provided care in COPD diagnosis and management. The study was guided by qualitative description methodology and reported using the consolidated criteria for reporting qualitative research (COREQ) checklist. We conducted semi-structured interviews with 12 participants who were recruited from community pharmacies, seniors’ centres, a general practice clinic, and a pulmonary rehabilitation centre. Using qualitative content analysis, we identified categories that revealed great variation in participants’ experience of pharmacy care based on the depth of patient–pharmacist engagement. Participants who regarded their pharmacists as an essential member of their healthcare team and those who did not, had contrasting experiences with education, communication, and ability to form connections with their pharmacists. For patients with COPD, it is important that the pharmacist is proactive in engaging patients through effective communication, education/provision of relevant information, identification of patient needs, and consistent provision of care with empathy.