The Future of Health-System Pharmacy: Opportunities and Challenges in Practice Model Change

Preceptor confidence and engagement in providing leadership activities to students in advanced pharmacy practice experiences

INTRODUCTION

Preceptor perceptions about providing leadership activities during the fourth year of the doctor of pharmacy curriculum were examined.

METHODS

An anonymous questionnaire was sent electronically to 610 preceptors of fourth year doctor of pharmacy students in August 2015 inquiring about confidence in leadership ability, extent of student engagement in leadership activities, and preceptor support needed. Differences based on leadership background, such as formal training, were examined using independent t-test. Continuous data are presented as mean (standard deviation). P-value < 0.05 was considered significant.

RESULTS

Survey response rate was 28% (n = 171). Preceptor confidence in ability to provide leadership activities was 7.38 + /-1.66 [0-10 Likert scale; 0 = cannot do at all, 10 = highly certain can do]. Preceptors were most confident teaching that leadership comes from those with and without titles (8.48 + /-1.64) and least confident engaging students in advocacy (5.41 + /-3.02). Preceptors were most likely to engage students in collaboration [3(1-4)] and least likely to involve them in advocacy [1(1-4)] (measured from 1-4 with 1 = never and 4 = very often). Preceptors with formal leadership training demonstrated higher confidence and more engagement with involving students in leadership activities than those without training (p < 0.05). Examples of common leadership activities shared by preceptors included experiential clinical activities and projects, teaching opportunities, discussions with leaders, and participation in meetings. Leadership training and development was the most requested type of support by preceptors (n = 23, 13.5%).

CONCLUSION

Preceptors were overall confident about their ability to provide leadership activities, were involving students in some leadership activities, and had the least confidence and engagement in involving students in advocacy. Preceptors may consider increasing engagement in teaching student leadership skills by utilizing examples in this study. Colleges of pharmacy and organizations may collaborate to increase preceptor access to formal leadership training programs and offer preceptor development programs designed to enhance preceptors' abilities to facilitate student leadership experience, reflection on experience, and feedback.

Interdisciplinary Care Team with Pharmacist in a Community-based HIV Clinic

BACKGROUND

Human immunodeficiency virus (HIV) infection presents a significant burden, especially in the Washington, DC area. Literature is limited in describing the role of pharmacists in the outpatient clinic setting to provide patient-centered pharmaceutical care for patients with HIV.

OBJECTIVE

Our study aims to describe an interdisciplinary HIV care model including a clinical pharmacist at a community-based transcultural clinic in the Washington, DC area, and to describe the role of the pharmacist as indicated by an association between non-adherence to antiretroviral therapy (ART) and an ART regimen change.

METHODS

Using the electronic health record at the clinic from May 2011 through July 2013, 53 patients were identified who were referred to the clinical pharmacist.

RESULTS

The average age of the patients with HIV was 46.57 years in the clinic. About 28% of patients had documented non-adherence to ART and 30% of patients had one or more ART regimen changes during the study period. Medication non-adherence was a significant predictor of ART regimen change (OR_adj 8.44; 95% CI 1.91-37.29). Substance use was a strong predictor of ART regimen change (OR_unadj 3.47; 95% CI 1.02-11.81), but the relationship disappeared in the multivariate analysis.

CONCLUSIONS

A strong association between pharmacist's evaluation of non-adherence to ART and a regimen change was demonstrated and the role of the pharmacist as the interdisciplinary team member was described. A follow-up study should be made to assess the services provided by the pharmacist on clinical, economic, and humanistic outcomes in the community-based clinical setting.

Documenting the evolution of the relationship between the pharmacy support workforce and pharmacists to support patient care

Since 2009 there has been a focus on the relationship between pharmacy technicians, pharmacy support workforce cadres and pharmacists in the literature. 2009-2011 saw a framework of role evolution develop, with publications from 2012 to 2015 documenting further maturity in the development of practice models for improved patient care and optimal use of personnel. The dominant narrative in the published academic literature has been made by certain high- income countries (mainly Canada, Denmark, United Kingdom and the United States of America). In these countries there are significant numbers of pharmacists available and there has been an increasing interest to utilize pharmacy support workforce cadres to allow the extension of clinical roles of pharmacists in these contexts. This is not a systematic presentation of all the literature available but rather a commentary overview supported by key papers. Key points from this literature include: (To allow the reader to clearly understand the country of origin of the themes presented, care has been taken to note the country of origin of the papers used in this commentary).

A global picture of pharmacy technician and other pharmacy support workforce cadres

INTRODUCTION

Understanding how pharmacy technicians and other pharmacy support workforce cadres assist pharmacists in the healthcare system will facilitate developing health systems with the ability to achieve universal health coverage as it is defined in different country contexts. The aim of this paper is to provide an overview of the present global variety in the technician and other pharmacy support workforce cadres considering; their scope, roles, supervision, education and legal framework.

MATERIAL AND METHODS

A structured online survey instrument was administered globally using the Survey Monkey platform, designed to address the following topic areas: roles, responsibilities, supervision, education and legislation. The survey was circulated to International Pharmaceutical Federation (FIP) member organisations and a variety of global list serves where pharmaceutical services are discussed.

RESULTS

193 entries from 67 countries and territories were included in the final analysis revealing a vast global variety with respect to the pharmacy support workforce.

ROLES AND COMPETENCY

From no pharmacy technicians or other pharmacy support workforce cadres in Japan, through a variety of cadre interactions with pharmacists, to the autonomous practice of pharmacy support workforce cadres in Malawi.

RESPONSIBILITIES

From strictly supervised practice with a focus on supply, through autonomous practice for a variety of responsibilities, to independent practice.

SUPERVISION

From complete supervision for all tasks, through geographical varied supervision, to independent practice.

EDUCATION

From on the job training, through certificate level vocational courses, to 3-4 year diploma programs.

LEGISLATION, REGULATION AND LIABILITY

From well-regulated and registered, through part regulation with weak implementation, to completely non-regulated contexts.

CONCLUSION

This paper documents wide differences in supervision requirements, education systems and supportive legislation for pharmacy support workforce cadres globally. A more detailed understanding of specific country practice settings is required if the use of pharmacy support workforce cadres is to be optimized.

Nontraditional Career Opportunities for Pharmacists

The changing landscape of health care mirrors that of health-system pharmacy, with pharmacists' scope of practice and provider status being the most significant changes. This creates new roles and opportunities; many of these roles are considered to be nontraditional in today's practice. This article reviews some new roles for pharmacy leaders that provide different career options and pathways. Nontraditional career opportunities discussed include expanded consulting roles in pricing analytics and drug pricing programs (contracting, 340B programs), pharmacogenomics patient consult services and clinics, specialty drug pharmacies, and compounding pharmacy services. To continue to develop high-performing pharmacy departments, pharmacy directors should recognize these roles and ensure they are clearly defined and managed. With the advent of these nontraditional opportunities, pharmacy departments can further expand their ability to provide advanced patient-centered pharmacy services.

Perceived needs of pharmaceutical care services among healthcare professionals in South Korea: a qualitative study

Purpose To explore the need for pharmaceutical care services, key features of desirable pharmacy services, and perceived barriers for advancing the services in hospital environments with doctors and nurses who are key co-workers of the interdisciplinary team care services.Methods Semi-structured, in-depth interviews with eighteen doctors and fifteen nurses employing purposive and snowballing sampling strategies were conducted in ten hospitals in South Korea. Results The level of pharmaceutical care was varied across regions or institutions in South Korea. The concept of pharmaceutical care was insufficiently defined, and tended to be limited to some parts of medication counseling. Through pharmaceutical care services, doctors desired to acquire comprehensive drug information from and to share clinical responsibilities with pharmacists. Nurses wished to lower their burdens of medication counseling services from their daily practices. Doctors and nurses asked for pharmacists providing essential and carefully selected medication information to their patients in a patient-centered manner. The listed barriers to pharmaceutical care included the lack of appropriate systems for reward, insufficient accessibility to patient records by pharmacists, ambiguous role descriptions of pharmacist, and absence of effective communication among professionals. Conclusion A successful pharmaceutical care service model should allow efficient exchange of information among healthcare professionals to build inter-professional trust and to provide a continuity of care both in terms of time and setting. As prerequisites of such system, it was warranted to develop clinical evidence and an appropriate reward system for pharmaceutical care services.

Evolving Pharmacist Productivity Models

Leaders in health-system pharmacy are challenged to minimize costs, maximize revenue, and maintain or improve quality while simultaneously expanding services. Strong command of productivity and workload measurement is necessary to achieve these goals. This article reviews foundational pharmacy productivity concepts and key terminology, reviews historical pharmacy productivity models and their limitations, and considers new and evolving pharmacist productivity models.

Change management in pharmacy: a simulation game and pharmacy leaders' rating of 35 barriers to change

OBJECTIVES

The primary objective was to rank barriers to change in pharmacy practice. Our secondary objective was to create a simulation game to stimulate reflection and discussion on the topic of change management.

METHODS

The game was created by the authors and used during a symposium attended by 43 hospital pharmacy leaders from all regions of Canada (Millcroft Conference, Alton, Ontario, June 2013). The main theme of the conference was 'managing change'.

KEY FINDINGS

The simulation game, the rating of 35 barriers to change and the discussion that followed provided an opportunity for hospital pharmacy leaders to reflect on potential barriers to change, and how change might be facilitated through the use of an organized approach to change, such as that described in Kotter's eight-step model.

CONCLUSIONS

This simulation game, and the associated rating of barriers to change, provided an opportunity for a group of hospital pharmacy leaders in Canada to reflect on the challenges associated with managing change in the healthcare setting. This simulation game can be modified and used by pharmacy practitioners in other countries to help identify and rank barriers to change in their particular pharmacy practice setting.

Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists

Background

As primary healthcare professionals, community pharmacists have both opportunity and potential to contribute to the prevention and progression of chronic diseases. Using cardiovascular disease (CVD) as a case study, we explored factors that influence community pharmacists’ everyday practice in this area. We also propose a model to best illustrate relationships between influencing factors and the scope of community pharmacy practice in the care of clients with established CVD.

Methods

In-depth, semi-structured interviews were conducted with 21 community pharmacists in New South Wales, Australia. All interviews were audio-recorded, transcribed ad verbatim, and analysed using a “grounded-theory” approach.

Results

Our model shows that community pharmacists work within a complex system and their practice is influenced by interactions between three main domains: the “people” factors, including their own attitudes and beliefs as well as those of clients and doctors; the “environment” within and beyond the control of community pharmacy; and outcomes of their professional care. Despite the complexity of factors and interactions, our findings shed some light on the interrelationships between these various influences. The overarching obstacle to maximizing the community pharmacists’ contribution is the lack of integration within health systems. However, achieving better integration of community pharmacists in primary care is a challenge since the systems of remuneration for healthcare professional services do not currently support this integration.

Conclusion

Tackling chronic diseases such as CVD requires mobilization of all sources of support in the community through innovative policies which facilitate inter-professional collaboration and team care to achieve the best possible healthcare outcomes for society.

Update on factors motivating pharmacy students to pursue residency and fellowship training

PURPOSE

The factors motivating pharmacy students to pursue residency and fellowship training in 2011 versus 1993 were assessed.

METHODS

A survey replicating previous research was electronically sent to 794 residency directors and 29 fellowship program directors with a request to forward the survey to current residents and fellows. A similar survey was sent to 124 colleges of pharmacy with a request to forward the survey to the faculty member most involved with residency and fellowship promotion within their doctor of pharmacy (Pharm.D.) curriculum. Participants were asked to rank leading motivating factors and barriers to pharmacy students pursuing these programs. Additional data collected included when and the methods by which these programs are promoted.

RESULTS

Among residents and fellows, 865 usable surveys were returned. The leading motivating reasons for residents and fellows to pursue training were "to gain knowledge and experience,"" a "desire for specialized training," [corrected] and "understood as a prerequisite for certain jobs." A total of 124 U.S. pharmacy schools were surveyed, and 65 (52%) returned completed responses. "Understood as a prerequisite for certain jobs," "faculty stressing importance," and "recognition of the new and challenging roles for pharmacists in the future" were the factors most frequently cited by faculty members.

CONCLUSION

Compared with previous research, a new factor motivating pharmacy students to pursue residency and fellowship training is the consideration that these opportunities are a prerequisite for certain jobs. This development may be attributable to trends in the supply and demand of pharmacists, the recognition of the value in these programs by major pharmacy organizations, and the evolving role of pharmacists in direct patient care.

Improving herpes zoster vaccination rates through use of a clinical pharmacist and a personal health record

BACKGROUND

Preventative health services, including herpes zoster vaccination rates, remain low despite known benefits. A new care model to improve preventative health services is warranted. The objective of this study is to investigate whether the functions of an electronic medical record, in combination with a pharmacist as part of the care team, can improve the herpes zoster vaccination rate.

METHODS

This study was a 6-month, randomized controlled trial at a General Internal Medicine clinic at The Ohio State University. The 2589 patients aged 60 years and older without documented herpes zoster vaccination in the electronic medical record were stratified on the basis of activated personal health record status, an online tool used to share health information between patient and provider. Of the 674 personal health record users, 250 were randomized to receive information regarding the herpes zoster vaccination via an electronic message and 424 were randomized to standard of care. Likewise, of the 1915 nonpersonal health record users, 250 were randomized to receive the same information via the US Postal Service and 1665 were randomized to standard of care. After pharmacist chart review, eligible patients were mailed a herpes zoster vaccine prescription. Herpes zoster vaccination rates were compared by chi-square tests.

RESULTS

Intervention recipients had significantly higher vaccination rates than controls in both personal health record (relative risk, 2.7; P = .0007) and nonpersonal health record (relative risk, 2.9; P = .0001) patient populations.

CONCLUSIONS

Communication outside of face-to-face office visits, by both personal health record electronic message and information by mail, can improve preventative health intervention rates compared with standard care.