Review of Community Based Organization and Community Pharmacy Partnerships for Preventive Care Services

Pharmacist-community-based organization collaboration to address health-related social needs

BACKGROUND

Community-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use.

OBJECTIVES

To develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications.

METHODS

Two different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses.

RESULTS

The CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel.

CONCLUSION

Both pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.

Impact of health information exchange access on medication management recommendations in a community-based pharmacy setting

BACKGROUND

Community-based pharmacists have historically lacked access to electronic medical records and clinical markers. Research was needed to assess the impact of obtaining clinical markers from a health information exchange (HIE) on pharmacist recommendations during a medication management encounter.

OBJECTIVE

The objective of this project was to quantify and characterize clinical recommendations by pharmacists, resident pharmacists, or student pharmacists within an independent pharmacy setting that had access to patient information via an HIE.

PRACTICE DESCRIPTION

Moose Pharmacy is one of few community pharmacies in North Carolina with access to a large health-system HIE.

PRACTICE INNOVATION

This cohort study reviewed data over 4 months. Patients were identified for medication management based on filling eligible medications for atherosclerotic cardiovascular disease (ASCVD), hypertension, diabetes, dyslipidemia, or heart disease. Pharmacy personnel used the HIE to acquire laboratory test results. At the medication management appointment, the pharmacist collected blood pressure (BP), assessed smoking history, and medication or disease concerns. ASCVD risk score, statin therapy, A1c, and BP were assessed. Follow-up with the patient or provider was determined, if needed, and documented.

EVALUATION METHODS

Collected records were reviewed to quantify the number and type of clinical recommendations made by the pharmacist, and their acceptance status by the prescriber. Descriptive analyses were used to analyze results.

RESULTS

Thirty-four encounters were included. Most participants had diabetes (n = 21, 62%) and hypertension (n = 31, 91%). Nearly one-third of encounters (n = 11, 32%) resulted in a pharmacist recommendation. Recommendations were for BP dose adjustments (n = 4, 36%), diabetes medication changes (n = 3, 27%), and statin initiations/escalations (n = 4, 36%). Four recommendations (36%) were accepted, with 1 requiring modifications from the provider; 3 recommendations (27%) were declined; and 3 recommendations (27%) were unanswered.

CONCLUSION

Access to progress notes and laboratory values using an HIE enhanced the pharmacist's ability to provide enhanced patient care recommendations during medication management consultations.

Rural-Urban Disparities in Access to Medicaid-Contracted Pharmacies in Washington State, 2017

INTRODUCTION

Community retail pharmacies offer multiple public health services to meet the health care needs of medically underserved rural communities. Many rural residents are enrolled in Medicaid insurance, and it is important that pharmacies contract with Medicaid to meet the health care needs of these people. The objective of this study was to evaluate disparities in access to Medicaid-contracted pharmacies across the rural-urban continuum in Washington State.

METHODS

We linked data on licensed community retail pharmacies in Washington State in 2017 to lists of state Medicaid-contracted pharmacies. We classified pharmacies as being located in small rural, large rural, suburban, and urban areas by using rural-urban commuting area (RUCA) codes. We evaluated the likelihood of zip code-level access to at least 1 pharmacy that was contracted with a Medicaid insurance plan across the rural-urban continuum by using descriptive statistics and modified Poisson regression models, adjusted for zip code-level community characteristics.

RESULTS

Of 1,145 pharmacies in our study sample, 8.4% (n = 96) were not contracted with a Medicaid plan. Compared with urban core zip codes, small rural zip codes (adjusted relative risk [ARR] = 0.64; 95% CI, 0.46-0.91) and large rural zip codes (ARR = 0.68; 95% CI, 0.49-0.95) were significantly less likely to have access to a Medicaid-contracted pharmacy. Suburban zip codes did not differ significantly from urban core areas in their access to Medicaid-contracted pharmacies.

CONCLUSION

In Washington State, the likelihood of access to a Medicaid-contracted pharmacy decreased significantly as rurality increased. Policy efforts should aim to improve access for Medicaid enrollees, especially those outside urban centers.

Estimating the Effect of a National Pharmacy-Led Influenza Vaccination Voucher Program on Morbidity, Mortality, and Costs

BACKGROUND

Influenza (also known as "flu") is estimated to cause between 12,000 and 79,000 deaths annually. Vaccinations are beneficial in preventing influenza cases and reducing the likelihood of severe outcomes. Unfortunately, vaccination coverage is low among uninsured populations. Removing the cost barrier can help increase vaccination coverage in this group, averting flu cases and related morbidity and costs.

OBJECTIVE

To model the potential effect of providing no-cost flu vaccinations to uninsured individuals on influenza-related morbidity, mortality, and costs.

METHODS

In collaboration with the Department of Health and Human Services and local agencies, Walgreens pharmacies provided free flu vaccinations through a nationwide voucher distribution program. We calculated the redemption rate, potentially averted cases, and estimated cost savings for the 2015-2016 and 2016-2017 flu seasons. Using incidence and vaccine effectiveness estimates from the Centers for Disease Control and Prevention, we calculated the rate of influenza in the general population and the estimated cases averted based on the number of redeemed vouchers. We applied patient age along with parameters from published studies to estimate averted ambulatory care visits, hospitalizations, mortality, productively losses, and overall related costs.

RESULTS

During the 2015-2016 flu season, the pharmacy chain distributed 600,000 vouchers with a redemption rate of 52.3%, resulting in 314,033 flu vaccinations. Improvements were subsequently made to the distribution process to increase utilization rates. There were 400,000 vouchers distributed during the 2016-2017 season with a higher redemption rate of 87.2%, resulting in 348,924 flu vaccinations. The estimated number of potentially averted cases was higher during the 2016-2017 season (13,347) than the 2015-2016 season (11,537) due to a higher redemption rate and increased flu activity. Taken together, we estimated that 8,621 ambulatory care visits, 314 hospitalizations, and 15 deaths were averted due to the flu voucher program. Averted health care costs totaled $937,494 in ambulatory care visits and $3,510,055 in hospitalizations. Averted productivity losses ranged from $4,473,509 to $14,613,502.

CONCLUSIONS

This study demonstrates the effectiveness of a pharmacy-led partnership with local community-based organizations to promote flu vaccinations among uninsured individuals. Our model found that a no-cost flu voucher program has the potential to reduce influenza-related morbidity, mortality, and costs.

DISCLOSURES

This study was funded by Walgreen Co. All authors are employees of Walgreen Co. and affiliated with Walgreens Center for Health and Wellbeing Research. Findings from this study were presented as a podium presentation at the Academy of Managed Care Pharmacy Nexus 2018; October 22-25, 2018; Orlando, FL.

Perceived Roles of Independent Community Pharmacists and Pharmacy Technicians in Patient Referrals to Community Resources: A Study from the Medication Safety Research Network of Indiana (Rx-SafeNet)

INTRODUCTION

Referrals to community resources represent one element of the Chronic Care Model, however, little is known about the perceived role of community pharmacy staff in referring patients to community resources.

OBJECTIVES

The objective of this study was to describe community pharmacists', community pharmacy technicians', and patients' perceptions of pharmacist referrals to community resources.

METHODS

Semi-structured interviews were conducted with community pharmacists, pharmacy technicians, and patients from community pharmacies that are members of the Medication Safety Research Network of Indiana (Rx-SafeNet). Qualitative analysis was conducted to identify emergent themes.

RESULTS

A total of 37 participants, including six community pharmacists, one pharmacy student completing an advanced pharmacy practice experience, 15 community pharmacy technicians, and 15 patients across four independently-owned community pharmacies were interviewed. Themes included: 1) Need to build on a foundation of strong patient-community pharmacist relationships to clearly define the pharmacist's role in referrals, 2) Need to improve familiarity with community resources, 3) Need to clearly delineate and support the role for pharmacy technicians in making referrals, and 4) Need to follow-up on referrals.

CONCLUSION

To enhance community pharmacy staff provision of referrals to community resources, interventions are needed to improve patient and pharmacist familiarity with available resources, patients' perception of the pharmacist's role outside of prescription fulfillment, and follow-up on referrals. Moreover, pharmacy technician education and training could be expanded to optimize their role in supporting community pharmacists in making referrals.