Implementation and evaluation of social determinants of health practice models within community pharmacy

BACKGROUND

While community pharmacies are an ideal setting for social needs screening and referral programs, information on social risk assessment within pharmacy practice is limited.

OBJECTIVES

Our primary objective was to describe 2 social determinant of health (SDOH) practice models implemented within community pharmacies. The secondary objective was to evaluate implementation practices utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

PRACTICE DESCRIPTION

Two pharmacy groups participated in a 3-month study, one in New York (9 pharmacies) and another in Missouri (1 pharmacy). The New York pharmacies implemented an SDOH specialist practice model, in which pharmacy staff members facilitate the program. The Missouri pharmacy implemented a community health worker (CHW) model by cross training their technicians. Each pharmacy developed their program using the Community Pharmacy Enhanced Services Network Care Model.

PRACTICE INNOVATION

Both programs expanded the technician role to take on additional responsibilities. The SDOH specialist model partnered with a local independent practice association to create a social needs referral program using a technology platform for closed-loop communication. All workflow steps of the self-contained CHW program were completed within the pharmacy, placing additional responsibility on the CHW and pharmacy staff.

EVALUATION METHODS

RE-AIM framework dimensions of Reach, Effectiveness, and Adoption.

RESULTS

Social challenges were identified in 49 of 76 (65%) generated SDOH screenings. The most prevalent social needs reported were affordability of daily needs (33%) and health care system navigation (15%). While most pharmacy staff indicated that workflow steps were clearly defined, assessments and referral tools were identified as potential gaps. While approximately 50% of pharmacy staff were comfortable with their assigned roles and in addressing SDOH challenges, physical and mental health concerns required additional education for intervention.

CONCLUSION

The successful implementation of community pharmacy SDOH programs connected patients with local resources. Community pharmacies are ideally positioned to expand their public health footprint through SDOH interactions that consequently improve patient care.

Scaling Community Pharmacy Transformation with the 'Flip the Pharmacy' Implementation Model: Program Origins

The rising costs of healthcare, increased chronic illnesses, and healthcare provider burnout has led to an environment desperate for scalable solutions to ease practice burdens. With a projected shortage in the number of primary healthcare providers available to provide team-based care, community-based pharmacy practitioners are accessible and eager to assist. In order to provide enhanced patient care services to aid their clinician colleagues, community-based pharmacists will have to transform their practices to support the provision of enhanced services and medication optimization in value-based payment models. The purpose of this article is to define how multiple factors in pharmacy, healthcare, technology and payment models aligned to create an opportunity for the Community Pharmacy Foundation and CPESN® USA to implement a nationwide community pharmacy practice model called 'Flip the Pharmacy'. This new model aims to scale community pharmacy practice transformation and move beyond filling prescriptions at a moment-in-time to caring for patients over time through a 24-month step-wise program paired with in-person pharmacist coaching. Preliminary observations from the first six months of the program highlight community pharmacy as a site of care with community-based pharmacist practitioners providing and documenting targeted patient care interventions.

Addressing social determinants of health in community pharmacy: Innovative opportunities and practice models

Social determinants of health (SDoH) account for up to 90% of health outcomes, whereas medical care accounts for only 10%-15%; despite this disparity, only 24% of hospitals and 16% of physician practices screen for the 5 social needs. Community-embedded and highly accessible, pharmacies are uniquely positioned to connect individuals to local community and social resources and thereby address SDoH. In this article, we explore novel community pharmacy practice models that address SDoH, provide real-world examples of these models, and discuss pathways for reimbursement and sustainability. A number of innovative community pharmacy practice models that focus on social issues are currently being explored. These include integrating community health workers (CHWs) or SDoH specialists, wherein CHWs are frontline public health workers who can effectively bridge the health care system and their community, whereas SDoH specialists are pharmacy team members trained with substantial SDoH knowledge and how to use it to connect pharmacy patients to community resources. Three community pharmacy networks have implemented pilot programs using either a CHW or SDoH specialist model. An essential component for program success in all cases has been partnership development and increased interdependence between the pharmacies, local community organizations, and the public health sector. New payment models and financial incentives will be necessary to expand and sustain these programs. A potential Approach may be the use of Z codes, a subset of ICD-10-CM codes specific to assessing SDoH. Although opportunities are developing for community pharmacies to play a major role in sustainably addressing SDoH, additional work is needed before there is a widespread acceptance of pharmacies becoming service referral destinations for patients with social needs. Evaluation of these models on a wider scale will be necessary to fully evaluate their effectiveness, costs, and implementation within different community pharmacy settings.

A Sleeping Giant: Community Pharmacy's Potential Is Unrivaled

DISCLOSURES

No funding was received for the writing of this commentary. The author has nothing to disclose.

Accuracy of Prescription Claims Data in Identifying Truly Nonadherent Patients

BACKGROUND

Administrative claims data are increasingly used to identify nonadherent patients. This necessitates a comprehensive review and assessment of their accuracy in identifying nonadherent patients.

OBJECTIVES

To (a) compare administrative claims-based measures of adherence with nonadherence verified by patient interview; (b) determine if and to what extent patients classified as nonadherent based on prescription claims differ from patients classified as nonadherent based on interventions designed to gather multiple types of medication lists to compare against the prescription fill history; and (c) assess the various patient-reported reasons for nonadherence.

METHODS

A cross-sectional study was used to identify patients from the Southern Piedmont Community Care Network of North Carolina who were enrolled with Medicaid between January 1, 2012, and May 31, 2013, and were using prescription medications for 1 or more chronic conditions. Patients with more than a 30-day gap in refill history were identified using prescription claims and were interviewed by pharmacists to assess the reasons for nonadherence. Based on the patient-reported reasons for a gap in refill, patients were classified as interview-verified nonadherent patients or interview-verified adherent patients. The positive predictive value of prescription claims in identifying nonadherent patients was calculated, and descriptive statistics were reported. Characteristics of interview-verified nonadherent patients were compared with adherent patients using t-tests and chi-square statistics.

RESULTS

1,425 patients representing 2,936 patient-class of medication combinations were included in the final analysis. 824 (28.07%) of the 2,936 records that were flagged as nonadherent using claims analysis were confirmed as adherent during patient interviews. The positive predictive value of claims records in identifying nonadherent patients was 0.72. The 2 most common reasons for patients to be misclassified as nonadherent in claims data following self-report were discontinuation of medication on prescribers' directions (21.93%) and having an alternate channel for receiving the medication (6.13%). Among interview-verified nonadherent patients, side effects, patient beliefs, education, and socioeconomic barriers were the most common patient-reported reasons for gaps in refill.

CONCLUSIONS

Prescription claims may underestimate adherence in patients. When interviewed directly by a pharmacist, most patients reported discontinuation of medication as per prescribers' directions. To determine the overall validity of prescription claims data, further analysis is required to assess its accuracy in identifying truly nonadherent patients among those who are identified as nonadherent by claims data.

DISCLOSURES

No outside funding supported this study. Glassberg and Wei were employees at Community Care of North Carolina when this research was conducted. Trygstad is an employee of Community Care of North Carolina; Robinson is an employee of Community Care of Southern Piedmont, a subsidiary of Community Care of North Carolina. The geographies, health care professionals, and subjects involved in the study were related to the care coordination work that Community Care of North Carolina was charged with implementing through its informatics and subject matter expertise assistance provided to these local entities to augment primary care activities. Farley has received funding from the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, American College of Clinical Pharmacy, the National Institutes of Health, and Community Care of North Carolina and has also received consulting funds from UCB. The other authors have nothing additional to report.

Stages of Change: Moving Community Pharmacies From a Drug Dispensing to Population Health Management Model

Given their clinical training and accessibility, community pharmacists are well positioned to support primary care, especially in providing medication management services. There is limited evidence, however, on implementation of community pharmacist-led services in coordination with other health care providers. The aim of this study was to examine the implementation process of community pharmacies in North Carolina participating in a Medicaid population health management intervention. We conducted semistructured interviews with 40 representatives from high- and low-performing community pharmacies from June to August 2017. We analyzed for themes organized around Rogers's Stages in the Innovation Process in Organizations. Community pharmacies employed numerous implementation strategies such as developing relationships with providers and redefining job responsibilities to ensure pharmacists and pharmacy technicians are working at the top of their license. Findings also revealed differences in the implementation process among high- and low-performing pharmacies. Continued research is needed to determine which implementation strategies improve program performance.

Lessons Learned from Using Global Outcome Measures to Assess Community Pharmacy Performance

INTRODUCTION

As value-based and alternative payment models proliferate, there is growing interest in measuring pharmacy performance. However, little research has explored the development and implementation of systems to measure pharmacy performance. Additionally, systems that currently exist rely on process and surrogate outcome measures that are not always relevant to patients and payers.

PROGRAM DESCRIPTION

This article describes the process used to design and implement a performance measurement program for a group of enhanced services pharmacies in North Carolina. This program was successful in measuring quality based on medication adherence, hospitalizations, emergency department visits, and total cost of medical care for nearly all North Carolina pharmacies. Measures were scored and combined into a single 11-point composite pharmacy performance score. To demonstrate the measures, we compared performance scores for enhanced services pharmacies (n = 119) to other North Carolina pharmacies (n = 1,616) during the baseline measurement period (March 1, 2015-May 31, 2015). Adherence measure scores for enhanced services pharmacies exceeded those of other pharmacies (P values < 0.0001-0.003), but total scores were not significantly different, with enhanced services pharmacy mean total scores of 6.54 vs. 6.29 for all other pharmacies (P = 0.115).

OBSERVATIONS

The program described provides an example of a composite performance measurement system that can be used to support alternative pharmacy payment models and shows that case-mix adjustment is possible for broad outcomes such as those used in this program. The measures used for the program depend on timely feeds of medical claims. Payers and pharmacy networks implementing a similar program may need to explore alternative structure or process measures.

IMPLICATIONS

As pharmacy payment models evolve, there may be value in collaboration between academics, pharmacists, and payers to bring different areas of expertise and perspectives into the performance measurement process. This program demonstrates that global outcome measurement is possible over a broad set of pharmacies and invites additional research to explore the validity of this and other methods to measure pharmacy quality and performance.

DISCLOSURES

The program described in this article was supported by Funding Opportunity Number 1C12013003897 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Community Care of North Carolina received the grant and subcontracted with the UNC Eshelman School of Pharmacy to carry out this project. Shasky, Pfeiffenberger, and Trygstad are employed by Community Care of North Carolina. Urick and Ferreri are employed by the UNC Eshelman School of Pharmacy. Farley was employed by the UNC Eshelman School of Pharmacy during data collection for this project and reports consulting fees from UCB Pharmaceutical Company unrelated to this project. Pfeiffenberger reports membership on the Pharmacy Quality Alliance (PQA) task force on pharmacy level measures; Trygstad is a PQA board member; Urick is a member of a scientific advisory committee for PQA.

The role of network ties to support implementation of a community pharmacy enhanced services network

BACKGROUND

Limited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients.

OBJECTIVES

The aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network.

METHODS

Using a semi-structured interview guide, we interviewed 40 community pharmacy representatives responsible for implementation of a community pharmacy enhanced services program. We analyzed for themes using social network theory to compare network ties among 24 high- and 16 low-performing community pharmacies.

RESULTS

The study found that high-performing pharmacies had a greater diversity of network ties (e.g., relationships with healthcare providers, care managers, and public health agencies). High-performing pharmacies were able to use those ties to support implementation of NC-CPESN. High- and low-performing pharmacies used similar strategies for establishing ties with patients, such as motivational interviewing and assigning staff members to be responsible for engaging high-risk patients. High-performing pharmacies used additional strategies such as assessing patient preferences to support patient engagement, increasing patient receptivity towards enhanced services.

CONCLUSIONS

Community pharmacies may vary in their ability to develop relationships with other healthcare providers, care management and public agencies, and patients. As enhanced services interventions that require care coordination are scaled up and spread, additional research is needed to test implementation strategies that support community pharmacies with developing and maintaining relationships across a diverse group of stakeholders (e.g., healthcare providers, care managers, public health agencies, patients).

Payment Reform Meets Pharmacy Practice and Education Transformation

The pharmacy profession has for the greater part of four decades been associated with dispensing activities and product reimbursement. This has hindered the ability of pharmacists to evolve their roles in their respective sites of care. Payment reform efforts that create an outcomes marketplace offer an opportunity for professional transformation.

Program for the use of antipsychotics with metabolic monitoring in North Carolina medicaid children

Introduction

Children are at greater risk than adults for weight gain and metabolic disorders including hyperlipidemia and diabetes with newer antipsychotics. A web-based safety-monitoring program using a prior documentation model required submission of patient safety data (prior documentation) for insurance coverage at the pharmacy point of sale. This program launched in April of 2011, covering all NC Medicaid and Health Choice recipients under age 18. Clinical monitoring parameters and interactive educational features were developed with pediatric psychiatric experts and key mental health stakeholder groups.

Objectives

Using a four-year run in period and a full 9 months of post implementation claims data, evaluate the rates of antipsychotic prescribing and safety monitoring before and after the implementation of the A + KIDS program.

Results

Implementation of this program was associated with a consistent monthly decrease in overall antipsychotic use and increases in patient monitoring of glucose and lipid (Figure. 1, Table 1).

Conclusions

The prior documentation registry was effective in decreasing antipsychotic use and increasing safety monitoring. The impact of changing to more traditional prior authorization on the same clinical endpoints is currently under evaluation.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence

BACKGROUND

The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain.

OBJECTIVE

The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT.

METHODS

We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence. Legislation in the United States has incentivized the use of HIT to facilitate and enhance medication adherence. The Health Information Technology for Economic and Clinical Health (HITECH) was recently adopted and establishes federal standards for the so-called "meaningful use" of certified electronic health record (EHR) technology that can directly impact medication adherence.

RESULTS

The four persistent HIT barriers to medication adherence include (1) underdevelopment of data reciprocity across clinical, community, and home settings, limiting the capture of data necessary for clinical care; (2) inconsistent data definitions and lack of harmonization of patient-focused data standards, making existing data difficult to use for patient-centered outcomes research; (3) inability to effectively use the national drug code information from the various electronic health record and claims datasets for adherence purposes; and (4) lack of data capture for medication management interventions, such as medication management therapy (MTM) in the EHR. Potential recommendations to address these issues are discussed.

CONCLUSION

To make meaningful, high quality data accessible, and subsequently improve medication adherence, these challenges will need to be addressed to fully reach the potential of HIT in impacting one of our largest public health issues.

Improving diabetes medication adherence: successful, scalable interventions

Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US health care system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population). We identify key characteristics that make these interventions effective and scalable. This information is intended to inform health care systems seeking proven, low resource, cost-effective solutions to improve medication adherence.

Community Care of North Carolina – A statewide initiative for innovative pharmacy practice with a behavioral health focus

Community Care of North Carolina (CCNC) is a state-wide public/private partnership, primarily serving North Carolina (NC) Medicaid recipients, which focuses on the Primary Care Medical Home model of care. The CCNC Behavioral Health Pharmacy Coordinator has a leadership role for the direction and management of Behavioral Health Initiative (BHI) pharmacy projects, while other CCNC clinical pharmacists work in a variety of settings and help to implement and support those BHI projects. CCNC clinical pharmacists also perform medication management in all settings, help to implement the NC Medicaid Preferred Drug List (PDL), support the care managers, and are involved with the transitional care (TC) process. Transitional care medication management focuses on the identification of medication list discrepancies after discharge from an acute care facility. Patients receiving TC were 20% less likely to return to the hospital in the coming year. We observed the same trend even when looking specifically at those patients who were discharged from a psychiatric unit (Wilcoxon-Gehan statistic = 21.22, p&lt;.0001). It is the goal of the CCNC behavioral health team to provide practicing pharmacists (those directly supported by CCNC and those collaborating with CCNC) with the tools to continue serving populations with behavioral health issues.

Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid

Elevated blood pressure can lead to serious patient morbidity and mortality. The aim of the study was to evaluate the implementation of a tailored multifaceted program, administered by care managers in a Medicaid setting to improve hypertension medication adherence. The program enrolled 558 Medicaid patients. Patients had at least one phone call by care managers. The individually tailored program focused on improving lifestyle and medication adherence. The primary outcome was the medication possession ratio (MPR), calculated using fill history from pharmacy claims. We observed an improvement of medication possession from 55% 9-12 months prior to program enrollment to 77% 9-12 months post initiation of the program. We demonstrated 12 month sustainability and increased MPR. Personal interaction by phone allows the intervention to be tailored to participants' current concerns, health goals, and specific barriers to achieving these goals.

A+KIDS, a web-based antipsychotic registry for North Carolina youths: an alternative to prior authorization

OBJECTIVE

The rise in use of antipsychotics among U.S. children is well documented. Compliance rates with current safety-monitoring guidelines are low. In response, the North Carolina Division of Medical Assistance established the Antipsychotics-Keeping It Documented for Safety (A+KIDS) registry. The initial objectives of the project were to successfully establish a Web-based safety registry and to obtain and evaluate clinical information derived from the registry.

METHODS

In April 2011, A+KIDS began asking prescribers of antipsychotics for children age 12 and under to respond to a set of questions regarding dose, indication, and usage history. Antipsychotic registrations were examined by linking North Carolina Medicaid prescription claims to registry entries. Prescribers were classified into different types, and the number of patients and registrations per prescriber were examined.

RESULTS

In the initial six months, 730 prescribers registered 5,532 patients, 19% below age seven. By month 6 of the registry, 72% of all fills were registered with the program. Top diagnosis groups for registry patients were unspecified mood disorders, autism spectrum disorders, and disruptive behavior disorders. Top target symptoms were aggression (48%), irritability (19%), and impulsivity (11%). Psychosis accounted for 5% of the target symptoms. Twenty-eight percent of children were receiving no form of psychotherapy. Twenty-five percent of all A+KIDS prescribers were responsible for 81% of the registrations.

CONCLUSIONS

The A+KIDS registry initiative has been successful, as measured by rapid uptake, and is providing clinical information not available from claims data alone. Future efforts will allow for detailed examinations of antipsychotic utilization and further safety improvement.

Evaluation of a pilot medication therapy management project within the North Carolina State Health Plan

OBJECTIVE

To assess the feasibility of a pharmacist-based medication therapy management (MTM) service for North Carolina State Health Plan enrollees.

DESIGN

Before/after design with two control groups.

SETTING

Community pharmacies and an ambulatory care clinic in North Carolina serving patients from October 2004 to March 2005.

PARTICIPANTS

67 patients who used a large number of prescription drugs, 10 community/ambulatory care pharmacists, and more than 600 participants from two control groups.

INTERVENTIONS

Pharmacist-conducted MTM reviews for volunteering patients.

MAIN OUTCOME MEASURES

Process measures (type and frequency of drug therapy problems detected and services performed), economic measures (number and cost of medications dispensed), and humanistic measures (patient satisfaction with services).

RESULTS

Pharmacists identified an average of 3.6 potential drug therapy problems (PDTPs) per patient at the first visit. The most common PDTP categories were "potential underuse" and "more cost-effective drug available." Pharmacist actions were divided nearly equally between activities that would result in increased and decreased drug use. Pharmacists recommended a drug therapy change in about 50% of patients and contacted the prescriber more than 85% of the time. About 50% of patients with PDTPs had a change in drug therapy. Prescription use during the postintervention period decreased in both the study and control groups but was statistically significant only among the control groups. No significant differences were observed in patient co-payment or insurer prescription costs. Pharmacists provided the following educational services: medication use (90%), disease management (88%), adherence, and self-care (60%). Survey results indicated that patients highly valued the service.

CONCLUSION

A voluntary MTM program targeted at ambulatory patients using a large number of medications reduced the number of PDTPs but did not necessarily result in reductions in prescription drug use or cost. Nearly all patients received some form of medication adherence or disease education associated with problem detection and resolution. Patient satisfaction levels with the service were very high.

A pharmacy management intervention for optimizing drug therapy for nursing home patients

BACKGROUND

A drug therapy management service was designed to reduce polypharmacy among Medicaid recipients. This service selectively focused on patients who were high users of prescription drugs and had potential drug therapy problems (PDTPs).

OBJECTIVES

This article reports the results of the first phase of the North Carolina Polypharmacy Initiative. The goals of this study were to determine: (1) the frequency with which recommendations were made by pharmacists in response to targeted profile alerts aimed at high-risk patients, (2) the frequency and type of drug therapy changes, and (3) the impact on drug-related quality and costs.

METHODS

A before-after design was used. Nursing home patient profiles with PDTP alerts for specific drugs and drug categories were provided to consultant pharmacists. Targeted patients had received 218 prescription fills within 90 days. Pharmacists were compensated for performing and documenting targeted drug regimen reviews. Interventions of pharmacists and results after physician consultation are described, and cost impacts of changes in drug therapy are reported. Monetary results are shown in year-2002 U.S. dollars.

RESULTS

Prescription profiles were generated from Medicaid claims data and sent to consultant pharmacists for 9208 patients in 253 nursing homes. Pharmacists returned 7548 (82%) of all profiles sent to them. After excluding 1204 patients (13%) who were discharged or deceased, 6344 patients (69%) remained for analysis. At baseline, patients used a mean (SD) of 9.52 prescriptions per month, costing the North Carolina Medicaid program a mean (SD) of 502.96 dollars (309.70). A mean of 1.58 recommendations were offered to prescribers. After physician consultation, > or =1 recommendation was implemented for 72% of patients with a change recommendation, 68% of whom experienced a switch to a lower-cost drug. Drug cost savings were a mean of 30.33 dollars/patient per month. Cost savings from 1 month alone covered the compensation paid to pharmacists for consultation efforts.

CONCLUSIONS

This supplemental program of medication reviews for targeted nursing home patients resulted in a reduction of polypharmacy and was beneficial based solely on drug cost savings.

Effect of Salts on the Micellization, Clouding, and Solubilization Behavior of Pluronic F127 Solutions

We have examined the effect of NaCl, Na(2)SO(4), Na(3)PO(4), and NaSCN on F127 solutions; properties examined were critical micellization temperature (cmt), cloud point, and solubilization of a model hydrophobic drug, propyl paraben. Static light scattering showed that the first three salts lower the cmt of F127 in the order Na(3)PO(4)>Na(2)SO(4)>NaCl. The extent of lowering depends on the salt concentration and can be ascribed to the water structure-making properties of these salts. NaSCN, a water structure breaker, was found to increase cmt. Pyrene fluorescence was used to study the changes in micellar interior in the presence of salts. We found that the micellar micropolarity is not significantly changed by salts, evidenced by a constant I(1)/I(3) ratio of pyrene. However, the I(e)/I(3) ratio changes significantly with salts, being lower for NaCl, Na(2)SO(4), and Na(3)PO(4) and higher for NaSCN. This is consistent with an increase in the total hydrophobic micellar domain, in micellar microviscosity, or both. Solubilization of propylparaben increases in the presence of Na(3)PO(4), consistent with a larger hydrophobic domain for solubilization. The thermodynamics of micellization continue to be entropically driven in the presence of salts, evidenced by a positive entropy overcoming an unfavorable enthalpy. Copyright 2000 Academic Press.

A Study of the Temperature-Dependent Micellization of Pluronic F127

We have examined the temperature-dependent micellization of the pharmaceutically important PEO-PPO-PEO copolymer, Pluronic F127, using static light scattering and various aspects of the pyrene fluorescence spectrum (monomer intensity, excimer formation and the I1/I3 ratio). All techniques gave essentially the same value for the critical micellization temperatures (cmt) of various F127 solutions, and our results agreed with those reported in the literature. Cmt values decrease with increasing F127 concentration. We observed significant solubilization of pyrene in F127 solutions below the cmt, which was also reflected in the measured I1/I3 ratios. The thermodynamics of the micellization process were studied and gave different results at low and high F127 concentrations. In the low F127 concentration range (up to approximately 50 mg/mL), we obtain DeltaH = 312 kJ mol-1 and DeltaS = 1.14 kJ mol-1 K-1. Above 50 mg/mL we obtain DeltaH = 136 kJ mol-1 and a DeltaS = 0.54 kJ mol-1 K-1. This discontinuity in thermodynamic behavior can be due to a change in aggregation number with temperature and/or a change in the micellization process at higher concentrations. Copyright 1999 Academic Press.