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In February 2022, the North Carolina legislature expanded pharmacist dispensing authority without a prescription. We conducted a cross-sectional interview of currently licensed pharmacy managers of outpatient pharmacies located in five counties in southeastern North Carolina. Pharmacy managers were eligible to participate if their pharmacy was either a community pharmacy, clinic-based pharmacy, or outpatient health system pharmacy. Forty-four of 116 eligible pharmacy managers participated (38% response rate). The most common services offered by pharmacies included medication synchronization services (93.2%), on-site immunizations (90.9%), and refill reminders (88.6%). The least common services offered include INR screens (0%), A1c screens (7%), and ‘incident-to’ billing services associated with CPT codes: annual wellness visits (0%), chronic care management (0%), transitional care management (0%), and remote patient monitoring (2.4%). The services that pharmacy managers wanted to learn more about through continuing education included: oral/transdermal contraceptives (60.5%), administration of long-acting injectables (LAIs) (36.8%), and dispensing of HIV post-exposure prophylaxis (PEP) (23.7%).

To support the successful integration of community pharmacies into value-based care models, research on the feasibility and effectiveness of novel pharmacist-provided patient care services is needed. The UNC Eshelman School of Pharmacy, supported by the National Association of Chain Drug Stores (NACDS) Foundation, designed the Community-based Valued-driven Care Initiative (CVCI) to (1) identify effective value-based patient care interventions that could be provided by community pharmacists, (2) implement and evaluate the feasibility of the selected patient care interventions, and (3) develop resources and create collaborative sustainability opportunities. The purpose of this manuscript is to describe recruitment strategies for CVCI and share lessons learned. The project team identified pharmacies for recruitment through a mixed data analysis followed by a “fit” evaluation. A total of 42 pharmacy organizations were identified for recruitment, 24 were successfully contacted, and 9 signed on to the project. During recruitment, pharmacies cited concerns regarding the financial sustainability of implementing and delivering the patient care services, challenges with staffing and infrastructure, and pharmacists’ comfort level. To foster participation, it was vital to have leadership buy-in, clear benefits from implementation, and assured sustainability beyond the research period.

Abstract Background Many state Medicaid programs are implementing pharmacist-led medication management programs to improve outcomes for high-risk beneficiaries. There are a limited number of studies examining implementation of these programs, making it difficult to assess why program outcomes might vary across organizations. To address this, we tested the applicability of the organizational theory of innovation implementation effectiveness to examine implementation of a community pharmacy Medicaid medication management program. Methods We used a hurdle regression model to examine whether organizational determinants, such as implementation climate and innovation-values fit, were associated with effective implementation. We defined effective implementation in two ways: implementation versus non-implementation and program reach (i.e., the proportion of the target population that received the intervention). Data sources included an implementation survey administered to participating community pharmacies and administrative data. Results The findings suggest that implementation climate is positively and significantly associated with implementation versus non-implementation (AME = 2.65, p

Objective: To describe a vial-to-pen conversion program driven by community-based pharmacists and determine conversion success rate. Methods: A report based on prescription claims was generated and identified 200 prescriptions filled for an insulin vial product and syringes. Patients were contacted by community-based pharmacists during a five-month period and were informed of the availability and potential benefits of insulin pen delivery systems (IPDS). If the patient agreed to the switch, the pharmacist contacted the prescriber to obtain a new prescription. Prescription refill records were tracked for six months post-intervention to determine whether patients who were converted remained on the IPDS. Results: The overall vial-to-pen conversion success rate was 26% out of 121 potential conversions. In addition, 52% of patients reached were willing to switch and prescribers approved 71% of the recommendations to switch from vial-to-pen. Of the prescriptions successfully converted to an IPDS, 84% of prescriptions were still dispensed as pen products six months following the conversion. Conclusion: Community-based pharmacists can serve as a resource to provide education on insulin delivery options and increase use of IPDS in patients with diabetes. Treatment of Human Subjects: IRB review/approval required and obtained Article Type: Original Research

Background: Certain medications place older adults at higher risk for experiencing falls. This is a modifiable risk factor that may be managed by community pharmacists, but requires prescriber acceptance of recommendations. Previous studies indicate that prescriber acceptance of pharmacist recommendations may be impacted by patient-reported concerns. Objective: To examine the relationship between patient-reported fear of falling and prescriber acceptance of pharmacist recommendations. Methods: A prospective, observational study design was used. Eligible patients were age 65 and older and received care at one of 31 participating pharmacies. Patients were screened for falls risk using three evidence-based questions; patients screening positive were eligible for a comprehensive medication review. Data were collected via a prescriber response form. The primary outcome was the prescriber acceptance of pharmacist recommendations. Results: Pharmacists communicated 562 recommendations to prescribers, with 338 (60%) for patients who worried about falling. There was no significant difference in prescriber acceptance rate between those who worried about falling and those who did not (36.1% vs. 41.1%, X2 = 0.23, p = 0.43). However, patient pharmacy was a significant predictor of recommendation acceptance (p = 0.047). Conclusion: Prescribers were not more likely to consider a pharmacist’s recommendations regarding medications that contribute to falls risk for patients who worried about falling.

Background: A questionnaire specific to community pharmacy characteristics, such as staffing models for clinical activities and business operations, does not exist. As community pharmacy practice expands, it is important to characterize how pharmacies are changing for outcomes research. The aim of this study was to conduct cognitive interviewing with community pharmacists to gain feedback on the formatting, readability, and content of items measuring community pharmacy characteristics to develop such a questionnaire. Methods: National surveys and previously developed survey work were reviewed to identify the following question categories: business operations, human resource management, division of clinical responsibilities, technology, and enhanced services. Questions for each domain were drafted and assessed for applicability across different states and level of importance by researchers in 3 different states. Using the “think aloud” method of cognitive interviewing to evaluate clarity in instructions, question items and response entry, an iterative process was established that included 3 rounds of interviews with discussion and modifications made by the research team between each round. Results: A total of thirteen cognitive interviews across 3 rounds were conducted via telephone and lasted between 30 and 60 minutes. Time for participant pharmacists to complete the questionnaire ranged from 12 minutes to 30 minutes. The interviews revealed areas of ambiguity, and missing response options for the variety of business structures. The question categories with the most problematic items were business operations, human resource management, and division of clinical responsibilities. Conclusion: Using cognitive interviewing, a community pharmacy questionnaire focusing on operational characteristics was developed. Future research is warranted to test the organizational characteristics defined in this paper with a larger sample size representing multiple states. Article Type: Original Research

Managing patient health is a complex task, requiring the support of an interprofessional healthcare team. Collaboration between neighboring community pharmacies and primary care practices can be an alternate solution for team-based patient care. The purpose of this project was to design and implement a communication strategy for patients with diabetes and hypertension between a community pharmacy and physician practice. An interprofessional team for the practice settings was formed to develop a strategy for collaboration. After agreeing on the common goals and target patient population for the disease states, the team devised a way to communicate via electronic health record (EHR). The communication strategy allowed for more frequent follow-up with the patients which has the potential to result in better clinical outcomes. A communication strategy between a community pharmacy and a physician practice office can be achieved using EHR technology. The greatest outcome of this project was the formation of the collaborative team between the practice settings that continues to work together on additional patient-centered initiatives. Further research is warranted to allow for incorporation of patient perspectives in development of communication strategies.

Objectives: 1) To determine parents' and/or guardians' interest in having pharmacists provide children's liquid medications in a pre-measured, individualized dosing device 2) To assess parents' and/or guardians' perception of dosing liquid medications for a child. Design: Observational survey Setting: Regional chain pharmacy in North Carolina Participants: > 18 years old, parent/guardian of a childchain, responsible for administering child's liquid medication Intervention: 14 item questionnaire Main Outcome Measure: Interest in pharmacists providing children's liquid medications in pre-measured, individualized dosing devices Results: 250 questionnaires were mailed; 42 were marked "return to sender" (16.8%), 22 were returned completed (10.6%), and 20 of the 22 met inclusion criteria (9.6%). 95% of study participants reported being interested in having pharmacists provide children's liquid medications in the proposed dosing device, and 40% were willing to pay for such a service. 90% of respondents reported it is "not at all difficult" to understand the amount of dose a child is to receive, while 55% reported it is "not at all difficult" to measure doses. 25% of respondents reported sometimes using a kitchen spoon to measure a child's medication. Conclusion: Community pharmacists should explore providing children's liquid medications in an individualized dosing device, as study results determined parents are interested in and willing to pay for the theoretical device. Further large-scale studies would be beneficial in determining interest in and willingness to pay for the dosing device in various pharmacy settings nationwide. Type: Original Research

Objective: To assess patient perceptions of a North Carolina community pharmacy-based warfarin monitoring service. Methods: Prospective study of patients 18 years of age and older, who filled a prescription for warfarin, in one of five Raleigh area community pharmacies, between May 1, 2010 and October 31, 2010. A 14 item survey, along with a self-addressed stamped envelope, was mailed to 330 identified patients. The survey inquired about details of current anticoagulation monitoring services, interest in utilizing a local community pharmacy for this service, and confidence in a pharmacist-managed program. Results: 26% of surveys were returned. 48% of surveyed individuals responded that they would be interested in having their warfarin monitoring performed by a trained pharmacist in a community pharmacy setting. Conclusion: Many participants responded that the community pharmacy would be more convenient than or as convenient as their current location. This may be a new clinical service that could be offered in certain community pharmacies. Type: Original Research

Objective: To determine if pharmacist-provided medication therapy management (MTM) improves medication adherence in Medicare patients. A secondary objective is to compare the total monthly cost of a patient's prescription medication regimen 6 months before and 6 months following a comprehensive medication review (CMR). Design: Retrospective analysis of medication adherence, pre-post comparison. Setting: Three independent pharmacies in North Carolina. Patients: 97 Medicare Part D beneficiaries with one or more chronic disease states who participated in a comprehensive medication review (CMR). Intervention: MTM services provided by community pharmacists. Main outcome measure: Change in adherence as measured by the proportion of days covered (PDC) and change in medication costs for patients and third party payers. Results: Patients were adherent to chronic disease-state medications before and after MTM (PDC≥ 0.8). Overall, change in mean adherence before and after MTM did not change significantly (0.87 and 0.88, respectively; p = 0.43). However, patients taking medications for cholesterol management, GERD, thyroid and BPH demonstrated improved adherence following a CMR. No change in adherence was noted for patients using antihypertensives and antidiabetic agents. Average total chronic disease-state medication costs for participants were reduced from $210.74 to $193.63 (p=0.08) following the comprehensive medication review. Total costs for patient and third party payers decreased from patients prescribed antilipemics, antihypertensives, GERD and thyroid disorders following a CMR. Conclusions: Pharmacist-provided MTM services were effective at improving medication adherence for some patients managed with chronic medications. Pharmacist-provided MTM services also were effective in decreasing total medication costs. Type: Original Research

Objectives: 1) To determine parents’ and/or guardians’ interest in having pharmacists provide children’s liquid medications in a pre-measured, individualized dosing device 2) To assess parents’ and/or guardians’ perception of dosing liquid medications for a child. Design: Observational survey Setting: Regional chain pharmacy in North Carolina Participants: > 18 years old, parent/guardian of a child

Objective: To assess patient perceptions of a North Carolina community pharmacy-based warfarin monitoring service. Methods: Prospective study of patients 18 years of age and older, who filled a prescription for warfarin, in one of five Raleigh area community pharmacies, between May 1, 2010 and October 31, 2010. A 14 item survey, along with a self-addressed stamped envelope, was mailed to 330 identified patients. The survey inquired about details of current anticoagulation monitoring services, interest in utilizing a local community pharmacy for this service, and confidence in a pharmacist-managed program. Results: 26% of surveys were returned. 48% of surveyed individuals responded that they would be interested in having their warfarin monitoring performed by a trained pharmacist in a community pharmacy setting. Conclusion: Many participants responded that the community pharmacy would be more convenient than or as convenient as their current location. This may be a new clinical service that could be offered in certain community pharmacies.