Search

Background: The past several years have seen sharp increases in opioid overdose mortality. Harm reduction resources, such as nonprescription syringes and naloxone, are used to save lives.Objectives: To develop a statewide approach to increase the use of opioid harm reduction services through community pharmacies.Practice Description: The North Carolina Association of Pharmacists was awarded a grant to address opioid mortality across the state, using community pharmacies to address opioid use disorder.Practice Innovation: A statewide, standardized approach was implemented to increase knowledge and use of opioid harm reduction resources in the community pharmacy setting.Evaluation Methods: Pharmacies were offered training related to harm reduction. Participating pharmacies provided monthly updates related to staff training, syringe access status, naloxone kits distributed, and comments about how the training was changing their practice. At the project conclusion, pharmacies provided retrospective naloxone dispensing data along with naloxone dispensing during the intervention period. Pharmacies shared the greatest benefit of the program, a potential change to make implementation simpler, and the biggest change in the pharmacist(s) as a result of the project. Descriptive statistics were used to analyze data.Results: A total of 58 pharmacies across 33 counties participated in the harm reduction project. Of the 100 North Carolina counties, 15 counties were identified as high-need, and 14 of the 15 high-need counties (93%) participated in this project. Of the 58 participating pharmacies, 40 pharmacies (69%) had or implemented a nondiscriminatory nonprescription syringe policy within their pharmacy. During the baseline period (January 1, 2018, to June 15, 2018), 177 prescriptions for naloxone were dispensed by participating pharmacies. During the intervention period (January 1, 2019, to June 15, 2019), 639 prescriptions for naloxone were dispensed, representing a 361% increase in naloxone dispensing.Conclusion: The successful implementation of a standardized, statewide approach increased access to harm reduction services. [ABSTRACT FROM AUTHOR]

Background: Published data on pharmacist-provided chronic care management (CCM) services is limited, particularly for programs led by community-based pharmacists.Objective: The objective was to quantify the total revenue generated from a community pharmacist-led CCM service, including CCM billing and appointment referrals. A second objective was to identify the types and frequencies of medication discrepancies identified during medication reconciliation.Practice Description: Realo Drugs is a group of 18 independent community pharmacies serving eastern North Carolina.Practice Innovation: Exploration of revenue generated from a community pharmacist-led CCM service.Evaluation Methods: This retrospective analysis assessed interventions completed by pharmacists between April 1, 2018 through June 30, 2019. Data was extracted from the electronic health record (EHR), including revenue generated from CCM billing codes, appointment referrals made by the pharmacist resulting in a completed in-office appointment, and which patients received medication reconciliation. The types and frequencies of medication discrepancies were documented, including medication no longer being used by the patient, medication omission, and strength or dose mismatch. Descriptive statistics were used to analyze data.Results: Over 15 months with a total of 112 patients, a total of $26,148 was generated from CCM services, representing an average of $15.56 per patient per month. The majority (approximately 80%) of the revenue was generated from noncomplex patient encounters. Of the 239 medication reconciliations completed, 609 medication discrepancies were identified. The majority of medication discrepancies (67%) were categorized as "patient no longer takes medication listed on EHR medication list." The second most common discrepancy was "patient takes medication not listed on the EHR medication list" (22%), followed by "strength/dose mismatch" (10%).Conclusion: These data can demonstrate to provider partners the sources of revenue that can be provided through CCM services. In addition to revenue, pharmacists can positively impact patient care through identification of medication discrepancies through medication reconciliation. [ABSTRACT FROM AUTHOR]

Background: Pharmacists in community-based settings document patient care using the Pharmacist eCare Plan (PeCP).Objective: To conduct a pilot evaluation of the PeCP use and documentation of Systemized Nomenclature of Medicine Clinical Terms (SNOMED CT) codes within select community-based pharmacies.Practice Description: Moose Pharmacy operates 7 locations in rural North Carolina that are part of the Community Pharmacy Enhanced Services Network (CPESN). The Moose Pharmacy Medication Adherence Program (MooseMAP) targets patients with a chronic condition who would benefit from medication synchronization, adherence packaging, and monthly calls.Practice Innovation: CPESN pharmacies use the PeCP to track a patient's concerns, goals, interventions, and medication-related information. The PeCP standard requires pharmacies to detail a patient's current medication regimen and health concerns as well as the pharmacy's interventions and patient's health over time.Evaluation Methods: Data were included if the patient was enrolled in MooseMAP and had a free-text note in the eCare Plan. Data were excluded if the medication-related problem (MRP) or intervention was a general health problem without a valid SNOMED CT code. Data were categorized into MRPs, medication interventions, education, and referrals. The International SNOMED CT browser and pharmacy health information technology (PHIT) value sets were searched; data sets without existing codes were submitted to the appropriate oversight authorities for future inclusion. Data were analyzed using descriptive statistics.Results: Emerging codes were identified that resulted in 91 recommendations to PHIT for development of new SNOMED CT codes and 113 recommendations to PHIT for inclusion in the PHIT value sets. In total, 66% of MRPs did not have a valid SNOMED CT code, and 78% of MRPs were not included in a PHIT value set. The most prevalent gap in MRP or intervention documentation related to medication use issues.Conclusion: Incorporating emerging codes into documentation systems should enable the profession to better communicate value to health care stakeholders. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of a community pharmacist-driven health coaching program on clinical outcomes from baseline to 1 year.Setting: Independent community pharmacy in western North Carolina.Practice Description: Sona Pharmacy + Clinic is an independent community pharmacy offering enhanced clinical services such as medication synchronization, adherence packaging, and free delivery. Sona Benefits offers pharmacy benefit manager (PBM) services to self-funded plans in western North Carolina.Practice Innovation: Sona Health Management Program is a disease management program offered to Sona Benefits PBM clients; the services began in October 2016.Evaluation: Change in clinical outcome measures (total number of medications, blood pressure, hemoglobin A1c, weight, low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], triglycerides [TG], patient health questionnaire [PHQ-9] scores, and asthma control test [ACT] scores) were assessed for members who participated in the program for a minimum of 12 months for at least 2 of the following conditions: hypertension, hyperlipidemia, diabetes, depression, and asthma.Results: Health coaching was provided to 42 members (mean age of 55.9 years and 2.7 qualifying disease states). The mean number of medications per patient significantly decreased from 7.2 to 6.2 (P = 0.02). Systolic and diastolic blood pressures were significantly reduced from 130.8 mm Hg to 125.7 mm Hg (P = 0.04) and 76.9 mm Hg to 73.7 mm Hg (P = 0.04), respectively. Other clinical outcome measures evaluated, such as hemoglobin A1c, weight, LDL-C, HDL-C, TG, and PHQ-9 and ACT scores, were improved but did not reach significance.Conclusion: These results suggest that community pharmacists can have a positive impact on patients with multiple chronic conditions through health coaching services. This project suggests a potential model of pharmacist health coaching through pharmacist-run PBM services. [ABSTRACT FROM AUTHOR]

Objective: To measure the change in knowledge of a certified pharmacy technician (CPhT) after completing a standardized educational module highlighting key information required to complete chronic care management services.Setting: Seven independent community pharmacy locations.Practice Description: Realo Discount Drugs is a group of 19 independent community pharmacies serving eastern North Carolina.Practice Innovation: Three modules were created to educate CPhTs: (1) basics of chronic care management, (2) medication and vaccination reconciliation and screening tools, and (3) assessing chronic diseases and setting goals. Each module averaged 10 minutes and was in the form of voice-over Microsoft PowerPoint (Microsoft Corporation, Redmond, WA) slides.Evaluation: The CPhTs anonymously took a computerized 20-question pretest before viewing the modules. The CPhTs were asked to view the modules within 7 days of completing the pretest. After at least 14 days of module completion, the CPhTs anonymously took the same computerized 20-question posttest and a 3-question survey. Pre- and posttest scores were compared using a paired t-test.Results: A total of 12 participants completed the study. The mean pretest score was 60% (12/20 points), the mean posttest score was 75% (15/20 points), the mean difference between pre- and posttest scores was an increase of 15% (3 points), and this difference was statistically significant (P = 0.004). There were 10 CPhTs who had an increase in score from pre- to posttest. Most of the CPhTs found the modules to be informative and to have value in increasing their abilities and responsibilities in performing as CPhTs. Some of the CPhTs reported using the learned information daily.Conclusion: These standardized modules were effective in increasing clinical knowledge of the CPhTs for completing chronic care management services. New topics can be added in the future, as well as following up with CPhTs on missed questions and knowledge application. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this study were to assess 30- and 60-day hospitalizations and to determine the number of medication therapy problems (MTPs) identified during pharmacy technician-driven medication reconciliation for high- to very high-risk home health patients.Setting: The study was conducted in 8 independent community pharmacy locations.Practice Description: Realo Discount Drugs is a group of 16 independent community pharmacies serving eastern North Carolina.Practice Innovation: Realo Discount Drugs partnered with Well Care Home Health to provide medication reconciliation services to high- and very high-risk patients. A pharmacy technician contacts the patient to obtain an accurate medication list and complete a falls risk assessment and depression screening. The technician updates the medication list, allergies, and vaccination status in the electronic health record (EHR). The pharmacist reviews the medication list for completeness; assesses for falls risk, depression, and medication interactions; and generates communication to the provider for clarifications or recommendations, if needed. Additional counseling points that need to be conveyed to the patient by the home health nurse are documented in the EHR.Evaluation: Thirty- and 60-day hospitalizations for enrolled patients were manually pulled from documented transfers in the EHR and compared with data from a third-party administrator. MTPs were categorized by the pharmacist and documented. Descriptive statistics were used to evaluate the data collected.Results: At 30 days from the start of care, 13.4% (93/695) of patients who received pharmacy services were hospitalized compared with 26.8% (143/534) of patients who did not receive pharmacy services (P < 0.01). At 60 days from the start of care, 20.9% (145/695) of patients who received pharmacy services were hospitalized compared with 33.3% (178/534) of patients who did not receive pharmacy services (P < 0.01).Conclusion: A technician-driven medication reconciliation process led to a reduction in hospitalizations and identified MTPs in home health patients. [ABSTRACT FROM AUTHOR]

Objectives: To implement a comprehensive vaccine screening program and to identify best practices in workflow for a vaccine screening program.Setting: Five independent community pharmacy locations with a common owner.Practice Description: Moose Pharmacy is an independent family owned and operated pharmacy in rural North Carolina. Moose Pharmacy has 5 dispensing pharmacy locations that fill from 750 to 2800 prescriptions weekly. Each pharmacy regularly uses clinical pharmacists and pharmacy residents to provide comprehensive patient care.Practice Innovation: A vaccine screening tool and documentation form were developed by the authors based on recommendations from the Centers for Disease Control and Prevention for immunizations that may be pharmacist administered by protocol in North Carolina.Interventions: A pharmacy team member used the screening tool to identify vaccination opportunities in the patient population. Patients 18 years of age or older who entered the pharmacy workflow process were eligible for screening.Evaluation: If pharmacy staff identified needed vaccinations for a patient, a pharmacist evaluated the screening and recommended immunization(s) to the patient. If the recommendation was accepted, the vaccine was administered. If the patient declined vaccination, a brief reason was designated from a predefined selection of choices.Results: During the 30-day study period, 631 screenings were performed. Pharmacy technicians and pharmacists performed 95.4% and 4.6% of screenings, respectively. Of completed screenings, 81.5% were completed at data entry, 13.9% at fill station, 4.1% at prescription verification, and 0.5% during a clinical consultation. As a result of this study the following vaccines were administered: influenza (n = 11), pneumococcal conjugate (n = 5), pneumococcal polysaccharide (n = 1), Tdap (n = 5), and zoster (n = 6).Conclusion: A comprehensive vaccine screening tool was successfully used by pharmacy technicians and pharmacists at data entry and fill station during the traditional workflow at an independent community pharmacy. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the economic and clinical impact of community pharmacist-led pharmacy benefit management (PBM) services.Setting: Independent community pharmacy in western North Carolina.Practice Description: Sona Benefits is a PBM partner to self-funded plans in western North Carolina. The services provided by Sona Benefits are led by pharmacists at its affiliate company, Sona Pharmacy + Clinic.Practice Innovation: In October 2016, Sona Benefits began providing PBM services to members employed by a local continuing care retirement community.Evaluation: Economic outcome measures included change in total medical and prescription costs per member per year (PMPY) and change in cost per prescription from baseline. Change in clinical outcome measures (hemoglobin A1C, weight, blood pressure) was assessed for members who participated in 2 or more quarterly health coaching sessions.Results: Prescription costs were reduced from $1219.72 to $858.57 PMPY and medical health care costs were reduced from $5910.76 to $4290.30 PMPY from baseline. This represented a total decrease of $1981.61 PMPY in health care costs. A reduction in the average cost per prescription from $95.10 to $61.88 was observed. For patients enrolled and active in health coaching, we observed reductions in weight, hemoglobin A1C, and blood pressure. Between the initial and final health coaching visits, average weight decreased from 204.6 lb (92.8 kg) to 203.6 lb (92.4 kg), the percentage of patients at hemoglobin A1C goal increased from 47% to 53%, and percentage of patients at goal for blood pressure increased from 58% to 78%.Conclusion: Inclusion of community pharmacists in PBM service delivery produced economic benefits for plan sponsors. Preliminary clinical data suggested benefits of pharmacist-led health coaching services, but further evaluation is needed to determine the long-term impact. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine whether community-based pharmacists in North Carolina have the personal confidence, comfort level, and resources needed to care appropriately for and interact with transgender patients.Methods: Using the North Carolina Board of Pharmacy database, a link to a 25-item questionnaire was e-mailed to all actively licensed community pharmacists in North Carolina. Survey items included pharmacist demographics, prior or current education on transgender health care, comfort regarding care provision for transgender patients, and the ability to care for transgender patients at the practice site. Questionnaire items were developed in collaboration with a pharmacist who actively participates in the care of transgender patients. The questionnaire was pilot-tested among a convenience sample of student pharmacists and pharmacists for feedback on validity and question structure. The survey was open for 30 days with a reminder sent on day 15. Upon survey completion, participants had the option to be entered into a drawing to receive a gift card incentive.Results: In total, 342 surveys were completed of 4784 surveys distributed, yielding a 7.1% response rate. Three percent of survey respondents reported receiving education on treating transgender patients during their respective pharmacy school curricula, and 12% of respondents sought other forms of transgender education (i.e., continuing education). Seventy-one percent of respondents viewed the role of the pharmacist as important in the care of transgender patients. Sixty-six percent of respondents were comfortable welcoming transgender patients into their practice sites, and 36% were comfortable asking for pronouns.Conclusion: Survey participants reported a lack of formal or postgraduate education, which describes a need for accessible education on transgender care. North Carolina community-based pharmacists believe that it is within their role as pharmacists to provide gender-affirming care, but they may need additional training to feel comfortable in providing this care. [ABSTRACT FROM AUTHOR]

Objectives: The objective was to assess the impact of a pharmacist embedded within a primary care practice on quality measures of the Merit-Based Incentive Payment System (MIPS) and patient-centered medical home (PCMH) by characterizing (1) measure achievement after pharmacist involvement in care and (2) measure achievement separately for patients seen by the pharmacist and patients not seen by the pharmacist.Setting: Multidisciplinary primary care practice in Charlotte, North Carolina.Practice Description: Pharmacists from an independent community pharmacy are highly integrated into the clinic. Pharmacists work alongside providers to furnish comprehensive care with a team-based approach. The initial focus for the pharmacist was on the Medicare annual wellness visits (AWV) and chronic care management (CCM).Practice Innovation: Quality measure achievement during face-to-face AWV, telephone-call CCM, or both.Evaluation: From January 1, 2017, to February 2, 2018, 193 patients had an AWV, CCM, or both from the pharmacist. Measure achievement was characterized with the use of descriptive statistics.Results: When characterizing quality measures before, during, and after pharmacist intervention for the clinic population, achievement of some measures improved and others worsened. However, for every measure evaluated, the cohort of patients seen by the pharmacist had a greater proportion of patients achieving the quality measure than the cohort of patients not seen by the pharmacist. The greatest differences were observed for influenza vaccination (41% of pharmacist cohort vs. 10% of nonpharmacist cohort), hemoglobin A1C control less than 9% (94% of pharmacist cohort vs. 67% of nonpharmacist cohort), and colorectal cancer screening (55% of pharmacist cohort vs. 28% of nonpharmacist cohort).Conclusion: Pharmacist provision of clinical services may increase the likelihood of quality measure achievement. The pharmacist integration model addressed gaps in care that appeared to positively affect MIPS and PCMH quality measures. This has the potential to increase reimbursement through value-based payment models. [ABSTRACT FROM AUTHOR]

Objective: To determine factors that encourage physicians to establish collaborative practice agreements with community pharmacists.Methods: A 20-item cross-sectional survey was mailed to a random sample of 1000 family medicine physicians practicing in North Carolina. Two weeks after the initial mailing, a reminder was sent to physicians. Physicians were entered into a drawing to receive a gift card as an incentive for survey completion. The questionnaire collected demographic information, factors important to physicians for collaboration with a community pharmacist, and physician perceptions of pharmacist qualifications. Descriptive statistics were used to analyze patterns in the Likert scale survey responses.Results: Of the 1000 mailed surveys, 67 were returned as undeliverable, resulting in a final sample size of 933 surveys. One hundred forty-six family medicine physicians responded to the survey, yielding a 15.6% response rate. Respondents were 58% male, 73% had been practicing longer than 10 years, and 60% had an academic affiliation. Our results indicate that an established relationship with a community pharmacist is the most important factor when considering a collaborative practice agreement. At least 90% of physicians reported that the most important pharmacist contributions were drug therapy adverse effect management, drug interaction management, medication access assistance, prescription counseling, and medication adherence. A majority of physicians reported that community pharmacists improve quality outcomes and metrics (74% and 72%, respectively).Conclusion: Physicians in North Carolina recognize the value of the services a pharmacist can provide to their patients. Developing relationships between community pharmacists and physicians and describing the value of additional credentialing in the provision of patient care will be integral in establishing collaborative practice agreements in the community setting. [ABSTRACT FROM AUTHOR]

Objective: To assess the effect of a community pharmacist-led intervention on the proportion of patients with diabetes placed on statin therapy.Design: The Pharmacy Quality Alliance endorsed a performance measure, Statin Use in Persons with Diabetes, which evaluates the percentage of patients aged 40-75 years who were dispensed a medication for diabetes and also received a statin medication.Setting: This new measure has been implemented within the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) dashboard.Participants: In this randomized controlled study, eligible patients identified in EQuIPP are those who received medications from a large chain community pharmacy in North Carolina, are 40-75 years, had ≥2 prescription fills of a diabetes medication, and were not receiving statin therapy.Intervention: The control group received no intervention. Primary care prescribers of patients in the intervention group were contacted by phone and fax to obtain a prescription for an appropriate statin.Main Outcome Measures: The primary outcome was the proportion of patients in each group who were dispensed a statin, calculated using Fisher exact test. Sub-analyses were performed to control for patient age, sex, and insurance type.Results: The number of statins prescribed was statistically significant between intervention group (n = 221) versus control group (n = 199) with 46 statins versus 17 statins, respectively (P <0.001). The number of statins dispensed was also statistically significant between groups with 34 statins in the intervention group versus 15 statins in the control group (P = 0.015). The fourth most common (9.2%) reason prescribers rejected statin therapy initiation was "Patient has normal cholesterol" and this caused the greatest amount of discussion between pharmacist and prescriber.Conclusion: Through a brief pharmacist-to-provider intervention, a significant gap closure in statin therapy was seen in patients with diabetes. There is an opportunity for pharmacies, health plans, and prescribers to utilize the community pharmacist in achieving quality, evidence-based patient care. [ABSTRACT FROM AUTHOR]

Objective: To develop a disease-specific patient questionnaire to be used during monthly follow-up telephone calls ("refill calls") for patients with rheumatoid arthritis receiving a noninfused biologic medication.Setting: Independent specialty community pharmacy in North Carolina.Practice Description: Realo Specialty Care was formed to provide a patient-centered care approach to patients with complex, chronic conditions such as HIV/AIDS, hepatitis, rheumatoid arthritis, and plaque psoriasis. The services include medication therapy management, patient education, prior authorization assistance, adverse drug reaction monitoring, and an adherence program.Practice Innovation: Using national guidelines, an 8-item questionnaire that addressed overall health, adherence, and adverse medication events for noninfused biologic medications for rheumatoid arthritis was developed. When an eligible patient was identified, a notification was added within the pharmacy's dispensing software. The pharmacist or technician was prompted to use the newly developed questionnaire during the monthly refill call.Evaluation: Patients' responses were archived in their profiles within the pharmacy's dispensing software. The change in adherence was assessed by the mean medication possession ratio (MPR) before the intervention (July 2018 to September 2018) and monthly after the intervention (November 2018 to February 2019).Results: A total of 29 patients were eligible on the basis of an MPR less than 90%; data from 18 patients were used. The mean MPR increased from 71% preintervention (September 2018) to 75% in the first month after the start of the intervention (November 2018). The mean MPR reached a high of 81% in the fourth month after the start of the intervention (February 2019), representing a 10% increase in the MPR.Conclusion: The specialty pharmacy team successfully developed and used the rheumatoid arthritis questionnaire during the monthly refill calls. The implementation of the disease-specific questionnaire led to increased medication adherence and enhanced communication with patients with regard to their health and outcome of therapy. [ABSTRACT FROM AUTHOR]

Objective: To develop an electronic tool to aid community-based pharmacists in incorporating diabetes-specific clinical services into pharmacy workflow and to determine the utility of the tool.Setting: Three independent community pharmacy locations.Practice Description: Realo Discount Drugs is a group of 18 independent community pharmacies, a specialty pharmacy, and a long-term care pharmacy, all with a common owner, serving eastern North Carolina.Practice Innovation: An electronic tool was developed to aid pharmacists in identifying gaps in therapy for patients with diabetes in alignment with the 2018 American Diabetes Association Standards of Medical Care in Diabetes. An RX edit (short code) alerted the pharmacist when a diabetes medication was verified. An electronic tool complemented the RX edit, through which the pharmacist would assess the patient record for the presence of an angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), aspirin, or a statin.Evaluation: The pharmacist used an electronic tool to identify gaps in therapy, to document medication therapy problems identified, to make therapeutic recommendations to the patient or provider, and to document interventions using the electronic tool.Results: Pharmacists used the tool 788 times during a 50-day period. Each completion of the tool represented 1 patient profile assessed. Pharmacists identified 99 patients (12.6%) who were not using an ACEI or ARB. Pharmacists recommended ACEI or ARB therapy for 56 patients (56.6%). Pharmacists identified 371 patients (47.1%) who were not using aspirin therapy, and recommended aspirin therapy for 198 patients (53.4%). Pharmacists identified 187 (23.7%) patients who were not given statin therapy and recommended statin therapy for 142 patients (76%). A total of 74 medication therapy problems (18.7%) were resolved.Conclusion: An electronic tool was developed and integrated into the dispensing workflow. The implementation of an electronic tool helped community-based pharmacists to identify gaps in therapy and to make recommendations in alignment with American Diabetes Association guidelines. [ABSTRACT FROM AUTHOR]