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Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time., Purpose: There is a growing number of specialty medications with accompanying requirements that exceed standard characteristics, which may be referred to as "ultra complex." This article details examples of ultra-complex specialty medications, including the characteristics that make them ultra complex, and strategies implemented by an integrated health-system specialty pharmacy (IHSSP) to maintain an optimal patient journey., Summary: Before therapy initiation, ultra-complex specialty medications often require additional steps that go beyond what is required of traditional specialty treatments, such as ensuring patients have appointments scheduled and attended and coordinating medical procedures. At the time of initiation, ultra-complex therapy might require additional immunizations or dosing based on specific tests. Finally, specialty pharmacists managing ultra-complex medications often have to dedicate more time and effort to medication monitoring to ensure patients are able to stay on appropriate doses without treatment interruption. Manufacturers of ultra-complex medications must consider the resources and requirements that will be needed to ensure the success of these medications in the real world. Health systems must be aware of resource and staffing requirements necessary to ensure the success of ultra-complex medications. One consideration is the addition of a dedicated risk evaluation and mitigation strategy (REMS) pharmacist whose primary role is to ensure compliance with REMS requirements., Conclusion: Ultra-complex specialty medications provide unprecedented therapeutic advancements but demand multidisciplinary resources and workflows to enable safe medication initiation, appropriate dosing and monitoring, and achievement of desired therapeutic goals. IHSSPs are integrated into the care team and provide advanced monitoring capabilities, making them an ideal setting for managing ultra-complex specialty medications. External IHSSP partnerships working together before and after the launch of ultra-complex specialty medications allow for an optimal patient and provider journey from medication initiation through ongoing care coordination and monitoring., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Patient-reported outcomes (PROs) are often used by clinicians to evaluate patient response to specialty medications used to treat multiple sclerosis (MS) and rheumatologic conditions. Identifying associations among PROs and patient characteristics could inform patient-centered treatment monitoring., Objective: To examine the association among patient characteristics and PROs, including patient-reported adherence (defined as no missed doses), medication tolerance, patient perceived effectiveness, and health care resource utilization (HCRU; defined as emergency department visits or hospitalizations), for patients prescribed specialty medications in 2 health system specialty pharmacies., Methods: A dual-center, retrospective review of monthly medication assessments completed by Vanderbilt Specialty Pharmacy and University of Illinois Hospital and Health Sciences System specialty pharmacy was conducted. Patients were included if they received at least 3 fills of a specialty medication from rheumatology or MS clinics from October 2019 to March 2022, excluding patients with more than a 30-day supply. Primary outcomes were the PROs of patient-reported adherence, medication tolerability, perceived effectiveness, and HCRU. For each of the 2 primary outcomes (adherence and tolerability), a mixed-effects logistic regression model was used to test for associations with age, sex, race, clinic, site, and the other PROs., Results: A total of 61,926 assessments were completed from 3,677 patients (Site 1 = 3,346; 91.0% and Site 2 = 331; 9.0%). Patients were predominantly White (75.6%) and female (71.7%) with a median age of 50 years (IQR = 37-61). Assessments most frequently originated from rheumatology (76.0%). Nonadherence was reported 4.0% of the time, with the most common explanations being forgetfulness (33.1%) and medication being held because of a procedure or illness (29.5%). Most responses indicated perceived effectiveness as good/excellent (93.9%), with 98.5% of responses indicating no issues with tolerability. Patients who reported tolerability issues were 2.5 times more likely to report a missed dose (95% CI = 1.87-3.23, P < 0.001). An effectiveness rating of fair was associated with a 61% increase in the odds of a missed dose compared with a rating of good/excellent (95% CI = 1.33-1.94)., Conclusions: Patients filling rheumatology or MS specialty medications within health system specialty pharmacies reported high rates of medication effectiveness and adherence and low rates of issues with tolerability and HCRU. Patients who report tolerability issues or lower perceived effectiveness may benefit from additional monitoring to prevent nonadherence.

Interprofessional education (IPE) activities provide students insight into healthcare teams, shared decision-making, and social determinants of health (SDOH). Virtual IPE activities with large student populations or across multicampus have not been evaluated. The study aimed to explore the interprofessional competency growth in students, across several disciplines, following participation in a large-scale, virtual IPE activity. Students from pharmacy, medicine, social work, and physician assistant programs across Tennessee participated in an IPE patient case and SDOH in fall 2020 and fall 2021. Pre- and postsurveys included Likert ranking of 16 statements based on the 2011 Interprofessional Education Collaborative (IPEC) framework. A total of 607 students completed surveys (overall response rate, 76%). Wilcoxon signed-rank tests were performed on the pre-/postsurvey data, in aggregate and by discipline. Significant increases in all IPEC competency statements were seen, both in aggregate (100% of statements with p < 0.001) and in pharmacy (100% of statements with p < 0.001) and medicine subgroups (94% of statements with p < 0.001). Implementing large virtual IPE activities involving a complex patient case and SDOH significantly increased student IPEC competency outcomes for participating students, whether in aggregate or on a discipline-specific basis.

Introduction: The 21st Century Cures Act has expanded patients' access to portals through smartphone applications (apps). To date, the prevalence of patient portal smartphone apps use is unclear, especially on a national scale., Methods: Using the 2019 Health Information National Trends Survey, we assessed factors associated with patient portal adopters accessing their records through a smartphone app. Multivariable logistic regression models were conducted and we reported results using predicted probability., Results: Across a weighted sample of 75,324,288 respondents, 39 % reported using a smartphone app to access their health records. Adults with smartphone-only internet (40.0 %; 95 % CI: 35.4-33.3) were more likely to use a smartphone app compared to adults with home internet access (30.6 %; 95 % CI: 27.9-44.7)., Conclusions: Optimizing the implementation and delivery of patient portal content via smartphone apps may improve their reach to patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

A 12-question survey instrument was developed, pilot-tested, and administered to 191 pharmacy students in their first professional year after engaging in a learning activity focusing on topics across five categories with clinical relevance to providing care to the LGBTQ+ community. A paired student t-test was performed on survey tool pre-test and post-test survey responses, with p < 0.05 considered significant. A total of 183 usable pre-test and post-test survey responses were received. Statistically significant differences between the pre-test and post-test correct responses were observed for scenarios involving proper pronoun use, hormone therapy (HT) counseling, immunization best practices, and communication hesitancy. The greatest knowledge change was reported in the categories of immunization best practices (48.9%), HT counseling (33.6%), and pronoun use (22.8%). Active learning assignments are effective teaching strategies to promote clinical knowledge in providing inclusive and culturally competent care to LGBTQ+ patients. Clinical topic areas including proper pronoun use, HT counseling, immunization best practices, privacy, risk awareness, and communication hesitancy are effective curricula additions for pharmacy colleges to advance inclusive curricula concerning providing care to the LGBTQ+ community.

Background: Lean methodology, specifically value stream mapping, can be used to identify and reduce inefficiencies in the medication synchronization process., Objectives: The objectives of this study were to (1) evaluate potential medication synchronization process improvements to reduce nonvalue-added actions, (2) assess fidelity to the medication synchronization core components, and (3) identify the best process for medication synchronization for an independent community pharmacy with multiple locations., Methods: This study used an observational, cross-sectional design. A value stream map was created to provide a detailed illustration of each step in the medication synchronization process. Time for each step of the medication synchronization process was observed on site on different days and times as well as the time required to process, package, and verify prescription medications. These steps were conducted before interventions were made to the process and after to compare the difference. The organizational readiness for change tool was administered to employees of the independent pharmacy before interventions to determine their perspective of the medication synchronization process and assess their readiness for change., Results: Owing to various interventions made to the medication synchronization process, 2 steps in the process were eliminated. This resulted in a decrease in adherence packaging time workflow by 69.4%. Staff (n = 9) rated the medication synchronization process on 4 components: acceptability of the current process (13.8 ± 3.6), intervention appropriateness (13.7 ± 3.7), feasibility of a new medication synchronization process (17.1 ± 2.3), and organizational level of support (21.8 ± 4.1)., Conclusion: Value stream mapping proved to be a valuable tool in identifying inefficiencies in the medication synchronization process and reducing nonvalue-added waste. The result was a decrease in time required for adherence packaging workflow and a more standardized medication synchronization process across multiple independent pharmacy locations. This more standardized process can play a key role in improving the continuity of patient care, increasing medication adherence, and in turn decreasing the number of hospital admissions., (Copyright © 2022 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Introduction: The objective was to examine the association between course grades and objective structured clinical examination (OSCE) performances in a pharmacy student cohort., Methods: A retrospective analysis of demographics, final grades in the Therapeutics I through IV and Communications courses, and multiple OSCE scores (therapeutic knowledge and general communication skills [GCS]) was performed for two cohorts., Results: Female students scored higher than male students on the warfarin OSCE therapeutic knowledge (P = .008) and GCS scores (P = .02). Age was inversely correlated with warfarin OSCE therapeutic knowledge score (P = .001). The warfarin OSCE therapeutic knowledge score was positively related to Therapeutics II final grades (P < .001). The Communications course final grade was positively correlated to the warfarin OSCE faculty-rated GCS score (P = .005). Therapeutics final grades were not significantly related to station scores of a multi-station OSCE (P > .05). The final regression model included gender and Therapeutics II final grade and explained 6% of the variance in warfarin OSCE therapeutic knowledge scores., Conclusions: A number of significant associations were found between demographics, final course grades, and specific OSCE scores. A regression model was significant, but only explained a low percentage of the warfarin OSCE therapeutic knowledge score variance, suggesting other factors not evaluated had a greater effect on scores. This research suggests that OSCEs play an important role in demonstrating student competency in educational domains other than knowledge and brings forth new data suggesting that age and/or gender may influence OSCE performance., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Qualitative research analytics and methodology are a useful part of many research projects. However, qualitative data analysis may be time intensive causing delays in results. This is especially problematic in time-sensitive projects where there an urgent need for results and a rapidly evolving situation being studied, such as during health crisis or early stages of project implementation. An emerging body of literature around the use of Rapid Assessment Procedures (RAP) suggests that this method of qualitative assessment provides more efficient coding and categorizing of data without comprising rigor. The objectives of this manuscript are to: 1) describe how RAP can be used in pragmatic healthcare research studies and 2) provide an example of when RAP was applied to a qualitative research study in the healthcare setting. RAP includes 5 core features: 1) use in combination with quantitative outcomes or process data (mixed methods approach), 2) quick timeline from start to finish (weeks to months), 3) population of interest participation in planning and implementing the research, 4) team approach to research process, and 5) iterative cycle of data collection and analysis. Use of RAP provides key stakeholders and decision makers the ability to generate solutions to problems faster than ever before without compromising rigor, a method needed now more than ever. The progression of healthcare and clinical management is moving at an unprecedented rate, and RAP allows researchers to stay ahead by providing quicker results for better outcomes., (Copyright © 2021. Published by Elsevier Inc.)

Introduction: Historically, pharmacy skills laboratory courses have primarily been delivered utilizing in-person instruction; however, changes in methods of healthcare delivery serve as a catalyst to consider best practices for virtual learning in the skills laboratory setting., Perspective: Shifting to a virtual delivery method is valuable for future curriculum and course development. Three specific delivery methods including flipped classroom, virtual formative simulations, and telehealth objective structured clinical examinations, provide examples of the opportunities and challenges instructors may encounter when shifting delivery methods. Furthermore, the examples illuminate the need to deliberately incorporate virtual technology into pharmacy skills laboratory courses to ensure students are practice-ready for the changing methods of delivery in the healthcare environment., Implications: Skills laboratory instructors and students must reimagine how patient care skills can be taught and assessed. It is imperative to reassess priorities and adapt skills-based courses to incorporate the virtual learning environment to prepare student pharmacists for future practice., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The social determinants of health (SDOH) play a key role in patients' access to health care and medications. There exists an area of opportunity to leverage community pharmacists to make a large impact in identifying and incorporating an understanding of a patient's SDOH into their treatment plan. Community pharmacies are accessible and trusted avenues for health care interventions. With the advancement of appointment-based models as well as the increased training of support personnel, community pharmacies may be well suited for this public health task. However, there are major challenges such as paradigm shifts in workflow, reimbursement, and training that must be addressed to make this endeavor successful. This commentary explores the sparse literature related to community pharmacists conducting screening for social risk factors to identify best practices and barriers to implementation and outlines how screening for social needs aligns with the Pharmacists' Patient Care Process., (Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: While medication synchronization programs are becoming a staple in community pharmacies, a standard process needs to be identified to provide consistent positive outcomes. Many studies demonstrate how medication synchronization affects individual level patients but have not examined how medication synchronization affects the pharmacy's performance. Because community pharmacies are calibrated based on performance to adherence measures for all patients, it is important to understand whether resource-intensive interventions, such as medication synchronization, lead to improved performance., Objectives: The aims of this study were to 1) examine pharmacy characteristics associated with medication synchronization adoption and 2) examine whether medication synchronization is associated with pharmacy-level performance on select medication adherence and utilization measures., Methods: This study used a cross-sectional design. Community pharmacies participating in the North Carolina Community Pharmacy Enhanced Services Network (NC CPESN℠) program were included in this study. Pharmacy performance was measured as summary score of pharmacy's performance on seven risk-adjusted measures which were used to measure pharmacy's performance in the program. Adoption of medication synchronization was measured as a binary variable capturing whether the pharmacy offered med sync at the time the survey was administered., Results: Surveys were received from 160 out of 268 participating pharmacies (59.7% response rate) with a total of 155 pharmacies being included in the analytic sample. Pharmacies that adopted medication synchronization were more likely to have a clinical pharmacist on staff (c = 5.4, p = 0.019). Holding all else constant, medication synchronization adoption was not significantly associated with total medication adherence performance (p = 0.371)., Conclusion: Medication synchronization has proven successful in improving individual patient level adherence but may not change a pharmacy's overall performance in adherence for all patients. Further research is needed to examine how effective implementation might contribute to whether a medication synchronization program leads to meaningful gains in adherence for all patients., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective. To review current conceptualizations and measurements of active-learning education within Doctor of Pharmacy degree programs as it pertains to social determinants of health (SDOH) and to determine the gaps and limitations in available literature. A secondary objective was to assess simulation-based educational methods related to SDOH in pharmacy. Findings. Sixteen articles were eligible for inclusion. Many simulation-based and non-simulation-based teaching strategies are described. The majority of articles included active-learning activities related to social/community context and health/health care, the other three 3 social determinants of health domains: education, economic stability, and neighborhood/built community, were not equally addressed. In the studies included in this review, schools and colleges of pharmacy did not appear to not be integrating all five components of SDOH into active learning curricula. The sparsity of literature and lack of diversity in published types of simulated experiences and assessments may suggest there is room for innovation in this area. Summary. More research is needed in order to fully characterize conceptualizations of social determinants of health in Doctor of Pharmacy degree programs in order to ensure students are provided with a full understanding of the SDOH factors that affect patient outcomes., (© 2020 American Association of Colleges of Pharmacy.)

Background: With the evolving roles of pharmacy technicians in the United States, the profession has attempted to define a national standard. Community pharmacy employers to-date have preferred on-the-job training to formal, accredited training programs or credentialing, however, limited evidence exists on the perceived needs of pharmacy technicians in the United States compared to those of community pharmacy employers., Objectives: The aims of this study were to explore: 1) community pharmacy employer perceptions of associated benefits and perceived value of pharmacy technician certification and 2) needs of employers related to pharmacy technician attitudes and knowledge, skills and abilities (KSAs)., Methods: Using a semi-structured interview guide, researchers interviewed 7 community pharmacy employers within top management teams in a variety of community pharmacy settings. The data were analyzed for themes using the human capital vs. signal theory., Results: Employers and managers generally saw both attitude and KSAs as vital to success. However, given a choice between experience and attitude, attitude was preferred. There was general agreement that certified technicians offered more value to their organization, however gaps in certified technician KSAs were noted (i.e., lack of day-to-day practical skills, vaccination screening, motivating patients to change behaviors, patient communication and workflow management)., Conclusions: New emerging directions for certification now exist due to the rapidly shifting pharmacy landscape, which is revolves around new and expanded clinical patient care services. This shifting landscape has exposed gaps, reinforced strengths, and uncovered potential new opportunities and needs related to technician certification., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the effects of a community pharmacy-based fall prevention intervention (STEADI-Rx) on the risk of falling and use of medications associated with an increased risk of falling., Design: Randomized controlled trial., Setting: A total of 65 community pharmacies in North Carolina (NC)., Participants: Adults (age ≥65 years) using either four or more chronic medications or one or more medications associated with an increased risk of falling (n = 10,565)., Intervention: Pharmacy staff screened patients for fall risk using questions from the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm. Patients who screened positive were eligible to receive a pharmacist-conducted medication review, with recommendations sent to patients' healthcare providers following the review., Measurements: At intervention pharmacies, pharmacy staff used standardized forms to record participant responses to screening questions and information concerning the medication reviews. For participants with continuous Medicare Part D/NC Medicaid coverage (n = 3,212), the Drug Burden Index (DBI) was used to assess exposure to high-risk medications, and insurance claims records for emergency department visits and hospitalizations were used to assess falls., Results: Among intervention group participants (n = 4,719), 73% (n = 3,437) were screened for fall risk. Among those who screened positive (n = 1,901), 72% (n = 1,373) received a medication review; and 27% (n = 521) had at least one medication-related recommendation communicated to their healthcare provider(s) following the review. A total of 716 specific medication recommendations were made. DBI scores decreased from the pre- to postintervention period in both the control and the intervention group. However, the amount of change over time did not differ between these two groups (P = .66). Risk of falling did not change between the pre- to postintervention period or differ between groups (P = .58)., Conclusion: We successfully implemented STEADI-Rx in the community pharmacy setting. However, we found no differences in fall risk or the use of medications associated with increased risk of falling between the intervention and control groups. J Am Geriatr Soc 68:1778-1786, 2020., (© 2020 The American Geriatrics Society.)

Objectives: This mixed methods study had 2 aims: (1) to describe the frequency of care coordination between pharmacists, prescribers, and care managers and (2) to identify pharmacists' strategies for care coordination and follow-up in a community pharmacy setting., Design: This study used a mixed methods design., Setting and Participants: Pharmacists who were responsible for implementing North Carolina community pharmacy enhanced services network (NC CPESN®) activities in their pharmacy during the first or second year of the 3-year program (September 2014-August 2016)., Outcome Measures: A survey was administered to gather data on care coordination in community pharmacies and for follow-up. In-depth interviews were conducted to expand on the findings from the quantitative data. Descriptive statistics were calculated for survey data. Interviews were recorded, transcribed verbatim, and analyzed using thematic analysis., Results: Surveys were received from 101 pharmacies (82.1% response rate). Fourteen pharmacies with missing responses were removed, resulting in 87 pharmacies being included in the analysis. The majority of pharmacies were single, independent pharmacies (46.5%), and approximately one-third of pharmacies had a clinical pharmacist on the staff (31.1%). To communicate with prescribers, pharmacists most frequently used facsimile (fax) (82.1%) or phone (65.5%). A total of 12 pharmacists participated in the semistructured interviews. Pharmacists defined care coordination as interdisciplinary collaboration and communication among the members of the health care team to provide the best possible patient-centered care. All pharmacists agreed that good health care provider (i.e., care manager and prescriber) relationships are crucial to the success of patient care; however, participants mentioned that building these relationships has been or is currently difficult to establish., Conclusion: Care coordination among pharmacists, prescribers, and care managers is important for improving patients' medication management and overall outcomes. To our knowledge, this is the first study to quantify care coordination between pharmacists, prescribers, and care managers and to identify strategies to facilitate care coordination. Results from this study have the potential to inform how care coordination and longitudinal follow-up are best implemented within the community pharmacy setting., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: The Drug Burden Index (DBI) was developed to assess patient exposure to medications associated with an increased risk of falling. The objective of this study was to examine the association between the DBI and medication-related fall risk., Methods: The study used a retrospective cohort design, with a 1-year observation period. Participants (n = 1562) were identified from 31 community pharmacies. We examined the association between DBI scores and four outcomes. Our primary outcome, which was limited to participants who received a medication review, indexed whether the review resulted in at least one medication-related recommendation (e.g., discontinue medication) being communicated to the participant's health care provider. Secondary outcomes indexed whether participants in the full sample: (1) screened positive for fall risk, (2) reported 1+ falls in the past year, and (3) reported 1+ injurious falls in the past year. All outcome variables were dichotomous (yes/no)., Results: Among those who received a medication review (n = 387), the percentage of patients receiving at least one medication-related recommendation ranged from 10.2% among those with DBI scores of 0 compared to 60.2% among those with DBI scores ≥1.0 (Chi-square (4)=42.4, p < 0.0001). Among those screened for fall risk (n = 1058), DBI scores were higher among those who screened positive compared to those who did not (Means = 0.98 (SD = 1.00) versus 0.59 (SD = 0.74), respectively, p < 0.0001)., Conclusion: Our findings suggest that the DBI is a useful tool that could be used to improve future research and practice by focusing limited resources on those individuals at greatest risk of medication-related falls.

Objectives: To (1) describe the implementation process for comprehensive medication reviews (CMRs) among community pharmacies (e.g., processes for prioritizing patients, staffing, and information collection) and (2) examine factors associated with community pharmacies' CMR information collection process., Methods: A survey was administered to the pharmacist responsible for implementation of CMRs (i.e., the lead pharmacist) in the community pharmacy (n = 87). The survey included questions about pharmacy characteristics, satisfaction with the NC community pharmacy enhanced services network (NC-CPESN) program, and implementation of CMRs. Frequencies and means were calculated to describe the sample characteristics and pharmacies' CMR implementation process. A multiple linear regression was conducted to examine which characteristics were associated with the CMR information collection process., Results: The majority of pharmacies in the sample were either independently owned single stores (46.5%) or multiple stores under the same independent ownership (41.6%). Most pharmacies used pharmacists (97.7%) or pharmacy technicians (65.5%) for patient outreach for CMRs. A small percentage of pharmacies used administrative staff to conduct patient outreach for CMRs (9.2%). Information for prescription medications (89.5%), indication (80%), and medication adherence (81.1%) was routinely collected. Information such as date of last dose for prescription medications (48.4%) and lifestyle factors, such as physical activity (21.1%), diet (29.5%), and alcohol (31.6%), was collected less routinely. Having a clinical pharmacist (P = 0.025) and pharmacist overlap hours (P = 0.009) significantly improved the CMR information collection process., Conclusion: Although CMRs are important interventions for improving patient outcomes, more guidance is needed on how to effectively implement them. This would allow the process to be efficient and assure implementation with fidelity across all community pharmacies. In addition, staffing appears to influence the quality of CMR information collection. Future research is warranted on CMR implementation to develop efficient staffing models and standardize the process of information collection., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Background: Medication non-adherence costs more than 100 billion dollars in avoidable hospitalizations yearly. As a result, community pharmacies have implemented medication synchronization programs to improve adherence. One function of most medication synchronization programs is the alignment of all of a patient's medications to refill on a single date. While aligning refills is a standard aspect of most programs, other features vary making it difficult to identify which program components lead to improved adherence., Objective: To review available literature and identify core components of medication synchronization and associated implementation techniques in community pharmacy., Methods: A systematic review was performed by searching electronic databases for studies, reviews, and other sources for grey literature discussing medication synchronization in community pharmacy settings. Studies were eligible for inclusion if they documented the operation of medication synchronization program in a community pharmacy. A framework analysis identified common themes present in the literature., Results: Twenty-six studies met criteria for final inclusion in this review. The majority of studies were retrospective cohorts, commentaries, and implementation guides. A wide variety of core components were included as part of medication synchronization program descriptions in the available literature. Several core components were identified as consistent throughout most of the published literature. These components were the identification and enrollment of patients, inclusion of a medication review and patient assessment, the alignment of refills, a formal process for preparation of medications, and the delivery of medications and other services., Conclusions: This review identified several common themes of medication synchronization in the literature, which could help standardize medication synchronization within community pharmacy and facilitate future research. Themes found in this review provide the foundation upon which a consensus definition of medication synchronization can be built., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To determine community pharmacist preferences in transition of care (TOC) communications., Methods: In this cross-sectional study, data were gathered via electronic survey of community pharmacists regarding their preferences for TOC communications. The survey was distributed via email by the North Carolina Board of Pharmacy. Results were analyzed using descriptive statistics., Results: Survey responses were received from 343 community pharmacists (response rate = 6.1%). Responders most commonly worked in an independent, single store (29.2%, n = 100) or national chain (29.2%, n = 100) pharmacy setting. Preferred method for a TOC communication was via electronic health record (63.0%, n = 184). Preferred TOC communication content are mentioned as follows: active (93.2%, n = 274) and discontinued (86.4%, n = 254) medications and reason for hospitalization (85.0%, n = 250). The top 3 self-identified barriers to utilizing a TOC communication: lack of care coordination with community pharmacy (35.0%, n = 14), lack of support from other health-care providers (22.5%, n = 9), and absence of compensation for providing the service (17.5%, n = 7). When asked if TOC communications were available, 97.5% (n = 278) indicated it would be useful., Conclusion: Community pharmacists acknowledged a need for TOC communications and shared their preferences in the content and method of communication. Future research is warranted to implement TOC communications between a health system and community pharmacy.

Community pharmacies are an ideal setting to manage high-risk medications and screen older adults at risk for falls. Appropriate training and resources are needed to successfully implement services in this setting. The purpose of this paper is to identify the key training, tools, and resources to support implementation of fall prevention services. The service was implemented in a network of community pharmacies located in North Carolina. Pharmacies were provided with onboard and longitudinal training, and a project coach. A toolkit contained resources to collect medication information, identify high-risk medications, develop and share recommendations with prescribers, market the service, and educate patients. Project champions at each pharmacy received a nine-question, web-based survey (Qualtrics) to identify usefulness of the training and resources. The quantitative data were analyzed using descriptive statistics. Thirty-one community pharmacies implemented the service. Twenty-three project champions (74%) completed the post-intervention survey. Comprehensive onboard training was rated as more useful than longitudinal training. Resources to identify high-risk medications, develop recommendations, and share recommendations with prescribers were considered most useful. By providing appropriate training and resources to support fall prevention services, community pharmacists can improve patient care as part of their routine workflow., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Objectives: To compare viewpoints of nationally certified and noncertified technicians and explore the perceived value of technician certification in the job performance domains of medication safety, skills and abilities, experience, engagement and satisfaction, and productivity., Methods: A cross-sectional survey of pharmacy technicians, from 6 states representing 4 regions of the United States, was conducted. Technician mailing lists were purchased from Boards of Pharmacy, and randomly selected technicians were sent survey invitations. Surveys were completed via Qualtrics and analyzed with the use of SAS., Results: Six hundred seventy-six technicians (547 certified, 103 noncertified, and 26 previously certified) responded to the survey (9.4% response rate). Certified technicians reported significantly higher confidence rating for desire to take on new responsibilities (P < 0.01; Cohen d 0.45) and plans to remain in the pharmacy field (P = 0.01, Cohen d 0.35), lower rating for leaving the job in the next 12 months (P < 0.01; Cohen d 0.35), and perceived lower rate of medication errors (P < 0.01; Cohen d 0.35) compared with other technicians in the work setting. The majority of respondents stated confidence in performing the "final check" on another technician's preparation of a new or refill medication if allowed. Both certified and noncertified technicians noted dissatisfaction with pay. The majority of respondents reported that they spent none of or less than 10% of their workday assisting pharmacists with medication therapy management (MTM) sessions, immunizations, or point-of-care tests; however, 71 respondents specifically described how they assist pharmacists with MTM., Conclusion: Results from our survey sample indicate that certified technicians have a stronger organizational and career commitment and desire to take on new roles. A majority of respondents noted dissatisfaction with pay but feel a sense of pride in their work. Both groups were confident in their abilities needed for tech-check-tech product verification., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: Little is known about how Medicare Part D Comprehensive Medication Review (CMR) affects quality of medication use and management. In this study, changes of plan level CMR completion rates over time were examined and their associations with medication use and management related (MUMR) quality measures., Methods: Using Medicare Part D plan Star Rating and contract information data, a longitudinal data set was developed with CMR completion rate and 17 MUMR measures. T-tests and one-way Analysis of Variance were used to examine the variation of CMR rates between contracts and over time, respectively, as well as the regression adjusted associations using fixed-effects and ordinary least squares models, verified by Generalized Estimating Equations., Results: CMR completion rates increased substantially from contract year 2013-2016, with a larger increase among Medicare Advantage Prescription Drug Plans than stand-alone Prescription Drug Plans. Prior year's CMR completion rates had marginally positive effects on 4 of the 17 MUMR measures: medication adherence with statin drugs, continuous beta blocker treatment, and pharmacotherapy management of chronic obstructive pulmonary disease exacerbation (systemic corticosteroid or bronchodilator). Increasing CMR completion also was associated with increased chronic use of atypical antipsychotics by elderly beneficiaries in nursing homes, an unintended outcome and a reflection of poor quality of care. CMR completion rates in the same year had even more limited associations with other MUMR measures., Conclusions: At plan level, CMR completion rates had limited and inconsistent association with other MUMR measures. Although our research used an observational study design, the associations observed have policy implications to the Center for Medicare & Medicaid (CMS) Star Ratings program and quality bonus payments, as well as implications for plans' quality improvement., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objective: To assess the correlation between pharmacy characteristics and a broad set of performance measures used to support a community pharmacy network., Methods: Baseline characteristics regarding demographics, services provided, technology, and staffing were collected via a 68-item survey for 123 pharmacies participating in the North Carolina community pharmacy enhanced services network. Performance metric data were collected, and scores were calculated for each pharmacy. Outcome measures for this study comprised of 4 adherence measures, a risk-adjusted hospitalization measure, a risk-adjusted emergency department visit measure, a total cost of medical care measure, and a composite pharmacy performance measure. Generalized estimating equations (GEE) were used to create multivariable statistical models measuring the correlation between pharmacy characteristics and performance measures., Results: After inclusion criteria were applied, 115 pharmacies remained in the analysis. These pharmacies were primarily single and multiple independent pharmacies, at 36.5% and 59.1%, respectively. Five characteristics were significantly associated with 3 measures, and none were associated with 4 or more. Having pharmacists in non dispensing roles was positively associated with total score, diabetes adherence, and chronic medication adherence. Home visits were positively associated with hypertension adherence, ED visit rate, and total score. Offering a smoking cessation program was positively associated with chronic medication, hypertension, and statin adherence. Offering free home delivery was positively associated with diabetes adherence but negatively associated with total medical spending and ED visit rate. Using dispensing automation was negatively associated with adherence to chronic medications, renin-angiotensin system antagonists, and statins., Conclusion: No pharmacy characteristics were associated with a majority of performance measures chosen. Additional research is needed to identify structural variables that can be used as minimum participation criteria for high-performing pharmacy networks., (Copyright © 2019 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objectives: To develop a common language for the medication synchronization process in community pharmacies., Methods: A systematic and iterative process was used to create and refine a common language for medication synchronization. First, a review of all available medication synchronization-related documents was completed. Second, a systematic scoping literature review was conducted to determine what core components of medication synchronization have been implemented by community pharmacies. Third, semistructured interviews were conducted with community pharmacists and key stakeholders to identify principles and successful practices. Findings from the document review, systematic scoping review, and semistructured interviews were integrated to develop a medication synchronization common language. Finally, researchers and key stakeholders refined the initial draft by means of a systematic process., Results: This process generated a medication synchronization common language that includes common language for the philosophy and values of medication synchronization. This profile also includes descriptions of core components with activities to be conducted for each of the identified 5 core components. The 5 core components are: 1) identification and enrollment of patients; 2) completion of a medication review and patient assessment; 3) alignment of medication refills; 4) preparation for medication delivery; and 5) delivery of medication and other services., Conclusion: The development of a common language for medication synchronization will allow for the promotion of consistency in implementation and operation of these programs across community pharmacies. Consistency in implementation will allow for better interpretation of patient outcomes such as adherence and other clinical measures., (Copyright © 2018 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

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., Competing Interests: The authors declare no conflict of interest.

Objective: To describe drug therapy problem (DTP) resolution as part of a statewide, team-based care management program., Methods: This was a retrospective, observational study of DTPs documented between March 1 and August 31, 2015. Data were retrieved from a Web-based platform 5 months after the observation period. DTPs were placed into groups based on the credentials of the person who documented the DTP. Next, they were identified as being documented in a transitional or nontransitional care setting. DTPs were further classified into 1 of 3 categories: medication adherence, discrepancy, or optimization. Lastly, DTP resolution was assessed. Results were analyzed using descriptive statistics., Results: During the 6-month study period, 135,100 DTPs were documented, with 99% (n = 133,847) being documented by social work care managers, nurse care managers, and pharmacy staff personnel. Pharmacy staff personnel documented the majority of DTPs (51.5%), and the majority of DTPs (55%) were identified in the transitional care setting. Nurse care managers resolved more discrepancy DTPs (59.3%), whereas pharmacy staff personnel resolved more optimization DTPs (47.2%). Social work care managers resolved more medication adherence DTPs (68.6%)., Conclusions: Pharmacy staff personnel primarily identified and resolved opportunities to optimize medication use, whereas nurse care managers primarily identified and resolved medication discrepancies. Social work care managers primarily identified and resolved problems related to medication adherence. When each member of the interdisciplinary care team functioned at the top of their license, all types of DTPs were effectively identified and resolved., (Copyright © 2017 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)