Brandon J. Patterson

Three-year financial analysis of pharmacy services at an independent community pharmacy

OBJECTIVE To assess the financial performance of pharmacy services including vaccinations, cholesterol screenings, medication therapy management (MTM), adherence management services, employee health fairs, and compounding services provided by an independent community pharmacy. METHODS Three years (2008-10) of pharmacy records were examined to determine the total revenue and costs of each service. Costs included products, materials, labor, marketing, overhead, equipment, reference materials, and fax/phone usage. Costs were allocated to each service using accepted principles (e.g., time for labor). Depending on the service, the total revenue was calculated by multiplying the frequency of the service by the revenue per patient or by adding the total revenue received. A sensitivity analysis was conducted for the adherence management services to account for average dispensing net profit. RESULTS 7 of 11 pharmacy services showed a net profit each year. Those services include influenza and herpes zoster immunization services, MTM, two adherence management services, employee health fairs, and prescription compounding services. The services that realized a net loss included the pneumococcal immunization service, cholesterol screenings, and two adherence management services. The sensitivity analysis showed that all adherence services had a net gain when average dispensing net profit was included. CONCLUSION Most of the pharmacist services had an annual positive net gain. It seems likely that these services can be sustained. Further cost management, such as reducing labor costs, could improve the viability of services with net losses. However, even with greater efficiency, external factors such as competition and reimbursement challenge the sustainability of these services.

Exploring relationships among pharmacy service use, patronage motives, and patient satisfaction

OBJECTIVES To describe and identify significant relationships among pharmacy service use, general and service-specific patient satisfaction, pharmacy patronage motives, and marketing awareness in a service-oriented, independent community pharmacy. DESIGN Cross-sectional study. SETTING Midwest United States during May through July 2011. PARTICIPANTS Stratified random sample of 500 participants. INTERVENTION Self-reported questionnaire mailed to participants. MAIN OUTCOME MEASURES Patient satisfaction, pharmacy service use, patronage motives, marketing awareness, and demographics. RESULTS Study participants were mostly satisfied with the pharmacy services on global and service-specific measures. Patronage motives of relationships, pharmacy atmosphere, and quality previous experience were associated with increased pharmacy service use at the study pharmacy, while a unique service patronage motivation was associated with decreased pharmacy service use at the study pharmacy. Participants citing pharmacy atmosphere and personnel competency as patronage motives did not use pharmacies other than the study pharmacy more often, whereas participants citing unique services as a patronage motive used pharmacies other than the study pharmacy more often. Direct marketing awareness increased pharmacy service awareness but not use. CONCLUSION Offering unique services may not be enough to bring in patients loyal to all services provided in a pharmacy. Pharmacists should focus on developing strong relationships with patients and conveying competence when delivering appropriate, quality pharmacy services in a professional pharmacy atmosphere.

A Leadership Elective Course Developed and Taught by Graduate Students

Objective. To develop and implement a flexible-credit elective course to empower student pharmacists to develop lifelong leadership skills and provide teaching practice opportunities for graduate students. Design. An elective course focusing on leadership development for second- and third-year doctor of pharmacy (PharmD) students was designed and taught by 4 graduate students under the mentorship of 2 faculty members. Student pharmacists could enroll in a 1-, 2-, or 3-credit-hour version of the course. Assessment. Attainment of course objectives was measured using student pharmacist reflection papers and continuing professional development portfolios. Additionally, self-assessments of graduate students and faculty members delivering the course were conducted. In their responses on course evaluations, student pharmacists indicated they found the course a valuable learning experience. Graduate students found course development to be challenging but useful in developing faculty skills. Conclusion. This flexible-credit elective course taught by graduate students was an innovative way to offer formal leadership instruction using limited college resources.

Living with disability: patterns of health problems and symptom mediation of health consequences.

BACKGROUND People with disability experience a range of symptoms that may serve as an important linkage between disability and other health consequences. The aims of this study were to describe and compare symptom experiences of people with and without disability using a population-based sample and to test direct relationships between disability and health status and indirect effects of disability mediated through symptom experience. METHODS A Midwestern sample of 12,249 adults aged 40 and older responded to a cross-sectional survey. Data collected included symptom prevalence and frequencies for 21 commonly reported symptoms, self-perceived health status and physical functioning, number of medications, and demographic variables. Two mediation analyses were conducted using cumulative symptom frequency as the mediator between disability status and both self-rated health and physical functioning. RESULTS Adults with disability reported significantly greater prevalence and frequencies for all 21 symptoms, with pain and fatigue being the most common. The indirect effect through cumulative symptom frequency explained roughly half of the total effect of disability on general health status, and about one third of the total effect of disability on physical functioning. CONCLUSIONS This study found evidence supporting the diverse and significant symptom experience of people living with disability, especially for symptoms of pain and fatigue. Moreover, symptom experience was found to partially mediate the effects of disability on self-reported general health status and physical functioning. This provides support for symptoms serving as an important link to health outcomes in patients with disability.

A qualitative investigation of protégé expectations and proposition of an evaluation model for formal mentoring in pharmacy education

BACKGROUND Student pharmacist mentoring programs have gained attention from colleges of pharmacy as a way to enhance the student experience. However, no evaluative models have been proposed or theoretical explanations described for use in improving formal mentoring programs in pharmacy or for guiding the construction of a literature base. OBJECTIVES The objectives of this study were to investigate student expectations and preferences for formal mentoring programs and propose a model for evaluating formal mentoring programs in pharmacy education. METHODS Five, 60-minute focus groups were conducted in September 2009. Participants were PharmD candidates in their first 3 years of professional education. Discussion was facilitated using a question guide. Following transcription, an initial iteration of the model was used to code the data. A consensus-forming process was used to derive themes and identify representative quotes. Elaboration and specification of the final proposed model is presented. RESULTS In all, 28 students participated. Emergent constructs were identified from the data. Structures or inputs of the formal mentoring program included mentor and protégé characteristics and program structure. Mentoring processes included mentor functions, mentoring activities, and relationship development. Outcomes included both proximal outcomes in the form of mentor and protégé change, program satisfaction, and organizational learning; and distal outcomes comprised mentor, protégé, and organizational outcomes. CONCLUSIONS This formal mentoring evaluation model was useful in guiding analysis of protégé experiences and preferences for a college-sponsored program. The model can be used to guide college administrators and researchers on future theory-based inquiry into protégé; mentor; and organizational structures, processes, and outcomes for formal mentoring programs.

Population characteristics associated with pharmacy-based influenza vaccination in United States survey data

OBJECTIVES To examine the population characteristics associated with the health behavior of receiving an influenza vaccine from a pharmacy-based setting. DESIGN Secondary analysis of data from states that participated in an optional influenza module in the 2014 Behavioral Risk Factor Surveillance System, a state-based observational survey of U.S. adults. SETTING AND PARTICIPANTS Analytic sample of 28,954 respondents from 8 states and Puerto Rico who reported receiving an influenza vaccination in the past year. MAIN OUTCOME MEASURES The main outcome was a self-reported categoric variable indicating the setting of the most recent seasonal influenza vaccination: doctors office, pharmacy-based store, or other setting. RESULTS Multinomial logistic regression results showed that environmental, predisposing, enabling, and need factors in the Andersen model were salient features associated with odds of using pharmacy-based influenza vaccination settings instead of a doctors office. Residents of states that allowed pharmacists as immunizers before 1999 reported greater use of pharmacy-based store settings (odds ratio [OR] 1.31). Compared with young adults, individuals 65 years of age and older were more likely to choose a pharmacy-based store than a doctors office (OR 1.41) and less likely to use other community settings (OR 0.45). Compared with non-Hispanic whites, black respondents were less likely to use pharmacy-based store vaccination (OR 0.51), and multiracial and Hispanic respondents were more likely to use other settings (ORs 1.47 and 1.60, respectively). Enabling and need factors were also associated with setting. CONCLUSION Based on this dataset of selected states from 2014, almost one-fourth of U.S. adults who reported receiving an annual influenza vaccination did so from a pharmacy-based store; 35% reported using other community-based settings that may enlist pharmacists as immunizers. There were striking disparities in use of nontraditional vaccination settings by age and race or ethnicity. Pharmacists and pharmacies should address missed opportunities for vaccination by targeting outreach efforts based on environmental and predisposing characteristics.

Variables Affecting Pharmacy Students’ Patient Care Interventions during Advanced Pharmacy Practice Experiences

Objective. To identify the temporal effect and factors associated with student pharmacist self-initiation of interventions during acute patient care advanced pharmacy practice experiences (APPE). Methods. During the APPE, student pharmacists at an academic medical center recorded their therapeutic interventions and who initiated the intervention throughout clinical rotations. At the end of the APPE student pharmacists completed a demographic survey. Results. Sixty-two student pharmacists were included. Factors associated with lower rates of self-initiated interventions were infectious diseases and pediatrics APPEs and an intention to pursue a postgraduate residency. Timing of the APPE, previous specialty elective course completion, and previous hospital experience did not result in any significant difference in self-initiated recommendations. Conclusion. Preceptors should not base practice experience expectations for self-initiated interventions on previous student experience or future intentions. Additionally, factors leading to lower rates of self-initiated interventions on infectious diseases or pediatrics APPEs should be explored.