Jennifer L. Bacci

Screening Community Pharmacy Patients for Risk of Prescription Opioid Misuse.

Objectives:This study tested screening feasibility and described the behavioral, mental, and physical health of patients filling prescriptions for opioid medications in the community pharmacy setting. Methods:We conducted a cross-sectional survey in rural/urban community pharmacies with adult noncancer patients. The survey included validated measures for opioid medication misuse risk, drug and alcohol use, and physical and mental health problems. Descriptive statistics were calculated, and bivariate and multivariable logistic regression evaluated relationships between opioid medication misuse risk and patient demographics, behavioral, mental, and physical health. Results:A total of 164 patients completed the survey (87% response rate), revealing positive screens for prescription opioid misuse risk (14.3%), illicit drug use (7.3%), hazardous alcohol use (21.4%), depression (25.8%), and posttraumatic stress disorder (PTSD; 17.1%). Bivariate analyses revealed increased odds of a positive opioid medication misuse risk score with a positive screen for illicit drug use in the previous year (odds ratio = 3.91; 95% confidence interval [CI], 1.05–14.63) and PTSD (odds ratio = 6.7; 95% CI, 2.54–17.69). In adjusted multivariable analyses, these relationships strengthened such that a positive screen for illicit drug use (adjusted odds ratio = 12.96; 95% CI, 2.18–76.9) and PTSD (adjusted odds ratio = 13.3; 95% CI, 3.48–50.66) increased odds for a positive opioid medication misuse risk score. Conclusions:Findings confirmed the feasibility of screening risk factors and positive opioid medication misuse risk among community pharmacy patients. Future research should validate these findings as a foundation to intervention development.

Behavioral, mental, and physical health characteristics and opioid medication misuse among community pharmacy patients: A latent class analysis

Background: Community pharmacists are well‐positioned to address the US opioid medication crisis, which has created a need to detect misuse risk in order to provide optimal patient care. Objectives: This study sought to identify community pharmacy patient subgroups at risk for opioid medication misuse. Methods: This study was a cross‐sectional survey that examined behavioral, mental, and physical health characteristics among patients filling opioid pain medications. A convenience sample of adult patients filling opioid pain medications who were not receiving cancer treatment were screened in 2 urban and 2 rural community pharmacies in southwestern Pennsylvania. Patient subgroups were identified using latent class analysis. Latent class regression analysis was used to examine the association between subgroup membership and misuse. Results: A total of 333 patients completed the survey (response rate 71.4%). Latent class analysis results showed that a 3‐class solution best fit the data, which were labeled: mental health (8.4%, n = 28), poor health (79.6%, n = 265), and hazardous alcohol use (12%, n = 40). Individuals within the mental health subgroup had an increased risk for opioid medication misuse (Odds Ratio = 6.23, 95% CI = 5.13–7.33). Conclusion: These findings demonstrate heterogeneity of this population receiving prescribed opioids and the potential to identify subgroups with high misuse risk. These findings also support routine screening of patients filling opioid medications and suggest the need for evidence‐based patient‐centered intervention development. HighlightsThe US opioid medication epidemic has brought an urgent need for pharmacists to regularly screen patients for misuse.Latent class analysis affords an analytical advancement for understanding patient misuse risk.Three subgroups of patients immerged from the latent class analysis; each group characterized by pain as well as other unique risk factors.Results showed patients within the mental health subgroup had elevated risk for misusing their opioid medication.

The Importance of Research and Scholarly Activity in Pharmacy Training

Regardless of practice setting, it is imperative that pharmacists be able to either participate in generating new knowledge or use the ever‐expanding body of literature to guide patient care. However, competing priorities in Pharm.D. curricula and residency training programs have resulted in limited emphasis on acquiring research and scholarly skills. Factors likely contributing to this reduced focus include the lack of curricular and postgraduate training standards emphasizing the development of research skills, time to commit to scholarly activity, and accessibility to experienced mentors. Strategies for increasing scholarly activity for pharmacy students and residents should therefore continue to be a focus of professional degree and residency training programs. Several resources are available for academic planners, program directors, and institutions to augment scholarly experience for pharmacy trainees and clinicians. This commentary highlights the importance of providing research opportunities for students and residents, describes the potential barriers to these activities, and provides recommendations on how to increase the instruction and mentoring of trainees to generate and use research.

Community pharmacy-based point-of-care testing: A case study of pharmacist-physician collaborative working relationships

Abstract Building collaborative working relationships (CWRs) with physicians or other prescribers is an important step for community pharmacists in establishing a collaborative practice agreement (CPA). This case study describes the individual, context, and exchange factors that drive pharmacist‐physician CWR development for community pharmacy‐based point‐of‐care (POC) testing. Two physicians who had entered in a CPA with community pharmacists to provide POC testing were surveyed and interviewed. High scores on the pharmacist‐physician collaborative index indicated a high level of collaboration between the physicians and the pharmacist who initiated the relationship. Trust was established through the physicians’ personal relationships with the pharmacist or due to the community pharmacy organizations strong reputation. The physicians’ individual perceptions of community pharmacy‐based POC testing affected their CWRs and willingness to establish a CPA. These findings suggest that exchange characteristics remain significant factors in CWR development. Individual factors may also contribute to physicians’ willingness to advance their CWR to include a CPA for POC testing.

Innovative Advances in Connectivity and Community Pharmacist Patient Care Services: Implications for Patient Safety

The scope of community pharmacy practice has expanded beyond the provision of drug product to include the provision of patient care services. Likewise, the community pharmacists approach to patient safety must also expand beyond prevention of errors during medication dispensing to include optimization of medications and prevention of adverse events throughout the entire medication use process. Connectivity to patient data and other health care providers has been a long‐standing challenge in community pharmacy with implications for the delivery and safety of patient care. We describe three innovative advances in connectivity in community pharmacy practice that enhance patient safety in the provision of community pharmacist patient care services across the entire medication use process. Specifically, we discuss the growing use of immunization information systems, quality improvement platforms, and health information exchanges in community pharmacy practice and their implications for patient safety.

Comparison of two training methods in community pharmacy: Project VACCINATE

OBJECTIVE To compare the impact of a whole-staff training strategy with a train-the-trainer strategy on 1) the number of influenza, pneumococcal, herpes zoster, and pertussis vaccines administered by community pharmacists to adults; 2) staff confidence; and 3) fidelity to the intervention. SETTING Eight Quality Food Centers (QFC) Pharmacies in Seattle, Washington. PRACTICE DESCRIPTION QFC Pharmacy is a grocery store division of The Kroger Co. with 30 pharmacies located in Washington State. QFC provides all routine and travel vaccines to adolescents and adults and has a culture of improving vaccine access to its community. PRACTICE INNOVATION Pharmacists and pharmacy technicians from 8 QFC pharmacies received training to enhance their immunization care for adults. The entire staff from 4 pharmacies received whole-staff training, and staff members from the other 4 pharmacies received a train-the-trainer approach. The whole-staff training group had all staff members attend a live, 2-hour training. The train-the-trainer group sent 1 pharmacist and 1 pharmacy technician champion to attend the live training and then return to their pharmacy to train the other staff members. EVALUATION The number of immunizations administered, staff confidence, and self-reported fidelity to the intervention were measured before and after training. All data were analyzed using descriptive statistics. RESULTS The number of total influenza, pneumococcal, herpes zoster, and pertussis vaccines administered increased 12.6% in the whole-staff training group and 15.2% in the train-the-trainer group. Both training strategies increased confidence in identifying patients eligible for vaccines, talking to patients about vaccine needs, and using the bidirectional immunization platform. Pharmacy staff members in both groups indicated fidelity to key steps in the intervention process. CONCLUSION Both whole-staff training and train-the-trainer approaches were associated with an improvement in the number of vaccines administered, staff confidence, and fidelity to the intervention. Community pharmacy organizations could use either training strategy when implementing enhancements to an existing patient care service. The train-the-trainer strategy may be less resource intensive.

A Qualitative Study Designed to Build an Experiential Education Curriculum for Practice-Ready Community Pharmacy-Bound Students

Objective. To design an experiential education curriculum that sequentially and deliberately prepares community pharmacy-bound graduates to practice at the level of the care provider and display the skills needed to be a pharmacist-in-charge. Methods. Semi-structured interviews were conducted with community pharmacy stakeholders. Transcriptions from the interviews were analyzed to identify common themes in needed community pharmacy training for core and elective advanced pharmacy practice experiences (APPEs). The themes were used to distinguish key elements of a community pharmacy experiential education curriculum that would meet the project objective. Results. Forty-two individuals were interviewed: 11 were interviewed individually and 31 in focus groups, with each group comprising two to six individuals. There were 11 focus groups. Theme analysis allowed differentiation of activities and performance levels for the community pharmacy introductory pharmacy practice experience (IPPE) and the core APPE as well as the goal of the core APPE for all program graduates. Participants identified two important elective APPEs for students planning to practice in community pharmacy after graduation: an advanced patient care experience and a management experience. Participants emphasized the importance of sequencing the core and advanced elective APPEs so that the advanced electives could build upon the skills demonstrated in the core APPE. Participants identified knowledge, skills, and attitudes needed for practice-readiness upon graduation. Conclusion. The identified experiential education curriculum for students planning to practice in the community pharmacy setting upon graduation will prepare them to provide care to complex community-dwelling patients and function as a pharmacist-in-charge in this setting.

An Analysis of Community Pharmacy Shared Faculty Members' Contributions to Teaching, Service, and Scholarship.

Objective. To identify community pharmacy shared faculty members across the United States and to describe their roles and responsibilities in terms of teaching, service, and scholarship. Methods. This study was a mixed-methods analysis using surveys and key informant interviews. Results. Twenty-two faculty members completed the survey; nine were interviewed. Their major roles and responsibilities included teaching in community-based and experiential learning courses, precepting students and/or residents, being actively involved in professional organizations, providing patient care while leading innovation, and disseminating findings through scholarship. Conclusion. Community pharmacy shared faculty members contribute to their academic institutions and community pharmacy organizations by educating learners, providing direct patient care, and advancing community practice through innovation and service to the profession. Findings of this study can be used as a guide for academic institutions and community pharmacy organizations interested in partnering to develop a community pharmacy shared faculty position.