Kenneth C. Hohmeier

Pharmacy Technicians and Immunizations

Objective: To provide background on immunizations and community pharmacies and identify opportunities for pharmacy technicians to assist pharmacists in providing community pharmacy-based immunization programs. Methods: Articles were identified through searches of MEDLINE/PubMed (1950–July 2010) with the following search terms: vaccination and technician, immunization and technician, vaccination and pharmacist, and immunization and pharmacist. Additionally, immunization resources from the American Pharmacists Association, the American Society of Health-System Pharmacists, and the Centers for Disease Control and Prevention were used. Results: Pharmacy technicians can help facilitate immunization programs and help reduce some of the barriers to providing superior services. Specific tasks that can be performed by pharmacy technicians include documentation, billing, assisting in the reporting of adverse events, and facilitating communication. Technicians can also take an active role in pharmacy-based immunization programs by obtaining cardiopulmonary resuscitation training and certification. Conclusions: Pharmacy technicians can help facilitate immunization programs and help pharmacists offer more robust and comprehensive immunization services.

Implementation of a health information exchange into community pharmacy workflow

OBJECTIVES To explore the feasibility and report preliminary outcomes of the integration of a health information exchange (HIE) into community pharmacy workflow clinical service delivery. SETTING Independent pharmacy in eastern Tennessee. PRACTICE DESCRIPTION The pharmacy offers medication reconciliation services via HIE access, as well as other clinical pharmacy services. The average number of prescriptions filled weekly is 1900, and staffing included 3.5 full-time-equivalent (FTE) pharmacists, and 7 FTE technicians. PRACTICE INNOVATION HIE integration within the workflow of the pharmacy was used to enhance existing patient care services, such as medication distribution, drug use review, medication therapy management, and immunizations, as well as to implement a novel transitional care service. EVALUATION A mixed-methods design was used to explore HIE workflow. Data collection included a pharmacist and pharmacy technician perceptions survey, mapping steps involved in HIE use in workflow via a think-aloud protocol, and quantitatively reporting the number and type of discordant medications found on medication reconciliation. RESULTS In total, 25 patients qualified for the medication reconciliation intervention and data collection. All 25 patients (100%) had at least 1 discordant medication. HIE access was used for 60% of patients. Community pharmacists were confident in their abilities to perform medication reconciliation and were able to perform the medication reconciliation with the use of the HIE within their workflow, albeit with some reported barriers. The average time spent per patient for HIE-facilitated transitional care was 21 minutes. CONCLUSION Integration and utilization of an HIE within the workflow for the purposes of patient care service delivery in the community pharmacy is feasible, but not without limitations. Such HIE utilization and extended access to the patients clinical picture may represent a scalable method to enhance currently delivered pharmacist services.

Pharmacogenomics testing in a community pharmacy: patient perceptions and willingness-to-pay

AIM To determine patient knowledge, interest and willingness-to-pay for pharmacogenomics testing in a community pharmacy. PATIENTS & METHODS The link to a cross-sectional, anonymous online survey was distributed to a convenience sample of patients. The contingent valuation method was used to assess willingness-to-pay. RESULTS Twenty seven surveys were completed. Eighty one percent of patients were interested in the service, but patients felt that they would be more likely to use the service if insurance covered the cost. CONCLUSION Patients indicated interest in a pharmacogenomics test, but varying levels of willingness-to-pay. Patients may not be able to connect the benefits of testing to their health, justifying further patient education in order to increase the viability of pharmacogenomics testing as a pharmacy service.

The Effect of Community Pharmacy Technicians on Industry Standard Adherence Performance Measures after Cognitive Pharmaceutical Services Training

Background: Cognitive pharmaceutical services (CPS) provided by pharmacists can improve patient adherence and industry standard performance measures. Community pharmacy technicians can aid in CPS support tasks on training, but it is unknown to what extent. Objective: To determine the effect of community pharmacy technicians on industry standard adherence performance measures after CPS training. Methods: Sixteen community pharmacy technicians within a supermarket chain division were chosen to participate in CPS training based on internal pharmacy benchmarking data. The training program consisted of 3 components: (1) classroom and (2) web-based training for medication therapy management platforms and (3) Hands-on in-pharmacy training. Researchers used pharmacy-specific EQuIPP reports of the proportion of days covered (PDC) for adherence related to diabetes, cholesterol, and hypertension to measure the primary outcome. September through October 2015 represented baseline data. November 2015 through March 2016 represented intervention data. Descriptive and inferential statistics were utilized for this retrospective analysis. The University of Tennessee Institutional Review Board classified the study exempt from review. Results: Overall, 100% of Cholesterol PDC 4-Star sites improved to a 5-Star score and 56% of sites improved in the Diabetes PDC score. All sites maintained a 5-Star score for RASA PDC postintervention. An average increase of 2.36% was observed for Cholesterol PDC across all sites. Possible lag time between the intervention and score improvements may limit relatability of results. Conclusions: This is the first study to report a positive trend between technician involvement in CPS and improvement in industry standard adherence performance measures. Further research capturing a longer time frame may be beneficial.

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.

Co-creation of market expansion in point-of-care testing in the United States: Industry leadership perspectives on the community pharmacy segment

Background: Point‐of‐care testing (POCT) is a specialty of laboratory medicine that occurs at the bedside or near the patient when receiving health services. Despite its established clinical utility and consumer demand in the community pharmacy, the implementation of POCT within this setting has remained modest for a variety of reasons. One possible solution to this problem is the concept of co‐creation – the partnership between consumer and manufacturer in the development of value for a service or device. Objective: Using the theoretical underpinning of co‐creation, this study aimed to investigate perceptions of point‐of‐care‐testing (POCT) industry leadership on the community pharmacy market in the United States to uncover reasons for limited implementation within community pharmacies. Methods: Participants were recruited for this study through the use of snowball sampling. A series of semi‐structured interviews were conducted with the participants via telephone. Interviews were recorded, transcribed, and entered into a qualitative analysis software program to summarize the data. Results: Five key themes were uncovered: gaps in understanding, areas of positive impact, barriers to implementation, facilitators of implementation, and community pharmacy – a potential major player. Conclusions: Through uncovering gaps in perceptions, it may be possible to leverage the U.S. pharmacy industrys size, potential for scalability, and ease of patient access to further patient care.

A multimodal approach to improving human papillomavirus vaccination in a community pharmacy setting

Background: Community pharmacy has become a major access point for several types of vaccinations. Despite the success of vaccination programs like influenza, pneumococcal, and herpes zoster, the rates of human papillomavirus vaccination continue to lag. Objectives: The primary objective is to describe and report on the impact of a multimodal series of pharmacist-led educational interventions on human papillomavirus vaccination rates in a community pharmacy setting. The primary outcome of this study was change in pharmacist-delivered human papillomavirus vaccination throughout a corresponding 8-week period in 2014 and 2015. Methods: A single-center, quasi-experimental interrupted time series mixed-methods pilot study was used to investigate a pharmacist-led, multimodal educational intervention approach to improve human papillomavirus vaccination rates in the community. Results: During the 2014 control period, there were no human papillomavirus vaccines dispensed or administered according to the internal prescription dispensing software. In 2015, a total of 10 patients indicated that they were vaccinated, with 9 patients receiving their first dose and 1 patient receiving his or her second dose at the pharmacy. Pharmacist recommendation was the most reported education method for increasing patient awareness of the human papillomavirus vaccine (n = 10). Conclusion: This study demonstrates pharmacist designed, educational interventions may impact human papillomavirus vaccination rates in the community. Further community-based research with larger sample sizes is warranted to verify these results. Due to the unique barriers to human papillomavirus vaccination, a multimodal and inter-professional approach such as the one presented here is warranted.

Student Perceptions of the Pharmacist’s Approach Across the Varying Levels of Medication Therapy Management Services

Objective. To explore third-year pharmacy (P3) student perceptions of medication therapy management (MTM) after an introduction to the various levels of MTM services within an MTM course. Methods. A qualitative survey was conducted of 158 P3 students. Open-ended questions were used to explore students’ thoughts, feelings, and perceptions related to the pharmacist’s approach in MTM following a lecture establishing differences in roles and responsibilities between the varying levels of MTM. Emphasis was placed on the pharmacist’s role when providing comprehensive medication management (CMM). CMM is a higher-level direct patient care service with a whole-patient focus that goes beyond medication or disease specific focuses of either a comprehensive medication review (CMR) or targeted medication review (TMR). Thematic analysis was performed and an inductive approach to data analysis was used. Results. The following five themes were identified: misperceptions entering the course, efficient delivery of MTM depends on understanding the differences between services, doctor of pharmacy education is a factor in confused MTM role expectations, role limitations exist and referrals to other providers, and the CMR meets unmet needs. Conclusion. Students noted initial confusion between their roles and responsibilities during a CMM versus a CMR. Pharmacy educators should address the varying roles and responsibility differences across MTM services within their curriculum.

Evaluation of racial and socioeconomic disparities in medication pricing and pharmacy access and services

Purpose. Results of a study to determine if disparities in drug pricing, pharmacy services, and community pharmacy access exist in a Tennessee county with a predominantly minority population are reported. Methods. A cross‐sectional survey of community pharmacies in Shelby County, a jurisdiction with a total population more than 60% composed of racial and ethnic minority groups, was conducted. Data collection included “out‐of‐pocket” (i.e., cash purchase) prices for generic levothyroxine, methylphenidate, and hydrocodone–acetaminophen; pharmacy hours of operation; availability of selected pharmacy services; and ZIP code–level data on demographics and crime risk. Analysis of variance, chi‐square testing, correlational analysis, and data mapping were performed. Results. Survey data were obtained from 90 pharmacies in 25 of the county’s 33 residential ZIP code areas. Areas with fewer pharmacies per 10,000 residents tended to have a higher percentage of minority residents (p = 0.031). Methylphenidate pricing was typically lower in areas with lower employment rates (p = 0.027). Availability of home medication delivery service correlated with income level (p = 0.015), employment rate (p = 0.022), and crime risk (p = 0.014). Conclusion. A survey of community pharmacies in Shelby County, Tennessee, found that areas with a high percentage of minority residents had lower pharmacy density than areas with a high percentage of white residents. Pharmacies located in communities with low average income levels, low employment rates, and high scores for personal crime risk were less likely to offer home medication delivery services.

Evaluating the impact of pharmacists on reducing use of sedative/hypnotics for treatment of insomnia in long-term care facility residents

OBJECTIVE To determine if pharmacist intervention can decrease the use of inappropriate sedative/hypnotics in the elderly population in the long-term care facility setting. DESIGN A multicenter, prospective chart review of sedative/hypnotic use for insomnia among long-term care facility residents. SETTING Eleven regional long-term care facilities in Northeastern Tennessee. PARTICIPANTS Long-term care facility residents older than 65 years of age, with confirmed insomnia diagnoses and no history of seizure or recent psychotropic gradual-dose reduction attempts. INTERVENTION Consultant pharmacist recommendations to decrease inappropriate use of sedative/hypnotics. MAIN OUTCOME MEASURE Acceptance rates for discontinuation/tapering of the selected sedative/hypnotics. RESULTS A total of 36 patients were enrolled in the study based on inclusion/exclusion criteria. Overall, 39 interventions were performed. Gradual dose reductions/ discontinuation of select sedative/hypnotics were accepted for 19 residents (48.7%). Of the other recommendations, 8 (20.5%) were denied and 12 (30.8%) were left unanswered. Primary reasons for denial included family refusal, satisfactory response to current dose, and requirement of increased dose as a result of worsening insomnia. CONCLUSIONS Overall, pharmacist intervention can have a meaningful impact on reducing inappropriate sedative/ hypnotic use in the elderly population through concise, evidence-based recommendations to physicians.