Mary F Powers

The Mandatory Residency Dilemma: Parallels to Historical Transitions in Pharmacy Education

Objective: To review recent literature regarding mandatory residencies in the perspective of the historical entry-level degree debate. Data Sources: Articles were identified through searches of MEDLINE/PubMed, national pharmacy association Web sites, and a review of the references of related literature. Study Selection and Data Extraction: Several studies, commentaries, and reviews are examined to discuss viewpoints from both the entry-level degree and mandatory residency debates. Similarities were observed between the 2 debates in regard to objectives and rationale for change, educational issues, pharmaceutical care issues, and economic issues. Data Synthesis: Fewer than 10 years ago, after many years of debate, colleges of pharmacy made the transition to offering the PharmD degree as the sole entry-level degree for licensure as a pharmacist. Similar debates have taken place over the past several years and continue to take place regarding the necessity for residency training. One key 2006 document by the American College of Clinical Pharmacy calls for mandatory residency training for entry into pharmacy practice by 2020. Conclusions: In parallel with the entry-level degree debate, consensus has yet to be reached among pharmacists and pharmacy organizations, but several have shown support for mandatory residency training for all pharmacists involved in direct patient care. Many questions have yet to be answered regarding the timeline, economics, and feasibility of such a mandate.

Pharmacy Technicians and Medication Therapy Management

Background: Although cognitive services have become more widely accepted among pharmacists since Medicare Part D provided a benefit to allow for billing of services, not all pharmacists have incorporated services into their practices. Objective: To identify opportunities for pharmacy technicians to aid pharmacists in medication therapy management (MTM). Methods: Articles were identified through searches of MEDLINE/PubMed (1950–July 2008) and review of MTM resources from the American Pharmacists Association. Articles describing medication therapy management and pharmacy technicians were included. Results: As the pharmacy profession embraces extensive patient counseling in the form of MTM, many aspects of the practice of pharmacy need to evolve to ensure MTM program success. Time constraints limit the ability of pharmacists to handle administrative tasks and represent a major barrier to MTM program implementation. Technicians can do some of the work to reduce this barrier. With proper training, technicians can assist pharmacists in the tasks that do not require the professional judgment of a pharmacist, freeing pharmacists to focus on clinical activities and enabling an MTM program to be more sustainable. For example, technicians can help in areas such as scheduling and patient reminders through phone calls. Medication histories and health histories can also be documented by technicians, as can chart construction, filing, and the documentation of release forms and health histories. Additional steps can be taken to further increase efficiency in the MTM process and include creation of a flow map and cross training of all pharmacy staff. Conclusions: Through developing new roles, technicians can help pharmacists provide pharmaceutical care and develop a successful MTM program.

Student pharmacists' perceptions of barriers to medication adherence counseling.

Purpose: To identify the barriers perceived by student pharmacists to counseling on medication adherence in a supermarket community pharmacy chain. Methods: Online surveys were made available to 65 student pharmacists. Subjects completed the survey anonymously and indicated their opinions and perceptions on topics related to medication adherence through the use of a 5-point Likert-type scale. Results: Of the surveyed student pharmacists, 26 completed the survey (40%). All participants (100%) agreed that they have knowledge on the importance of medication adherence. Student pharmacists stated that they did not have the time to cover adherence in a counseling session (72.7%) nor did they have time to perform follow-up phone calls with the patient (54.5%). The majority of student pharmacists (81.8%) were comfortable bringing up the topic of adherence with the patient but thought that they did not have access to resources on adherence to provide to the patient (59%). Conclusions: Surveyed students indicated they were constrained for time to counsel patients on adherence and to perform continued follow-up with patients afterward. Factors cited as barriers to counseling patients on medication adherence include time, lack of specific training in adherence management, lack of resources to provide to the patient, and patient disinterest in the subject.

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.

Barriers to implementing a pharmacist-run immunization service, as perceived by pharmacists, in a community pharmacy chain

Background: Thousands of people die each year from vaccine-preventable diseases. Pharmacists can be a valuable resource in aiding the success of immunizations. Objective: To determine the barriers to implementing a program utilizing pharmacists as immunizers, as perceived by pharmacists, in a supermarket pharmacy chain. Methods: A 15 question survey regarding the perceived barriers to implementing a pharmacist-run immunization program was distributed to 60 pharmacists in a supermarket chain in northwestern Ohio. The responses were tabulated using a 5 point Likert scale. The data were analyzed utilizing the Statistical Package for Social Sciences. Results: Of the 60 pharmacists who received the survey, 43 completed the questionnaire (response rate 72.0%). A majority of the pharmacists surveyed believed that patient privacy was an issue in administering adult immunizations in a community pharmacy. The majority of pharmacists were concerned about the risk of adverse reactions to the vaccines and the need for a quick response to control these reactions. Twenty-five pharmacists believed that the prescription volume at their pharmacy limited them from having time to immunize. Twenty-one pharmacists cited cost as the main determining factor in a pharmacy immunization program. Conclusions: Many barriers to implementing a pharmacist-run immunization program exist. The future success of such an immunization program rests on overcoming the perceived barriers in a formal and timely manner.

Roles for Pharmacy Technicians in Community Pharmacy Practice Accreditation

Objective: To review community pharmacy accreditation and identify opportunities for pharmacy technicians to help community pharmacies meet accreditation standards. Data Sources: Articles were identified through MEDLINE/PubMed (2001–2012) using search terms designed to locate English-language articles describing the role of the pharmacy technician, community pharmacy accreditation, and health care reform. Additionally, resources on community pharmacy accreditation and health care reform were used from the Institutes of Medicine, American Pharmacists Association, Council on Credentialing in Pharmacy, Center for Pharmacy Practice Accreditation, and Utilization Review Accreditation Commission. Study Selection and Data Extraction: Articles describing the role of the pharmacy technician, community pharmacy accreditation, and health care reform were included. Data Synthesis: Pharmacy technicians can help community pharmacies meet accreditation standards by taking on specific roles under 5 main domains: practice management, patient counseling, patient care services, technology, and quality improvement. Technicians can help by engaging in management-related tasks; improving communication between pharmacists, patients, and providers; and collecting and analyzing pharmacy data. Further, with proper training, pharmacy technicians can take on an expanded role to aid pharmacists with advanced patient care services and quality improvement measures. Conclusions: Pharmacy technicians can play a vital role in helping pharmacies meet standards necessary for community pharmacy accreditation.

Training Pharmacy Technicians in Community Pharmacy about Technical Aspects of Blood Glucose Meters

Objective: To develop a structured training module for community pharmacy technicians to enhance on-the-job training, with a focus on the technical aspects associated with blood glucose meters. Methods: A 3-hour live training session was offered about the technical features of blood glucose meters. A 54-page manual was developed and provided to enhance the training sessions and for later use as a reference. Participation was voluntary and participants answered a 10-item pre-training survey and a 15-item post-training survey. The surveys contained questions about the knowledge and beliefs the technicians had about blood glucose meters. Results: Thirty-nine pharmacy technicians from 21 pharmacies participated in the training. Seventy-three percent of the participants expressed that they were very interested in taking an advanced role as a pharmacy technician. Sixty-four percent of the participants strongly agreed that the content of the program added to their knowledge about blood glucose meters. Fifty-two percent of the participants have been employed for >3 years by their employer. Conclusions: Community pharmacists today are striving to integrate patient care with the goods and services traditionally associated with pharmacy. Pharmacy technicians are recognized as an important resource in helping pharmacists provide better patient care. The structured training module described in this article is designed to supplement on-the-job training. Formal training through accredited training programs may be required in the future. Structured technician training modules may provide a means for transition from predominantly on-the-job training to formal training.

Comparison of patient assistance program software

PURPOSE The capabilities of available software programs for the management of applications to patient assistance programs (PAPs) and associated administrative tasks are reported. SUMMARY Fifteen PAP software programs available at the time of data collection (July-September 2010) were identified through an Internet search and from e-mailed responses to a listserv request. To supplement and confirm the information obtained online, the software makers were contacted; additional data were collected through follow-up correspondence. The survey was restricted to standalone programs; all manufacturer-provided information was assumed to be accurate, and the products were not tested. The 15 software products evaluated (11 Web-based and 4 Windows-based programs) offered a wide range of capabilities to streamline the PAP application process, such as storage of patient and physician profiles, automatic completion of forms with stored data, application status tracking, and customized report generation. The Web-based programs offered some advantages over the Windows-based programs, including greater user accessibility and automatic updates. Product pricing varied widely, depending on the specific licensing terms. Some manufacturers offered discounts to health care organizations participating in the 340B Prime Vendor Program; some offered volume discounts. In addition, grant support may be available to help pay software licensing costs. CONCLUSION There are at least 15 software programs for streamlining and enhancing the process of PAP application management. No single program can meet the needs of every organization; selecting the right product demands a close look at the needs of an organization and the features and logistics of each program.

Recently Approved Medicare Provisions for Prescription Drugs and Medication Management Services

Objective: To review recent changes in Medicare affecting the practice of pharmacy. Data Sources: Articles were identified through searches of MEDLINE (2003–March 2004), LEXISNEXIS ACADEMIC (2003–March 2004), and LEXISNEXIS CONGRESSIONAL databases (2003–March 2004), using the key words Medicare, pharmacist, pharmacy, and drug costs. Additional references were located through review of the bibliographies of the articles cited and through searches of the Web sites for Medicare, Social Security, and the American Pharmacists Association. Study Selection and Data Extraction: Reports about Medicare and Medicare Part D were selected. Articles describing the history of Medicare and changes that impact pharmacy were included. Data Synthesis: The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MPDIMA) provides an optional prescription drug benefit for Medicare beneficiaries in 2006 as Medicare Part D. Before its full implementation, eligible Medicare beneficiaries may qualify for a temporary Medicare-approved Drug Discount Card. The prescription drug benefits will be administered by private entities. Other provisions of the MPDIMA affect pharmacy, including a provision for medication therapy management services to ensure that the covered Part D drugs are appropriately used. This will be the first time that Medicare provides for payment of pharmacist-administered patient care services. Conclusions: Recent changes in Medicare provide Medicare beneficiaries with optional coverage for prescription drugs. Full implementation of the Medicare prescription drug benefit will occur in 2006, with an interim Drug Discount Card available through December 2005.

Impact of a Transitions of Care Training Module on Community Pharmacists’ Knowledge and Attitudes

Background: Community pharmacists’ accessibility to patient histories and personal patient relationships situates them to have a potentially significant impact on transitions of care. Recent literature has demonstrated that improved patient outcomes and an overall reduction in health care costs occur when pharmacists are involved in medication reconciliation during transitions of care. Objective: To develop a transitions of care training module for community pharmacists. To assess the training module’s impact on pharmacists’ transition of care knowledge and their attitude toward actively participating in the transitions of care for their patients. Methods: Community pharmacists practicing in a supermarket pharmacy chain participated in this study. A pretest and posttest were administered around a 30-minute transitions of care training module. The attitude assessment consisted of a 5-point Likert-type scale, while the knowledge-based assessment consisted of true/false and multiple-choice questions. SPSS version 21.0 was used to generate descriptive and nonparametric statistical analyses. The study was approved by the University of Toledo Social, Behavioral, and Educational Institutional Review Board. Results: Thirty-six pharmacists (72%) successfully completed the pre–post survey. The average pharmacist posttest knowledge survey score improved from the pretest score, 73% to 99%. A paired Student’s t test demonstrated the posttest percentage of correct questions on the knowledge-based survey improved from the baseline knowledge. Pharmacists’ average posttest attitudes regarding participation in patients’ transitions of care statistically improved compared to their pretest attitudes. Conclusion: Community pharmacists’ transitions of care knowledge and attitudes can be improved through a training module.