As community pharmacy transitions from a fee-for-service model to a focus on value-based care, the desired skills of pharmacist graduates in contemporary practice is an evolving paradigm. Meanwhile, most student pharmacists pursuing a career in community pharmacy upon graduation rely solely upon their pharmacy school training as preparation for entering practice. Community pharmacy preceptors are stakeholders in a unique position to compare the dichotomy of the current climate of community practice with the preparedness of graduating students to enter this field. Therefore, these preceptors’ perceptions of contemporary practice services and skills essential for new graduates may be useful in identifying methods of educating and assessing PharmD candidates in their preparation to enter the evolving landscape of community practice. The objective of this research was to identify essential skills for new graduates in contemporary community pharmacy as perceived by these current practitioners. To accomplish this, researchers developed an anonymous web-based survey using REDCap which was emailed to active Advanced Pharmacy Practice Experiences (APPE) community preceptors. The survey included 3 sections: (1) preceptor demographics; (2) perceptions of “contemporary” services and an evaluation of services offered at their sites; and (3) essential skills for graduates entering contemporary community practice. Following a 30-day window of the survey being open, 25% of preceptors responded (n = 42). Survey responses provided clarity in comparing the proportionality in services offered versus services viewed as contemporary. This information may be useful in identifying transformations that have already seen implementation in practice compared to emerging areas yet to be implemented. We also found broad consensus in the perceived importance of most skill areas offered in the survey with just a few showing broader discrepancies with a minority of respondents suggesting skills which held less importance. Monitoring fluctuations of these parameters over time may disclose trends in community pharmacy practice transformation, further delineating service areas that are trending toward adoption in contemporary practice. Therefore, continued use of preceptor surveys may offer insights on the incremental progression of community pharmacy curricula.

Background: One approach to increasing the reach of syringe programs in rural areas could be through provision of syringes at community pharmacies. This study evaluated relationships between state-specific syringe policies, pharmacy, and pharmacist characteristics and pharmacists’ nonprescription syringe dispensing behaviors in a 3- state Appalachian region at high risk for HIV and HCV transmission. Methods: We conducted a telephone census of community pharmacies in the Appalachian counties of North Carolina, Tennessee, and Virginia from April–June 2018. Behaviors studied included having ever sold syringes without a prescription, quantity of individuals to whom nonprescription syringes were dispensed in the past 30 days, having ever denied a request for nonprescription syringes, and past 30-day denial of nonprescription syringe requests. Behavioral intention and perceptions of legality were elicited. Results: A response rate of 52.3 % was achieved (N = 391). North Carolina pharmacists reported increased past 30-day dispensing, less denial of nonprescription syringe requests, and decreased justification for syringe dispensing (proof of medical need) as compared to Tennessee and Virginia pharmacists. Behavioral intention to dispense did not vary by state but did vary by political affiliation. Perceptions of syringe dispensing legality in NC were significantly different from those in TN and VA. Conclusions: Significant differences in pharmacists’ perceptions and behaviors were noted across state lines with North Carolina pharmacists reporting more engagement in syringe dispensing as compared to pharmacists in Tennessee and Virginia. Policy allowing pharmacists to dispense syringes to people who inject drugs appears to foster some but not all pharmacist engagement in this harm reduction intervention.

Background Drug utilization review (DUR) is a central role of the pharmacist, especially within the community pharmacy setting. Previous literature has shown risk of “alert fatigue”, supporting the necessity of pharmacists to utilize a step-wise approach in evaluation of drug therapy during the verification process. Many students are intimidated by this process, and may lack verification practice or experience until their first day as a licensed pharmacist. Educational Activity and Setting An innovative skills-based laboratory exercise was developed for third-year pharmacy students to develop DUR skills. Through simulation of patient prescriptions, profiles, and drug information resources, students were tasked with completing a DUR for each patient case. Students were expected evaluate the clinical significance of various drug-related problems, determine if they would or would not dispense the prescription, and were required to provide rationale for their decision. Findings This learning activity was well-received by the student population; however, students struggled with the volume of cases along with identifying a solution to the clinical scenario. On average, students required nine minutes per case, which is likely longer than community pharmacists can devote to a single DUR in practice. Discussion In response, to student challenges with the activity, the number of cases was condensed to highlight key concepts and cases that facilitated strong discussion. To improve students’ approach to the DUR process, faculty developed a vodcast to watch prior to the activity explaining a systematic approach to the DUR process as well as considerations a pharmacist should have. Summary Development and integration of an active-learning, simulated dispensing activity allowed students to gain valuable experience completing the DUR process, a foundational community pharmacy practice skill; however, repeated experience should be provided to ensure competency.

Introduction: With community pharmacy transitioning from a fee-for-service model to a value-based care focus, the desired skills of pharmacist graduates is an evolving paradigm. As active stakeholders in community practice, pharmacist preceptors are in a unique position to compare the ever-changing dichotomy between pharmacy practice and training. Examining preceptors' assessments of these essential contemporary practice skills may provide useful insights. Methods: A survey was emailed to all regional, active college of pharmacy community advanced pharmacy practice experiences preceptors. Participating preceptors were given 30 days to complete the online survey. Weekly reminders were provided. Results: Of the 168 preceptors invited to participate, 42 (25%) completed the survey. Descriptive analysis compared preceptors' perceptions of transformative services vs. their relative implementation in practice. This revealed service areas such as health screenings that were proportionate in their prevalence of offering and perception as contemporary. In contrast, services such as pharmacogenomic testing were more widely perceived as contemporary compared to their low prevalence as an offering. Participants showed broad consensus in the importance of most skills listed in the survey, predominantly indicating these skills were either “very important” or “extremely important.” Only a few specific skills areas were identified that showed less consensus, with a minority of respondents specifying that these skills were of less importance. Conclusions: Preceptor surveys may offer insights on the progression of community practice curricula. Continued monitoring of changes in service parameters over time may reveal trends in practice transformation, identifying service areas being more widely adopted.

Abstrakt Bakgrund: Under lång tid har apoteksbranschen och den farmaceutiska professionen önskat utveckla farmaceutiska tjänster på öppenvårdsapotek samt få offentlig finansiering för dessa. Nya metoder som ska införas i en verksamhet tar ofta lång tid, kostar mycket och misslyckas ofta. Den process som används för att införa nya metoder i en verksamhet kallas implementering. Forskning visar att kunskap om implementering kan påverka resultatet framgångsrikt och att processen tar två till fyra år utan sådan kunskap genomförs implementeringen efter i genomsnitt 17 år. Syfte: Syftet är att identifiera vilka faktorer som kan påverka implementering av farmaceutiska tjänster på öppenvårdsapotek och belysa hur dessa faktorer påverkar implementeringen Metod: Arbetet har baserats på en litteraturstudie med hjälp av SBU:s handbok. SBU:s handbok handlar om utvärdering av metoder i hälso- och sjukvården och insatser i socialtjänsten. Artikel sökningen gjordes mellan 2020-04-08 till 2020-04-15. Totalt inkluderades 30 artiklar via databas PubMed och involverade följande termer: Cognitive service, community pharmacy, implementation science, barriers and facilitators.        Resultat: Implementering av farmaceutiska tjänster på öppenvårdsapotek är en komplex process och det finns olika faktorer som påverkar implementeringsprocessen och resultatet. De centrala begreppen för implementering är bl.a. process-modell, innovation, sammanhängande domäner av faktorer, strategier och utvärdering. Process-modellen består av fem olika delar, bland annat utforskning, förberedelse eller installation, testning och initial implementering, full verksamhet och hållbarhet. Ett vanligt ramverk som används i olika studier kallas det konsoliderade (förstärkta) ramverket för implementeringsforskning (CFIR). CFIR används för bedömning av olika faktorer som påverkar implementeringen. Faktorerna som påverkar implementeringen delas in i två grupper, hindrande (barriärer) och underlättande (faciliterande) faktorer. Slutsats: Implementering av farmaceutiska tjänster på öppenvårdsapotek påverkas av olika hindrande och underlättande faktorer. För att få en framgångsrik implementering behövs en processmodell och ett ramverk. Det behövs mer forskning för att utveckla processmodellerna och ramverket för få bättre resultat av implementering av farmaceutiska tjänster på öppenvårds apotek.

Background: The central Appalachian region is at an elevated risk for HIV/HCV outbreaks, primarily due to injection drug use. Regional risk assessments highlight gaps in the evidence-based continuum of primary, secondary, and tertiary prevention strategies to minimize HIV/HCV transmission. One potential strategy for increasing the reach of HIV/HCV prevention efforts in rural areas is through provision of services at community pharmacies. Objective: To qualitatively describe community pharmacists' HIV/HCV-related prevention behaviors, attitudes, and beliefs in a 3-state central Appalachian region. Methods: Key informant interviews were conducted with 15 practicing community pharmacists. Theory of Planned Behavior-based questions probed for perceptions about the role of pharmacies in preventing and reducing HIV/HCV outbreaks in rural areas through activities such as syringe services, screening for HIV/HCV, and linking people to treatment when appropriate. Investigators applied thematic analysis to deductively and inductively generate themes from the interview transcripts. Results: Two overarching themes regarding pharmacist engagement in HIV/HCV-related prevention services were generated: 1) current approaches to primary prevention through nonprescription syringe sales (e.g., gatekeeping behaviors) and 2) potential for uptake of the continuum of HIV/HCV-related prevention services in community pharmacies. Future engagement of community pharmacists in the continuum of HIV/HCV-related prevention services comprised 2 subthemes as possible underlying factors: general and specific willingness to provide services and perceived fit within the pharmacy profession. Conclusions: Central Appalachian community pharmacists express a general willingness to help patients who may benefit from HIV/HCV-related prevention services, but current engagement, willingness, and perceived fit for offering specific prevention services in the community pharmacy setting is variable. This has potential immediate implications, such as prioritizing the introduction of more widely accepted services (e.g., provision of HIV/HCV-related prevention education) to community pharmacy practice, and longer-term implications, such as the integration and framing of HIV/HCV-related prevention services as helping behavior within the pharmacist professional identity.

No description available.

Yes / Background The first UK wave of the Covid-19 pandemic in 2020 placed unprecedented stress on community pharmacy. Various policies and initiatives were announced during this period to support community pharmacy to continue to perform in a manner that prioritised patient safety. However, little is understood about how these policies and initiatives were implemented by staff working in community pharmacy, and the system adaptions and responses that were initiated to maintain patient safety. Objective The study aimed to investigate how staff working in UK community pharmacy during the first waves of the COVID-19 pandemic in 2020 responded and adapted to system stressors to maintain patient safety. Methods We adopted a qualitative interview approach, underpinned by Resilient Healthcare theory, with interview data collected between July 2020 and January 2021. Data were synthesised and analysed using Framework Analysis. Results 23 community pharmacy staff from England and Scotland were interviewed. We identified five themes supported by between two and six sub-themes: 1. Covid-19, an impending threat to the system. 2. Patient safety stressors during the first waves of Covid-19. 3. Altering the system, responding to system stressors. 4. Monitoring and adjusting. 5. Learning for the future. Conclusion Privileging the accounts of community pharmacy staff working on the frontline during the pandemic illuminated how responses and adaptions were developed and deployed, how continual monitoring occurred, and the factors that supported or hindered system resilience. The key learning derived from this study can serve to shorten the gap between ‘work as imagined’ and ‘work as done’, and in doing so, support the future resilience performance of community pharmacy during future outbreaks of Covid-19 or similar events. / This research was funded by the National Institute for Health Research (NIHR) Yorkshire and Humber Patient Safety Translational Research Centre (NIHR Yorkshire and Humber PSTRC).

Yes / Background Interventions to reduce medicines discontinuity at transitions during and reinforced after discharge are effective. However, few studies have linked hospital-based counseling with onward referral for community pharmacy-based follow-up to support patients' medicines use. Objective To determine the effects of targeted hospital pharmacist counseling on discharge or targeted community pharmacy medicines reviews post-discharge on patients' knowledge of newly started medication. Methods The study was a controlled trial of targeted medicines discharge counseling provided by hospital pharmacists or follow-up post-discharge medicines review provided by community pharmacists compared with usual care (nurse counseling). Outcomes measured using a structured telephone survey conducted at two and four weeks after patients were discharged from hospital. Results Patients who received hospital pharmacist counseling were significantly more likely to report being told the purpose of their new medicine and how to take it versus those receiving usual care. Fewer than half of the patients who were allocated to receive a community pharmacy medicines review received one. Conclusions Patient knowledge of medicines newly prescribed in the hospital was increased by targeted counseling of hospital pharmacists. The findings suggest the need to improve the consistency of the information covered when providing counseling, perhaps by the implementation of a counseling checklist for use by all disciplines of staff involved in patient counseling. The potential of community pharmacy follow-up medicines review is currently undermined by several barriers to uptake.

No / OBJECTIVE: To develop, validate and apply a scale to measure patient satisfaction in a randomised controlled trial of community pharmacy service. METHODS: Published scales were reviewed to inform development of the patient satisfaction scale. Questionnaires were sent to patients in the control (n=500) and intervention (n=941) groups of a randomised controlled trial of community pharmacy-led management of coronary heart disease at baseline and 12-month follow-up. Any underlying main factors were assessed with exploratory factor analysis. Reliability and construct validity were tested. The 15-item scale was used to compare patient satisfaction across arms with their most recent pharmacy visit. RESULTS: Response rates were 92% (461/500) for control and 96% (903/941) for intervention groups at baseline and 85% control (399/472) and intervention (810/941) at follow-up. At baseline satisfaction was very similar in the intervention and control groups (median scores of 42). At follow-up mean satisfaction had significantly improved for the intervention compared with the control (median scores of 46 compared with 43; P<0.01); intervention females were more likely to be satisfied with the service than males (49 compared with 44; P<0.01). Three main factors explained the majority of the data variance. Cronbach's alpha was 0.7-0.9 for both groups over time for all factors and total scale. An increase in the overall satisfaction corresponding to a decrease in subjects wanting that particular service to be provided during their next visit indicated construct validity of the scale. CONCLUSION: A new scale of patient satisfaction with community pharmacy services was developed and shown to be reliable and valid. Its application showed increased satisfaction in the intervention group receiving a new pharmacy service.