scholarly journals "Until they know how much you care": A qualitative analysis of an innovative practice in community pharmacy

2011 ◽  
Vol 2 (2) ◽  
Author(s):  
Michael Melczak ◽  
Janice Pringle
Keyword(s):  
Medication Adherence ◽  
Therapeutic Alliance ◽  
Community Pharmacy ◽  
Patient Outcomes ◽  
Qualitative Content Analysis ◽  
Original Research ◽  
Routine Practice ◽  
Medication Therapy ◽  
Advantages And Disadvantages ◽  
Innovative Practice

Purpose: This qualitative study was concerned with investigating community pharmacists' thoughts on the use of two brief scales to measure patient outcomes and therapeutic alliance in the context of their Medication Therapy Management (MTM) services. The scales were originally developed for use in behavioral healthcare, but were used in a novel (community pharmacy) setting as part of a previous parent study. We describe this practice (using these scales in a novel setting) as an innovative practice, report on the pharmacists' experiences with the practice, and discuss relative advantages and disadvantages for integrating the use of the scales as part of routine practice. Methods: Six community pharmacy practitioners participated in a semi-structured interview pertaining to the use of the scales in their MTM services. Pharmacist interviews were transcribed, analyzed according to qualitative content analysis methodology, and presented in relation to the guiding interview questions. Results: Pharmacists had varying opinions on the use of the scales as part of their practice. Initial concerns included patient (mis)understanding about the purpose and proper completion of the scales, as well as apprehension about the use of the information. These concerns were largely resolved through education, repeated use, and routinization. Pharmacists, in general, saw a value to using these scales in clinical practice, for clinical and professional reasons, although there was variability on the degree to which pharmacists integrated the scales into practice after the study completion. Pharmacists had varied opinions as well as on the degree to which the use of the scales would impact medication adherence. Pharmacists were most surprised by how much participation in this study prompted them to reflect on their interactions with patients. Conclusions: Pharmacists, in general, were receptive to participating in the parent study and using two brief scales to measure patient outcomes and therapeutic alliance. Pharmacists had varying opinions on the degree to which the use of these scales could impact patient medication adherence, although they perceived other value and benefits secondary to the interactions. While most pharmacists did not maintain formal use of the scales after study end, they took away general principles of patient-centered care and individualized feedback.   Type: Original Research

scholarly journals Medication adherence and its relationship to the therapeutic alliance: Results from an innovative pilot study within a community pharmacy MTM practice

2011 ◽  
Vol 2 (1) ◽  
Author(s):  
Janice Pringle ◽  
Michael Melczak ◽  
Arnie Aldridge ◽  
Margie Snyder ◽  
Randall Smith
Keyword(s):  
Medication Adherence ◽  
Therapeutic Alliance ◽  
Community Pharmacy ◽  
Comparison Group ◽  
Intervention Group ◽  
Community Pharmacists ◽  
Original Research ◽  
Percentage Point Increase ◽  
Medication Therapy ◽  
Quasi Experimental

Objectives: To determine whether patients who received Medication Therapy Management (MTM) from community pharmacists using a brief scale to measure Therapeutic Alliance (i.e., MTM + TA) would show better medication adherence than patients who received MTM without use of the TA scale (MTM only). Design: Quasi-experimental, using a direct intervention group (MTM + TA) and a comparison group of randomly selected claims records from patients who received only the MTM service (MTM only). We used a doubly robust propensity score approach to estimate the average effect of therapeutic alliance on medication adherence. The analysis was limited to the following broad medication categories: antihypertensives, antidiabetic agents, and antihyperlipidemics. Setting: The direct intervention group included patients receiving MTM services from pharmacists in a community pharmacy chain setting. Participants: After matching with claims data, the direct intervention group was n=117, with an average age of 76.4. The comparison group was n=146, with an average age of 76.2. Intervention: Administration of two brief scales designed to measure general health outcomes and TA within the context of MTM (with focus on TA scale administration). Main Outcome Measures Proportion of Days Covered (PDC) and PDC80. Results: Using the therapeutic alliance scales in the context of community pharmacist-provided MTM was associated with a 3.1 percentage point increase in patients' overall PDC (p<.001) and an increase of 4.6 percentage points in PDC80 (p=.02) as compared to patients receiving MTM without use of the therapeutic alliance scales. Conclusion: Measuring therapeutic alliance in the context of MTM is associated with improved medication adherence and represents one strategy for enhancing the effectiveness of MTM encounters. Furthermore, administration of the therapeutic alliance scales used very little time; therefore it is likely feasible for pharmacists to routinely use the scales in their practice. Type: Original Research

scholarly journals Development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population

2013 ◽  
Vol 4 (4) ◽  
Author(s):  
Sarah E. Kelling ◽  
David R. Bright ◽  
Timothy R. Ulbrich ◽  
Donald L. Sullivan ◽  
James Gartner ◽  
...  
Keyword(s):  
Community Pharmacy ◽  
Care Service ◽  
Care Program ◽  
Medication Therapy Management ◽  
Original Research ◽  
Transition Of Care ◽  
Therapy Management ◽  
Medication Therapy ◽  
Medicaid Population ◽  
Managed Medicaid

Objective: To describe successes and barriers with the development and implementation of a community pharmacy medication therapy management-based transition of care program in the managed Medicaid population. Setting: A single supermarket chain pharmacy Practice description: Community pharmacists provide dispensing and non-dispensing pharmacy services including medication therapy management, biometric wellness screenings, and immunizations. Practice innovation: Developed and implemented a community pharmacy medication therapy management-based transition of care program for patients with managed Medicaid Main outcome measures: Feasibility of developing and implementing a transition of care service in a community pharmacy Results: During the first six months, a total of 17 patients were seen as part of the program. Study pharmacists identified successes and potential strategies for overcoming barriers. Conclusion: Developing and implementing a community pharmacy transition of care program for patients with managed Medicaid was logistically feasible.   Type: Original Research

scholarly journals Knowledge about Disease, Medication Therapy, and Related Medication Adherence Levels among Patients with Hypertension

Medicina ◽  
2019 ◽  
Vol 55 (11) ◽  
pp. 715 ◽  
Author(s):  
Gavrilova ◽  
Bandere ◽  
Rutkovska ◽  
Šmits ◽  
Mauriņa ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Patient Outcomes ◽  
Study Data ◽  
The Self ◽  
Demographic Differences ◽  
Cross Sectional ◽  
Medication Therapy ◽  
Adherence Scale ◽  
Medication Taking Behavior ◽  
Insight Into

Background and Objectives: A particular problem in cardiology is poor adherence to pharmacological treatment among patients with hypertension. It is known that approximately half of these patients do not use their medications as prescribed by their doctor. Patients may choose not to follow the doctor’s recommendations and regularly do not control their blood pressure, owing to many factors. A convenient method for measuring the level of adherence is the Morisky Medication Adherence Scale, which also provides insight into possible remedies for low adherence. We investigated their therapy, knowledge about the disease and its control, and demographic differences to assess the adherence of patients with hypertension. Materials and Methods: This was a cross-sectional observational study. Data were collected through a survey of 12 pharmacies in Latvia. The study involved 187 participants with hypertension. Results: The prevalence of non-adherence was 46.20% in Latvia. The oldest patients were the most adherent (p = 0.001, β = 0.27). The higher the self-rated extent from 0 to 10, to which the patient takes their antihypertensives exactly as instructed by their physician, the higher the level of adherence (p < 0.0001, β = 0.38), where at “0”, the patient does not follow physician instructions at all, and at “10”, the patient completely follows the physician’s instructions. Non-adherent patients tend to assess their medication-taking behavior more critically than adherent patients. The longer the patient is known to suffer from hypertension, the more adherent he or she is (p = 0.014, β = 0.19). Conclusions: Medication non-adherence among patients with hypertension is high in Latvia. Further investigations are needed to better understand the reasons for this and to establish interventions for improving patient outcomes.

scholarly journals Integrating Components of Medication Therapy Management Services into Community Pharmacy Workflow

2014 ◽  
Vol 5 (2) ◽  
Author(s):  
Corey A. Lester ◽  
Jennifer L. Helmke ◽  
Tana N. Kaefer ◽  
Leticia R. Moczygemba ◽  
Jean-Venable R. Goode
Keyword(s):  
Community Pharmacy ◽  
Health Monitoring ◽  
Medication Therapy Management ◽  
Original Research ◽  
Community Practice ◽  
Therapy Management ◽  
Work System ◽  
Medication Therapy ◽  
Before And After ◽  
Management Services

Objective: The objective of this study was to develop and evaluate a process for integrating components of medication therapy management services into a community pharmacy workflow. Secondary objectives were to evaluate outcomes as well as patient and pharmacist satisfaction with this change. Methods: This prospective, 3-month observational study took place in a small, independent community pharmacy. This intervention included a redesigned work system that included a seated private desk area and focus on the pharmacist, rather than the technician, being the first contact when patients entered the pharmacy. Pharmacists participated in a focus group before and after the implementation of the new workflow to better understand the delivery of the intervention and assess satisfaction. Process outcomes included time spent with the patient, the number of medication-related problems identified and recommendations made, the type of disease education provided, type and number of immunizations administered, and health monitoring tests performed. Patient satisfaction surveys were distributed after completing the intervention during the third month of the study. Results: A total of 56 patients were enrolled in this study resulting in 82 encounters. Forty medication-related problems, including experiencing an adverse drug reaction and ineffective therapy, were identified with recommendations made to patients or prescribers. Disease education, such as goals of therapy, was provided 46 times. Health monitoring tests, such as blood pressure, were performed 16 times and eight immunizations were administered. The revised workflow incorporating components of MTM services was successful in that 39% of encounters were less than two minutes and 49% of encounters were between two and five minutes in length. Only 12% of encounters were greater than five minutes. Overall, patients were very satisfied with the intervention. Pharmacists responded positively, but expressed concern that the changes to the work system prevented them from overseeing technician functions. Conclusion: Pharmacists in community practice are able to provide components of medication therapy management services during a brief, face-to-face interaction with patients. Overall, patients and pharmacists were satisfied with the changes to the pharmacy work system and that additional work system changes are needed to further expand the role of the community pharmacist and facilitate patient-pharmacist interactions.   Type: Original Research

scholarly journals Identifying medication-related needs of HIV patients: foundation for community pharmacist-based services

2014 ◽  
Vol 5 (1) ◽  
Author(s):  
Yardlee Kauffman ◽  
Elana Barkowitz ◽  
Nicole Cerussi ◽  
Jan Pringle ◽  
Melissa McGivney
Keyword(s):  
Community Pharmacy ◽  
Community Pharmacist ◽  
Patient Perspectives ◽  
Rural Site ◽  
Urban Site ◽  
Original Research ◽  
Care Providers ◽  
Medication Therapy ◽  
Living With Hiv ◽  
Hiv Aids

Background: Patients living with HIV/AIDS have complex medication regimens. Pharmacists within community pharmacy settings can have a role managing patients living with HIV/AIDS. Patients' perspectives surrounding implementation about community pharmacist-based services is needed as limited information is available. Objective: To identify medication-related needs of HIV-infected patients who receive prescriptions from a community pharmacy. To determine patient perspectives and knowledge of community pharmacist-based services. Methods: A qualitative research study involving in-depth, semi-structured interviews with patients was conducted. Inclusion criteria included: HIV positive men and women at least 18 years of age who receive care at a HIV clinic, currently take medication(s) and use a community pharmacy for all prescription fills. Patients were recruited from one urban and one rural health center. Patients answered questions about their perceptions and knowledge about the role and value of pharmacy services and completed a demographic survey. The recordings of the interviews were transcribed verbatim and were analyzed using principles of Grounded Theory. Results: Twenty-nine interviews were conducted: 15 participants from the urban site and 14 from the rural site. Five main themes emerged including: patients experience ongoing and varying medication-related needs; patients desire a pharmacist who is caring, knowledgeable and integrated with health care providers; patients expect ready access to drug therapy; patients value an individualized patient encounter, and patients need to be informed that a pharmacist-service exists. Conclusion: Patients with HIV value individualized and personal encounters with pharmacists at time intervals that are convenient for the patient. Patients felt that a one-on-one encounter with a pharmacist would be most valuable when initiating or modifying medication therapy. These patient perspectives can be useful for pharmacists and pharmacies interested in providing advanced care to patients with HIV.   Type: Original Research

Does improved medication adherence reduce inpatient hospital expenditures?

2017 ◽  
Vol 11 (3) ◽  
pp. 248-270 ◽  
Author(s):  
David M. Scott ◽  
Tom Christensen ◽  
Anqing Zhang ◽  
Daniel L. Friesner
Keyword(s):  
Medication Adherence ◽  
Calcium Channel ◽  
Community Pharmacy ◽  
North Dakota ◽  
Patient Specific ◽  
Administrative Claims ◽  
Inpatient Hospitalization ◽  
Content Type ◽  
Medication Therapy ◽  
Hospitalization Costs

Purpose This study aims to assess whether patients [who receive community pharmacy services at locations where routine medication therapy management (MTM) care is reimbursed] who were adherent to their medications generated lower inpatient hospitalization expenses. Design/methodology/approach This is a retrospective, descriptive and cross-sectional study using administrative claims data drawn from 84 community pharmacies in North Dakota. The included patients were enrolled in a Blue Cross Blue Shield of North Dakota insurance plan and were taking one or more of eight groups of medications (metformin, antidepressants, anti-asthmatics, ACEs/ARBs, beta-blockers, calcium channel blockers, diuretics and statins) commonly prescribed to treat chronic conditions filled between July 1, 2014 and June 30, 2015. Community pharmacists used software that allowed the pharmacists to provide and bill for MTM services. Data from these sources were used to calculate medication adherence and inpatient costs. Findings Patients prescribed a beta blocker, a calcium channel blocker, and a diuretic or an anti-diabetic medication, and those who are fully adherent to their medications were associated with significantly lower inpatient hospitalization costs (as measured by insurance payments to hospitals) as compared to non-adherent patients. Patients who were fully adherent to their medications had no statistically significant differences in patient-specific costs compared to non-adherent patients. Originality/value Patients receiving services at a community pharmacy that offers MTM services and those who were adherent to their medication regimens generate lower health care expenses. Most of the savings come from lower hospitalization expenses, rather than patient-paid expenses.

scholarly journals Medication Adherence Improvements in Employees Participating in a Pharmacist-Run Risk Reduction Program

2012 ◽  
Vol 3 (4) ◽  
Author(s):  
Mallory C. McKenzie ◽  
Thomas L. Lenz ◽  
Nicole D. Gillespie ◽  
Jessica J. Skradski
Keyword(s):  
Medication Adherence ◽  
Risk Reduction ◽  
Medication Possession Ratio ◽  
Employee Health ◽  
Adherence Rate ◽  
Original Research ◽  
Matched Cohort ◽  
Medication Therapy ◽  
Reduction Program ◽  
High Adherence

Objective: To evaluate the medication adherence of individuals participating in a pharmacist-run employee health Cardiovascular and Diabetes Risk Reduction Program. Design: Retrospective analysis of medication adherence using pharmacy refill data. Setting: A medium sized university located in the Midwest United States and the organization's outpatient pharmacy. Participants: 38 participants ≥ 18 years of age, employed and receiving their health insurance through the organization, and have a diagnosis of hypertension, hyperlipidemia, diabetes mellitus, or a combination thereof. Intervention: Participation in the risk reduction program that emphasizes medication therapy management (MTM), lifestyle medicine and care coordination. Main Outcome Measures: The Proportion of Days Covered (PDC) and the Medication Possession Ratio (MPR). Results: PDC and MPR analysis showed a statistically significant improvement in medication adherence for 180 days and 360 days post enrollment versus the 180 days prior to enrollment (P<0.01). The PDC analysis demonstrated a statistically significant improvement in the number of medications that achieved a PDC ≥ 80% (high adherence) for the 180 days post enrollment versus the 180 days prior to enrollment (+30%, P<0.01). The MPR analysis showed a non-statistically significant improvement in the number of medications that achieved an MPR ≥ 80% (high adherence) pre enrollment versus post enrollment (+10%, P=0.086). The percentage of participants in the program that reached a PDC and MPR adherence rate ≥ 80% at 180 days post enrollment was 78.9% and 94.4%, respectively which exceeds that of a matched cohort that reached a PDC and MPR adherence rate ≥ 80% of 66.4% and 82.8%, respectively. Conclusion: Pharmacists can improve medication adherence as measured by PDC and MPR when working with employees enrolled in a novel pharmacist-run employee health risk reduction program. Medication adherence was shown to be sustainable for at least one year and was shown to be better when compared to a matched cohort of similar age, condition and region.   Type: Original Research

scholarly journals The Effect of Zero Copayments on Medication Adherence in a Community Pharmacy Setting

2019 ◽  
Vol 10 (2) ◽  
pp. 16
Author(s):  
Melissa Jimenez ◽  
Goar Alvarez ◽  
Albert Wertheimer ◽  
Leanne Lai ◽  
Leroy Koh ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Community Pharmacy ◽  
Financial Burden ◽  
Prescription Medication ◽  
Original Research ◽  
Article Type ◽  
Significant Difference ◽  
Generic Medications ◽  
Proportion Of Days Covered ◽  
Prescription Refill

Background: Prescription medication copayments can be a financial burden to many patients. When patients cannot afford their medications, they may become nonadherent, and as a result, this can lead to an increase in chronic disease complications and healthcare costs. Objective: The objective of this study was to determine if zero copayments have an effect on medication adherence in a community pharmacy. Methods: This retrospective cohort study examined the prescription refill records of patients who filled specific generic medications for hypertension, hyperlipidemia, and gastroesophageal reflux disease (GERD) in 2016 at the NSU Clinic Pharmacy. The adherence rates of patients with zero copayments were compared to the adherence rates of patients with copayments greater than $0. Adherence was determined by calculating the proportion of days covered (PDC). Patients were considered adherent if their PDC was greater than or equal to 80%. Results: GERD patients with no copayments had average PDC ratios of 87.4% and were statistically significantly more adherent than GERD patients with copayments, who had average PDC ratios of 76.7% (P = 0.042). Hyperlipidemia and hypertension patients with no copayments had average PDC ratios of 89.3% and 90.3%, respectively, and those with copayments had PDC ratios of 85.3% (P = 0.314) and 87.9% (P = 0.534). Conclusion: Overall, patients with $0 copayments had higher adherence rates than patients with copayments greater than $0. GERD patients with no copayments were significantly more adherent than GERD patients with copayments. However, no statistically significant difference was found between patients with or without copayments in the hyperlipidemia and hypertension cohorts. Further studies are recommended to analyze additional factors that may influence medication adherence.   Article Type: Original Research

scholarly journals Blending Indigenous Sharing Circle and Western Focus Group Methodologies for the Study of Indigenous Children’s Health: A Systematic Review

2021 ◽  
Vol 20 ◽  
pp. 160940692110151
Author(s):  
Sarah C. Hunt ◽  
Nancy L. Young
Keyword(s):  
Systematic Review ◽  
Focus Group ◽  
Focus Groups ◽  
Qualitative Content Analysis ◽  
Children's Health ◽  
Children’S Health ◽  
Community Advisory Board ◽  
Original Research ◽  
Research Approach ◽  
Sharing Circles

The primary objective of this systematic review was to investigate how Western focus groups and Indigenous sharing circles have been blended for the study of Indigenous children’s health. The secondary objective of this study was to propose recommendations for adapting focus groups to include elements of sharing circles. This systematic review was conducted using a systematic search of original research articles published between 2009 and 2020 that (a) focused on North American Indigenous children’s health and (b) used group-based qualitative methods including focus groups and sharing circles. Each of the articles was screened for relevance and quality. The methods sections were reviewed, subjected to qualitative content analysis, and codes were analyzed to identify common themes and synthesize results. We identified 29 articles, most of which followed a community-based participatory research approach. In these publications, most included a community advisory board, ethics approval was obtained, and in some cases, community members were included as research assistants. There was evidence that sharing circles and focus group methods had been blended in the recent Indigenous children’s health literature. This was particularly apparent in the authors’ approaches to recruitment, location, facilitation techniques, question format and reimbursement. Several groups have published results that describe approaches that successfully incorporated aspects of Indigenous sharing circles into Western focus groups, thus establishing a research method that is culturally safe and appropriate for the study of Indigenous children’s health.

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