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Building the Case: Changing Consumer Perceptions of the Value of Expanded Community Pharmacist Services
Abstract
Background:
The role of the community pharmacist has traditionally been a medication dispenser; however, community pharmacists' responsibilities must expand to include more direct patient care services in order to transform primary care practice.
Objectives:
Use case-based scenarios to (1) determine factors that contribute to positive and negative consumer perceptions of expanded community pharmacist patient care roles, (2) identify facilitators and barriers that contribute to consumer perceptions of the value of expanded community pharmacist patient care services, and (3) develop a successful approach and strategies for increasing consumer advocacy for the value of expanded community pharmacist patient care services.
Methods:
Two consumer focus groups used scenario-based guided discussions and Likert scale questionnaires to elicit consumer reactions, facilitators, and barriers to expanded community pharmacist services.
Results:
Convenience, timeliness, and accessibility were common positive reactions across all 3 scenarios. Team approach to care and trust were viewed as major facilitators. Participant concerns included uncertainty about pharmacist training and qualifications, privacy, pharmacists' limited bandwidth to accept new tasks, and potential increased patient costs. Common barriers to service uptake included a lack of insurance payment and physician preference to provide the services.
Conclusion:
Consumer unfamiliarity with non-traditional community pharmacist services is likely an influencer of consumers' hesitancy to utilize such services; therefore, an opportunity exists to engage consumers and advocacy organizations in supporting expanded community pharmacist roles. This study can inform consumers, advocates, community pharmacists, primary care providers, and community-based organizations on methods to shape consumer perceptions on the value of community pharmacist expanded services.
... The passive approach, using the flyer method resulted in a very low uptake of screenings, whereas a personalised approach from trusted pharmacy staff resulted in higher yield. 28 Interventions with adequate training has been described to generate more positive results and outcomes. 29 All pharmacy staff interviewed described a willingness to conduct screening, and this is consistent with a high level of altruism expressed by pharmacists regarding participation in public health interventions. ...
... However, an observer effect may detract from the natural method of the study, especially as the pre-existing relationship and encouragement between pharmacy staff and consumer was cited to be a major facilitator. 28,40 This difficulty in measuring fidelity to the intervention is similar to other studies. 7 Additionally, this was a feasibility study for the screening service where individualisation of service delivery to cater to the pharmacy's unique consumers and workflow is ideal. ...
Issues Addressed
Osteoporosis and poor bone health impact a large proportion of the Australian population, but is drastically underdiagnosed and undertreated. Community pharmacies are a strategic location for osteoporosis screening services due to their accessibility and the demographic profile of customers. The aim of this study was to develop, implement and evaluate a community pharmacy health promotion service centred on encouraging consumers to complete an anonymous osteoporosis screening survey called Know Your Bones.
Methods
The implementation process was documented using the REAIM (reach, effectiveness, adoption, implementation, maintenance) framework. Uptake of the Know Your Bones screening tool was monitored anonymously with website traffic. Surveys and interviews were designed to capture consumer outcomes after screening. Semi‐structured interviews were conducted with Australian community pharmacy stakeholders during design and implementation phases to explore their perspectives of the barriers and facilitators.
Results
The service was implemented in 27 community pharmacies. There were 448 visits to the screening website. Interviews were conducted with 41 stakeholders. There were a range of factors that appeared to influence implementation of the service. Perceived acceptability was critical, which depended on staff training, pharmacists' altruism, and remuneration. Staff relied heavily on their existing close relationships with consumers. No consumers completed non‐anonymous surveys or agreed to participate in interviews post‐screening.
Conclusion
Using an implementation science approach, a community pharmacy osteoporosis screening service for the Australian context was designed and found to be acceptable to pharmacy staff and effective in reaching the target population.
So What?
This low‐cost and non‐invasive health promotion has potential to sustainably increase national screening rates for osteoporosis.
... 11 Other studies have identified barriers related to inadequate pharmacist training, staff shortages, and service costs. 12 Furthermore, the lack of supportive legalisation of ECPSs 13 and incentives for pharmacists have been highlighted. 14 In June 2016, the Saudi government unveiled its ambitious 2030 vision plan. ...
... ECPSs and associated tools, such as APSs, are emerging applications worldwide that can potentially improve health management and reduce avoidable medical complications. 12 Despite their added value, the transition to ECPSs is limited or unequal worldwide and particularly slow in SA. Thus, this study investigated the capacity and readiness of CPs for Saudi national strategic and health system reforms towards APS and ECPS applications. ...
Background
Private sector partnerships through community pharmacies are essential for effective healthcare integration to achieve the United Nations 2030 Agenda for Sustainable Development Goals. This partnership can provide significant clinical outcomes and reduce health system expenditures by delivering services focused on patient-centred care, such as public health screening and medication therapy management.
Objectives
To assess the understanding of the proposed strategic and health system reform in Saudi Arabia by exploring community pharmacists' perspectives towards the capacity and readiness of community pharmacies to use automated pharmacy systems, provide extended community pharmacy services, and identify perceived barriers.
Materials and methods
This multicentre, cross-sectional, web-based survey was conducted in Saudi Arabia (October–December 2021). Graphical and numerical statistics were used to describe key dimensions by the background and characteristics of the respondents, and multiple ordinal logistic regression analyses were sought to assess their associations.
Results
Of the 403 consenting and participating community pharmacists, most were male (94%), belonged to chain pharmacies (77%), and worked >48 h per week (72%). Automated pharmacy systems, such as electronic prescriptions, were never utilised (50%), and health screening services, such as blood glucose (76%) and blood pressure measurement (74%), were never provided. Services for medication therapy management were somewhat limited. Age groups ≤40 years, chain pharmacies, >10 years of experience and ≥ 3 pharmacists in place with <100 daily medication prescriptions and Jazan province were significantly more likely to provide all medication therapy management services than others. Operational factors were the barriers most significantly associated with the independent variables.
Conclusion
The results showed that most services and automated pharmacy systems remained limited and well-needed. When attempting to implement these services to drive change, community pharmacies face numerous challenges, and urgent efforts by private and government sectors are essential to improve pharmaceutical care in community pharmacy settings.
... 75 Overall, there was an insufficient level of privacy within pharmacy services. 57 Participants expressed increased privacy could be achieved by reducing noise, moving to a quieter area of the store or avoiding conversations in front of other people. 51 The dominance of privacy as an issue in pharmacy health service is an important one affecting an individual's decision to use community pharmacy as the first point of contact. ...
... Seubert et al. 56 Australia Focus groups Pharmacists (28); pharmacy assistants (5); and pharmacy service users (27) Privacy within the pharmacy environment Steckowych et al. 57 The US Focus groups Pharmacy service users (18) and community pharmacies (18) (independent pharmacies (1) and chains (17) (67)); location (cites (108) and suburbs (2)); and drug misuse services Privacy within the pharmacy environment ...
Aim
This systematic review aimed to provide new insights into how pharmacy spaces, or the architecture of pharmacies, are experienced by pharmacy service users and staff. The review sought to identify environmental factors which may influence service users’ and staff participation in community-based pharmacy health services.
Method
Ten databases were searched for English language publications, using a combination of search terms relating to pharmacy service users and staff; pharmacy spaces; and health and social care outcomes. Data from the final selected studies were extracted, thematically analysed using a narrative approach and the quality of each study assessed using the Integrated quality Criteria for the Review of Multiple Study designs (ICROMS).
Results
80 articles reporting 80 studies published between 1994 and 2020 were identified; they were from 28 countries, involving around 3234 community pharmacies, 13,615 pharmacy service users, 5056 pharmacists and 78 pharmacy health staff. Most studies (94%) met the ICROMS minimum score, and half did not meet the mandatory quality criteria. Four themes likely to influence service users’ and staff experiences of pharmacy health services were identified: (1) privacy; (2) experience of the physical environment; (3) professional image; and (4) risk of error.
Conclusion
To optimise the delivery and experience of pharmacy health services, these spaces should be made more engaging. Future applied research could focus on optimising inclusive pharmacy design features.
... When a new function of pharmacists is introduced into medical practice, patients will be concerned about the training and qualifications of pharmacists. 45 The consultation room of PMC is an important determinant for patients in the experiential and content types, but not for patients in the economic type. As shown in some studies, patients' preference for a dedicated consultation room may be related to their need for privacy protection. ...
Purpose
This study aimed to survey and analyze the preferences for pharmacist-managed clinic among urban residents in China.
Materials and Methods
A discrete choice experiment was conducted in Nanjing, China. A D-efficient fractional factorial design was used to generate the questionnaire. Three models were used to investigate each patient’s strength of preference and preference heterogeneity. The relative importance for each treatment attribute was also determined.
Results
156 usable questionnaires (of 228 questionnaires sent out) were received. Respondents preferred pharmacist-managed clinics with the following characteristics: good pharmacists’ knowledge and clinical medication practice competency, lower consultation fees, a dedicated consultation room, physician-pharmacist joint clinic, with pharmacists’ knowledge competency receiving the highest priority. Latent class analysis revealed three classes (Experiential Type, Content Type and Economic Type) were identified based on respondents’ preferences for pharmacist-managed clinics.
Conclusion
The respondents were willing to choose a PMC relative to the current situation. When deciding on a pharmacist-managed clinic, residents are driven by pharmacists’ competency, consultation fee, availability of consultation rooms and collaborative care or independent pharmacist service. Differences in patients’ preferences identified in the study provide information on pharmacist-managed clinics that meet residents’ expectations.
... Community pharmacies are essential healthcare destinations that serve as an optimal resource for addressing non-urgent inquiries, such as safe injecting practices, management of adverse drug reactions, and medication provision, thus reducing the burden on general practitioners (GPs) [1,2]. Pharmacists also have a role in addressing social determinants of health and promoting health equity, including the support of primary prevention strategies such as harm reduction interventions [3], for example through needle and syringe programs (NSPs) [4,5]. ...
Background
While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic–androgenic steroid (AAS) consumers.
Objective
This study aimed to triangulate the attitudes and experiences of AAS consumers and community pharmacist’s regarding AAS harm reduction.
Methods
Semi-structured interviews were conducted with AAS consumers (n = 8) and community pharmacists (n = 15) between December 2022 and August 2023 in Australia. Interview data were analysed using reflexive thematic analysis.
Results
While consumers emphasised easy access to pharmacies, particularly in urban areas, challenges were noted in rural regions. AAS consumers expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with AAS consumers. Similarly, pharmacists expressed receptivity to providing harm reduction information but acknowledged knowledge gaps, suggesting a need for tailored education programs to support AAS consumers effectively.
Conclusions
Community pharmacies can be an important environment for AAS harm reduction. Strategies include utilising private spaces for open discussions with AAS consumers and enhancing pharmacists' understanding of AAS to foster trust and support. Further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.
... The IBD cohort in the current study identified lack of privacy to discuss sensitive concerns and long wait times among barriers to expanded care from pharmacists. Patients in other studies have also raised concerns about privacy in pharmacies, 4,16,17 indicating this reflects a broader issue. A mobile phone app was suggested as one means of enhancing privacy. ...
Background:
Patients' perceptions of their interaction with pharmacists can affect how they use this resource for chronic disease care.
Objective:
This qualitative study explored pharmacist-patient interactions and patients' perceptions of pharmacists' roles in cardiovascular disease (CVD) and inflammatory bowel disease (IBD).
Methods:
Patient volunteers, recruited through Janssen's Patient Engagement Research Council program, completed a 15-minute prework survey before a 90-minute live virtual focus group session to provide feedback on pharmacist-patient interactions, the pharmacist's role in patient care, and recommendations for improvement.
Results:
In total, 27 patients participated. Amongst patients with CVD (n=18), 56% were female, 61% aged ≥65 years, and 39%/39% Black/White. Of those with IBD (n=9), 56% were female, 89% aged 25-44 years, and 33%/56% Black/White. In the CVD cohort, patients conversed with their pharmacists at least monthly, on average. Patients were generally happy with their relationship with their pharmacist, viewing pharmacists as a trusted resource for medication information. Polypharmacy was common in the CVD cohort (mean, 10.8 medications). For patients with IBD, pharmacist-patient interactions were less frequent, relationships were generally perceived as transactional, patients took fewer medications (mean, 3.2), and felt uncomfortable discussing their disease in public. All patients (CVD and IBD) were unaware of pharmacists' medical training/knowledge. Recommendations included private spaces for sensitive conversations, phone/text support, in-depth regular check-ins, and proactive communication to highlight that the pharmacist's role is to provide patient-centered holistic care.
Conclusion:
This research demonstrates a lack of understanding of pharmacist training, accessibility, and role among patients with chronic disease, and highlights opportunities to amend delivery of care. These insights can be used to inform strategies and approaches tailored to address unique needs of specific patient populations to enhance pharmacist-patient interactions.
... Community pharmacies are essential healthcare destinations that serve as an optimal resource for addressing non-urgent inquiries, such as safe injecting practices, management of adverse drug reactions, and medication provision, thus reducing the burden on general practitioners (GPs) 15,16 . Pharmacists also have a role in addressing social determinants of health and promoting health equity, including the support of primary prevention strategies such as harm reduction interventions 17 , for example through needle and syringe programs (NSPs) 18, 19 . ...
Background
While community pharmacies have been successful in providing harm reduction support for illicit substance consumers, little research has explored their role in addressing the needs of anabolic-androgenic steroid (AAS) consumers.
Objective
This study aims to understand the attitudes and experiences of AAS users in relation to community pharmacies, with the goal of identifying opportunities for harm reduction interventions and creating safer-use environments.
Methods
Semi-structured interviews were conducted with eight AAS consumers living in Australia between December 2022 and April 2023. Interview data were analysed using reflexive thematic analysis.
Results
Participants discussed accessing AAS equipment and overcoming challenges, such as limited access in rural areas. They highlighted the disparity between the availability and accessibility of equipment from pharmacies and needle and syringe programs. Participants expressed a preference for community pharmacies, perceiving them as less confronting and a feasible avenue for accessing professional advice, highlighting the potential role of pharmacists in nurturing therapeutic alliances with users of AAS. Overall consumers supported the idea of AAS safe-injecting kits being available in pharmacies and they were receptive to pharmacies as potential sources of information and support.
Conclusions
The findings suggest that community pharmacies can further contribute to promoting safer AAS use and providing support for consumers. However, further research is needed to address knowledge gaps and training needs for pharmacy staff, with the aim of creating a safer environment for AAS consumers.
... The literature so far has not focused on the entire policy process, only pieces of the process. For example, the international literature has only reported some barriers to integrating pharmacists, such as the lack of regulation and role standards, which may prevent accountability and role responsibilities for advanced pharmacist positions (Bader et al., 2017;Steckowych et al., 2018). In regard to the design and implementation of expanded services in community pharmacies, Moullin et al., (2016), show that there is a lack of collaboration and communication between the pharmacy profession and other health professions, which may exacerbate the challenges (e.g. ...
A well-integrated primary health care system helps address the health needs of an ageing population with complex multiple health conditions. In Australia pharmacists provide services to maximise health gains from medication use, although they are not well integrated into primary care. Using the case of Australia, this study investigates why integrating pharmacists in primary care has not been addressed at the national level and also identifies strategies that could promote policy change. Using a unique dataset generated via 33 semi-structured interviews with healthcare leaders and policymakers across relevant disciplines, we undertake a systematic and comprehensive analysis of the policy with the Multiple Stream Framework. This framework examines the policy process with five elements: problem, policy, and political streams; policy entrepreneur; and policy window. The problem stream showed that the primary healthcare system struggles to cope with the increasing healthcare demand and the prevalence of medication-related problems. The policy stream suggests that the consumers would benefit from an integration of pharmacists into primary care to solve these problems; however, policy proposals cannot survive under current circumstances. The political stream revealed the political barriers that have come from conflicts among interest groups within the profession and the healthcare sector. To advocate their pet policy, policy entrepreneurs should have stronger roles in shaping the “policy idea” to gain its acceptance among the policy community, and to reduce political barriers. Strategies to overcome the barriers include evidence accumulation, role development in light of population needs, and interorganisational collaboration across members of the healthcare network.
... The current study indicated that actual knowledge about pharmacists professional competence was insufficient in all ethnic groups. Other studies have shown that the absence of the patient-pharmacist relationship causes patients to be uncertain of the pharmacist's role, but also that a pharmacist's own professional identity and associated role conflict could be seen as a barrier for delivering person-centered care [47][48][49]. Therefore, a person-centered approach recognizing a patient s preferences, values and needs to increase their independence and autonomy should be considered in the future. ...
The unique professional competence of pharmacists can support the safe and effective use of medicines by patients. Additionally, it is important to acknowledge and incorporate the needs of patients with various cultural and social backgrounds. The objective of this study was to assess and compare the experiences and expectations of Russian- and Estonian-speaking pharmacy customers about medicines-related services in Estonian community pharmacies. Cross-sectional study among pharmacy customers was conducted in Estonia 2018–2020. For data analysis, an Independent t-Test was used to compare experiences and expectations of respondents towards medicines-related services. The study involved 552 pharmacy customers: 58.5% (n = 323) Estonians and 41.5% (n = 229) Russians. The majority of the total sample (78.3%) considered the pharmacist competent to help. Medicines-related concerns were more common among Russians (p = 0.037), however, they sought less contact to consult a pharmacist than Estonians (p < 0.001). Furthermore, expectations about different medicines-related services in the future were higher among Estonians than among Russians (p < 0.001). Community pharmacists in Estonia should focus more on person-centered care to better meet the expectations and needs of different ethnic groups about medicines-related services. It is also important to reduce the language barrier and to increase the recognition of cultural traditions by health professionals.
... 30 Therefore, high and equitable participation is crucial to ensuring health gain and preventing health inequalities, and it requires patients and physicians to recognize the clinical skills of pharmacists. 31,32 A study by the National Health Service on the CVD risk profile of the Portuguese population revealed a high prevalence of CVD risk factors and the need for health authorities to develop strategies to screen the general population for CVD risk factors. 33 This study aims to evaluate the feasibility of the whole process of CVD risk screening in Portuguese community pharmacies, including the characterization of the profile of the community pharmacy customers, the evaluation of their acceptability of CVD risk assessment by the pharmacist, the evaluation of the reasons for nonattendance, and the assessment of CVD risk status and CVD risk factors identified among the customers. ...
Background: Cardiovascular disease (CVD) remains the leading cause of human mortality. As highly accessible and qualified health professionals, community pharmacists can be included in the early detection of patients at risk for CVD by implementing CVD screening programs.
Objective: To assess the feasibility of CVD risk screening services in Portuguese community pharmacies from the evaluation of customers acceptability.
Methods: A cross-sectional study was conducted in a community pharmacy in Portugal. The purpose of entering the pharmacy was recorded for all customers. Afterwards, the customers were invited to be interviewed by the pharmacist, who registered their willingness to participate and collected the participants’ data and biochemical and physical parameters to assess their CV risk by applying the Systematic COronary Risk Evaluation (SCORE) model. For the participants who were not eligible for the SCORE-based risk assessment, the pharmacist considered the major modifiable CVD risk factors - hypertension, dyslipidemia, smoking habits, obesity, impaired fasting glucose and sedentary behavior - according to the ESC guidelines.
Results: Picking up medication was the most prevalent reason 69.8% (n=1,600) for entering the pharmacy, and among the contacted customers, 56.4% (n=621) agreed to have their CVD risk assessed. Of the 588 participants, 56.6% (n=333) were already on CV pharmacotherapy and were therefore not eligible for screening. Of the 43.4% (n=255) CV pharmacotherapy-naïve participants, 94.9% (n=242) were screened with at least one CVD risk factor; 52.9% (n=135) were not eligible for the SCORE assessment, of which 92.6% (n=125) presented CVD risk factors. Of the 120 SCORE eligible participants, 80.0% (n=96) were at least at moderate risk of CVD.
Conclusions: We determined the feasibility of CVD risk screening in Portuguese community pharmacies, as we found high customer acceptability, noted the reasons for nonattendance, and found a high prevalence of CVD risk factors in at-risk patients. This is an opportunity for Portuguese community pharmacists to take a leading role in the early detection of CVD.
... Typically, focus groups have sample sizes of around 6-10 participants per homogenous group, and samples may be selected to provide a variation of factors such as age and gender ( Morgan and Krueger, 1998 ;Moser and Korstjens, 2018 ). The homogeneity of each focus group enables researchers to explore a particular topic from the perspectives of participants who share certain broad characteristic(s) relevant to the research topic and aims ( Ahmed et al., 2019 ;Anderson et al., 2016 ;Steckowych et al., 2019 ;Vaz-Fernandes and Caeiro, 2019 ). ...
Bio-based plastics are produced from bio-based raw materials such as sugar cane, potatoes, corn, and agricultural and slaughterhouse waste. The evolution of the bio-based plastics market is affected by the stakeholders involved owing to their role in production processes, environmental guidelines and purchasing decisions. It is therefore imperative to understand the perceptions of stakeholders in order to inform the development of the bio-based plastics sector. This novel exploratory study investigates the perceptions and opinions of three stakeholder groups: environmental professionals and plastic processors; university students; and consumers in Belfast, Northern Ireland. During the focus groups (25 participants in total), samples of bio-based plastics, including starch-based monolayer and multilayer, and polyethylene terephthalate (PET), were presented. A qualitative analysis using the framework method revealed that environmental professionals and plastic processors were aware of both the benefits of bio-based plastics, such as a reduction in use of fossil fuels; and the challenges, which include the utilisation of agricultural land for biomass substrates and possible contamination of current conventional plastic recycling streams. Although there was a general lack of knowledge among students and consumers about bio-plastics, they conveyed their beliefs that the use of agricultural waste will lead to closed-loop systems, resulting in a balanced approach to production and waste management. Among students and consumers, concern was raised about contamination of food by bio-based packaging prepared from slaughterhouse waste. However, these participants supported the use of slaughterhouse waste in the production of bio-based plastics for non-food contact items. The students and consumers and some of the environmental professionals and plastic processors were reluctant to pay more for bio-based plastics. The results indicate that manufacturers of bio-based plastics could benefit by informing consumers on the environmental impacts of beginning-of-life parameters, such as production processes and feedstocks, by using life cycle assessment parameters. This should be incorporated into information provided on labelling using standards from neutral organisations. This research could inform future communication strategies around bio-based plastics with both the public and industry.
Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions aimed at increasing CRC screening are delivered through primary care clinics. Pharmacies are more accessible than traditional primary care settings and may be ideally suited for delivering CRC screening and increasing access. Fecal immunochemical test is an at-home, stool-based CRC screening test that could be distributed through pharmacies. The purpose of our study was to assess patient perspectives on receiving fecal immunochemical test-based CRC screening through pharmacies. We conducted semi-structured interviews with participants residing in North Carolina and Washington. Interviews explored acceptability and intervention design preferences for a pharmacy-based CRC screening program. The interview guide was informed by Andersen's Healthcare Utilization Model and the Theoretical Domains Framework. Interviews were conducted at the University of North Carolina at Chapel Hill and Fred Hutchinson Cancer Research Center, audio-recorded, and transcribed. Patients perceived a pharmacy-based CRC screening program to be highly acceptable, citing factors such as ease of pharmacy access and avoiding co-pays for an office visit. Some concerns about privacy and coordination with patients' primary care provider tempered acceptability. Trust and positive relationships with providers and pharmacists as well as seamless care across the CRC screening continuum also were viewed as important. Patients viewed pharmacy-based CRC screening as an acceptable option for CRC screening. To improve programmatic success, it will be important to ensure privacy, determine how communication between the pharmacy and the patient's provider will take place, and establish closed-loop care, particularly for patients with abnormal results.
O termo “farmácia comunitária” faz referência a estabelecimentos farmacêuticos não hospitalares e não ambulatoriais que atendem à comunidade. O grande crescimento do número de farmácias no país vem tornando este mercado cada vez mais competitivo, o que evidencia a importância de conhecer as preferências e comportamento dos consumidores, buscando assim a diferenciação entre as concorrentes e a fidelização dos clientes. Neste sentido, este estudo buscou conhecer o perfil dos consumidores de farmácias comunitárias da região do extremo oeste de Santa Catarina através da aplicação de um questionário a voluntários residentes em cidades da região. A pesquisa foi realizada entre os meses de março e maio de 2022, contou com a participação de 220 voluntários com faixa etária entre 18 e 70 anos e evidenciou que a maioria dos entrevistados (55,5%) ainda não realiza suas compras no segmento farmacêutico através do e-commerce, porém para 34,9% dos mesmos o meio de divulgação de ofertas mais popular foi considerado o aplicativo para troca de mensagens WhatsApp. Entre os entrevistados 42,3% afirmou frequentar as farmácias apenas uma vez ao mês, destacando que a maioria (76,4%) acredita que o atendimento é o fator mais importante para manter-se fidelizado a uma farmácia, seguido pelos preços atrativos (61,8%). Outro resultado que merece destaque é o interesse dos entrevistados (24,1%) em frequentar farmácias que possuam profissionais capacitados a esclarecer suas dúvidas sobre os produtos e repassar maiores explicações no momento das compras, dado que valida a importância do profissional farmacêuticos nestes estabelecimentos.
The draw and write technique is an arts-informed research method that has been used to explore a range of social and health-related topics. This method was initially developed for use with children and subsequently adapted as a qualitative research method for adult participants. More recently, it has gained the interest of pharmacy researchers seeking to understand illness and health service delivery as well as pharmacy educators for its ability to capture nuances of perception and experience. This chapter situates the technique within pharmacy-related arts-informed research, introducing the draw and write technique and some of its variations. Use of the method is demonstrated by presenting details of a study in which this approach was applied to explore public perceptions of community pharmacy services. The approach developed for this study was inspired by recent adaptations to the technique in combination with focus group interviews. This approach evoked visual expression of participants’ perceptions and experiences with community pharmacy services. It produced rich visual and textual data, allowing researchers access to a more diverse range of experiences and perspectives and an emphasis on emotion than they might otherwise have obtained. Details of the study, potential application of the draw and write technique to pharmacy education, and researchers’ experiences with the technique are presented.
Background
The COVID-19 pandemic has increased usage of medication delivery service (MDS) significantly. MDS improves adherence to medication and clinical outcomes.
Objectives
To study behavioral change factors that affect adoption of MDS, determine existing patient satisfaction level, and make recommendations to improve MDS adoption.
Methods
A single-institution, cross-sectional survey was conducted at the outpatient pharmacy of the largest ambulatory cancer centre in Singapore. The survey consisted of sections on demographics, Theory of Planned Behavior constructs and patient satisfaction questions. Descriptive analysis and logistic regression were used.
Results
A total of 881 patients responded. Respondents were mostly Chinese, female and subsidized patients, with a mean age of 62.4 years old. MDS use is strongly predicted by favourable attitude (OR 3.54, 95%CI 2.64–4.75; p < 0.001) and subjective norm (OR 3.07, 95%CI 2.30–4.09; p < 0.001) towards its use and greater perceived behavioral control (OR 2.48; 95%CI 1.86–3.30; p < 0.001). Being ill or frail has been identified as facilitators, while absence of face-to-face consultation and cost of delivery were barriers to the adoption of MDS. Encouragingly, the satisfaction level of our existing patients was generally high (80.2, SD16.7). Recommendation to improve MDS adoption targets facilitators and barriers identified and aims to further elevate patient satisfaction level. Establishment of a centralised pharmacy for MDS together with a call centre would be essential in the long run.
Conclusions
MDS is becoming increasingly important, in line with our national strategy. Implementation of suggested short-term and long-term measures will encourage its use.
Background
The community pharmacy profession is in transition, with emphasis on the provision of cognitive pharmaceutical services (CPS). In contrast, previous research showed that the general public prefers more convenience related services. However, this was based on currently available services and not on innovative services.
Objective
To identify patients’ preferences regarding innovative pharmacy services and whether they tend towards convenience related or CPS.
Design
Online survey using a discrete choice experiment (DCE).
Participants
Participants were from the AMP pharmacy patient panel. Main outcome measures: Preferences (utility scores) and the identification of specific classes (latent class analysis).
Results
In total 2462 panel members (27.3%) filled out the completed the online DCE questionnaire. The majority of participants were male (54.1%) with an average age of 65.3 years and used on average 4.6 medicines. Four patient classes were distinguished based on preferences for services. Highly preferred were an online mediation record, prescription drugs for minor ailments without a doctors’ prescription and clinical testing with diagnosis by the pharmacist.
Discussion and conclusion
The majority of participants tend towards a more CPS focused approach by the community pharmacist. Patients visiting community pharmacies can have a diverging set of preferences regarding services being provided. In daily practice, community pharmacists should provide both convenience and CPS related services to address this diverse set of preferences.
In many countries around the world, people go to community pharmacies to receive primary health care services. Awareness of public views and experiences may help to identify opportunities for greater uptake of primary health care services provided by pharmacists and ways to improve care. Arts-informed research offers the possibility to provide additional insights into public perceptions of community pharmacy services. The purpose of this exploratory study is to describe the process and results of an arts-informed research project using an adapted version of the draw and write technique in combination with focus group interviews to explore public perceptions of community pharmacy services. The draw and write technique was introduced as an introductory activity to evoke a visual expression of participants’ perceptions and experiences with community pharmacy services. Participants were invited to answer the question, “What do community pharmacy services mean to you?” in the form of a drawing and words. They were then prompted to discuss their drawings in a focus group interview. This approach resulted in rich visual and textual data. Analysis consisted of a combination of manual sorting of the visual data and examination of the focus group interview data that were transcribed verbatim, anonymized, and analyzed using an inductive comparative approach. NVIVO version 12 software was used to code and manage all data. Use of the draw and write technique elicited initial, fresh perspectives about community pharmacy services prior to discussions with participants in the focus group interviews. This approach allowed researchers to access a diverse range of experiences and perspectives.
Objective
Community pharmacists are often the first healthcare professional encountered following discharge from a hospital, but what extent of services provided is not fully described across a variety of community pharmacy settings. Our objective was to capture and report recommendations made by community pharmacists during a transitions of care interventional study and to determine if visit‐related factors affected the risk of readmission.
Methods
The content of pharmacists' notes were analyzed from encounters during a transitions of care interventional study for patients discharged from a hospital with five high‐risk conditions (heart failure, acute myocardial infarction, diabetes, pneumonia, or chronic obstructive pulmonary disease), where the primary purpose of the intervention was to enhance inpatient and community pharmacist communication to improve patient care. Summary statistics were utilized to describe the content of pharmacist notes and actions, and a Cox proportional hazards model was used to test for the impact of several patient or visit‐related characteristics on the risk of 90‐day readmissions.
Results
As part of an interventional study, patients spent an average of 9 minutes (standard deviation [SD] 6.9) with pharmacists during each visit and had three visits on average within 90‐day of discharge. Responses to checklist questions were documented on 99% of notes, and pharmacists provided recommendations 58% of the time. Recommendations varied by condition with the most frequent being adherence (10%), vaccinations (8%), and disease monitoring (7%). In multivariate models, readmission was higher among patients with highest comorbidity (hazard ratio [HR] = 10.18, 95% confidence interval [CI], 3.53‐29.36), two or more medications added at discharge (HR = 3.83, 95% CI, 1.49‐9.82), or vaccine gaps (HR = 3.51, 95% CI, 1.09‐11.33).
Conclusions
In a transitions of care service, community pharmacists actively engaged patients and caregivers at regular intervals, providing largely patient‐oriented recommendations during relatively short consultation encounters. Patient and visit‐related items associated with higher readmission risk such as higher comorbidity, medication additions, and incomplete vaccinations signal opportunity for community pharmacist‐led interventions to improve care of patients in the postdischarge period.
Objectives:
The primary objective of this study was to identify and summarize the perspectives of managers, pharmacists, and pharmacy technicians regarding the implementation of the Optimizing Care Model and corresponding task delegation of final product verification to pharmacy technicians in the community pharmacy. A secondary objective was to better understand successes and concerns in implementing the model.
Design:
This qualitative research study employed the use of semistructured interviews. The authors served as coders and analyzed the transcripts with the use of inductive and deductive thematic analysis.
Setting and participants:
Key informants included managers, pharmacists, and pharmacy technicians participating in the Optimizing Care Model in community pharmacies across both chain and independent pharmacy settings in Iowa, Tennessee, and Wisconsin. Interviews were conducted via telephone.
Results:
The research team interviewed 14 participants. Six themes were identified: The Optimizing Care Model catalyzes patient care service delivery expansion in the community pharmacy setting, effectiveness is driven by "freed-up" pharmacist time compared with the traditional model, the model positively affects roles and job satisfaction of pharmacy personnel, technician engagement and ownership have a strong impact on the success and ramifications of the model, significant changes to pharmacy operations are necessary for successful implementation, and there are several factors ensuring successful implementation and sustaining of the Optimizing Care Model.
Conclusion:
Various participants (pharmacists, managers, technicians) in a technician product verification program known as the Optimizing Care Model agreed that patient care delivery can be enhanced through the task delegation of final product verification to pharmacy technicians. Additional positive impacts on organizational and individual level outcomes were found, which included quality of work life, engagement, and commitment.
Objective: Patients’ opinion about prevalence of pharmaceutical services available in a community pharmacy among patients living in a rural area of the United Kingdom. The secondary objective was to identify appropriate action(s) to enhance patients’ awareness of pharmaceutical services in rural areas.
Methods: A self-administered, anonymous questionnaire was distributed to patients visiting a community pharmacy in Eye, Suffolk, United Kingdom between July and August, 2015. The main inclusion criterion was living in a rural area. Comparisons were performed using chi-square tests and logistic regression.
Results: The study included 103 respondents: 70 women (69.0%) and 33 men (32.0%), aged 16–85 years. Most respondents declared the primary tasks of a community pharmacy were dispensing medicines (86.4% of respondents) and repeat dispensing (72.8% of respondents). Additionally, 23.3% of respondents treated minor ailments at the pharmacy, including bacterial/viral infections, minor injuries, stomach problems, and allergies. The Medicines Use Review service was the only advanced service used in this pharmacy (12.6% of respondents), primarily by men. Younger patients were more familiar with the term of pharmaceutical care (p
Background
To optimise positive outcomes, the design of new pharmacy services should consider the preferences of consumers with chronic condition(s) and their carers.
Objectives
(i) To evaluate the relative importance of community pharmacy service characteristics, from the perspective of consumers with chronic condition(s) and carers; (ii) To compare consumer and carer preferences to health professional beliefs about ideal service characteristics for consumers.
Method
A discrete choice experiment was completed by consumers with chronic condition(s) and/or carers (n=602) and health professionals (n=297), recruited from four regions in Australia. Participants were each randomised to one survey version containing four (from a total 72) different choices between two new pharmacy services. Consumer and carer participants were also given an ‘opt out’ alternative of current service. Each service was described using six attributes related to pharmacy service characteristics: continued medicines supply, continuity and coordinated care, location, medication management, education and information, and cost.
Results
Consumers and carers placed highest priority on continued medicines supply by a pharmacist for regular and symptom flare up medicines (100 priority points), a pharmacy located within a ‘one-stop’ health centre (61 points) and home delivery of medicines (52 points). Although continued medicines supply was most important for consumers and carers, pharmacy location was perceived by health professionals to be the most important characteristic for consumers. Participants were less inclined to choose new services if their current pharmacy offered high quality services that were person-centred, easy to access and responsive to their needs. Younger, more highly educated and employed participants, and those with established condition(s) were more likely to choose new services.
Conclusions
Person-centred care is a fundamental tenet for pharmacy services. The provision of continued medicines supply (e.g. through pharmacist prescribing), convenient and coordinated care delivered through a one stop health centre, and home delivery of medicines, should be prioritised when planning pharmacy services to best assist consumers to manage chronic conditions.
This study investigated patients' preferences for an innovative combined prescribing-and-dispensing role for pharmacists in the management of drug therapies, compared to the more traditional dispensing-only role.
The project was a cross-sectional study. A structured self-completed Discrete Choice Experiment questionnaire was administered to a sample of patients aged over 18 years waiting to see their doctor at the surgery. Respondents compared the proposed combined innovative service with both their 'current' service and a 'dispensing-only pharmacist' service. Analyses were initially conducted for all respondents and then repeated excluding those with constant preferences (i.e., those who always chose the same option). The setting was two general practices in Aberdeen, Scotland.
We approached 244 people and 204 returned an evaluable questionnaire. Everything else being equal, respondents preferred their 'current' service to either the proposed combined prescribing-and-dispensing role or a dispensing-only service. However, those without constant preferences, who were mostly younger, preferred the combined service, where a pharmacist both prescribed and dispensed.
Patients value input from their pharmacists, but are resistant to change and prefer their current situation. However, younger people are more willing to trade between alternatives, and preferred the innovative combined prescribing-and-dispensing service. Changes in the pharmaceutical service could be supported by the public. The Discrete Choice Experiment approach is considered a useful tool for evaluating preferences for alternative pharmacy services.
Purpose
Privileges for administering nonvaccine injectable medications among pharmacists in the United States were assessed.
Methods
An e-mail inquiry on specific protocols for the administration of injectables was sent to the state boards of pharmacy (BOPs) for all 50 states and the District of Columbia that had a valid e-mail address listed on the National Association of Boards of Pharmacy website. Respondents were encouraged to include in their response a link to state regulations so that information from the BOP laws on privileges for administering injectables could be closely reviewed. State guidelines were reviewed online for all BOPs that did not respond to the first e-mail in order to complete the study. A follow-up e-mail was sent only to those respondents whose states granted pharmacists privileges for administering nonvaccine injectables in order to clarify the specific drugs allowed to be injected by pharmacists.
Results
Responses received included either links to state regulations or explicit statements of the rules regarding pharmacists' injectable privileges. A total of 21 states currently grant pharmacists articulate written information or rules pertaining to the privilege of administering nonvaccine injectable products. Authority is provided through collaborative practice agreements for most states. Products administered by pharmacists vary by state.
Conclusion
Pharmacists in 21 states were found to have privileges for administering injectable medications other than vaccines. Pharmacists were authorized to administer these drugs through completion of training approved by the Accreditation Council for Pharmacy Education, collaborative practice agreements, valid prescription orders, board certification, or other broad privileges as specified in state regulations.
Am J Health-Syst Pharm. 2012; 69:2002-5
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 clinical utility, POCT implementation in the community pharmacy setting is slow due to uncertainty about the market for this novel service and remuneration for services rendered.
Objective:
To identify 1) demographics and 2) willingness-to-pay preferences of the market niche of consumers who prefer to receive POCT services in the community pharmacy.
Methods:
A sample of 188 participants matched to the U.S. population were surveyed in February of 2016 utilizing a self-explicated conjoint analysis survey model.
Results:
Age groups differed between the community pharmacy consumer niche and the entire sample. The largest age group of the pharmacy niche consumer group were between 20 and 34 years old. Of those who preferred the community pharmacy setting to receive POCT services, 75% indicated they would be willing to pay 50 or less.
Conclusions:
There exists a latent and niche group of consumers interested in community pharmacy provided POCT services. This market niche is younger, and in general willing-to-pay more than the general population for these tests.
Objectives
To introduce the term community-based pharmacist practitioner (CPP), detail how community pharmacists are transitioning into this essential role, suggest 4 tenets of CPPs, and discuss the role of CPPs in future pharmacy practice.
Summary
The focus and nature of community pharmacy is expanding into new practice settings and including enhanced patient care services. With these shifts toward better meeting the health care needs of the communities they serve, community-based pharmacists who provide patient care services have refined specialized skills and should be widely viewed and accepted by the profession, patients, other health care providers, and the public as health care practitioners. Four suggested tenets of CPPs are: deliver direct patient care, contribute to team-based care, manage patient care services, and serve as leaders for advancing patient care.
Conclusion
Pharmacist-provided patient care services are expanding in a variety of community-based settings. The term “community-based pharmacist practitioner” highlights the unique skillset that pharmacists use when they provide patient care services, and it brings recognition to the value community pharmacists contribute to patients, communities, and the health care system.
Background:
The roles of community pharmacists are evolving to include provision of expanded professional pharmacy services, thus leading to an increased interest in pharmacist-patient interactions. Role theory can be used to explain the interaction between this pair of individuals, by focusing on the roles performed by each one.
Objective:
To develop and test a model that relates patients' image of the pharmacist to their expectations of pharmacist's role, and how this then influences patients' reactions toward the pharmacist's role.
Methods:
A qualitative study was undertaken, and a questionnaire was created for the development of the model, based on role theory. The content, dimensions, validity and reliability of the questionnaire were pre-tested qualitatively and in a pilot mail survey. The reliability and validity of the proposed model were tested using confirmatory factor analysis (CFA). Structural equation modelling (SEM) was used to explain relationships between dimensions of the final model.
Results:
A final model was developed. CFA concluded that the model was valid and reliable (Goodness of Fit indices: χ(2)(109) = 227.662, P = 0.000, RMSEA = 0.05, SRMR = 0.05, GFI = 1.00, NNFI = 0.90, CFI = 0.92). SEM indicated that "perceived pharmacist image" was associated positively and significantly with both "professional expectations" (the standardized path coefficient of (H) = 0.719, P < 0.05), as well as "courtesy expectations" (the standardized path coefficient of (H) = 0.582, P < 0.05). At the same time, "professional expectations" were associated positively and significantly with "positive reactions" (the standardized path coefficient of (H) = 0.358, P < 0.05), but negatively with "Negative reactions" (the standardized path coefficient of (H) = -0.427, P < 0.05). "Courtesy expectations" were associated positively and significantly with "positive reactions" (the standardized path coefficient of (H) = 0.081, P < 0.05), as well as "negative reactions" (the standardized path coefficient of (H) = 0.450, P < 0.05).
Conclusions:
A valid and reliable model of patients' image of the pharmacist related to their expectations and reactions to the pharmacist's role was developed and tested. When the perceived image of the pharmacist is enhanced, patients' expectations of the pharmacist are heightened; in turn, these expectations were associated with reactions of patients.
Community pharmacists are the third largest healthcare professional group in the world after physicians and nurses. Despite their considerable training, community pharmacists are the only health professionals who are not primarily rewarded for delivering health care and hence are under-utilized as public health professionals. An emerging consensus among academics, professional organizations, and policymakers is that community pharmacists, who work outside of hospital settings, should adopt an expanded role in order to contribute to the safe, effective, and efficient use of drugs-particularly when caring for people with multiple chronic conditions. Community pharmacists could help to improve health by reducing drug-related adverse events and promoting better medication adherence, which in turn may help in reducing unnecessary provider visits, hospitalizations, and readmissions while strengthening integrated primary care delivery across the health system. This paper reviews recent strategies to expand the role of community pharmacists in Australia, Canada, England, the Netherlands, Scotland, and the United States. The developments achieved or under way in these countries carry lessons for policymakers world-wide, where progress thus far in expanding the role of community pharmacists has been more limited. Future policies should focus on effectively integrating community pharmacists into primary care; developing a shared vision for different levels of pharmacist services; and devising new incentive mechanisms for improving quality and outcomes.
Copyright © 2015. Published by Elsevier Ireland Ltd.
Purpose Privileges for administering nonvaccine injectable medications among pharmacists in the United States were assessed. Methods An e-mail inquiry on specific protocols for the administration of injectables was sent to the state boards of pharmacy (BOPs) for all 50 states and the District of Columbia that had a valid e-mail address listed on the National Association of Boards of Pharmacy website. Respondents were encouraged to include in their response a link to state regulations so that information from the BOP laws on privileges for administering injectables could be closely reviewed. State guidelines were reviewed online for all BOPs that did not respond to the first e-mail in order to complete the study. A follow-up e-mail was sent only to those respondents whose states granted pharmacists privileges for administering nonvaccine injectables in order to clarify the specific drugs allowed to be injected by pharmacists. Results Responses received included either links to state regulations or explicit statements of the rules regarding pharmacists' injectable privileges. A total of 21 states currently grant pharmacists articulate written information or rules pertaining to the privilege of administering nonvaccine injectable products. Authority is provided through collaborative practice agreements for most states. Products administered by pharmacists vary by state. Conclusion Pharmacists in 21 states were found to have privileges for administering injectable medications other than vaccines. Pharmacists were authorized to administer these drugs through completion of training approved by the Accreditation Council for Pharmacy Education, collaborative practice agreements, valid prescription orders, board certification, or other broad privileges as specified in state regulations. Am J Health-Syst Pharm. 2012; 69:2002-5.
Background:
The current UK government agenda is for community pharmacists to assume greater responsibility for medication management in patients with chronic conditions. This agenda may require a significant change in the way patients currently interact with their community pharmacist.
Objectives:
To explore the experiences and views of patients with type 2 diabetes regarding the current and proposed future role of community pharmacists.
Methods:
This study used focus groups to collect experiences and views of patients with type 2 diabetes. A National Health Service (NHS) ethics committee approved this study. Pharmacists identified all patients with type 2 diabetes to whom they provided an information sheet and a consent form which included a request to supply basic demographic details. Focus group members were purposively sampled to gain a diverse range of opinions. Two researchers independently coded and thematically analyzed the transcripts. The researchers discussed the emergent themes to ensure all valid themes had been identified.
Results:
Twenty-five participants attended one of 4 focus groups. Two broad themes were identified: the place of pharmacy in the wider primary care team and pharmacy as a healthcare destination. Participants who had been living with diabetes for a long time and those who felt they had received a lower level of care from the medical practice were more likely to acknowledge contributions of pharmacists in their care for advice on side effects, drug interactions and supply than participants with a good relationship with their general practitioner (GP) or practice nurse and whose diabetes was well controlled.
Conclusions:
Participants with type 2 diabetes identified a role for pharmacists in their care linked to their perceived expertise on medicines. However, the extent to which they would engage with the pharmacist depended on the quality of relationship with their GP or practice nurse.
To examine the views of regular pharmacy clients on pharmacist prescribing and employ agency theory in considering the relationship between the stakeholders involved.
Computer assisted telephone interviews were conducted with 400 pharmacy clients recruited around Australia. Potential respondents were identified using a random number generation function in Microsoft Excel. Data were analysed with SPSS version 17 using one-way analysis of variance, principal component analysis and linear regression. The relationships between the main stakeholders involved were explored using agency theory.
A total of 1153 answered calls recruited 400 consenting pharmacy clients. Most respondents (71%) trusted pharmacists adopting an expanded role in prescribing, however the majority (66%) supported this only after a diagnosis had been made by a doctor. Those who accepted pharmacist diagnosing and prescribing preferred that this was limited to pain management and antibiotics. Most respondents (64%) considered that expanded pharmacist prescribing would improve their access to prescription medicines, although those over 65 years of age were less supportive than younger respondents. Factors which contributed positively to clients' perception of trust in an expanded prescribing role for pharmacists were identified, and improved access to medicines was found to be the strongest predictor (P < 0.0001).
Most pharmacy clients trusted pharmacists adopting an expanded prescribing role, but preferred that this was limited to doctors performing the initial diagnosis. Agency theory would conceptualize the introduction of pharmacist prescribers, as disrupting the principal (patient) agent (doctor) relationship. Its introduction would best be facilitated by careful change management.
This article presents a framework for thinking about the fundamental activities of inference--data analysis and interpretation--by researchers using qualitative data. I contrast these two activities. For analysis I describe seven operations: categorization, abstraction, comparison, dimensionalization, integration, iteration, and refutation. For interpretation I suggest metaphor and other literary devices as models for understanding the meanings of others, identifying patterns in these meanings, and representing how systems of meanings reproduce culture. The purpose of these descriptions is to suggest a vocabulary for and stimulate discussion about how researchers using qualitative analytical techniques arrive at conclusions and make sense of data. Copyright 1994 by the University of Chicago.
Pharmacists have been involved with patient care at the Family Medicine Center, affiliated with the Medical University of South Carolina, for over 20 years. In 1999, to add to existing clinical services, pharmacists administered immunizations (influenza and pneumonia) to over 400 adult patients during clinic visits in designated patient care rooms. A few months after the immunization period, both health care providers and immunized patients were asked to respond to a survey regarding their opinions of pharmacist-administered immunizations. Response rates were 71% for health care providers and 16% for all immunized patients. Most (90%) of the health care respondents felt comfortable with pharmacists providing immunizations and thought it was appropriate for pharmacists to provide this service. However, 35% of the providers did not agree that pharmacists should provide immunizations in local pharmacies. Most (97%) of the immunized patients felt comfortable with their provider but did not recall that a pharmacist had administered the immunization. In addition, 64% questioned the qualifications of a pharmacist to administer immunizations, and only 43% felt comfortable having a community pharmacist administer a vaccine. By extrapolation of these data, one can determine that patients do not regard pharmacists as qualified providers of immunizations. Further study of patient perception of pharmacists in this role is being conducted.
Get the Medications Right: A Nationwide Snapshot of Expert Practices—Comprehensive Medication Management in Ambulatory/Community Pharmacy
- T Mcinnis
- K Capps
Washington State Law: Pharmacists Now Providers in Private Health Plans
- L Bonner
- Washington State
- Law
Exploring Pharmacists’ Role in a Changing Healthcare Environment. National Association of Chain Drug Stores Website
- Avalere Health
The Expanding Role of Pharmacists in a Transformed Health Care System. National Governors’ Association Website
- F Isasi
- E Krofah
Washington State Law: Pharmacists Now Providers in Private Health Plans. American Pharmacist's Association Website
- L Bonner
Get the Medications Right: A Nationwide Snapshot of Expert Practices-Comprehensive Medication Management in Ambulatory/Community Pharmacy. Health2 Resources
- T Mcinnis
- K Capps