Act for the Future of Community Pharmacy.

Community pharmacies serve as a vital gateway to primary care and public health, offering face-to-face pharmacist expert care to assure safe and effective medication use. However, they are disappearing at an alarming rate, with 20-30% of all community pharmacy locations projected to close within the next year. The objective of this commentary is to highlight the critical need for systemic reforms and collective action within our profession to address the unique challenges faced by community pharmacies, ensuring their sustainability and continued role in providing essential healthcare services for patients.

Implementation and evaluation of social determinants of health practice models within community pharmacy.

Background: While community pharmacies are an ideal setting for social needs screening and referral programs, information on social risk assessment within pharmacy practice is limited.

Objectives: Our primary objective was to describe 2 social determinant of health (SDOH) practice models implemented within community pharmacies. The secondary objective was to evaluate implementation practices utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.

Addressing social determinants of health in community pharmacy: Innovative opportunities and practice models.

Social determinants of health (SDoH) account for up to 90% of health outcomes, whereas medical care accounts for only 10%-15%; despite this disparity, only 24% of hospitals and 16% of physician practices screen for the 5 social needs. Community-embedded and highly accessible, pharmacies are uniquely positioned to connect individuals to local community and social resources and thereby address SDoH. In this article, we explore novel community pharmacy practice models that address SDoH, provide real-world examples of these models, and discuss pathways for reimbursement and sustainability.

Scaling Community Pharmacy Transformation with the 'Flip the Pharmacy' Implementation Model: Program Origins.

The rising costs of healthcare, increased chronic illnesses, and healthcare provider burnout has led to an environment desperate for scalable solutions to ease practice burdens. With a projected shortage in the number of primary healthcare providers available to provide team-based care, community-based pharmacy practitioners are accessible and eager to assist. In order to provide enhanced patient care services to aid their clinician colleagues, community-based pharmacists will have to transform their practices to support the provision of enhanced services and medication optimization in value-based payment models.

Patient outcomes from implementing an enhanced services pharmacy network.

Objective: To evaluate the effect of implementing a network of community pharmacies on medication adherence, health service utilization, and health care spending.

Design: Quasi-experimental difference-in-difference analysis with a nonequivalent control group.

Setting And Participants: Eligible Medicaid-enrolled patients in North Carolina were attributed to intervention pharmacies between March 2015 and December 2016.

A Sleeping Giant: Community Pharmacy's Potential Is Unrivaled.

No funding was received for the writing of this commentary. The author has nothing to disclose.

Accuracy of Prescription Claims Data in Identifying Truly Nonadherent Patients.

Background: Administrative claims data are increasingly used to identify nonadherent patients. This necessitates a comprehensive review and assessment of their accuracy in identifying nonadherent patients.

Objectives: To (a) compare administrative claims-based measures of adherence with nonadherence verified by patient interview; (b) determine if and to what extent patients classified as nonadherent based on prescription claims differ from patients classified as nonadherent based on interventions designed to gather multiple types of medication lists to compare against the prescription fill history; and (c) assess the various patient-reported reasons for nonadherence.

Stages of Change: Moving Community Pharmacies From a Drug Dispensing to Population Health Management Model.

Given their clinical training and accessibility, community pharmacists are well positioned to support primary care, especially in providing medication management services. There is limited evidence, however, on implementation of community pharmacist-led services in coordination with other health care providers. The aim of this study was to examine the implementation process of community pharmacies in North Carolina participating in a Medicaid population health management intervention.

Lessons Learned from Using Global Outcome Measures to Assess Community Pharmacy Performance.

Introduction: As value-based and alternative payment models proliferate, there is growing interest in measuring pharmacy performance. However, little research has explored the development and implementation of systems to measure pharmacy performance. Additionally, systems that currently exist rely on process and surrogate outcome measures that are not always relevant to patients and payers.

The role of network ties to support implementation of a community pharmacy enhanced services network.

Background: Limited evidence exists on how to integrate community pharmacists into team-based care models, as the inclusion of community pharmacy services into alternative payment models is relatively new. To be successful in team-based care models, community pharmacies need to successfully build relationship with diverse stakeholders including providers, care managers, and patients.

Objectives: The aims of this study are to: (1) identify the role of network ties to support implementation of a community pharmacy enhanced services network, (2) describe how these network ties are formed and maintained, and (3) compare the role of network ties among high- and low-performing community pharmacies participating in an enhanced services network.

Payment Reform Meets Pharmacy Practice and Education Transformation.

The pharmacy profession has for the greater part of four decades been associated with dispensing activities and product reimbursement. This has hindered the ability of pharmacists to evolve their roles in their respective sites of care. Payment reform efforts that create an outcomes marketplace offer an opportunity for professional transformation.

Health Information Technology: Meaningful Use and Next Steps to Improving Electronic Facilitation of Medication Adherence.

Background: The use of health information technology (HIT) may improve medication adherence, but challenges for implementation remain.

Objective: The aim of this paper is to review the current state of HIT as it relates to medication adherence programs, acknowledge the potential barriers in light of current legislation, and provide recommendations to improve ongoing medication adherence strategies through the use of HIT.

Methods: We describe four potential HIT barriers that may impact interoperability and subsequent medication adherence.

Improving diabetes medication adherence: successful, scalable interventions.

Effective medications are a cornerstone of prevention and disease treatment, yet only about half of patients take their medications as prescribed, resulting in a common and costly public health challenge for the US health care system. Since poor medication adherence is a complex problem with many contributing causes, there is no one universal solution. This paper describes interventions that were not only effective in improving medication adherence among patients with diabetes, but were also potentially scalable (ie, easy to implement to a large population).

Transitional care cut hospital readmissions for North Carolina Medicaid patients with complex chronic conditions.

Recurrent hospitalizations represent a substantial and often preventable human and financial burden in the United States. In 2008 North Carolina initiated a statewide population-based transitional care initiative to prevent recurrent hospitalizations among high-risk Medicaid recipients with complex chronic medical conditions. In a study of patients hospitalized during 2010-11, we found that those who received transitional care were 20 percent less likely to experience a readmission during the subsequent year, compared to clinically similar patients who received usual care.

A+KIDS, a web-based antipsychotic registry for North Carolina youths: an alternative to prior authorization.

Objective: The rise in use of antipsychotics among U.S. children is well documented.

Pharmacist engagement in medical home practices: report of the APhA-APPM Medical Home Workgroup.

Objectives: To identify factors that have led to successful involvement of pharmacists in patient-centered medical home (PCMH) practices, identify challenges and suggested solutions for pharmacists involved in medical home practices, and disseminate findings.

Data Sources: In July 2011, the American Pharmacists Association Academy of Pharmacy Practice & Management convened a workgroup of pharmacists currently practicing or conducting research in National Committee for Quality Assurance-accredited PCMH practices.

Data Synthesis: A set of guiding questions to explore the early engagement and important process steps of pharmacist engagement with PCMH practices was used to conduct a series of conference calls during an 8-month period.

Evaluation of a self-management implementation intervention to improve hypertension control among patients in Medicaid.

Elevated blood pressure can lead to serious patient morbidity and mortality. The aim of the study was to evaluate the implementation of a tailored multifaceted program, administered by care managers in a Medicaid setting to improve hypertension medication adherence. The program enrolled 558 Medicaid patients.

Pharmacist and physician satisfaction and rates of switching to preferred medications associated with an instant prior authorization program for proton pump inhibitors in the North Carolina Medicaid program.

Background: Proton pump inhibitors (PPIs) are among the highest expenditure drugs covered by health care plans. During fiscal year 2001-2002, Medicaid programs nationwide spent nearly $2 billion on PPIs. Although the costs of individual PPIs vary widely, there is little variation in therapeutic effectiveness.

A physician-friendly alternative to prior authorization for prescription drugs.

Objective: To determine if the instant approval (IA) process differs from the traditional prior authorization (PA) process in preferred drug channeling, resultant gaps in therapy, and provider dissatisfaction.

Study Design: An interrupted time series analysis using pharmacy claims and a retrospective cohort study.

Methods: The study assessed changes in preferred drug use and subsequent cost reductions.

Analysis of the North Carolina long-term care polypharmacy initiative: a multiple-cohort approach using propensity-score matching for both evaluation and targeting.

Background: The high cost and undesirable consequences of polypharmacy are well-recognized problems among elderly long-term care (LTC) residents. Despite the implementation of the 1987 Omnibus Budget Reconciliation Act, which requires pharmacist review of drug regimens in this setting, medical and drug costs for LTC residents have continued to increase.

Objective: This study evaluates the North Carolina Long-Term Care Polypharmacy Initiative, a large-scale medication therapy management program (MTMP) that combined drug utilization review activities with drug regimen review techniques.

Versatile synthesis of the C3-C14 domain of 7-deoxyokadaic acid.

Described is a flexible synthesis of the C3-C14 domain of 7-deoxyokadaic acid that is amenable to facile structural diversification. Treatment of ynone 10 under acidic conditions led to net bis-conjugate addition of the latent diol to give the thermodynamically favored spiroketal 27, a versatile intermediate, en route to 7-deoxyokadaic acid and analogs.

Evaluation of a pilot medication therapy management project within the North Carolina State Health Plan.

Objective: To assess the feasibility of a pharmacist-based medication therapy management (MTM) service for North Carolina State Health Plan enrollees.

Design: Before/after design with two control groups.

Setting: Community pharmacies and an ambulatory care clinic in North Carolina serving patients from October 2004 to March 2005.