PDF herunterladen
Appl Clin Inform 2018; 09(02): 391-402
DOI: 10.1055/s-0038-1651488
Research Article
Schattauer

Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application

Kea Turner
1   Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
,
Chelsea Renfro
2   Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis, Tennessee, United States
,
Stefanie Ferreri
3   Division of Practice Advancement and Clinical Education, University of North Carolina Eshelman School of Pharmacy, Chapel Hill, North Carolina, United States
,
Kim Roberts
4   Community Pharmacy Enhanced Services Network, Community Care of North Carolina, Raleigh, North Carolina, United States
,
Trista Pfeiffenberger
4   Community Pharmacy Enhanced Services Network, Community Care of North Carolina, Raleigh, North Carolina, United States
,
Christopher M. Shea
1   Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
› Institutsangaben Funding The project described was supported by Grant Number 1C1CMS331338 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.
Weitere Informationen

Publikationsverlauf

05. Januar 2018

08. April 2018

Publikationsdatum:
30. Mai 2018 (online)

   Lizenzen und Reprints

Abstract

Objective Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies.

Methods Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network. Interviews were recorded, transcribed verbatim, and analyzed for themes using the Expert Recommendations for Implementing Change (ERIC).

Results Findings suggest that leadership support, clinical training, and computer literacy facilitated implementation, while lack of system integration, staff resistance to change, and provider reluctance to share data served as barriers. To overcome the barriers, implementation support was provided, such as assessing readiness for implementation, developing a standardized and interoperable care plan, and audit and feedback of documentation quality.

Conclusion Participants used a wide array of strategies to support community pharmacies with implementation and tailored approaches to accommodate pharmacy-specific preferences. Most of the support was delivered preimplementation or in the early phase of implementation and by program or research staff rather than peer-to-peer. Implementing new pharmacy information system requires a significant amount of implementation support to help end-users learn about program features, how to integrate the software into workflow, and how to optimize the software to improve patient care. Future research should identify which implementation strategies are associated with program performance.

Keywords

community pharmacy - pharmacy information systems - implementation and deployment - medication management - clinical documentation - implementation science - medication management application - documentation

Note

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.


Protection of Human and Animal Subjects

The Institutional Review Board of the University of North Carolina at Chapel Hill approved this study (IRB # 16–0530).


 

  • References

  • 1 Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis 2014; 11: E62
    PubMedGoogle Scholar
  • 2 Gerteis J, Izrael D, Deitz D. , et al. Multiple Chronic Conditions Chart Book. Rockville, MD: 2014. . Contract No.: AHRQ Publications No, Q14–0038
    Google Scholar
  • 3 Brown MT, Bussell JK. Medication adherence: WHO cares?. Mayo Clin Proc 2011; 86 (04) 304-314
    CrossrefPubMedGoogle Scholar
  • 4 DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 2004; 42 (03) 200-209
    CrossrefPubMedGoogle Scholar
  • 5 Frieden TR. ; Centers for Disease Control and Prevention (CDC). Use of selected clinical preventive services among adults--United States, 2007–2010. MMWR Suppl 2012; 61 (02) 1-2
    PubMedGoogle Scholar
  • 6 CCNC. Community Pharmacy Enhanced Services Network; 2016. Available at: https://www.communitycarenc.org/population-management/pharmacy/community-pharmacy-enhanced-services-network-cpesn/ . Accessed October 21, 2016
    PubMedGoogle Scholar
  • 7 Urick B, Brown P, Easter JC. Achieving better quality and lower costs in Medicaid through enhanced pharmacy services. N C Med J 2017; 78 (03) 188-189
    PubMedGoogle Scholar
  • 8 Smith M, Giuliano MR, Starkowski MP. In Connecticut: improving patient medication management in primary care. Health Aff (Millwood) 2011; 30 (04) 646-654
    CrossrefPubMedGoogle Scholar
  • 9 Doucette WR, Rippe JJ, Gaither CA, Kreling DH, Mott DA, Schommer JC. Influences on the frequency and type of community pharmacy services. J Am Pharm Assoc (2003) 2017; 57 (01) 72-76
    CrossrefPubMedGoogle Scholar
  • 10 Van Wijk BL, Klungel OH, Heerdink ER, de Boer A. Effectiveness of interventions by community pharmacists to improve patient adherence to chronic medication: a systematic review. Ann Pharmacother 2005; 39 (02) 319-328
    CrossrefPubMedGoogle Scholar
  • 11 Viswanathan M, Kahwati LC, Golin CE. , et al. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Intern Med 2015; 175 (01) 76-87
    CrossrefPubMedGoogle Scholar
  • 12 Mekonnen AB, McLachlan AJ, Brien JA. Pharmacy-led medication reconciliation programmes at hospital transitions: a systematic review and meta-analysis. J Clin Pharm Ther 2016; 41 (02) 128-144
    CrossrefPubMedGoogle Scholar
  • 13 Nazar H, Nazar Z, Portlock J, Todd A, Slight SP. A systematic review of the role of community pharmacies in improving the transition from secondary to primary care. Br J Clin Pharmacol 2015; 80 (05) 936-948
    CrossrefPubMedGoogle Scholar
  • 14 Bailey AM, Wermeling DP. Naloxone for opioid overdose prevention: pharmacists' role in community-based practice settings. Ann Pharmacother 2014; 48 (05) 601-606
    CrossrefPubMedGoogle Scholar
  • 15 Blalock SJ, Roberts AW, Lauffenburger JC, Thompson T, O'Connor SK. The effect of community pharmacy-based interventions on patient health outcomes: a systematic review. Med Care Res Rev 2013; 70 (03) 235-266
    CrossrefPubMedGoogle Scholar
  • 16 Williams AB, Mertz K, Wilkins TL. Issue Brief: Medication Adherence and Health IT. Washington DC: Office of the National Coordinator for Health Information Technology; 2014
    Google Scholar
  • 17 Phansalkar S, Her QL, Tucker AD. , et al. Impact of incorporating pharmacy claims data into electronic medication reconciliation. Am J Health Syst Pharm 2015; 72 (03) 212-217
    CrossrefPubMedGoogle Scholar
  • 18 Gabriel MH, Smith JY, Sow M, Charles D, Joseph S, Wilkins TL. Dispatch from the non-HITECH-incented Health IT world: electronic medication history adoption and utilization. J Am Med Inform Assoc 2016; 23 (03) 562-569
    CrossrefPubMedGoogle Scholar
  • 19 Fitzgerald RJ. Medication errors: the importance of an accurate drug history. Br J Clin Pharmacol 2009; 67 (06) 671-675
    CrossrefPubMedGoogle Scholar
  • 20 Smith M, Bates DW, Bodenheimer T, Cleary PD. Why pharmacists belong in the medical home. Health Aff (Millwood) 2010; 29 (05) 906-913
    CrossrefPubMedGoogle Scholar
  • 21 Collaborative P. System Vendor Checklist for Pharmacist Clinical Documentation Workflow. Washington, DC: 2015
    Google Scholar
  • 22 Hohmeier KC, Spivey CA, Boldin S, Moore TB, Chisholm-Burns M. Implementation of a health information exchange into community pharmacy workflow. J Am Pharm Assoc (2003) 2017; 57 (05) 608-615
    CrossrefPubMedGoogle Scholar
  • 23 Johnson CM, Marcy TR, Harrison DL, Young RE, Stevens EL, Shadid J. Medication reconciliation in a community pharmacy setting. J Am Pharm Assoc (2003) 2010; 50 (04) 523-526
    CrossrefPubMedGoogle Scholar
  • 24 Keller ME, Kelling SE, Cornelius DC, Oni HA, Bright DR. Enhancing practice efficiency and patient care by sharing electronic health records. Perspect Health Inf Manag 2015; 12: 1b
    PubMedGoogle Scholar
  • 25 Adler-Milstein J, McAfee AP, Bates DW, Jha AK. The state of regional health information organizations: current activities and financing. Health Aff (Millwood) 2008; 27 (01) w60-w69
    CrossrefPubMedGoogle Scholar
  • 26 Held AD, Woodall LJ, Hertig JB. Pharmacists' familiarity, utilization, and beliefs about Health Information Exchange: a survey of pharmacists in an Indiana pharmacy organization. J Am Pharm Assoc (2003) 2014; 54 (06) 625-629
    CrossrefPubMedGoogle Scholar
  • 27 Brock KA, Casper KA, Green TR, Pedersen CA. Documentation of patient care services in a community pharmacy setting. J Am Pharm Assoc (2003) 2006; 46 (03) 378-384
    CrossrefPubMedGoogle Scholar
  • 28 Guirguis LM, Lee S, Sanghera R. Impact of an interactive workshop on community pharmacists' beliefs toward patient care. Int J Clin Pharm 2012; 34 (03) 460-467
    CrossrefPubMedGoogle Scholar
  • 29 Bright DR, Lengel AJ, Powers MF. Pharmacists' perceptions of barriers to implementing medication therapy management and the role of pharmacy technicians in overcoming the barriers. J Pharm Technol 2009; 25 (06) 361-367
    PubMedGoogle Scholar
  • 30 Lounsbery JL, Green CG, Bennett MS, Pedersen CA. Evaluation of pharmacists' barriers to the implementation of medication therapy management services. J Am Pharm Assoc (2003) 2009; 49 (01) 51-58
    CrossrefPubMedGoogle Scholar
  • 31 Smith MG, Ferreri SP, Brown P, Wines K, Shea CM, Pfeiffenberger TM. Implementing an integrated care management program in community pharmacies: a focus on medication management services. J Am Pharm Assoc (2003) 2017; 57 (02) 229-235
    CrossrefPubMedGoogle Scholar
  • 32 Becker C, Bjornson DC, Kuhle JW. Pharmacist care plans and documentation of follow-up before the Iowa Pharmaceutical Case Management program. J Am Pharm Assoc (2003) 2004; 44 (03) 350-357
    CrossrefPubMedGoogle Scholar
  • 33 Millonig MK. Mapping the route to medication therapy management documentation and billing standardization and interoperabilility within the health care system: meeting proceedings. J Am Pharmacists Assoc 2009; 49 (03) 372-382
    PubMedGoogle Scholar
  • 34 Gaskins RE. Innovating Medicaid: the North Carolina experience. N C Med J 2017; 78 (01) 20-24
    PubMedGoogle Scholar
  • 35 CCNC. PHARMACeHOME; 2017. Available at: http://www.pharmacyhomeproject.com/the-project/hie-challenge-grant-program/pharmacehome . Accessed August 1, 2017
    PubMedGoogle Scholar
  • 36 Ulin PR, Robinson ET, Tolley EE. Qualitative Methods in Public Health. 1st ed. San Francisco, CA: Josey-Bass; 2004
    Google Scholar
  • 37 Powell BJ, McMillen JC, Proctor EK. , et al. A compilation of strategies for implementing clinical innovations in health and mental health. Med Care Res Rev 2012; 69 (02) 123-157
    CrossrefPubMedGoogle Scholar
  • 38 Powell BJ, Waltz TJ, Chinman MJ. , et al. A refined compilation of implementation strategies: results from the Expert Recommendations for Implementing Change (ERIC) project. Implement Sci 2015; 10: 21
    CrossrefPubMedGoogle Scholar
  • 39 Proctor EK, Powell BJ, McMillen JC. Implementation strategies: recommendations for specifying and reporting. Implement Sci 2013; 8: 139
    CrossrefPubMedGoogle Scholar
  • 40 Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012; 50 (03) 217-226
    CrossrefPubMedGoogle Scholar
  • 41 NCPDP. Pharmacist eCare Plan: Guidance on the Usage of the HL7 CDA Consolidated Templates for Clinical Notes R2.1 Care Plan. Scottsdale, AZ: National Council for Prescription Drug Programs; 2016
    Google Scholar
  • 42 CPESN. Pharmacist eCare Plan Gains Momentum. Raleigh, NC: Community Pharmacy Enhanced Services Network; 2017. . Available at: https://cpesn.com/newsroom/pharmacist-ecare-plan-gains-momentum/ . Accessed December 21, 2017
    Google Scholar
  • 43 Boas SJ, Bishop TF, Ryan AM, Shih SC, Casalino LP. Electronic health records and technical assistance to improve quality of primary care: lessons for regional extension centers. Healthc (Amst) 2014; 2 (02) 103-106
    PubMedGoogle Scholar
  • 44 Lynch K, Kendall M, Shanks K. , et al. The Health IT Regional Extension Center Program: evolution and lessons for health care transformation. Health Serv Res 2014; 49 (1 Pt 2): 421-437
    CrossrefPubMedGoogle Scholar
  • 45 Jamtvedt G, Young JM, Kristoffersen DT, O'Brien MA, Oxman AD. Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Qual Saf Health Care 2006; 15 (06) 433-436
    CrossrefPubMedGoogle Scholar
  • 46 Ivers NM, Grimshaw JM, Jamtvedt G. , et al. Growing literature, stagnant science? Systematic review, meta-regression and cumulative analysis of audit and feedback interventions in health care. J Gen Intern Med 2014; 29 (11) 1534-1541
    CrossrefPubMedGoogle Scholar
  • 47 Wandersman A, Duffy J, Flaspohler P. , et al. Bridging the gap between prevention research and practice: the interactive systems framework for dissemination and implementation. Am J Community Psychol 2008; 41 (3-4): 171-181
    CrossrefPubMedGoogle Scholar
  • 48 Helfrich CD, Li YF, Sharp ND, Sales AE. Organizational readiness to change assessment (ORCA): development of an instrument based on the Promoting Action on Research in Health Services (PARIHS) framework. Implement Sci 2009; 4: 38
    CrossrefPubMedGoogle Scholar
  • 49 Oladapo AO, Rascati KL. Review of survey articles regarding medication therapy management (MTM) services/programs in the United States. J Pharm Pract 2012; 25 (04) 457-470
    CrossrefPubMedGoogle Scholar
  • 50 Snyder ME, Earl TR, Gilchrist S. , et al. Collaborative drug therapy management: case studies of three community-based models of care. Prev Chronic Dis 2015; 12: E39
    PubMedGoogle Scholar
  • 51 Law AV, Okamoto MP, Brock K. Ready, willing, and able to provide MTM services? A survey of community pharmacists in the USA. Res Social Adm Pharm 2009; 5 (04) 376-381
    CrossrefPubMedGoogle Scholar
  • 52 Hughes CA, Guirguis LM, Wong T, Ng K, Ing L, Fisher K. Influence of pharmacy practice on community pharmacists' integration of medication and lab value information from electronic health records. J Am Pharm Assoc (2003) 2011; 51 (05) 591-598
    CrossrefPubMedGoogle Scholar
  • 53 Bonner L. Pharmacists inch closer to accessing EHRs and HIEs. Pharmacy Today 2016; 22: 44-47
    PubMedGoogle Scholar