The U.S. population is expanding at an estimated 8% every ten-years.1 As the population ages, both the number of people with chronic conditions and the burden on primary care will increase as well.2 As a result, primary care physicians (PCPs) are tasked with managing all of a patient’s health conditions and coordinating care with other providers. Compounding the problem is the expected shortage of PCPs of from 15,000 to 50,000 by 2030, according to the Association of Medical Colleges.3 To address these concerns, new innovative care models such as patient-centered medical homes and accountable care organizations-where PCPs collaborate with other healthcare providers to improve outcomes for patients-have been developed.2
Pharmacists have traditionally been integrated into team-based care (TBC) models in health systems. Now, TBC programs are being expanded to the community pharmacy setting.2 Community pharmacists have demonstrated their value in providing services such as medication therapy management, decreasing medication errors, improving adherence, reducing hospital readmissions, and decreasing costs of healthcare.2,4 As a result, many payers are interested in programs that scale up and increase medication management services (MMS) offered by community pharmacists. The Community Pharmacy Enhanced Service Network (CPESN) is one approach being used to provide pharmacist-led MMS and obtain payment.5 The inclusion of community pharmacy services into alternative payment models is relatively new. Limited evidence exists covering the effective implementation of enhanced service networks.
To better understand what drives effective implementation of community pharmacy TBC models, a mixed methods study using implementation science was conducted by Kea Turner, PhD, MPH; Chelsea Renfro, PharmD; and their colleagues at the University of North Carolina and the University of Tennessee. This study was supported by the Community Pharmacy Foundation.
What Is Implementation Science?
Implementation science (IS) is “the scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice to improve the quality and effectiveness of health services.”6 The ultimate goal of IS is the improvement of the quality of healthcare, usually beginning with an evidence-based practice (EBP) that is under-used.7 The EBP is then evaluated, and quality gaps at the provider, clinic, or healthcare system level are identified and addressed. It is important to note that IS is not the same as clinical research, since IS studies generally focus on the rates and quality of use of EBPs rather than their effects.7 For example, an IS outcome would measure the number of pharmacists providing hypertension management in a community pharmacy as opposed to the impact of pharmacist-led hypertension management on health status. IS focuses on evaluating the process of implementation and its effect on the EBP.7 A comprehensive discussion of implementation science is beyond the scope of this article, but has been reviewed elsewhere.6,7
CPF Study Grant Synopsis
The study, “Removing Barriers to Organizational Change in Community Pharmacies: An Analysis of the Successes and Challenges of Implementing Enhanced Services,” was completed in 2018.8 It was a cross-sectional mixed-methods study that surveyed 268 North Carolina community pharmacies, and interviewed 40 community pharmacists responsible for implementing CPESN in their pharmacy. Implementation strategies among high-performing and low-performing pharmacies were compared using performance metrics for payment identified by the NC-CPESN. Implementation effectiveness was measured by the number of comprehensive medications reviews conducted and the reach of comprehensive medication reviews via the number of eligible patients who received the intervention. Turner and colleagues then evaluated organizational factors that contributed to or hindered the successful implementation of enhanced services in community pharmacies.8
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