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Objectives(1) To develop an adaptation framework for MTM delivery for pharmacists (the MTM Adaptability Framework), (2) to examine the impact of an educational intervention informed by the MTM Adaptability Framework on MTM completion rates over a 2-year period, and (3) to explore pharmacists’ perceptions regarding knowledge and beliefs about MTM and MTM implementation self-efficacy pre- and post-intervention.MethodsThis study is a prospective, mixed-methods research study including a quasi-experimental, one-group pretest-posttest quantitative study with a sequential explanatory qualitative study arm featuring semi-structured key informant interviews. US supermarket pharmacy chain setting included 93 community pharmacy sites located in Tennessee, Kentucky, and Alabama. MTM completion rates are reported as percentage of completed comprehensive medication reviews (CMRs) and targeted medication reviews (TMRs) and pharmacist perceptions.ResultsAn 11.4% absolute increase in MTM completion rates was seen after the educational intervention targeting adaptation of MTM in the community pharmacy setting. This was found to be significant (46.92% vs. 58.3%; p < 0.001). Responses to the semi-structured interviews were mapped against CFIR and included themes: “knowledge and beliefs about MTM (pre-intervention),” “self-efficacy for MTM implementation (pre-intervention),” “knowledge and beliefs about MTM (post-intervention),” and “self-efficacy for MTM implementation (post-intervention).” Data convergence was found across these methodologies and suggested that targeting adaptability of MTM delivery increases MTM completion rates (quantitative data) and positively changes perceptions of MTM feasibility and self-efficacy (interviews).ConclusionThe use of an educational intervention about adaptation of MTM to influence adaptation of MTM to a chain community pharmacy setting part of an implementation strategy improved MTM completion rates significantly. Future research should investigate combined implementation strategies and their impact on MTM implementation success.

Background: Cognitive pharmaceutical services (CPS) provided by pharmacists can improve patient adherence and industry standard performance measures. Community pharmacy technicians can aid in CPS support tasks on training, but it is unknown to what extent. Objective: To determine the effect of community pharmacy technicians on industry standard adherence performance measures after CPS training. Methods: Sixteen community pharmacy technicians within a supermarket chain division were chosen to participate in CPS training based on internal pharmacy benchmarking data. The training program consisted of 3 components: (1) classroom and (2) web-based training for medication therapy management platforms and (3) Hands-on in-pharmacy training. Researchers used pharmacy-specific EQuIPP reports of the proportion of days covered (PDC) for adherence related to diabetes, cholesterol, and hypertension to measure the primary outcome. September through October 2015 represented baseline data. November 2015 through March 2016 represented intervention data. Descriptive and inferential statistics were utilized for this retrospective analysis. The University of Tennessee Institutional Review Board classified the study exempt from review. Results: Overall, 100% of Cholesterol PDC 4-Star sites improved to a 5-Star score and 56% of sites improved in the Diabetes PDC score. All sites maintained a 5-Star score for RASA PDC postintervention. An average increase of 2.36% was observed for Cholesterol PDC across all sites. Possible lag time between the intervention and score improvements may limit relatability of results. Conclusions: This is the first study to report a positive trend between technician involvement in CPS and improvement in industry standard adherence performance measures. Further research capturing a longer time frame may be beneficial.

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Sperm-dependent parthenogens are expected to promote higher female fecundity at the expense of the production of excessive numbers of sperm. They are also expected to trade sperm strictly, in order to compensate for the loss of nutrients invested in sperm, that otherwise could be allocated to the female function. In this paper, we present evidence that in a natural population of the freshwater planarian Girardia (= Dugesia) tigrina, sperm-dependent parthenogenesis is alternated with ®ssipary, a combination not reported before for freshwater¯atworms. More speci®cally, we found that most individuals that engage in a copulation have no or only few testes and sperm available, despite the presence of a fully developed penis, indicating that male allocation is fairly low in this (dense) population. Female fecundity on the contrary is rather high, with isolated individuals producing up to six fertilized cocoons over a 3-week period, releasing ®ve young per cocoon on average. An analysis of the mating behaviour further shows that matings in this species are simple and direct with no distinct courtship behaviour. Copulations last for about 36 min and occur at a rate of at least one copulation a day. Bilateral sperm transfer is the rule, but a considerable number of copulations are unidirectional or without sperm transfer. Nonreciprocal inseminations mainly result from the fact that one or both partners has no sperm stored prior to copulation, indicating that strict sperm trading plays no role in this population of G. tigrina.