Barriers and facilitators to implementing pharmacist-provided comprehensive medication management in primary care transformation

Abstract

Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose How to effectively integrate pharmacists into team-based models of care to maximize the benefit they bring to patients and care teams, especially during times of primary care transformation (PCT), remains unknown. The objective of this study was to identify barriers and facilitators when integrating pharmacist-provided comprehensive medication management (CMM) services into a health system’s team-based PCT using the Consolidated Framework for Implementation Research (CFIR). Methods Semistructured qualitative interviews were carried out with 22 care team members regarding their perceptions of the implementation of CMM in the PCT. Transcripts were coded to identify CMM implementation barriers and facilitators, and resulting codes were mapped to corresponding CFIR domains and constructs. Results Fifteen codes emerged that were labeled as either a barrier or a facilitator to implementing CMM in the PCT. Facilitators were the perception of CMM as an invaluable resource, precharting, tailored appointment lengths, insurance coverage, increased pharmacy presence, enhanced team-based care, location of CMM, and identification of CMM advocates. Barriers included limited clinic leadership involvement, a need for additional resources, CMM pharmacists not always feeling part of the core team, understanding of and training around CMM’s role in the PCT, changing mindsets to utilize resources such as CMM more frequently, underutilization of CMM, and CMM scheduling. Conclusion Clinical pharmacists providing CMM represent a valuable interdisciplinary care team member who can help improve healthcare quality and access to primary care. Identifying and addressing implementation barriers and facilitators early during PCT rollout is critical to the success of team-based services such as CMM and becoming a learning health system.

Integrating comprehensive medication management in specialty clinics: A feasibility study

“…Gaining an understanding of CMM as a service and its potential role within a specialty clinic, ensuring buy‐in from clinics and management, identifying implementation strategies such as preparation of workflows, and using a standardized MTP documentation form were highlighted as critical to successful implementation. These facilitators are consistent with previous literature on successful CMM implementation 19,26,27 …”

“…These facilitators are consistent with previous literature on successful CMM implementation. 19,26,27 Interestingly, when examining the data more closely, it also seemed that perceptions of implementation feasibility were influenced by respondent's roles (pharmacist, pharmacy manager, clinic team member) and clinic type (highly specialized, such as melanoma, vs. more comprehensive in approach to patient care, such as transplant). Across all feasibility indicators, clinic team members scored higher than pharmacists who in turn scored higher than pharmacy managers.…”

Integrating clinical pharmacists into transitions of care: A qualitative study of barriers and facilitators among federally qualified health centers

“…Identifying these aspects early on can ensure that facilitators are maximized and barriers are addressed to foster successful implementation. Furthermore, understanding barriers can aid the development of implementation strategies and quality improvement efforts to address and overcome those barriers 19,20 …”

Pharmacist-Led Education for Increasing Physician Comfort Prescribing Oral COVID-19 Antivirals

“… 7 Beyond their direct patient care role, pharmacists benefit physician—and team—education and knowledge, which benefits the overall quality of the team's patient care. 9 , 10 A systematic review and meta-analysis by Jaam et al 6 established that pharmacist educational programs are pivotal interventions that significantly decrease medication error rates, which can be sustained with subsequent educational programs (unlike single programs without continued follow-up or frequency of education). Indeed, the benefits of pharmacists’ involvement extend beyond patient education to team-based learning.…”

“…In addition to providing educational programs, pharmacists can be further integrated within a complex practice like primary care. 10 As mentioned above, pharmacists are valuable team members because they are drug experts who can share their knowledge with their colleagues. 8 Thus, collaboration and the opportunity to build trust through knowledge sharing, professional respect, and team communication are key aspects of pharmacist integration within a team.…”