Journal Of The American Pharmacists Association[JOURNAL]
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200 papers
Implementation and evolution of a citizen council to support patient-oriented pharmacy practice research in Ontario, Canada.
DeMarco M, Vernon-Wilson E, Mehdi M … +4 more , Dolovich L, Waite NM, Jones J, Rosenberg Yunger ZRS
J Am Pharm Assoc (2003) · 2026 · PMID 41260485 · Publisher ↗
BACKGROUND: The Ontario Pharmacy Evidence Network (OPEN) introduced the OPEN Citizens' Council (OCC) in 2019 as a forum for citizen engagement. The OCC provides OPEN researchers with a mechanism for collecting citizens'...
BACKGROUND: The Ontario Pharmacy Evidence Network (OPEN) introduced the OPEN Citizens' Council (OCC) in 2019 as a forum for citizen engagement. The OCC provides OPEN researchers with a mechanism for collecting citizens' perspectives on research priorities, strategies, data interpretation, and methods. OBJECTIVE: This paper examines the development and learning from OCC meeting data to provide insight into how a citizen advisory forum can enhance health practice research. METHODS: OCC evaluation used mixed methods. The Public and Patient Engagement Evaluation Tool (PPEET) and participant feedback interviews were offered to both OCC members and researcher presenters following OCC meetings. Descriptive statistical analysis of quantitative data (PPEET survey) was conducted. Inductive thematic analysis was used to conceptualize themes from qualitative semi-structured interviews from both OCC members and researcher presenters. RESULTS: Ongoing collection and analysis of survey data guided changes to OCC delivery. These included adjusting training, modifying meeting duration and scheduling, expanding preparation and discussion by posting materials online prior to meetings. Qualitative analysis of interview data led to development of four major themes: 1) rationale for participation in OCC, 2) OCC meeting experience, 3) lessons learned about citizen engagement, and 4) research impact and ramifications of citizen engagement (CE). CONCLUSION: Regular evaluation enabled council development that provided pharmacy researchers with a way to explore societal views on strategic and implementation research stages. By tapping into broad, civic knowledge, citizen engagement panels can complement other research engagement activities that include patients who have specific, lived experiences. Greater recognition of engagement types, activities, and associated value, along with resources to support collaborative initiatives, will lead to a more responsive research landscape.
Barriers, facilitators, and confidence to provide maternal health services in pharmacies in South Carolina.
Davies A, Rudisell E, Ballou J … +3 more , Hite P, Fabel PH, Hastings TJ
J Am Pharm Assoc (2003) · 2026 · PMID 41207656 · Publisher ↗
BACKGROUND: Maternal morbidity remains a significant public health concern, disproportionately affecting mothers in rural areas. Community pharmacy staff in these regions, often the most accessible health care providers,...
BACKGROUND: Maternal morbidity remains a significant public health concern, disproportionately affecting mothers in rural areas. Community pharmacy staff in these regions, often the most accessible health care providers, are well-positioned to improve maternal health outcomes. However, few currently offer maternal health services. OBJECTIVES: This study aimed to assess the knowledge, confidence, and perceived barriers and facilitators among pharmacists and pharmacy technicians regarding the implementation of maternal health services in community pharmacies in South Carolina (SC). METHODS: A cross-sectional electronic survey was conducted from February to April 2023 among SC pharmacists and pharmacy technicians. Maternal health was defined to include care during contraception, preconception and fertility, prenatal, and postnatal periods. Descriptive statistics were used to analyze demographic and pharmacy characteristics. Exploratory factor analysis with varimax rotation was performed on scales measuring perceived barriers and facilitators, with reliability assessed via Cronbach's alpha. The mean scale scores were calculated for confidence, barriers, and facilitators subscales, and 1-way analysis of variance was used to examine differences in perceived barriers and facilitators across demographic groups. RESULTS: Among the 176 respondents (123 pharmacists, 69.9%; 51 pharmacy technicians, 29%), knowledge gaps were most pronounced in hormonal contraception, preconception and fertility care, and postnatal domains. Confidence was highest in providing contraception services. Factor analysis identified 3 key factors each for barriers (pharmacy, external, and patient) and facilitators (pharmacy, community support, and access/convenience), with Cronbach's alpha scores ranging from 0.642 to 0.823. Perceived barriers and facilitators varied significantly by demographic characteristics, including rurality, parental status, and pharmacy type. CONCLUSION: Although pharmacists in rural areas are highly accessible, numerous barriers hinder the provision of maternal health services. Efforts are needed to enhance knowledge, boost confidence, and address these barriers to enable broader implementation of maternal health services in community pharmacies.
Patient and provider perspectives on the implementation of DPYD testing in oncology care clinics in an academic health system.
Wittner V, Purcell J, Cayabyab M … +6 more , Hoffecker G, Kalman J, Teitelbaum U, Schnoll R, Rendle KA, Tuteja S
J Am Pharm Assoc (2003) · 2026 · PMID 41207655 · Publisher ↗
BACKGROUND: Pharmacogenomic variants in dihydropyrimidine dehydrogenase (DPYD) are associated with increased risk of severe treatment related adverse events (TRAEs) with standard fluoropyrimidine dosing. Pretreatment tes...
BACKGROUND: Pharmacogenomic variants in dihydropyrimidine dehydrogenase (DPYD) are associated with increased risk of severe treatment related adverse events (TRAEs) with standard fluoropyrimidine dosing. Pretreatment testing with preemptive dose reductions in variant carriers can prevent TRAEs. However, testing is not widely implemented, highlighting the need to understand barriers to increase adoption and maintenance. OBJECTIVES: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) and Consolidated Framework for Implementation Research (CFIR) frameworks, we implemented DPYD testing within gastrointestinal oncology clinics. Our study aimed to collect qualitative data from key stakeholders to identify barriers and facilitators of testing following the initial implementation phase into practice. METHODS: We conducted key informant interviews and focus groups with oncology clinicians, gastrointestinal oncology patients, and caregivers. Semi-structured interview guides informed by EPIS/CFIR were developed. Purposeful sampling was utilized to identify potential participants. Interviews were recorded and transcribed. Research team notes were used where recordings were unavailable, and rapid qualitative methods were used to summarize findings and complete a priori coded matrices based on the EPIS framework. Barriers and facilitators were extracted and categorized by themes. RESULTS: From 8/2022 to 3/2025, 20 patients, 4 caregivers, and 26 clinicians from 7 sites participated. Immediately after the implementation phase, clinicians mentioned electronic health record integration of test results, availability of blood-based testing, and improved patient safety as main facilitators while cost, evidence uncertainty, and integration into pre-existing workflows were identified as barriers. After clinical testing was implemented, clinician barriers shifted toward lack of clarity in drug labeling and workflow challenges with early patient identification and timely test ordering. Patients were generally unaware of testing and emphasized education as the key facilitator. CONCLUSION: Patients, caregivers, and providers were in favor of clinical DPYD testing to prevent fluoropyrimidine TRAEs but identified key barriers that can guide efforts toward scaling and maintenance.
Projecting financial sustainability for clinical pharmacy services: An implementation science brief report.
Ellis AW, Grant CC, Finch CK … +2 more , Frye RF, Sorensen TD
J Am Pharm Assoc (2003) · 2026 · PMID 41205870 · Publisher ↗
BACKGROUND: The United States faces a projected shortage of 86,000 physicians by 2036, disproportionately affecting rural areas. Meanwhile, 90% of Americans live within 5 miles of a pharmacy, positioning pharmacists to h...
BACKGROUND: The United States faces a projected shortage of 86,000 physicians by 2036, disproportionately affecting rural areas. Meanwhile, 90% of Americans live within 5 miles of a pharmacy, positioning pharmacists to help address care gaps. Despite demonstrated clinical value, pharmacist integration into primary care is hindered by unclear compensation pathways. OBJECTIVES: This study developed and piloted the Pharmacist Revenue and Integration Modeling Engine (PRIME), a novel tool to support financial decision-making for pharmacist integration. Objectives included (1) developing PRIME, (2) exploring implementation strategies, and (3) modeling financial viability. METHODS: The University of Tennessee Health Science Center partnered with an academic family medicine clinic in Memphis, TN, to re-establish clinical pharmacy services. PRIME used the 2025 Medicare Physician Fee Schedule, adjusted for Medicaid, private insurance, and self-pay, to model revenue across 4 service delivery scenarios. A full-time pharmacist (40 h/wk, 46 wk/y) was assumed, and projected revenue was compared to personnel costs. RESULTS: Financial viability varied by service type and volume. Preventive care and collaborative physician-pharmacist visits (e.g., annual wellness visits and 99,214 E/M codes) were key revenue drivers. The most successful model (approach 1.5) blended preventive and collaborative services, generating $286,700 in annual revenue and a net surplus of $105,500 (ROI 1.58:1). This led to a clinic-academic partnership placing 2 pharmacists (1 full-time equivalent) in the clinic. CONCLUSION: Strategic use of billing codes can make clinical pharmacy services financially self-sustaining in primary care. PRIME offers a customizable roadmap for clinics to evaluate and implement pharmacist integration. This model supports workforce expansion, training opportunities, and improved access to care.
Pharmacy staff willingness to establish pre-exposure prophylaxis-based collaborative practice agreements in the Southeast United States.
Nicholas A, Chandra C, Zissette S … +6 more , Hudson A, Hamilton C, Klepser D, Quamina A, Holland DP, Crawford ND
J Am Pharm Assoc (2003) · 2026 · PMID 41205869 · Publisher ↗
BACKGROUND: A collaborative practice agreement (CPA) allows a pharmacist to provide various patient care functions (i.e., ordering labs and modifying drug therapies) under the supervision of a provider. CPAs could facili...
BACKGROUND: A collaborative practice agreement (CPA) allows a pharmacist to provide various patient care functions (i.e., ordering labs and modifying drug therapies) under the supervision of a provider. CPAs could facilitate pharmacists to provide human immunodeficiency virus (HIV) prevention services such as pre-exposure prophylaxis screening and prescribing, which could enhance HIV prevention services in places with historically low access. OBJECTIVE: We evaluate correlates of pharmacy staff willingness to establish CPAs and to provide specific patient care functions. METHODS: The Collaborative Agreement-based pre-exposure prophylaxis Using Pharmacists study conducted online surveys among pharmacy staff from 8 states in the Southeast United States. Data collection began in January 2024 and is ongoing. Survey questions were developed using Consolidated Framework for Implementation Research constructs and capture the history of CPA usage, attitudes about CPAs, and willingness to establish CPAs. Descriptive analysis and Poisson regression were performed using preliminary data to evaluate pharmacy staff willingness to offer specific patient care functions through CPAs. RESULTS: Among 246 respondents, 67 (27%) currently have at least 1 CPA in place, with 20 (30%) of those CPAs involving infectious disease care. About 75% were willing to establish a CPA to provide additional services to their patients. Most pharmacy staffs were willing to provide medication therapy management (91%), patient counseling (82%), and modification of existing therapy (73%); fewer were willing to interpret laboratory tests (54%), order laboratory tests (52%), and perform laboratory tests (39%). The strongest correlate of willingness to establish a CPA was having received formal training on CPAs. CONCLUSION: Most pharmacy staffs were willing to establish CPAs to provide additional services beyond their current scope of practice, but few have experience with infectious disease CPAs. Future research is needed to identify factors that will allow for successful development and implementation of HIV prevention-specific CPAs and understand barriers to willingness for pharmacy staff who are unwilling to establish CPAs.
Association between state policies enabling pharmacist-led human immunodeficiency virus pre-exposure prophylaxis and need for human immunodeficiency virus prevention: An ecological analysis.
Chandra C, Hamilton C, Young HN … +2 more , Holland DP, Crawford ND
J Am Pharm Assoc (2003) · 2026 · PMID 41203205 · Full text
BACKGROUND: Models of pharmacist-led pre-exposure prophylaxis (PrEP) services have been shown to effectively reach populations disproportionately affected by human immunodeficiency virus (HIV). Pharmacist prescriptive au...
BACKGROUND: Models of pharmacist-led pre-exposure prophylaxis (PrEP) services have been shown to effectively reach populations disproportionately affected by human immunodeficiency virus (HIV). Pharmacist prescriptive authority for PrEP varies across states, limiting the potential scale up of these models. OBJECTIVE: We investigated whether states with the most restrictive policies were also the states that could benefit the most from expanded PrEP access. METHODS: We classified U.S. states and the District of Columbia into 5 distinct policy categories ranked from most restrictive to least restrictive and estimated the association between these categories and the state PrEP-to-need ratio, the ratio of current PrEP users to new HIV diagnoses in the state. RESULTS: Most states had restrictive policies that limit pharmacists' ability to initiate PrEP for their clients. States with the most restrictive policy of patient-specific collaborative practice agreements may be more likely to benefit from expanded PrEP access compared to states with the least restrictive policy (i.e., unrestricted authority/statute). CONCLUSION: In the absence of a national strategy or policy to expand pharmacist-led PrEP, state-level efforts are needed to improve access to PrEP in pharmacies.
Implementation strategies for the provision of fentanyl test strips in community pharmacies: Perspectives from pharmacy teams and harm reduction experts.
Nguyen TQ, Smith BE, Foo I … +2 more , Chaves M, Carroll JC
J Am Pharm Assoc (2003) · 2026 · PMID 41203204 · Publisher ↗
BACKGROUND: Fentanyl test strips (FTS) are harm reduction (HR) tools that allow people who use drugs (PWUD) to check drug supplies for fentanyl. Pharmacies can be locations to access FTS services given their accessibilit...
BACKGROUND: Fentanyl test strips (FTS) are harm reduction (HR) tools that allow people who use drugs (PWUD) to check drug supplies for fentanyl. Pharmacies can be locations to access FTS services given their accessibility in communities; however, many pharmacy teams may not know how to provide this service. There is a need to better understand best practices for the implementation of FTS within pharmacies. OBJECTIVES: This research aimed to identify strategies for implementing the provision of FTS in Pennsylvania community pharmacies. METHODS: This was a preimplementation qualitative study. We conducted focus groups with pharmacy teams and HR experts. Participants were selected using a purposeful, mixed heterogeneity and snowball sampling strategy. The discussion guide was informed by (1) the National Harm Reduction Coalition's Principles of Harm Reduction, (2) previous published barriers to HR in the pharmacies, and (3) the Consolidation Framework for Implementation Research 2.0. Data were analyzed using an inductive thematic analysis, and findings were returned to participants for member checking purposes. RESULTS: Seven pharmacy team members and 7 HR experts participated in 4 focus group discussions. Seven strategies were identified: (1) adopt HR principles in your pharmacy practice before FTS implementation; (2) educate yourself, your pharmacy team, your patients, health care providers, and your community about FTS and HR; (3) partner with organizations and providers to implement FTS and other HR services; (4) normalize providing drug checking tools, like FTS, and other HR products and services in the pharmacy; (5) build relationships with PWUD and their communities; (6) offer other health and patient care services alongside providing FTS; and (7) plan for FTS/HR service implementation and sustainability. CONCLUSION: Both pharmacists and HR experts supported FTS distribution through community pharmacies. Seven strategies emerged from focus group discussions that guide FTS service implementation within pharmacies.
Engaging community pharmacies and schools of pharmacy.
Mitchell H, Rosenthal M, Brown M … +2 more , Jenkins A, Rayborn LM
J Am Pharm Assoc (2003) · 2026 · PMID 41203203 · Publisher ↗
BACKGROUND: Academic institutions are in a unique position to build relationships with community pharmacies, with most facilitated engagements in the literature focusing on students as facilitators of these partnerships....
BACKGROUND: Academic institutions are in a unique position to build relationships with community pharmacies, with most facilitated engagements in the literature focusing on students as facilitators of these partnerships. However, preceptors note challenges managing time and incorporating students into workflow. Applying community-based participatory research (CBPR) principles can help ensure that partnerships between schools and pharmacies are sustainable, responsive to current needs, and positioned to advance practice. OBJECTIVE: To demonstrate how schools/colleges of pharmacy can develop equitable, sustainable, and mutually beneficial partnerships with community pharmacies by describing the process undertaken by the University of Mississippi School of Pharmacy (UMSOP), using CBPR principles to host a pharmacy summit event for community preceptors. METHODS: A preprogram survey was sent to all community pharmacy preceptors associated with the UMSOP that consisted of 4 questions: 3 utilizing a Likert scale and a fourth open response. Preprogram survey responses were used by the planning committee to create the itinerary for the summit. The same preceptors who were asked to complete the preprogram survey were also invited to the summit. Summit attendees were given an opportunity to obtain continuing education credit by completing a business plan for a revenue-generating care service to provide in their pharmacy and filling out a postprogram evaluation. RESULTS: The preprogram survey received 25 of 76 responses from community pharmacy preceptors. Top interests from preceptors were Advocacy/Legislation Updates, Non-Dispensing Revenue, and Effectively Utilizing Pharmacy Students, and the top challenges were recognized as Low Reimbursement Rates, Pharmacy Cash Payment Model, and Marketing. The summit hosted 12 pharmacists from 12 different pharmacies, 7 faculty, 8 state pharmacy organization representatives, and 4 students/residents. Seven attendees submitted business plans, which all directly correlated to content from the event itinerary. CONCLUSION: This pharmacy summit demonstrates how academic institutions can use this distinctive approach to develop and build on partnerships with community pharmacies, and we hope it can serve as a model for other schools seeking to engage with community pharmacies. The goal for UMSOP is to continue to host a pharmacy summit on an annual basis and develop more projects rooted in the principles of CBPR in order to continuously develop community pharmacy partnerships.
Development of a community-focused emergency response tool for medication-related preparedness.
Schneider S, Connor S, Barik K … +3 more , Jonkman LJ, Truong HA, Carroll JC
J Am Pharm Assoc (2003) · 2026 · PMID 41203202 · Publisher ↗
BACKGROUND: Pharmacists are among the first health care providers to respond after a disaster. They serve a vital role through mass medication dispensing or vaccination and triaging the medication needs of the community....
BACKGROUND: Pharmacists are among the first health care providers to respond after a disaster. They serve a vital role through mass medication dispensing or vaccination and triaging the medication needs of the community. Their role during the COVID-19 pandemic and other disasters have highlighted a need to engage pharmacists in local emergency preparation and community planning efforts. OBJECTIVE: The objective of this project was to develop an expert-informed medication-related emergency response readiness tool for community-based pharmacists. METHODS: Pharmacists with expertise in the different phases of disaster management informed revisions of an existing emergency response readiness checklist for short-term humanitarian response. The checklist was chosen to adapt because it focuses on pharmacist medication expertise while guiding users through all phases of the disaster management cycle. A variation of nominal group technique was used to gather expert feedback on the checklist and gain consensus on the adapted tool. RESULTS: The expert panel included 9 pharmacists with collective experience in over 50 emergencies in more than 20 countries. The panel recommended adapting the checklist to a comprehensive tool format to represent the continuousness of disaster management cycle. The panel recommended keeping the tool line items focused on medication access and prompting pharmacists to think about how they can use their medication expertise to ensure equitable access to care during and after an emergency. Most revisions were in the prevention and preparedness phases of the tool and build up capacity for a local response effort through community partnerships. CONCLUSION: To our knowledge, this emergency response readiness tool is the first to guide community-based pharmacists through the critical steps required for disaster and emergency medication-related preparation. Medication-related disaster management requires a multiple-step process that is ongoing as the needs of communities change over time.
Bridging the gap between expanded pharmacy services and payment models: A jurisdictional scan.
Ceka A, Juneja B, Tseng O … +7 more , Zhang W, Kuo IF, Bansback N, Law MR, Lynd LD, Zed PJ, Mitton C
J Am Pharm Assoc (2003) · 2026 · PMID 41203201 · Publisher ↗
BACKGROUND: Over the past few decades, pharmacists' roles have expanded beyond dispensing to include medication reviews, minor ailment prescribing, and vaccinations. In British Columbia, Canada, the fee-for-service model...
BACKGROUND: Over the past few decades, pharmacists' roles have expanded beyond dispensing to include medication reviews, minor ailment prescribing, and vaccinations. In British Columbia, Canada, the fee-for-service model has been recognized as a barrier to service uptake. To design future payment models that support uptake, it is important to examine the impacts of models used in other jurisdictions. OBJECTIVES: To examine pharmacy remuneration models minor ailments provided by pharmacists across Organization for Economic Co-operation and Development (OECD) countries. The objectives of this study were to (1) identify the structure, funding mechanisms, and provider-level incentives for these models and (2) to assess the reported impacts of these models on service uptake, cost-effectiveness, health care access, and associated barriers and facilitators within community pharmacy settings. METHODS: We conducted a literature review to investigate the payment structures for pharmacists providing expanded services for minor ailments. Guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched MEDLINE and EMBASE databases from January 1, 2003, to September 20, 2023, focusing on pharmacy services, remuneration, and minor ailments in OECD countries such as the United Kingdom, Australia, New Zealand, the United States, etc. RESULTS: The search yielded 1662 records, of which 11 primary studies and 5 systematic reviews met the inclusion criteria, which examined 3 payment models for pharmacies providing minor ailment services: fee-for-service, performance-based payment models (PBPM) and capitation models. Fee-for-service models were found to encourage dispensing based on volume but provided little incentive for quality care. PBPM models were effective in promoting quality care but were noted to lack flexibility. Evidence on capitation models was minimal. CONCLUSION: This overview of remuneration models explored alternative payment models to encourage expanded pharmacist services. The review highlights that various payment models come with their own unique benefits, such as cost savings and improved patient care. When designing a payment model, it is essential to prioritize stakeholder engagement and address equity concerns.
Using implementation science to evaluate perceived feasibility of pharmacy-based HIV services in the Southeastern United States.
Hamilton C, Hudson A, Borate SN … +5 more , Zissette S, Chandra C, Nicholas A, Young HN, Crawford ND
J Am Pharm Assoc (2003) · 2026 · PMID 41203200 · Publisher ↗
BACKGROUND: The Southern United States accounts for over half of new HIV diagnoses despite representing just over one-third of the population and remains a priority region in the Ending the HIV Epidemic (EHE) initiative....
BACKGROUND: The Southern United States accounts for over half of new HIV diagnoses despite representing just over one-third of the population and remains a priority region in the Ending the HIV Epidemic (EHE) initiative. Community pharmacies are accessible, trusted health care sites with potential to expand HIV prevention services, yet limited evidence exists on pharmacy staff perspectives across the Southeast. OBJECTIVES: Guided by the Consolidated Framework for Implementation Research (CFIR), we assessed implementation related factors and demographic characteristics to identify correlates of perceived feasibility of tailoring HIV services to community pharmacies in EHE priority counties across eight Southeastern states. METHODS: We conducted a cross-sectional survey (November 2023-June 2025) of community pharmacy staff in eight Southeast states. Eligible participants were recruited from independent and chain pharmacies using the National Council for Prescription Drug Programs database. Survey items, informed by CFIR, captured constructs across intervention characteristics, outer setting, inner setting, and characteristics of individuals. The primary outcome was perceived feasibility of tailoring HIV services (yes/no). Descriptive statistics summarized all variables, chi-square and Fisher's exact test examined bivariable associations, and modified Poisson regression with robust standard errors estimated adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs). RESULTS: Of 291 respondents, 48.8% perceived that it was feasible to tailor HIV services to their pharmacy. In adjusted models higher feasibility was associated with being Asian (PR = 1.51; 95% CI: 1.17-1.96) or Black (PR = 1.37; 95% CI: 1.15-1.62), having a private area available for HIV testing (PR = 1.36; 95% CI: 1.01-1.84) and perceiving that there is enough evidence to support HIV testing in pharmacies (PR = 2.12; 95% CI: 1.32-3.58). CONCLUSION: Guided by the CFIR, perceived feasibility of pharmacy-based HIV services was strongly associated with intervention characteristics and inner setting factors. Strengthening evidence dissemination and addressing structural barriers may be critical for advancing scalable, pharmacy-based HIV prevention in the US Southeast.
Pharmacy HIV pre-exposure prophylaxis/post-exposure prophylaxis furnishing: The benefits of collaborating with peer navigators.
Morehead-Gee A, Selders D, Hill K … +5 more , Chavez A, Gonzalez J, Takata L, Nazarian J, Mosqueda D
J Am Pharm Assoc (2003) · 2026 · PMID 41198029 · Publisher ↗
BACKGROUND: California Senate Bill 159 (2019) enables pharmacists to furnish oral human immunodeficiency virus pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) without a clinician's prescription; howev...
BACKGROUND: California Senate Bill 159 (2019) enables pharmacists to furnish oral human immunodeficiency virus pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) without a clinician's prescription; however, its implementation has been limited by barriers including time and space constraints. Noting these barriers, a peer navigator-led pharmacy PrEP/PEP program was created within a Southern California Federally Qualified Health Center (FQHC). OBJECTIVE: The program aimed to enable pharmacist PrEP/PEP furnishing through collaboration with navigators and increase the FQHC's number of PrEP patients by 25% in 2 years. METHODS: In 2021, a multidisciplinary team developed a program that involved navigators meeting with patients, conducting eligibility assessments, and providing human immunodeficiency virus testing to facilitate pharmacists' PrEP/PEP furnishing. From 2021 to 2023, the team implemented the program at 11 FQHC pharmacies by providing SB-159-required online trainings followed by in-person simulation trainings, allowing pharmacists to practice the workflow with navigators. This study evaluates the program using components of the RE-AIM framework, assessing the program's reach (number/type of encounters and demographics of program users) and efficacy (percentage of encounters that led to follow-up PrEP/PEP clinic visits) in its first 2 years. RESULTS: The pharmacy program had 238 total encounters within its first 2 years; 161 (67.6%) were for PrEP and 77 (32.4%) were for PEP. Of the 216 unique program users, 166 (76.9%) were documented as having Hispanic/Latinx ethnicity, and 145 (67.1%) were documented as LGBTQ+. Encounters led to 195 (81.9%) follow-up appointments scheduled, of which 156 (80.0%) were attended. The FQHC's number of enrolled PrEP patients increased from 239 in January 2022 to 339 in December 2023 (41.8%). CONCLUSION: This pharmacy program successfully increased PrEP/PEP access by creating a collaborative workflow led by peer navigators. Navigators are key to facilitating PrEP/PEP furnishing by aiding pharmacists in completing requirements and offering individuals a nonjudgmental peer encounter to obtain PrEP/PEP.
Identifying barriers and facilitators to providing enhanced naloxone education services in community pharmacies.
Kieck D, Middleton N, Cherinka E … +3 more , Polivka N, Eidle C, Pezzino N
J Am Pharm Assoc (2003) · 2026 · PMID 41198028 · Publisher ↗
BACKGROUND: Opioid misuse remains a critical public health issue in the United States, with approximately 80,000 opioid-related deaths reported in 2023. Community pharmacists are well-positioned to improve access to and...
BACKGROUND: Opioid misuse remains a critical public health issue in the United States, with approximately 80,000 opioid-related deaths reported in 2023. Community pharmacists are well-positioned to improve access to and education about naloxone. Despite the availability of naloxone through standing orders and over-the-counter options, barriers such as stigma, cost, and workflow limitations persist. OBJECTIVES: This study aimed to identify barriers and facilitators to implementing and billing for reimbursable naloxone education services via a payer contract in community pharmacies. METHODS: This implementation science study utilized a qualitative approach. Pennsylvania Pharmacists Care Network eCare plan submissions were analyzed using descriptive statistics. Pharmacies were included in a semi-structured interview if they submitted an eCare plan for the naloxone education service since January 2023. An interview guide was developed based on the RE-AIM framework, which evaluates service implementation across five domains: Reach, Effectiveness, Adoption, Implementation, and Maintenance. Interviews were recorded and transcribed via Zoom, then independently coded by 3 investigators in NVivo. A mixed deductive-inductive thematic analysis was conducted to identify barriers, facilitators, and sustainability themes related to program implementation. RESULTS: Forty pharmacies submitted 653 eCare plans for the naloxone and education dispensing payer program for reimbursement. Twelve participated in semi-structured interviews, which represented 232 of the submitted eCare plans. Six themes emerged from the interviews, including building relationships with community members; expanding staff roles and empowering team collaboration in patient care to support and initiate patient services; consistent processes for identifying, educating, and billing; reducing stigma and increasing naloxone distribution through open communication and community engagement; common barriers to implementing naloxone education services; and the need for enhanced education and training resources to improve service efficiency. CONCLUSION: Naloxone education by community pharmacists is important in preventing opioid-related adverse events. Providing pharmacists with educational resources and training may enhance their ability to effectively educate patients about naloxone.
Substance use disorder education via digital outreach: An evaluation of program dissemination and implementation.
Taylor A, McCormick N, Phillippe H … +4 more , Delaney R, Fox B, Marlowe K, Hohmann L
J Am Pharm Assoc (2003) · 2026 · PMID 41198027 · Publisher ↗
BACKGROUND: Substance use disorders (SUDs) remain a significant public health concern in Alabama, where usage rates for substances such as opioids, alcohol, and tobacco exceed national averages. Vulnerable populations fa...
BACKGROUND: Substance use disorders (SUDs) remain a significant public health concern in Alabama, where usage rates for substances such as opioids, alcohol, and tobacco exceed national averages. Vulnerable populations face additional barriers due to stigma, access issues, and systemic inequities. There is a need for accessible, scalable educational interventions targeting both health care professionals and community members. OBJECTIVES: To design, disseminate, and implement a web-based educational initiative-the Substance Use Disorders in Alabama (SUDA) program-to address emerging substance use trends among key audiences across the state. METHODS: The SUDA program was developed through a partnership between Auburn University Harrison College of Pharmacy's Center for Opioid Research, Education, and Outreach and the Alabama Department of Mental Health. Thirteen expert-led webinars were produced and made available on-demand, covering topics such as opioid use disorder, stimulant misuse, and vaping. The program targeted health care professionals (with continuing education (CE) credits offered) and community members through a digital marketing campaign using geo-targeting and behavioral data. Dissemination and implementation outcome metrics including ad impressions, click-through rates (CTR), webpage visits, webinar downloads, and CE credits issued were used to evaluate program reach, engagement, and adoption. RESULTS: The digital campaign generated 8 million impressions and reached 1.4 million unique users with an average CTR of 0.10%. Within 3 months of launch, the SUDA website received over 3000 unique visitors. More than 2948 CE credit hours were issued. Highest digital advertisement engagement rates were seen among LGBTQ (lesbian, gay, bisexual, transgender, or queer) individuals, elected officials, and social service workers. Tablet users showed the highest CTRs. CONCLUSION: The SUDA program successfully disseminated and implemented a scalable, accessible digital education initiative for addressing SUDs in Alabama. Digital engagement and CE incentives effectively reached health care and community audiences. Future efforts should focus on improving access and expanding outreach to underserved populations.
Exploring workflows for long-acting antiretroviral therapy administration in community pharmacies.
Clinard V, Bumanglag K, Saberi P … +6 more , Hester K, Sigua M, Udeani G, Sherman E, Cuca Y, Cocohoba J
J Am Pharm Assoc (2003) · 2026 · PMID 41198026 · Publisher ↗
BACKGROUND: Long-acting injectable antiretroviral therapy (LA-ART) can improve adherence and virologic suppression in people with human immunodeficiency virus (HIV). While some clinics have successfully implemented these...
BACKGROUND: Long-acting injectable antiretroviral therapy (LA-ART) can improve adherence and virologic suppression in people with human immunodeficiency virus (HIV). While some clinics have successfully implemented these services, others face staffing and system barriers. Community pharmacies offer an alternative venue for LA-ART administration, but little is known about how workflows might be optimized. OBJECTIVE: This study aims to outline key considerations in an ideal workflow to implement LA-ART into community pharmacies from the perspective of clinic, pharmacy, and patient stakeholders. METHODS: Data were derived from a convergent-parallel mixed-methods parent study. Surveys and semi-structured interviews were conducted to explore perspectives on the feasibility of LA-ART administration in community pharmacies. Using thematic analysis, excerpts specific to ideal pharmacy workflows were extracted, coded, and analyzed. A process map was developed to visualize pharmacy workflow activities. RESULTS: Of the 63 study participants, 59 provided insights on ideal workflows for LA-ART administration in pharmacies. Seven primary themes emerged: (1) communication across stakeholders, (2) staffing and logistical operational structure, (3) patient management and follow-up, (4) insurance and reimbursement barriers, (5) physical space and infrastructure, (6) pharmacist and patient education, and (7) patient choice and flexibility. Effective communication, appointment-based systems, and private spaces were emphasized. Participants identified challenges such as unclear protocols for patient management, insurance and reimbursement complexities, and the need for pharmacists and patient education to ensure successful implementation. CONCLUSION: Community pharmacies are a promising venue for LA-ART administration. Key workflow issues must be addressed to ensure successful implementation. Understanding stakeholder perspectives provides a foundation for developing scalable models to expand access to HIV treatment and prevention.
Interprofessional medication review in the outpatient setting: A mixed-method contextual analysis.
Wälti LS, Jeiziner C, Broggini L … +4 more , Maydl S, Kim D, Boeni F, Allemann SS
J Am Pharm Assoc (2003) · 2026 · PMID 41198025 · Publisher ↗
BACKGROUND: Medication review (MR) reduces drug-related problems and improves medication safety. Community pharmacists are trained to deliver MRs, but implementation in outpatient settings remains low. OBJECTIVES: This c...
BACKGROUND: Medication review (MR) reduces drug-related problems and improves medication safety. Community pharmacists are trained to deliver MRs, but implementation in outpatient settings remains low. OBJECTIVES: This contextual analysis aimed to develop an Implementation Research Logic Model with strategies for the implementation of an interprofessional MR service in the outpatient setting. Feasibility and acceptability of the service for primary care patients were pilot tested. METHODS: A mixed-methods study design combining qualitative and quantitative data was used. The Basel Approach for coNtextual ANAlysis framework guided the contextual analysis, which included a scoping review, pilot study, qualitative interviews, and stakeholder involvement. For the pilot study, a convenience sample of co-working general practitioner (GP) practices and community pharmacies was recruited and instructed to deliver the new MR service. Screening questionnaires and process indicators were analyzed descriptively. Semistructured interviews were performed with GPs, medical practice assistants, community pharmacists, and patients and analyzed for feasibility and acceptability of the service. RESULTS: One hundred seventy-two patients from 3 GP practices completed the screening for increased risk of drug-related problems, and 23 were referred to the community pharmacy. MRs took 94 ± 61 minutes and led to 2.95 ± 1.54 suggestions to optimize medication therapy. The interviewed health care professionals were satisfied with the instruction workshop and valued the idea of the service; however, the process was criticized for several reasons: lack of time, more work in primary health care, and difficulties in involving the whole team. CONCLUSION: This contextual analysis of an interprofessional MR service to improve patients' medication safety was highly accepted by health care professionals and patients. Integration into daily routine should be further improved to increase feasibility. These results will be used to widely and sustainably implement interprofessional MR in Swiss primary care.
Best practices and barriers to implementing value-based payer programs in community pharmacies: An application of the EPIS framework.
Ballou JM, Bell L, Johnson AG … +2 more , Page R, Rosenthal M
J Am Pharm Assoc (2003) · 2026 · PMID 41198024 · Publisher ↗
BACKGROUND: The advancement of clinical services in the community pharmacy setting hinges on workflow augmentations that will assist pharmacies in successful implementation. Community Pharmacy Enhanced Services Network (...
BACKGROUND: The advancement of clinical services in the community pharmacy setting hinges on workflow augmentations that will assist pharmacies in successful implementation. Community Pharmacy Enhanced Services Network (CPESN) Mississippi is a network of community-based pharmacies collaborating to optimize medication use to promote positive patient health outcomes. OBJECTIVE: The purpose of this study was to evaluate barriers to and best practices for implementing patient care services while participating in payer engagements. METHODS: This qualitative, quality improvement study was approved as exempt by the University of Mississippi Institutional Review Board. Subjects included owners or managers of pharmacies participating in CPESN Mississippi, an accountable pharmacy organization. Investigators developed two interview guides using the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework. One interview guide was intended to gather information on best practices for the implementation of services, while the other was geared toward assessing barriers to implementation. Pharmacies were sorted into 2 groups to receive either the barriers or best practices questions based on their participation in a payer program in the fall of 2021. Interviews were conducted via telephone and were digitally recorded. Three attempts to contact each pharmacy were made on different days and times. Interviews were transcribed via Trint and underwent analysis for thematic content. RESULTS: A total of 21 pharmacists at community pharmacies in CPESN Mississippi were interviewed for a response rate of 41%. There were 8 interviews in the best practices group and 13 in the barriers group. The content analysis identified 4 themes in best practices (role specialization, clear communication, support from leadership, and patient engagement) and 4 themes in barriers (infrastructure needs, documentation complications, staff buy-in, and reimbursement). CONCLUSION: Study findings concluded that community pharmacists are eager to find alternative sources of revenue but require support with implementation. The use of the EPIS Framework allows for the identification of specific implementation strategies for testing in future studies and creating sustainable and scalable change in the community pharmacy setting.
Perceptions and practices of long-acting injectable antipsychotic administration in community pharmacies within Washington State: A qualitative implementation science study.
English C, Helfrich C, Bacci JL … +2 more , Fox J, Mog AC
J Am Pharm Assoc (2003) · 2026 · PMID 41192510 · Publisher ↗
BACKGROUND: Use of long-acting injectable antipsychotics (LAIAs) for schizophrenia are associated with improved medication adherence and reduce relapse and hospitalizations compared to oral antipsychotics; however, despi...
BACKGROUND: Use of long-acting injectable antipsychotics (LAIAs) for schizophrenia are associated with improved medication adherence and reduce relapse and hospitalizations compared to oral antipsychotics; however, despite these advantages LAIAs remain underutilized. Community pharmacies could improve access and reduce logistical barriers to LAIA administration; however, relatively few deliver this service, and we do not yet fully understand why. OBJECTIVE: To assess the contextual fit of administering LAIAs in community pharmacies, identify determinants influencing implementation, and inform implementation strategies to optimize and increase LAIA delivery across Washington State. METHODS: Key informant interviews were conducted with community pharmacy staff in Washington State using a hybrid deductive-inductive qualitative approach to explore determinants and compatibility of LAIA administration. Interviews were conducted using a semi-structured guide informed by Proctor's Implementation Outcomes Framework. Using rapid analysis, transcripts were summarized in a structured matrix and coded into a priori domains. Barriers and facilitators were inductively categorized and then deductively-mapped to the Consolidated Framework for Implementation Research domains; recommendations were identified to inform future implementation strategies. RESULTS: Ten interviews were conducted with 9 community pharmacists and one pharmacy technician. Current practices varied across participants administering LAIAs in community pharmacies. Reimbursement and payment for LAIA administration emerged as the top barrier. Appointment-based models were seen as facilitators by improving predictability for staffing and medication inventory. Participants recommended streamlining reimbursement and turnkey toolkits for training, care coordination, and communication between prescribers. CONCLUSION: For community pharmacies within Washington State, payment models and reimbursement present a critical barrier to LAIA administration. Optimizing billing processes, improving funding and contracting mechanisms, and engaging payers may expand LAIA services. These represent both outer-setting and inner-setting factors, meaning that optimizing LAIA administration in community pharmacies will require system-level, multistakeholder involvement and research.
Lessons learned in optimizing recruitment and data collection for a pharmacy-based implementation trial.
Shackley AG, Carpenter DM, Charton H … +5 more , Teeter BS, Smith M, Hastings TJ, Hughes T, Curran G
J Am Pharm Assoc (2003) · 2026 · PMID 41192509 · Full text
BACKGROUND: In Fall 2023, we initiated a National Institutes of Health-funded study to test the effectiveness of implementation strategies to support pharmacy implementation of a COVID-19 vaccine hesitancy counseling int...
BACKGROUND: In Fall 2023, we initiated a National Institutes of Health-funded study to test the effectiveness of implementation strategies to support pharmacy implementation of a COVID-19 vaccine hesitancy counseling intervention. Our stepped-wedge trial compared a standard implementation condition (training and technical assistance) to a virtual facilitation (or one-on-one coaching) intervention. Within 6-8 weeks, problems emerged related to pharmacist engagement and data collection that threatened the study's success. OBJECTIVE: To describe formative evaluation results for the initial trial year and the strategies we developed and deployed in Fall 2024 to address identified engagement and data collection problems. METHODS: The formative evaluation consisted of 5 semistructured key informant interviews with highly-engaged and unengaged pharmacists and a review of coaches' notes. All qualitative data were coded using a rapid template analysis method. To interpret the results and identify solutions, we consulted rural patient and implementation science expert advisory panels. Consensus was reached on study modification recommendations, which received funder approval. RESULTS: Numerous barriers impacted pharmacist engagement and data collection, such as poor demand for the COVID-19 vaccine, most patients declining to be audio-recorded to assess our primary outcome of pharmacist counseling fidelity, difficulties submitting encounter forms (our secondary outcome), staffing shortfalls, and pharmacist reluctance to approach "very hesitant" patients. DISCUSSION: Study modifications included changes to data collection (e.g., shift to using standardized patients for fidelity assessments), pharmacy recruitment, and the standard implementation approach (e.g., more training and tools). These modifications were deployed in the new first year of our implementation trial (August 2024 - April 2025) and we saw major improvements in study engagement and data collection. CONCLUSION: Implementation trials often encounter potentially fatal problems due to shifting contexts. Studies can be salvaged if the team takes quick action, in partnership with funders and other constituents, to systematically understand the problems and develop solutions.
Implementation of community pharmacy-based testing and treatment for Chlamydia trachomatis and Neisseria gonorrhoeae in Nova Scotia (Swab-Rx study).
d'Entremont-Harris M, Ramsey TD, McInnis SJL … +6 more , Booker C, DeYoung D, Bishop A, Furlotte K, Hatchette TF, Wilby KJ
J Am Pharm Assoc (2003) · 2026 · PMID 41192508 · Publisher ↗
BACKGROUND: Chlamydia and gonorrhea are the most reported bacterial sexually transmitted infections in North America. Accessible, efficient, and convenient testing mechanisms are essential to identify infections, reduce...
BACKGROUND: Chlamydia and gonorrhea are the most reported bacterial sexually transmitted infections in North America. Accessible, efficient, and convenient testing mechanisms are essential to identify infections, reduce transmission, access treatment, and prevent complications. OBJECTIVE: This study aimed to implement pharmacy-based asymptomatic chlamydia and gonorrhea management in Nova Scotian community pharmacies and evaluate effectiveness and patient acceptability. METHODS: The study occurred in 4 community pharmacies in Nova Scotia, Canada. Pharmacists offered chlamydia and gonorrhea testing using patient self-collected swabs and first-catch urine. Specimens were tested at the Central Zone Microbiology Laboratory and reported back to the pharmacist who then provided results to the patient and prescribed treatment for any identified infection(s). An electronic questionnaire and posttesting interview explored patient acceptability. Pharmacist workload was explored in time per encounter and tests per week. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and Theoretical Framework of Acceptability informed the study design. RESULTS: Ninety-seven discrete participants were enrolled for 99 testing encounters. Eighty percent (78/97) of participants responded to the sociodemographic questionnaire, of which 64% were between the ages of 25 and 44, 26% identified as sexually diverse, and 15% as gender diverse. Many respondents reported never having been tested for chlamydia (23%) or gonorrhea (27%). Of the participants tested, 17% had positive test results; 14% had chlamydia and 3% gonorrhea infections. All participants with positive test results were prescribed antibiotic treatment by the pharmacist. Pharmacists required an average of 21 minutes for testing and 17 minutes for treatment encounters. Participants predominantly reported the service was highly acceptable, should always be available, and they would not have been tested if it was not available. Participants raised concerns regarding privacy, increased workload on pharmacists, and cost of the service. CONCLUSION: Community pharmacy-based testing and treatment of asymptomatic chlamydia and gonorrhea was highly acceptable to service users. The model successfully identified new cases and pharmacists efficiently prescribed treatment.
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