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Am J Pharm Educ. 2020 Jan; 84(one): 7125.

Essential Attributes for the Customs Pharmacist equally Care Provider

Received 2018 April 23; Accustomed 2019 Jun 24.

Abstruse

Objective. To identify skills and attributes that pharmacy students demand upon graduation if planning to pursue a career path as a customs chemist's practice care provider.

Methods. In-depth interviews with customs pharmacy stakeholders were conducted, audio-recorded, and transcribed. Interview transcripts were thematically analyzed to identify the skills and attributes pharmacy students need upon graduation to be prepared to practice as a customs pharmacy-based care provider.

Results. Forty-two participants were interviewed. Identified attributes that were accounted transformative for community chemist's exercise included 3 behaviors, five skills, and ii cognition areas. Behavioral attributes needed past future community pharmacists were an approach to practice that is frontwards thinking and patient-centric, and having a provider mentality. The nigh usually mentioned skill was the power to provide direct patient care, with other skills being organizational competence, communication, building relationships, and management and leadership. Critical knowledge areas were treatment guidelines and drug noesis, and regulatory and payer requirements. Additional skills needed by community pharmacy-based providers included identification and treatment of acute cocky-limiting illnesses and monitoring activities for chronic health conditions.

Determination. Essential attributes of community pharmacists that volition let practice transformation to take place include behaving in a forward-thinking, patient-centric manner; displaying a provider mentality through use of effective communication to build relationships with patients and other providers, and learning how to see regulatory and payer requirements for prescribers. These attributes should be fostered during the student'due south experiential curriculum.

Keywords: community pharmacy, pharmacist provider, qualitative enquiry

INTRODUCTION

Community pharmacists are the largest and most accessible grouping of health intendance providers in the US wellness care arrangement. There are more than 60,000 customs-based pharmacies in the United states employing more than than 170,000 pharmacists.ⁱ Further, 93% of Americans live inside five miles of a community chemist's.² No longer responsible solely for the provision of drug products, community pharmacists play an integral role in community health and wellness through expanded services such as medication management and reconciliation, educational and behavioral counseling, and preventative health services.³ Patient care services in specialty areas such as heart failure medication management and point-of-care testing in pharmacies have been described in the literature.^iv-8 These expanded services are within the chemist'southward scope of practise and facilitated via collaborative do agreements (CPAs) with prescribers.^nine Well-nigh states permit pharmacists to prescribe and alter therapy through CPAs.^x

Despite the pivotal function of pharmacists on the health care squad, pharmacists have not historically been recognized as wellness intendance providers by national health policy makers and payers.¹¹ Lack of reimbursement for pharmacist services performed has been a major impediment to expanded intendance provision.^12,13 More than recently, meaning legislative breakthroughs have been fabricated, with states such as California mandating recognition of pharmacists as intendance providers.¹⁴ In May 2015, legislators in Washington State passed a nib (SB5557) requiring that pharmacists be included in health insurance medical provider networks and thus must be compensated for the patient care they provide within their scope of practice.¹⁵

Equally federal and land legislation moves frontwards to ensure payment to pharmacists for patient intendance services, schools and colleges of chemist's must adequately set up students to exercise in this changing environs. A 2012 National Clan of Chain Drug Stores (NACDS) Foundation, National Community Chemist's shop Association (NCPA), and American Quango for Pharmacy Education (ACPE) identified 80 entry-level performance competencies needed for customs pharmacy practice.¹⁶ Over fourscore% of these competencies addressed not-dispensing functions, indicating that dispensing medications should be a small part of the skill set needed past pharmacy graduates. In a subsequent written report, only one of 23 different identified competency areas expected by customs pharmacy employers of new chemist's shop graduates described dispensing skills.¹⁷ Additionally, the 2013 Centre for Advocacy of Chemist's Education (CAPE) outcomes did not list "dispenser" as a central function for pharmacists.¹⁸ The prototype modify of chemist equally care provider rather than product dispenser in the community chemist's shop setting appears mandated on several levels and will exist an of import coming disrupter of current pharmacy exercise.¹⁹

Another disrupter is the expanding role of the pharmacy technician, with pilot programs in identify for technicians to check filled prescriptions for accuracy.^20,21 The Idaho State Lath of Pharmacy in 2017 passed new rules stating that certified technicians, if authorized by a chemist, could receive a new verbal prescription drug order from a prescriber, consult with a prescriber on needed clarifications for prescriptions being filled, transfer a prescription drug order to another pharmacy, verify accurateness of filled prescription products, and administrate immunizations.²² Interest in these functions foretell a futurity where technicians will largely be responsible for many functions currently performed by pharmacists.

An additional disrupter of electric current pharmacy exercise is the trend toward the "retail clinic" inside chain shop pharmacies. These clinics, typically staffed by nurse practitioners and placed in a location close to the pharmacy, have a lower cost of intendance even so a college frequency of visits compared to traditional medical clinics.^23,24 The higher frequency of visits illustrates and reinforces the public's perception of the chemist's shop every bit the first identify to go for subacute health conditions. Clinics within pharmacies typically operate within a local health care system, but patients who select their pharmacy based on convenience and location may not be a member of that health care system.²⁵ The ability to assess subacute conditions and brand accurate clinical decisions to treat, watch, or refer the patient to a physician are of import skills needed by the community chemist's shop intendance provider. The role of the community chemist's shop practise provider has been recognized legislatively in Idaho, where House Bill 191 increased the chemist's prescriptive telescopic of exercise to medical atmospheric condition that do not require a new diagnosis, are minor and self-limiting, take a exam that can be performed and the results used to guide diagnosis or clinical controlling, or threaten the immediate wellness or safety of the patient if not dispensed.²⁶ Pharmacists who practice in community settings may need to acquire new diagnostic and triage skills to successfully navigate the change from being a product dispenser to a care provider.²⁷

Pharmacists in community practise currently spend over half of their time on activities related to dispensing.²⁸ From conversations with preceptors, we learned that at many community chemist's sites a chemist'due south functioning was judged and staffing decisions were made based primarily on how many or how chop-chop prescriptions were filled. Given this reality, nosotros wondered how community pharmacy stakeholders such as staff pharmacists, pharmacy managers, and educators of hereafter community pharmacists perceived the practice environment of the time to come and what new attributes would be needed by pharmacists to do in that future surroundings. We thus designed a study to determine stakeholders' vision of the future of chemist's shop practice and to apply our findings to blueprint a curriculum to fix students for that vision. The main objective of the electric current written report was to distinguish and better understand key attributes needed by customs chemist's providers in a future where they will be reimbursed primarily for services provided, rather than for products dispensed.

METHODS

This report was a thematic assay of community pharmacy stakeholders' opinions obtained through fundamental informant interviews. A database of electric current preceptors at our institution was used to identify individuals practicing in the area of customs pharmacy. Stratified purposeful sampling was used to select a roughly equal number of potential participants who were practicing community pharmacists and pharmacists who were non practicing community pharmacy on a daily ground simply oversaw or otherwise influenced practice of those who did.²⁹ Potential participants were contacted by email and invited to participate. The written report protocol was reviewed by a University of Washington Human being Subjects Sectionalisation subcommittee and determined to qualify for exemption.

A semi-structured interview guide using a neo-positivist approach—where the interviewer asks few open-concluded questions and contributes minimally to the chat—was developed and slightly refined based on feedback from a pilot interview conducted with a small group of faculty members with customs chemist's practice backgrounds.³⁰ The interview guide contained iv initial questions, for which the offset question was, "What skills will a community chemist's practitioner of the futurity need?" The interviewer then showed participants a list of subacute and chronic health conditions, asking which of the conditions participants would feel comfy treating, and whether the customs practitioner of the time to come would, in the participant's opinion, be treating those conditions. A 4th initial question was almost the degree of dispensing done by pharmacists in the time to come or whether robotics or technicians would largely fill that role. In addition to asking these scripted questions, the interviewer was allowed to ask probing questions to farther clarify participant responses. During the interviews, the four initial questions were followed by iii questions almost an experiential education curriculum for a future community pharmacy practitioner. Results and conclusions arising from analysis of these subsequent questions were the subject of a separate report.³¹

The first writer conducted all of the interviews, and the 2d author recorded the session and took notes. All interviews were conducted in private locations at community pharmacies, regional management offices, or other locations user-friendly to the participants. Interviews ranged from fifteen to 50 minutes in elapsing and were audio-recorded with the participants' consent. Interviews continued until no new information was detected in two sequential interviews.

All audio-recorded interviews were transcribed and de-identified by a enquiry team member. After an initial reading of the data, the first and second authors independently read and inductively coded^32-35 words and phrases in the transcripts using ATLAS.ti, version 7.v.10 (ATLAS.ti GmbH, Berlin, Frg), a qualitative inquiry software plan. The primary coders met repeatedly to compare codes, reconcile differences, and improve code definitions until themes and subthemes emerged.^35,36 The 3rd writer independently reviewed the transcripts, codes, and themes for gaps, inconsistencies, and new interpretations to improve analysis validity.³⁷ The entire research team adult and achieved consensus on the final themes. Verification coding was performed by an individual outside of the research team. Pct agreement, Cohen's kappa, and Gwet's starting time agreement coefficient, used to check intercoder understanding betwixt investigator and verifier coders, were calculated using R, version 3.5.0 (The R Foundation, Vienna, Austria), a Linux-based compilation of statistical software.^38,39 A kappa of greater than 0.6 was considered satisfactory agreement.⁴⁰ Gwet'southward beginning understanding coefficient was used considering Cohen's kappa is tin can exist overly bourgeois when coding tasks are hard because of long and circuitous participant responses, as was the example in our report.⁴¹ Thematic analysis was not performed on the participant responses to the lists of acute and chronic weather condition nor to the responses to the question about relegating dispensing tasks in the future to robotics or technicians.

RESULTS

Semi-structured key informant interviews were conducted between August and November 2015. Twoscore-two subjects were interviewed either singly (n=11), in pairs (n=10), in groups of iii (northward=15), and in 1 group of six. Twenty of the 42 participants were pharmacists who adept in customs pharmacies on a daily footing. These 20 included 16 staff pharmacists or pharmacy managers, one resident, and three pharmacy students. The remaining 22 participants did non practice in a community chemist's on a daily footing merely influenced the exercise of pharmacists who did. These 22 included 14 surface area managers, six kinesthesia members (3 with customs pharmacy background and 3 teaching therapeutics skills laboratory courses), and ii leaders of the state pharmacy arrangement. Iii of the interviews were with pharmacists practicing in sites offering innovative patient care services, eg, in-home visits with patients who would otherwise require placement in a skilled nursing facility, and management of patients with circuitous HIV/AIDS treatment regimens. Iii interviews were with pharmacists who actively educated legislators and whose work resulted in the passing of SB5557 in Washington State. More details about the participants tin be found in Table 1.

Table i.

Job and Practice Descriptions of Participants in a Study to Place Attributes Needed by Future Community Pharmacy Providers

Assay of responses to the question, "What skills will be needed by a community chemist's practitioner of the future?" yielded 3 key attitudinal-behavioral attributes, which included forward thinking, patient-centric, and provider mentality; five skill attributes which included organizational competence, advice, building relationships, patient care, and direction and leadership; and two knowledge attributes which included treatment guidelines and drug knowledge, and regulatory and payer requirements. These ten attributes are further explained in Table 2, which also includes illustrative quotes.

Table 2.

Attributes Needed by Future Customs Pharmacy Providers as Identified in Interviews With Community Pharmacy Stakeholders

Stakeholders in this written report, particularly pharmacists in daily practice, most frequently named the skill of providing direct patient intendance as a key attribute. Key attitudes and behaviors that reflected forrard thinking and being patient centric were the side by side most common themes, followed by the characteristic of having a provider mentality, ie, thinking and acting like other prescribers. The need for a frontward-thinking attitude and the characteristic of a provider mentality was voiced during each of the regional manager interviews, during two of the three interviews of pharmacists practicing in innovative care settings, and by the individuals who were instrumental in passing SB5557 in Washington Land.

When shown a list of pocket-size acute conditions that might be seen in a typical walk-in medical clinic, well-nigh of the participants stated they would be comfortable evaluating the items on the list, adding that they evaluated several of the weather on a daily basis in their current practice. Some participants stated discomfort with some conditions (eye and joint), feeling that their part was primarily referral. Almost every participant brought up skin conditions, suggesting that community pharmacy-bound students need actress training in this surface area. As one participant remarked, "All pharmacists should accept a pocket-sized in dermatology." A few participants noted that the actual services offered would primarily depend on the pharmacy's usual clientele.

There were iii specific points made by participants about pharmacists providing acute care on the same level as a nurse practitioner or physician's banana. First, clear written guidelines well-nigh when to treat and when to refer are needed for every common astute status. 2nd, companies are less probable to pay a pharmacist to provide this level of care if they can hire a nurse practitioner or physician's assistant to do and then at lower wages. Finally, pharmacists providing this level of care will need personal malpractice insurance at a coverage level like to that of other providers. One individual who played a key role in passage of the Washington State pecker emphasized the importance of taking steps to avoid conflicts of involvement past pharmacists who both prescribe and dispense.

Participants also stressed the importance of collaboration with the patient'due south primary care provider to obtain the referral for intendance of chronic health conditions, delineate the limits of care that would exist provided, and admission laboratory and other data needed to monitor drug therapy. Some participants felt that specialty intendance would be the focus of care provision by the community chemist, while others indicated that specialty intendance would exist best handled in the clinic setting. Pharmacists who were actively practicing were more likely than regional managers to identify barriers to chronic disease state management, particularly lack of access to laboratory data and lack of fourth dimension to spend with the patient in the electric current practice model.

In response to the question, "Should the community pharmacist of the future be responsible for dispensing, or should that function be relegated to robotics or technicians?" participants in general felt that robotics and technicians could fulfill almost all the technical functions of the dispensing procedure. Three sites we visited had robotic systems filling new prescriptions, and several participants noted that the market was driving the dispensing part toward robotics. A participant who was a pharmacy managing director and member of the country Pharmacy Quality Commission stated, "I think that applied science is coming and coming quickly, so as it moves into that setting I recollect that about of the standard dispensing functions are going to get abroad from the pharmacist's standpoint. We've talked most this for years, nearly doing that, and it never happened considering we never actually had the technology to brand information technology work, just now we accept the applied science to go far work."

The role that participants felt could not be delegated to robotics or technicians was the prospective drug utilization review, which is required by constabulary in Washington State. Too mentioned was the usefulness of knowing the concrete characteristics of a drug (for example, knowing tablet size when working with mail service-stroke patients who accept difficulty swallowing) and which drugs are covered past a specific insurance plan.

DISCUSSION

This report clarified what community chemist's shop stakeholders feel are the time to come skills and abilities needed by students planning to practice in this setting. Information technology was important to gain this perspective because up to 50% of graduates from the University of Washington Schoolhouse of Pharmacy enter community chemist's practice upon graduation. We need to prepare pharmacy students for their irresolute role in community pharmacy practice even though the nature of that role has non been fully elucidated.

The participants responses revealed that a driver of change in chemist's shop practice is the expanding use of robotics in the dispensing procedure, which was already in place at some of the sites we visited. Another driver of modify that was non seen in our study only is axiomatic elsewhere is the enhanced role of the chemist's technician in completing tasks currently associated with pharmacists, such as assisting with transition of care between the hospital and the customs intendance setting, administering immunizations, and performing some aspects of medication therapy management.^42-45 Because immunizations and medication therapy management are what many of the community pharmacists in our study considered to exist the "clinical" aspects of their job, clearly the emerging roles for technicians in these areas volition brand the role of the clinical community chemist of the future radically different than it is now. This changing part, which we termed "forward-thinking," was the top attitudinal-behavioral theme attribute in our study.

The future of customs chemist's practice lies in the provision of direct patient intendance through patient-centered intendance, which was the acme skill attribute and second virtually common attitudinal-behavioral attribute seen in our study. Although the skill (ie, direct patient intendance) and the attribute (ie, patient-centered care) may sound like the same thing, the Pharmacist's Patient Care Process, which is the skill set up that pharmacists must possess to effectively provide care to patients, is different from how pharmacists cull to utilise that skill, which is a beliefs.⁴⁶ Desired patient-centered behaviors for all health care providers include interacting with patients and family unit members, respecting the perspectives and choices of those individuals, sharing information to assist them make informed decisions, and encouraging their participation in determination-making; these behaviors will be critical for time to come community pharmacy practitioners to demonstrate.^47,48

Demonstrating a provider mentality, another behavioral theme attribute, will likely be the well-nigh hard change for community chemist's practitioners. In order to achieve provider status and be paid for providing care, what pharmacists do needs to look more like what other providers do, nonetheless fill a unique and distinct office within the health care squad. This evolution in practice will require fundamental changes in expectations by three important groups: the public, other health intendance practitioners, and all members of the pharmacy profession. Community chemist's shop exercise must undergo a seismic shift similar to the transformation of nurses to nurse practitioners, such that when a patient enters a community pharmacy, the expectation is that pharmacists will collect a thorough history, assess a patient's clinical condition, decide on management of the presenting condition and whether to prescribe or refer, identify appropriate medications, seek patient input into the treatment plan, and monitor response to therapy.⁴⁹ Notably, dispensing, which is currently a large component of community pharmacy practice, is non a office of this description.^28,50-52

An important challenge will exist shifting the public's expectations of pharmacists, because many people believe that a chemist'southward abilities are express to drug dispensing, providing information, and managing the side furnishings of drugs.^53-56 During study visits to collect information from our stakeholders, we observed common diction on the signage inside stores, with "Pharmacy" in large letters to a higher place the pharmacy area of the shop and smaller signs on either side reading, "Drop Off" and, "Pick Up," reinforcing the public'due south perception that the purpose of a chemist's shop is to provide a product rather than a service. In the nearly time to come, customs pharmacists will need to take and utilise a consultation room to provide services for patients with acute care needs and those with chronic health conditions. This room will demand to be adjacent to merely divide from the prescription filling surface area and will be where the customs pharmacist will primarily work. During scheduled patient visits, pharmacists volition assess chronic medical conditions for patients receiving drug therapy (a role that most participants in our study agreed that pharmacists can do) and have medication and wellness histories for new patients presenting with acute wellness atmospheric condition.⁵⁷

Another of import claiming will be assimilating customs pharmacists into the network of other health care providers.⁵⁸ A forum for regular communication about intendance of their common patients will allow pharmacists to more fully integrate into the patient's wellness intendance team. In pharmacies with an embedded astute intendance clinic staffed by a nurse practitioner, the two provider's consultation rooms should be in close proximity to facilitate interprofessional dialogue.

The last challenge will lie in shifting electric current community pharmacy practice in the direction of the chemist as provider. At that place are structural, logistical, and legal hurdles that may seem insurmountable to current practicing community pharmacists. In our study, the themes of forward thinking and provider mentality were more usually voiced by practitioners who were not practicing community pharmacy on a daily basis. It is difficult for pharmacists who are responding to the daily needs and responsibilities of the practice environment to imagine how that environment could exist dissimilar. Today'south customs pharmacists volition need thoughtful back up from their corporate direction, regulatory agencies, and professional organizations in making the transition to a primarily patient care practice.⁵⁹ Many community pharmacists will need to retool their skills in patient examination, assessment, and prescribing for conditions commonly seen in their patients. Clinical customs pharmacists volition need to document all intendance decisions in a format that will run into payer audit requirements and also communicate clinical reasoning to the patient's other care providers. This vision may seem radical, yet many of the drivers for pharmacists to get chief care providers are aligning.⁶⁰

Changes in customs pharmacy practice will touch and be affected by how pharmacists are trained. Students planning to enter customs chemist's shop exercise volition need excellent physical and verbal exam skills and enhanced preparation in diagnosis of cocky-express medical conditions similar to those on the list nosotros showed to participants in our study. Many of the conditions on the listing were identified areas of grooming in the American College of Clinical Chemist's's didactic curriculum toolkit,⁶¹ so chemist's education programs probable have the didactic coursework in place, although boosted skills grooming and experiential practice will be needed. Chemist's educators should examine the curricular transformation from nurse to nurse practitioner every bit similar curricular changes could help chemist's students build confidence in their ability to practice as a provider. Initially, a paucity of role models will make it difficult for students and electric current practitioners to envision how such a practice would look. It may exist desirable for students planning to become community pharmacists to consummate an advanced pharmacy practice experience with a nurse practitioner, to enable edifice of diagnostic and triage skills. Coursework will need to introduce students to the complexities of medical billing.

Data assay in any qualitative study is inevitably influenced by the lens through which the investigators view the information, so it is of import to explain what that lens was. The kickoff author in this project is an experiential education manager who uses qualitative research methods to better understand the experiences of preceptors and students in the practise setting, interacts regularly with chemist's shop preceptors at community practise sites, and has family unit members who take good in community pharmacy. The 2d writer was trained in social science data collection and analysis techniques during a homo-centered design and engineering caste program and has no groundwork or training in pharmacy. The third author has feel as a community pharmacist and is an implementation scientist evaluating community chemist's patient care services. None of the authors had a role in the passage of SB5557 in Washington State.

This study had several limitations. We asked pharmacists about acute and chronic wellness conditions but did non enquire about preventive health intendance, yet community pharmacists participate in preventative care initiatives, such every bit administering immunizations. Participant answers to questions may take been influenced past passage of SB5557; thus, pharmacists from states without similar legislation might have different perspectives about the time to come of pharmacy practice. Almost participants skilful in an urban surround and and then would likely have a different vision of practice compared to community pharmacists from rural areas. Finally, we only interviewed pharmacy stakeholders who were familiar with the chemist's scope of practice. Interviewing other stakeholders, particularly other health care providers and patients who would be the recipients of pharmacists' care, will be an important adjacent stride in the process of envisioning the future role of pharmacists as care providers.

This study helped the states characterize the skills and attributes needed by future pharmacy graduates from our program planning to enter community pharmacy practice. Conducting this study also provided an invaluable opportunity to appoint our community pharmacy practice partners and incorporate their insights into our curriculum.

CONCLUSION

Community pharmacists are the outward face of the chemist's profession, and that seen by near members of the public. In order for customs pharmacists to become the intendance providers of the future, they will demand to spend the majority of their time providing direct patient care rather than dispensing, which will be largely done in the futurity by robotics and pharmacy technicians. Essential attributes for community pharmacists of the hereafter include the attitudinal qualities of being forrad thinking, patient-centric, and having a provider mentality. These attributes will allow community pharmacists to finer address and be reimbursed for the acute and chronic medical weather experienced past their patients.

ACKNOWLEDGMENTS

The authors gratefully acknowledge the time given and thoughtful answers expressed by all the participants in this written report and the assistance of Donal O'Sullivan, PhD, with statistical analysis.

REFERENCES

1. Centers for Disease Command and Prevention. Select features of land pharmacist collaborative practise laws. Atlanta, GA: US Department of Health and Human Services, Centers for Affliction Control and Prevention; Published December 2013. https://world wide web.cdc.gov/dhdsp/pubs/docs/pharmacist_state_law.pdf. Accessed May 26, 2019. [Google Scholar]

4. Bleske BE, Dillman NO, Cornelius D, et al. . Center failure assessment at the community pharmacy level: a feasibility pilot report. J Am Pharm Assoc . 2014;54(6):634-641. [PubMed] [Google Scholar]

5. Klepser DG, Klepser ME. Cost-effectiveness of chemist-provided handling of adult pharyngitis. Am J Managed Care . 2012;18(four):e145-54. [PubMed] [Google Scholar]

6. Weidle PJ, Lecher S, Botts LW, et al. . HIV testing in community pharmacies and retail clinics: a model to expand access to screening for HIV infection. J Am Pharm Assoc. 2014;54(five):486-492. [PMC free commodity] [PubMed] [Google Scholar]

7. Darin KM, Klepser ME, Klepser DE, et al. . Pharmacist-provided rapid HIV testing in two community pharmacies. J Am Pharm Assoc . 2015;55(1):81-88. [PubMed] [Google Scholar]

8. Gubbins PO, Klepser ME, Dering-Anderson AM, et al. . Point-of-care testing for infectious diseases: opportunities, barriers, and considerations in community chemist's shop. J Am Pharm Assoc . 2014;54(ii):163-171. [PubMed] [Google Scholar]

9. Albanese NP, Rouse MJ. Scope of contemporary chemist's practice: roles, responsibilities, and functions of pharmacists and chemist's shop technicians. J Am Pharm Assoc . 2010;50(2):e35-69. [PubMed] [Google Scholar]

10. McBane SE, Dopp AL, Abe A, et al. . Collaborative drug therapy management and comprehensive medication management—2015. Pharmacotherapy . 2015;35(4):e39-l. [PubMed] [Google Scholar]

12. Unhurt J, Murawski MM, Ives TJ. Perceived successes and challenges of clinical chemist's practitioners in North Carolina. J Am Pharm Assoc . 2013:53(6):640-643. [PubMed] [Google Scholar]

17. Vlasses PH, Patel N, Rouse MJ, Ray MD, Smith GH, Beardsley RS. Employer expectations of new pharmacy graduates: implications for the pharmacy degree accreditation standards. Am J Pharm Educ . 2013;77(3):Commodity 47. [PMC costless article] [PubMed] [Google Scholar]

xviii. Medina MS, Plaza CM, Stowe CD, et al. . Center for the advocacy of chemist's education 2013 educational outcomes. Am J Pharm Educ . 2013;77(8):Article 162. [PMC gratis article] [PubMed] [Google Scholar]

xx. Andreski M, Myers M, Gainer K, Pudlo A. The Iowa new do model: advancing technician roles to increment pharmacusts' time to provide patient intendance services. J Am Pharm Assoc . 2018;58(three):268-274.e1. [PubMed] [Google Scholar]

21. Napier P, Norris P, Braund R. Introducing a checking technician allows pharmacists to spend more time on patient-focused activities. Res Soc Admin Pharm . 2018;14(4):382-386. [PubMed] [Google Scholar]

23. Inglehart JK. The expansion of retail clinics—corporate titans versus organized medicine. N Engl J Med. 2015;373(4):301-303. [PubMed] [Google Scholar]

24. Ashwood JS, Gaynor M, Setodji CM, Reid RO, Weber E, Mehrotra A. Retail clinic visits for low-acuity weather condition increase utilization and spending. Health Affairs . 2016;35(3):449-455. [PubMed] [Google Scholar]

25. Chang JE, Brundage SC, Chokshi DA. User-friendly ambulatory care—promise, pitfalls, and policy. N Engl J Med . 2015;373(4):382-388. [PubMed] [Google Scholar]

27. Clay PA. Pharmacists entering "a brave new world." J Am Pharm Assoc. 2016;56(ane):104. [PubMed] [Google Scholar]

28. Schommer JC, Pederson CA, Gaither CA, Doucette WR, Kreling DH, Mott DA. Pharmacists' desired and actual times in work activities: evidence of gaps from the 2004 national pharmacist workforce study. J Am Pharm Assoc . 2006;46(iii)340-347. [PubMed] [Google Scholar]

29. Guest GS, Namey EE, Mitchell ML. Collecting qualitative information: a field manual for applied research. Yard Oaks, CA: Sage;2012. [Google Scholar]

30. Roulston 1000. Considering quality in qualitative interviewing. Qual Res . 2010;10(2):199-228. [Google Scholar]

31. O'Sullivan TA, Sy E, Bacci J. A qualitative study designed to build an experiential instruction curriculum for do-ready community pharmacy-bound students. Am J Pharm Educ. 2017;81(ten):Article 6055. [PMC free article] [PubMed] [Google Scholar]

32. Elo South, Kyngas H. The qualitative content analysis process. J Adv Nurs . 2008;62(one):107-115. [PubMed] [Google Scholar]

33. Merriam SB. Qualitative inquiry: a guide to pattern and implementation. two^nd ed. San Francisco, CA: Jossey-Bass, 2009. [Google Scholar]

34. Saldana J. The coding transmission for qualitative researchers. two^nd ed. Chiliad Oaks, CA: Sage Publications Inc, 2013. [Google Scholar]

35. Guest G, MacQueen KM, Namey EE. Applied thematic analysis. Thou Oaks, CA: Sage;2012. [Google Scholar]

36. Creswell JW, Poth CN. Qualitative inquiry & research design: choosing amidst 5 approaches. 4^th ed. Thousand Oaks, CA: Sage;2018. [Google Scholar]

37. Patton MQ. Enhancing the quality and brownie of qualitative assay. Health Serv Res . 1999;34(5 role 2):1189-1208. [PMC free article] [PubMed] [Google Scholar]

40. Viera AJ, Garrett JM. Agreement interobserver understanding: the kappa statistic. Fam Med . 2005;37(v):360-363. [PubMed] [Google Scholar]

41. Wongpakaran North, Wongpakaran T, Wedding ceremony D, Gwet KL. A comparison of Cohen's kappa and Gwet's AC1 when calculating inter-rater reliability coefficients: a report conducted with personality disorder samples. BMC Med Res Methodol . 2013;13(April 29):61. [PMC free commodity] [PubMed] [Google Scholar]

42. Bailey JE, Surbhi S, Bell PC, Jones AM, Rashed Due south, Ugwueke MO. SafeMed: using pharmacy technicians in a novel role every bit community health workers to improve transitions of intendance. J Am Pharm Assoc . 2016;56(one):73-81. [PubMed] [Google Scholar]

43. McKeirnan KC, Frazier KR, Nguyen M, MacLean LG. Training chemist's technicians to administer immunizations. J Am Pharm Assoc . 2018;58(two):174-178. [PubMed] [Google Scholar]

44. Lengel Thou, Kuhn CH, Worley K, Wehr AM, McAuley JW. Chemist's technician interest in community pharmacy medication therapy management. J Am Pharm Assoc . 2018;58(2):179-185. [PubMed] [Google Scholar]

45. Gernant SA, Nguyen MO, Siddiqui Due south, Schneller Grand. Use of pharmacy technicians in elements of medication therapy management delivery: a systematic review. Res Soc Admin Pharm . 2018;14(x):883-890. [PubMed] [Google Scholar]

47. Patient and family-centered care. [Internet] Bethesda (Doctor): Institute for Patient- and Family unit-Centered Intendance. Accessed May 26, 2019. http://www.ipfcc.org/about/pfcc.html.

48. Institute of Medicine. Crossing the Quality Chasm. Washington (DC): National University Press; 2001. [Google Scholar]

49. Ross JD, Kettles AM. Mental health nurse independent prescribing: what are nurse prescribers' views of the barriers to implementation? J Psychiatr Ment Wellness Nurs . 2012;xix(x):916-932. [PubMed] [Google Scholar]

50. Davies JE, Barber N, Taylor D. What practice customs pharmacists do? results from a work sampling written report in London. Int J Pharm Pract . 2014;22(v):309-318. [PubMed] [Google Scholar]

51. Gregory P, Austin Z. Postgraduation employment experiences of new pharmacists in Ontario in 2012-2013. Tin Pharm J . 2014;147(5):290-299. [PMC gratis article] [PubMed] [Google Scholar]

52. van de Political leader JM, Geljon JG, Belitzer SV, Frederix GWJ, Hovels AM, Bouvy ML. Pharmacy in transition: a work sampling report of community pharmacists using smartphone technology. Res Soc Admin Chemist's. 2019;15(i):seventy-76. [PubMed] [Google Scholar]

53. Gillaumie L, Ndayizigiye A, Beaucage C, et al. . Patient perspectives on the function of community pharmacists for antidepressant treatment: a qualitative report. Can Pharm J . 2018;151(2):142-148. [PMC free article] [PubMed] [Google Scholar]

54. Kember J, Hodson Thousand, James DH. The public'south perception of the part of customs pharmacists in Wales. Int J Pharm Pract . 2018;26(2):120-128. [PubMed] [Google Scholar]

55. Yanicak A, Mohorn PL, Monterroyo P, Furgiuele Thou, Waddington L, Bookstaver PB. Public perceptions of pharmacists: idiot box portrayals from 1970 to 2013. J Am Pharm Assoc . 2015;55(6):578-586. [PubMed] [Google Scholar]

56. Peterson GM, Jackson SL, Hughes JD, Fitzmaurice KD, Murphy LE. Public perceptions of the role of Australian pharmacists in cardiovascular disease. J Clin Pharm Ther . 2010;35(6):671-677. [PubMed] [Google Scholar]

57. Barnes B, Hincapie AL, Luder H, Kirby J, Frede S, Heaton PC. Appointment-based models: a comparison of three model designs in a large concatenation customs pharmacy setting. J Am Pharm Assoc . 2018;58(2):156-162. [PubMed] [Google Scholar]

58. MacNaughton K, Chreim S, Bourgeault IL. Function construction and boundaries in interprofessional primary health care teams: a qualitative report. BMC Wellness Serv Res . 2013;thirteen:486. [PMC gratis article] [PubMed] [Google Scholar]

59. Franco-Trigo 50, Tudball J, Benrimoj SI, Sabater-Hernandez D. A stakeholder visioning do to enhance chronic care and the integration of customs pharmacy services. Res Soc Admin Pharm. 2019;15(1):31-44. [PubMed] [Google Scholar]

60. Trygstad T. Payment reform meets chemist's practice and instruction transformation. N C Med J . 2017;78(3):173-176. [PubMed] [Google Scholar]

61. Schwinghammer TL, Crannage AJ, Boyce EG, et al. . The 2016 ACCP pharmacotherapy didactic curriculum toolkit. Pharmacotherapy . 2016;36(11):e189-194. [PubMed] [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7055410/

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