Assessment of pharmacists’ delivery of public health services in rural and urban areas in Iowa and North Dakota
Background: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists’ delivery of public health services.
Objective: To assess Iowa and North Dakota pharmacists’ practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas.
Methods: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota.
Results: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (P<0.05). For some public health services, pharmacists in rural areas reported higher frequency of delivery than did pharmacists in urban areas (P < .05) that included: medication therapy management, immunizations, tobacco counseling, and medication take-back programs. For some essential services, pharmacists (particularly independents) in rural areas reported more frequent delivery than did pharmacists in urban areas (P < .05), these included: evaluate the services the pharmacy provides, partner with the community to identify and help solve health problems, and conduct needs assessments to identify health risks in my community.
Conclusion: Rural pharmacists more frequently deliver public health services than urban in both Iowa and North Dakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking.
2. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47(3):533-543.
3. Cranor CW, Bunting BA, Christensen DB. The Asheville project: long-term clinical and economic outcomes of a community pharmacy diabetes care program. J Am Pharm Assoc (Wash). 2003;43(2):173-184. doi: 10.1331/108658003321480713
4. Fera T, Bluml B, Ellis W. Diabetes ten city challenge: final economic and clinical results. J Am Pharm Assoc (2003). 2009;49(3):383-391. doi: 10.1331/JAPhA.2009.09015
5. Bunting B, Smith B, Sutherland S. The Asheville project: clinical and economic outcomes of a community-based long-term medication therapy management program for hypertension and dyslipidemia. J Am Pharm Assoc (2003). 2008;48(1):23-31. doi: 10.1331/JAPhA.2008.07140
6. Chisholm-Burns MA, Kim Lee J, Spivey CA, Slack M, Herrier RN, Hall-Lipsy E, Graff Zivin J, Abraham I, Palmer J, Martin JR, Kramer SS, Wunz T. US pharmacists’ effect as team members on patient care: systematic review and meta‐analysis. Med Care. 2010;48(10):923-933. doi: 10.1097/MLR.0b013e3181e57962
7. Roberts GE1, Rubin SE, Smith JK, Adams AJ, Klepser DG. Public health perceptions of community pharmacy partnership opportunities. J Public Health Manag Pract. 2015;21(4):413-415. doi: 10.1097/PHH.0000000000000276
8. American Society of Health-System Pharmacists. ASHP statement on the role of health-system pharmacists in public health. Am J Health Syst Pharm. 2008;65(5):462-467. doi: 10.2146/ajhp070399
9. American Public Health Association. Policy statement database: the role of the pharmacist in public health. Policy #200614. Washington, DC: APhA; 2008.
10. National Association of Chain Drug Stores. 2011-2012 Chain Pharmacy Industry Profile. Alexandria, VA: National Association of Chain Drug Stores; 2011.
11. Strand MA, Tellers J, Patterson A, Ross A, Palombi L. The achievement of public health services in pharmacy practice: A literature review. Res Social Adm Pharm. 2016;12(2):247-256. doi: 10.1016/j.sapharm.2015.06.004
12. American Pharmacists Association. The role of pharmacists in public health awareness. Adopted policy statements 1963-2007. Washington, DC: APhA; 2007.
13. Eades CE, Ferguson JS, O’Carroll RE. Public health in community pharmacy: a systematic review of pharmacist and consumer views. BMC Public Health. 2011;11:582. doi: 10.1186/1471-2458-11-582
14. Casserlie LM, DiPietro-Mager NA. Pharmacists’ perceptions of advancing public health priorities through medication therapy management. Pharm Pract (Granada). 2016 Jul-Sep;14(3):792. doi: 10.18549/PharmPract.2016.03.792
15. Scott DM. Assessment of pharmacists’ perception of patient care competence and need for training in rural and urban areas in North Dakota. J Rural Health. 2010;26(1):90-96. doi: 10.1111/j.1748-0361.2009.00270.x
16. Traynor K. North Dakota begins year with pharmacy focus. Am J Health Syst Pharm. 2015;72(13):1080. doi: 10.2146/news150045
17. The University of Iowa College of Pharmacy. Rsearch areas. http://www.pharmacy.uiowa.edu/research/current-research (accessed October 14, 2016).
18. Drake University College of Pharmacy. Available at: http://www.drake.edu/pharmacy/ (accessed October 14, 2016).
19. Institute of Medicine. Quality through Collaboration: The Future of Rural Health. Washington, DC: The National Academy Press; 2004.
20. Health Resources and Services Administration. The Pharmacist Workforce: A Study of Supply and Demand for Pharmacists. Rockville, MD: Health Resources and Services Administration; 2000.
21. Knapp KK, Cultice JM. New pharmacist supply projections: lower separation rates and increased graduates boost supply estimates. J Am Pharm Assoc (2003). 2007;47(4):463-470.
22. Kreling DH, Doucette WR, Mott DA, Gaither CA, Pedersen CA, Schommer JC. Community pharmacists’ work environments: evidence from the 2004 national pharmacist workforce study. J Am Pharm Assoc (2003). 2006;46(3):331-339.
23. Scott DM. 2006 North Dakota pharmacists’ wage and workload assessment. J Pharm Technol. 2009;25:14-23.
24. Peterson C, Anderson H. The North Dakota Telepharmacy Project: restoring and retaining pharmacy services in rural communities. J Pharm Technol. 2004;20:28-39.
25. Peterson C, Rathke AM, Skwiera J, Anderson H. Hospital telepharmacy network: delivering pharmacy services to rural hospitals. J Pharm Technol. 2007;23:158-165.
26. Khan S, Snyder HW, Rathke AM, Scott DM, Peterson CD. Is there a successful business case for telepharmacy?. Telemed J E Health. 2008;14:235-244.
27. Friesner D, Scott DM. Exploring the formation of patient satisfaction in rural community telepharmacies. J Am Pharm Assoc (2003). 2009;49(4):509-518. doi: 10.1331/JAPhA.2009.08110
28. The University of Iowa School of Public Health. http://www.public-health.uiowa.edu/ (accessed October 14, 2016).
29. North Dakota State University College of Health Professions, Department of Public Health. Available at: https://www.ndsu.edu/publichealth/ (accessed October 14, 2016).
30. Truong H, Taylor C, DiPietro N. The Assessment, Development, Assurance Pharmacist’s Tool (ADAPT) for ensuring quality implementation of health promotion programs. Am J Pharm Educ. 2012;76(1):12. doi: 10.5688/ajpe76112
31. Scott A, Bond C, Inch J, Grant A. Preferences of community pharmacists for extended roles in primary care: a survey. Pharmacoeconomics. 2007;25(9):783-792.
32. Dillman D, Smyth J, Christian L. Internet, mail, and mixed mode surveys: the tailored design method. 3rd ed. Hoboken, NJ: John Wiley and Sons; 2009.
33. Nulty D. Adequacy of response rates to online and paper surveys: What can be done?. Assess & Eval Higher Educ. 2008;33(3):301-314.
34. SAS/STAT User’s Guide. Version 6. 4th ed. Cary, NC: SAS Institute; 1990.
35. Mott DA, Doucette WR, Gaither CA, Kreling DH, Pedersen CA, Schommer JC. Pharmacist participation in the workforce: 1990, 2000, and 2004. J Am Pharm Assoc (2003). 2006;46(3):322-330.
36. Moore K, Jiang L, Manson SM, Beals J, Henderson W, Pratte K, Acton KJ, Roubideaux Y. Case management to reduce cardiovascular disease risk in American Indians and Alaska Natives with diabetes: results from the Special Diabetes Program for Indians Healthy Heart Demonstration Project. Am J Public Health. 2014;104(11):e158-e164. doi: 10.2105/AJPH.2014.302108
37. Scott DM, Boyd ST, Stephans M, Augustine SC, Reardon TP. Outcomes of pharmacist-managed diabetes care services in a community health center. Am J Health Syst Pharm. 2006;63(21):2116-2122.
38. Scott DM, Nordin JD. Pharmacist role in projects for children and youth. Am J Hosp Pharm. 1980;37(10):1339-1342.
39. NDPERS Program Info. Available at: http://www.aboutthepatient.net/patients/diabetes-info/ndpers-program-info/ (accessed July 14, 2016).
40. Pain Management Program (WSI). Available at: http://www.aboutthepatient.net/patients/wsi-pain-management-program/ (accessed July 13, 2016).
41. Dole EJ, Murawski MM, Adolphe AB, Aragon FC, Hockstadt B. Provision of pain management by a pharmacist with prescribing authority. Am J Health Syst Pharm. 2007;64(1):85-89.
42. Gortney JS, Seed S, Borja-Hart N, Young V, Woodard LJ, Nobles-Knight D, Scott DM, Nash JD. The prevalence and characteristics of dual PharmD/MPH programs offered at US colleges and schools of pharmacy. Am J Pharm Educ. 2013;77(6):116. doi: 10.5688/ajpe776116
43. Accreditation standards and key elements for the professional program in pharmacy leading to the Doctor of Pharmacy degree. Available at: https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf (accessed May 12, 2016).
44. Millonig MK. Mapping the route to medication therapy management documentation and billing standardization and interoperability within the health care system: meeting proceedings. J Am Pharm Assoc (2003). 2009;49(3):372-382. doi: 10.1331/JAPhA.2008.09518
45. Balick, R. Evolving pharmacist roles increase importance of credentialing. Pharmacy Today. 2016;22(7):46-47.
46. Official policy positions: Health care workforce distribution and shortage issues in rural America. Available at: http://www.ruralhealthweb.org/go/left/policy-and-advocacy/policy-documents-and-statements/official-nrha-policy-positions (accessed February 21, 2016).
47. State health facts: Primary care Health Professional Shortage Areas (HPSAs). Available at: http://kff.org/other/state-indicator/primary-care-health-professional-shortage-areas-hpsas/ (accessed February 21, 2016).
48. Ruble JH. Prescriber-pharmacist collaboration: Re-engineering the partnership to optimize pain patient care. J Pain Palliat Care Pharmacother. 2013;27(4):365-366. doi: 10.3109/15360288.2013.849322
49. Bradley F, Ashcroft DM, Noyce PR. Integration and differentiation: A conceptual model of general practitioner and community pharmacist collaboration. Res Social Adm Pharm. 2012;8(1):36-46. doi: 10.1016/j.sapharm.2010.12.005
50. Roberts GE, Rubin SE, Smith JK, Adams AJ, Klepser DG. Public health perceptions of community pharmacy partnership opportunities. J Public Health Manag Pract. 2015;21(4):413-5. doi: 10.1097/PHH.0000000000000276
51. Abramowitz PW. Achieving provider status for pharmacists. Am J Health Syst Pharm. 2013;70(3):184. doi: 10.2146/news130012
52. Schommer JC, Gaither CA. A segmentation analysis for pharmacists’ and patients’ views of pharmacists’ roles. Res Social Adm Pharm. 2014;10(3):508-528. doi: 10.1016/j.sapharm.2013.10.004
53. Wood K, Gibson F, Radley A, Williams B. Pharmaceutical care of older people: What do older people want from community pharmacy? Int J Pharm Pract. 2015;23(2):121-130. doi: 10.1111/ijpp.12127
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