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Introduction: University of Utah Health is an academic health care system that serves residents in Utah and beyond. Clinical pharmacists with the health care system’s pharmacy primary care services (PPCS) team provide medication education, population-based care, and medication management through collaborative practice agreements. With the expansion of clinical pharmacist and technician positions and services, the need to measure and assess the impact of pharmacy services and create a value proposition for internal and external stakeholders became an important goal, and the decision was made to better align practices across all PPCS sites. This paper highlights University of Utah Health’s approach to implement comprehensive medication management (CMM) across all primary care clinics with embedded clinical pharmacy staff and subsequent evaluation of implementation fidelity. Methods: Implementation of CMM was assisted by participation in the National A3 Collaborative and by using selected principles from the Active Implementation Framework. Stages of implementation included exploration, instillation, and initiating improvement cycles. An implementation team consisting of PPCS employees was created to help with standardization, developing implementation plans, and creating a dissemination strategy for all PPCS team members. The CMM care process was subsequently presented and implemented by clinical pharmacists in primary care clinics. Following implementation, fidelity measures were collected including identification and resolution of medication therapy problems (MTPs) and responses from a questionnaire distributed to the clinical pharmacists to self-report understanding and implementation of CMM key elements. The number and type of MTPs identified were tracked over 18 months. Results: Within the measurement window, clinical pharmacists identified 17,953 MTPs. Of the total number of MTPs identified, 21% were related to indication, 53% to efficacy, 15% to safety and 11% to adherence. The questionnaire was distributed to clinical pharmacists 9 months after CMM implementation, with a 71% response rate. Pharmacists reported “always” or “often” performing each step in the patient care process as follows: indication (93%), effectiveness (93%), safety (87%), and adherence (93%). Reported barriers to implementation of the CMM include lack of time to complete all aspects of the process efficiently, lack of a standardized format for documentation, and changing practice habits. Conclusion: Implementation of a CMM process within University of Utah Health’s PPCS services with the help of a national collaborative and implementation framework yielded identification of 17,953 MTPs over 18 months and foundational fidelity to core principles.   Article type: Clinical Experience

Disclaimer In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose As the pharmacist’s role expands, particularly in primary care practice settings, there is an opportunity for expansion of pharmacy technician duties to aid in administrative and clinical tasks that do not require the pharmacist’s professional judgment. Identifying, defining, and expanding the roles of pharmacy technicians has been deemed a key part of the pharmacy practice model. These roles have been shown to enhance pharmacist efficiency and patient outreach; however, examples of the various innovative activities performed by technicians in the primary care setting are lacking in the literature. Methods The duties of primary care pharmacist technicians were compiled and defined in 2 different healthcare systems. The role of the technician was separately implemented at each institution, and study designs and protocols were individually created and executed. One institution utilized a 4-round consensus-building process to systematically refine and codify tasks for a dictionary of duties. The second institution utilized a free-text survey, task documentation data in the electronic medical record, and a telephone discussion with the technicians. Results Despite a lack of methods- and data-sharing between the 2 institutions, similar tasks were identified, including conducting patient outreach, assisting with medication affordability and access, providing patient education, managing referrals, and scheduling appointments. Differences in technician involvement were noted in areas such as prior authorization, care coordination meetings, and quality improvement projects. Conclusion Pharmacy technicians are a helpful, yet underutilized, resource in the primary care setting. Further exploration of technician roles is needed to determine the financial and clinical impact of expanding these roles.

Objective: The objectives of this study were to identify barriers to influenza vaccination recommendation adherence and determine potential methods to improve influenza vaccination rates at the outpatient primary care health centers within an academic health care system. Methods: This descriptive study consisted of a questionnaire distributed to primary care providers at outpatient health centers within an academic health care system. The questionnaire assessed provider opinions regarding knowledge of influenza vaccination recommendations, barriers to following clinical guidelines, and methods to decrease delay of guideline use. Influenza vaccination rates at each of the health centers were also determined through documentation of vaccination for adults who visited a primary care provider during the 2011-2012 influenza season. Vaccination rates were used as a potential model for vaccination recommendation adherence. Results: When providers were asked about barriers to guideline implementation, 75.0% stated lack of awareness that guidelines have been released and 62.5% identified insufficient time to learn new guidelines as barriers. When asked which would be useful to more quickly implement clinical guidelines, respondents selected education for providers of new guidelines (79.2%), reminders in the electronic medical record (62.5%), and involvement of other health care professionals including pharmacists (54.2%) as potential strategies. Most questionnaire respondents (70.8%) strongly agreed that well-developed guidelines would improve quality of care at their practice site. During the 2011-2012 influenza season, 26.0% of 67,827 adults with an office visit at all outpatient health centers had documentation of administration of an influenza vaccine. Conclusion: Influenza vaccination rates at the outpatient primary care health centers at this academic health care system represent an area for improvement. Provider perceived barriers to clinical practice guideline implementation and adherence at the health centers include lack of awareness of new guidelines and lack of resources such as time and personnel to follow all recommendations. A health care system-wide process needs to be created to better identify strategies to improve adherence to influenza vaccination recommendations and vaccination documentation.   Type: Original Research