“…RURAL‐CP provides the infrastructure necessary to study the impact of rural pharmacies on their communities and help translate services and practice models to a rural context. Due to the recent pandemic, the majority of research conducted with RURAL‐CP pharmacies to‐date has focused on coronavirus disease 2019 (COVID‐19), 8 , 27 , 28 but the network is now expanding to address other areas of importance to member pharmacies, including service reimbursement. Individuals interested in joining RURAL‐CP or recruiting RURAL‐CP pharmacies for implementation science studies should visit the study website at www.ruralcp.web.unc.edu .…”
Practice‐based research networks (PBRNs) support the translation and evaluation of evidence‐based practices and interventions on a large scale and have primarily been used in primary care settings. Few pharmacy PBRNs exist. Our objective is to describe the composition and characteristics of the Rural Research Alliance of Community Pharmacies (RURAL‐CP), which is the first PBRN exclusively for rural community pharmacies. For each enrolled pharmacy, a pharmacist liaison completed a survey that assessed the pharmacy's operational characteristics, including business operations, human resource management, division of clinical responsibilities, technology and enhanced services, organizational context, and research priorities. Additionally, up to five other pharmacy staff members completed a brief survey on organizational context. Descriptive statistics were calculated. As of May 2023, there were 126 pharmacies across seven southeastern states that were enrolled in RURAL‐CP. Most pharmacies (91%) were independent pharmacies and operated 6 days per week (82%). On average, pharmacies employed 10 staff members and most trained student pharmacists. Pharmacies offered valuable services in their community, including immunizations, naloxone dispensing, and medication delivery. Blood glucose testing was the most common point‐of‐care (POC) test offered, and most pharmacies were interested in expanding POC offerings, particularly A1c testing and cholesterol screening. RURAL‐CP pharmacies have, on average, relatively strong organizational contexts and readiness for change. Pharmacists' top research priorities were expansion of clinical services, reimbursement, patient adherence, and addressing diabetes and hypertension. Although not generalizable to all rural pharmacies, results indicate that rural pharmacies deliver many important services in their communities and are interested in increasing services provided.
“…RURAL‐CP provides the infrastructure necessary to study the impact of rural pharmacies on their communities and help translate services and practice models to a rural context. Due to the recent pandemic, the majority of research conducted with RURAL‐CP pharmacies to‐date has focused on coronavirus disease 2019 (COVID‐19), 8 , 27 , 28 but the network is now expanding to address other areas of importance to member pharmacies, including service reimbursement. Individuals interested in joining RURAL‐CP or recruiting RURAL‐CP pharmacies for implementation science studies should visit the study website at www.ruralcp.web.unc.edu .…”
Practice‐based research networks (PBRNs) support the translation and evaluation of evidence‐based practices and interventions on a large scale and have primarily been used in primary care settings. Few pharmacy PBRNs exist. Our objective is to describe the composition and characteristics of the Rural Research Alliance of Community Pharmacies (RURAL‐CP), which is the first PBRN exclusively for rural community pharmacies. For each enrolled pharmacy, a pharmacist liaison completed a survey that assessed the pharmacy's operational characteristics, including business operations, human resource management, division of clinical responsibilities, technology and enhanced services, organizational context, and research priorities. Additionally, up to five other pharmacy staff members completed a brief survey on organizational context. Descriptive statistics were calculated. As of May 2023, there were 126 pharmacies across seven southeastern states that were enrolled in RURAL‐CP. Most pharmacies (91%) were independent pharmacies and operated 6 days per week (82%). On average, pharmacies employed 10 staff members and most trained student pharmacists. Pharmacies offered valuable services in their community, including immunizations, naloxone dispensing, and medication delivery. Blood glucose testing was the most common point‐of‐care (POC) test offered, and most pharmacies were interested in expanding POC offerings, particularly A1c testing and cholesterol screening. RURAL‐CP pharmacies have, on average, relatively strong organizational contexts and readiness for change. Pharmacists' top research priorities were expansion of clinical services, reimbursement, patient adherence, and addressing diabetes and hypertension. Although not generalizable to all rural pharmacies, results indicate that rural pharmacies deliver many important services in their communities and are interested in increasing services provided.
“…In addition, COVID-19 boosters may have been less available in some rural or socially vulnerable areas [ 16 ]. Potential strategies to increase COVID-19 vaccination uptake in rural and socially vulnerable communities include increasing vaccine confidence among rural communities through consistent and transparent communication strategies and campaigns, increasing access, and creating sustainable systems to maintain access to vaccines for rural and frontier populations [ 17 ].…”
“…We will update our website and sample verbiage on a regular basis to stay current with reports from the field and published results on hesitancy concerns and points of discussion shown to overcome them. Most community pharmacies in the RURAL-CP network have been delivering the COVID-19 vaccine for over 2 years [ 21 ], so the logistical ordering and administration processes have already been established, though pharmacists can receive support for logistical issues during virtual facilitation if needed.…”
Section: Discussionmentioning
confidence: 99%
“…Thus, pharmacists can address vaccine concerns frequently and make repeated vaccination offers. For pharmacists to maximize the delivery of vaccinations [ 18 ], they need guidance on how to address vaccine hesitancy [ 19 ] and updated information to address patients’ evolving vaccine concerns as well as implementation support, including training and ongoing guidance, to deliver evidence-based vaccine hesitancy counseling interventions [ 20 , 21 ].…”
Background
Uptake of COVID-19 vaccines remains problematically low in the USA, especially in rural areas. COVID-19 vaccine hesitancy is associated with lower uptake, which translates to higher susceptibility to SARS-CoV-2 variants in communities where vaccination coverage is low. Because community pharmacists are among the most accessible and trusted health professionals in rural areas, this randomized clinical trial will examine implementation strategies to support rural pharmacists in delivering an adapted evidence-based intervention to reduce COVID-19 vaccine hesitancy.
Methods
We will use an incomplete stepped wedge trial design in which we will randomize 30 rural pharmacies (unit of analysis) to determine the effectiveness and incremental cost-effectiveness of a standard implementation approach (consisting of online training that describes the vaccine hesitancy intervention, live webinar, and resource website) compared to adding on a virtual facilitation approach (provided by a trained facilitator in support of the delivery of the vaccine hesitancy counseling intervention by pharmacists). The intervention (ASORT) has been adapted from an evidence-based vaccine communication intervention for HPV vaccines through a partnership with rural pharmacies in a practice-based research network in seven southern US states. ASORT teaches pharmacists how to identify persons eligible for COVID-19 vaccination (including a booster), solicit and address vaccine concerns in a non-confrontational way, recommend the vaccine, and repeat the steps later if needed. The primary trial outcome is fidelity to the ASORT intervention, which will be determined through ratings of recordings of pharmacists delivering the intervention. The secondary outcome is the effectiveness of the intervention, determined by rates of patients who agree to be vaccinated after receiving the intervention. Other secondary outcomes include feasibility, acceptability, adoption, reach, and cost. Cost-effectiveness and budget impact analyses will be conducted to maximize the potential for future dissemination and sustainability. Mixed methods will provide triangulation, expansion, and explanation of quantitative findings.
Discussion
This trial contributes to a growing evidence base on vaccine hesitancy interventions and virtual-only facilitation of evidenced-based practices in community health settings. The trial will provide the first estimate of the relative value of different implementation strategies in pharmacy settings.
Trial registration
NCT05926544 (clinicaltrials.gov); 07/03/2023.
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