Objectives This substudy’s objectives were to (1) examine the transferability of a four archetype framework (simplified pattern of prototypical features) for patients at high risk for opioid use disorder (OUD) developed from a previous study with a similar population; (2) explore how patient preferences for terminology can inform clinician communication strategies for patients with OUD across archetypes and (3) explore how patient perceptions of opioid risks can inform clinician communication strategies across patient archetypes.Design This qualitative study collected data via semistructured phone interviews with patients about views on opioid-related discussions with primary care clinicians. Qualitative data were coded using the Rigorous and Accelerated Data Reduction technique and analysed via iterative inductive/deductive thematic analysis.Setting 40 primary care clinics affiliated with two health systems (site1=Pennsylvania; site2=Minnesota, Wisconsin and North Dakota).Participants 40 adults meeting one of the following: OUD diagnosis; taking medication for OUD (MOUD) and ≥3 opioid prescriptions in the previous year.Results The aforementioned four archetype framework transferred well to the study sample and hinted at archetype differences in participant OUD-terminology preferences and opioid risk perceptions. Two additional archetypes of ‘in treatment/recovery for OUD and not taking MOUD’ and ‘in treatment/recovery for OUD and taking MOUD’ were identified. Participants best fitting archetypes 1–4 preferred clinicians to refrain from using addiction terminology to describe their relationship with opioids, finding the term ‘dependence’ as more appropriate and a signal that clinicians cared for patients. Participants who best first archetypes 5–6 felt ‘addiction’ was an appropriate, direct term that accurately described their condition, often using it themselves. Patients in all archetypes recognised risks of harm from using opioids, especially participants fitting archetypes 2, 5 and 6 who conveyed the greatest concern.Conclusion The modified six archetype framework may help clinicians tailor their communication and care for patients diagnosed with or at high risk for OUD.Trial registration number NCT04198428.

Medical Marijuana (MMJ) is available in Pennsylvania and participation in the state-regulated program requires a patient to register and receive a certification by an approved physician. There is currently no integration of MMJ certification data in Pennsylvania into health records that would allow for physicians to rapidly identify patients that are using MMJ, as there are with other scheduled drugs. This absence of a formal data sharing structure necessitates tools that aid in consistent documentation practices to enable comprehensive patient care. Customized smart data elements (SDE) were made available to clinicians at an integrated health system, Geisinger, following MMJ legalization in Pennsylvania. The purpose of this project was to examine and contextualize the use of MMJ SDEs in the Geisinger population. We accomplished this goal by developing a systematic chart review protocol, with the goal of creating a tool that resulted in consistent human data extraction. We developed a chart review protocol for extracting MMJ-related information. The protocol was developed between August to December of 2022 and focused on a patient group that received one of several MMJ SDE between 1/25/2019 and 5/26/2022. Characteristics were first identified on a small pilot sample of patients (N=5), which were then iteratively reviewed to optimize for consistency. Following the pilot, two reviewers were assigned 200 patient charts, selected randomly from the larger cohort, with a third reviewer examining a subsample to determine reliability. We then summarized the clinician-level and patient-level features from n=156 charts with a table-format SDE that best captured MMJ information. We found the chart review protocol was feasible for those with minimal medical background to complete, with high inter-rater reliability (Kappa = 0.966 (p <0.001), 95% CI (0.954 - 0.978)). MMJ certification was largely documented by nurses and medical assistants (87.2%) and typically within primary care settings (68.6%). The SDE has 6 pre-set field prompts, including certifying provider, authorized dispensary, certifying conditions, dosage, product, and active ingredient. We found preset fields were overall well-recorded (76.6% across all fields). Individual fields were more heterogeneous in terms of completion, with dispensary specified in 87.8% of documentation, certifying provider specified in 61.5% of documentation, and product dose specified in only 30.8% of documentation. This method of chart review yields high quality data extraction that can serve as a model for other health record inquiries. Our evaluation showed relatively high completeness of SDE fields, primarily by clinical staff responsible for rooming patients. Improving adoption and fidelity of SDE data collection may present a valuable data source for future research on patient MMJ use and treatment efficacy and outcomes. N/A

BACKGROUND:Guideline-directed medical therapies (GDMTs), initiated in-hospital and continued during the transition to outpatient care, are paramount to successful outcomes for patients with acute coronary syndrome (ACS). Incomplete discharge medication prescribing and delayed follow-up lead to worse cardiovascular outcomes.OBJECTIVES:We investigated a system of care using inpatient and outpatient clinical pharmacists to close GDMT gaps, ensure seamless transition to outpatient care, improve patient education, and optimize therapies.METHODS:We conducted a pre-post cohort analysis of patients with ACS pre- versus post-intervention to compare process metrics and key outcomes using electronic health record data.RESULTS:There were 181 and 135 patients in the pre- and post-intervention cohorts, respectively. Patients post-intervention were significantly more likely to have appropriately-timed follow-up visits scheduled with cardiology (79% vs. 51%, P < 0.0001) and primary care (57% vs. 43%, P = 0.01), to be discharged with prescriptions for P2Y12 inhibitors (87% vs. 64%, P < 0.0001), high dose statins (86% vs. 70%, P = 0.001), and beta blockers (87% vs. 76%, P = 0.01), and significantly less likely to have 30-day all-cause hospital readmissions (4% vs. 12%, P = 0.02) and emergency department (ED) visits (10% vs. 18%, P = 0.04).CONCLUSIONS:The integration of advanced practicing pharmacists into a cardiology team at transition and post-hospitalization resulted in improved rates of posthospital follow-up visits, optimization of GDMT medications, and significantly lower 30-day hospital readmission and ED utilization.

Background: Medical marijuana (MMJ) is available in Pennsylvania, and participation in the state-regulated program requires patient registration and receiving certification by an approved physician. Currently, no integration of MMJ certification data with health records exists in Pennsylvania that would allow clinicians to rapidly identify patients using MMJ, as exists with other scheduled drugs. This absence of a formal data sharing structure necessitates tools aiding in consistent documentation practices to enable comprehensive patient care. Customized smart data elements (SDEs) were made available to clinicians at an integrated health system, Geisinger, following MMJ legalization in Pennsylvania. Objective: The purpose of this project was to examine and contextualize the use of MMJ SDEs in the Geisinger population. We accomplished this goal by developing a systematic protocol for review of medical records and creating a tool that resulted in consistent human data extraction. Methods: We developed a protocol for reviewing medical records for extracting MMJ-related information. The protocol was developed between August and December of 2022 and focused on a patient group that received one of several MMJ SDEs between January 25, 2019, and May 26, 2022. Characteristics were first identified on a pilot sample (n=5), which were then iteratively reviewed to optimize for consistency. Following the pilot, 2 reviewers were assigned 200 randomly selected patients' medical records, with a third reviewer examining a subsample (n=30) to determine reliability. We then summarized the clinician- and patient-level features from 156 medical records with a table-format SDE that best captured MMJ information. Results: We found the review protocol for medical records was feasible for those with minimal medical background to complete, with high interrater reliability (kappa=0.966; P< .001; odds ratio 0.97, 95% CI 0.954-0.978). MMJ certification was largely documented by nurses and medical assistants (n=138, 88.5%) and typically within primary care settings (n=107, 68.6%). The SDE has 6 preset field prompts with heterogeneous documentation completion rates, including certifying conditions (n=146, 93.6%), product (n=145, 92.9%), authorized dispensary (n=137, 87.8%), active ingredient (n=130, 83.3%), certifying provider (n=96, 61.5%), and dosage (n=48, 30.8%). We found preset fields were overall well-recorded (mean 76.6%, SD 23.7% across all fields). Primary diagnostic codes recorded at documentation encounters varied, with the most frequent being routine examinations and testing (n=34, 21.8%), musculoskeletal or nervous conditions, and signs and symptoms not classified elsewhere (n=21, 13.5%). Conclusions: This method of reviewing medical records yields high-quality data extraction that can serve as a model for other health record inquiries. Our evaluation showed relatively high completeness of SDE fields, primarily by clinical staff responsible for rooming patients, with an overview of conditions under which MMJ is documented. Improving the adoption and fidelity of SDE data collection may present a valuable data source for future research on patient MMJ use, treatment efficacy, and outcomes.

BackgroundPatient portal secure messaging allows patients to describe health-related behaviors in ways that may not be sufficiently captured in standard electronic health record (EHR) documentation, but little is known about how cannabis is discussed on this platform. ObjectiveThis study aimed to identify patient and provider secure messages that discussed cannabis and contextualize these discussions over periods before and after its legalization for medical purposes in Pennsylvania. MethodsWe examined 382,982 secure messages sent by 15,340 patients and 6101 providers from an integrated health delivery system in Pennsylvania, United States, from January 2012 to June 2022. We used an unsupervised natural language processing approach to construct a lexicon that identified messages explicitly discussing cannabis. We then conducted a qualitative content analysis on a random sample of identified messages to understand the medical reasons behind patients’ use, the primary purposes of the cannabis-related discussions, and changes in these purposes over time. ResultsWe identified 1782 messages sent by 1098 patients (7.2% of total patients in the study) and 800 messages sent by 430 providers (7% of total providers in the study) as explicitly discussing cannabis. The most common medical reasons for use stated by patients in 190 sampled messages included pain or a pain-related condition (50.5% of messages), anxiety (13.7% of messages), and sleep (11.1% of messages). We coded 56 different purposes behind the mentions of cannabis in patient messages and 33 purposes in 100 sampled provider messages. In years before the legalization (2012-2016), patient and provider messages (n=20 for both) were primarily driven by discussions about cannabis screening results (38.9% and 76.5% of messages, respectively). In the years following legalization (2017-2022), patient messages (n=170) primarily involved seeking assistance to facilitate medical use (35.2% of messages) and reporting current use (25.3% of messages). Provider messages (n=80) were driven by giving assistance with medical marijuana access (27.5% of messages) and stating that they were unable to refer, prescribe or recommend medical marijuana (26.3% of messages). ConclusionsPatients showed a willingness to discuss cannabis use over patient portal secure messages and expressed interest in use after the legalization of medical marijuana. Some providers responded to patient inquiries with assistance in obtaining access to medical marijuana, while others cautioned patients on the risks of use. Insight into cannabis-related discussions through secure messages can help health systems determine opportunities to improve care processes around patients’ cannabis use, and providers should be supported to communicate accurate and consistent information.

Background: Headaches, including migraines, are one of the most common causes of disability and account for nearly20%-30% of referrals from primary care to neurology. In primary care, electronic health record-based alerts offer a mechanismto influence health care provider behaviors, manage neurology referrals, and optimize headache care. Objective: This project aimed to evaluate the impact of an electronic alert implemented in primary care on patients' overallheadache management. Methods: We conducted a stratified cluster-randomized study across 38 primary care clinic sites between December 2021to December 2022 at a large integrated health care delivery system in the United States. Clinics were stratified into 6 blocksbased on region and patient-to-health care provider ratios and then 1:1 randomized within each block into either the controlor intervention. Health care providers practicing at intervention clinics received an interruptive alert in the electronic healthrecord. The primary end point was a change in headache burden, measured using the Headache Impact Test 6 scale, frombaseline to 6 months. Secondary outcomes included changes in headache frequency and intensity, access to care, and resourceuse. We analyzed the difference-in-differences between the arms at follow-up at the individual patient level. Results: We enrolled 203 adult patients with a confirmed headache diagnosis. At baseline, the average Headache Impact Test6 scores in each arm were not significantly different (intervention: mean 63, SD 6.9; control: mean 61.8, SD 6.6; P=.21).We observed a significant reduction in the headache burden only in the intervention arm at follow-up (3.5 points; P=.009).The reduction in the headache burden was not statistically different between groups (difference-in-differences estimate -1.89,95% CI -5 to 1.31; P=.25). Similarly, secondary outcomes were not significantly different between groups. Only 11.32%(303/2677) of alerts were acted upon. Conclusions: The use of an interruptive electronic alert did not significantly improve headache outcomes. Low use of alertsby health care providers prompts future alterations of the alert and exploration of alternative approaches. Trial Registration: ClinicalTrials.gov NCT05067725; https://clinicaltrials.gov/study/NCT05067725

BACKGROUND:Despite sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor/neprilysin inhibitors (ARNi) being cost-effective evidenced-based therapies for the management of Heart Failure with Reduced Ejection Fraction (HFrEF), research shows that less than 30% of patients with HFrEF are prescribed these agents. OBJECTIVE:This study aimed to understand clinician-perceived barriers and facilitators to prescribing ARNi and SGLT2i in patients with HFrEF. METHODS:We conducted virtual and in-person semi-structured interviews in a large integrated healthcare delivery system in the United States. Twenty cardiology clinicians managing patients with HFrEF were recruited using purposeful sampling to target providers across professions and practice sites. The interview guide was developed based on a literature review and insights from a practicing cardiologist. It inquired about perceived prescribing behaviors, focusing on factors affecting the use of ARNi and SGLT2i. We identified key themes using rapid qualitative analysis. RESULTS:Twenty clinicians were interviewed: 13 physicians, 5 advanced practitioners, and 2 clinic-based pharmacists. Eighteen interviews were analyzed; we excluded 2 as the clinicians interviewed did not meet the inclusion criteria. Three major themes were identified: 1) clinician-reported prescribing patterns don't always align with the American College of Cardiology/American Heart Association guidelines for the use of SGLT2i and ARNi due to clinical inertia, lack of familiarity, knowledge, and comfort with use, and concerns over polypharmacy or adverse events, 2) clinician-perceived and actual out-of-pocket cost reduced prescribing of ARNi or SGLT2i to patients, exacerbated by a lack of visibility into patients' prescription coverage, denials of coverage by insurance, and navigating prior authorization related workflows, and 3) incorporation of a clinic-based pharmacist increased the prescribing of these medications. CONCLUSION:Increasing cost transparency, implementing interventions to overcome clinical inertia and cost hurdles, and increasing clinic-based pharmacist support may improve evidenced-based prescribing in patients with HFrEF, especially for comparatively novel classes such as ARNi and SGLT2i.

BackgroundNewer diabetes medications have cardiorenal benefits beyond blood sugar lowering that make them a preferred treatment option in many patients. Despite this, studies have shown that prescribing of these medications remains suboptimal with medication costs being hypothesized as a reason for underutilization.ObjectiveTo understand clinicians’ decision-making processes for prescribing diabetes medications in older adults, focusing on higher cost medications.MethodsObservations of patient encounters and semi-structured interviews were conducted with clinicians from primary care, endocrinology, and geriatrics to elucidate themes into diabetes medication prescribing. A qualitative descriptive approach was used to analyze the data from interviews using an inductive coding scheme with themes derived from the data.ResultsTwenty-one interviews were conducted. Five themes were identified: 1) out-of-pocket costs drive prescribing decisions 2) out-of-pocket costs can be variable due to changing insurance plans or changing coverage 3) clinicians have difficulty with determining patient-specific out-of-pocket costs 4) clinicians manage the tradeoffs existing between cost, efficacy, and safety and 5) clinicians can use cost-modifying strategies such as patient assistance.ConclusionAddressing the challenges that medication costs pose to prescribing evidence-based medications for type 2 diabetes is necessary to optimize diabetes care for older adults.

Background Despite type 2 diabetes guidelines recommending against the use of sulfonylureas in older adults and for the use of sodium-glucose cotransporter-2 inhibitors (SGLT2) and glucagon-like peptide-1 agonists (GLP1s) in patients with atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD), and heart failure (HF), real-world guideline-concordant prescribing remains low. While some factors such as cost have been suggested, an in-depth analysis of the factors associated with guideline-concordant prescribing is warranted. Objective To quantify the extent of guideline-concordant prescribing in an integrated health care delivery system and examine provider and patient level factors that influence guideline-concordant prescribing. Design We performed a cross-sectional study. Participants Participants were included if they had a diagnosis of type 2 diabetes, were prescribed a second-line diabetes medication between January 1, 2018 and December 31, 2020 and were at least 65 years old at the time of this second-line prescription. Main Measures Our outcome of interest was guideline-concordant prescribing. The definition of guideline-concordant prescribing was based on American Diabetes Association and American Geriatric Society recommendations as well as expert consensus. Factors affecting guideline concordant prescribing included patient demographics and provider characteristics among others. Key Results We included 1,693 patients of which only 50% were prescribed guideline-concordant medications. In a subgroup of 843 patients with cardiorenal conditions, only 30% of prescriptions were guideline concordant. Prescribing of guideline-concordant prescriptions was more likely among pharmacists than physicians (RR 1.34, 95% CI 1.19-1.51, p <0.001) and in endocrinology practices compared to primary care practices (RR 1.41 95% CI 1.16-1.72, p =0.007). Additionally, guideline concordant prescribing increased over time (42% in 2018 vs 53% in 2019 vs 53% in 2020, p <0.001). Conclusions Guideline-concordant prescribing remains low in older adults, especially among those with cardiorenal conditions. Future studies should examine barriers to prescribing guideline-concordant medications and interventions to improve guideline-concordant prescribing.

Aim: Pre-emptive testing of pharmacogenomic (PGx) variations has potential to improve medication safety and effectiveness; however, testing is not routine. Given the newfound payor coverage of multigene testing and the potential value of testing within aging patients, it is imperative to test local PGx testing capabilities, report results to patients and providers, and determine the value of testing. Materials & methods: We designed a randomized clinical pilot of a pre-emptive PGx testing process using the electronic health record compared with usual care among an aging primary care population. Results & conclusion: The impact of the program on prescribing patterns, healthcare utilization and costs of care will be evaluated. We hypothesize that implementation of a pre-emptive multigene PGx panel is feasible among elderly, polypharmacy, primary care patients, measured by the number of enrolled patients with PGx results entered in the medical record. Health system wide PGx implementation, including capacity needed to integrate these valuable results, is also described.

Elimination of the X-waiver increased potential buprenorphine prescribers 13-fold, but growth in prescribing will likely be much lower. We explored self-assessments of nonwaivered primary care clinicians (PCCs) for factors affecting their likelihood to prescribe buprenorphine were the X-waiver eliminated (since realized January 2023) and the potential impacts of a clinical decision-support (CDS) tool for opioid use disorder (OUD). Cross-sectional survey data were obtained between January 2021 and March 2022 from 305 nonwaivered PCCs at 3 health systems. Factors explored were patient requests for buprenorphine, PCC access to an OUD-CDS, and PCC confidence and abilities for 5 OUD-care activities. Relationships were described using descriptive statistics and odds ratios. Only 26% of PCCs were more likely to prescribe buprenorphine upon patient request, whereas 63% were more likely to prescribe with the OUD-CDS. PCC confidence and abilities for some OUD-care activities were associated with increased prescribing likelihood from patient requests, but none were associated with the OUD-CDS. The OUD-CDS may increase buprenorphine prescribing for PCCs less likely to prescribe upon patient request. Future research is needed to develop interventions that increase PCC buprenorphine prescribing. Clinical trial registration: ClinicalTrials.gov. Identifier: NCT04198428. Clinical trial name: Clinical Decision Support for Opioid Use Disorders in Medical Settings (Compute 2.0)

Background Osteoarthritis (OA) is a complex disease, and prior studies have documented the health and economic burdens of patients with OA compared to those without OA. Our goal was to use two strategies to further stratify OA patients based on both pain and treatment intensity to examine healthcare utilization and costs using electronic records from 2001-2018 at a large integrated health system. Methods Adult patients with ≥1 pain numerical rating score (NRS) and diagnosis of OA were included. Pain episodes of ≥90 days were defined as mild (0-3), moderate (4-6) or severe (7-10) based on initial NRS. Patients were initially classified as mild and moved to moderate-severe OA if any of eight treatment-based criteria were met. Outpatient visits (OP), emergency department visits (ED), inpatient days, and healthcare costs (both all-cause and OA-specific) were compared among pain levels and OA severity levels as frequencies and per-member-per-year rates, using generalized linear regression models adjusting for age, sex and body mass index, with contrasts of p<0.05 considered significant. Results We identified 127,656 patients, 92,576 with pain scores. Moderate and severe pain were associated with significantly higher rates of OA-related utilization and costs, and all-cause ED visits and pharmacy costs. Moderate-severe OA patients had significantly higher OA-related utilization and costs, and all-cause OP, ED and pharmacy costs. Conclusions Pain and treatment intensity were both strongly associated with OA-related resource utilization but not consistently with all-cause utilization. With better understanding of how OA patients intensify services, thus increasing costs, we can deploy targeted preventative strategies aimed at halting progression into more costly phases of the disease.

Authors do not have any relevant personal or financial real or potential conflicts of interest to disclose.

BACKGROUND:Despite routine review of medication lists during patient encounters, patients' medication lists are often incomplete and not reflective of actual medication use. Contributing to this situation is the challenge of reconciling medication information from existing health records, along with external locations (eg, pharmacies, other provider/hospital records, and care facilities) and patient-reported use. Advances in the interoperability and digital collection of information provides a foundation for integration of these once disparate information sources.OBJECTIVE:We aim to evaluate the effectiveness of and satisfaction with an electronic health record (EHR)-integrated web-based medication reconciliation application, MedTrue (MT).METHODS:We conducted a cluster-randomized controlled trial of MT in 6 primary care clinics within an integrated health care delivery system. Our primary outcome was medication list accuracy, as determined by a pharmacist-collected best-possible medication history (BPMH). Patient and staff perspectives were evaluated through surveys and semistructured interviews.RESULTS:Overall, 224 patients were recruited and underwent a BPMH with the pharmacist (n=118 [52.7%] usual care [UC], n=106 [47.3%] MT). For our primary outcome of medication list accuracy, 8 (7.5%) patients in the MT arm and 9 (7.6%) in the UC arm had 0 discrepancies (odds ratio=1.01, 95% CI 0.38-2.72, P=.98). The most common discrepancy identified was patients reporting no longer taking a medication (UC mean 2.48 vs MT mean 2.58, P=.21). Patients found MT easy to use and on average would highly recommend MT (average net promoter score=8/10). Staff found MT beneficial but difficult to implement.CONCLUSIONS:The use of a web-based application integrated into the EHR which combines EHR, patient-reported data, and pharmacy-dispensed data did not improve medication list accuracy among a population of primary care patients compared to UC but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies would impact the effectiveness of the application.

We read with interest and appreciation the recent publication in this journal by Kolesar and Vermeulen1 titled "Precision Medicine: Opportunities for Health-System Pharmacists." In the publication, the authors identify the inevitability of clinical implementation of state-of-the-art precision medicine advances and detail the many barriers to precision medicine implementation. As technological advances continue to push evidence-based precision medicine strategies from the bench to the bedside, new standards of care will certainly replace current best practices. Because of this changing landscape of practice, health-system pharmacists have taken and must continue to take sufficient steps to support the implementation of these data.2 The authors are unmistakably correct in identifying that the role of the pharmacist must continue to adapt to support these improvements to patient care and changes in clinical workflows. In addition, we recognize the authors' reference to our own institution, Geisinger, and our precision medicine initiatives. Precision medicine, the...

OBJECTIVES:To understand the extent to which behaviors consistent with high quality medication reconciliation occurred in primary care settings and explore barriers to high quality medication reconciliation.DESIGN:Fully mixed sequential equal status design including ethnographic observations, semi-structured interviews, and surveys.SETTING:Primary care practices within an integrated healthcare delivery system in the United States.PARTICIPANTS:We conducted 170 observations of patient encounters across 15 primary care clinics, 48 semi-structured interviews with staff, and 10 semi-structured interviews with patients. We also sent out surveys to 2,541 eligible staff with 616 responses (24% response rate) and to 5,132 eligible patients with 577 responses (11% response rate).RESULTS:Inconsistency emerged as a major barrier to effective medication reconciliation. This inconsistency was present across a variety of factors such as the lack of standardized workflows for conducting medication reconciliation, a lack of knowledge about medication and the process of medication reconciliation, varying levels of importance ascribed to medication reconciliation, and inadequate integration of medication reconciliation into clinical workflows. Findings were generally consistent across all data collection methods.CONCLUSION:We have identified several barriers which impact the process of medication reconciliation in primary care settings. Our key finding is that the process of medication reconciliation is plagued by inconsistencies which contribute to inaccurate medication lists. These inconsistencies can be broken down into several categories (standardization, knowledge, importance, and inadequate integration) which can be targets for future studies and interventions.

Introduction Access to healthcare is a problem in the United States, exacerbated by inefficient system processes that warrant innovative reengineering solutions like centralized telehealth services. Objective The aim of this study is to describe the genesis and evolution of a centralized pharmacy telehealth center ("TelePharmacy") at Geisinger, an integrated health delivery system. Methods Descriptive statistics on the operations and impact of the TelePharmacy program were performed from inception in August 2017 to November 2020 using electronic health record data. In addition, a survey of clinic staff prior to and after initial TelePharmacy roll-out was conducted to assess the impact on time spent on medication-related activities and satisfaction with the service. Results TelePharmacy completed over two million refills, resulting in a decreased workload for 40% of clinic staff. TelePharmacy pharmacists identified and rectified 3372 medication therapy problems over a 12-month period. Over the first 3.5 years, TelePharmacy expanded into other clinical areas such as anticoagulation, transitions of care, and urinary tract infection management. Conclusion Geisinger was able to initiate and expand services offered by a centralized pharmacy telehealth center and positively impact care team burden. TelePharmacy is expected to continue to expand its efforts to improve the patient care experience at Geisinger.

The Health Care Systems Research Network (HCSRN) is comprised of 19 not-for-profit health systems with embedded research departments. The network's annual conference serves as a forum for member institutions to highlight research findings, explore new collaborations, and share insights and opportunities. Abstracts accepted for oral and poster presentation at the 2021 HCSRN Conference are published in this supplement of Journal of Patient-Centered Research and Reviews, the official scientific journal of the annual conference.

Background: Collaborative relationships between community pharmacists and health care professionals in primary care practices can assist with the provision of medication and disease management services in community pharmacy settings. Objectives: The objective was to describe the attitudes of providers working in primary care practices with on-site pharmacist collaborators to understand how to facilitate similar collaborations with pharmacists in community pharmacy settings. Methods: This qualitative study was conducted among physicians, nurse practitioners, and nurses of 3 primary care practice sites in the Commonwealth of Pennsylvania. A demographic survey and a semistructured interview were conducted to elicit feedback on participant perceptions about building relationships with community pharmacists. Interviews were audio-recorded and transcribed. A qualitative analysis was performed to identify emerging themes using an inductive approach. Demographic data were summarized using descriptive statistics. This study was approved by the University's Institutional Review Board. Results: Nineteen interviews were conducted. Fifty-eight percent of participants were physicians and 68% were female with a mean age of approximately 46 years. Five themes were identified: (1) Pharmacists were highly valued and were effective team members to promote coordination of medication-related care; (2) Direct access to pharmacists facilitates efficient communication and effective patient care; (3) Trust is the foundation of an effective collaboration between pharmacists and providers; (4) Pharmacists demonstrating responsibility for patients enables collaboration with providers who view themselves as stewards of patient care; and (5) Providers believe that community pharmacists' dispensing requirements may limit their ability to participate in patient care. Conclusions: The following strategies to establish relationships with primary care practices are suggested: pharmacists should initiate face-to-face relationships with providers in practices; communication and patient interventions should be conveyed directly to providers and be conducted by the same person; and pharmacists need to demonstrate their commitment to patient care by following up promptly on patient interventions. (C) 2021 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

BACKGROUND:Sub-optimal medication use results in significant avoidable morbidity, mortality, and costs. Programs, such as comprehensive medication management (CMM), can help to optimize medication use, improve outcomes, and reduce costs. However, implementing programs like CMM can be challenging and differences in how CMM has been implemented may be responsible for observed heterogeneity in the outcomes associated with CMM.OBJECTIVE(S):Describe the implementation strategies utilized in implementing CMM telephonically within a team-based at-home care program and evaluate the implementation process.METHODS:The implementation of CMM was facilitated using various implementation strategies including: develop educational material and conduct training, change record system, audit and feedback, learning collaborative, quality monitoring, readiness assessment, and implementation team formation. The impact of these strategies as well as pharmacist and team member perspectives on the implementation of CMM were examined using mixed methods and guided by Proctor's conceptual model for implementation.RESULTS:The pharmacists felt that most of the implementation strategies used to facilitate consistent delivery of CMM were useful, but were unable to successfully implement all of them. Despite this, significant increases in fidelity to steps of the patient care process was achieved. The pharmacists felt that CMM was acceptable, appropriate for patient population, and feasible, but barriers (e.g., the telephonic and remote nature of the practice, the evolving nature of the program, and the difficulty in coordinating care between the patients primary care team and the care team affiliated with the program) affected the feasibility and organizational fit of CMM within this team-based, at-home care program. General pharmacy services, however, were seen as acceptable, appropriate, and feasible.CONCLUSION:Deliberately designing and utilizing a variety of implementation strategies can facilitate the implementation of CMM and significantly increase fidelity to the patient care process. To improve feasibility and organizational fit of CMM, additional barriers and challenges need to be addressed.