(1361) Evaluation of Barriers and Facilitators of Pharmacy Practice Advancement in a State's Pharmacist Workforce

Objectives: The school of pharmacy formed a workgroup to evaluate current barriers and facilitators of the advancement of pharmacy practice in the state. Over the past decade, legislation such as collaborative practice agreements between pharmacists and physicians, injectable medication administration by pharmacists, independent naloxone dispensing, and testing and treating for acute illness has been implemented, but legislative successes do not automatically translate into practice changes.

Methods: The workgroup was formed with representatives from school of pharmacy faculty, the state pharmacists association, and state health systems pharmacists association. The project consisted of two phases – online survey then live focus group discussions. To advertise the survey, postcards were distributed via mail to all pharmacists licensed in the state (n=7957) and promoted via social media accounts, emails to association membership, and an email to preceptors. The survey was administered via Qualtrics and open from 4/4/2023-7/9/2023.

Survey respondents who identified interest in future focus group opportunities were contacted via email to participate in a 90-minute in-person or online video conference focus group discussion during summer 2023. Pharmacists were allowed to share the invitation with other local pharmacists. The associations also emailed membership with invitations to participate in the focus groups. Eight focus groups were completed: five in-person across the state and three online sessions. Discussions included five to ten participants each and were facilitated by one to two workgroup members. All focus groups were recorded, then transcribed by a research assistant. After transcription, major themes were identified.

Results: A total of 388 pharmacists (4.9%) completed the online survey. Reflecting the population centers of the state, most responses came from the metropolitan areas of the state). Most respondents were female (61%, n=237), White (93.3%, n=362), and a mean age of 42 years old. Hospital pharmacy was the most common practice setting (37.9%, n=147), followed by independent community (18.3%, n=71), and chain community (17.5%, n=68). Other practice settings represented were ambulatory care, long term care, mail order, academia, industry, compounding, and managed care. Most pharmacists responding had not completed advanced training (60.3%, n=234). Of those that had advanced training, this included PGY1 residency (26.2%, n=102), PGY2 residency (11.6% n=45), or a master’s degree (10.8%, n=42).

The top three facilitators to advancing pharmacy practice identified across all practice settings were pharmacist mentorship (77%, n=147/191), customer or patient demand (50.9%, n=110/216), and collaborators such as area physicians (46.3%, n=93/201). The top three barriers were time to complete services (75.3%, n=198/263), current workload (71.8%, n=193/269), and poor insurance reimbursement (74.0%, n=148/200).

Facilitators and barriers were broken down for each practice type with ≥25 responses (hospital, independent community, chain community, and ambulatory care). All practice settings identified time to complete services as a barrier. Additional key barriers noted were physical space and billing infrastructure in ambulatory care, billing infrastructure in independent community, and liability concerns in chain community. Independent community pharmacists noted support staff such as interns, technicians, and schedulers among their top three facilitators. Ambulatory care pharmacists noted sharing of electronic health records as a key facilitator.

Conclusions: When working to improve and advance pharmacy practice in the state, stakeholders need to be aware of and collaborate to overcome key barriers common to all practice types such as pharmacy workload and poor insurance reimbursement for services. Facilitators such as improving pharmacist mentorship programs, networking with supportive collaborators, and meeting the demands of patients in a changing healthcare system will be instrumental to a safe, effective, and thriving pharmacy practice of the future.