Strategies to facilitate the implementation of collaborative practice agreements in chain community pharmacies

Objectives: The objectives of this study were to describe (1) key factors affecting the implementation and scalability of collaborative practice agreements (CPAs) and (2) CPA implementation strategies that have been used by chain community pharmacy organizations. Design: Qualitative analysis using a work system approach. Setting: Eight chain community pharmacy organizations with at least one pharmacy location in New York, Ohio, Pennsylvania, or West Virginia from August 2014 to March 2015. Participants: Ten clinical pharmacist managers and 9 practicing community pharmacists. Intervention: Semistructured interviews with study participants. Interview transcripts were thematically analyzed using the Systems Engineering Initiative for Patient Safety (SEIPS) 2.0 model of work system and patient safety. Main outcome measures: Clinical pharmacist managers' and community pharmacists' perceptions of key factors and strategies for implementing and scaling CPAs, tools, and resources that could facilitate the implementation of CPAs. Results: Seven themes emerged as key factors for the implementation and scalability of CPAs within the person, organization, external environment, and task domains of the SEIPS model, which include the need for building relationships with physicians and other health care providers, optimizing pharmacists' education and training, addressing patient perceptions, ensuring consistent operations, developing a sustainable business model, advocating for permissive state and federal legislation, and structuring time and workload. Examples of specific strategies included using existing physician relationships, identifying pharmacy-and regional-level champions, and allocating staffing based on prescription volume and clinical services. Conclusion: A number of key factors were identified that, when addressed, can facilitate the implementation and scalability of patient care services and CPAs. Chain community pharmacies should use the specific strategies for addressing each key factor that match the needs of their organization. (C) 2016 American Pharmacists Association. Published by Elsevier Inc. All rights reserved.