CAPSLEAD
Evaluating the impact of COVID-19 on ambulatory care pharmacists.
Skills
Qualitative Interviews
Thematic Coding
Presentation
Role
Interviewer
Data Analyst
Recruiter
Presenter
Timeline
April 2022 - April 2023
Team
7 pharmacy students
**This longitudinal project was part of the University of California, San Francisco School of Pharmacy's California Pharmacy Student Leadership (CAPSLEAD) program. Upon completion, our team presented our findings during the California Pharmacy Association's Western Pharmacy Exchange.
Table of Contents
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The Challenge
The Question
How did the COVID-19 pandemic alter the scope of ambulatory care pharmacy practice at academic, research, and rural institutions throughout California?
Ambulatory care pharmacists provide direct patient care services managing various conditions, such as chronic illnesses, through in-person or tele-health appointments, patient education classes, or other forms of wellness visits.
The COVID-19 pandemic posed various challenges onto the healthcare community, requiring many providers to assume new roles to continue providing quality care to patients.
Although there are many studies that explored how pharmacists had taken on new responsibilities due to the pandemic, many of them focused on community and hospital settings.
My team and I were interested in understanding the effects of the pandemic from an ambulatory care pharmacist's perspective. This included its effects on administration, pharmacist-perceived patient engagement, and provider roles and well-being with tele-health prior to COVID-19 versus during COVID-19.
The Process
01 Plan
Created the initial Qualtrics Survey and planned our 1 hour virtual semi-structured interview and questions.
02 Participant Recruitment
We recruited ambulatory care pharmacists based on geographic location within California, role, institution, and employment timeline. I reached out to pharmacists affiliated with different pharmacy schools and additional pharmacy contacts were provided by our team advisor.
03 Data Collection
After the screening process, we first sent out an online Qualtrics survey to each of the participants about their perception on how the pandemic influenced their scope of practice, use of telehealth, and administrative logistics. We then conducted virtual semi-structured interviews to better understand their experiences and further elaborate on their survey responses.
04 Analysis
We conducted inductive coding and thematic analysis based on our survey and interview responses. Our coding was initially completed individually and then revised and reconciled both individually and amongst the team until an appropriate inter-rater reliability was achieved. During the analysis, we synthesized main and sub themes based on code occurrences.
05 Present Findings
We presented our findings at the annual California Pharmacy Association's Western Pharmacy Exchange to pharmacy legislative leaders, professors, and students as part of the CAPSLEAD showcase.
The Why's
Research Method
Since our research goal was to understand how the COVID-19 pandemic altered the scope of practice of ambulatory care pharmacists in California, we chose a qualitative approach to gain a deeper understanding of the experiences and perceptions ambulatory care pharmacists had. Utilizing user surveys provided us with both quantitative and qualitative data that explained their opinions on the impacts from a more logistical point of view, while the interviews gave the pharmacists an opportunity to further explain their answers while also sharing their own story on how their jobs changed as a result of the pandemic.
Participant Selection
By speaking with pharmacists from all throughout California, we aimed to understand how the COVID-19 pandemic affected various communities and what kinds of resources were available to support the healthcare teams in different areas. In addition to understanding the environment, our team decided to interview both ambulatory care pharmacy leadership and clinical pharmacists to gain insight into how these different roles played a factor into their perception of how the pandemic impacted their teams. We also wanted to compare their experiences both before and after the pandemic, therefore one of our inclusion criteria was to be employed prior to the beginning of the COVID-19 pandemic, which we defined as March 2020.
The Findings
1. Administration:
Statements related to administrative and logistical changes or concerns affected by the pandemic.
At the time of the study and currently, pharmacists are not considered as recognized providers in California, meaning they cannot be reimbursed for providing patient care services through Medicare Part B independently. With COVID-19 increasing the use of tele-health visits, many new issues related to billing were raised, which prevented some pharmacists from successfully billing for these services. This emphasizes the need for pharmacists to be moved to provider status.
"Billing rules have changed, and they're reimbursing a lower amount for tele-health visits than they are for in person visits."
2. Provider Impact
Statements related to how providers and practices have been affected by COVID-19.
Some pharmacists experienced an increase in their breadth of practice or were relied on more heavily by other providers, which led to an increase in work volume but consistent staffing amongst pharmacy services. As a result, some pharmacists expressed increased burnout, but still a sense of value as they were practicing at the top of their license.
"I felt very valued and needed by my team. It was tiring but also really gratifying to be able to be there for the team and the patients."
3. Patient Engagement
Statements about changes in patient engagement through pharmacist interactions due to COVID-19.
The increased use of tele-health offered more flexibility and convenience to both pharmacists and patients. This also helped to reduce barriers that previously prevented patients from attending appointments with their caretakers. Conversely, this platform was not ideal for certain services, such as physical examinations and building rapport and trust.
Increased tele-health was an overarching theme that connected administrative changes, provider impact, and patient engagement.
"Some of the socioeconomic issues of spending the time and money to travel, take time off of work… those challenges are almost non-existent when a patient's using their own personal cell phone, iPad, or laptop instead of having to do all that travel."
The Final Poster
The Takeaways
This study shined some light on the major impacts ambulatory care pharmacists experienced as a result of the COVID-19 pandemic. During our poster presentation at the Western Pharmacy Exchange, we were able to share our findings with several stakeholders, including pharmacy legislative advocates, pharmacists in academia, and California Pharmacy Association representatives to urge the need to advocate for pharmacists for both their well-being and provider status.
Some key insights to take away are:
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Increased tele-health appointment options would help increase accessibility for patients, especially when attending with caretakers. Many pharmacists expect a retention in higher tele-health appointments compared to in-person visits for the next 5 years
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There is a need to advocate for pharmacists to be recognized as providers in California in order to allow for proper billing protocols for critical patient care services.
Next Steps
Future research studies can explore the impact of the COVID-19 pandemic on other pharmacy practices, such as industry and inpatient pharmacies.