Community pharmacy practice transformation: Evaluating sustainability of patient care services

Background: Flip the Pharmacy (FtP) is a transformation initiative that “flips” community pharmacies from a primarily dispensing model to providing patient care services. More than 450 pharmacies nationwide engaged in the first cohort of FtP. Previous studies demonstrated FtP support was effective in practice transformation. However, it is unknown to what extent patient care services continued once FtP ended. Objective: To evaluate the sustainability of patient care services at community pharmacies participating in FtP. Methods: An online survey was emailed to key informants. Survey questions were adapted from the National Health Services (NHS) Sustainability Model which identifies barriers and facilitators to sustainment in 3 domains: process, staff, and organization. The survey evaluated continued offerings of patient care services, addition of new patient care services, integration of services with personnel, continued use of FtP resources, and pharmacy characteristics. Descriptive statistics were calculated for survey variables. Linear regression was used to test if process factors, staff factors, organization factors, continued use of resources, or payment explained service sustainability. Results: The response rate was 45% (n = 210). Almost all respondents (n = 209, 99.5%) reported that one patient care service continued. Reported sustainability scores for each domain were 75.2% (process), 81.6% (staff) and 78.1% (organization). All domains achieved more than 55% indicating optimism of initiative sustainment. More than half of pharmacies (56.7%) offered a new patient care service. Most respondents continued to utilize FtP resources at least some of the time each month. Linear regression revealed service sustainment was positively associated with the process component of NHS sustainability measure (ß = 0.324; P < 0.001), the continued use of FtP resources (ß = 0.246; P < 0.001), and service payment (ß = 0.148; P = 0.028). Conclusion: Community pharmacies engaged in FtP demonstrated ability to sustain patient care services.