An Evaluation of the Spread and Scale of PatientToc™ from Primary Care to Community Pharmacy Practice for the Collection of Patient-Reported Outcomes

Medication adherence--taking medications as prescribed--is critical to treating chronic conditions. Fifty percent of individuals taking at least one regularly scheduled prescribed medication are non-adherent with their medications. Reasons for this are multi-faceted, including forgetting to take a medication, an inability to obtain or afford them, and avoidance due to side effects. Typically, adherence is monitored by prescribing providers during in-person visits or may be informed by prescription fill histories and claims. However, relying on infrequent visits does not provide timely information, and merely filling a prescription does not necessarily mean that an individual is taking their medications as prescribed. Pharmacists may be in a unique position to improve medication non-adherence, given their accessibility and the frequency in which they see patients. The use of patient-reported outcomes (PROs) might allow for the collection of information on non-adherence that may be used by pharmacists and prescribers to improve non-adherence.

The research team will implement PatientToc™, a mobile application for PRO collection, in pharmacies to collect information on medication adherence. Pharmacists will be able to immediately use these data to inform their counseling of patients in the pharmacy. PatientToc™ is currently used in 36 primary care practices and can provide audio assistance in up to 200 languages; its use has not extended to pharmacies to date.

The specific aims of the research are as follows:

• Determine community pharmacy workflow and current practices for identifying and resolving medication non-adherence, identify potential barriers and facilitators to PatientToc™ implementation, and create a draft implementation toolkit. 
• Conduct two plan-do-study-act cycles to refine an implementation toolkit for spreading and scaling implementation of PatientToc™ in community pharmacies. 
• Conduct a comprehensive, theory-driven evaluation of the quality of care, implementation, and patient health outcomes of spreading and scaling PatientToc™ to community pharmacies. 

Initially, the software will be implemented at up to three pharmacies in each of three States and will later expand to six to 10 locations in each of those States. Patients with Medicare Part D will be targeted for involvement. Mixed methods will be used to evaluate the implementation, including conducting interviews and observations, and analyzing administration data.

The findings of the research will inform long-term collection of PROs data affecting medication adherence in community pharmacies by spreading and scaling PatientToc™ for health information technology-enabled PROs collection.