How pharmacists would design and implement a community pharmacy-based colorectal cancer screening program

Figures & data

Table 1. Community pharmacist demographic characteristics.

		North Carolina n = 12	Washington n = 11	Total n = 23
		(SD or %)	(SD or %)	(SD or %)
Age (average)		38.5 (8.6)	38 (9.8)	38 (9.8)
Gender
	Male	7 (58)	4 (36)	11 (48)
	Female	5 (42)	7 (64)	12 (52)
Race
	White	7 (58)	9 (82)	16 (70)
	Black/African American	1 (8)	–	1 (4)
	Asian/Pacific Islander	2 (17)	1 (9)	3 (13)
	American Indian/Alaska Native	–	–	–
	Multiple or other	2 (17)	–	2 (9)
	Declined	–	1 (9)	1 (4)
Ethnicity
	Non-Hispanic	12 (100)	11 (100)	23 (100)
	Hispanic	–	–	–
Years in practice at current pharmacy (average)		4.4 (3.1)	4.5 (2.9)	4.5 (2.9)

Table 2. Pharmacy setting characteristics.

		North Carolina n = 12	Washington n = 11	Total n = 23
		(% or SD)	(% or SD)	(% or SD)
Pharmacy type
	Independent (single location)	7 (58)	3 (27)	10 (43)
	Independent (multiple locations)	0 (0)	1 (9)	1 (4)
	Supermarket chain	2 (17)	0 (0)	2 (9)
	Traditional chain	1 (8)	3 (27)	4 (17)
	Federally qualified health center	2 (17)	4 (36)	6 (26)
Structure of pharmacy
	Waiting room/area	12 (100)	7 (64)	19 (83)
	Semi-private exam room	3 (25)	3 (27)	6 (26)
	Private exam room	7 (58)	8 (72)	15 (65)
	Parking lot	12 (100)	11 (100)	23 (100)
	Paid parking	0 (0)	1 (9)	1 (4)
	Street parking	2 (17)	2 (18)	4 (17)
	Drive through	3 (25)	1 (9)	4 (17)
	Parking ramp	0 (0)	1 (9)	1 (4)
Services advertised^A
	Blood pressure	9 (75)	9 (82)	18 (78)
	Flu vaccinations	9 (75)	9 (82)	18 (78)
	HPV vaccinations	6 (50)	7 (64)	13 (57)
	Tetanus vaccine	1 (8)	0 (0)	1 (4)
	Tobacco cessation	8 (67)	3 (27)	11 (48)
	In-pharmacy urgent care clinic	4 (33)	2 (18)	6 (26)
	Adherence packaging	4 (33)	0 (0)	4 (17)
	Glucose testing	2 (17)	0 (0)	2 (9)
Operating hours – average
	Monday – Friday	9.9 (1.2)	10.6 (2.0)	10.2 (1.6)
	Saturday^B	5.7 (2.4)	7.6 (2.5)	6.6 (2.6)
	Sunday^B	7.3 (0.6)	9.3 (1.2)	8.3 (1.4)

^A Services advertised indicates pharmacy-displayed promotional materials (e.g. posters or advertisements) about these patient care services.

^B Excluded pharmacies that were closed on weekends.

Figure 1. PharmFIT™ Intervention Features and Qualitative Themes Mapped onto CFIR Domains.

Notes: PharmFIT™ Intervention: Community pharmacy-based CRC screening intervention. CFIR: Consolidated Framework for Implementation Research. CRC: Colorectal Cancer. FIT kit: Fecal Immunochemical Testing kit. PCP: Primary Care Provider.

Table 3. Qualitative Themes, CFIR Domains and Constructs, and Illustrative Quotes for the Implementation of a Community Pharmacy-Based CRC Screening Intervention: PharmFIT™.

Qualitative themes	CFIR domains and constructs	Illustrative quotes
PharmFIT™ Program Design Preferences	Intervention Characteristics Design quality and packaging Outer Setting External policies and incentives	‘What I particularly like is the kits – at least the one that we have, it has simple instructions inside with visuals and you can pull it out and show it to the patient’. – Clinical pharmacist at FQHC in WA
		‘We’ve got this system called Prescribe Wellness. Where we can actually make a campaign for whatever we want, so we could put out a reminder call. We could put out a reminder text campaign. We could do alerts. We also have social media pages, where we can do digital alerts’. – Independent pharmacy manager and owner in NC
		‘I guess it would be interesting, the general model of the financial aspect of the service and how it would be offered and how it would be covered. But obviously any new service that we do, you know there does need to be some kind of ROI (return on investment) and so looking and evaluating that’. – Independent pharmacy pharmacist and owner in WA
CRC Screening Compatibility in Community Pharmacies	Inner Setting Compatibility Available resources	‘Anytime you add something [another service], there’s always a hesitation [by pharmacy staff]. We’ve just incorporated [FIT distribution] into our flow … . we’ve learned it really doesn’t take very long. So, it’s going well since we’ve incorporated [the program]’. – Clinical pharmacist at FQHC in WA
		‘You know I don’t foresee it being extremely burdensome until it gets to be very large, and then we’d obviously have to address it. But at the level of phone calls, we could have it scripted where any level staff can be making those calls, it doesn’t necessarily have to be a pharmacist. So, dedicating some hours would be pretty easy I would say. I don’t think it would be burdensome until it gets too big’. – Independent pharmacy pharmacist and owner in WA
		‘Behind the counter, we're low on space. But if it was something, where we could readily order them, and we didn't have to keep hundreds at a time and we could just keep like a weekly supply’. – Pharmacy Manager at retail chain pharmacy in NC
Care Coordination and Internal Workflow Considerations and Concerns	Outer Setting Cosmopolitanism Inner Setting Networks and communication	‘If we don’t get a response [from the PCP about receiving FIT test results] … what do we do? Do we call the patient or the provider? Or how do we follow up that that message was received and they’re working on it? Because I don’t think doctors’ offices will get back to us to let us know what they are going to do with our request … Some [clinics] will say thank you for sending a message. We’ll talk to the patient. But most other places, they’re also so busy they may not even let us know’. – Independent pharmacy pharmacist and owner in NC
		‘We would, probably, either fax [test results] – actually, that’s probably the only option we have right now. We could fax a sheet with the results to the provider’. – Independent pharmacy manager and owner in NC
		‘If the pharmacist orders anything, [they] are responsible for any abnormal results. So, as long as you refer the positive result out to [the patient’s] primary care doctor … and [inform] the patient, you’ve completed your duty … ’. – Clinical pharmacist at FQHC in WA
		‘I wouldn’t imagine we need something overly complex in the situation [tracking who FIT kits were distributed to]. I think something simple, just a filing binder or already in place filing systems, I think that would be sufficient’. – Pharmacy manager at retail chain pharmacy in WA
Support for CRC Screening and Willingness to Learn	Inner Setting Access to knowledge and information Characteristics of Individuals Knowledge and beliefs about the intervention	‘I think it should be the standard for every pharmacist to do it, at least at some level [colorectal cancer screening]. I know if somebody’s just dropping off a simple medication, they don’t necessarily want to spend a lot of time with the pharmacist talking about stuff. But I think every pharmacist should be screening all of their patients’. – Clinical pharmacist at FQHC in WA
		‘I don’t mind screening for the eligibility, but what are the things I have to look for? They’re age 50? Is there a state format, or how does that work?’ – Independent pharmacy pharmacist and owner in NC
		‘And update myself on the latest guidelines with it. That would probably be the only thing [I would need to distribute kits]’. – Independent pharmacy manager and owner in NC