Inside the pharmacy: A qualitative study uncovering community pharmacists' experiences with Paxlovid prescribing

Background

Community pharmacists were authorized to prescribe Paxlovid to eligible patients, yet little is known about their experiences in this role. Understanding these experiences is crucial for improving patient access.

Objectives

This study aimed to 1) describe the Paxlovid prescribing process in community pharmacies and 2) explore associated barriers and facilitators.

Methods

This exploratory qualitative study involved semi-structured virtual interviews with pharmacists in Wisconsin (June-September 2023). Pharmacists were identified using the Wisconsin Department of Health Services list of pharmacies offering Paxlovid and the Pharmacy Practice Enhancement and Action Research Link network. The interview guide, pretested with one pharmacist, was informed by the Consolidated Framework for Implementation Research (CFIR). Descriptive statistics and thematic analysis guided by the CFIR were used.

Results

Five pharmacists were interviewed, including 3 in leadership roles. One represented a pharmacy partnering with 2 health systems, while another represented a health care system collaborating with 15 independent pharmacies. On average, pharmacists dispensed 130 (±142) Paxlovid doses, with eligibility screening taking 5 to 45 minutes, conducted in person, by phone, or via electronic health records (EHRs). The prescribing process involved 2 steps: 1) assessing eligibility and 2) dispensing the appropriate prescription, with slight variations based on pharmacy's EHR access. Key themes describing facilitators and barriers to Paxlovid prescribing emerged within 4 CFIR domains (i.e., inner setting, outer setting, individual characteristics, and process). Major barriers included limited access to patient health information and inadequate reimbursement. Facilitators included access to decision-making support tools, compatibility, and the ability to screen and counsel patients remotely.

Conclusion

Community pharmacists are vital to expanding access to Paxlovid but struggle with limited access to patient health information and inadequate reimbursement. Ensuring EHR access and advocating for provider status will enhance patient care. Involving pharmacists in public health program design can optimize resource allocation and effectiveness.