Table 3 Summary of recommendations, implementation strategies^a, and initial PatientToc™ implementation toolkit developed through the EBQI process^b

1. Ensure all pharmacy team members (pharmacists, technicians/other support staff, management) are engaged/bought-in to implementation of PatientToc™. (Staff)

Develop stakeholder interrelationships: conduct local consensus discussions

- PatientToc™ Mission Statement Template

- Kickoff Agenda Template

- Have check-in meetings

- Audit and Feedback Report Template

PatientToc™ Mission Statement document is intended to create buy-in. The template is guided by the following three questions and includes example responses. The three questions are as follows:

1. Why are we using PatientToc™?

2. How will we use it in our pharmacy?

3. What goals are we trying to meet with PatientToc™?

Example statement:

“At [insert pharmacy name] pharmacy, our mission for using PatientToc™ is to [insert answer(s) to question 1]. We will accomplish this mission by using PatientToc™ to [insert answer(s) to question 2]. In using PatientToc™, our goals are to [insert answer(s) to question 3].

Kickoff Agenda document provides an overview of training and site preparation activities/resource tools.

Develop and deploy routine Check-in Meetings to be held weekly via alternating phone/Web-based calls and in-person site visits. Provide Audit and Feedback report of key measures and problem-solving activities. Examples of measures in the report include number of patients using PatientToc™, where PatientToc™ is being used in the workflow (e.g., pharmacy waiting area, during appointment, outside of pharmacy with delivery driver)

2. Have clear PatientToc™ implementation goals, measure outcomes (e.g., adherence, patient satisfaction, pharmacist interventions made, ROI), and provide feedback on outcomes and progress toward goals. (Staff)

Use evaluative and iterative strategies: audit and provide feedback

- PatientToc™ Mission Statement Template

- Have check-in meetings

- Audit and Feedback Report Template

For the most part, implementation goals and evaluation outcomes are set by the study team but align with measurement outcomes desired by staff.

Goals will be included in each pharmacy-specific PatientToc™ Mission Statement document.

Audit and Feedback Document and routine Check-In Meetings to share data and problem-solve.

3. Explore the use of incentives for pharmacy team members (e.g., bonuses, food, praise) and/or patients (e.g., coupons, food, gift cards) to support PatientToc™ implementation. (Both)

Utilize financial strategies: alter incentive/allowance structures

Not applicable

Incentives will not be provided by the study team as part of the implementation toolkit; individual pharmacies may choose to use incentives for their staff.

4. Provide hands-on training and resources for pharmacy teams, possibly for continuing education credit, to support PatientToc implementation. (Staff)^c

Train and educate stakeholders:

• Conduct ongoing training

• Provide ongoing consultation

• Develop educational materials

• Make training dynamic

• Distribute educational materials

• Conduct educational outreach visits

• Work with educational institutions

- PatientToc™ Training Modules

- Social Determinants of Health (SDOH) Continuing Education (CE) modules

There will be both required and optional PatientToc™ Training Modules on topics including initial tablet set-up and troubleshooting, overview of PROs being captured, use of delivery drivers, reports, and documentation.

Per request by the multi-stakeholder advisory panel, SDOH CE modules were created and will be accredited through collaboration with a college of pharmacy continuing education office, as optional training for both pharmacists and pharmacy technicians. This will provide information on how to identify and address SDOH barriers based on PatientToc™ responses from patients.

5. Work with pharmacy teams and vendors to ensure PatientToc™ is well integrated with the pharmacies’ dispensing systems. (Staff)

Adapt and tailor to context: promote adaptability

Not applicable

Not applicable, part of intervention development/finalized build of adapted PatientToc™ application for use in community pharmacies.

Provide interactive assistance: provide local technical assistance

6. Ensure a PatientToc™ 24/7 help line is available to pharmacy teams. (Staff)

Provide interactive assistance: centralize technical assistance

Not applicable

-Availability/way of reaching PatientToc™ will be provided as part of training; however, a 24/7 help line is not currently available.

7. Consider adapting PatientToc™ for more languages. (Both)

Adapt and tailor to context: promote adaptability

Not applicable

Not applicable, part of intervention development/finalized build of adapted PatientToc™ application for use in community pharmacies (when needed).

8. Provide clear and simple messaging to patients that emphasize the expected benefits of PatientToc™ to patients. These messages should be provided (1) verbally by pharmacy staff, (2) written as part of introductory instructions in the PatientToc™ application, and/or (3) written as part of general pharmacy marketing materials (e.g., websites, waiting room televisions). (Both)^c

Engage consumers: prepare patients/consumers to be active participants

- Patient-facing print (large and small posters, pamphlets, bag stuffers) and digital media (social media posts) materials

- Provide scripted language for pharmacies’ use

Provide patient-facing print and digital media materials, as well as scripted language for pharmacies to use on websites, signs, TVs, as introduction scripts for staff, etc.

Clarity across messaging (brochures, etc.) that PatientToc™ is private and expected to “help the pharmacy to better help the patient.”

9. Implement PatientToc™ first with specific patient sub-groups (e.g., complex patients). (Both)

Engage consumers: prepare patients/consumers to be active participants

Not applicable

Not applicable, for study evaluation purposes, the study cohort has already been determined; pharmacies will choose scope/where in their workflow they will implement PatientToc™.

10. Enable access to PatientToc™ in various ways (e.g., tablet in adjacent primary care practice site, delivery drivers bring a tablet, patient uses application on their own device) based on pharmacy workflow/patient needs. (Both)

Change infrastructure:

• Change physical structure and equipment

• Change service sites

- Sample workflows

- Workflow cheat sheets

The study team has decided that pharmacies will get to choose where/how in their workflow they use PatientToc™.

Sample Workflows for various use cases chosen and staffing patterns at the pharmacy.

Cheat Sheets for each staff member per workflow option describing roles, activities, sample language to use with patient, etc.

11. Ensure patients can complete PatientToc™ questionnaires in 2–10 min (e.g., pre-populate information when possible, reduce the need for typing). (Both)^c

Engage consumers: prepare patients/consumers to be active participants

Not applicable

Not applicable, part of intervention development/finalized build of adapted PatientToc™ application for use in community pharmacies.

12. Use PatientToc™ to optimize patient prescription wait times as well as other appointment-based services (e.g., MTM, medication synchronization program). (Both)

Engage consumers: prepare patients/consumers to be active participants

- Sample workflows

- Workflow cheat sheets

The study team has decided that pharmacies will get to choose where/how in their workflow they use PatientToc™.

Sample Workflows for various use cases chosen and staffing patterns at the pharmacy.

Cheat Sheets for each staff member per workflow option describing roles, activities, sample language to use with patient, etc.

13. Use PatientToc™ to update patient demographics (e.g., contact information, allergies, etc.) and medication lists. (Both)

Support clinicians: support relay of clinical data to providers

Not applicable

Not applicable, part of intervention development/finalized build of adapted PatientToc™ application for use in community pharmacies.

14. Consider including patient education and/or information/referrals to pharmacy services on PatientToc™. (Both)

Adapt and tailor to context: promote adaptability

- Referrals Cheat Sheet

The Referrals Cheat Sheet provides a modifiable template of resources for pharmacy teams to consider when reviewing PatientToc™ results to identify and address medication non-adherence.