Purpose

The multidisciplinary Pharmacy Service Enhancement Project (PSEP) team is piloting an education-based intervention to assist independent community pharmacies, and other ambulatory care pharmacy practices in North Dakota with addressing commercial tobacco use and treatment interventions in their patients based on recommendations from stakeholders such as the U.S. Public Health Service and Centers for Disease Control and Prevention (CDC).

Goals

1. Create health-systems change based on the integration of the guidelines and current scientific literature
2. Demonstrate pharmacies’ change can improve tobacco and nicotine dependence treatment in terms of quit attempts and successful quitline referrals
3. Identify and describe barriers and facilitators to implementation of tobacco and nicotine dependence services.

An additional component of the project recognizes the implementation of any pharmacy-based intervention does not happen in a vacuum and that contextual factors (social, cultural, political, and economic) play significant roles. North Dakota is unique in having a pharmacy ownership law, enacted in 1963, which requires all pharmacies to be majority owned by registered pharmacists; pharmacists thus occupy dual roles as healthcare providers and small business owners. Pharmacists are the most accessible and sometimes only formally-trained healthcare providers in rural communities, with their roles and responsibilities continuing to expand in the wake of the Covid-19 pandemic.

As such, ethnographic research, including observational site visits and semi-structured interviews, carried out at the pilot sites explore how pharmacies function as part of the local healthcare landscape with a particular focus on tobacco cessation efforts. How pharmacists grapple with implementing new nicotine dependence treatment workflows sheds light on the challenges pharmacists face in the contemporary healthcare climate in North Dakota's healthcare policy context specifically, and the strategies they enact to overcome these challenges.

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Research Team

Principle Investigator (PI)
Brody Maack, PharmD, BCACP, CTTS

Co-Principle Investigators (Co-PI’s) 
Ellen Rubinstein, PhD (Anthropology), Kelly Buettner-Schmidt, PhD, RN, FAAN (Nursing), Natasha Petry, PharmD, BCACP (Co-PI, Pharmacy Practice), Lisa Nagel, PharmD (CAP Center)

Research Assistants/Ethnographers
Emma DuPont, BS (Lead); Amanda Bergman, BS

Student Research Assistants
Conner Armstrong (PharmD Candidate 2024), Joy Dahlen (PharmD Candidate 2024), Kelly Corr (MPH Candidate), Brooke Suttles (PharmD Candidate 2025), Julia Jones (PharmD Candidate 2025), Taylor Giesen (PharmD Candidate 2025), Hailey Wanner (PharmD Candidate 2025), Anton Feyerherm (BS Candidate, 2025), Julianna Berg (BS Candidate, 2026)

Consultants
Mary Ann Kliethermes (Consultant, American Society of Health-System Pharmacists), Laura Heinemann, PhD (Creighton University)

Collaborating Organizations
ND Department of Health and Human Services, ND Society of Health-System Pharmacists (NDSHP), Ambulatory Reimbursement and Innovation Enhancement Group (ARIES), NDSU CAP Center, ND Board of Pharmacy, University of California-San Francisco/Purdue University College of Pharmacy