Evaluating the implementation and sustainment potential of a pharmacy-embedded community health worker model

Rural communities in the United States face ongoing disparities in health care access and outcomes. Community pharmacies, as highly accessible health care settings, offer a promising platform for addressing these gaps. Embedding Community Health Workers (CHWs) in pharmacies may improve care coordination and health outcomes in underserved communities.

To evaluate the implementation and sustainment potential of a pharmacy-embedded CHW model in rural community pharmacies.

We used a sequential explanatory mixed-methods design to evaluate the model. All CHWs (n = 53) and pharmacy supervisors (n = 49) in Project Reaching Everyone to Achieve Community Health-a federally funded initiative embedding CHWs in 49 rural Arkansas pharmacies-were surveyed. Surveys assessed implementation outcomes of acceptability, feasibility, and appropriateness using validated instruments. Additional items addressed satisfaction and sustainability intentions beyond the funding period. Descriptive statistics were used to analyze survey data. Ten pharmacies-5 with higher and 5 lower composite implementation scores-were selected for qualitative interviews. We conducted semi-structured interviews with one CHW and one supervisor from each selected pharmacy (n = 20). A rapid qualitative analysis technique was utilized and themes were mapped to the Consolidated Framework for Implementation Research.

Survey response rates were 89% of CHWs (n = 47) and 86% of supervisors (n = 41). Overall, CHWs and supervisors rated the model as rated the service as acceptable, feasible and appropriate in the pharmacy setting. Most CHWs (85%) were satisfied with their role, and 91% felt the model worked well in the pharmacy setting. The majority of supervisors (83%) recognized clear benefits, and 79% would recommend the model in other pharmacies. Facilitators included adaptable materials, community need, leadership support, and CHWs' familiarity with patients. Barriers included intensive training demands and a limited rural applicant pool.

Both CHWs and supervisors found the model acceptable, feasible, and appropriate. This model shows promise for improving rural health care delivery. Further research is needed to assess cost-effectiveness, long-term outcomes, and strategies to address implementation barriers.