**3. Results**

A total of six participants were interviewed. Recruitment was stopped after six technicians since theme saturation (i.e., occurrence of similar themes with no new information collected) was reached [16]. Participants were full-time, certified pharmacy technicians with 8.3 ± 2.7 years of experience. Participants worked an average of 39.5 ± 1.1 hours per week. All participants interviewed had been employed at the supermarket chain studied for their entire career.

#### *3.1. Inner Setting of ABM Implementation*

Questions exploring the Access to Knowledge and Information construct found that while training effectively described the utility of the program, technicians were not always familiarized with the ABM support software adequately (Table 2). One participant expressed that the overall training was "useless" due to the lack of specific ABM user interface training. Technicians preferred the hands-on instruction. Technician training consisted of a presentation by a pharmacist or shadowing a pharmacist during the enrollment process for one training session. Repeat sessions were available if needed.


**Table 2.** Interview constructs, definitions, and illustrative quotations.


**Table 2.** *Cont*.

Relative Priority of the program was a barrier because participants often felt they did not have enough time allocated to complete this task. Other time-consuming duties and initiatives in the pharmacy technicians stressed the already limited workforce hours allocated. This program was of secondary importance to the core operations of the pharmacy due to time constraints.

#### *3.2. Outer Setting of the ABM Implementation Environment*

The Patient Needs and Resources construct exploration in the technician interviews found that technicians perceived that patients benefit from the simplification of their medication regimens and the convenience of having to pick up once per month or once per quarter. Notably, adherent patients on a stable regimen were said to benefit the most from the program. The convenience of ABM was reported to allow patients to make fewer trips to the pharmacy. Technicians reported that some elderly patients had an aversion to change and a desired to remain on their current schedule of medication orders. Technicians perceived patient concerns about the increased single, monthly cost per pharmacy visit, as the cost of their monthly medication regimen would no longer be spread out over the entire month.

#### *3.3. Intervention Characteristics Enabling ABM Success*

The inability to adapt the ABM program to local needs was described as a barrier by technicians. The lack of integration of the ABM platform with the pharmacy dispensing software system caused prescriptions to "fall off" or old prescriptions to be filled. There was no dynamic update to accurately reflect the patient profile in the ABM portal, so technicians reported frustration managing medications manually (calculate the days' supply on hand and fill the corresponding, appropriate quantity) to fit the ABM profile. The lack of ABM integration to the patient profile was identified as a critical issue with the program by pharmacy team members, that led to disrupted workflow and unneeded fills. The listing of every medication a patient has had on the ABM profile was described as a "busy" distraction that was a source of confusion when technicians are attempting to enroll patients with multiple medications.

#### *3.4. Process ABM Follows for Success*

For the construct of champion, having a technician responsible for leading ABMS implementation and working with the team to achieve ABM goals was perceived to yield successful goal achievement and increased pharmacy sta ff buy-in. Roles reported included; taking the initiative to engage patients on the ABM enrollment list and managing the existing patient fills. These champions would actively listen to patients and sugges<sup>t</sup> ABM to those individuals who expressed that travel to the pharmacy or complexity of regimen was a concern for them. Teams with a champion reported an increase in successful enrollments.

Enrollment of Innovation Participants happened one of three ways: a patient would ask to have medications synchronized for convenience's sake, a technician would identify the need based upon a past relationship with a patient, or the ABM program or sync center would (central location with telephonically available pharmacy technicians trained in medication synchronization) generate a list of patients to enroll. Here was an identified need for better communication from the sync center to the pharmacy, so that the correct patients could be identified. The ABM program is structured to automatically generate appropriate patients, but technicians reported making judgement calls on eligible patients who would likely benefit the most. The automatically generated call list, that was described as helpful by technicians, also caused unnecessary calls to unwilling patients. Promotional materials, such as flyers, were not always reported to be in use, but were always reported to be helpful by technicians when they did have them. The most frequent goal for enrollment of new patients within the program was stated to be two patients per week. Two pharmacies had no goal for patient enrollments and one pharmacy had a goal of 5–10 enrollments/week.
