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Kuo T, Barragan NC, Chen S. Leveraging Community Pharmacies to Address Social Needs: A Promising Practice to Improve Healthcare Quality. PHARMACY 2024; 12:139. [PMID: 39311130 PMCID: PMC11417871 DOI: 10.3390/pharmacy12050139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 09/04/2024] [Accepted: 09/09/2024] [Indexed: 09/26/2024] Open
Abstract
Emerging research suggests that chronic conditions such as cardiovascular disease, diabetes, and asthma are often mediated by adverse social conditions that complicate their management. These conditions include circumstances such as lack of affordable housing, food insecurity, barriers to safe and reliable transportation, structural racism, and unequal access to healthcare or higher education. Although health systems cannot independently solve these problems, their infrastructure, funding resources, and well-trained workforce can be realigned to better address social needs created by them. For example, community pharmacies and the professionals they employ can be utilized and are well-positioned to deliver balanced, individualized clinical services, with a focus on the whole person. Because they have deep roots and presence in the community, especially in under-resourced neighborhoods, community pharmacies (independent and chain) represent local entities that community members recognize and trust. In this article, we provide case examples from California, United States, to illustrate and explore how community pharmacies can be leveraged to address patient social needs as part of their core responsibilities and overall strategy to improve healthcare quality.
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Affiliation(s)
- Tony Kuo
- Department of Family Medicine, David Geffen School of Medicine at University of California, Los Angeles (UCLA), Los Angeles, CA 90095, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
- Population Health Program, UCLA Clinical and Translational Science Institute, Los Angeles, CA 90095, USA
| | - Noel C. Barragan
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA 90010, USA;
| | - Steven Chen
- Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, CA 90089, USA;
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Somma McGivney MA, Jahjah KA, Brooks A, Cahill J, Corelli R, Guthrie K, Hill A, Kirby J, Luchen G, Maki E, McWilliams G, Patel K, Rattinger G, Register D, Walmsley L, Williams N, Bradley-Baker LR, Leon N. Envisioning the Near Future of Community Pharmacy Patient Care Practice: Report of the 2023-2024 AACP Professional Affairs Standing Committee. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100742. [PMID: 38925530 DOI: 10.1016/j.ajpe.2024.100742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
The 2023-2024 Professional Affairs Committee was charged to (1) Create an action plan in response to the clear urgent need for transformation of community pharmacy practice; and (2) Develop "readiness for change" instrument that addresses multiple pharmacy stakeholder groups that are based on the ACT "community pharmacy enhanced services" definition. Due to the continuous and rapid-paced changes occurring in community pharmacy practice, the committee developed a document that provides the baseline elements that should be considered for community pharmacy practice currently and into the future. This document, Envisioning the Near Future of Community Pharmacy Patient Care Practice: Key Elements of Practice Redesign in Community Pharmacies, contains 8 sections and is recommended to be socialized within the pharmacy profession to ensure that it resonates with current and future community pharmacy practice.
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Affiliation(s)
| | | | - Amie Brooks
- American College of Clinical Pharmacy, Lenexa, KS, USA
| | | | - Robin Corelli
- University of California, San Francisco School of Pharmacy, San Francisco, CA, USA
| | - Kendall Guthrie
- University of Missouri-Kansas City School of Pharmacy, Kansas City, MO, USA
| | - Allison Hill
- American Pharmacists Association, Washington, DC, USA
| | | | - Gina Luchen
- American Society of Health-System Pharmacists, Bethesda, MD, USA
| | - Erik Maki
- Drake University College of Pharmacy and Health Sciences, Des Moines, IA, USA
| | | | - Kripali Patel
- Massachusetts College of Pharmacy and Health Sciences-Boston School of Pharmacy, Boston, MA, USA
| | - Gail Rattinger
- Binghamton University School of Pharmacy and Pharmaceutical Sciences, Johnson City, NY, USA
| | - Drew Register
- National Community Pharmacists Association, Alexandria, VA, USA
| | | | - Nancy Williams
- Southwestern Oklahoma State University College of Pharmacy, Oklahoma City, OK, USA
| | | | - Nicholas Leon
- Jefferson University School of Pharmacy, Philadelphia, PA, USA
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Guignet M, Steve White H, Novotny EJ, Benedict Nwogu I, Zaraa S, Stergachis A, Ems D, Bacci JL. Community Pharmacist-Centered training program improves confidence in delivering epilepsy care. Epilepsy Behav 2024; 158:109933. [PMID: 38970894 DOI: 10.1016/j.yebeh.2024.109933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/11/2024] [Accepted: 06/29/2024] [Indexed: 07/08/2024]
Abstract
RATIONALE Incorporating pharmacists into interdisciplinary healthcare teams can improve patient outcomes across disease states; however, there is little evidence describing pharmacists' contributions to epilepsy care. Previous research from our group revealed that community pharmacists are well positioned to serve as patient advocates, monitor medications, and provide education for people living with epilepsy. However, pharmacists would like to receive additional training in epilepsy management. Advanced training in neurology is not a practical approach for community pharmacists who engage daily with patients having a variety of conditions and medications. OBJECTIVE To develop and evaluate a flexible, community pharmacist-centered training program to improve both confidence and competence in delivering epilepsy care. METHODS The training program consisted of five 1-hour, self-paced online modules and two 90-minute synchronous virtual sessions. Topics included the classification of the epilepsies, comorbid conditions, antiseizure medicine (ASM) therapy, special populations (pregnancy, people of childbearing potential, older adults), seizure emergencies, and sudden unexpected death in epilepsy (SUDEP), as well as social determinants of health. The training program was delivered over 6 weeks to pharmacists located at two community pharmacies in Washington State. Learning was assessed using a pre- and post-training questionnaire containing questions that evaluated knowledge and confidence in the training material. RESULTS The training program did not significantly change pharmacists' mastery of the material. However, the pharmacists' confidence in delivering the material significantly improved in 14 of the 16 areas that were evaluated. Pharmacists' mastery and confidence were strongest in areas around ASM management, SUDEP and seizure emergencies, people of child-bearing potential and older adults with epilepsy, and comorbidities, whereas social health disparities in epilepsy care remained an area that required further training. CONCLUSION Our findings support the idea that community pharmacists are well positioned with the knowledge to play an important role in epilepsy care. However, dedicated training tailored to community pharmacists' needs may improve their confidence in providing such care.
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Affiliation(s)
- Michelle Guignet
- Center for Epilepsy Drug Discovery, School of Pharmacy, Department of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357630, Seattle, WA, 98195, USA.
| | - H Steve White
- Center for Epilepsy Drug Discovery, School of Pharmacy, Department of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357630, Seattle, WA, 98195, USA.
| | - Edward J Novotny
- Department of Neurology and Pediatrics, University of Washington, 1959 NE Pacific St, RR-650, Seattle, WA 98195, USA; Seattle Children's Hospital, Seattle, WA Neurology M/S MB.7.420, 4800 Sandpoint Way, NE, Seattle, WA 98105, USA.
| | - Ifechukwu Benedict Nwogu
- Department of Pharmacy, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357630, Seattle, WA, 98195, USA.
| | - Sabra Zaraa
- Department of Pharmacy, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357630, Seattle, WA, 98195, USA.
| | - Andy Stergachis
- Department of Pharmacy, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357630, Seattle, WA, 98195, USA; School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15(th) Ave NE, Seattle, WA 98195, USA.
| | - Derek Ems
- UCB Pharma, 1950 Lake Park Drive, Smyrna, GA 30080, USA.
| | - Jennifer L Bacci
- Department of Pharmacy, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357630, Seattle, WA, 98195, USA.
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Zhan C, McNellis RJ, O'Malley PG, Buchongo PC, Kato EU, Tong ST, Liu L, Crosson J, Bierman AS, Eden AR, Miller T. A Pragmatic Approach to Identifying and Profiling Primary Care Clinicians and Primary Care Practices in the USA. J Gen Intern Med 2024; 39:1962-1968. [PMID: 38273069 PMCID: PMC11306469 DOI: 10.1007/s11606-024-08627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND There are no consistent data on US primary care clinicians and primary care practices owing to the lack of standard methods to identify them, hampering efforts in primary care improvement. METHODS We develop a pragmatic framework that identifies primary care clinicians and practices in the context of the US healthcare system, and applied the framework to the IQVIA OneKey Healthcare Professional database to identify and profile primary care clinicians and practices in the USA. RESULTS Our framework prescribes sequential steps to identify primary care clinicians by cross-examining clinician specialties and organizational affiliations, and then identify primary care practices based on organization types and presence of primary care clinicians. Applying this framework to the 2021 IQVIA data, we identified 365,751 physicians with a primary specialty in primary care, and after excluding those who further specialized (24%), served as hospitalists (5%), or worked in non-primary care settings (41%), we determined that 179,369 (49%) of them were actually practicing primary care. We identified 287,506 nurse practitioners and 134,083 physician assistants and determined that 88,574 (31%) and 29,781 (22%), respectively, were delivering primary care. We identified 94,489 primary care practices, and found that 45% of them were with one primary care physician, 15% had two physicians, 12% employed nurse practitioners or physician assistants only, and 19% employed both primary care physicians and specialists. CONCLUSIONS Our approach offers a pragmatic and consistent alternative to the diverse methods currently used to identify and profile primary care workforce and organizations in the USA.
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Affiliation(s)
- Chunliu Zhan
- Agency for Healthcare Research and Quality, Rockville, MD, USA.
- Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement, Rockville, MD, USA.
| | - Robert J McNellis
- National Institutes of Health, Office of Disease Prevention, Bethesda, MD, USA
| | | | - Portia C Buchongo
- University of Maryland School of Public Health, College Park, MD, USA
| | | | | | - Lingrui Liu
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Jesse Crosson
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | | | - Aimee R Eden
- Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Therese Miller
- Agency for Healthcare Research and Quality, Rockville, MD, USA
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Appolon G, Tang S, Gabriel N, Morales J, Berenbrok LA, LaCroix AZ, Guo J, Mathis WS, Hernandez I. Racial and ethnic inequities in spatial access to pharmacies: A geographic information system analysis. J Am Pharm Assoc (2003) 2024; 64:102131. [PMID: 38796160 DOI: 10.1016/j.japh.2024.102131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Pharmacy accessibility is crucial for equity in health care access because community pharmacists may reach individuals who do not have access to other health care providers. OBJECTIVE The objective of this study was to determine whether spatial access to pharmacies differs among racial/ethnic groups across the rural-urban continuum. METHODS We obtained a 30% random sample of the Research Triangle Institute synthetic population, sampled at the census block level. For each individual, we defined optimal pharmacy access as having a driving distance ≤2 miles to the closest pharmacy in urban counties, ≤5 miles in suburban counties, and ≤10 miles in rural counties. We used a logistic regression model to measure the association between race/ethnicity and pharmacy access, while controlling for racial/ethnic composition of the census tract, area deprivation index, income, age, gender, and U.S. region. The model included an interaction between race/ethnicity and urbanicity to evaluate whether racial/ethnic inequities differed across the rural-urban continuum. RESULTS The sample included 90,749,446 individuals of whom 80.6% had optimal pharmacy access. Racial/ethnic inequities in pharmacy access differed across the rural-urban continuum (P value for interaction= <0.0001). In rural areas, Black (OR 0.87; 95% CI 0.86-0.87), Hispanic (OR 0.80; 95% CI 0.79-0.80), and indigenous (OR 0.47; 95% CI 0.47-0.48) individuals had lower odds of optimal pharmacy access, than White individuals. Hispanic (OR 0.96; 95% CI 0.96-0.97) and Indigenous individuals (OR 0.75; 95% CI 0.75-0.76) had lower odds of optimal pharmacy access compared to White individuals in suburban areas. In Western states, Asian had lower odds of optimal pharmacy access in suburban (OR 0.88; 95% CI 0.86-0.90) and rural areas (OR 0.91; 95% CI 0.87-0.95) compared to White individuals. CONCLUSIONS Racial/ethnic inequities in spatial access to community pharmacies vary between urban and rural communities. Underrepresented racial/ethnic groups have significantly lower pharmacy access in rural and some suburban areas, but not in urban areas.
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Sandhu RK, Fradette M, Lin M, Youngson E, Lau D, Bungard TJ, Tsuyuki RT, Dolovich L, Healey JS, McAlister FA. Stroke Risk Reduction in Atrial Fibrillation Through Pharmacist Prescribing: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2421993. [PMID: 39046741 PMCID: PMC11270136 DOI: 10.1001/jamanetworkopen.2024.21993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/14/2024] [Indexed: 07/25/2024] Open
Abstract
Importance Major gaps in the delivery of appropriate oral anticoagulation therapy (OAC) exist, leaving a large proportion of persons with atrial fibrillation (AF) unnecessarily at risk for stroke and its sequalae. Objective To investigate whether pharmacist-led OAC prescription can increase the delivery of stroke risk reduction therapy in individuals with AF. Design, Setting, and Participants This prospective, open-label, patient-level randomized clinical trial of early vs delayed pharmacist intervention from January 1, 2019, to December 31, 2022, was performed in 27 community pharmacies in Alberta, Canada. Pharmacists identified patients 65 years or older with 1 additional stroke risk factor and known, untreated AF (OAC nonprescription or OAC suboptimal dosing) or performed screening using a 30-second single-lead electrocardiogram to detect previously unrecognized AF. Patients with undertreated or newly diagnosed AF eligible for OAC therapy were considered to have actionable AF. Data were analyzed from April 3 to November 30, 2023. Interventions In the early intervention group, pharmacists prescribed OAC using guideline-based algorithms with follow-up visits at 1 and 3 months. In the delayed intervention group, which served as the usual care control, the primary care physician (PCP) was sent a notification of actionable AF along with a medication list (both enhancement over usual care). After 3 months, patients without OAC optimization in the control group underwent delayed pharmacist intervention. Main Outcomes and Measures The primary outcome was the difference in the rate of guideline-concordant OAC use in the 2 groups at 3-month follow-up ascertained by a research pharmacist blinded to treatment allocation. Results Eighty patients were enrolled with actionable AF (9 [11.3%] newly diagnosed in 235 individuals screened). The mean (SD) age was 79.7 (7.4) years, and 45 patients (56.3%) were female. The median CHADS2 (congestive heart failure, hypertension, age, diabetes, and stroke or transient ischemic attack) score was 2 (IQR, 2-3). Seventy patients completed follow-up. Guideline-concordant OAC use at 3 months occurred in 36 of 39 patients (92.3%) in the early intervention group vs 23 of 41 (56.1%) in the control group (P < .001), with an absolute increase of 34% and number needed to treat of 3. Of the 23 patients who received appropriate OAC prescription in the control group, the PCP called the pharmacist for prescribing advice in 6 patients. Conclusions and Relevance This randomized clinical trial found that pharmacist OAC prescription is a potentially high-yield opportunity to effectively close gaps in the delivery of stroke risk reduction therapy for AF. Scalability and sustainability of pharmacist OAC prescription will require larger trials demonstrating effectiveness and safety. Trial Registration ClinicalTrials.gov Identifier: NCT03126214.
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Affiliation(s)
- Roopinder K. Sandhu
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
- Division of Cardiology, University of Alberta, Edmonton, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Miriam Fradette
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Meng Lin
- Alberta Strategy for Patient-Oriented Research, University of Alberta, Edmonton, Canada
| | - Erik Youngson
- Alberta Strategy for Patient-Oriented Research, University of Alberta, Edmonton, Canada
- Alberta Health Services Provincial Research Data Services, Edmonton, Canada
| | - Darren Lau
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
| | | | - Ross T. Tsuyuki
- Division of Cardiology, University of Alberta, Edmonton, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Finlay A. McAlister
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
- Division of General Internal Medicine, University of Alberta, Edmonton, Canada
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Abdul Razzak HA, Syed Sulaiman SA, Khan AH, Thomas S. Attitudes of community pharmacists towards extending their professional roles in Oman. J Pharm Policy Pract 2024; 17:2367018. [PMID: 38952489 PMCID: PMC11216276 DOI: 10.1080/20523211.2024.2367018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Over the last few decades, the pharmacy profession has witnessed a substantial evolution accompanied by the developing role of community pharmacists (CPs). Evidence indicates that extending the role of CPs contributes to fostering public health outcomes. However, in many countries, their role is still underused. To extend the role of CPs in Oman, it is crucial to understand their perception and determine the influences. Aim This study determines the willingness of CPs in Oman to extend their role and assess their perception towards barriers. Method A cross-sectional study was conducted across Oman using an online self-administered survey targeting CPs working in the private sector. Result Generally, respondents welcomed broadening their professional role. However, among the top perceived barriers were shortage of staff, insufficient training, lack of interconnection between CPs and physicians, and regulation constraints. Different socio-demographic characteristics of respondents showed a noticeable impact on their responses. Conclusion CPs welcomed extending their role. However, several obstacles were raised that need to be tackled to enable CPs to advance their role.
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Affiliation(s)
| | | | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, Universiti Sains Malaysia, Penang, Malaysia
| | - Sabin Thomas
- College of Pharmacy, University of Nizwa, Nizwa, Oman
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Chiereghin A, Squillace L, Pizzi L, Bazzani C, Roti L, Mezzetti F. Applying the healthcare failure mode and effects analysis approach to improve the quality of an organised colorectal cancer screening programme. J Med Screen 2024; 31:70-77. [PMID: 37674432 DOI: 10.1177/09691413231197300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
OBJECTIVE The first level of a colorectal cancer (CRC) screening process was systematically analysed using the Healthcare Failure Mode and Effects Analysis (HFMEA) approach by a multidisciplinary team aiming to improve the programme quality. SETTING The study was conducted at the Local Health Authority of Bologna, Northern Italy. METHODS Seven brainstorming sessions were conducted and all the activities performed were recorded on a FMEA worksheet consisting of individual records reporting the specific phases of the analysed process along with associated activities, possible failure modes, their causes and effects, the obtained risk priority numbers (RPNs) and the control measures to plan. RESULTS Twenty-three failure modes, 14 effects and 12 possible causes were identified. Nine failure modes were prioritised according to the RPN obtained; most resulted in possible false-negative faecal immunochemical test (FIT) results (66.7%), followed by sample loss (22.2%) and not reaching the entire target population (11.1%). This leads to 66.7% of corrective/preventive actions being applied to the phase of returning the stool sample by the citizen. For this phase reorganisation, the local pharmacies were involved not only as FIT kit delivery points but also as specimen collection and sending points to the laboratory. These organisational changes allowed the introduction of complete traceability of kits and specimens flow, as well as temperature control. A re-evaluation of the prioritised failure modes 6 months after launching the implemented screening process showed that HFMEA application decreased the risk of potential errors by 75.9%. CONCLUSION HFMEA application in CRC screening programme is a useful tool to reduce potential errors.
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Affiliation(s)
- Angela Chiereghin
- Governance of Screening Programs Unit, Health Management Staff, Local Health Authority of Bologna, Bologna, Italy
| | - Lorena Squillace
- Governance of Screening Programs Unit, Health Management Staff, Local Health Authority of Bologna, Bologna, Italy
| | - Lorenzo Pizzi
- Governance of Screening Programs Unit, Health Management Staff, Local Health Authority of Bologna, Bologna, Italy
| | - Carmen Bazzani
- Screening Center, Department of Public Health, Local Health Authority of Bologna, Bologna, Italy
| | - Lorenzo Roti
- Health Management, Local Health Authority of Bologna, Bologna, Italy
| | - Francesca Mezzetti
- Governance of Screening Programs Unit, Health Management Staff, Local Health Authority of Bologna, Bologna, Italy
- Pianura Est District, Local Health Authority of Bologna, Bologna, Italy
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Susan A M. Development of a physical activity prescription course in a Doctor of Pharmacy program. ADVANCES IN PHYSIOLOGY EDUCATION 2024; 48:338-346. [PMID: 38482562 DOI: 10.1152/advan.00173.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 04/17/2024]
Abstract
Pharmacists are increasingly becoming the healthcare professional who interacts most regularly with patients who have diseases or disorders for which exercise is an effective and recommended treatment. With the relative scarcity of clinical exercise physiologists in the United States, pharmacists are expected to provide lifestyle advice to their patients, especially in community (i.e. retail) pharmacy settings, but student pharmacists typically receive no formal or informal training in exercise physiology and prescription. To address this deficit, an elective course was developed to provide student pharmacists with the knowledge and skill set that will enable them to apply evidence-based physical activity guidelines in the pharmacy. The course utilized the Exercise is Medicine resources for chronic diseases and disorders that are routinely encountered in community pharmacies, in addition to analysis of interactions between exercise and medications commonly prescribed for these conditions. After completion of the course, students reported being significantly more comfortable discussing physical activity with their patients compared to the start of the course (P < 0.001). Similarly, at the end of the course, 99% of students reported that they felt confident in their ability to apply evidence-based recommendations of common diseases and disorders to their patients. Postcourse student evaluations clearly demonstrated that student pharmacists viewed the course positively and as essential in their professional training. These data highlight the feasibility and efficacy of improving self-perceptions for the provision of physical activity recommendations via an elective course in physical activity prescription in a Doctor of Pharmacy program.NEW & NOTEWORTHY This study describes a new elective course in physical activity prescription for Doctor of Pharmacy students. After completing the course, students reported improved self-perceptions for the provision of physical activity recommendations. This course fills a gap in pharmacy education and this study provides future directions to improve training in lifestyle modifications.
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Affiliation(s)
- Marsh Susan A
- College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, Washington, United States
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Albanese NP, Voell-White A, Woodruff AE. Evaluating the Impact of an Innovative Integrative Health-Focused Elective in a Doctor of Pharmacy Program. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2024; 88:100704. [PMID: 38703947 DOI: 10.1016/j.ajpe.2024.100704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVE To assess knowledge and perceptions of integrative health principles. METHODS This was a retrospective, pre-post observational cohort study evaluating Doctor of Pharmacy students following completion of an innovative elective course that was offered between 2020-2022. This Integrated Health in Pharmacy elective was created at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in the Spring of 2020. The primary objective was to assess student knowledge of integrative health principles. The secondary objective was to assess student confidence and perceptions of integrative health principles. RESULTS Students completed a pre-course assessment (n = 80/81) and a post-course assessment (n = 73/81). Overall, the mean (SD) performance on the assessment questions increased between the pre-post assessment groups (57.59 [12.98]% vs 65.46 [14.43]%). Survey results indicated that students' perceptions and confidence pertaining to integrative health increased after completing this elective course offering. CONCLUSION Participation in this innovative elective course was associated with improved knowledge and perceptions of integrative health principles.
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Affiliation(s)
- Nicole P Albanese
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA.
| | - Alice Voell-White
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
| | - Ashley E Woodruff
- University at Buffalo, School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
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Dalton K, Callaghan R, O'Sullivan N, McCarthy L. Community pharmacists' awareness, identification, and management of prescribing cascades: A cross-sectional survey. Res Social Adm Pharm 2024; 20:102-112. [PMID: 38768989 DOI: 10.1016/j.sapharm.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/30/2023] [Accepted: 02/19/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Prescribing cascades can lead to unnecessary medication use, healthcare costs, and patient harm. Pharmacists oversee prescriptions from multiple prescribers and are well positioned to identify such cascades, making pharmacists key stakeholders to address them. OBJECTIVES To evaluate community pharmacists' awareness, identification, and management of prescribing cascades and to assess behavioural determinants that may be targeted in future strategies to minimise inappropriate prescribing cascades. METHODS An online survey was developed using the Theoretical Domains Framework (TDF) and emailed to all registered community pharmacists in Ireland (n = 3775) in November 2021. Quantitative data were analysed using descriptive and inferential statistics. Free-text sections were given to capture reasons for non-resolution of identified prescribing cascades and suggestions to aid prescribing cascade identification and management; this text underwent content analysis. RESULTS Of the 220 respondents, 51% were aware of the term 'prescribing cascade' before the survey, whilst 69% had identified a potentially inappropriate prescribing cascade in practice. Over one third were either slightly confident (26.4%) or not confident at all (10%) in their ability to identify potentially inappropriate prescribing cascades in patients' prescriptions before the survey, whilst 55.2% were concerned that patients were receiving prescribing cascades they had not identified. Most respondents wanted further information/training to help prescribing cascade identification (88.3%) and management (86.1%). Four predominant TDF domains identified were common to both i) influencing non-resolution of identified prescribing cascades and ii) in the suggestions to help identify and manage prescribing cascades: 'Environmental Context and Resources', 'Social/Professional Role and Identity', 'Social Influences' and 'Memory, Attention and Decision Processes'. CONCLUSIONS There is a clear need to provide additional resources to help community pharmacists identify and manage prescribing cascades. These findings will support the development of theory-informed behaviour change strategies to aid the minimisation of inappropriate prescribing cascades and decrease the risk of medication-related harm for patients.
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Affiliation(s)
- Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Robert Callaghan
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Niamh O'Sullivan
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - Lisa McCarthy
- Leslie Dan Faculty of Pharmacy and Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
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Fisk-Hoffman RJ, Ranger SS, Gracy A, Gracy H, Manavalan P, Widmeyer M, Leeman RF, Cook RL, Canidate S. Perspectives Among Health Care Providers and People with HIV on the Implementation of Long-Acting Injectable Cabotegravir/Rilpivirine for Antiretroviral Therapy in Florida. AIDS Patient Care STDS 2024; 38:275-285. [PMID: 38686517 PMCID: PMC11301705 DOI: 10.1089/apc.2024.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Abstract
Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) for antiretroviral therapy (ART) could benefit many people with HIV (PWH). However, its impact will largely be determined by providers' willingness to prescribe it and PWH's willingness to take it. This study explores the perceived barriers and facilitators of LAI CAB/RPV implementation among PWH and HIV care providers in Florida, a high prevalence setting. Semi-structured qualitative interviews were conducted in English with 16 PWH (50% non-Hispanic White, 50% cis men, and 94% on oral ART) and 11 providers (27% non-Hispanic Black, 27% Hispanic, 73% cis women, and 64% prescribed LAI CAB/RPV) throughout the state. Recruitment occurred between October 2022 and October 2023 from HIV clinics. Interviews were recorded, professionally transcribed, and then double coded using thematic analysis. The Consolidated Framework for Implementation Research guided the interview guide and coding. While PWH viewed LAI CAB/RPV as effective, predominant barriers included administration via injection, challenges of attending more clinic visits, and a feeling that this made HIV the center of one's life. Providers additionally expressed concerns about the development of integrase resistance. Barriers noted by PWH and providers outside of the clinic included transportation, stigma, access inequities, and payor issues. Within clinics, providers identified the need for extra staffing and the increased burden on existing staff as barriers. These barriers decreased the perceived need for LAI CAB/RPV among PWH and providers, especially with the high effectiveness of oral ART. Many of the identified barriers occur outside of the clinic and will likely apply to other novel long-acting ART options.
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Affiliation(s)
- Rebecca J. Fisk-Hoffman
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Sashaun S. Ranger
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Abigail Gracy
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Hannah Gracy
- Department of Human Development & Family Science, College of Human Sciences, Auburn University, Auburn, Alabama, USA
| | - Preeti Manavalan
- Division of Infectious Diseases & Global Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Maya Widmeyer
- Unconditional Love Incorporated, Melbourne, Florida, USA
| | - Robert F. Leeman
- Department of Health Sciences, School of Community Health & Behavioral Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
- Department of Health Education & Behavior, College of Health and Human Performance, University of Florida, Gainesville, Florida, USA
| | - Robert L. Cook
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Shantrel Canidate
- Department of Epidemiology, College of Public Health and Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
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Ryan GW, Kahl AR, Callaghan D, Kintigh B, Askelson NM. Locations of COVID-19 vaccination provision: Urban-rural differences. J Rural Health 2024; 40:476-482. [PMID: 37957524 PMCID: PMC11089067 DOI: 10.1111/jrh.12811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE Our goal was to compare locations of COVID-19 vaccine provision in urban and rural communities over the course of the pandemic. METHODS We used the Iowa Immunization Registry Information System (IRIS) to identify the organizations providing COVID-19 vaccines (eg, pharmacies, public health departments, and medical providers). Proportions of first-dose vaccines by organization type and patient census-based statistical area were generated. We calculated Chi-square tests to assess differences among metropolitan, micropolitan, and noncore communities. FINDINGS IRIS data revealed that 64% (n = 2,043,251) of Iowans received their first COVID-19 vaccine between December 14, 2020, and December 31, 2022. For metropolitan-dwelling individuals, most first doses were administered at pharmacies (53%), with similar trends observed for micropolitan (49%) and noncore (42%) individuals. The second most common location for metropolitan individuals was medical practices (17%); public health clinics and departments were the second most common provider for micropolitan (26%) and noncore (33%) individuals. These trends shifted over time. In December 2020, hospitals were the most common vaccine provider for everyone, but by December 2022, medical providers were the most common source for metropolitan individuals, and pharmacies were most common for micropolitan and noncore individuals. CONCLUSIONS Trends in the type of vaccine provider differentiated metropolitan residents from micropolitan and noncore residents. For the latter groups, local public health departments played a more significant role. Across all groups, pharmacists emerged as a critical vaccine provider. Our findings can be used to plan for seasonal vaccine campaigns as well as potential future mass vaccination campaigns.
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Affiliation(s)
- Grace W Ryan
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Amanda R Kahl
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Iowa Cancer Registry, University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Don Callaghan
- Bureau of Immunization & TB, Iowa Health and Human Services, Des Moines, Iowa, USA
| | - Bethany Kintigh
- Bureau of Immunization & TB, Iowa Health and Human Services, Des Moines, Iowa, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
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14
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Odebunmi OO, Wangen M, Waters AR, Ferrari RM, Marciniak MW, Rohweder C, Wheeler SB, Brenner AT, Shah PD. Colorectal cancer screening knowledge among community pharmacists: A national survey. J Am Pharm Assoc (2003) 2024:102130. [PMID: 38796158 DOI: 10.1016/j.japh.2024.102130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Colorectal cancer (CRC) screening can reduce CRC morbidity and mortality. Community pharmacies could be a viable option for delivering home-based CRC screening tests such as fecal immunochemical tests (FITs). However, little is known about community pharmacists' knowledge about CRC screening guidelines. OBJECTIVE We assessed community pharmacists' knowledge about CRC screening to identify education and training needs for a pharmacy-based CRC screening program. METHODS Between September 2022 and January 2023, we conducted an online national survey of community pharmacists practicing in the United States. Responders were eligible if they were currently-licensed community pharmacists and currently practiced in the United States. The survey assessed knowledge of national CRC screening guidelines, including recommended starting age, frequency of screening, different screening modalities, and follow-up care. Using multiple linear regression, we evaluated correlates of community pharmacists' level of CRC screening knowledge, defined as the total number of knowledge questions answered correctly from "0" (no questions correct) to "5" (all questions correct). RESULTS A total of 578 eligible community pharmacists completed the survey, with a response rate of 59%. Most community pharmacists correctly answered the question about the next steps following a positive FIT (87%) and the question about where a FIT can be done (84%). A minority of community pharmacists responded correctly to questions about the age to start screening with FIT (34%) and how often a FIT should be repeated (28%). Only 5% of pharmacists answered all knowledge questions correctly. Community pharmacists answered more CRC screening knowledge questions correctly as their years in practice increased. Board-certified community pharmacists answered more CRC screening knowledge questions correctly compared to those who were not board-certified. CONCLUSION To ensure the successful implementation of a pharmacy-based CRC screening program, community pharmacists need to be educated about CRC screening and trained to ensure comprehensive patient counseling and preventive service delivery.
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Cox N, Hohmeier KC, Cernasev A, Field C, Elliott S, LaFleur G, Barland KM, Green M, Gardner JW, Gordon AJ, Cochran G. Engaging community pharmacies in practice-based research: Lessons from opioid-focused research. Res Social Adm Pharm 2024; 20:457-462. [PMID: 38262889 PMCID: PMC10939711 DOI: 10.1016/j.sapharm.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/14/2023] [Accepted: 01/16/2024] [Indexed: 01/25/2024]
Abstract
There is an established need to translate evidence-based practices into real-world practice. Community pharmacists and their corresponding pharmacies are well-positioned to be effective partners as researchers seek to study and implement practice-based research. Challenges exist when partnering with community pharmacies which can vary based on the study type, the nature of the community pharmacy, and stakeholder groups (i.e., patients, staff, leadership, physicians). This commentary seeks to describe these challenges and provide recommendations that can help mitigate and/or overcome these challenges. Recommendations are provided for team structure, communication, research tools/technology, motivational factors, workflow, and sustainability. These recommendations are based on the authors' experience in partnering with community pharmacy for opioid-related research in a variety of study types, states, and pharmacy environments.
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Affiliation(s)
- Nicholas Cox
- University of Utah College of Pharmacy, United States.
| | | | - Alina Cernasev
- University of Tennessee Health Science Center, United States.
| | - Craig Field
- The University of Texas at El Paso, United States.
| | - Stacy Elliott
- University of Tennessee Health Science Center, United States.
| | - Grace LaFleur
- University of Utah College of Pharmacy, United States.
| | | | | | - John W Gardner
- Veterans Affairs Salt Lake City Health Care System, United States.
| | - Adam J Gordon
- University of Utah School of Medicine, United States.
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Ngwu RO, Lindeau R, Bielecki LM, Daly CJ. Assessing Community Pharmacists' Perception on Readiness to Initiate Point-of-Care Testing for SARS-CoV-2 in New York State During the Pandemic. J Pharm Pract 2024; 37:324-334. [PMID: 36242519 DOI: 10.1177/08971900221134642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Pursuant to the COVID-19 pandemic, an executive order issued by the New York State (NYS) governor allowed pharmacists to act as laboratory directors for a limited-service laboratory (LSL) to order and perform Food and Drug Administration (FDA) and Emergency Use Authorization (EUA) Clinical Laboratory Improvement Amendment (CLIA)-waived COVID-19 point-of-care testing (POCT). Objectives: To (i) assess the status of NYS community pharmacists with POCT in the early stages of the COVID-19 pandemic, (ii) assess the readiness and willingness of community pharmacists to incorporate COVID-19 POCT into their workflow during a pandemic, and (iii) assess community pharmacists' perception of the barrier to initiating COVID-19 POCT. Methods: This is a prospective cross-sectional study conducted from February 4 to February 21, 2021. An electronic survey consisting of 66 Likert-type questions, select all that apply, and fill-in-style questions were emailed to 250 Community Pharmacy Enhanced Service Network (CPESN) NY pharmacies, with a follow-up email sent halfway into the data collection period. The data were analyzed using descriptive statistics. Results: The result indicated that most participants (median = 5) demonstrated readiness and willingness to offer COVID-19 testing. Barriers to COVID-19 POCT were identified: impact on pharmacy workflow (59%), lack of payment mechanism (55%) and lack of sufficient training (21%). Most participants expressed interest in continuing POCT beyond the pandemic (86.1%). Conclusion: Community pharmacists in NYS reported willingness to initiate COVID-19 POCT. Addressing the identified barriers, such as workflow disruption and reimbursement challenges, will enable pharmacies to be better prepared to provide patient care, including POCT.
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Affiliation(s)
- Ruth O Ngwu
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
- Middleport Family Health Center, Middleport, NY, USA
| | - Ryan Lindeau
- Primary care of Western New York, Buffalo, NY, USA
| | | | - Christopher J Daly
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA
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17
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Cernasev A, Hohmeier KC, Oyedeji O, Kintziger KW, Hagemann TM. Views of the Pharmacists' Role in HPV Vaccinations: A Qualitative Study in Tennessee. PHARMACY 2024; 12:57. [PMID: 38668083 PMCID: PMC11053700 DOI: 10.3390/pharmacy12020057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 04/29/2024] Open
Abstract
The Human Papillomavirus (HPV) is a frequently occurring sexually transmitted infection in adults and is associated with various cancers that can affect both males and females. Recently, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for the HPV vaccine to include patients aged 27-45 years with shared clinical decision-making. A commonly reported obstacle to receiving the HPV vaccine among adults is a lack of healthcare provider recommendations. Considering the suboptimal HPV vaccine coverage figures and noting that the vast majority of hesitancy research has been conducted among children and adolescents, limited research is available on the adult perception of HPV vaccination in pharmacies. This study focuses on understanding adults' opinions and perceptions regarding the role of pharmacists in the uptake of the HPV vaccine and awareness of its availability in the pharmacy setting. METHODS After receiving approval from the Institutional Review Board (IRB), the qualitative study was initiated using virtual focus groups (FGs). Concepts from the Transtheoretical Model, the Health Belief Model, and the Social Cognitive Theory guided the study design. The corpus of data was collected in 2021 and 2022 by two researchers, and a third party transcribed the FGs to avoid any biases. The data were analyzed using Braun and Clarke's Thematic Analysis. RESULTS Out of 35 subjects that participated in six FGDs, most identified as female, with ages ranging from 18 to 45 years. The following four themes emerged: (1) HPV vaccine awareness; (2) stigmas leading to reduced education and vaccination rates; (3) education preferences; (4) follow-up in vaccination series reminders and preferences. CONCLUSION Participants' views of the HPV vaccine and the ability to receive the vaccine in a pharmacy are influenced by a myriad of factors. Common factors include improved awareness, preferences for educational modalities, avoiding stigmas associated with HPV vaccination, combating gender-focused biases, and preferences for the location of vaccination. These barriers provide opportunities for pharmacists to promote and enhance vaccine uptake.
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Affiliation(s)
- Alina Cernasev
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 301 S. Perimeter Park Dr., Suite 220, Nashville, TN 37211, USA; (K.C.H.); (T.M.H.)
| | - Kenneth C. Hohmeier
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 301 S. Perimeter Park Dr., Suite 220, Nashville, TN 37211, USA; (K.C.H.); (T.M.H.)
| | - Oluwafemifola Oyedeji
- Department of Public Health, University of Tennessee, Knoxville 390 HPER, 1914 Andy Holt Ave., Knoxville, TN 37996, USA;
| | - Kristina W. Kintziger
- Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Tracy M. Hagemann
- Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 301 S. Perimeter Park Dr., Suite 220, Nashville, TN 37211, USA; (K.C.H.); (T.M.H.)
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18
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Eldridge LA, Meyerson BE, Agley J. Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report. JMIR Form Res 2024; 8:e54077. [PMID: 38498037 PMCID: PMC10985598 DOI: 10.2196/54077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/28/2023] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND The number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies' ubiquity and pharmacists' extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education. OBJECTIVE In 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team's control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the "file-drawer" (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors' hypotheses. METHODS This paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies. RESULTS Retrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive. CONCLUSIONS Community pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/42373.
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Affiliation(s)
- Lori Ann Eldridge
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, United States
| | - Beth E Meyerson
- Harm Reduction Research Lab, Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, AZ, United States
- Comprehensive Center for Pain and Addiction, University of Arizona Health Sciences, University of Arizona, Tucson, AZ, United States
| | - Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, United States
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Look KA, Black P, Arzt J, Crahan J, Helgeson CB, Lucey MS, Lee M, Rox KR, Portillo E. Assessing community pharmacy services in health professional shortage areas across Wisconsin. J Am Pharm Assoc (2003) 2024; 64:506-511.e3. [PMID: 37940092 DOI: 10.1016/j.japh.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Primary care health professional shortage areas (HPSAs) lack sufficient primary care providers to meet their health care needs, which contributes to worse health outcomes within underserved populations. Community pharmacies are commonly located in HPSAs and provide nondispensing services that can help address unmet health care needs. However, there is limited data on the nature, scope, and reimbursement for community pharmacy services. OBJECTIVES Using survey data from the state of Wisconsin, this study compares the prevalence of and reimbursement for services provided by community pharmacies in primary care HPSAs and non-HPSAs and describes barriers to pharmacy service implementation. METHODS A survey tool on pharmacy services, reimbursement, and barriers to service implementation was developed, pilot tested, and administered to every community pharmacy in Wisconsin. Data were collected via mail and online over two waves of survey administration from November 2021 to May 2022. Pearson's chi-squared and t tests were used to compare the prevalence of and reimbursement for services between HPSA and non-HPSA pharmacies. Content analysis was used to identify themes that described barriers to pharmacy service implementation. RESULTS Responses were received from 287 of 774 eligible community pharmacies (37.1%). HPSA pharmacies were significantly more likely to be in rural areas. Regardless of pharmacy location, community pharmacies reported commonly providing a variety of services, but reimbursement for these services was considerably less frequent. The prevalence of reimbursement was <50% for two-thirds of services. Pharmacy staffing, time, and financial issues were the most commonly reported barriers to service implementation. CONCLUSIONS Community pharmacies provide a diverse set of services to meet the health care needs of their patients, but often do so with inadequate staffing or reimbursement. Action is needed to support community pharmacies in meeting the health care needs of their communities and to ensure patient access to medications and pharmacy services.
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20
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Sharareh N, Zheutlin AR, Qato DM, Guadamuz J, Bress A, Vos RO. Access to community pharmacies based on drive time and by rurality across the contiguous United States. J Am Pharm Assoc (2003) 2024; 64:476-482. [PMID: 38215823 DOI: 10.1016/j.japh.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/03/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Considering that mail-order pharmacy use remains low in the United States, geographic accessibility of community pharmacies (pharmacy access) can have an outsized impact on a community's access to services and care, especially among rural residents. However, previous measurements of pharmacy access rely on methods that do not capture all aspects of geographic access. OBJECTIVES This study aimed to measure pharmacy access across the contiguous United States and by rural, suburban, and urban areas using drive-time analysis and an improved methodological approach. METHODS The 2-step floating catchment area method was used to measure pharmacy access by considering the supply capacity of pharmacies, population demand for pharmacies, and the interaction between them within a reasonable travel time range. This method is a methodologically improved approach compared with previous methods for measuring geographic access. Network analysis was used to measure drive time from the population-weighted centroids of census tracts to the geocoded location of community pharmacies. Census tract-level pharmacy access was measured using a 10- and 20-minute drive time. Census tracts were also categorized based on population per square mile as rural (< 1000), suburban (1000-3000), and urban (> 3000). RESULTS Across the contiguous United States, 79.9% and 91.1% of census tracts had access to at least 1 pharmacy per 10,000 people within a 10- and 20-minute drive time, respectively. Rural census tracts had the lowest share of access to at least 1 pharmacy per 10,000 people compared with suburban and urban tracts and for both drive times. CONCLUSION Community pharmacies are highly accessible health care access points, specifically in urban and suburban areas. Pharmacies should be considered to expand access to services with limited geographic accessibility such as treatment programs for opioid use disorders, primary care, and healthy foods.
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Langhinrichsen-Rohling J, Richie F, Kelley M, Selwyn C, Archer S, Blejwas E. Charitable Pharmacies as Catalysts for Coordinated Care: Pharmacist Management of Blood Glucose Among Under-Resourced Patients With Type 2 Diabetes. Health Promot Pract 2024; 25:254-262. [PMID: 36627769 DOI: 10.1177/15248399221115082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This community-academic-pharmacy partnership evaluated the impact of a pharmacist-led approach to diabetes management in under-resourced charitable pharmacy patients. Charitable pharmacies serve a large volume of under-resourced patients; pharmacist involvement may improve blood glucose management due to the frequency with which patients access the pharmacy for medications. The purpose of this study was to examine the impact of a pharmacist-led approach to diabetes management (measured by blood glucose levels) by providing medication therapy management (MTM) and leveraging communication between the pharmacist and patients' primary care providers (PCPs). Study participants were Federally Qualified Health Center (FQHC) patients with type 2 diabetes who obtained free diabetes-related medications from the pharmacy. Participants were randomly assigned to treatment as usual (TAU), MTM, or MTM plus coordinated care between the pharmacist and the patient's PCP. The blood glucose levels of patients who received MTM remained stable throughout the duration of the study while blood glucose levels for TAU patients significantly increased. A previously non-existent communication channel between pharmacists and FQHC providers was established and recommendations were exchanged. This relatively small investment on behalf of the pharmacy (e.g., routinely checking blood glucose, sharing medication recommendations) led to a return on health outcomes for a high-risk, low-resource patient population. This study yielded a beneficial change in practice as the pharmacy has institutionalized measuring at-risk patients' blood glucose levels during pharmacy visits. The pharmacy has also continued to enhance their relationship with the FQHC to provide integrated, patient-centered care to this shared vulnerable patient population.
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Affiliation(s)
| | - Fallon Richie
- University of South Alabama, Mobile, AL, USA
- The University of North Carolina-Charlotte, Charlotte, NC, USA
| | | | | | | | - Emily Blejwas
- Gulf States Health Policy Center, Bayou La Batre, AL, USA
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22
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Bacci JL, Pollack SW, Skillman SM, Odegard PS, Danielson JH, Frogner BK. Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce. Med Care Res Rev 2024; 81:39-48. [PMID: 37830446 DOI: 10.1177/10775587231204101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.
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23
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Raczkiewicz D, Owoc J, Bojar I, Sarecka-Hujar B. Satisfaction of people at post-working age with pharmacists' health promotion in Poland. BMC Public Health 2024; 24:281. [PMID: 38262991 PMCID: PMC10807121 DOI: 10.1186/s12889-024-17751-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The study aimed to analyze how people at post-working age evaluate health promotion conducted for them by pharmacists in community pharmacies in Poland. We also assessed whether this evaluation is correlated with the frequency of health behaviors. METHODS The study comprised 712 Polish people at post-working age (retired), including women 60 + and men 65+. Health Behaviors Inventory and authors' Questionnaire for Evaluation of Pharmacists' Health Promotion were used. RESULTS Conducting health promotion by pharmacists in community pharmacies is relevant in the opinion of post-working-aged people (5.8 on average in the scale of 1-10). However, the patients were not satisfied with the reliability (4.7), accessibility (4.7), communicativeness (5.0), and effectiveness (4.6) of health promotion provided by pharmacists for them. The empathy and politeness of pharmacists during health promotion were rated neutrally (5.4, i.e. neither good nor bad). The evaluations of reliability, accessibility, communicativeness, empathy and politeness, relevance, and effectiveness of pharmacists' health promotion did not correlate with age, marital status, place of residence, type of job in the past, or chronic pain currently (p > 0.05). The men evaluated accessibility higher than the women (5.1 vs. 4.6, p = 0.049), but the other domains were evaluated similarly by both genders (p > 0.05). All the domains of pharmacists' health promotion were assessed the better the higher the frequency of health behaviors the post-working aged people was. CONCLUSIONS People in post-working age assessed that health promotion conducted by pharmacists in community pharmacies is important, however they were not satisfied with the reliability, accessibility, communicativeness, and effectiveness of health promotion conducted by pharmacists.
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Affiliation(s)
- Dorota Raczkiewicz
- Department of Medical Statistics, School of Public Health, Centre of Postgraduate Medical Education, Kleczewska 61/63 Street, 01-826, Warsaw, Poland
| | - Jakub Owoc
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1 Street, 02-637, Warsaw, Poland
| | - Iwona Bojar
- Department of Women's Health, Institute of Rural Health in Lublin, Jaczewskiego 2 Street, 20- 090, Lublin, Poland
| | - Beata Sarecka-Hujar
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia in Katowice, Kasztanowa 3 Street, 41-200, Sosnowiec, Poland.
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Shah PD, Wangen M, Rohweder CL, Waters AR, Odebunmi OO, Marciniak MW, Ferrari RM, Wheeler SB, Brenner AT. Patient Willingness to Use a Pharmacy-Based Colorectal Cancer Screening Service: A National Survey of U.S. Adults. Cancer Epidemiol Biomarkers Prev 2024; 33:63-71. [PMID: 37909917 PMCID: PMC10842686 DOI: 10.1158/1055-9965.epi-23-0763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND We aimed to understand U.S. adults' willingness to use a pharmacy-based fecal immunochemical test (FIT) distribution service for routine colorectal cancer screening called PharmFIT using Diffusion of Innovation Theory, evaluating patient's appraisals of the program's relative advantage, compatibility, and complexity. METHODS From March to April 2021, we conducted a national online survey of 1,045 U.S. adults ages 45 to 75. We identified correlates of patient willingness to use PharmFIT using structural equation modeling. RESULTS Most respondents (72%) were willing to get a FIT from their pharmacy for their regular colorectal cancer screening. Respondents were more willing to participate in PharmFIT if they perceived higher relative advantage ($\hat{\beta}$= 0.184; confidence interval, CI95%: 0.055-0.325) and perceived higher compatibility ($\hat{\beta}$ = 0.422; CI95%: 0.253-0.599) to get screened in a pharmacy, had longer travel times to their primary health care provider ($\hat{\beta}$ = 0.007; CI95%: 0.004-0.010). Respondents were less willing to participate in PharmFIT if they were 65 years or older ($\hat{\beta}$ = -0.220; CI95%: -0.362 to -0.070). CONCLUSIONS Most U.S. adults would be willing to participate in PharmFIT for their routine colorectal cancer screening. Patient perceptions of the relative advantage and compatibility of PharmFIT were strongly associated with their willingness to use PharmFIT. Pharmacies should account for patient preferences for these two traits of PharmFIT to increase adoption and use. IMPACT Pharmacy-based colorectal cancer screening may be a viable public health strategy to significantly increase equitable access to screening for U.S. residents.
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Affiliation(s)
- Parth D. Shah
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Catherine L. Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Austin R. Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27510, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27510, USA
| | - Olufeyisayo O. Odebunmi
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27510, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27510, USA
| | - Macary W. Marciniak
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC, USA
| | - Renée M. Ferrari
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27510, USA
| | - Stephanie B. Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27510, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27510, USA
| | - Alison T. Brenner
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27510, USA
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27510, USA
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25
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Covvey JR. Why can't we be friends? The manufactured fear of pharmacist "scope creep". J Am Pharm Assoc (2003) 2024; 64:43-46. [PMID: 37940097 DOI: 10.1016/j.japh.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
The American Medical Association has engaged in a longitudinal campaign against "scope creep" in other health care professions, characterized as a threat to patient safety. Arguments made by the organization regarding the lack of training and ability of pharmacists to engage in services beyond dispensing fail to accurately characterize our value. The expansion of pharmacist scope of practice has support across much of the health care community and is further reinforced by ample scientific evidence. In addition, already existing models of expanded scope are available in many states and several other countries. Now, more than ever, professional organizations within medicine and pharmacy should focus their efforts on solving a myriad of pressing issues for health care workers and patients, as opposed to engaging in turf battles.
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26
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Zaraa S, Steve White H, Stergachis A, Novotny EJ, Protos C, Simic G, Bacci JL. Using design thinking to strengthen the community pharmacist's role in epilepsy care. Epilepsy Behav 2024; 150:109542. [PMID: 38035539 DOI: 10.1016/j.yebeh.2023.109542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE To use design thinking to develop a community pharmacist-led intervention for people living with epilepsy (PWE) with desirable, feasible, and viable features. METHODS This study used design thinking. Three patient personas were created based on previous research: a newly diagnosed PWE, a well-controlled PWE, and a complex PWE with uncontrolled seizures. An intervention prototype was developed for each of the three personas. Structured interviews were conducted with pharmacists, pharmacy students, patients with diagnosed epilepsy, and caregivers to elicit feedback on which features of each intervention prototype were desirable, feasible, and viable. Interviews were analyzed using rapid content analysis. A multidisciplinary advisory group and the research team prioritized features of the prototypes to include in the final intervention. RESULTS The following four features were identified as desirable, feasible, and viable for a pharmacist-led intervention for PWE: (1) pharmacist-patient consultations, (2) care plan development, (3) regular check-ins, and (4) care coordination with other health care providers. SIGNIFICANCE This study identified evidence-based features for a community pharmacist intervention to support epilepsy care using design thinking. A pilot study to evaluate this intervention on the quality of life (QoL), health outcomes and satisfaction of PWE can inform the implementation and feasibility of such patient services.
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Affiliation(s)
- Sabra Zaraa
- Department of Pharmacy, University of Washington School of Pharmacy, 1959 NE Pacific Street, Box 357630, Seattle, WA 98195, USA.
| | - H Steve White
- Department of Pharmacy, University of Washington School of Pharmacy, 1959 NE Pacific Street, Box 357630, Seattle, WA 98195, USA
| | - Andy Stergachis
- Department of Pharmacy, University of Washington School of Pharmacy, 1959 NE Pacific Street, Box 357630, Seattle, WA 98195, USA; Department of Global Health, University of Washington School of Public Health, Seattle, WA, USA
| | - Edward J Novotny
- Department of Neurology, University of Washington School of Medicine, Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA
| | | | | | - Jennifer L Bacci
- Department of Pharmacy, University of Washington School of Pharmacy, 1959 NE Pacific Street, Box 357630, Seattle, WA 98195, USA
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Yoon HS, Teshome BF, Eisenbeis A, Micek ST. Pharmacy technicians trained as community health workers: A prospective multicenter cohort study. J Am Pharm Assoc (2003) 2024; 64:47-54.e1. [PMID: 37673283 DOI: 10.1016/j.japh.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Community health workers (CHWs) are health professionals who are experts in linking patients to health resources. Although CHWs are employed in a variety of health institutions, access to their services may be challenging for patients in underserved locations. Community pharmacies are uniquely positioned to mitigate this barrier as they provide readily accessible care for patients residing in these areas. OBJECTIVES To 1) quantify and report the CHW services provided by certified pharmacy technicians (CPhTs) in an underserved population and 2) provide an initial framework for the implementation of CHW services in community pharmacies or similar health care settings. METHODS This prospective cohort study reports the findings of training CPhTs as CHWs in 3 independent community pharmacies from January 1, 2021 to July 1, 2021. CPhT-CHWs conducted monthly visits by phone, patient home, or pharmacy and documented services using a standardized assessment form. Descriptive statistics were used to summarize the baseline characteristics of the patient population, service codes, types of services and referrals made, and time spent per visit by CPhT-CHWs. RESULTS A total of 198 patient visits by phone, patient home, or at the pharmacy were completed in a 6-month timespan. During these visits, the CPhT-CHW provided 351 services (203 primary services and 149 secondary services) and completed 51 referrals. The average time spent per visit (standard deviation) was 15.5 (11.5) 68.9 (35.4), and 30.6 (16.8) minutes for phone, home, and pharmacy visits, respectively. Patient home visits resulted in the highest average primary services per visit, longest time spent with the patient, and accounted for a majority of social services. CONCLUSION CPhT-CHWs were able to use various methods to contact these patients to further develop patient-to-provider and patient-to-pharmacy relationships. Training CPhTs as CHWs can be an effective way to increase patient contact and provide additional health services.
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28
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Waters AR, Meehan K, Atkins DL, Ittes AH, Ferrari RM, Rohweder CL, Wangen M, Ceballos RM, Issaka RB, Reuland DS, Wheeler SB, Brenner AT, Shah PD. How pharmacists would design and implement a community pharmacy-based colorectal cancer screening program. PREVENTIVE ONCOLOGY & EPIDEMIOLOGY 2024; 2:10.1080/28322134.2024.2332264. [PMID: 38881823 PMCID: PMC11177275 DOI: 10.1080/28322134.2024.2332264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background Distributing CRC screening through pharmacies, a highly accessible health service, may create opportunities for more equitable access to CRC screening. However, providing CRC screening in a new context introduces a substantial implementation challenge. Methods We conducted 23 semi-structured interviews with community pharmacists practicing in Washington state and North Carolina about distributing fecal immunochemical tests (FIT) to patients in the pharmacy. The Consolidated Framework for Implementation Research (CFIR) was used to guide analysis. Results Pharmacists believed that delivering FITs was highly compatible with their environment, workflow, and scope of practice. While knowledge about FIT eligibility criteria varied, pharmacists felt comfortable screening patients. They identified standardized eligibility criteria, patient-facing educational materials, and continuing education as essential design features. Pharmacists proposed adapting existing pharmacy electronic health record systems for patient reminders/prompts to facilitate FIT completion. While pharmacists felt confident that they could discuss test results with patients, they also expressed a need for stronger communication and care coordination with primary care providers. Discussion When designing a pharmacy-based CRC screening program, pharmacists desired programmatic procedures to fit their current knowledge and context. Findings indicate that if proper attention is given to multi-level factors, FIT delivery can be extended to pharmacies.
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Affiliation(s)
- Austin R Waters
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Katherine Meehan
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA 98109, USA
| | - Dana L Atkins
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98109, USA
| | - Annika H Ittes
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Catherine L Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Rachel M Ceballos
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Rachel B Issaka
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- Division of Gastroenterology, Department of Medicine, University of Washington School of Medicine. Seattle, WA, 98195, USA
| | - Daniel S Reuland
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Stephanie B Wheeler
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Alison T Brenner
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC 27510, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27510, USA
| | - Parth D Shah
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA 98109
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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29
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Curran G, Mosley C, Gamble A, Painter J, Ounpraseuth S, Brewer NT, Teeter B, Smith M, Halladay J, Hughes T, Shepherd JG, Hastings T, Simpson K, Carpenter D. Addressing COVID-19 vaccine hesitancy in rural community pharmacies: a protocol for a stepped wedge randomized clinical trial. Implement Sci 2023; 18:72. [PMID: 38110979 PMCID: PMC10726603 DOI: 10.1186/s13012-023-01327-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Uptake of COVID-19 vaccines remains problematically low in the USA, especially in rural areas. COVID-19 vaccine hesitancy is associated with lower uptake, which translates to higher susceptibility to SARS-CoV-2 variants in communities where vaccination coverage is low. Because community pharmacists are among the most accessible and trusted health professionals in rural areas, this randomized clinical trial will examine implementation strategies to support rural pharmacists in delivering an adapted evidence-based intervention to reduce COVID-19 vaccine hesitancy. METHODS We will use an incomplete stepped wedge trial design in which we will randomize 30 rural pharmacies (unit of analysis) to determine the effectiveness and incremental cost-effectiveness of a standard implementation approach (consisting of online training that describes the vaccine hesitancy intervention, live webinar, and resource website) compared to adding on a virtual facilitation approach (provided by a trained facilitator in support of the delivery of the vaccine hesitancy counseling intervention by pharmacists). The intervention (ASORT) has been adapted from an evidence-based vaccine communication intervention for HPV vaccines through a partnership with rural pharmacies in a practice-based research network in seven southern US states. ASORT teaches pharmacists how to identify persons eligible for COVID-19 vaccination (including a booster), solicit and address vaccine concerns in a non-confrontational way, recommend the vaccine, and repeat the steps later if needed. The primary trial outcome is fidelity to the ASORT intervention, which will be determined through ratings of recordings of pharmacists delivering the intervention. The secondary outcome is the effectiveness of the intervention, determined by rates of patients who agree to be vaccinated after receiving the intervention. Other secondary outcomes include feasibility, acceptability, adoption, reach, and cost. Cost-effectiveness and budget impact analyses will be conducted to maximize the potential for future dissemination and sustainability. Mixed methods will provide triangulation, expansion, and explanation of quantitative findings. DISCUSSION This trial contributes to a growing evidence base on vaccine hesitancy interventions and virtual-only facilitation of evidenced-based practices in community health settings. The trial will provide the first estimate of the relative value of different implementation strategies in pharmacy settings. TRIAL REGISTRATION NCT05926544 (clinicaltrials.gov); 07/03/2023.
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Affiliation(s)
- Geoffrey Curran
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
| | - Cynthia Mosley
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Abigail Gamble
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Jacob Painter
- Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Songthip Ounpraseuth
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ben Teeter
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megan Smith
- Center for Implementation Research, Department of Pharmacy Practice, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jacquie Halladay
- Department of Family Medicine, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
- The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Tamera Hughes
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - J Greene Shepherd
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Tessa Hastings
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC, USA
| | - Kit Simpson
- Department of Health Care Leadership and Management, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
- Department of Public Health Science, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Delesha Carpenter
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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30
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Brenner AT, Waters AR, Wangen M, Rohweder C, Odebunmi O, Marciniak MW, Ferrari RM, Wheeler SB, Shah PD. Patient preferences for the design of a pharmacy-based colorectal cancer screening program. Cancer Causes Control 2023; 34:99-112. [PMID: 37072526 PMCID: PMC10113122 DOI: 10.1007/s10552-023-01687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE To assess preferences for design of a pharmacy-based colorectal cancer (CRC) screening program (PharmFIT™) among screening-eligible adults in the United States (US) and explore the impact of rurality on pharmacy use patterns (e.g., pharmacy type, prescription pick-up preference, service quality rating). METHODS We conducted a national online survey of non-institutionalized US adults through panels managed by Qualtrics, a survey research company. A total of 1,045 adults (response rate 62%) completed the survey between March and April 2021. Sampling quotas matched respondents to the 2010 US Census and oversampled rural residents. We assessed pharmacy use patterns by rurality and design preferences for learning about PharmFIT™; receiving a FIT kit from a pharmacy; and completing and returning the FIT kit. RESULTS Pharmacy use patterns varied, with some notable differences across rurality. Rural respondents used local, independently owned pharmacies more than non-rural respondents (20.4%, 6.3%, p < 0.001) and rated pharmacy service quality higher than non-rural respondents. Non-rural respondents preferred digital communication to learn about PharmFIT™ (36% vs 47%; p < 0.001) as well as digital FIT counseling (41% vs 49%; p = 0.02) more frequently than rural participants. Preferences for receiving and returning FITs were associated with pharmacy use patterns: respondents who pick up prescriptions in-person preferred to get their FIT (OR 7.7; 5.3-11.2) and return it in-person at the pharmacy (OR 1.7; 1.1-2.4). CONCLUSION Pharmacies are highly accessible and could be useful for expanding access to CRC screening services. Local context and pharmacy use patterns should be considered in the design and implementation of PharmFIT™.
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Affiliation(s)
- Alison T Brenner
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Austin R Waters
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Olufeyisayo Odebunmi
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Macary Weck Marciniak
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Parth D Shah
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA
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Fahey MC, Krukowski RA, Anderson RT, Cohn WF, Porter KJ, Reid T, Wiseman KP, You W, Wood CH, Rucker TW, Little MA. Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment. Contemp Clin Trials 2023; 134:107335. [PMID: 37730197 PMCID: PMC10841546 DOI: 10.1016/j.cct.2023.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/25/2023] [Accepted: 09/15/2023] [Indexed: 09/22/2023]
Abstract
INTRODUCTION Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment. METHODS This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks). RESULTS Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes. CONCLUSION This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence. CLINICAL TRIALS NCT05660525.
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Affiliation(s)
- M C Fahey
- Medical University of South Carolina, Charleston, SC, USA
| | - R A Krukowski
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - R T Anderson
- University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - W F Cohn
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K J Porter
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - T Reid
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - K P Wiseman
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - W You
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA
| | - C H Wood
- My Pharmacy, Greensboro, NC, USA
| | - T W Rucker
- University of Virginia, Health Systems, Nellysford, VA, USA
| | - M A Little
- University of Virginia, Department of Public Health Sciences, Charlottesville, VA, USA.
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Vascimini A, Saba Y, Baskharoun F, Crooks K, Huynh V, Wasson S, Wright E, Bullers K, Franks R, Carris NW, Cowart K. Pharmacist-driven continuous glucose monitoring in community and ambulatory care pharmacy practice: A scoping review. J Am Pharm Assoc (2003) 2023; 63:1660-1668.e2. [PMID: 37541390 DOI: 10.1016/j.japh.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) devices improve clinical outcomes and facilitate achieving patient-specific goals. However, opportunities and barriers to implementation of pharmacist-driven CGM services are not well-described. OBJECTIVES This scoping review was conducted to identify opportunities and barriers to implementing pharmacist-driven CGM services in the community and ambulatory care setting. Clinical outcomes resulting from pharmacist-driven CGM were also explored. METHODS A health librarian searched Ovid MEDLINE, Cochrane CENTRAL, Embase, Web of Science, Scopus, International Pharmaceutical Abstracts using keywords and subject headings from inception through December 2, 2022 to identify studies describing pharmacist or pharmacy-based CGM programs. No publication type, date limits, language restrictions, or other filters were applied. The database search was supplemented by a search of Google Scholar and a citation search of preselected gold standard articles. RESULTS The scoping review initially identified 942 citations of which 249 passed abstract screening and 11 were included in the review. Among studies, the most common design was retrospective, populations varied, control groups were not consistently used, follow-up was primarily short, and sample sizes were small. One study evaluated pharmacist-driven CGM in a community pharmacy setting. Ten studies took place in the ambulatory care setting. Barriers to initiating pharmacist-driven CGM as a clinical service include educational, logistical, workflow, and financial incentive. Beneficial outcomes from pharmacist-driven CGM include improved quality of life, increased empowerment, and improved glycemic control. CONCLUSION There is lack of strong evidence to support pharmacist-driven CGM in the community pharmacy setting. However, small studies suggest pharmacist-driven CGM is feasible and beneficial in the ambulatory care setting. Further exploration of how educational, logistical, workflow, and financial barriers can be overcome is warranted, given potential for improved clinical outcomes.
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Beam TA, Klepser DG, Klepser ME, Bright DR, Klepser N, Schuring H, Wheeler S, Langerveld A. COVID-19 host genetic risk study conducted at community pharmacies: Implications for public health, research and pharmacists' scope of practice. Res Social Adm Pharm 2023; 19:1360-1364. [PMID: 37567834 PMCID: PMC10264161 DOI: 10.1016/j.sapharm.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 03/06/2023] [Accepted: 06/10/2023] [Indexed: 08/13/2023]
Abstract
Community pharmacists serve a large, diverse population of patients, resulting in the potential to utilize community pharmacies as recruitment sites for clinical research. Beyond traditional roles as one of the most accessible health care professionals in the US healthcare system, pharmacists have played a major role in the response to the COVID-19 pandemic, administering hundreds of thousands of vaccines and tests. However, less emphasis is placed on the ability to leverage community pharmacies as research-focused partners for clinical studies. In this study, we demonstrate the feasibility and workflow of recruiting study participants from community pharmacies and confirm genetic markers of COVID-19 susceptibility. Specific genetic markers include those associated with COVID-19 infection risk (ACE2, TMEM27, and RAVER1), difficulty breathing (NOTCH4), and hospitalization (OAS3). In addition, collaboration with a clinical laboratory allowed for a more seamless consenting process without substantial training needs or workflow disruption at the community pharmacy site. The COVID-19 pandemic has demonstrated that the expansion of pharmacists' scope of practice is a key factor in managing the population health crisis; this study demonstrates that pharmacies can also advance clinical research studies by serving as sites for patient recruitment from a large, diverse, and ambulatory study population.
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Affiliation(s)
- Teresa A Beam
- Manchester University College of Pharmacy, Natural and Health Sciences 10627 Diebold Road, Fort Wayne, IN, 46845, USA.
| | - Donald G Klepser
- University of Nebraska Medical Center, 986120, Omaha, NE, 68198-6120, USA.
| | - Michael E Klepser
- Ferris State University College of Pharmacy, 1000 Oakland Drive, Kalamazoo, MI, 49008, USA.
| | - David R Bright
- Ferris State University College of Pharmacy, 220 Ferris Dr, Big Rapids, MI, 49307, USA.
| | - Nicklas Klepser
- Genemarkers, 126 East South Street, Kalamazoo, MI, 49007, USA; 15811 Louis Dr, Omaha, NE, 68118, USA.
| | - Hannah Schuring
- Genemarkers, 126 East South Street, Kalamazoo, MI, 49007, USA.
| | | | - Anna Langerveld
- Genemarkers, 126 East South Street, Kalamazoo, MI, 49007, USA.
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McCormick N, Jackson BN, Durham SH, Hohmann NS, Westrick SC. Qualitative analysis of community pharmacy-based COVID-19 immunization service operations. J Am Pharm Assoc (2003) 2023; 63:1574-1582.e6. [PMID: 37394061 DOI: 10.1016/j.japh.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The unprecedented coronavirus disease 2019 (COVID-19) pandemic has generated worldwide impacts while positioning community pharmacies as easily accessible immunizers to rollout the COVID-19 vaccine. OBJECTIVES This study describes community pharmacists' experiences, success stories, and lessons learned from providing COVID-19 immunization services. METHODS This study was conducted in February to March 2022 using semistructured interviews with licensed pharmacists practicing full-time in Alabama community pharmacies. Transcribed interviews' content analysis was conducted by 2 independent coders in ATLAS.ti software. RESULTS Nineteen interviews were completed. Pharmacists' experiences in the implementation of COVID-19 immunization services are described across 4 themes: (1) on-site and off-site immunization locations, (2) roles and responsibilities of pharmacy personnel, (3) vaccine storage and administration, and (4) vaccine waste reduction and immunization uptake strategies. This study found that pharmacists' ability to adapt is vital to maintaining their ability to offer immunization services and other services. Pharmacists' capacity for adapting is exemplified through their ability to acclimate to becoming a primary hub of outpatient health care services, accommodating to COVID-19 social distancing and vaccine guidelines, and disseminating a novel vaccine with varying supply and demand. In addition, pharmacies gathered and maintained waitlists of patients and adopted an appointment-based model as to predict, plan, and provide for patients. Pharmacists also used reactive techniques and workflow aspects to dissuade COVID-19 vaccine waste such as in contacting interested patients on waitlists or switching to a walk-in acceptance model. The COVID-19 pandemic elicited unprecedented alterations to the legal, health care responsibilities granted to pharmacy staff with participants describing pharmacy technicians as making a considerable impact to pharmacies' workflow. CONCLUSIONS Pharmacists stepped up as frontline providers during a time of public health emergency with their diverse experiences granting policy makers and researchers much to learn from as, in their communities, pharmacists have continued to increase access to care during a national health crisis.
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Fazelipour M, Dhatt A, Sun T, Nemir A, Wilbur K. Pharmacy Students Practicing Health Advocate Competency Roles in Workplace-Based Training. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:100118. [PMID: 37714657 DOI: 10.1016/j.ajpe.2023.100118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/25/2023] [Accepted: 04/05/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Health advocacy competency roles are found in the educational outcomes of many health disciplines, yet their development is neglected in the professional curriculum and clinical learning environment. We explored how pharmacy students conceptualize health advocacy through their practice in workplace-based learning and any feedback they receive. METHODS We conducted a longitudinal diary study of Canadian pharmacy students completing Advanced Pharmacy Practice Experiences in hospital and community practices in their graduating year. At pre-determined intervals, 25 students recorded workplace-based activities they recognized as health advocacy and any feedback they received from supervisors, patients, or other staff. Written diary data from 180 records were analyzed by 5 researchers according to inductive content analysis steps and principles. RESULTS Pharmacy student records reflecting health advocacy roles were organized into 5 categories including, (1) disease prevention; (2) health promotion; (3) seamless care; (4) usual pharmacist care; and (5) professional advocacy. Although many activities were consistent with current competency role descriptions, they do not reflect educational outcomes associated with patient- or systems-level support necessary to address socio-political determinants of health. Although Advanced Pharmacy Practice Experience in training evaluation reports included scores for items related to health advocacy competency, few students confirmed receiving specific written or verbal feedback. CONCLUSION Pharmacy students construct health advocacy roles in workplace-based training through biomedical-oriented practices with little direct input offered by supervisors. Pharmacy educational outcomes require contemporary updates to health advocacy competency descriptions which offer examples for practical enactment at system-level and recommendations for feedback and assessment.
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Affiliation(s)
- Mojan Fazelipour
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Amninder Dhatt
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Tom Sun
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Arwa Nemir
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
| | - Kerry Wilbur
- The University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada.
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Brenner AT, Rohweder CL, Wangen M, Atkins DL, Ceballos RM, Correa S, Ferrari RM, Issaka RB, Ittes A, Odebunmi OO, Reuland DS, Waters AR, Wheeler SB, Shah PD. Primary care provider perspectives on the role of community pharmacy in colorectal cancer screening: a qualitative study. BMC Health Serv Res 2023; 23:892. [PMID: 37612656 PMCID: PMC10463525 DOI: 10.1186/s12913-023-09828-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The United States Preventive Services Task Force (USPSTF) lists 32 grade A or B recommended preventive services for non-pregnant United States (US) adults, including colorectal cancer screening (CRC). Little guidance is given on how to implement these services with consistency and fidelity in primary care. Given limited patient visit time and competing demands, primary care providers (PCPs) tend to prioritize a small subset of these recommendations. Completion rates of some of these services, including CRC screening, are suboptimal. Expanding delivery of preventive services to other healthcare providers, where possible, can improve access and uptake, particularly in medically underserved areas or populations. Fecal immunochemical testing (FIT) (at-home, stool-based testing) for CRC screening can be distributed and resulted without PCP involvement. Pharmacists have long delivered preventive services (e.g., influenza vaccination) and may be a good option for expanding CRC screening delivery using FIT, but it is not clear how PCPs would perceive this expansion. METHODS We used semi-structured interviews with PCPs in North Carolina and Washington state to assess perceptions and recommendations for a potential pharmacy-based FIT distribution program (PharmFIT™). Transcripts were coded and analyzed using a hybrid inductive-deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate potential multi-level facilitators of and barriers to implementation of PharmFIT™. RESULTS We completed 30 interviews with PCPs in North Carolina (N = 12) and Washington state (N = 18). PCPs in both states were largely accepting of PharmFIT™, with several important considerations. First, PCPs felt that pharmacists should receive appropriate training for identifying patients eligible and due for FIT screening. Second, a clear understanding of responsibility for tracking tests, communication, and, particularly, follow-up of positive test results should be established and followed. Finally, clear electronic workflows should be established for relay of test result information between the pharmacy and the primary care clinic. CONCLUSION If the conditions are met regarding pharmacist training, follow-up for positive FITs, and transfer of documentation, PCPs are likely to support PharmFIT™ as a way for their patients to obtain and complete CRC screening using FIT.
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Affiliation(s)
- Alison T Brenner
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, US.
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Catherine L Rohweder
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Mary Wangen
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Dana L Atkins
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Rachel M Ceballos
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Sara Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Rachel B Issaka
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
- Division of Gastroenterology, School of Medicine, University of Washington, Seattle, WA, 98104, 98109, USA
| | - Annika Ittes
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
| | - Olufeyisayo O Odebunmi
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Daniel S Reuland
- Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, US
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Austin R Waters
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- UNC Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Parth D Shah
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Center, Seattle, WA, 98109, USA
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Hayes KN, Harris DA, Zullo AR, Chachlani P, Wen KJ, Smith-Ray RL, Djibo DA, McCarthy EP, Pralea A, Singh TG, McMahill-Walraven C, Taitel MS, Deng Y, Gravenstein S, Mor V. Racial and ethnic disparities in COVID-19 booster vaccination among U.S. older adults differ by geographic region and Medicare enrollment. Front Public Health 2023; 11:1243958. [PMID: 37637796 PMCID: PMC10456997 DOI: 10.3389/fpubh.2023.1243958] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction COVID-19 booster vaccines are highly effective at reducing severe illness and death from COVID-19. Research is needed to identify whether racial and ethnic disparities observed for the primary series of the COVID-19 vaccines persist for booster vaccinations and how those disparities may vary by other characteristics. We aimed to measure racial and ethnic differences in booster vaccine receipt among U.S. Medicare beneficiaries and characterize potential variation by demographic characteristics. Methods We conducted a cohort study using CVS Health and Walgreens pharmacy data linked to Medicare claims. We included community-dwelling Medicare beneficiaries aged ≥66 years who received two mRNA vaccine doses (BNT162b2 and mRNA-1273) as of 8/1/2021. We followed beneficiaries from 8/1/2021 until booster vaccine receipt, death, Medicare disenrollment, or end of follow-up (12/31/2021). Adjusted Poisson regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) comparing vaccine uptake between groups. Results We identified 11,339,103 eligible beneficiaries (mean age 76 years, 60% female, 78% White). Overall, 67% received a booster vaccine (White = 68.5%; Asian = 67.0%; Black = 57.0%; Hispanic = 53.3%). Compared to White individuals, Black (RR = 0.78 [95%CI = 0.78-0.78]) and Hispanic individuals (RR = 0.72 [95% = CI 0.72-0.72]) had lower rates of booster vaccination. Disparities varied by geographic region, urbanicity, and Medicare plan/Medicaid eligibility. The relative magnitude of disparities was lesser in areas where vaccine uptake was lower in White individuals. Discussion Racial and ethnic disparities in COVID-19 vaccination have persisted for booster vaccines. These findings highlight that interventions to improve vaccine uptake should be designed at the intersection of race and ethnicity and geographic location.
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Affiliation(s)
- Kaleen N. Hayes
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Daniel A. Harris
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Andrew R. Zullo
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States
| | - Preeti Chachlani
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Katherine J. Wen
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, United States
| | - Renae L. Smith-Ray
- Walgreens Center for Health and Wellbeing Research, Walgreen Company, Deerfield, IL, United States
| | | | - Ellen P. McCarthy
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States
- Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Alexander Pralea
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
| | - Tanya G. Singh
- Walgreens Center for Health and Wellbeing Research, Walgreen Company, Deerfield, IL, United States
| | | | - Michael S. Taitel
- Walgreens Center for Health and Wellbeing Research, Walgreen Company, Deerfield, IL, United States
| | - Yalin Deng
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Stefan Gravenstein
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States
- Division of Geriatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, RI, United States
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, United States
- Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, United States
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Cho BH, O'Halloran A, Pike J. Investigation of barriers to county-level seasonal influenza vaccine uptake among Medicare beneficiaries in the United States - 2018-2019 seasonal influenza season. Vaccine X 2023; 14:100326. [PMID: 37577260 PMCID: PMC10422654 DOI: 10.1016/j.jvacx.2023.100326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 08/15/2023] Open
Abstract
Introduction As most public health decisions are made at the local level, public health interventions implemented at the local level may vary by their own unique circumstances, such as demographic composition or the availability of resources. Our objective is to estimate and characterize county-level flu vaccine uptakes among Medicare-covered adults aged ≥65 years. Methods The flu vaccine uptake was estimated from Medicare Fee-for-Service claims for those who continuously enrolled during the 2018-2019 flu season. County-level characteristics were obtained from Centers for Disease Control and Prevention (CDC)'s Minority Health Social Vulnerability Index and Behavioral Risk Factor Surveillance System data as well as Health Resources and Services Administration's Area Health Resources File. A generalized linear regression was used to assess the relationship between selected characteristics and uptake. Results A total of 30,265,047 beneficiaries from 3,125 counties were identified, of which 53% received a flu vaccination during the 2018-2019 flu season. For 3,006 counties with more than 500 Medicare beneficiaries, the mean county-level uptake was estimated to be 47.7%. The mean uptakes in counties designated as a health professional shortage area (HPSA) (42.6% and 48.4%, respectively), were lower than the uptakes for the non-HPSA counties (53.8%). Metro counties (53.2%) showed higher uptakes than non-metro counties (44.2%). Regression analysis results showed that the percent of working adults aged 18-64 years and female were positively associated, while the percent of Black and Hispanic adults were negatively associated. Proportions of persons with limited proficiency of English, college education or above, single parent families, multi-unit housing, and living in group quarters were positively associated and significant. Conclusions The results confirmed that county-level flu vaccine uptakes are low, reflect persistent racial disparities in vaccine uptake, and that Medicare populations in medically underserved communities with lower socioeconomic status need more attention in improving flu vaccine uptake.
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Affiliation(s)
- Bo-Hyun Cho
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Alissa O'Halloran
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Jamison Pike
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Obad A, Singh R, Nasruddin S, Holmes E, Rosenthal M. The Development of a New Tool to Help Patients and Their Providers Evaluate Self-Management of Type 2 Diabetes Mellitus. Healthcare (Basel) 2023; 11:2117. [PMID: 37570359 PMCID: PMC10418372 DOI: 10.3390/healthcare11152117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/09/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
Diabetes self-management or self-care activity related to diet, physical activity, and glucose monitoring, among other things, is recognized as important to effectively managing this condition. The aim of this study was to create an assessment tool for evaluating knowledge and self-management behavior in Type 2 Diabetes Mellitus (T2DM) for patients and their providers. The study utilized an online survey with a cross-sectional design of adults diagnosed with Type 2 diabetes. The survey consisted of 8 sections and a total of 56 questions, which were designed to measure the participants' current knowledge and behavior regarding diabetes self-management. The total sample size was 306 participants, and the results revealed a significant association between performance on diabetes knowledge questions and self-management behavior (β = 0.46; 95% CI: 0.34, 0.58; p < 0.001). Furthermore, education had a significant impact on diabetes self-management behavior (β = 0.59; 95% CI: 0.14, 1.03; p = 0.01). Overall, the data indicated that participants who performed well on knowledge-based questions exhibited higher scores in desired diabetes management behaviors. Increasing awareness of this work in the diabetic community could facilitate the clinical encounters between diabetic patients and their healthcare providers, with an emphasis on each individual's needs being taken into consideration.
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Affiliation(s)
| | | | | | | | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS 38677, USA
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Roller J, Pfeiffer A, Humphries C, Richard C, Easter J, Ferreri S, Livet M. Community Pharmacy Recruitment for Practice-Based Research: Challenges and Lessons Learned. PHARMACY 2023; 11:121. [PMID: 37489352 PMCID: PMC10366889 DOI: 10.3390/pharmacy11040121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/07/2023] [Accepted: 07/17/2023] [Indexed: 07/26/2023] Open
Abstract
To support the successful integration of community pharmacies into value-based care models, research on the feasibility and effectiveness of novel pharmacist-provided patient care services is needed. The UNC Eshelman School of Pharmacy, supported by the National Association of Chain Drug Stores (NACDS) Foundation, designed the Community-based Valued-driven Care Initiative (CVCI) to (1) identify effective value-based patient care interventions that could be provided by community pharmacists, (2) implement and evaluate the feasibility of the selected patient care interventions, and (3) develop resources and create collaborative sustainability opportunities. The purpose of this manuscript is to describe recruitment strategies for CVCI and share lessons learned. The project team identified pharmacies for recruitment through a mixed data analysis followed by a "fit" evaluation. A total of 42 pharmacy organizations were identified for recruitment, 24 were successfully contacted, and 9 signed on to the project. During recruitment, pharmacies cited concerns regarding the financial sustainability of implementing and delivering the patient care services, challenges with staffing and infrastructure, and pharmacists' comfort level. To foster participation, it was vital to have leadership buy-in, clear benefits from implementation, and assured sustainability beyond the research period.
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Affiliation(s)
- Jessica Roller
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Anna Pfeiffer
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Courtney Humphries
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Chloe Richard
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Jon Easter
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Stefanie Ferreri
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Melanie Livet
- UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Shafai G, Aungst TD. Prescription digital therapeutics: A new frontier for pharmacists and the future of treatment. J Am Pharm Assoc (2003) 2023; 63:1030-1034. [PMID: 37019379 DOI: 10.1016/j.japh.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023]
Abstract
Within digital health, digital therapeutics (DTx) are increasingly used to provide clinical treatment. DTx are evidence-based, U.S. Food and Drug Administration-authorized software to treat or manage medical conditions and are available either via prescription or as nonprescription products. DTx that require clinician initiation and oversight are called prescription DTx (PDTs). DTx and PDTs have unique mechanisms of action and are expanding treatment options beyond traditional pharmacotherapy. They may be implemented on their own or used in combination with a drug and in some cases may be the only treatment option for a particular disease state. This article explains how DTx and PDTs function and how these technologies can be incorporated by pharmacists as they attend to their patients' care.
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Herbert SMC, Herbert BM, Hake KL, McGrath SH. Flip the Pharmacy's impact on comprehensive medication management performance. J Am Pharm Assoc (2003) 2023; 63:1070-1076. [PMID: 37055010 DOI: 10.1016/j.japh.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/06/2023] [Accepted: 04/06/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Clinically integrated networks of community pharmacies are expanding partnerships with health care payers for sustainable provision of patient care services. The Pennsylvania Pharmacists Care Network (PPCN), a part of CPESN USA, launched its first payer program in 2017 with a Medicaid managed care organization for comprehensive medication management (CMM). Some PPCN pharmacy teams have participated in Flip the Pharmacy, a national practice transformation initiative. OBJECTIVES This study aimed to determine whether pharmacy participation in Flip the Pharmacy was associated with a greater rate of CMM encounters than in nonparticipating pharmacies within a statewide clinically integrated network. METHODS This project was a retrospective quantitative study. CMM encounter data including total number of encounters and total number of eligible members were extracted from monthly reports. Generalized estimating equations were used to assess the association between Flip the Pharmacy participation and CMM encounter rates. RESULTS Of 103 pharmacies that participated in the CMM program in 2019 and 2020, 77.7% of pharmacies (n = 80) were included in analyses. Of these, 31.3% (n = 25) participated in Flip the Pharmacy. Overall, 80 pharmacies documented 8460 patient encounters through the CMM program. On average, pharmacies participating in Flip the Pharmacy recorded 1.67 times the rate of encounters compared with non-Flip the Pharmacy pharmacies (95% CI 1.10-2.54), controlling for single versus multiple pharmacy sites and weekend hours. On average, pharmacies participating in Flip the Pharmacy recorded 1.18 times the rate of initial encounters (95% CI 0.84-1.59) and 2.06 times the rate of follow-up encounters (95% CI 1.22-3.48) compared with non-Flip the Pharmacy pharmacies. CONCLUSION Participation in Flip the Pharmacy in Pennsylvania was associated with greater engagement and completion of encounters within a payer program for CMM. Continued practice transformation efforts are needed to ensure the sustainability of community pharmacy practice as it continues to expand into payment for patient care services.
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Berenbrok LA. 2023 Prescott Lecture: Leading with excitement, purpose, and proof. J Am Pharm Assoc (2003) 2023; 63:1263-1264. [PMID: 37178977 DOI: 10.1016/j.japh.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023]
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O'Driscoll M, Carpenter DM, Foley A, Moloney E, Reddin K, Sahm LJ. A needs assessment for suicide prevention training within community pharmacies. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 10:100285. [PMID: 37333967 PMCID: PMC10276177 DOI: 10.1016/j.rcsop.2023.100285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 06/20/2023] Open
Abstract
Background Suicide is a leading cause of deaths globally, with over 700,000 deaths by suicide reported annually. In Ireland, numbers of suicides increased by 5.4% from 2015 to 2019. Community pharmacists are one of the most accessible and trusted healthcare professionals, and together with their staff they are well placed to identify those who may be at risk of suicide and guide them towards care pathways. Furthermore, their role in medication management can limit vulnerable patient access to potentially harmful medications. This study aims to explore the experience of community pharmacists and their staff in dealing with patients at risk of suicide and to identify ways of increasing education and support in this area. Methods Pharmacists registered with the Pharmaceutical Society of Ireland (PSI) were invited to complete an anonymous online survey via Google Forms in May 2020, and to circulate the online survey link to their community pharmacy staff (CPS). The survey comprised 29 questions across the following categories: interactions with at-risk patients; communication; training and resources. Free text responses to the following question were invited: "Without any identifying information, please tell us briefly about a time when you interacted with a patient who you were concerned may hurt himself or herself". Data were analysed using descriptive statistics and thematic analysis. Results Of 219 eligible responses (67% female, 94% pharmacists, 6% other pharmacy staff), 61% percent (n = 134) reported having a patient die by suicide. Forty percent (n = 87) of participants reported feeling either very or moderately uncomfortable communicating with patients that may be at risk of suicide or self-harm. Most respondents (88.5%, n = 194) had not completed any suicide training. Online/webinar style trainings (82.1%, n = 180), and local/regional in-person events (50%, n = 111) were the most preferred education mode. Qualitative themes that emerged were: (i) accessibility; (ii) medication management; (iii) therapeutic relationship; (iv) knowledge and training; and (v) continuum of care pathways. Conclusion This study highlights the high frequency of community pharmacy interactions with those at risk of suicide and the necessity for appropriate training in suicide prevention. Further research-informed action is required to facilitate navigation of such interactions with knowledge and confidence.
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Affiliation(s)
- Michelle O'Driscoll
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - Delesha M. Carpenter
- UNC Eshelman School of Pharmacy, 220 Campus Drive, CPO 2125/114G Karpen Hall, Asheville, NC 28804, United States of America
| | - Ailbhe Foley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - Emily Moloney
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - Katie Reddin
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
| | - Laura J. Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Ireland
- Department of Pharmacy, Mercy University Hospital, Grenville Place, Cork, Ireland
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Makhinova T, Johnson JA, Minhas-Sandhu JK, Necyk C, Bhutani M, Eurich DT. Pharmacists' chronic disease management in chronic obstructive pulmonary disease: Effect on health services utilization. J Manag Care Spec Pharm 2023; 29:671-679. [PMID: 37276041 PMCID: PMC10388007 DOI: 10.18553/jmcp.2023.29.6.671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND: There is limited real-world evidence on evaluation of chronic disease management initiatives provided by pharmacists to patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE: To evaluate changes in COPD-related health care resource utilization between patients with COPD who had pharmacist-provided chronic disease management (comprehensive annual care plan [CACP]) vs those who did not have CACP. METHODS: Patients with COPD who received a CACP in Alberta between 2012 and 2015 were identified within the Alberta Health administrative data. Each of these patients were matched with 2 control patients with COPD based on age, sex, provider, date of service, and qualifying comorbidities. Controlled interrupted time series analysis was used to evaluate changes in COPD-specific hospitalizations, emergency department (ED) visits, physician visits, and claims for pulmonary function test. Immediate and temporal changes were calculated for the difference in outcomes 1 year before and 1 year after receiving the CACP for the intervention group and matched controls. RESULTS: Eligible patients (N = 74,365), of whom 28,795 (38.7%) had received CACPs, were matched to a total of 45,570 controls. In 1 year after the CACPs implementation, the number of COPD-related hospitalization visits decreased by 174 (95% CI = -270.8 to -76.5) per 10,000 patients per month, COPD-related ED visits decreased by 123 (95% CI = -294.9 to 49.6) per 10,000 per month, general practitioner visits decreased by 153.9 per 10,000 per month (95% CI = -293.3 to -14.5), and pulmonary function test claims decreased by 19.5 per 10,000 per month (95% CI = -70.1 to 31.2) when compared with the matched controls. However, significant difference between the 2 groups was found for COPD-related hospitalizations only, which was not confirmed by the sensitivity analysis. CONCLUSIONS: In patients with COPD who were provided with care plans by their community pharmacists, there was no significant decrease in COPD-related hospitalizations or ED visits over 1 year compared with the matched controls who did not have a pharmacist-provided care plan. Physician visits and pulmonary function tests did not change significantly for those who had CACP compared with those who did not. There is a need to further understand how care plans can better impact other outcomes that are important in COPD management. DISCLOSURES: This study was supported by a grant from the M.S.I. Foundation (Grant#895) based in Alberta, Canada. Dr Bhutani has consulted for Astra Zeneca, GlaxoSmithKline, Boehringer Ingelheim, Valeo, Covis, and Sanofi. The authors declare no other relevant conflicts of interest or financial relationships. This study is based on data provided by Alberta Health. The interpretation and conclusions of the results are those of the researchers and do not necessarily represent the views of the government of Alberta nor the funder (M.S.I. Foundation). All authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors.
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Affiliation(s)
| | | | | | | | - Mohit Bhutani
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Stover AN, Lavigne JE, Carpenter DM. A Scoping Review of Suicide Prevention Training Programs for Pharmacists and Student Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe8917. [PMID: 35012944 PMCID: PMC10159549 DOI: 10.5688/ajpe8917] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/05/2022] [Indexed: 05/06/2023]
Abstract
Objective. This scoping review updates a 2018 review of suicide prevention training programs for community and student pharmacists. Five scholarly databases were searched for articles published between January 2018 and December 2020. Articles were excluded if they did not describe an educational or training program for pharmacists or student pharmacists, did not explicitly include suicide, focused solely on attitudes, or did not provide sufficient detail to evaluate program content. The quality of each study was examined using a quality assessment tool.Findings. Seven studies met inclusion criteria. Most trainings (86%) were delivered live with interactive or role play scenarios to promote verbal and behavioral skill practice. About half (57%) assessed changes in knowledge, and fewer programs (29%) assessed changes in communication. All assessed participants' ability to identify suicide warning signs and included referral resources. Six studies were assessed for quality, of which 67% had a rating of good and 33% were rated as fair.Summary. Given the increase in suicide rates nationally, it is likely that pharmacists will encounter a patient in need of suicide prevention services. Since 2018, seven new suicide prevention training programs for community and student pharmacists have been reported, which demonstrates growing interest in suicide prevention training in the pharmacy profession. When integrated in Doctor of Pharmacy (PharmD) curricula, trainings may help prepare the pharmacy workforce for encounters with patients in crisis. The impact of training on self-efficacy and communication skills warrants additional attention. Variation between programs should be evaluated to understand which instructional methods best prepare pharmacy professionals to engage in suicide prevention.
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Affiliation(s)
- Amanda N Stover
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Jill E Lavigne
- St John Fisher College, Wegmans School of Pharmacy, Rochester, New York
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, New York
| | - Delesha M Carpenter
- University of North Carolina, Eshelman School of Pharmacy, Chapel Hill, North Carolina
- Center of Excellence for Suicide Prevention, Department of Veterans Affairs, Canandaigua, New York
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AlMahasis SO, Fox B, Ha D, Qian J, Wang CH, Westrick SC. Pharmacy-based immunization in rural USA during the COVID-19 pandemic: A survey of community pharmacists from five southeastern states. Vaccine 2023; 41:2503-2513. [PMID: 36898932 PMCID: PMC9988709 DOI: 10.1016/j.vaccine.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Immunization rates for seasonal and non-seasonal vaccines dropped during the COVID-19 pandemic. Little is known about the extent to which community pharmacies in the USA continued to serve as immunization sites during the pandemic. This study compared 1) the types and perceived changes in non-COVID-19 vaccine doses administered at rural community pharmacies in 2020 (during the pandemic) to 2019 (pre-pandemic) and 2) the delivery of non-COVID-19 immunization services in 2020 to 2019. METHODS A mixed-mode (paper/electronic) survey of a convenience sample of 385 community pharmacies operating in rural settings and have administered ≥1 vaccine in 2019 and 2020 was distributed in May-August 2021. Survey development was informed by relevant literature, pre-tested with three individuals, and pilot-tested with 20 pharmacists. Non-response bias was assessed, and survey responses were analyzed using descriptive and bivariate statistics. RESULTS Of the 385 community pharmacies, 86 qualified pharmacies completed the survey (Response Rate = 23.8%). The percentage of pharmacies offering a given vaccine in 2019 and 2020 were similar; with one exception, a higher percentage of pharmacies reported having MMR administered for adults in the pharmacy in 2020 (McNemar's test; p-value = 0.0253). For each given vaccine, the majority of respondents did not perceive a change in the number of doses administered in 2020 compared to 2019. Further, the majority reported no difference in how they delivered immunization services during and pre-pandemic. However, a small percentage of respondents (6.0-22.0%) adapted their services by adopting several measures to ensure the safety and continuity of immunizations during the pandemic. CONCLUSION Findings highlight the importance of community pharmacies as immunization sites during the pandemic. Community pharmacies continued immunization delivery at community pharmacies during the pandemic with almost no noticeable change to types and doses of vaccines compared to pre-pandemic nor the process of vaccine delivery.
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Affiliation(s)
- Sura O AlMahasis
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA; Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Brent Fox
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - David Ha
- Stanford Health Care, Stanford, CA, USA; Stanford University, Stanford, CA, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Chih-Hsuan Wang
- Department of Educational Research, Measurement, and Assessment, Auburn University, Auburn, AL, USA
| | - Salisa C Westrick
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA.
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Babbrah P, Solomon MR, Stember LA, Hill JW, Weiker M. Formulary & benefit and real-time pharmacy Benefit: Electronic standards delivering value to prescribers and pharmacists. J Am Pharm Assoc (2003) 2023; 63:725-730. [PMID: 36842895 DOI: 10.1016/j.japh.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
The use of standard transactions in the electronic sharing of prescription-related information among payers, prescribers and pharmacists aids in the delivery of effective, safe, and affordable medication therapy to patients. Integral to electronic medication management (eMM) in this environment is the availability of data to aid in the determination of the most appropriate medication for a patient considering benefits coverage restrictions, therapeutic effectiveness, and cost. Key elements of this formulary decision support are the National Council for Prescription Drug Programs Formulary & Benefit (F&B) standard and the related Real-time Pharmacy Benefit (RTPB) standard. In this article, we review the foundational role of F&B in the electronic prescribing of medications, the value it delivers to prescribers, and dispensing pharmacists. The combination of F&B and RTPB to enhance the quality of information available in eMM is also discussed with evidence presented on how these standards help to minimize manual tasks and rework in the pharmacy, optimize time to therapy, lower patient out-of-pocket costs, and result in the dispensing of prescriptions less likely to be abandoned. We conclude with a view of the future of F&B to support new eMM requirements.
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Berenbrok LA, Gessler C, Kirisci L, Herrera-Restrepo O, Coley KC. Impact of pharmacist motivational interviewing on hepatitis B vaccination in adults with diabetes. J Am Pharm Assoc (2003) 2023; 63:66-73.e1. [PMID: 36115757 DOI: 10.1016/j.japh.2022.08.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/12/2022] [Accepted: 08/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND In 2011, the Advisory Committee on Immunization Practices recommended hepatitis B (HepB) vaccination for previously unvaccinated adults (aged 19-59 years) with diabetes. Despite these recommendations, vaccination coverage for HepB vaccination for persons with diabetes remains low. OBJECTIVES The primary objective was to determine the impact of a community pharmacist-led motivational interviewing (MI) intervention on HepB vaccination initiation among adults with diabetes who were previously unvaccinated against HepB. The secondary objective was to describe HepB vaccination series completion among adults with diabetes who initiated the first dose of a HepB vaccine. METHODS A prospective, nonrandomized, controlled cluster trial was conducted across 58 regional grocery store chain pharmacies: a total of 29 pharmacies in the MI group and 29 pharmacies in the control group. Pharmacy location-level baseline data were collected during a 12-month pre-program period. The MI program was delivered over 10 months. Alerts were generated during prescription processing throughout the study period for eligible patients at each MI pharmacy location. The MI consisted of a face-to-face conversation between the pharmacist and the patient at the time of prescription pick-up. The difference in the primary outcome of HepB vaccination series initiation between patients receiving MI and control patients was assessed using a difference-in-differences analysis. For series completion, patients who initiated the HepB vaccination series were followed up for over 12 months after their first HepB vaccine dose. RESULTS There was a statistically significant 3.711% increase in HepB vaccination when comparing eligible individuals who received the MI intervention (n = 1569) to eligible individuals in the control group (n = 3640). Of the patients in the MI group who initiated HepB vaccination, 40 of 65 patients (61.5%) completed the vaccination series. CONCLUSION A pharmacist-led MI intervention increased HepB vaccination rates among adult patients with diabetes. Community pharmacists can effectively provide vaccinations that require multiple doses to complete the vaccination series.
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Beuschel T, Gootee E, Jordan M, Sikkenga T, Klepser DG, Holmquist H, de Voest A, Klepser ME. Time and motion study of hepatitis C virus point-of-care testing in community pharmacies. J Am Pharm Assoc (2003) 2023; 63:435-439. [PMID: 36463010 DOI: 10.1016/j.japh.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Point-of-care (POC) testing for hepatitis C virus (HCV) is readily available for implementation in community pharmacies, but it is unknown how feasible administration of the tests would be in the current community pharmacy model. OBJECTIVE The primary objective of this study was to describe time associated with each step in a pharmacy HCV screening program and compare the results to influenza management in the pharmacy workflow. METHODS For this time and motion study, the process was broken into 10 categories. A standardized patient was used for each location to accurately assess and compare the integration of HCV testing in the various workflows. Data were collected for each category during 2 random visits at each of 6 community pharmacies. Times were averaged, and a standard deviation calculated for each specific category. The data were then compared to previous time-in-motion values collected for influenza management. RESULTS The average total time (patient identification to completion of visit) to complete the HCV POC test was 59 minutes 44 seconds (+/- 9:23). The average time that pharmacists and technicians actively spent with each patient was 10 minutes 23 seconds and 11 minutes 20 seconds, respectively. The average labor cost per patient for pharmacists and technicians were $11.55 and $3.75, respectively. CONCLUSION The hands-on time requirements and workflow associated with offering HCV screening in a pharmacy using the Oraquick HCV rapid antibody test were similar to those noted with other pharmacy based POC testing services. Labor costs could be lessened by delegation of some non-clinical functions to a qualified pharmacy technician. We suggest an HCV rapid antibody test can be incorporated into pharmacy workflow with reasonable efficiency.
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