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Barnett MJ, Clubbs B, Woodyard A, Wasem V, Prinze J, Tirupasur A, Hosseini S, Kim M, Gallardo F, Polich N, Desselle S. Barriers and motivational factors for engaging in novel opioid and medication disposal-related services in community pharmacies. Res Social Adm Pharm 2024; 20:713-722. [PMID: 38719767 DOI: 10.1016/j.sapharm.2024.03.011] [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: 03/07/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE This study aimed to explore and identify motivational factors and barriers for pharmacy personnel participation in specific opioid mitigation programs, using the Theory of Planned Behavior (TPB) as an investigational framework. METHODS A naturalistic inquiry method was employed involving semi-structured interviews with pharmacy personnel to assess their intentions, attitudes, normative beliefs, and behaviors towards participating in naloxone dispensing and provision of at-home drug disposal solutions. Purposive sampling was utilized to recruit participants, with saturation achieved after 12 interviews. Interviews were transcribed and coded to identify recurring themes. RESULTS Four primary themes emerged: 1) the value and benefits of helping others, emphasizing societal, patient, and environmental benefits; 2) limits and barriers to participation, including financial concerns, management support, and time constraints; 3) pharmacists' intrinsic motivators, highlighting personal motivations and differentiation between programs for specific patient types; and 4) program implementation challenges and strategies. CONCLUSION The findings underscore the applicability of the TPB in understanding pharmacy engagement in opioid abatement programs. Despite facing barriers such as financial considerations and time constraints, the overall positive attitudes towards the programs indicate a strong motivation to contribute to public health efforts. Addressing identified barriers and leveraging motivators could enhance participation, potentially mitigating the opioid crisis. Future research should incorporate patient perspectives to fully understand the impact and effectiveness of pharmacy-led interventions, such as naloxone dispensing and disposal solutions, in opioid misuse prevention.
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Affiliation(s)
- Mitchell J Barnett
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Brooke Clubbs
- Southeast Missouri State University, One University Plaza, Cape Girardeau, MO, 63701, USA.
| | - Ashley Woodyard
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Valerie Wasem
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Joyce Prinze
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Anuradha Tirupasur
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Sina Hosseini
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Madison Kim
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
| | - Faviola Gallardo
- University of Iowa, College of Pharmacy, 180 S Grand Ave, Iowa City, IA, 52242, USA.
| | - Natalie Polich
- Drake University College of Pharmacy & Health Sciences, 2507 University Avenue, Des Moines, IA, 50311, USA.
| | - Shane Desselle
- Touro University California College of Pharmacy, 1310 Club Dr, Vallejo, CA, 94592, USA.
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Cheetham A, Grist E, Nielsen S. Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research. Curr Opin Psychiatry 2024; 37:251-257. [PMID: 38726819 DOI: 10.1097/yco.0000000000000943] [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] [Indexed: 06/01/2024]
Abstract
PURPOSE OF REVIEW Collaborative models of care where pharmacists work alongside physicians have been developed for a range of physical health conditions, with benefits including improved patient outcomes and increased access to ongoing care. Opioid agonist treatment (methadone and buprenorphine) is a clinically effective and cost-effective treatment for opioid use disorder that is under-utilized in many countries due to a shortage of prescribers. In recent years, there has been increased interest in the development of collaborative models that utilize pharmacists to overcome barriers to treatment. In this article, we present a narrative review to synthesise recent work in this rapidly developing area. RECENT FINDINGS Two key aspects of opioid agonist treatment were identified: Collaborative models have utilized pharmacists to facilitate buprenorphine induction, and collaborative models provide increased capacity for delivering ongoing care in a variety of settings and patient groups where prescriber access is limited. Pharmacists have undertaken direct patient care responsibilities with varying degrees of autonomy, with benefits including a reduction in prescriber workload, and improvements in treatment retention and continuity of care. SUMMARY Collaborative models in which pharmacists are responsible for buprenorphine induction and ongoing management with methadone and buprenorphine have been shown to reduce demands on prescribers while improving or maintaining patient outcomes, and appear feasible and acceptable in a wide range of outpatient settings.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
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3
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Krichbaum M, Fernandez D, Singh-Franco D. Barriers and Best Practices on the Management of Opioid Use Disorder. J Pain Palliat Care Pharmacother 2024; 38:56-73. [PMID: 38100521 DOI: 10.1080/15360288.2023.2290565] [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: 07/21/2023] [Accepted: 11/26/2023] [Indexed: 12/17/2023]
Abstract
Opioids refer to chemicals that agonize opioid receptors in the body resulting in analgesia and sometimes, euphoria. Opiates include morphine and codeine; semi-synthetic opioids include heroin, hydrocodone, oxycodone, and buprenorphine; and fully synthetic opioids include tramadol, fentanyl and methadone. In 2021, an estimated 5.6 million individuals met criteria for opioid use disorder. This article provides an overview of the pharmacology of heroin and non-prescription fentanyl (NPF) and its synthetic analogues, and summarizes the literature related to the management of opioid use disorder, overdose, and withdrawal. This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population. This is followed by a description of barriers to treatment and best practices for management with a discussion on recent updates and their potential impact on this patient population.
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Affiliation(s)
- Michelle Krichbaum
- Clinical Manager-Pain Management and Palliative Care, Baptist Health South Florida, Miami, FL, USA
| | | | - Devada Singh-Franco
- Associate Professor, Pharmacy Practice, Nova Southeastern University, Health Professions Division, Barry and Judy Silverman College of Pharmacy, Fort Lauderdale, FL, USA
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Jarrett JB, Bratberg J, Burns AL, Cochran G, DiPaula BA, Dopp AL, Elmes A, Green TC, Hill LG, Homsted F, Hsia SL, Matthews ML, Ghitza UE, Wu LT, Bart G. Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy. Subst Abus 2023; 44:264-276. [PMID: 37902032 PMCID: PMC10870734 DOI: 10.1177/08897077231203849] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.
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Affiliation(s)
- Jennie B. Jarrett
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, USA
| | - Jeffrey Bratberg
- Department of Pharmacy Practice and Clinical Research, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Anne L. Burns
- American Pharmacists Association, Washington, DC, USA (retired)
| | - Gerald Cochran
- Department of Internal Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Bethany A. DiPaula
- Department of Practice, Sciences, and Health Outcomes Research, School of Pharmacy, University of Maryland Baltimore, Baltimore, MD, USA
| | | | - Abigail Elmes
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois Chicago, Chicago, USA
| | - Traci C. Green
- COBER on Opioids and Overdose at Rhode Island Hospital and the Warren Alpert Medical School of Brown University, Providence, RI, USA
- Opioid Policy Research Collaborative, The Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Lucas G. Hill
- The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | | | - Stephanie L. Hsia
- Department of Clinical Pharmacy, San Francisco School of Pharmacy, University of California, San Francisco, CA, USA
| | - Michele L. Matthews
- Department of Pharmacy Practice, School of Pharmacy, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Udi E. Ghitza
- National Institute on Drug Abuse (NIDA), Center for the Clinical Trials Network (CCTN), Bethesda, MD, USA
| | - Li-Tzy Wu
- Duke University School of Medicine, Durham, NC, USA
| | - Gavin Bart
- Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA
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Skoy E, Frenzel O, Pajunen H, Eukel H. Implementation of a Pharmacy Follow-Up Program for Dispensed Opioid Medications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6628. [PMID: 37681768 PMCID: PMC10487139 DOI: 10.3390/ijerph20176628] [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: 06/27/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There have been multiple reported pharmacy initiatives to reduce opioid misuse and accidental overdose to address our nation's public health crisis. To date, there has not been a description in the literature of a community pharmacy follow-up initiative for dispensed opioids. METHODS A follow-up program was designed and implemented in community pharmacies as part of a previously developed opioid overdose and misuse prevention program (ONE Program). Five to twelve days after the dispensing of an opioid, pharmacy technicians called the patient to follow up on opioid safety topics. Pharmacy technicians used a questionnaire to inquire about medication disposal plans, if the patient was taking the medication more than prescribed, medication side effects, and if the patient needed a pharmacist consultation. The results from that questionnaire were documented. RESULTS During the first 18 months of the follow-up program, 1789 phone calls were completed. Of those contacted, 40% were still using their opioid medication, and over 10% were experiencing side effects which triggered a pharmacist consult. Patients were reminded of proper medication disposal methods, and most patients (78%) desired to dispose of unused medication at the pharmacy medication disposal box. CONCLUSIONS Follow-up phone calls post-opioid medication dispensing were shown to add value to a previously established opioid misuse and accidental overdose prevention program and allowed for the fulfillment of the Pharmacist Patient Care Process.
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Affiliation(s)
- Elizabeth Skoy
- Department of Pharmacy Practice, School of Pharmacy, North Dakota State University, Dept 2660, Fargo, ND 58108, USA; (O.F.); (H.P.); (H.E.)
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Abraham O, Slonac E, Paulsen Z. Pharmacists' perspectives on MedSMA℞T: A serious game to educate youth about opioid safety. J Am Pharm Assoc (2003) 2023; 63:1087-1094.e1. [PMID: 37116795 PMCID: PMC10942740 DOI: 10.1016/j.japh.2023.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Adolescent opioid misuse has been recognized as a dire public health issue. Despite efforts to address the opioid epidemic in the United States, opioid-related morbidity and mortality have continued to rise. Few interventions have been tailored to prevent adolescent opioid misuse. MedSMA℞T: Adventures in PharmaCity (MedSMA℞T), is a serious game that educates the end-user by challenging them to make applicable decisions in a low-stakes environment. OBJECTIVE The study aimed to characterize pharmacists' perspectives on using MedSMA℞T to educate adolescents and families about opioid medication safety. METHODS Pharmacists were recruited from the Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin. Consented pharmacists played the MedSMA℞T game for 30 minutes while a research team member observed via Zoom. Virtual semi-structured interviews (45 minutes) were recorded and transcribed verbatim. Two members of the research team independently coded each transcript using NVivo software to conduct inductive thematic analyses. Bi-weekly meetings were held to discuss and refine codes as well as the master codebook, and identify prevalent themes (intercoder reliability, kappa = 0.91). RESULTS Twenty-two pharmacists were interviewed between August and November 2021. Four themes were identified: game content and design, patient education, implementation barriers, and implementation facilitators. Most pharmacists perceived MedSMA℞T to be an effective resource for opioid safety education. Pharmacists reported that age-appropriate language was used in combination with realistic scenarios and relatable characters. Pharmacists also highlighted the value of interactive gameplay to engage the player to actively learn and recall educational content. CONCLUSIONS Pharmacists play an integral role as medication experts and contributed valuable insights into using and incorporating the MedSMA℞T game into various pharmacy practice settings. Future work is necessary to understand parents' and adolescents' perceptions of using MedSMA℞T as an opioid safety education tool in pharmacies.
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Affiliation(s)
- Olufunmilola Abraham
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
| | - Evan Slonac
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
| | - Zachary Paulsen
- University of Wisconsin School of Pharmacy, Social and Administrative Sciences Division, Madison, WI
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Chatterjee A, Bannister M, Hill LG, Davis CS. Prescribing Syringes to People Who Inject Drugs: Advancing Harm Reduction in Primary Care. J Gen Intern Med 2023; 38:1980-1983. [PMID: 37020124 PMCID: PMC10271981 DOI: 10.1007/s11606-023-08183-7] [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: 08/08/2022] [Accepted: 03/20/2023] [Indexed: 04/07/2023]
Abstract
Access to new syringes can reduce the risk of HIV and hepatitis C transmission, skin and soft tissue infections, and infectious endocarditis for people who inject drugs (PWID). Syringe service programs (SSPs) and other harm reduction programs are a good source of syringes. However, they are sometimes not accessible due to limited hours, geographic barriers, and other factors. In this perspective, we argue that when PWID faces barriers to syringes physicians and other providers should prescribe, and pharmacists should dispense, syringes to decrease health risks associated with syringe re-use. This strategy is endorsed by professional organizations and is legally permissible in most states. Such prescribing has numerous benefits, including insurance coverage of the cost of syringes and the sense of legitimacy conveyed by a prescription. We discuss these benefits as well as the legality of prescribing and dispensing syringes and address practical considerations such as type of syringe, quantity, and relevant diagnostic codes, if required. In the face of an unprecedented overdose crisis with many associated health harms, we also make the case for advocacy to change state and federal laws to make access to prescribed syringes uniform, smooth, and universal as part of a suite of harm reduction efforts.
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Affiliation(s)
- Avik Chatterjee
- Boston Health Care for the Homeless Program, Boston, MA, USA.
- Boston Medical Center, Boston, MA, USA.
- Boston University School of Medicine, Boston, MA, USA.
| | | | - Lucas G Hill
- The University of Texas at Austin College of Pharmacy, Austin, TX, USA
| | - Corey S Davis
- Network for Public Health Law, Edina, MN, USA
- NYU Grossman School of Medicine, New York City, NY, USA
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8
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Cheetham A, Morgan K, Jackson J, Lord S, Nielsen S. Informing a collaborative-care model for delivering medication assisted treatment for opioid dependence (MATOD): An analysis of pharmacist, prescriber and patient perceptions. Res Social Adm Pharm 2023; 19:526-534. [PMID: 36216753 DOI: 10.1016/j.sapharm.2022.09.009] [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: 02/15/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Demand for medication assisted treatment for opioid dependence (MATOD) in Australia exceeds capacity, particularly in rural and regional areas. There is increasing recognition that community pharmacists are well-positioned to take on expanded roles in MATOD delivery, however there has been limited Australian research exploring attitudes of pharmacists, prescribers, and patients to collaborative models of care. OBJECTIVE(S) This study aimed to better understand enablers and barriers to a collaborative model for MATOD, to inform implementation in regions where increases in treatment capacity are urgently needed. METHODS Semi-structured telephone interviews were conducted with pharmacists (n = 11), prescribers (n = 6), and patients (n = 8) recruited from the Frankston-Mornington Peninsula region in Victoria, Australia, where transport and access to services have impacts on health care utilisation. The COM-B model was used to explore perceptions of pharmacists' capability, opportunity, and motivations for delivering collaborative care. RESULTS There was strong motivation among healthcare professionals to participate in a collaborative model of care, with the main perceived benefits including improvements in accessibility, convenience, and continuity of care, and leverage of pharmacists' high level of patient engagement. Key barriers identified by both pharmacists and prescribers included a perceived lack of pharmacist skills in some areas (capability) and resources (opportunity) to deliver collaborative care in a community pharmacy setting. Established relationships between all stakeholders (social opportunity) and communication between pharmacists and prescribers were identified as facilitators. Barriers and facilitators aligned with seven key areas: skills, confidence, relationships, patient selection, protocols, communication and resources. CONCLUSIONS Findings informed the development of a collaborative model that was individualised, protocol based, and supported by training and clear processes. PROJECT IMPACT This study identifies specific barriers and facilitators to a pharmacist-prescriber collaborative model of care for MATOD. The resulting model will be tested in a hybrid implementation-effectiveness trial in the Frankston-Mornington Peninsula region.
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Affiliation(s)
- Ali Cheetham
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia.
| | - Kirsty Morgan
- Frankston Mornington Peninsula Primary Care Partnership, Peninsula Health, Victoria, Australia
| | - John Jackson
- Centre for Medicine Use and Safety (CMUS), Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sarah Lord
- Pharmacotherapy Mediation, Advocacy, and Support (PAMS), Harm Reduction Victoria, Australia
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University Peninsula Campus, Frankston, Victoria, Australia
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9
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Loera LJ, Hill LG, Zagorski CM, Jermain ML, Tirado CF. Description and Evaluation of a Pilot Advanced Pharmacy Practice Experience in Addiction Medicine. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2023; 87:ajpe8926. [PMID: 35131764 PMCID: PMC10159605 DOI: 10.5688/ajpe8926] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/01/2022] [Indexed: 05/06/2023]
Abstract
Objective. To assess the impact of a pilot advanced pharmacy practice experience (APPE) on fourth-year (P4) Doctor of Pharmacy (PharmD) students' knowledge and confidence related to substance use disorder, harm reduction, and co-occurring psychiatric conditions.Methods. Beginning in 2020, a 62-item assessment was developed and administered to P4 students at the beginning and end of the six-week APPE. The assessment tested knowledge in 10 content areas related to substance use disorder, harm reduction, and co-occurring disorders. Students also ranked their confidence in providing care related to each content area. The post-assessment included a free-text (open-ended) item to provide feedback on the APPE experience. Descriptive statistics and paired t tests were used to analyze the data.Results. Complete pre- and post-assessments were obtained from all participating students (N=7). The mean cumulative knowledge score increased from 55.2% to 81.5%, and the mean cumulative confidence score improved from 34.2% to 81.8%. Free-text responses garnered positive feedback from students, who indicated that the APPE allowed them to immerse themselves in all stages of the recovery process, gain confidence in presentation skills with patients, and solidify their passion for addiction medicine.Conclusion. A novel APPE in addiction medicine addressed a current gap in pharmacy education, earned positive evaluations from student pharmacists, increased student knowledge and confidence related to substance use disorder, harm reduction, and co-occurring disorders, and supported the development of new interprofessional collaborations. United States colleges of pharmacy that do not yet offer APPEs in this clinical domain should consider this model.
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Affiliation(s)
- Lindsey J Loera
- The University of Texas at Austin, College of Pharmacy, Austin, Texas
| | - Lucas G Hill
- The University of Texas at Austin, College of Pharmacy, Austin, Texas
| | - Claire M Zagorski
- The University of Texas at Austin, College of Pharmacy, Austin, Texas
| | - Mandy L Jermain
- Pharmacyclics, An AbbVie Company, Silicon Valley, California
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10
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Positive Patient Postoperative Outcomes with Pharmacotherapy: A Narrative Review including Perioperative-Specialty Pharmacist Interviews. J Clin Med 2022; 11:jcm11195628. [PMID: 36233497 PMCID: PMC9572852 DOI: 10.3390/jcm11195628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 11/19/2022] Open
Abstract
The influence of pharmacotherapy regimens on surgical patient outcomes is increasingly appreciated in the era of enhanced recovery protocols and institutional focus on reducing postoperative complications. Specifics related to medication selection, dosing, frequency of administration, and duration of therapy are evolving to optimize pharmacotherapeutic regimens for many enhanced recovery protocolized elements. This review provides a summary of recent pharmacotherapeutic strategies, including those configured within electronic health record (EHR) applications and functionalities, that are associated with the minimization of the frequency and severity of postoperative complications (POCs), shortened hospital length of stay (LOS), reduced readmission rates, and cost or revenue impacts. Further, it will highlight preventive pharmacotherapy regimens that are correlated with improved patient preparation, especially those related to surgical site infection (SSI), venous thromboembolism (VTE), nausea and vomiting (PONV), postoperative ileus (POI), and emergence delirium (PoD) as well as less commonly encountered POCs such as acute kidney injury (AKI) and atrial fibrillation (AF). The importance of interprofessional collaboration in all periprocedural phases, focusing on medication management through shared responsibilities for drug therapy outcomes, will be emphasized. Finally, examples of collaborative care through shared mental models of drug stewardship and non-medical practice agreements to improve operative throughput, reduce operative stress, and increase patient satisfaction are illustrated.
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11
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Skoy E, Frenzel O, Eukel H, Lothspeich E, Steig J, Strand M, Werremeyer A. Evaluation of a Program to Screen Patients in Community Pharmacies for Opioid Misuse and Accidental Overdose. Prev Chronic Dis 2022; 19:E41. [PMID: 35834737 PMCID: PMC9336191 DOI: 10.5888/pcd19.220028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Community pharmacies nationwide have adopted new strategies to combat the opioid epidemic. One strategy to prevent opioid misuse and accidental overdose is patient screening to identify those at risk. The purpose of our study was to determine whether such screening in community pharmacies led pharmacy personnel to intervene with patients at risk and to describe the proportion of patients they identified as at risk. Methods We implemented the Opioid and Naloxone Education (ONE) program in North Dakota to give community pharmacies and pharmacists training and tools to provide preventive screening for opioid misuse and accidental overdose before dispensing a prescribed opioid. Data were collected and analyzed from September 15, 2018, through May 15, 2021, to evaluate overall patient risk characteristics for opioid misuse and accidental overdose. Results Of 8,217 patients screened, 3.9% were identified as at high risk for opioid misuse, and 18.3% at risk for accidental overdose. Nearly 1 of 3 screenings (31.7%) indicated opioid medication use in the past 60 days. Pharmacists delivered 1 or more risk-factor–dependent interventions to 41.1% of patients in the study. Following screening, naloxone dispensing in pharmacies increased to 6 times the national average. Conclusion Pharmacy-based patient screening for risk of opioid misuse and accidental overdose led to risk-dependent interventions targeted to individual patients. The tools and risk-dependent interventions applied in the ONE program increased patient awareness of opioid risks and ways to reduce risk. Future studies should examine long-term outcomes, including reduction in overdose, treatment of opioid use disorder, and reduced opioid-related acute care.
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Affiliation(s)
- Elizabeth Skoy
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58108.
| | - Oliver Frenzel
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Heidi Eukel
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Emily Lothspeich
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Jayme Steig
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Mark Strand
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Amy Werremeyer
- North Dakota State University School of Pharmacy, Fargo, North Dakota
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12
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Chen AMH, Gardner J, Wandling E, Wicker E, Grauer P, Sweeney MA. The impact of a provider motivational interviewing-based training on chronic pain management in a federally-qualified health center. Res Social Adm Pharm 2022; 18:3839-3845. [PMID: 35400614 DOI: 10.1016/j.sapharm.2022.04.001] [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: 06/20/2021] [Revised: 02/04/2022] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND While the issue of opioid misuse is very complex, pharmacists have a unique opportunity to participate in interprofessional, team-based care. Motivational interviewing (MI) has been shown to be effective in chronic disease management and could improve patient engagement and chronic pain outcomes. OBJECTIVES To determine the impact of an MI-based provider training on changes in chronic pain management prescribing and on provider and patient perceptions. METHODS Providers participated in a pharmacist-led, 4-session educational intervention covering the CDC opioid prescribing guidelines, pain management, clinical pearls, and MI. Providers were then asked to implement the training in patient appointments for chronic pain management and refer appropriate patients for follow-up on goals. In the follow-up, student pharmacists called patients twice monthly for three months using MI. To address the primary outcome, the number of opioid prescriptions, morphine daily equivalents, and naloxone prescriptions were recorded and compared from the electronic medical record for the year preceding and following the intervention. Patients and providers completed surveys to assess the impact of these interventions. RESULTS Providers (n = 11) reported increased confidence in MI from baseline to 12 months following the intervention but no change in satisfaction. Patients (n = 19) were able to set and accomplish 20 goals throughout the phone call intervention. Meanwhile, the number of opioid prescriptions significantly decreased from 569 to 368 prescriptions per year before and after the intervention, respectively. Morphine daily equivalents per prescription decreased from 26.8 to 26.4 for the year before versus the year following the intervention. CONCLUSIONS MI interventions for providers and patients may positively impact goal setting and opioid prescribing. However, MI alone may not successfully address provider satisfaction and patient physical functioning. Pain management is an area that may benefit from a multi-faceted, interprofessional approach.
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Affiliation(s)
- Aleda M H Chen
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Julia Gardner
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Elizabeth Wandling
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Emily Wicker
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
| | - Phyllis Grauer
- ChaRxis Consulting, 7661 Cook Rd., Plain City, OH, 43064, USA.
| | - Marc A Sweeney
- Cedarville University School of Pharmacy, 251 N. Main St., Cedarville, OH, 45314, USA.
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13
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Kosobuski L, Hawn A, France K, Chen N, LaPlante C, Palombi L. Using Qualitative, Community-Based Input to Steer Post-COVID-19 Pharmacy Practice in Substance Use. J Am Pharm Assoc (2003) 2022; 62:1555-1563.e2. [PMID: 35428578 PMCID: PMC8933963 DOI: 10.1016/j.japh.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/02/2022] [Accepted: 03/16/2022] [Indexed: 11/24/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a disproportionately negative impact on individuals with a substance use disorder (SUD). A rapidly changing public health and treatment environment has resulted in increased needs for pharmacist engagement in SUD-focused patient care. Objectives This study used semistructured interviews of SUD professionals to evaluate where they believe pharmacy practice could better support people at risk of or having SUD in light of challenges posed by the COVID-19 pandemic. Methods Professionals dedicated to the care of individuals with SUD were recruited from a large community substance use coalition to participate in a qualitative study examining how pharmacists could take a more active role in SUD prevention, intervention, recovery, and harm reduction (HR). A consensual qualitative research approach was used in data analysis. Results Domains identified in analysis included pharmacists as educators of patients and communities, pharmacists as educators of health care providers, pharmacists as advocates for individuals with SUD, the need for increased pharmacist engagement owing to COVID-19 challenges for individuals with SUD, the need for expanded pharmacy practice interventions, and the need for pharmacist self-development. Conclusion Increased medication counseling, HR practices, addressing stigma, and community-level education focused on SUD were among the most commonly reported areas for pharmacy practice development. In addition, the urgent need to adjust pharmacy practice in response to the COVID-19 pandemic was also identified by interviewees.
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14
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Caron O, Fay AE, Pressley H, Seamon G, Taylor SR, Wilson CG. Four models of pharmacist‐integrated office‐based opioid treatment. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Olivia Caron
- Mountain Area Health Education Center (MAHEC) Family Health Center, 123 Hendersonville Rd Asheville North Carolina USA
| | | | - Haley Pressley
- University of North Carolina (UNC) Eshelman School of Pharmacy Chapel Hill North Carolina
| | - Gwen Seamon
- MAHEC Family Health Center Asheville North Carolina
| | | | - Courtenay Gilmore Wilson
- Department of Family Medicine, Mountain Area Health Education Center (MAHEC) Asheville North Carolina
- Department of Research, UNC Health Sciences at MAHEC Asheville North Carolina
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy Chapel Hill North Carolina
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15
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Cleary J, Engle A, Winans A. Pharmacists' role in buprenorphine management for opioid use disorder: A narrative review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Amanda Engle
- Albany College of Pharmacy and Health Sciences Albany New York USA
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16
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Kelsch JR, Bailey AM, Baum RA, Metts EL, Weant KA. Guidance for emergency medicine pharmacists to improve care for people with opioid use disorder. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jordan R. Kelsch
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Abby M. Bailey
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Regan A. Baum
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Elise L. Metts
- Department of Pharmacy University of Kentucky HealthCare Lexington Kentucky USA
| | - Kyle A. Weant
- Department of Clinical Pharmacy and Outcome Sciences University of South Carolina College of Pharmacy Columbia South Carolina USA
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17
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Mohammad I, Berri D, Tutag Lehr V. Pharmacists and opioid use disorder care during COVID-19: Call for action. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021; 5:203-213. [PMID: 34909605 PMCID: PMC8661525 DOI: 10.1002/jac5.1556] [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: 02/16/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022]
Abstract
Opioid use disorder (OUD) is a chronic relapsing condition characterized by problematic opioid use causing significant impairment in daily life. Medication for opioid use disorder using buprenorphine, methadone, and naltrexone with behavioral therapy reduces illicit opioid use and risk of overdose death. Despite evidence and decades of experience, barriers limit access to treatment and care for individuals with OUD. Barriers include a lack of treatment centers particularly in rural areas, regulations on buprenorphine prescribing, and stigma from the community and health care professionals. While many barriers are longstanding, the coronavirus disease 2019 (COVID‐19) pandemic‐forced isolation and associated stress has exacerbated challenges for individuals with mental health conditions such as OUD. Pharmacists are well‐positioned to bridge existing gaps in OUD care, particularly during the COVID‐19 pandemic. Roles for pharmacists include OUD risk identification and screening, referral of patients to treatment and support programs, ensuring medication access, expanding naloxone access, and advocacy initiatives. This review article identifies barriers to care for patients with OUD during the COVID‐19 pandemic and explores opportunities and resources for pharmacists to improve OUD care during the pandemic and beyond.
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Affiliation(s)
- Insaf Mohammad
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan USA.,Ambulatory Care Clinical Pharmacy Beaumont Hospital, Dearborn Dearborn Michigan USA
| | - Dena Berri
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan USA
| | - Victoria Tutag Lehr
- Department of Pharmacy Practice Eugene Applebaum College of Pharmacy and Health Sciences Wayne State University Detroit Michigan USA
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18
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Juba KM, Triller D, Myrka A, Cleary JH, Winans A, Wahler RG, Argoff C, Meek PD. Pain
management‐related
assessment and communication across the care continuum: Consensus of the opioid task force of the island peer review organization pain management coalition. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Katherine M. Juba
- Department of Pharmacy Practice St. John Fisher College, Wegmans School of Pharmacy Rochester New York USA
| | - Darren Triller
- Department of Quality Improvement Island Peer Review Organization Albany New York USA
| | - Anne Myrka
- Department of Quality Improvement Island Peer Review Organization Albany New York USA
| | - Jacqueline H. Cleary
- Department of Pharmacy Practice Albany College of Pharmacy and Health Sciences Albany New York USA
| | - Amanda Winans
- Bassett Healthcare Network Bassett Medical Center Cooperstown New York USA
| | - Robert G. Wahler
- Department of Pharmacy Practice University at Buffalo School of Pharmacy and Pharmaceutical Sciences Buffalo New York USA
| | - Charles Argoff
- Department of Neurology Albany Medical College Albany New York USA
- Comprehensive Pain Center, Albany Medical Center Albany New York USA
| | - Patrick D. Meek
- Department of Pharmacy Practice Albany College of Pharmacy and Health Sciences Albany New York USA
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19
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Irwin MN, Walkerly A. Role of the pharmacist in acute care interventions for opioid use disorder: A scoping review. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Madison N. Irwin
- Department of Pharmacy Services Michigan Medicine Ann Arbor Michigan USA
- University of Michigan College of Pharmacy Ann Arbor Michigan USA
| | - Autumn Walkerly
- Department of Pharmacy Services Michigan Medicine Ann Arbor Michigan USA
- University of Michigan College of Pharmacy Ann Arbor Michigan USA
- Department of Clinical Pharmacy University of Southern California School of Pharmacy, Los Angeles County + USC Medical Center Los Angeles California USA
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20
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Fatani S, Bakke D, Halpape K, D'Eon M, El-Aneed A. Development and validation of patient-community pharmacist encounter toolkit regarding substance misuse: Delphi procedure. J Am Pharm Assoc (2003) 2021; 62:176-186. [PMID: 34538771 DOI: 10.1016/j.japh.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/15/2021] [Accepted: 08/15/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pharmacists' roles and services for patients with substance use are not well defined and inconsistent from site to site. Several barriers have been identified that hinder pharmacists' care for people who use substances, such as a lack of training and resources. Clinical practice tools can aid in transferring evidence-based approaches to the practice sphere. OBJECTIVES The aim of the study was to develop a substance misuse management toolkit for community pharmacists to help them manage their encounters with people who use substances. METHODS A focused literature review was conducted and 2 needs assessment studies, one for community pharmacists and one for patients informed the development of the toolkit. The toolkit is an adaption of the screening, brief intervention, and referral to treatment (SBIRT) approach, which is one of the most well-defined and effective strategies for substance use management. However, SBIRT is a novel care model in community pharmacy settings. Therefore, a substance misuse management toolkit with 20 items was created for community pharmacists incorporating evidence-based strategies and clinical algorithms. Delphi procedure was used to validate the toolkit. RESULTS Two rounds of questions were sent to experts in the field of substance misuse, some of whom were pharmacists. In both rounds, these experts were asked to rate the appropriateness and clarity of items in the toolkit and provide comments and suggestions. Items with a median rating of 7 or more out of 10 were included in the toolkit. In the second round, the experts were asked to rerate the revised version and provide additional feedback. After the second round, agreement was reached for almost all items of the toolkit. CONCLUSION A Delphi procedure was successfully used to provide evidence of the validity of the new guiding toolkit for community pharmacists. The toolkit will be implemented and evaluated to provide additional evidence of validity in practice.
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21
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Muzzy Williamson JD, DiPietro Mager N, Bright D, Cole JW. Opioid use disorder: Calling pharmacists to action for better preconception and pregnancy care. Res Social Adm Pharm 2021; 18:3199-3203. [PMID: 34400110 DOI: 10.1016/j.sapharm.2021.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 08/03/2021] [Accepted: 08/03/2021] [Indexed: 11/28/2022]
Abstract
Opioid use disorder (OUD) in women of child-bearing potential is problematic in the United States. This has resulted in increasing risk for adverse maternal outcomes, neonatal abstinence syndrome, fetal and neonatal harm, prolonged hospitalizations, and increased health care costs. Pharmacists in all practice settings have opportunities to provide preconception and pregnancy care to prevent and manage OUD. Given pharmacists' scope of practice and expertise, key roles include assessing patients for OUD; mitigating exposure; educating patients regarding potential infant effects; recommending contraceptive methods and counseling on proper use; ensuring safe breastfeeding with concurrent medications; and linking patients to needed services. Through patient counseling, medication management, and harm reduction interventions, pharmacists can work to combat this public health crisis. To encourage increased uptake of pharmacists into these roles, more needs to be done to reimburse pharmacists for these important services and quantify their impact on patient and population health outcomes.
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Affiliation(s)
- Julia D Muzzy Williamson
- North Dakota State University School of Pharmacy, 1401 Albrecht Boulevard, Fargo, ND, 58108, USA.
| | - Natalie DiPietro Mager
- Ohio Northern University Raabe College of Pharmacy, 525 S. Main St, Ada, OH, 45810, USA.
| | - David Bright
- Ferris State University College of Pharmacy, 220 Ferris Dr, Big Rapids, MI, 49307, USA.
| | - Justin W Cole
- Cedarville University School of Pharmacy, 251 N. Main St, Cedarville, OH, 45314, USA.
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