Pharmacist contributions to the ten essential services of public health in three National Association of Boards of Pharmacy regions

Pain Physicians' Attitudes and Experiences Regarding Clinical Pharmacy Services in China: A National Cross-Sectional Survey

Purpose

Pharmacists are key members of the pain management interdisciplinary team in many developed countries. However, the implementation of clinical pharmacy services in pain management is impeded by the imbalance between the pain physicians and clinical pharmacists specializing in pain management in China. The purpose of this study was to elucidate the perceptions, expectations and current experience of Chinese pain physicians regarding clinical pharmacy services.

Patients and Methods

An anonymous, self-administered questionnaire was designed according to previously published studies with minor modifications and distributed online to 1100 pain physicians selected randomly in hospitals across all 31 provinces of mainland China in 2021. Data were analyzed using descriptive and inferential statistics.

Results

A total of 1071 valid questionnaires were included for analysis. The pain physicians were from all 31 provinces of mainland China and most of them were from tertiary hospitals holding an undergraduate degree. Among listed kinds of clinical pharmacy services, pain physicians were less comfortable with pharmacists treating minor illnesses (p < 0.001). Pain physicians' experiences with clinical pharmacy services were far less than their expectations (p < 0.001), which is in line with the results that most of pain physicians (65.9%) interacted with pharmacists at a frequency of less than once a week. Significant differences in the experiences were found among ages (p < 0.01) and among years of work experience (p < 0.05) of pain physicians. Pain physicians' expectations of pharmacists were positively correlated with their experiences with clinical pharmacy services (p < 0.001).

Conclusion

Pain physicians in China had positive perceptions and high expectations, but relatively low experiences regarding clinical pharmacy services. Expanding clinical pharmacist pain management credentialing and increasing pain physicians' exposure to clinical pharmacy services are favourable to support the interdisciplinary collaboration in pain management in China.

A comparative analysis of pharmaceutical workforce development needs across the commonwealth

BACKGROUND

Increasing demographic healthcare challenges, such as increased life expectancy coupled with increased use of medicines for complex morbidities, point to the need for globally applicable transformative policies in health workforce development. The International Pharmaceutical Federation (FIP) has established a set of 21 Global Development Goals (FIP DGs) to strengthen pharmacy workforce and benchmark professional developmental needs.

OBJECTIVE

This study aimed to identify policy directions and factors affecting pharmacy workforce development across the Commonwealth, and to examine country progress made towards implementing workforce oriented FIP DGs.

METHODS

The study involved a literature review and a global survey of commonwealth countries professional leadership bodies. The literature database search included PubMed/Medline, CINAHL, Scopus and PsychINFO databases as well as the websites of the respective national pharmacy organisations of Commonwealth countries. A global survey was also conducted to assess country-level alignment with the workforce component of FIP DGs.

RESULTS

Thirty-one articles representing 21 Commonwealth countries were included in the literature overview. The development needs identified were workforce shortages and inequitable distribution across practice areas and geographical regions, low workforce supply capacity, workforce feminisation, lack of professional recognition, limited training opportunities, low job satisfaction, high workload and attrition. The survey showed disparities in country-level progress and alignment with the FIP DGs. High-income countries in the survey sample reported alignment with most of the FIP DGs, while the low-income countries reported alignment with fewer DGs. More than two-thirds of the countries showed alignment with the FIP DGs related to academic capacity, early career training, quality assurance and advancing integrated services. About half reported alignment with the FIP DGs related to competency and leadership development, respectively, while only a third aligned with the equity and equality DG.

CONCLUSION

This study identified realistic pharmacy workforce developmental needs across a range of Commonwealth countries. Addressing these needs through appropriate policy interventions will be essential for increasing the pharmacy workforce capacity and assuring the delivery of high-quality pharmaceutical care and medicines expertise in these countries.

A case of pharmacist-led care team interventions to maximize rural patient quality of life

A 64-year-old rural home bound patient in Washington State was identified to be at increased risk for negative health care outcomes related to chronic end kidney disease and poorly controlled diabetes. The patient lacked understanding of the use of monitoring equipment as well as diabetes education to improve quality of health; he also did not have access to medical supply equipment. A pharmacist-led care team comprised of a pharmacist, a community health worker, and a home health nurse implemented comprehensive medication review techniques as well as direct patient care education to engage the patient in managing his health. Involvement with this home visit care team combined with the patient's recently developed interest in managing his health re-engaged the patient. He began attending more frequent visits with his providers and increased his interest in meeting with a diabetes educator at the local clinic. Resulting interactions with the patient's providers, pharmacy, and community resources increased patient's compliance, access to specialists of care, and in-home safety measures. Factors contributing to poorer overall health and higher rates of death among rural patients include increased travel time to health care facilities and providers, higher rates of unhealthy lifestyle choices such as cigarette smoking and obesity, higher rates of poverty and less access to healthcare in general. This scenario emphasizes the important role an interprofessional team plays in the care of isolated, rural health patients in managing chronic disease states for stability as well as quality of life.

Rural-Urban Disparities in Access to Medicaid-Contracted Pharmacies in Washington State, 2017

INTRODUCTION

Community retail pharmacies offer multiple public health services to meet the health care needs of medically underserved rural communities. Many rural residents are enrolled in Medicaid insurance, and it is important that pharmacies contract with Medicaid to meet the health care needs of these people. The objective of this study was to evaluate disparities in access to Medicaid-contracted pharmacies across the rural-urban continuum in Washington State.

METHODS

We linked data on licensed community retail pharmacies in Washington State in 2017 to lists of state Medicaid-contracted pharmacies. We classified pharmacies as being located in small rural, large rural, suburban, and urban areas by using rural-urban commuting area (RUCA) codes. We evaluated the likelihood of zip code-level access to at least 1 pharmacy that was contracted with a Medicaid insurance plan across the rural-urban continuum by using descriptive statistics and modified Poisson regression models, adjusted for zip code-level community characteristics.

RESULTS

Of 1,145 pharmacies in our study sample, 8.4% (n = 96) were not contracted with a Medicaid plan. Compared with urban core zip codes, small rural zip codes (adjusted relative risk [ARR] = 0.64; 95% CI, 0.46-0.91) and large rural zip codes (ARR = 0.68; 95% CI, 0.49-0.95) were significantly less likely to have access to a Medicaid-contracted pharmacy. Suburban zip codes did not differ significantly from urban core areas in their access to Medicaid-contracted pharmacies.

CONCLUSION

In Washington State, the likelihood of access to a Medicaid-contracted pharmacy decreased significantly as rurality increased. Policy efforts should aim to improve access for Medicaid enrollees, especially those outside urban centers.

Global Scope of Hospital Pharmacy Practice: A Scoping Review

The pharmacy profession has undergone tremendous changes over the past few decades. Pharmacists’ roles have expanded their boundaries to encompass more patient-centered services. However, the degree to which these roles are practised may vary. This scoping review is aimed at describing the extent and range of the professional pharmacy services offered in hospital pharmacies across different countries and the barriers underlying inappropriate or incomplete implementation of these services. Studies published in the English language between 2015 and 2019 were retrieved from the following databases: PubMed, CINAHL, Scopus, EBSCO Discovery Service, and Web of Science. A thematic analysis across the included studies produced two main themes. “Scope of practice” comprised three subthemes: pharmaceutical care practice, clinical pharmacy practice, and public health services and “Multiple levels of influence” comprised five subthemes: individual, interpersonal, institutional, community, and public policy-related factors. The hospital pharmacy services across countries ranged from traditional drug-centered pharmacy practice to a more progressive, clinically oriented practice. In some countries, there is an apparent inadequacy in the clinical pharmacy services provided compared to other clinical settings. Understanding the current pharmacy practice culture across different health care systems is an essential step towards improving the profession.