Rural Disparities in Alzheimer's Disease-Related Community Pharmacy Care in the United States

Rural-urban differences in use of health services before and after dementia diagnosis: a retrospective cohort study

BACKGROUND

Rural-urban differences in health service use among persons with prevalent dementia are known. However, the extent of geographic differences in health service use over a long observation period, and prior to diagnosis, have not been sufficiently examined. The purpose of this study was to examine yearly rural-urban differences in the proportion of patients using health services, and the mean number of services, in the 5-year period before and 5-year period after a first diagnosis of dementia.

METHODS

This population-based retrospective cohort study used linked administrative health data from the Canadian province of Saskatchewan to investigate the use of five health services [family physician (FP), specialist physician, hospital admission, all-type prescription drug dispensations, and short-term institutional care admission] each year from April 2008 to March 2019. Persons with dementia included 2,024 adults aged 65 years and older diagnosed from 1 April 2013 to 31 March 2014 (617 rural; 1,407 urban). Matching was performed 1:1 to persons without dementia on age group, sex, rural versus urban residence, geographic region, and comorbidity. Differences between rural and urban persons within the dementia and control cohorts were separately identified using the Z-score test for proportions (p < 0.05) and independent samples t-test for means (p < 0.05).

RESULTS

Rural compared to urban persons with dementia had a lower average number of FP visits during 1-year and 2-year preindex and between 2-year and 4-year postindex (p < 0.05), a lower likelihood of at least one specialist visit and a lower average number of specialist visits during each year (p < 0.05), and a lower average number of all-type prescription drug dispensations for most of the 10-year study period (p < 0.05). Rural-urban differences were not observed in admission to hospital or short-term institutional care (p > 0.05 each year).

CONCLUSIONS

This study identified important geographic differences in physician services and all-type prescription drugs before and after dementia diagnosis. Health system planners and educators must determine how to use existing resources and technological advances to support care for rural persons living with dementia.

Features of the Physical and Social Neighborhood Environment and Neighborhood-Level Alzheimer's Disease and Related Dementia in South Carolina

BACKGROUND

Studies are increasingly examining the relationship between the neighborhood environment and cognitive decline; yet, few have investigated associations between multiple neighborhood features and Alzheimer's disease and related dementias (ADRD).

OBJECTIVE

We investigated the relationship between neighborhood features and ADRD cumulative incidence from 2010 to 2014 in the South Carolina Alzheimer's Disease Registry (SCADR).

METHODS

Diagnosed ADRD cases ≥ 50  years of age were ascertained from the SCADR by ZIP code and census tract. Neighborhood features from multiple secondary sources included poverty, air pollution [particulate matter with a diameter of 2.5 micrometers or less (PM 2.5 )], and rurality at the census-tract level and access to healthy food, recreation facilities, and diabetes screening at the county level. In addition to using Poisson generalized linear regression to estimate ADRD incident rate ratios (IRR) with 95% confidence intervals (CIs), we applied integrated nested Laplace approximations and stochastic partial differential equations (INLA-SPDE) to address disparate spatial scales. We estimated associations between neighborhood features and ADRD cumulative incidence.

RESULTS

The average annual ADRD cumulative incidence was 690 per 100,000 people per census tract (95% CI: 660, 710). The analysis was limited to 98% of census tracts with a population ≥ 50  years old (i.e., 1,081 of 1,103). The average percent of families living below the federal poverty line per census tract was 18.8%, and ∼ 20 % of census tracts were considered rural. The average percent of households with limited access to healthy food was 6.4%. In adjusted models, every 5 μ g / m 3 ) increase of PM 2.5 was associated with 65% higher ADRD cumulative incidence (IRR = 1.65 ; 95% CI: 1.30, 2.09), where PM 2.5 at or below 12   μ g / m 3 is considered healthy. Compared to large urban census tracts, rural and small urban tracts had 10% (IRR = 1.10 ; 95% CI: 1.00, 1.23) and 5% (IRR = 1.05 ; 95% CI: 0.96, 1.16) higher ADRD, respectively. For every percent increase of the county population with limited access to healthy food, ADRD was 2% higher (IRR = 1.02 ; 95% CI: 1.01, 1.04).

CONCLUSIONS

Neighborhood environment features, such as higher air pollution levels, were associated with higher neighborhood ADRD incidence. The INLA-SPDE method could have broad applicability to data collected across disparate spatial scales. https://doi.org/10.1289/EHP13183.

Development and Assessment of Targeted, Live, and Interactive Continuing Pharmacy Education Workshops in Dementia Care for North Dakota Pharmacists

Background With the growing US aging population, need for a health care workforce able to provide dementia care will increase. Objective To develop, deliver, and assess interactive live workshops for licensed North Dakota pharmacists in dementia care. Methods Prospective interventional study of impact of free-of-charge, interactive, five-hour workshops for pharmacists providing advanced training in Alzheimer's disease, vascular and Parkinson's disease dementia, dementia with Lewy bodies, and common reversible causes of cognitive impairment. The workshop was offered three times across two different locations in ND: Fargo and Bismarck. Online pre- and postworkshop questionnaires were administered to collect demographics, attendance rationale, perceived ability to provide dementia care, and workshop quality/satisfaction. A 16-item assessment instrument/ test (1 point/item) was developed to assess pre- and postworkshop competency in dementia-related care (ie, knowledge, comprehension, application, and analysis). Descriptive statistics and paired t-test were performed using Stata 10.1. Results Sixty-nine pharmacists were trained and completed the competency test assessments; 95.7% ND pharmacists completed pre-and postworkshop questionnaires. The overall competency test scores improved from 5.7 ± 2.2 to 13.0 ± 2.8 (P < 0.001) and individual scores for each disease/problem also improved significantly (P < 0.001). Increases corresponded with increased self-reported perceived ability to provide dementia care; 95.4 to 100% of participants agreed/strongly agreed learning needs were met, teaching was effective, were satisfied with content and educational material usefulness, and would recommend workshop. Conclusion Workshop had measurable, immediate benefit on knowledge and ability to apply learned information. Structured, interactive workshops are valuable for improving pharmacists' competency in dementia care.

Insights into disease and pharmacotherapy knowledge of Alzheimer's disease among community pharmacists: a cross-sectional study

OBJECTIVE

To assess the knowledge level and awareness of Alzheimer's disease, including knowledge about the disease, pharmacotherapy, provision of patient education and associated factors among community pharmacists across Turkey and Northern Cyprus.

METHODS

This was a descriptive, cross-sectional study conducted among community pharmacists working in Turkey (Group A) and Northern Cyprus (Group B). Disease and pharmacotherapy knowledge of AD were assessed using AD Knowledge Scale (ADKS), and drug treatment (KADT) scale, respectively.

RESULTS

Both groups reported a moderate level of knowledge of AD, especially medically-oriented domains, with no significant difference regarding the mean ADKS domains (18.8 ± 2.8 vs. 18.9 ± 3.4; p = .98). Nevertheless, participants from both groups reported a good level of KADT knowledge about AD treatment (p = .03). Group A reported a statistically significant higher level of knowledge about drug interactions compared with Group B (54.6% vs. 45.8%; p = .01), and knowledge about proper information (79.6% vs. 31.8%; p = .02). There was a statistically significant KADT difference correlated with gender, those having a Master degree, more than 5 years of work experience, and those taking AD training courses.

CONCLUSION

There is still a lack of knowledge regarding AD reported by moderate ADKS score, especially in medically-oriented domains, which creates a barrier to early provision of care and preventing AD, noted with no difference among community pharmacists across Turkey and Northern Cyprus.

Examining the barriers of influenza vaccine hesitancy in persons with dementia: a literature review

BACKGROUND/AIMS

Despite the proven benefits of vaccine prevention and the continuous development of this important public health measure, vaccine hesitancy is among the top ten threats to global health according to the World Health Organization in 2019. Those who contract the influenza virus will typically develop a mild illness. However, for populations at a higher risk, including those diagnosed with dementia, influenza is proven to be more detrimental. Persons with dementia (PWD) face a serious threat to influenza on an annual basis, and vaccine hesitancy may further potentiate this risk. The purpose of this paper is to explore and understand the barriers PWD face in receiving the influenza vaccine.

METHODS

A literature review was conducted to examine the barriers that prevent PWD from seeking out the annual influenza vaccine. A thematic analysis provided an understanding of the overarching relationships found among the influences between the identified themes.

RESULTS

Three main influences were identified: (1) intra-personal, (2) inter-personal, and (3) extra-personal, with each influence containing several subsequent sub-themes.

DISCUSSION/CONCLUSION

The literature review found that there is a lack of research involving this high-risk population and the barriers they face, especially within the extra-personal influences. Further research is required to understand how each barrier relates and connects with each other. Understanding this connection will aid public health organizations in decreasing the threat of vaccine hesitancy, thus decreasing the incidents of preventable deaths.

The Role of Pharmacist in the Health Care System: Current Scenario in India

Pharmacists are society's specialists on drugs. The Pharmacist of today is a drug-maker, drug-dispenser, drug-custodian, patient-counselor, drug-researcher, and drug-educator and above all an honest and patriotic citizen. The techno-proficient foundation of the drug expert gives him/her the certainty of providing services with a moral way to deal with the satisfaction of patients. The consecrated qualities are required to be cherished and professed by the pharmacist. Pharmacists assume a significant job in giving health care services, benefits by means of community pharmacy services in rural areas where physicians are not accessible or where physician services are unreasonably expensive for meeting the health care necessities. The paper at that point recognizes how pharmacists give expanded services, identifies key challenges and barriers, and suggests rules and regulations that could help secure open doors for pharmacists to play out an extended job.

Pharmacists’ Utilization of Information Sources Related to Community and Population Needs in the Upper Midwest and Associations with Continuing Professional Education

Background: To investigate information sources utilized in pharmacists’ assessment of population-based health needs and/or community changes; and the association between information sources utilized and reported completion of continuing professional education topics. Methods: In 2017; licensed pharmacists (n = 1124) in North Dakota; South Dakota; Minnesota; Iowa; and Nebraska completed a questionnaire on continuing professional education and information sources on population-based health needs and community changes. Data were entered; cleaned and imported into Stata 11.1. Census Bureau county-level population density data were used to classify local area characteristics. Descriptive statistics and multivariate logistic regression analyses were performed. Results: Most sources of primary; county-level data on population-based health needs or community changes were minimally utilized. Pharmacists in more rural areas were statistically more likely to use local health professionals; local non-health professionals; and/or the state health department compared to pharmacists in less rural areas. Pharmacists reporting higher use of population-based information sources were more likely to have completed continuing education in the past 12 months for all 21 surveyed topics; 13 significantly so. Conclusions: There is a reliance of pharmacists on information from local health and non-health professionals for information on population-based health needs and/or community changes. Utilization of health departments and other primary information sources was associated with increased rates of completion of an array of continuing professional education topics. Expanding utilization of evidence-driven information sources would improve pharmacists’ ability to better identify and respond to population-based health needs and/or community changes through programs and services offered; and tailor continuing professional education to population-based health needs.