Pharmacists perceptions of providing colorectal cancer screening in community-based practice

BACKGROUND

Colorectal cancer (CRC) is the third most common diagnosed cancer in the United States. Kentucky pharmacists can be instrumental in the CRC early detection process through board-authorized protocols (BAPs): a regulatory approach managed by the Kentucky Board of Pharmacy that allows pharmacists to increase access to care while saving lives through early detection screening. Determining the barriers and successes of implementing CRC screening can improve access to education and care for patients.

OBJECTIVE

This study aimed to evaluate community pharmacists' perceptions of implementing a colorectal screening for patients via protocol and identify pharmacists' confidence and potential barriers such as cost, staff support, and patient need for colorectal screening in community pharmacy settings.

METHODS

A survey was sent electronically to a convenience sample of pharmacists throughout Kentucky. The survey collected demographics, opinions regarding implementation of the CRC screening protocol, pharmacists' perceptions of knowledge, and the barriers and benefits associated with implementation of CRC services.

RESULTS

A total of 207 responses were received and of those 151 were from community-based pharmacists; 34% of pharmacists agreed or strongly agreed to offer CRC screening. Overwhelmingly, 81.3% of pharmacists reported need for additional training. There were no statistically significant differences in support among demographic factors: practice setting (P = 0.937), gender (P = 0.973), age (P = 0.568), and years practicing (P = 0.870). In addition, the most common barriers reported were lack of reimbursement (97%), lack of willingness for patients to pay (98%), and time or workflow issues (97%). Most pharmacists stated that lack of trust in pharmacists was not a barrier (87%).

CONCLUSIONS

Overall, 34% of pharmacists either agreed or strongly agreed to offer CRC screening via the board-approved protocol. However, overwhelmingly the pharmacists believe that there is a need for additional training and opportunities for additional training on BAPs have increased drastically in Kentucky. Barriers such as lack of reimbursement, willingness to pay, and time or workflow issues need to be overcome before implementation. Finding solutions to these barriers will increase pharmacist's support.

Patient Willingness to Use a Pharmacy-Based Colorectal Cancer Screening Service: A National Survey of U.S. Adults

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.

The community pharmacy model for colorectal cancer screening: Policy insights from a national programme

BACKGROUND

In Italy, a recent national project has expanded local collaboration between colorectal (CRC) screening programmes and pharmacies to the national level.

OBJECTIVE

The objective of this study is to provide an overview of the existing agreements between regional authorities and pharmacy owners in Italy regarding CRC screening programmes, to make internationally available the most qualifying elements of the collaboration.

METHODS

We analyzed the agreements, in force on 01/08/2021, arranged between the Regions and their respective pharmacy owners, describing the process phases addressed such as the faecal occult blood test pathway and supplementary activities provided by the pharmacies together with the CRC screening kit delivery.

RESULTS

Agreements were received from 18 Regions (86% of the total). The amount of money paid for each kit varies a lot, with a range from 0 to 18 EUR. The number of process phases covered by the agreements ranged from a maximum of 16 (out of 18) to a minimum of 0. The processes most frequently covered were the supply/delivery of kits and education/awareness of CRC screening (68.8%). Less covered processes were warehouse management and awareness of other healthcare initiatives (12.5%), and delivery of preparation for intestinal cleansing (6.3%).

CONCLUSIONS

Arrangements between pharmacies and CRC screening programmes in Italy vary widely and lack a unified model. Collaboration quality standards should be set at the national/international level.

Knowledge and attitudes of pharmacists towards colorectal cancer health education in Jordan: A cross-sectional study

AIMS OF THE STUDY

The purpose of this study was to assess pharmacists' knowledge and attitude towards early detection of colorectal cancer (CRC) in Jordan and to explore potential predictor variables of such knowledge and attitude.

METHODS USED TO CONDUCT THE STUDY

An electronic, self-reported questionnaire was used to collect data about demographics, knowledge and attitude regarding early detection of CRC. Both content and face validity were tested in a panel of experts. The participants' responses were analysed using descriptive statistics and multiple linear regressions.

RESULTS OF THE STUDY

The 352 pharmacists (78% females, 94% Jordanian) had a median age of 28 years and graduated mostly (83%) from public universities. Surprisingly, 90% were not able to identify carcinoembryonic antigen (CEA) as a non-accurate diagnostic method and almost one-third did not identify the correct screening tests. On a scale of 5, the majority of participants (59%) had moderate knowledge scores (3 or 4) in case scenarios. The median knowledge Percent of Maximum Possible (POMP) score was 67% and higher scores were associated with more years since graduation, pharmacists with MSc degree and higher, working in urban areas, studying oncology course and received oncology training (P < .05). Most participants showed a positive attitude towards early detection of CRC (median attitude POMP score was 78%). However, none of the analysed variables predicted their level of attitude.

CONCLUSIONS DRAWN FROM THE STUDY AND CLINICAL IMPLICATIONS

Although the majority of pharmacists demonstrated a positive attitude towards early detection of CRC, their knowledge was inadequate. The study highlighted the importance of optimising the education programmes to improve the pharmacists' knowledge about CRC early detection and preparing the pharmacists for participating in future national screening initiatives.

Role of community pharmacies in a population-based colorectal cancer screening program

In Catalonia (Spain), population-based colorectal cancer (CRC) screening offers biennial fecal occult blood testing to men and women aged 50-69 years old. The program is organized in screening hubs, most of which use a pharmacy-based model to distribute and collect fecal immunochemical test (FIT) kits The comprehensive evaluation of CRC screening programs, which include the role and implications of pharmacy involvement, is essential to ensure program quality and identify areas for further improvement. The present study aimed to assess the adherence of community pharmacies to the CRC screening program and to analyze data on FIT kit distribution and collection in the Metropolitan area of Barcelona (Catalonia, Spain). Time to FIT completion was assessed by Kaplan-Meier estimation, and with the log-rank test. A Cox regression model was used to adjust for other variables associated with the completion of FIT such as sex, age, deprivation score index and previous screening behavior. Overall, 82.4% of pharmacies adhered with CRC screening program. Out of 82,902 FIT kits distributed to screening invitees 77,524 completed FIT kits were returned to pharmacies (93.5%) with a participation of 39.8% among the 193,766 invitees. From those who completed a FIT, the median time to return the kit was 3 days. FIT completion time was significantly lower among women, older age, high deprivation score index and previous CRC screening (p < 0.005). Our findings highlight the large involvement of community pharmacists with CRC screening program as well as a high quality in the process of FIT distribution and collection.

The influence of intervention complexity on barriers and facilitators in the implementation of professional pharmacy services - A systematic review

BACKGROUND

Community pharmacies increasingly offer professional pharmacy services, whose implementation is often influenced by facilitating or obstructive implementation factors. The occurrence and composition of implementation factors vary among different services with discrete characteristics and complexity of the intervention, making it difficult to foresee potential barriers in implementation.

OBJECTIVE(S)

This paper investigates potential associations between intervention complexity and occurring implementation factors.

METHODS

A systematic literature search on the implementation factors and intervention complexity of professional pharmacy services in the community setting was carried out in electronic databases (PubMed, CINAHL, and PsycINFO) throughout December 2018. Implementation factors were extracted from semi-structured interviews, focus groups, and surveys with community pharmacists and categorized using the Consolidated Framework for Implementation Research (CFIR). The complexity of each service was assessed using the following complexity parameters: (I) number of involved healthcare professions, (II) number of service components such as recruiting of patients, screening intervention, and follow-up, (III) frequency of the service, (IV) expenditure of time per patient (encounter), and (V) workflow distortion, i.e. booking appointments for intervention with the patient. Finally, the association between implementation factors and intervention complexity was analyzed by quantifying implementation factors and by relating them to specific intervention characteristics using Fisher's exact test.

RESULTS

15 studies covering a broad spectrum of professional pharmacy services were included. There was a trend that in services with higher complexity more implementation factors occurred (p = 0.094). Single key complexity parameters can trigger specific implementation factors. For instance, general practitioner and pharmacy technician involvement were significantly associated with interprofessional communication and leadership engagement, respectively.

CONCLUSION

Key implementation factors and associated complexity parameters seem to be of similar or more importance than the total number of implementation factors with regard to successful implementation. By assessing various complexity parameters of an intervention, potential key barriers could be identified and subsequently addressed prior to implementation.

ECCO Essential Requirements for Quality Cancer Care: Primary care

BACKGROUND

ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration.

[Colorectal cancer screening in primary care pharmacy in Corsica: a support for the prevention in general medicine]

Colorectal cancer (CRC) affects approximately 43,000 people each year in France and is responsible for nearly 18,000 deaths a year. The national organized screening program contributes to its early detection. The test is available to the preferred GP or, to the Regional Center in charge of the invited public. Often the process of going to his doctor to get the test is not well accepted and the participation in organized screening is low. Our project aims to evaluate the impact of the provision of this test in pharmacies on screening for colorectal cancer in Corsica. The article describes the method used to mobilize the primary care pharmacists of the territory, provide them the test kits and follow-up of the people who took part in the test. The results presented highlight a very positive impact of the experiment with a progression of the realized rate to 36% over the period of 9 months.

Low participation in organized colorectal cancer screening in France: underlying ethical issues

International studies have shown a significant reduction in colorectal cancer (CRC) mortality following the implementation of organized screening programs, given a sufficient participation rate and adequate follow-up. The French national CRC screening program has been generalized since 2008 and targets 18 million men and women aged 50-74 years. Despite broad recommendations, the participation rate remains low (29.8%), questioning the efficiency of the program. A panel of experts was appointed by the French National Cancer Institute to critically examine the place of autonomy and efficiency in CRC screening and propose recommendations. In this paper, we explore the ethical significance of a public health intervention that falls short of its objectives owing to low take-up by the population targeted. First, we analyze the reasons for the low CRC screening participation. Second, we examine the models that can be proposed for public health actions, reconciling respect for the individual and the collective good. Our expert panel explored possible ways to enhance take-up of CRC screening within the bounds of individual autonomy, adapting awareness campaigns, and new educational approaches that take into account knowledge and analysis of sociocultural hurdles. Although public health actions must be universal, target actions should nonetheless be developed for nonparticipating population subgroups.

Health promotion of bowel cancer and breast cancer screening in community pharmacies: Pharmacists' perceptions of their role, knowledge and confidence

Objectives:

To identify community pharmacists’ perceptions of their role, knowledge and confidence in relation to bowel cancer and breast cancer screening health promotion.

Methods:

This was a mixed-methods study with community pharmacists and key informants in the Metro South Health (MSH) region of Brisbane, Queensland, Australia. In Part 1, quantitative data was collected from community pharmacists via an electronic survey. In Part 2, qualitative data was collected from community pharmacists and key informants via in-depth interviews. This paper reports the findings of community pharmacists’ perceptions of their role, knowledge and confidence to promote bowel cancer and breast cancer screening in community pharmacies.

Results:

A total of 27 community pharmacists (13 males, 14 females) completed the survey. Most (71%) either ‘agreed’ or ‘strongly agreed’ discussing health advice, such as cancer screening, with their consumers was valuable and integral to their broader role. An average of 60% described their confidence as ‘average’ or ‘good’ when discussing bowel and breast cancer screening and prevention with consumers. In eight knowledge questions about bowel and breast cancer and cancer screening, an average of 82% of community pharmacists responded with correct answers (range 52% to 100%). Community pharmacists were consistently more confident and knowledgeable about bowel cancer services than breast cancer services. Five (5) community pharmacists participated in in-depth interviews. The interview findings supported the quantitative findings. Most community pharmacists described their confidence to promote bowel cancer and breast cancer screening as moderate, and consistently reflected they felt more knowledgeable and confident about bowel cancer topics than breast cancer topics.

Conclusions:

Overall, this research supports the feasibility of promoting bowel cancer screening in community pharmacies. It suggests further training is warranted for community pharmacists to increase their knowledge of breast cancer and their confidence in promoting breast cancer referral and screening services. It highlights the important role community pharmacists have in increasing engagement in the national bowel cancer and breast cancer screening programs, and in potentially decreasing the mortality rates of these cancers.

Role and impact of pharmacists in Spain: a scoping review

Background The role of the pharmacist has evolved greatly over the last decades, expanding to patient-oriented activities, administrative tasks and public health functions. However, considerable differences emerge across regions. Aim of the review To gather evidence in order to describe and highlight the different characteristics of the pharmacists' role and the impact of their activities in Spain. Method A review of the existing literature was conducted. The literature search was undertaken in PubMed between 01/01/2006 and 15/08/2017. Results were screened and reviewed to extract previously established criteria such as author(s), publication year, language, study design, setting, pharmaceutical activity, patient care programs, targeted diseases and intervention description using DEPICT2 tool. Pharmaceutical intervention were classified into eight outcome measures and categorized by types of outcomes reported: descriptive or impact evaluation regarding the effect of the service (positive, neutral or negative). Results The search strategy resulted in 473 articles and 108 articles met the inclusion criteria. The most common design was observational (n = 76, 70%). Most articles were published after 2011 (75%), in English (69%). Studies were conducted in hospitals (60%) and community pharmacies (30%). Of the 24 pharmaceutical activities identified, medication review was the activity most frequently studied (n = 42), followed by patient education (n = 29), risk and prevention (n = 27) and medication reconciliation (n = 19). Only 39 articles (36%) had outcome measures with impact evaluation. Of the 223 impact outcome measures, 48% (107/223) had a positive effect. Conclusion This review shows the substantial scientific production focusing on pharmacy practice in Spain over the last years. The evidence reviewed reflects the pharmacist role at various professional settings, providing a wide variety of activities on diverse targeted diseases and patient care programs, in line with the increasing specialization of clinical pharmacists over the last years.