Trends in Out-of-Pocket Costs for and Characteristics of Pharmacy-Dispensed Naloxone by Payer Type

This study examines mean yearly out-of-pocket cost for naloxone dispensed from retail pharmacies by payer between 2018 and 2022 and by prescription characteristics and payer in 2022.

Non-prescription sale of antibiotics and service quality in community pharmacies in Guangzhou, China: A simulated client method

OBJECTIVE

To measure the situation of the non-prescription sale of antibiotics and the service quality of community pharmacies in Guangzhou, China.

METHODS

A simulated client method was conducted to estimate the non-prescription sale of antibiotics and service quality based on scenarios about adult acute upper respiratory tract infection in 2019. A total of 595 community pharmacies from 11 districts were investigated in Guangzhou, China. We used binary logistic regression to evaluate the factors associated with the non-prescription sale of antibiotics.

RESULTS

The proportion of non-prescription dispensing of antibiotics was 63.1% in Guangzhou, China, with a higher incidence of antibiotic dispensing without prescription in outer districts (69.3%). Cephalosporin (44.1%) and Amoxicillin (39.0%) were sold more often than other antibiotics. Chain pharmacies had better performance on the prescription sale of antibiotics and service quality. Traditional Chinese medicine was commonly recommended by pharmacy staff.

CONCLUSION

Since the non-prescription sale of antibiotics is prevalent in Guangzhou, effective solutions should be determined. Strengthened public awareness and regulatory system innovation are needed.

Accessing Take-Home Naloxone in British Columbia and the role of community pharmacies: Results from the analysis of administrative data

INTRODUCTION

British Columbia's (BC) Take-Home Naloxone (THN) program provides naloxone to bystanders for use in cases of suspected opioid overdose. This study seeks to provide trends and analysis from the provincial BC THN program since inception in 2012 to the end of 2018.

MATERIALS AND METHODS

BC THN shipment and distribution records from 2012-2018 were retrieved. Frequency distributions were used to describe characteristics of individuals accessing the program. To evaluate correlates of distribution after the addition of hundreds of pharmacy distribution sites, an analytic sample was limited to records from 2018, and multivariate logistic regression was used to evaluate correlates of collecting naloxone at a pharmacy site.

RESULTS

Since program inception to the end of 2018, there were 398,167 naloxone kits shipped to distribution sites, 149,999 kits reported distributed, and 40,903 kits reported used to reverse an overdose in BC. There was a significant increasing trend in the number of naloxone kits used to reverse an overdose over time (p<0.01), and more than 90% of kits that were reported used were distributed to persons at risk of an overdose. Individuals not personally at risk of overdose had higher odds of collecting naloxone at a pharmacy site, compared to other community sites (including harm reduction supply distribution sites, peer led organizations, drop-in centers, and supportive housing sites) (Adjusted Odds Ratio (AOR): 2.69; 95% CI: 2.50-2.90).

CONCLUSIONS

This study documents thousands of opioid overdose reversals facilitated through the BC THN program. While those at highest risk of overdose may preferentially access naloxone through community sites, naloxone distribution through pharmacies has allowed the BC THN program to expand dramatically, increasing naloxone availability through longer opening hours on evenings and weekends. and in rural and remote regions. A diversity of naloxone distribution sites and strategies is crucial to prevent rising opioid overdose deaths.

A Sleeping Giant: Community Pharmacy's Potential Is Unrivaled

DISCLOSURES

No funding was received for the writing of this commentary. The author has nothing to disclose.

Community's extent of use and approval of extended pharmacy services in community pharmacies in Southwest Ethiopia

Background

The emergence of chronic diseases as major causes of disability and death has necessitated the introduction of new strategies to effectively address the ever-changing nature of public health problems. As a result, the role of community pharmacies in promoting public health is growing in recent years through the provision of extended pharmacy services. This study was conducted with the aim of assessing community’s extent of use and approval of extended pharmacy services at community pharmacies in Bonga town, Southwest Ethiopia.

Materials and methods

Community based cross-sectional study was conducted in Bonga town, Southwest Ethiopia, on households selected by systematic random sampling. Data was collected using semi-structured questionnaire. Data was collected by personally delivering questionnaires to respondents in selected households. Results of the study were described by frequency, mean and standard deviation (SD). Binary logistic analysis was performed to identify potential associations between dependent and independent variables.

Results

Out of 356 individuals included in the study, 58.4% recalled visiting community pharmacy premises during the previous six months. Out of these, 34.6% visited the community pharmacies to get extended pharmacy services. College educated participants were 19.4 times more likely to have used extended pharmacy services as compared to illiterate individuals whereas those who earn monthly income more than 5000 Ethiopian Birr were 3.6 times more likely than those with monthly income of 2000 Ethiopian Birr or less. Of the total participants, 91.3% approved the provision of extended pharmacy services in community pharmacies.

Conclusion

The extent of community’s use of extended pharmacy services at community pharmacies was found to be low. Nevertheless, majority of the study subjects approved the provision of extended pharmacy services at community pharmacies. Efforts to improve the practice of extended pharmacy service provision at community pharmacies should be made by all stake holders.

Market structure and competition in the healthcare industry : Results from a transition economy

The present paper provides first empirical evidence on the relationship between market size and the number of firms in the healthcare industry for a transition economy. We estimate market-size thresholds required to support different numbers of suppliers (firms) for three occupations in the healthcare industry in a large number of distinct geographic markets in Slovakia, taking into account the spatial interaction between local markets. The empirical analysis is carried out for three time periods (1995, 2001 and 2010) which characterise different stages of the transition process. Our results suggest that the relationship between market size and the number of firms differs both across industries and across periods. In particular, we find that pharmacies, as the only completely liberalised market in our dataset, experience the largest change in competitive behaviour during the transition process. Furthermore, we find evidence for correlation in entry decisions across administrative borders, suggesting that future market analysis should aim to capture these regional effects.

Update: Independently Owned Pharmacy Closures in Rural America, 2003-2018

This Policy Brief continues the series of reports from the RUPRI Center updating the number of pharmacy closures in rural America with annual data. See our website for other analyses of trends and assessment of issues confronting rural pharmacies. Key Findings: (1) Over the last 16 years, 1,231 independently owned rural pharmacies (16.1 percent) in the United States have closed. The most drastic decline occurred between 2007 and 2009. This decline has continued through 2018, although at a slower rate. (2) 630 rural communities that had at least one retail (independent, chain, or franchise) pharmacy in March 2003 had no retail pharmacy in March 2018.

The involvement of pharmacies in the screening of undiagnosed atrial fibrillation

Early identification of atrial fibrillation (AF) is now a priority in cardiovascular prevention because AF is common although often asymptomatic, and is associated with poor outcomes that are highly preventable with appropriate medical treatment. In Italy, AF prevalence among subjects aged ≥65 years ranges from 5 to 6% in observational studies based on the diagnosis recorded by general practitioners to 10-11% in studies where ECG screening is routinely offered. It is thus evident that a large number of subjects are not detected by conventional approach, and new strategies are required to increase early detection of AF. In particular, the changing position of pharmacies in the health system should be considered. Because of its small geographical size, insular nature and captive population, the Isle of Elba represents an ideal setting to test new strategies for stroke reduction. The Elba-FA project was thus designed to determine the feasibility and impact of the combined involvement of pharmacies and general practices to screen undiagnosed AF, with the ultimate aim of reducing the burden of stroke and arterial thromboembolism. The findings obtained with this approach might have broad implications for cardiovascular prevention at the general population level in Italy.

Pharmaceutical Care in Community Pharmacies: Practice and Research in the US

Objective:

To describe the state of community pharmacy, including patient care services, in the US.

Findings:

Chain pharmacies, including traditional chains, mass merchandisers, and supermarkets, comprise more than 50% of community pharmacies in the US. Dispensing of drugs remains the primary focus, yet the incidence of patients being counseled on medications appears to be increasing. More than 25% of independent community pharmacy owners report providing some patient clinical care services, such as medication counseling and chronic disease management. Most insurance programs pay pharmacists only for dispensing services, yet there are a growing number of public and private initiatives that reimburse pharmacists for cognitive services. Clinical care opportunities exist in the new Medicare prescription drug benefit plan, as it requires medication therapy management services for specific enrollees.

Discussion:

The private market approach to healthcare delivery in the US, including pharmacy services, precludes national and statewide strategies to change the basic business model. To date, most pharmacies remain focused on dispensing prescriptions. With lower dispensing fees and higher operating costs, community pharmacies are focused on increasing productivity and efficiency through technology and technicians. Pharmacists remain challenged to establish the value of their nondispensing-related pharmaceutical care services in the private sector. As the cost of suboptimal drug therapy becomes more evident, medication therapy management may become a required pharmacy benefit in private drug insurance plans. Pharmacy school curricula, as well as national and state pharmacy associations, continually work to train and promote community pharmacists for these roles. Practice research is driven primarily by interested academics and, to a lesser degree, by pharmacy associations.

Conclusions:

Efficient dispensing of prescriptions is the primary focus of community pharmacies in the US. Some well designed practice-based research has been conducted, but there is no national research agenda or infrastructure. Reimbursement for cognitive services remains an infrequent, but growing, activity.

Pharmaceutical Care in Community Pharmacies: Practice and Research in Sweden

Objective:

To describe the organization and delivery of community pharmacy and medical care, as well as pharmaceutical care practice and research, in Sweden.

Findings:

The Swedish retail pharmacy system of 800 community pharmacies and nearly 80 hospital pharmacies is unique in that it is organized into one single, government-owned chain, known as Apoteket AB. The pharmacy staff consists of pharmacists, prescriptionists, and pharmacy technicians. Some activities related to pharmaceutical care have been directed toward specific patient groups during annual theme campaigns. In the past few years, there has been a growing emphasis on the identification, resolution, and documentation of drug-related problems (DRPs) in Swedish pharmacy practice. A classification system for documenting DRPs and pharmacy interventions was developed in 1995 and incorporated into the software of all community pharmacies in 2001. A national DRP database (SWE-DRP) was established in 2004 to collect and analyze DRPs and interventions on a nationwide basis. Recently, a new counseling technique composed of key questions to facilitate the detection of DRPs has been tested successfully. Patient medication profiles are kept in 160 pharmacies, and a new national register of drugs dispensed to patients became available in 2006. Most pharmaceutical care studies in Sweden have focused on DRPs and resulting pharmacy interventions.

Discussion:

Swedish community pharmacy DRP work is in the international forefront but there is a potential for further developing cognitive services, given the beneficial organization of the country's pharmacies into one single pharmacy chain. The introduction of patient medication profiles has been both late and slow and has only had a marginal effect on pharmaceutical care practice so far. The universities do not appear to have any desire to influence the practice of pharmacy and could potentially take on a more active role in preparing pharmacy students for patient-oriented services. Current threats to pharmaceutical care practice and research include organizational changes, budget cuts, and reduced manpower of Apoteket AB.

Conclusions:

The identification, resolution, and documentation of DRPs are central to community pharmacy practice in Sweden, resulting in a number of research studies. A national DRP database, patient medication profiles, and a new national register of drugs dispensed to patients provide opportunities for growth in pharmaceutical care practice and research in the country.

Pharmaceutical Care in Community Pharmacies: Practice and Research in Germany

Objective:

To discuss the provision of pharmaceutical care in community pharmacies in Germany including community pharmacy, organization and delivery of health services, pharmacy education, community pharmacy services, research in community pharmacy, and future plans for community pharmacy services.

Findings:

In Germany, cognitive pharmaceutical services have been developed for more than 12 years. Several studies and programs have shown that pharmaceutical care and other pharmaceutical services are feasible in community pharmacy practice and that patients benefit from these services. In 2003, a nationwide contract was established between representatives of the community pharmacy owners and the largest German health insurance fund. In this so-called family pharmacy contract, remuneration of pharmacists for provision of pharmaceutical care services was successfully negotiated for the first time. In 2004, a trilateral integrated care contract was signed that additionally included general practitioners, combining the family pharmacy with the family physician. Within a few months, the vast majority (>17 000) of community pharmacies have registered to participate in this program.

Conclusions:

German community pharmacies are moving from the image of mainly supplying drugs toward the provision of cognitive pharmaceutical services.

Increase in Naloxone Prescriptions Dispensed in US Retail Pharmacies Since 2013

Distribution of naloxone, traditionally through community-based naloxone programs, is a component of a comprehensive strategy to address the epidemic of prescription opioid and heroin overdose deaths in the United States. Recently, there has been increased focus on naloxone prescription in the outpatient setting, particularly through retail pharmacies, yet data on this practice are sparse. We found an 1170% increase in naloxone dispensing from US retail pharmacies between the fourth quarter of 2013 and the second quarter of 2015. These findings suggest that prescribing naloxone in the outpatient setting complements traditional community-based naloxone programs.

Can Walmart make us healthier? Prescription drug prices and health care utilization

This paper analyzes how prices in the retail pharmaceutical market affect health care utilization. Specifically, I study the impact of Walmart's $4 Prescription Drug Program on utilization of antihypertensive drugs and on hospitalizations for conditions amenable to drug therapy. Identification relies on the change in the availability of cheap drugs introduced by Walmart's program, exploiting variation in the distance to the nearest Walmart across ZIP codes in a difference-in-differences framework. I find that living close to a source of cheap drugs increases utilization of antihypertensive medications by 7 percent and decreases the probability of an avoidable hospitalization by 6.2 percent.

Update: independently owned pharmacy closures in rural America, 2003-2013

Key Findings. (1) From March 2003 to December 2013, there was a loss of 924 (12.1%) independently owned rural pharmacies in the United States. The most drastic loss occurred between 2007 and 2009. From 2010-2013, the trend has been for more closures, although the decline is not as pronounced or clear as in earlier years. (2) Four hundred ninety rural communities that had one or more retail pharmacy (including independent, chain, or franchise pharmacy) in March 2003 had no retail pharmacy in December 2013.

Antismoking centers in Milan's communal pharmacies: analysis of the 2010-2011 campaign

AIMS AND BACKGROUND

According to recent assessments from the Italian Istituto Superiore della Sanità, information and assistance to smokers are still far from satisfactory. We evaluated the impact of a new smoking cessation service located in pharmacies. Smokers' individual characteristics were also considered.

MATERIAL AND METHODS

A 1-year pilot study was carried out from October 2010 to September 2011. Five pharmacies in Milan were selected. A psychologist with experience in smoking cessation was present in each pharmacy one afternoon per week, and pharmacists were trained by a team from the Antismoking Center of the Fondazione IRCCS Istituto Nazionale dei Tumori. Each pharmacy was equipped with informative material, carbon monoxide analyzers, and motivational and nicotine dependence questionnaires, in addition to a clinical briefcase. Counseling sessions were also arranged upon request.

RESULTS

In the first 12 months of activity, 216 persons asked for a consultation. The sample, aged 15-79 years, reported the following median values: 30 pack/years, 14 ppm CO, and a Fagerström Test of Nicotine Dependence score of 5. More than one-third of the sample (40.3%) had one pathology and 25% had more than one. In some cases (15.7%), people just wanted information about what the service offered. For those who tried to quit, smoking cessation rates were 33.3% at 3 months, 28% at 6 months, and 24.6% at 1 year. Three kinds of pharmacologic therapies were suggested to smokers: nicotine replacement therapy (75.5%), varenicline (17.5%), and bupropion (7%).

CONCLUSIONS

The results show that an accessible and free smoking cessation service is considered useful by smokers as demonstrated by the large number of requests compared with other smoking centers in Italy. Increased involvement of pharmacists in supporting smoking cessation makes this a promising initiative for the near future.

Demographic and economic characteristics associated with sole county pharmacy closures, 2006-2010

Key Findings. Twenty-five counties lost their sole community pharmacy between May 2006 and December 2010. Among these: (1) The average population density is 10.4 persons per square mile, compared to 87.4 for the United States. (2) The average population decreased by 1.6% between 2000 and 2010. Excluding the largest county, the average decrease was 2.4%. (3) The population age 65 years and older increased 5.4% between 2000 and 2010. Excluding the largest county, the 65-and-older population increased 2.1%. (4) The average change in the percentage of persons in poverty increased by 0.6 points between 2000 and 2010, from 15.5% to 16.1%, compared to a 4.0 point increase (11.3% to 15.3%) for the United States. (5) The average percentage of people younger than 65 years without health insurance was 24.6% in 2010, compared to 16.2% for the United States. (6) Nineteen of the 25 counties were designated "whole county" Health Professional Shortage Areas (HPSAs), meaning there was a shortage of primary medical care physicians across the entire county. (7) The average number of active doctors per 1,000 persons was 0.44, compared to 2.86 for the United States. Six of the 25 counties (24%) had no active MDs or DOs in 2010.

[The influence of pharmacoeconomic laws on pharmacies between 2007-2010 in Hungary]

OBJECTIVES

In 2006 a law for the economical use of medications was introduced into the Hungarian legislation. This law--among others--facilitated the foundation of new pharmacies. The aim of our study is to analyse the effect of that legislation on the number of pharmacies.

MATERIALS AND METHODS

Data were derived from the pharmaceutical database of the Hungarian Health Insurance Fund Administration (OEP), the only health care financing agency in Hungary. We analysed the 5 years period between 2006-2010. The number of pharmacies were analysed according to the number of population of different settlements.

RESULTS

The number of community pharmacies increased from 2030 (2006) to 2576 (2010) by 546 pieces (26.9 %). The number of pharmacies showed a different pattern according to the size of population of settlements. In villages with a population of 0-449, 500-999 and 1000-1999, the number of pharmacies decreased (3 pieces/3.6%; 18 pieces/20.0%; 23 pieces/10.6% respectively). In cities with a population between 2000-4999 we found a slight increase in the number of pharmacies (11 pieces/3.0%). In bigger towns there was a clear increase in the number of pharmacies: 5000-9999 population 53 pieces/29.0%; 10000-49999 194 pieces/37.1%; 50000-99999 population 129 pieces/33.0% and over the population of 100000: 158 pieces/42.9%.

CONCLUSIONS

After the introduction of the new law for the economical use of medications in 2006, the number of pharmacies significantly changed in Hungary. However, this change in the number of pharmacies was inequal according to the size of the population: in villages with a population lower than 2000 people there was a decrease, while in cities with bigger population the number of pharmacies significantly increased.

Independently owned pharmacy closures in rural America

The closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2011 coincides with the implementation of two major policies related to payment for prescription medications: (1) Medicare prescription drug discount cards were introduced on January 1, 2004; and (2) the Medicare prescription drug benefit (Part D) began on January 1, 2006. In this brief, we focus on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community. Services include providing medications from local stock without delay or travel, overseeing administration of medications to nursing homes and hospitals, and patient consultation.

Use of social media by pharmacy preceptors

OBJECTIVE

To define current use patterns of Facebook and Twitter among pharmacy preceptors and assess perceptions regarding use of social media within professional practice.

METHODS

An electronic survey instrument was sent to 315 pharmacists registered as advanced pharmacy practice experience (APPE) preceptors for Purdue University College of Pharmacy.

RESULTS

Approximately 60% of the 155 respondents used a Facebook account and 9% used a Twitter account. Respondents were willing to complete continuing education (CE) credit (46%) using social media, and were interested in following professional organizations (39%) on social media; however, the majority were not interested in obtaining drug or disease-state information, identifying employment opportunities, or participating in clinical discussion forums via social media.

CONCLUSION

Despite the growing popularity of social media across multiple disciplines, the majority of pharmacy preceptors surveyed were not willing to use these venues in professional practice.

Historical development and emerging trends of community pharmacy residencies

Clinical pharmacy services necessitate appropriately trained pharmacists. Postgraduate year one (PGY1) community pharmacy residency programs (CPRPs) provide advanced training for pharmacists to provide multiple patient care services in the community setting. These programs provide an avenue to translate innovative ideas and services into clinical practice. In this paper, we describe the history and current status of PGY1 community pharmacy residency programs, including an analysis of the typical settings and services offered. Specific information on the trends of community programs compared with other PGY1 pharmacy residencies is also discussed. The information presented in this paper is intended to encourage discussion regarding the need for increasing the capacity of PGY1 community pharmacy residency programs.

Independently owned pharmacy closures in rural America, 2003-2010

The purpose of this policy brief is to provide policy makers, researchers, and stakeholders with information about the closure of rural independently owned pharmacies, including pharmacies that are the sole source of access to local pharmacy services, from 2003 through 2010. This period coincides with the implementation of two major policies related to payment for prescription medications: (1) Medicare prescription drug discount cards were introduced on January 1, 2004; and (2) the Medicare prescription drug benefit began on January 1, 2006. In this brief, we focus on rural pharmacy closure because of the potential threat such closures present to access to any local pharmacy services in a community. Those services include providing medications as needed (not waiting for mail order), overseeing administration of medications to nursing homes and hospitals, and patient consultation.

Estimated cost savings associated with the transfer of office-administered specialty pharmaceuticals to a specialty pharmacy provider in a Medical Injectable Drug program

BACKGROUND

A large managed care organization (MCO) in western Pennsylvania initiated a Medical Injectable Drug (MID) program in 2002 that transferred a specific subset of specialty drugs from physician reimbursement under the traditional "buy-and-bill" model in the medical benefit to MCO purchase from a specialty pharmacy provider (SPP) that supplied physician offices with the MIDs. The MID program was initiated with 4 drugs in 2002 (palivizumab and 3 hyaluronate products/derivatives) growing to more than 50 drugs by 2007-2008.

OBJECTIVE

To (a) describe the MID program as a method to manage the cost and delivery of this subset of specialty drugs, and (b) estimate the MID program cost savings in 2007 and 2008 in an MCO with approximately 4.6 million members.

METHODS

Cost savings generated by the MID program were calculated by comparing the total actual expenditure (plan cost plus member cost) on medications included in the MID program for calendar years 2007 and 2008 with the total estimated expenditure that would have been paid to physicians during the same time period for the same medication if reimbursement had been made using HCPCS (J code) billing under the physician "buy-and-bill" reimbursement rates.

RESULTS

For the approximately 50 drugs in the MID program in 2007 and 2008, the drug cost savings in 2007 were estimated to be $15.5 million (18.2%) or $290 per claim ($0.28 per member per month [PMPM]) and about $13 million (12.7%) or $201 per claim ($0.23 PMPM) in 2008. Although 28% of MID claims continued to be billed by physicians using J codes in 2007 and 22% in 2008, all claims for MIDs were limited to the SPP reimbursement rates.

CONCLUSION

This MID program was associated with health plan cost savings of approximately $28.5 million over 2 years, achieved by the transfer of about 50 physician-administered injectable pharmaceuticals from reimbursement to physicians to reimbursement to a single SPP and payment of physician claims for MIDs at the SPP reimbursement rates.

Health care policy and community pharmacy: implications for the New Zealand primary health care sector

The aim of our paper is to expose the challenges primary health care reform is exerting on community pharmacy and other groups. Our paper is underpinned by the notion that a broad understanding of the issues facing pharmacy will help facilitate engagement by pharmacy and stakeholders in primary care. New models of remuneration are required to deliver policy expectations. Equally important is redefining the place of community pharmacy, outlining the roles that are mooted and contributions that can be made by community pharmacy. Consistent with international policy shifts, New Zealand primary health care policy outlines broad directives which community pharmacy must respond to. Policymakers are calling for greater integration and collaboration, a shift from product to patient-centred care; a greater population health focus and the provision of enhanced cognitive services. To successfully implement policy, community pharmacists must change the way they think and act. Community pharmacy must improve relationships with other primary care providers, District Health Boards (DHBs) and Primary Health Organisations (PHOs). There is a requirement for DHBs to realign funding models which increase integration and remove the requirement to sell products in pharmacy in order to deliver services. There needs to be a willingness for pharmacy to adopt a user pays policy. General practitioners (GPs) and practice nurses (PNs) need to be aware of the training and skills that pharmacists have, and to understand what pharmacists can offer that benefits their patients and ultimately general practice. There is also a need for GPs and PNs to realise the fiscal and professional challenges community pharmacy is facing in its attempt to improve pharmacy services and in working more collaboratively within primary care. Meanwhile, community pharmacists need to embrace new approaches to practice and drive a clearly defined agenda of renewal in order to meet the needs of health funders, patients and other primary care providers. There are significant barriers to change. Some of these are financial but many are professional and organisational and require a genuine commitment from the whole primary health care sector.

The Impact of the Internet on Community Pharmacy Practice

The purpose of this study was to forecast the impact of Internet pharmacy commerce on various stakeholders. A panel of experts assembled from a list of academicians in the social and administrative pharmaceutical sciences participated in a three-iteration Delphi procedure. Feedback from the aggregate responses of the panel was used to construct questionnaires employed in subsequent iterations of the Delphi. The panel converged to form a consensus upon a variety of issues. They forecasted the attainment of a 10-15% share in the market of prescription and over-the-counter pharmaceuticals through on-line purchases, the formation of strategic alliances among stakeholders in the drug distribution process, a shift in marketing strategies by brick-and-mortar stores, an increase in the prevalence of niching among pharmacy service providers and a subsequent growth in the implementation of cognitive services throughout the industry. With few exceptions, the forecast produced by the Delphi panel appears to be coming to fruition.

The general pharmacy work explored in The Netherlands

Objective To determine the frequency and nature of general pharmacy work at three Dutch community pharmacies. Methods In a purposive and convenience sample of three Dutch community pharmacies the general work was investigated. Multi-dimensional work sampling (MDWS) was used. The study took six weeks: two weeks at each pharmacy. Main outcome measure The number of care related items emerging in the general work. Results Care related work represented 34% of all pharmacy activities. Conclusion Although care related work was present at all three studied pharmacies, this part of the work still needs serious attention of Dutch pharmacists in order to advance pharmaceutical care. It is suggested that an efficient pharmacy organization in combination with robotization, task specialization, and interior design can expand the care related work at the pharmacy.

Online availability of dextropropoxyphene over time, 2003-2005

Online pharmacies are increasingly common, and some of them have been reported to inappropriately supply prescription-only medicines. Dextropropoxyphene-containing compounds are addictive and frequently implicated in fatalities occurring in the United Kingdom. We aimed here at assessing the online availability of dextropropoxyphene for purchase over a time-span of 2 years (September 2003-August 2005). A Google search was run in September 2003 using different sets of keywords and the first 100 links identified were thoroughly assessed. In March 2005, the same e-pharmacies websites identified at baseline were accessed again and a Google search using the same sets of keywords previously used was run as well. Furthermore, a specialized search with Froogle was run both in March and August 2005. Although an illegal practice in most countries, a number of websites willing to sell the compound internationally were identified at the time of the baseline search. In March 2005, the Google search for vending websites identified 361,000 links, compared with 40,000 18 months before. Only half of dextropropoxyphene vending e-pharmacies were still active by March 2005 but, at that point in time, access to Froogle apparently facilitated the task of online dextropropoxyphene purchase. By August 2005, however, the same Froogle search identified only one link aimed at online dextropropoxyphene shopping. In the United Kingdom, dextropropoxyphene-related products will be withdrawn later this year but this may have only limited impact on the availability of the compound. The emergence of Internet as an unregulated source of controlled substances is an important development that may have significant public health implications. This issue needs to be dealt with at both international and national level.

Predicting the impact of Medicare Part D implementation on the pharmacy workforce

BACKGROUND

There is currently a shortage of pharmacist manpower, and it is expected to continue into the near future. It is also likely that the implementation of Medicare Part D will further aggravate the shortage by increasing demand, but it is not clear how much impact it will have.

OBJECTIVE

The purpose of this study was to estimate the impact that the new Medicare drug benefit program will have on pharmacy workforce demand.

METHODS

Analysis was conducted using forecasting techniques, which combines traditional statistical theory with both quantitative and qualitative methods. The Aggregated Demand Index (ADI) was designated as the dependent variable. A number of independent variables were selected for their potential to affect the workforce, demand for prescriptions or clinical services, and patient population. Data for the identified variables were collected from a variety of sources. Supply and demand data were analyzed at a national level.

RESULTS

Both historical and univariate forecasts indicated that the demand for pharmacists will continue to exceed the supply of pharmacists. The ADI ratio of pharmacist demand-to-supply has recently leveled off which means that demand and supply are in an equilibrium that falls to the demand side. Consequently, the Medicare Modernization Act (MMA) is not predicted to produce a dramatic increase in prescription volume, which would change the current demand for pharmacists. Multivariate forecasting models were not robust primarily due to the lack of precise predictor variables.

CONCLUSIONS

Despite the reliance on preliminary univariate forecasts and imprecise predictor variables, it appears that the increased use of prescriptions due to the MMA Part D will have minimal impact on pharmacist demand.

Decreased availability of antimalarials in the private sector following the policy change from chloroquine to sulphadoxine-pyrimethamine in the Kilombero Valley, Tanzania

Background

Malaria control strategies emphasize the need for prompt and effective treatment of malaria episodes. To increase treatment efficacy, Tanzania changed its first-line treatment from chloroquine to sulphadoxine-pyrimethamine (SP) in 2001. The effect of this policy change on the availability of antimalarials was studied in rural south-eastern Tanzania.

Methods

In 2001 and 2004, the study area was searched for commercial outlets selling drugs and their stocks were recorded. Household information was obtained from the local Demographic Surveillance System.

Results

From 2001 to 2004, the number of general shops stocking drugs increased by 15% and the number of drug stores nearly doubled. However, the proportion of general shops stocking antimalarials dropped markedly, resulting in an almost 50% decrease of antimalarial selling outlets. This led to more households being located farther from a treatment source. In 2004, five out of 25 studied villages with a total population of 13,506 (18%) had neither a health facility, nor a shop as source of malaria treatment.

Conclusion

While the change to SP resulted in a higher treatment efficacy, it also led to a decreased antimalarial availability in the study area. Although there was no apparent impact on overall antimalarial use, the decline in access may have disproportionately affected the poorest and most remote groups. In view of the imminent policy change to artemisinin-based combination therapy these issues need to be addressed urgently if the benefits of this new class of antimalarials are to be extended to the whole population.

Current state of community pharmacy in Japan: practice, research, and future opportunities or challenges

OBJECTIVE

To describe the activities related to pharmaceutical care and research in community pharmacies in Japan.

FINDINGS

Japan is an aging society; the proportion of elderly people aged at least 65 years was 19.9% in 2005 and is expected to rise to 26.0% by 2015. This increase will result in ballooning healthcare costs. To curb the huge and rapidly increasing expenditure on medical treatment, many structural reforms have been undertaken in Japan. The healthcare services in community pharmacies will also undergo reforms to meet social needs and patient/customer requirements. In 2006, the undergraduate pharmacy program offered by universities was changed to a 6 year program, including 6 months of clinical training in both hospitals and community pharmacies. This change should provide an opportunity for community pharmacists and academics to communicate with each other, and we anticipate that it will further the research in community pharmacies. Accreditation programs will also improve the level of health care.

DISCUSSION

The healthcare system should undergo reforms to address the problems related to Japan's low birth rate and the needs of an aging population. Such reforms are also required to ensure a healthy aging society and should not have adverse effects on socially vulnerable children and the elderly. Pharmacists should contribute to the development of a healthcare system for an aging society by providing appropriate pharmaceutical care. Since a large number of prescriptions are dispensed through community pharmacies, pharmacists have a greater opportunity to improve health care. In addition, pharmacist associations are encouraging their members to actively participate in home medical care services. An effective community healthcare program should reduce the need for institutional care.

CONCLUSIONS

Although Japanese pharmacists are not fully capable of providing pharmaceutical care at this stage, they will play a crucial role in ensuring a healthy aging society in the future, particularly in the community setting.

Governance and the pharmaceutical workforce in England

A key component of a commitment to patient safety is ensuring the fitness to practice of health professionals. This article uses the changing landscape of the regulation of the pharmaceutical workforce and the extended roles and responsibilities of pharmacy practitioners in England to explore the challenges for governance within contemporary pharmacy practice, and consider the powers and structures necessary for effective regulation. In England, it is recognised that the approach of the national regulatory body for pharmacy should be consistent with that of the regulators of other health professions, and focus on assuring the competence and performance of practitioners. Pharmacy employers will have complementary adjunct responsibilities. Attention is being concentrated on ensuring the continuing fitness to practice of health professionals, with regular revalidation certain to become a requirement for all. Particular challenges arise in the effective regulation of advanced practitioners, and in ensuring the continuing competence of prescribing practitioners, who in England may come from a range of health disciplines, including pharmacy, and practice in a variety of settings and circumstances. A separate professional register is to be established for pharmacy technicians, whereupon they will also have to demonstrate continuing competence to practice, and be subject to regulation in the same way as pharmacists. Significant change is also planned in the professional control of community pharmacies. In future the law will require a "responsible pharmacist" to be identified for each community pharmacy, rather than insisting on a pharmacist always being present to supervise the dispensing and sale of medicines.