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Abdellatife OE, Makowsky MJ. Factors influencing Implementation of point-of-care testing for acute respiratory infectious diseases in community pharmacies: A scoping review using the Consolidated Framework for Implementation research. Res Social Adm Pharm 2024; 20:1-24. [PMID: 38431516 DOI: 10.1016/j.sapharm.2024.02.009] [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: 12/27/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Emerging evidence suggests pharmacy-based point-of-care (POC) testing for acute respiratory infectious diseases is beneficial, but not widely implemented. A theory-informed review to understand the factors influencing service Implementation is lacking. OBJECTIVE To examine the extent, range, and nature of research available on enablers and barriers to POC testing Implementation for infectious respiratory diseases in community pharmacies and identify their underpinning theoretical constructs using the Consolidated Framework for Implementation Research (CFIR). METHODS Scoping review guided by the JBI Manual for Evidence Synthesis. A comprehensive search from inception to June 28th, 2022 was conducted using Medline, Embase, CINAHL, Cochrane Library, and ProQuest dissertations without date or language restriction. Eligible articles investigated barriers and/or facilitators to strep throat, influenza, C-reactive protein, and COVID-19 POC testing in community pharmacies. Two reviewers independently performed title & abstract screening, full-text screening, and data extraction. Content analysis was conducted according to a pre-established Framework and concepts were mapped to the CFIR. RESULTS Forty-three studies were included. Most originated from the USA (n = 24; 56%) and investigated strep throat. The majority were testing/initial Implementation projects (n = 23; 54%) conducted in urban centers (n = 17; 40%). Thirty-six (84%) studies used quantitative methodology, while 6 (14%) were qualitative. Only four studies (9%) used theory to guide their inquiry. The 124 identified Implementation factors mapped onto 21 CFIR constructs, covering all 5 domains. The domain "Outer setting" (n = 35/43; 81%) was most prevalent as were the constructs "Patient needs and resources," (n = 21/43; 49%) "External policy & incentives," (n = 17/43; 40%) and "Relative advantage" (n = 17/43; 40%). CONCLUSION A large volume of research explores factors influencing the Implementation of pharmacy-based respiratory infectious disease POC testing services, but few studies use qualitative or theory-informed methods. Knowledge of the wide range of facilitators and barriers identified can help pharmacy managers and researchers design strategies to support successful service Implementation.
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Affiliation(s)
- Omar E Abdellatife
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9
| | - Mark J Makowsky
- Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada, T6G 1C9.
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Walpola RL, Issakhany D, Gisev N, Hopkins RE. The accessibility of pharmacist prescribing and impacts on medicines access: A systematic review. Res Social Adm Pharm 2024; 20:475-486. [PMID: 38326207 DOI: 10.1016/j.sapharm.2024.01.006] [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: 11/03/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND Pharmacist prescribing has been introduced in several countries as a strategy to improve access to health care and medicines. However, the direct impacts of pharmacist prescribing on medicines access, and the overall accessibility of pharmacist prescribing services, are not well known. OBJECTIVES This systematic review aimed to assess the direct impacts of pharmacist prescribing on medicines access, and the accessibility of pharmacist prescribing services, in community and primary care settings. METHODS PubMed, Embase, and CINAHL were searched for studies published in English between 01 January 2003 to 15 June 2023. Both quantitative and qualitative primary studies were included if they described pharmacist prescribing in a primary care setting. Outcomes included findings related to access to medicines as a result of pharmacist prescribing (primary outcome), and access to pharmacist prescribing services overall (secondary outcome). Narrative synthesis of outcomes was undertaken. RESULTS A total of 47 studies were included from four countries (United States, United Kingdom, Canada, New Zealand). Thirteen studies provided evidence that pharmacist prescribing may improve medicines access in several ways, including: increasing the proportion of eligible people receiving medicines, increasing the number of overall dispensed prescriptions, or reducing time to receipt of treatment. The remainder of the included studies reported on the accessibility of pharmacist prescribing services. Published studies highlight that pharmacist prescribers practicing in community settings are generally accessible, with pharmacist prescribers viewed by patients as easy and convenient to consult. There was limited evidence about the affordability of pharmacy prescribing services, and a number of potential equity issues were observed, including reduced access to pharmacist prescribers in more socioeconomically disadvantaged areas and those with greater proportions of populations at risk of health inequities, such as culturally and linguistically diverse communities. CONCLUSIONS This systematic review found that pharmacist prescribing services were both highly accessible and beneficial in improving access to medicines. However, measures of medicines access varied, and few studies included direct measures of medicines access as an outcome of pharmacist prescribing, highlighting a need for future studies to incorporate direct measures of medicines access when assessing the impact of pharmacist prescribing services.
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Affiliation(s)
- Ramesh L Walpola
- School of Health Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia; School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia.
| | - Dabrina Issakhany
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Ria E Hopkins
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
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3
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Adams AJ. Regulating Pharmacist Clinical Services: Is Legal Silence Golden or Deafening? J Pharm Pract 2023:8971900231199283. [PMID: 37646272 DOI: 10.1177/08971900231199283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In the United States, the scope of practice of pharmacists is determined primarily at the state level. Not all state laws expressly permit or prohibit pharmacists from providing certain services; in between is a grey area of legal silence. Does legal silence permit pharmacists to perform a service that is not specifically permitted, but not expressly prohibited? Point-of-care testing provides a useful case study in legal silence: there are 1536 pharmacies currently holding a CLIA-waiver to administer tests in states reporting that pharmacists are not expressly permitted to administer tests. Legal silence may even provide a better framework for pharmacy based testing as it is naturally inclusive of any point-of-care test and no laws need updated when a new test comes to the market. Other health professions navigate this legal silence by governing according to a "standard of care." Rather than specifying a list of services a health professional can or cannot provide in law, it provides a flexible framework for the health professional to provide any service that other similarly situated health professionals would provide in the same or similar situation. A standard of care regulatory framework should thus be the target of the pharmacy profession in order to advance patient care.
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Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, Eagle, ID, USA
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Riegler AN, Larsen N, Amerson-Brown MH. Point-of-Care Testing for Sexually Transmitted Infections. Clin Lab Med 2023; 43:189-207. [PMID: 37169442 DOI: 10.1016/j.cll.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Point-of-care testing for sexually transmitted infections is essential for controlling transmission and preventing sequelae in high-risk populations. Since the World Health Organization published the ASSURED criteria, point-of-care testing has improved for use in large population screening and rapid testing that prevents loss of clinical follow-up. Recent advancements have been advantageous for low-resource areas allowing testing at a minimal cost without reliable electricity or refrigeration. Point-of-care nucleic acid detection and amplification techniques are recommended, but are often inaccessible in low-resource areas. Future advancements in point-of-care diagnostic testing should focus on improving antibody-based assays, monitoring viral loads, and detecting antimicrobial resistance.
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Affiliation(s)
- Ashleigh N Riegler
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Natalie Larsen
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA
| | - Megan H Amerson-Brown
- Department of Pathology, The University of Alabama at Birmingham, Marnix E. Heersink School of Medicine, 619 East 19th Street South, WP240J, Birmingham, AL 35249-7331, USA.
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Saha SK, Promite S, Botheras CL, Manias E, Mothobi N, Robinson S, Athan E. Improving diagnostic antimicrobial stewardship in respiratory tract infections: a protocol for a scoping review investigating point-of-care testing programmes in community pharmacy. BMJ Open 2023; 13:e068193. [PMID: 36828657 PMCID: PMC9972425 DOI: 10.1136/bmjopen-2022-068193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 02/03/2023] [Indexed: 02/26/2023] Open
Abstract
INTRODUCTION Diagnostic uncertainty regarding the cause of respiratory tract infections (RTIs) multiplies the problem of unnecessary use of antibiotics and antimicrobial resistance in primary care. Point-of-care testing (POCT) programmes have been recognised as a potential stewardship strategy to optimise antimicrobial use in primary care. There is a need for greater understanding of community pharmacy-based POCT programmes in reducing the unnecessary use of antimicrobials in patients with RTIs. This review systematically maps out evidence around the effectiveness, feasibility and implementation challenges of POCT programmes in community pharmacy to improve safe antimicrobial use in RTIs. METHODS AND ANALYSIS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist and the Arksey and O'Malley methodology framework will guide the reporting of this review. We will systematically review studies with either randomised controlled trial, non-randomised controlled trial, before-after study, observational study or pilot feasibility study design. Medline, Emcare, PubMed, Health Technology Assessment, Cochrane Central Register of Controlled Trials and Google Scholar databases will be used to search for articles. Three reviewers will independently screen, review and select studies with POCT programmes involving community pharmacists for antimicrobial stewardship in RTIs. Summary statistics and random effects model, if data permit, will be used to summarise the effectiveness, feasibility and cost-effectiveness of the POCT programme. The Consolidated Framework for Implementation Research will capture POCT implementation drivers. ETHICS AND DISSEMINATION This review study does not require research ethics approval. Findings will be disseminated through national and international conferences, seminars and publication in a peer-reviewed journal.
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Affiliation(s)
- Sajal K Saha
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shukla Promite
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia
| | - Carly L Botheras
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Barwon Health, Geelong, Victoria, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Geelong, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Nomvuyo Mothobi
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Barwon Health, Geelong, Victoria, Australia
| | - Suzanne Robinson
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- EnAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Eugene Athan
- School of Medicine, Deakin University, Geelong, Victoria, Australia
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Barwon Health, Geelong, Victoria, Australia
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Crawford ND, Lewis CF, Moore R, Pietradoni G, Weidle P. Examining the Multilevel Barriers to Pharmacy-Based HIV Prevention and Treatment Services. Sex Transm Dis 2022; 49:S22-S25. [PMID: 35550478 PMCID: PMC9560970 DOI: 10.1097/olq.0000000000001643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Natalie D Crawford
- From the Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | | | | | - Paul Weidle
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Klepser M, Koski RR. Molecular point-of-care testing in the community pharmacy setting: current status and future prospects. Expert Rev Mol Diagn 2022; 22:1-14. [PMID: 36269237 DOI: 10.1080/14737159.2022.2139178] [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: 08/08/2022] [Accepted: 10/19/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Clinical Laboratory Improvement Amendments (CLIA)-waived point-of-care tests (POCTs) have been available since the late 1980s, but their use in community pharmacy has expanded over the last several years. Barriers exist for community-pharmacy-based CLIA-waived POC testing, including pharmacy workflow, pharmacist scope of practice, and reimbursement. As pharmacies work to reduce these barriers, the number of pharmacies participating in POCT programs has dramatically increased. There are several lateral flow and nucleic acid amplification CLIA-waived POC tests available for use in community pharmacy settings. The majority of data regarding pharmacy-based POC testing programs currently highlights the role of lateral flow testing for influenza and acute pharyngitis. AREAS COVERED A comprehensive review of the current state of CLIA-waived rapid point-of-care infectious pathogen testing in community pharmacies is presented. EXPERT OPINION Knowing which CLIA-waived rapid POCTs are available and understanding their key characteristics will be helpful in identifying the best tests to incorporate into individual pharmacies. Choices will also depend on specific pharmacy workflow patterns, local populations and insurances, and state regulations regarding pharmacist scope of practice. As nucleic acid amplification tests evolve, the business case and the framework for implementation for using molecular tests in community pharmacy will become clearer.
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Affiliation(s)
- Michael Klepser
- Pharmacy Practice Department, Ferris State University College of Pharmacy, USA
| | - Renee R Koski
- Pharmacy Practice Department, Ferris State University College of Pharmacy, USA
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Saha SK, Thursky K, Kong DCM, Mazza D. A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists. Antibiotics (Basel) 2022; 11:antibiotics11091158. [PMID: 36139938 PMCID: PMC9495087 DOI: 10.3390/antibiotics11091158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 11/28/2022] Open
Abstract
Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care.
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Affiliation(s)
- Sajal K. Saha
- School of Medicine, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- Department of General Practice, The School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia
- National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, VIC 3000, Australia
- Public Health Unit, Geelong Centre for Emerging Infectious Disease, Barwon Health, Geelong, VIC 3220, Australia
- Correspondence: ; Tel.: +61-0452639559
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, VIC 3000, Australia
| | - David C. M. Kong
- School of Medicine, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, VIC 3000, Australia
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade Parkville, Melbourne, VIC 3052, Australia
- Pharmacy Department, Ballarat Health Services, Ballarat, VIC 3350, Australia
| | - Danielle Mazza
- Department of General Practice, The School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia
- National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, VIC 3000, Australia
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Patient perceptions of acute infectious disease point-of-care tests (POCT) and treatment within community pharmacy settings. J Am Pharm Assoc (2003) 2022; 62:1786-1791. [DOI: 10.1016/j.japh.2022.05.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 11/20/2022]
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Saha SK, Kong DCM, Mazza D, Thursky K. A systems thinking approach for antimicrobial stewardship in primary care. Expert Rev Anti Infect Ther 2021; 20:819-827. [PMID: 34968161 DOI: 10.1080/14787210.2022.2023010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The establishment of antimicrobial stewardship (AMS) in primary care is central to substantially reduce the antimicrobial use and the associated risk of resistance. This perspective piece highlights the importance of systems thinking to set up and facilitate AMS programs in primary care. AREAS COVERED The challenges that primary care faces to incorporate AMS programmes is multifactorial: an implementation framework, relevant resources, team composition, and system structures remain under-researched, and these issues are often overlooked and/or neglected in most parts of the world. Progress in the field remains slow in developed countries but potentially limited in low- and middle-income countries. EXPERT OPINION The key AMS strategies to optimize antimicrobial use in primary care are increasingly known; however, health system components that impact effective implementation of AMS programs remain unclear. We highlight the importance of systems thinking to identify and understand the resource arrangements, system structures, dynamic system behaviors, and intra- and interprofessional connections to optimally design and implement AMS programs in primary care. An AMS systems thinking systemigram (i.e. a visual representation of overall architecture of a system) could be a useful tool to foster AMS implementation in primary care.
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Affiliation(s)
- Sajal K Saha
- Department of General Practice, The School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Ellengowan Drive, Darwin, Australia
| | - David C M Kong
- National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Medicine Use and Safety, Monash University, Victoria, Australia.,Pharmacy Department, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Danielle Mazza
- Department of General Practice, The School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship (NCAS), Department of Infectious Diseases, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
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Oregon pharmacists' intention to prescribe under HB2397. Res Social Adm Pharm 2021; 18:2837-2847. [PMID: 34244074 DOI: 10.1016/j.sapharm.2021.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/23/2021] [Accepted: 06/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In 2017, Oregon passed legislation that authorized pharmacists to autonomously prescribe specified medications or devices that were included on the Formulary and Protocol Compendia (FPC). Factors that impact pharmacists' intention to prescribe from the FPC are not currently known. OBJECTIVES Identify factors that influence pharmacists' intention to prescribe. METHODS The Theory of Planned Behavior (TPB) served as the framework. Three focus groups were conducted with Oregon pharmacists between May and June 2019 to elicit salient beliefs about prescribing related to TPB constructs, including attitudes, subjective norms, perceived behavioral control, and perceived obligation. Two investigators conducted a qualitative content analysis and reached agreement on names of categories during consensus meetings. A codebook was created after analysis of the first focus group and used to guide the remaining analysis. Participants reported background information and awareness of prescribing rules via a questionnaire; descriptive statistics were used to report background information and the prescribing awareness summary score. RESULTS Thirteen participants had 14.1 ± 10.8 years of pharmacist experience. Most earned a Doctor of Pharmacy degree (84.6%) and worked in a community pharmacy setting (61.5%). The mean score on the awareness assessment was 6.3 ± 0.9 (7 = highest awareness). The majority (76.9%) had previous prescribing experience. Attitudes were found to be shaped by behavioral beliefs related to the impact of pharmacist prescribing on patient-centered care and on practice transformation. Normative beliefs were primarily driven by outside groups past experiences with pharmacists and pharmacies. Control beliefs included the following categories: operational readiness; the relationships between comfort, competence, and confidence; and Board of Pharmacy requirements. CONCLUSIONS TPB was useful for exploring pharmacists' beliefs related to their intention to prescribe using the FPC. Determining the relative importance of these factors in a broader population will enable stakeholders to develop interventions to improve uptake of prescribing via the FPC.
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Rogers J, Eastland T. Understanding the most commonly billed diagnoses in primary care: Acute pharyngitis. Nurse Pract 2021; 46:48-54. [PMID: 33882043 DOI: 10.1097/01.npr.0000742908.69893.bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT This is a 12-part series on the most commonly billed diagnoses in primary care. The article discusses the pathophysiologic processes of acute pharyngitis as well as the clinical manifestations and treatments and how they are linked to disease pathogenesis.
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Silva-Suárez G, Alvarado Reyes Y, Colón-Pratts FM, Sanchez J, Ortiz BI, Rabionet SE. Assessing the willingness of community pharmacists to test–treat–immunize during the COVID-19 pandemic in Puerto Rico. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [PMCID: PMC8083608 DOI: 10.1093/jphsr/rmab009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objective
The objective of this study was to assess community pharmacists’ willingness to test, treat and immunize for COVID-19 in Puerto Rico.
Methods
In this cross-sectional study, a 37-item survey was distributed via email and social media in May 2020 through REDCap online software. All licensed community pharmacists in Puerto Rico (N = 1200) were invited to complete the survey. Retired community pharmacists were excluded. Analysis of frequencies and chi-square tests were performed to evaluate the willingness to test, treat and immunize for COVID-19 and their associations with sociodemographic variables.
Key findings
The survey response rate was 26% (314/1200). Subjects’ mean age was 42 (±13), 86.1% were female, and most practiced in independent community or specialty pharmacy (62%). Among respondents, 44% reported willingness to test. Top concerns for testing were family (73.4%) and self (66.8%) exposure and ability to manage the workflow (53.3%). Most participants indicated their willingness to treat (88.4%) and to administer the COVID-19 vaccine (76.1%). Study participants who worked in retail pharmacies were more willing to test for COVID-19 (50.9%, P = 0.34) and to immunize (91.2%, P < 0.001). Pharmacists ≤39 years (90.3%), those who graduate in 2000 or later (88.3%), and those with a Pharm.D. degree or higher (88.6%), were more willing to immunize (P < 0.001).
Conclusions
Most community pharmacists were more willing to treat and immunize, than to perform COVID-19 testing. This underscores the need for training and workflow changes to facilitate the acquisition of this new role. Local pharmacists’ associations should advocate for a safe and manageable work environment. These efforts are vital to empower pharmacists to adopt new roles during a public health emergency.
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Affiliation(s)
- Georgina Silva-Suárez
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, San Juan, Puerto Rico
| | | | | | - Jesus Sanchez
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Blanca I Ortiz
- Department of Pharmacy Practice, Nova Southeastern University, San Juan, Puerto Rico
| | - Silvia E Rabionet
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University, Fort Lauderdale, FL, USA
- Department of Social Science, School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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Development of an antimicrobial stewardship implementation model involving collaboration between general practitioners and pharmacists: GPPAS study in Australian primary care. Prim Health Care Res Dev 2021; 22:e2. [PMID: 33504411 PMCID: PMC8057431 DOI: 10.1017/s1463423620000687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Rising antimicrobial resistance (AMR) in primary care is a growing concern and a threat to community health. The rise of AMR can be slowed down if general practitioners (GPs) and community pharmacists (CPs) could work as a team to implement antimicrobial stewardship (AMS) programs for optimal use of antimicrobial(s). However, the evidence supporting a GP pharmacist collaborative AMS implementation model (GPPAS) in primary care remains limited. Aim: With an aim to design a GPPAS model in Australia, this paper outlines how this model will be developed. Methods: This exploratory study undertakes a systematic review, a scoping review, nationwide surveys, and qualitative interviews to design the model. Medical Research Council (MRC) framework and Normalization Process Theory are utilized as guides. Reviews will identify the list of effective GPPAS interventions. Two AMS surveys and paired interviews of GPs and CPs across Australia will explore their convergent and divergent views about the GPPAS interventions, attitudes towards collaboration in AMS and the perceived challenges of implementing GPPAS interventions. Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model and factor analyses will guide the structure of GPPAS model through identifying the determinants of GPPAS uptake. The implementable GPPAS strategies will be selected based on empirical feasibility assessment by AMS stakeholders using the APEASE (Affordability, Practicability, Effectiveness and cost-effectiveness, Acceptability, Side-effects and safety, Equity) criteria. Discussion: The GPPAS model might have potential implications to inform how to better involve GPs and CPs in AMS, and, to improve collaborative services to optimize antimicrobial use and reduce AMR in primary care.
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Gallimore CE, Porter AL, Barnett SG, Portillo E, Zorek JA. A state-level needs analysis of community pharmacy point-of-care testing. J Am Pharm Assoc (2003) 2021; 61:e93-e98. [PMID: 33431252 PMCID: PMC7832632 DOI: 10.1016/j.japh.2020.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 11/16/2022]
Abstract
Background The uptake of point-of-care testing (POCT) within community pharmacies at state and national levels is largely unknown despite the endorsement and advocacy efforts of pharmacy organizations, recent legislative advances, and numerous models for successful POCT implementation within individual pharmacy sites. Objectives The study aimed to describe the current landscape of POCT in Wisconsin community pharmacies and identify opportunities for the advancement of testing and the key factors influencing the realization of these opportunities. Methods A survey was administered over the telephone to pharmacy managers of community pharmacies in Wisconsin. The sites were randomly selected from predefined geographic regions to mirror pharmacy distribution across Wisconsin. The survey items evaluated provision of POCT, future direction of POCT, barriers and motivators to offering POCT, and pharmacy demographics. Descriptive statistics and thematic analysis were used to analyze data. Results Pharmacy managers from 147 of the 938 registered community pharmacies (15.7%) participated in the survey. Only 17.1% of the pharmacies were offering POCT; however, 48.3% of managers reported that their pharmacy would likely implement or expand POCT within the next 5 years. The most commonly reported barriers to initiating or expanding POCT were the limitations on pharmacist availability to oversee testing and workflow restrictions. Continuing to advance the pharmacy profession was a top reason for offering or expanding testing services. Discussion While few pharmacies are offering POCT in Wisconsin, there is motivation for expansion in coming years. Understanding, anticipating and addressing common barriers can faciliate this process. Conclusion This needs analysis offers a blueprint for researchers, educators, and clinicians to shape POCT efforts by examining the landscape of pharmacy-based testing in their own states and communities.
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Rusic D, Bukić J, Seselja Perisin A, Leskur D, Modun D, Petric A, Vilovic M, Bozic J. Are We Making the Most of Community Pharmacies? Implementation of Antimicrobial Stewardship Measures in Community Pharmacies: A Narrative Review. Antibiotics (Basel) 2021; 10:antibiotics10010063. [PMID: 33440609 PMCID: PMC7827930 DOI: 10.3390/antibiotics10010063] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 12/01/2022] Open
Abstract
Community pharmacists recognize the need to implement antimicrobial stewardship activities in community pharmacies. They are in a unique position to provide triage for common primary care indications and to lower the burden of patients at general practitioners’ offices. However, research shows that, in some areas, dispensing of antimicrobials without valid prescription is still highly prevalent. Regardless of training, every community pharmacist can give his contribution to antimicrobial stewardship. One of the basic elements should be antimicrobial dispensing according to regulations, either prescription only, or according to guidelines where pharmacists have prescribing authority. Patient consultation supported with educational materials, such as leaflets, may reduce patients’ expectations to receive antibiotics for self-limiting infections and reduce pressure on general practitioners to prescribe antibiotics on patients’ demand. Treatment optimization may be achieved in collaboration with the prescribing general practitioners or by providing feedback. At last, pharmacists provided with additional training may be encouraged to provide consultation services to long-term care facilities, to introduce point-of-care testing for infectious diseases in their pharmacies or prescribe antimicrobials for uncomplicated infections. These services are welcomed by patients and communities. Expanding pharmacy services and pharmacists’ prescribing autonomy have shown a positive impact by reducing antibiotics consumption, thus ensuring better compliance with treatment guidelines.
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Affiliation(s)
- Doris Rusic
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Josipa Bukić
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Seselja Perisin
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Dario Leskur
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Darko Modun
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
| | - Ana Petric
- Department of Pharmacy, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia; (D.R.); (J.B.); (A.S.P.); (D.L.); (D.M.); (A.P.)
- The Split-Dalmatia County Pharmacy, Dugopoljska 3, 21 204 Dugopolje, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21 000 Split, Croatia;
- Correspondence:
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Divergent and Convergent Attitudes and Views of General Practitioners and Community Pharmacists to Collaboratively Implement Antimicrobial Stewardship Programs in Australia: A Nationwide Study. Antibiotics (Basel) 2021; 10:antibiotics10010047. [PMID: 33466476 PMCID: PMC7824809 DOI: 10.3390/antibiotics10010047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 12/29/2020] [Accepted: 01/03/2021] [Indexed: 11/23/2022] Open
Abstract
Setting up an interprofessional team for antimicrobial stewardship (AMS) to improve the quality and safety of antimicrobial use in primary care is essential but challenging. This study aimed to investigate the convergent and divergent attitudes and views of general practitioners (GPs) and community pharmacists (CPs) about AMS implementation and their perceived challenges of collaboration to design a GP–pharmacist collaborative AMS (GPPAS) model. Nationwide surveys of GPs and CPs across Australia were conducted January-October 2019. Chi square statistics and a theoretical framework were used for comparative analyses of quantitative and qualitative data, respectively. In total, 999 participants responded to the surveys with 15.4% (n = 386) response rates for GPs and 30.7% (n = 613) for CPs. GPs and CPs were aware about AMS however their interprofessional perceptions varied to the benefits of AMS programs. CPs indicated that they would need AMS training; significantly higher than GPs (GP vs. CP; 46.4% vs. 76.5%; p < 0.0001). GPs’ use of the Therapeutic Guideline Antibiotic was much higher than CPs (83.2% vs. 45.5%; p < 0.0001). No interprofessional difference was found in the very-limited use of patient information leaflets (p < 0.1162) and point-of-care tests (p < 0.7848). While CPs were more willing (p < 0.0001) to collaborate with GPs, both groups were convergent in views that policies that support GP–CP collaboration are needed to implement GPPAS strategies. GP–pharmacist collaborative group meetings (54.9% vs. 82.5%) and antimicrobial audit (46.1% vs. 86.5%) models were inter-professionally supported to optimise antimicrobial therapy, but an attitudinal divergence was significant (p < 0.001). The challenges towards GP–CP collaboration in AMS were identified by both at personal, logistical and organisational environment level. There are opportunities for GP–CP collaboration to improve AMS in Australian primary care. However, strengthening GP–pharmacy collaborative system structure and practice agreements is a priority to improve interprofessional trust, competencies, and communications for AMS and to establish a GPPAS model in future.
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Pontinha VM, Wagner TD, Holdford DA. Point-of-care testing in pharmacies-An evaluation of the service from the lens of resource-based theory of competitive advantage. J Am Pharm Assoc (2003) 2020; 61:e45-e54. [PMID: 33309067 DOI: 10.1016/j.japh.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Point-of-care tests (POCTs) are innovative services that are increasingly offered in community pharmacies. Assessments of these services should consider their financial sustainability in addition to their effectiveness if they are to be successful over time in a competitive environment. OBJECTIVES The aim of this research was to review and evaluate the POCT practice innovations literature through the lens of the resource-based theory (RBT) of competitive advantage. DATA SOURCES Articles describing POCT services were identified systematically through PubMed, exclusively. STUDY SELECTION All POCT articles in the review met the following inclusion criteria: (1) articles were published after 1999; (2) interventions were pharmacist-led innovations within a community pharmacy; (3) articles described research studies with results; and (4) articles were published in English, Spanish, or Portuguese. DATA EXTRACTION The RBT was operationalized using a strengths, weaknesses, opportunities, threats matrix and a business model canvas, which were employed to extract and analyze data. Articles were assessed according to the degree to which they articulated elements that the RBT needed to assess their financial sustainability in targeted markets. RESULTS A total of 36 articles describing POCTs and associated services were included in this review. Most of the studies reported aspects pertaining to the contextual environment of the innovation, value proposition, key activities, partners, and channels of distribution. However, the competitive dimension of the environment, as well as the cost structure and revenue streams, were often neglected in the studies. CONCLUSIONS The RBT is a widely tested framework that can be used for planning and reporting POCT practice innovations. On the basis of this framework, pharmacists seem to do a good job in describing how to provide POCT but fall short in explaining how these services are sustainable over time.
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Saha SK, Kong DCM, Thursky K, Mazza D. Antimicrobial stewardship by Australian community pharmacists: Uptake, collaboration, challenges, and needs. J Am Pharm Assoc (2003) 2020; 61:158-168.e7. [PMID: 33187894 DOI: 10.1016/j.japh.2020.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/29/2020] [Accepted: 10/18/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess community pharmacists' (CPs') awareness and uptake of evidence-based antimicrobial stewardship (AMS) strategies, attitudes toward collaboration with general practitioners (GPs), and needs to improve AMS practices. METHODS A nationwide survey of randomly sampled community pharmacies across Australia was conducted in April-October 2019. RESULTS The response rate of CPs was 30.7% (613 of 2000) and 592 participating CPs (96.5%) described the key barriers to and facilitators of improving AMS. CPs (447 of 613, 72.9%) were familiar with AMS but felt that they would require training (468 of 612, 76.5%) and access to AMS practice guidelines (566 of 605, 93.6%). Respondents perceived that AMS programs could reduce the inappropriate use of antimicrobials (409 of 612, 66.8%) and the costs of treating infection (508 of 612, 83.0%). CPs often counseled patients (591 of 609, 97.0%) and reviewed drug interactions or allergies (569 of 607, 93.8%) before dispensing antimicrobials. Respondents less often used the national Therapeutic Guidelines: Antibiotic (274 of 602, 45.5%) or assessed guideline-compliance of prescribed antimicrobials (231 of 609, 37.9%). CPs were less likely to communicate with GPs (254 of 609, 41.8%) when an antimicrobial prescription was believed to be suboptimal and perceived that GPs are not receptive to their intervention regarding the antimicrobial choice (500 of 606, 82.6%) and dosage (416 of 606, 68.6%). Point-of-care tests (114 of 596, 19.1%) and patient information leaflets (149 of 608, 24.5%) were used uncommonly. Most respondents supported policies that could foster GP-pharmacist collaboration (560 of 606, 92.4%), limit accessibility of selected antimicrobials (420 of 604, 74.4%), and reduce repeat-dispensing of antimicrobial prescriptions (448 of 604, 74.2%). CPs faced interpersonal, interactional, structural, and resource-level barriers to collaborate with GPs for practicing AMS. CONCLUSIONS CPs are aware of the importance of sensible use of antimicrobials but have had limited training and resources to conduct AMS activities. Improving GPs' receptiveness and system structures for increased GP-CP collaboration seem to be a priority to accelerate CP-led AMS implementation. Further study is required to understand the views of stakeholders about the feasibility of implementing evidence-based GP-CP collaborative AMS approaches.
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Smith MG, Rains L. Evaluation of an accredited training program on implementation of point-of-care testing in community pharmacies. J Am Pharm Assoc (2003) 2020; 60:e140-e144. [DOI: 10.1016/j.japh.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 03/30/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
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Essack S, Bell J, Burgoyne D, Tongrod W, Duerden M, Sessa A, Altiner A, Shephard A. Point-of-Care Testing for Pharyngitis in the Pharmacy. Antibiotics (Basel) 2020; 9:E743. [PMID: 33126412 PMCID: PMC7693205 DOI: 10.3390/antibiotics9110743] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023] Open
Abstract
Pharyngitis (also known as sore throat) is a common, predominately viral, self-limiting condition which can be symptomatically managed without antibiotic treatment. Inappropriate antibiotic use for pharyngitis contributes to the development and spread of antibiotic resistance. However, a small proportion of sore throats caused by group A streptococcal (GAS) infection may benefit from the provision of antibiotics. Establishing the cause of infection is therefore an important step in effective antibiotic stewardship. Point-of-care (POC) tests, where results are available within minutes, can distinguish between viral and GAS pharyngitis and can therefore guide treatment in primary healthcare settings such as community pharmacies, which are often the first point of contact with the healthcare system. In this opinion article, the evidence for the use of POC testing in the community pharmacy has been discussed. Evidence suggests that pharmacy POC testing can promote appropriate antibiotic use and reduce the need for general practitioner consultations. Challenges to implementation include cost, training and 'who prescribes', with country and regional differences presenting a particular issue. Despite these challenges, POC testing for pharyngitis has become widely available in pharmacies in some countries and may represent a strategy to contain antibiotic resistance and contribute to antimicrobial stewardship.
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Affiliation(s)
- Sabiha Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - John Bell
- Graduate School of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Douglas Burgoyne
- College of Pharmacy, University of Utah, Salt Lake City, UT 84112, USA;
| | - Wirat Tongrod
- Faculty of Pharmaceutical Sciences, Huachiew Chalermprakiet University, Samut Prakan 10540, Thailand;
| | - Martin Duerden
- School of Medicine, Centre for Medical Education, Cardiff University, Cardiff CF14 4XN, UK;
| | - Aurelio Sessa
- Italian College of General Practitioners and Primary Care (SIMG, Società Italiana di Medicina Generale delle Cure Primarie), 50142 Florence, Italy;
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Center, 18055 Rostock, Germany;
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Hardin R, Roberts P, Hudspeth B, Tracy A, Baldwin L, Raque M, Kebodeaux CD. Development and Implementation of an Influenza Point-Of-Care Testing Service in a Chain Community Pharmacy Setting. PHARMACY 2020; 8:pharmacy8040182. [PMID: 33036133 PMCID: PMC7712436 DOI: 10.3390/pharmacy8040182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/25/2020] [Accepted: 09/29/2020] [Indexed: 11/16/2022] Open
Abstract
Point-of-care testing is becoming increasingly commonplace in community pharmacy settings. These tests are often used in the management of chronic disease, such as blood sugar, hemoglobin A1c and lipid levels, but can also be used for acute conditions such as influenza infection and group A streptococcus pharyngitis. When used for these acute infections, point-of-care tests can allow for pharmacist-initiated treatment. In this study, an influenza point-of-care testing service was developed and implemented in a chain community pharmacy setting and a retrospective review was conducted to assess the service. Of patients tested, 29% tested positive for influenza A and/or B; 92% of patients testing positive received a prescription as a result. While health insurance cannot be billed for the service due to current pharmacy reimbursement practices, this did not appear to negatively affect patient willingness to participate. As point-of-care testing services become more commonplace in community pharmacy settings, patient awareness will similarly increase and allow for more widespread access to acute outpatient care.
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Affiliation(s)
- Rachel Hardin
- Kroger Louisville Division, University of Kentucky College of Pharmacy, Louisville, KY 40223, USA; (R.H.); (P.R.); (A.T.); (L.B.); (M.R.)
- Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40509, USA;
| | - Pheli Roberts
- Kroger Louisville Division, University of Kentucky College of Pharmacy, Louisville, KY 40223, USA; (R.H.); (P.R.); (A.T.); (L.B.); (M.R.)
| | - Brooke Hudspeth
- Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40509, USA;
| | - Angela Tracy
- Kroger Louisville Division, University of Kentucky College of Pharmacy, Louisville, KY 40223, USA; (R.H.); (P.R.); (A.T.); (L.B.); (M.R.)
| | - Lauren Baldwin
- Kroger Louisville Division, University of Kentucky College of Pharmacy, Louisville, KY 40223, USA; (R.H.); (P.R.); (A.T.); (L.B.); (M.R.)
| | - Michael Raque
- Kroger Louisville Division, University of Kentucky College of Pharmacy, Louisville, KY 40223, USA; (R.H.); (P.R.); (A.T.); (L.B.); (M.R.)
| | - Clark D. Kebodeaux
- Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY 40509, USA;
- Correspondence:
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Young EH, Panchal RM, Yap AG, Reveles KR. National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016. Pharmacotherapy 2020; 40:1012-1021. [PMID: 32867003 DOI: 10.1002/phar.2456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prior studies have found that outpatient antibiotics are commonly prescribed for non-bacterial conditions. It is unclear if national prescribing has changed in recent years given recent public health and antimicrobial stewardship initiatives. This study aimed to describe antibiotic prescribing in United States (U.S.) physician offices. MATERIALS/METHODS This was a cross-sectional study of all sampled patient visits in the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. Antibiotic use was defined as at least one oral antibiotic prescription during the visit as identified by Multum code(s). Patient visits were categorized by U.S. geographic region and season. ICD-9-CM and ICD-10 codes were used to assess diagnoses and categorize antibiotic use as appropriate, possibly appropriate, or inappropriate. RESULTS Seven billion visits were included for analysis, with 793,415,182 (11.3%) including an antibiotic. Prescribing rates were relatively stable over the study period (102.9-124.9 prescriptions per 1000 visits); however, 2016 had one of the lowest prescribing rates (107.7 per 1000 visits). The most commonly prescribed antibiotic class was macrolides (25 per 1000 visits). The South region and winter season had the highest antibiotic prescribing (118.2 and 129.7 per 1000 visits, respectively). Of patients who received an antibiotic, 55.9%, 35.7%, and 8.4% were classified as inappropriate, possibly appropriate, and appropriate, respectively. The most common conditions in which antibiotics were prescribed inappropriately included those with no indication in any of the predefined diagnosis codes (40.1%), other skin conditions (17.3%), and viral upper respiratory conditions (13.3%). CONCLUSIONS There was no significant reduction in outpatient antibiotic prescribing rates among U.S. outpatients from 2009 to 2016 and prescribing varied by region and season. These data suggest that more than half of antibiotics were prescribed inappropriately, with the majority of antibiotics prescribed with no indication. However, these findings need to be confirmed with robust prospective studies.
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Affiliation(s)
- Eric H Young
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Rupesh M Panchal
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Alexander G Yap
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA
| | - Kelly R Reveles
- College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.,Pharmacotherapy Education & Research Center, UT Health San Antonio, San Antonio, Texas, USA
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McCormick JZ, Cardwell SM, Wheelock C, Wong CM, Vander Weide LA. Impact of ambulatory antimicrobial stewardship on prescribing patterns for urinary tract infections. J Clin Pharm Ther 2020; 45:1312-1319. [DOI: 10.1111/jcpt.13210] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/21/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Julia Z. McCormick
- Department of Pharmacy PeaceHealth Family Medicine of Southwest Washington Vancouver WA USA
| | - Sophia M. Cardwell
- Department of Pharmacy PeaceHealth Southwest Medical Center Vancouver WA USA
| | | | - Carolyn M. Wong
- Department of Pharmacy PeaceHealth Family Medicine of Southwest Washington Vancouver WA USA
| | - Luke A. Vander Weide
- Department of Pharmacy PeaceHealth Family Medicine of Southwest Washington Vancouver WA USA
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A Nationwide Survey of Australian General Practitioners on Antimicrobial Stewardship: Awareness, Uptake, Collaboration with Pharmacists and Improvement Strategies. Antibiotics (Basel) 2020; 9:antibiotics9060310. [PMID: 32521720 PMCID: PMC7345044 DOI: 10.3390/antibiotics9060310] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 02/01/2023] Open
Abstract
Implementing antimicrobial stewardship (AMS) programs is central to optimise antimicrobial use in primary care. This study aims to assess general practitioners’ (GPs’) awareness of AMS, uptake of AMS strategies, attitudes towards GP–pharmacist collaboration in AMS and future AMS improvement strategies. A paper-based survey of nationally representative GPs across Australia was conducted in 2019. Of 386 respondent GPs, 68.9% were familiar with AMS. Respondents most frequently used the Therapeutic Guidelines (TG) (83.2%, 321/385) and delayed antimicrobial prescribing (72.2%, 278/385) strategies, whereas few utilised point-of-care tests (18.4%, 71/382), patient information leaflets (20.2%, 78/384), peer prescribing reports (15.5%, 60/384) and audit and feedback (9.8%, 38/384). GPs were receptive to pharmacists’ recommendations on the choice (50.5%, 192/381) and dose (63%, 241/382) of antimicrobials, and more than 60% (235/381) supported a policy fostering increased GP–pharmacist collaboration. Most GPs agreed to have AMS training (72%, 278/386), integration of electronic TG (eTG) with prescribing software (88.3%, 341/386) and policies limiting the prescribing of selected antimicrobials (74.4%, 287/386) in the future. Conclusively, GPs are aware of the importance of judicious antimicrobial prescribing but inadequately uptake evidence-based AMS strategies. The majority of GPs support GP–pharmacist collaborative AMS approaches to optimise antimicrobial use. Developing a feasible GP–pharmacist collaborative AMS implementation model and facilitating stewardship resources and training could foster AMS activities in primary care.
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Kufel WD, Mastro KA, Mogle BT, Williams KS, Jester J, Snyder J, Lubowski T, Bohan KH. Providers' knowledge and perceptions regarding antibiotic stewardship and antibiotic prescribing in rural primary care clinics. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2020. [DOI: 10.1002/jac5.1198] [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)
- Wesley D. Kufel
- Binghamton University School of Pharmacy and Pharmaceutical Sciences Binghamton New York
- State University of New York Upstate Medical University Syracuse New York
- State University of New York Upstate University Hospital Syracuse New York
| | - Keri A. Mastro
- Binghamton University School of Pharmacy and Pharmaceutical Sciences Binghamton New York
| | - Bryan T. Mogle
- State University of New York Upstate University Hospital Syracuse New York
| | | | - James Jester
- United Health Services Hospitals Johnson City New York
| | - John Snyder
- United Health Services Hospitals Johnson City New York
| | | | - KarenBeth H. Bohan
- Binghamton University School of Pharmacy and Pharmaceutical Sciences Binghamton New York
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Herbin SR, Klepser DG, Klepser ME. Pharmacy-Based Infectious Disease Management Programs Incorporating CLIA-Waived Point-of-Care Tests. J Clin Microbiol 2020; 58:e00726-19. [PMID: 32075903 PMCID: PMC7180239 DOI: 10.1128/jcm.00726-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There are roughly 48,000 deaths caused by influenza annually and an estimated 200,000 people who have undiagnosed human immunodeficiency virus (HIV). These are examples of acute and chronic illnesses that can be identified by employing a CLIA-waived test. Pharmacies across the country have been incorporating CLIA-waived point-of-care tests (POCT) into disease screening and management programs offered in the pharmacy. The rationale behind these programs is discussed. Additionally, a summary of clinical data for some of these programs in the infectious disease arena is provided. Finally, we discuss the future potential for CLIA-waived POCT-based programs in community pharmacies.
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Affiliation(s)
- S R Herbin
- College of Pharmacy, Ferris State University, Big Rapids, Michigan, USA
| | - D G Klepser
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - M E Klepser
- College of Pharmacy, Ferris State University, Big Rapids, Michigan, USA
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Kirby J, Mousa N. Evaluating the impact of influenza and streptococcus point-of-care testing and collaborative practice prescribing in a community pharmacy setting. J Am Pharm Assoc (2003) 2020; 60:S70-S75. [PMID: 32253085 DOI: 10.1016/j.japh.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 02/26/2020] [Accepted: 03/03/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if a difference in the use of point-of-care (POC) testing and treatment under a collaborative pharmacy practice agreement exists between insured and uninsured patients and also between patients established with a primary care provider (PCP) and those who are not established. A secondary objective was to assess patient satisfaction with a new, pharmacist-provided service. SETTING Two independent community pharmacies. PRACTICE DESCRIPTION Perkins Drugs is an independent community pharmacy practice that operates 2 sites in Gallatin, Tennessee. PRACTICE INNOVATION This practice innovation was pharmacist-provided POC influenza and group A Streptococcus (GAS) pharyngitis testing and associated treatment when appropriate. Pharmacists entered into a collaborative pharmacy practice agreement with a physician at a nearby primary care clinic, which allowed for the testing and prescribing of medication under a predetermined decision tree. EVALUATION Patient demographics and satisfaction levels with the service were collected. The service, while continuing, was implemented in December 2018, and cumulative data were collected until April 2019. RESULTS Pharmacists tested a total of 73 patients for influenza or GAS. Of the total, 24 patients (33%) did not have an established PCP, and 31 (42.5%) were uninsured. No significant difference was found in the use of the service when comparing the insured and uninsured groups, and participants were more likely to have an established PCP than not have. Of the patients who were contacted for follow-up, 98% reported satisfaction with the delivery of the service stating they would use it again. CONCLUSION Community pharmacy-based POC testing provides access to urgent care services for patients regardless of insurance status. In our experience, the service was well liked by patients and provided a nondispensing source of revenue. This service could potentially be duplicated, as state-based pharmacist scope of practice allows, to provide both a needed service to patients and elevate the pharmacist's role within the health care system.
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Morley VJ, Firgens EPC, Vanderbilt RR, Zhou Y, Zook M, Read AF, MacGeorge EL. Factors associated with antibiotic prescribing for acute bronchitis at a university health center. BMC Infect Dis 2020; 20:177. [PMID: 32102652 PMCID: PMC7045376 DOI: 10.1186/s12879-020-4825-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antibiotics are not indicated for treating acute bronchitis cases, yet up to 70% of adult acute bronchitis medical visits in the USA result in an antibiotic prescription. Reducing unnecessary antibiotic prescribing for acute bronchitis is a key antibiotic stewardship goal set forth by the Centers for Disease Control and Prevention. Understanding what factors influence prescribing for bronchitis cases can inform antimicrobial stewardship initiatives. The goal of this study was to identify factors associated with antibiotic prescribing at a high-volume student health center at a large US university. The Pennsylvania State University Health Services offers on-campus medical care to a population of over 40,000 students and receives over 50,000 visits every year. Methods We conducted a retrospective chart review of acute bronchitis visits for the 2015–2016 academic year and used a multivariate logistic regression analysis to identify variables associated with antibiotic prescribing. Results Findings during lung exams increased the likelihood of an antibiotic prescription (rales OR 13.95, 95% CI 3.31–80.73; rhonchi OR 5.50, 95% CI 3.08–10.00; percussion abnormality OR 13.02, 95% CI 4.00–50.09). Individual clinicians had dramatically different rates of prescribing (OR range 0.03–12.3). Male patients were more likely than female patients to be prescribed antibiotics (OR 1.68, 95% CI 1.17–2.41). Patients who reported longer duration since the onset of symptoms were slightly more likely to receive prescriptions (OR 1.04 per day, 95% CI 1.03–1.06), as were patients who reported worsening symptoms (OR 1.78, 95% CI 1.03–3.10). Visits with diagnoses or symptoms associated with viral infections or allergies were less likely to result in prescriptions (upper respiratory tract infection (URI) diagnosis OR 0.33, 95% CI 0.18–0.58; sneezing OR 0.39, 95% CI 0.17–0.86; vomiting OR 0.31, 95% CI 0.10–0.83). An exam finding of anterior cervical lymphadenopathy was associated with antibiotic prescribing (tender OR 3.85, 95% CI 1.70–8.83; general OR 2.63, 95% CI 1.25–5.54). Conclusions Suspicious findings during lung examinations (rales, rhonchi, percussion abnormality) and individual healthcare providers were important factors influencing antibiotic prescribing rates for acute bronchitis visits. Patient gender, worsening symptoms, duration of illness, symptoms associated with viral infections or allergies, and anterior cervical lymphadenopathy also influenced prescribing rates.
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Affiliation(s)
- Valerie J Morley
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Emily P C Firgens
- Department of Communication Arts & Sciences, The Pennsylvania State University, University Park, State College, PA, USA
| | - Rachel R Vanderbilt
- Department of Communication Arts & Sciences, The Pennsylvania State University, University Park, State College, PA, USA
| | - Yanmengqian Zhou
- Department of Communication Arts & Sciences, The Pennsylvania State University, University Park, State College, PA, USA
| | - Michelle Zook
- University Health Services, The Pennsylvania State University, University Park, State College, PA, USA
| | - Andrew F Read
- Center for Infectious Disease Dynamics, Department of Biology, The Pennsylvania State University, University Park, State College, PA, USA.,Huck Institutes for the Life Sciences, The Pennsylvania State University, University Park, State College, PA, USA.,Department of Entomology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Erina L MacGeorge
- Department of Communication Arts & Sciences, The Pennsylvania State University, University Park, State College, PA, USA.
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Factors that influence patient acceptance of clinical pharmacy services: A nationwide survey. J Am Pharm Assoc (2003) 2020; 60:1058-1067.e4. [PMID: 32962899 PMCID: PMC9840879 DOI: 10.1016/j.japh.2020.08.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/21/2020] [Accepted: 08/28/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Examine the factors that influence a patient's likelihood of participating in clinical pharmacy services so that pharmacists can use this knowledge to effectively expand clinical services. METHODS An online survey was distributed to U.S. citizens 55 years of age or older through a market research company. The survey assessed pharmacy and medication use, general health, interest in clinical pharmacy services, and general demographics. The specific clinical services examined included medication therapy management (MTM) and a collaborative practice agreement (CPA). Logistic regression and best-worst scaling were used to predict the likelihood of participating and determine the motivating factors to participate in clinical pharmacy services, respectively. RESULTS Two hundred eight (58.45%) respondents reported being likely to participate in MTM services, and 108 (50.6%) reported being likely to participate in the services offered by a pharmacist with a CPA, if offered. The motivations to participate in MTM were driven by pharmacist management of medication interactions and adverse effects (best-worst scores 0.62 and 0.51, respectively). The primary motivator to participate in a CPA was improved physician-pharmacist coordination (best-worst score 0.80). Those with a personal pharmacist were more likely to participate in MTM (odds ratio [OR] 2.43 [95% CI 1.41-4.22], P = 0.002) and a pharmacist CPA (2.08 [1.26-3.44], P = 0.004). Previous experience with MTM increased the likelihood of participating again in MTM (5.98 [95% CI 2.50-14.35], P < 0.001). Patient satisfaction with the pharmacy increased the likelihood of participating in a pharmacist CPA (1.47 [95% CI 1.01-2.13], P = 0.04). CONCLUSION Patients are interested in clinical pharmacy services for the purposes of medication interaction management, adverse effect management, and improved physician-pharmacist coordination. The factors that influenced the likelihood of participating included having a personal pharmacist, previous experience with MTM, and pharmacy satisfaction. These results suggest a potential impact of the patient-pharmacist relationship on patient participation in clinical services.
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Experiences of medical dominance in pharmacist-doctor interactions - An elephant in the room? Res Social Adm Pharm 2019; 16:1177-1182. [PMID: 31862212 DOI: 10.1016/j.sapharm.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/24/2019] [Accepted: 12/14/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND The development of new roles by pharmacists supports the delivery of healthcare services but potentially also encroaches into other healthcare professions' domains of practice. Some novel pharmacy services are only reluctantly accepted by the medical profession and are surrounded by a discourse which expresses medical dominance, with pharmacists facing resistance to their closer involvement in patient care. OBJECTIVE To investigate whether and how pharmacists may experience medical dominance in their practice. METHODS For this qualitative study, pharmacists working in primary care settings were introduced to concepts of sociology in healthcare and medical dominance, then asked to reflect on personal experiences of potential medical dominance, and their emotional and behavioural response. The reflective texts were thematically analysed using a framework based on theories of medical dominance, self-regulation and the influence of emotions on cognition to interpret themes. RESULTS Twenty-five pharmacists provided detailed reflective accounts. Most worked in a community pharmacy when they experienced medical dominance in interactions with doctors. They described how doctors demarcated territory, evaded scrutiny or disparaged pharmacists' professional expertise. Pharmacists perceived limited options in negotiating these experiences and often employed patients in resolving issues which were left unaddressed. They felt frustrated, undervalued and angry after their experiences and described apprehensiveness in future interactions with doctors. CONCLUSION Although experiences of medical dominance by pharmacists working in primary care seem to be an infrequent though regular occurrence pharmacists do not seem to be well prepared to counter or negotiate around it. Perceived and actual dominance in interprofessional interactions with doctors are stressors which may affect pharmacists' ability to problem-solve, their role effectiveness and satisfaction.
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McKeirnan K, Czapinski J, Bertsch T, Buchman C, Akers J. Training Student Pharmacists to Perform Point-of-Care Testing. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2019; 83:7031. [PMID: 31619825 PMCID: PMC6788142 DOI: 10.5688/ajpe7031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/17/2018] [Indexed: 05/30/2023]
Abstract
Objective. To implement training in point-of-care testing (POCT) for student pharmacists and to assess students' comfort with performing and recommending POCT for Group A streptococcus (GAS), influenza, and human immunodeficiency virus (HIV) after completion of training. Methods. The POCT training was provided to students via a 3.5-hour module imbedded in an intensive, week-long course. The module included a lecture with active-learning exercises and time dedicated to practicing performing nasal and throat swabs. Student performance of swab procedures was evaluated via a rubric-based skills assessment graded by a faculty member. Student pharmacists completed a pre- and post-training Likert scale survey regarding their comfort with performing and recommending POCT, and initiating appropriate treatment. Student knowledge of POCT material was evaluated via a multiple-choice examination. Results. Most students performed proficiently on the POCT skills assessment on the first attempt (86% achieved proficiency in performing throat swabs and 88% in performing nasal swabs), and all students were proficient by the third attempt. Student comfort and interest in performing POCT and willingness to implement POCT in their future practice significantly increased from the pre- to the post-training survey. All students achieved competency as demonstrated by achieving a score of 80% or higher on the knowledge examination on the first or second attempt. Conclusion. Following a POCT training module, student pharmacists displayed increased willingness to perform and recommend POCT for GAS, influenza, and HIV. Expanding this training to other pharmacy schools and colleges could increase patient access to POCT.
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Affiliation(s)
| | | | - Taylor Bertsch
- Washington State University College of Pharmacy, Spokane, Washington
| | - Christina Buchman
- Washington State University College of Pharmacy, Spokane, Washington
| | - Julie Akers
- Washington State University College of Pharmacy, Spokane, Washington
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Cole KA, Rivard KR, Dumkow LE. Antimicrobial Stewardship Interventions to Combat Antibiotic Resistance: an Update on Targeted Strategies. Curr Infect Dis Rep 2019; 21:33. [PMID: 31473861 DOI: 10.1007/s11908-019-0689-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Overutilization of antimicrobials is a known contributor to the development of antimicrobial resistance, which is a threat to global health. The goal of antimicrobial stewardship programs (ASPs) is to implement targeted interventions to reduce inappropriate antimicrobial prescribing and prevent development of antimicrobial resistance. We aim to review recently published literature focused on five categories of ASP interventions that have demonstrated success in optimizing appropriate antimicrobial use, improving patient outcomes, and fighting antimicrobial resistance. RECENT FINDINGS In the past year, ASP interventions in the published literature have focused on minimizing duration of antimicrobial therapy for infectious syndromes, implementing novel methods for performing prospective audit and feedback, utilizing microbiology laboratory or rapid diagnostic tests to expedite diagnosis, leveraging clinical decision support and electronic medical record tools, and performing penicillin allergy assessment. While the majority of studies assessing ASP interventions do not assess changes in antimicrobial resistance, outcomes demonstrating improved appropriate antibiotic use have been used as a surrogate. Successful ASPs should seek to implement and evaluate novel interventions targeting improvement in antimicrobial prescribing. Such interventions are of critical importance to prevent further growth of antimicrobial resistance.
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Affiliation(s)
- Kelli A Cole
- Department of Pharmacy Services, University of Toledo Medical Center, 3000 Arlington Ave. MS 1013, Toledo, OH, 43614, USA.
| | - Kaitlyn R Rivard
- Department of Pharmacy, Cleveland Clinic, 9500 Euclid Avenue (Hb-105), Cleveland, OH, 44195, USA
| | - Lisa E Dumkow
- Department of Pharmacy Services, Mercy Health Saint Mary's, 200 Jefferson SE, Grand Rapids, MI, 49503, USA.
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Klepser DG, Klepser ME, Murry JS, Borden H, Olsen KM. Evaluation of a community pharmacy-based influenza and group A streptococcal pharyngitis disease management program using polymerase chain reaction point-of-care testing. J Am Pharm Assoc (2003) 2019; 59:872-879. [PMID: 31474527 DOI: 10.1016/j.japh.2019.07.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/24/2019] [Accepted: 07/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to demonstrate the feasibility of implementing a Clinical Laboratory Improvement Amendments-waived real-time polymerase chain reaction (PCR) molecular test into a community pharmacy setting as part of a collaborative influenza and group A Streptococcus (GAS) disease management program. SETTING AND PARTICIPANTS Two community pharmacy sites in Tennessee. PRACTICE DESCRIPTION Patients presenting to the pharmacy with symptoms consistent with influenza or GAS from November 1, 2016, to April 30, 2018. PRACTICE INNOVATION Influenza and GAS management programs based on previously developed protocols occurred at 2 community pharmacies in Tennessee. Pharmacies used the Cobas Liat testing system (Roche Diagnostics). Based on test results and under a collaborative practice agreement, pharmacists dispensed prescription medications for patients with a positive test: oseltamivir for influenza and amoxicillin for GAS. Patients with negative tests were treated with over-the-counter (OTC) medications or referred. Patients testing negative for GAS were asked to consent to having a second throat swab sent for culture. EVALUATION Number of patients tested, point-of-care test results, and treatment received. RESULTS Two hundred and two patients received care at the 2 pharmacies (116 for influenza, 46 for GAS, and 43 for both). Sixty (38%) tested positive for influenza, with 51 receiving an antiviral prescription, and 16 (18%) tested positive and were treated for GAS. No patient testing negative for either or positive for influenza was dispensed an antibiotic. For patients consenting to a follow-up culture, all GAS cultures sent for confirmatory testing were negative. CONCLUSION A protocol-driven community pharmacy-based disease management program using real-time PCR testing for influenza and GAS was able to offer appropriate treatment to patients without overuse of antibiotics.
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Goode JV, Owen J, Page A, Gatewood S. Community-Based Pharmacy Practice Innovation and the Role of the Community-Based Pharmacist Practitioner in the United States. PHARMACY 2019; 7:E106. [PMID: 31382690 PMCID: PMC6789634 DOI: 10.3390/pharmacy7030106] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 11/25/2022] Open
Abstract
Community-based pharmacy practice is evolving from a focus on product preparation and dispensing to becoming a health care destination within the four walls of the traditional community-based pharmacy. Furthermore, community-based pharmacy practice is expanding beyond the four walls of the traditional community-based pharmacy to provide care to patients where they need it. Pharmacists involved in this transition are community-based pharmacist practitioners who are primarily involved in leading and advancing team-based patient care services in communities to improve the patient health. This paper will review community-based pharmacy practice innovations and the role of the community-based pharmacist practitioner in the United States.
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Affiliation(s)
- Jean-Venable Goode
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA 23298, USA.
| | - James Owen
- Practice and Science Affairs, American Pharmacists Association, Washington, DC 20037, USA
| | - Alexis Page
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Sharon Gatewood
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University, Richmond, VA 23298, USA
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Novel Image Processing Method for Detecting Strep Throat (Streptococcal Pharyngitis) Using Smartphone. SENSORS 2019; 19:s19153307. [PMID: 31357633 PMCID: PMC6695774 DOI: 10.3390/s19153307] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 11/16/2022]
Abstract
In this paper, we propose a novel strep throat detection method using a smartphone with an add-on gadget. Our smartphone-based strep throat detection method is based on the use of camera and flashlight embedded in a smartphone. The proposed algorithm acquires throat image using a smartphone with a gadget, processes the acquired images using color transformation and color correction algorithms, and finally classifies streptococcal pharyngitis (or strep) throat from healthy throat using machine learning techniques. Our developed gadget was designed to minimize the reflection of light entering the camera sensor. The scope of this paper is confined to binary classification between strep and healthy throats. Specifically, we adopted k-fold validation technique for classification, which finds the best decision boundary from training and validation sets and applies the acquired best decision boundary to the test sets. Experimental results show that our proposed detection method detects strep throats with 93.75% accuracy, 88% specificity, and 87.5% sensitivity on average.
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Klepser DG. Collaborative practice agreements a useful tool for researchers. J Am Pharm Assoc (2003) 2018; 56:618-619. [PMID: 27836125 DOI: 10.1016/j.japh.2016.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Klepser ME, Adams AJ. Pharmacy-based management of influenza: lessons learned from research. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 26:573-578. [PMID: 30265414 DOI: 10.1111/ijpp.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/17/2018] [Indexed: 01/13/2023]
Abstract
Recently, several jurisdictions have pursued legislative and regulatory changes to allow pharmacy-based influenza management models in which pharmacists can initiate appropriate antiviral therapy in community pharmacy settings. While studies have been published in Canada, Japan, New Zealand, Norway and the United States, concerns have been expressed over pharmacist training, the accuracy of rapid influenza diagnostic tests, and the potential impact on antimicrobial resistance, among others. Studies have demonstrated that pharmacists provide safe and effective influenza management, with high rates of patient satisfaction, while maintaining or improving antimicrobial stewardship.
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Abstract
The goals of antimicrobial stewardship are to optimize antimicrobial use to improve patient outcomes and minimize adverse consequences. A successful antimicrobial stewardship program is one that is multidisciplinary. Pharmacists are core members of antimicrobial stewardship and undertake multiple roles to accomplish the goals of the program. As antimicrobial stewardship continues to expand across the patient care continuum, pharmacists will serve a vital role in preserving the armamentarium of antimicrobials and improving quality of patient care.
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Affiliation(s)
- Diane M Parente
- Infectious Diseases and Antimicrobial Stewardship, Department of Pharmacy, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA.
| | - Jacob Morton
- Infectious Diseases, Department of Pharmacy, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, USA
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Bright DR, Klepser ME, Murry L, Klepser DG. Pharmacist-Provided Pharmacogenetic Point-of-Care Testing Consultation Service: A Time and Motion Study. J Pharm Technol 2018; 34:139-143. [PMID: 34860961 DOI: 10.1177/8755122518756651] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: With recent advances in pharmacogenomics (PGx) comes the potential to customize medication use based on genetic data. Support for PGx has found practical limitations in terms of workflow and turnaround time of a test. However, with the expansion of point-of-care testing (POCT) in pharmacy practice models comes opportunity for PGx testing in the pharmacy setting. Objective: The purpose of this study is to quantify the amount of time spent during each step of a PGx POCT encounter in a community pharmacy setting. Methods: A time and motion study was conducted using a mock community pharmacy space for a simulated PGx-focused encounter to manage antiplatelet therapy following hospital discharge. PGx POCT was conducted using the Spartan RX instrument. Simulated patient encounters were divided into 7 categories. Time spent in each step, as well as total time spent, was tracked. Results: A total of 54 simulated PGx POCT encounters took place with an average time of 9.49 minutes (SD ± 1.38 minutes). Instrument run time adds 60 minutes to the total time required to obtain a result. Duties that could be performed by an appropriately trained pharmacy technician totaled 6.86 minutes. Conclusions: PGx POCT would require 9.49 minutes of pharmacy staff hands-on time for the encounter, which could be reduced to 2.64 minutes of pharmacist time with appropriate pharmacy technician involvement. Time requirements for PGx POCT are similar to that of community pharmacy-based immunizations. Future studies could explore how practice could change if PGx testing were routinely performed in the pharmacy.
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Blanchette L, Gauthier T, Heil E, Klepser M, Kelly KM, Nailor M, Wei W, Suda K. The essential role of pharmacists in antibiotic stewardship in outpatient care: An official position statement of the Society of Infectious Diseases Pharmacists. J Am Pharm Assoc (2003) 2018; 58:481-484. [PMID: 30007508 DOI: 10.1016/j.japh.2018.05.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 05/15/2018] [Accepted: 05/29/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this position statement is to describe the essential role of pharmacists in antimicrobial stewardship in outpatient care. DATA SOURCES N/A. SUMMARY The majority of antibiotic prescribing occurs in outpatient care settings highlighting the need for antibiotic stewardship in the community. Given their expertise on medication management, pharmacists are essential to any antibiotic stewardship effort. CONCLUSION As the regulations for antibiotic stewardship in outpatient settings continue to evolve and optimal stewardship strategies are defined, pharmacists must be leaders in the implementation of these programs.
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Comparison of two training methods in community pharmacy: Project VACCINATE. J Am Pharm Assoc (2003) 2018; 58:S94-S100.e3. [DOI: 10.1016/j.japh.2018.04.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/20/2018] [Accepted: 04/03/2018] [Indexed: 11/23/2022]
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Exploring pharmacists’ perceptions regarding influenza and streptococcal testing within a chain pharmacy. J Am Pharm Assoc (2003) 2018; 58:438-441.e1. [DOI: 10.1016/j.japh.2018.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/26/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
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Gubbins PO, Klepser ME, Adams AJ, Jacobs DM, Percival KM, Tallman GB. Potential for Pharmacy-Public Health Collaborations Using Pharmacy-Based Point-of-Care Testing Services for Infectious Diseases. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2018; 23:593-600. [PMID: 27997479 DOI: 10.1097/phh.0000000000000482] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Health care professionals must continually identify collaborative ways to combat antibiotic resistance while improving community health and health care delivery. Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived point-of-care (POC) testing (POCT) services for infectious disease conducted in community pharmacies provide a means for pharmacists to collaborate with prescribers and/or public health officials combating antibiotic resistance while improving community health and health care delivery. OBJECTIVE To provide a comprehensive literature review that explores the potential for pharmacists to collaborate with public health professionals and prescribers using pharmacy-based CLIA-waived POCT services for infectious diseases. DESIGN Comprehensive literature review. SETTING PubMed and Google Scholar were searched for manuscripts and meeting abstracts for the following key words: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. INTERVENTION All relevant manuscripts and meeting abstracts utilizing POCT in community pharmacies for infectious disease were reviewed. OUTCOME MEASURE Information regarding the most contemporary evidence regarding CLIA-waived POC infectious diseases tests for infectious diseases and their use in community pharmacies was synthesized to highlight and identify opportunities to develop future collaborations using community pharmacy-based models for such services. RESULTS Evidence demonstrates that pharmacists in collaboration with other health care professionals can leverage their knowledge and accessibility to provide CLIA-waived POCT services for infectious diseases. Testing for influenza may augment health departments' surveillance efforts, help promote rationale antiviral use, and avoid unnecessary antimicrobial therapy. Services for human immunodeficiency virus infection raise infection status awareness, increase access to health care, and facilitate linkage to appropriate care. Testing for group A streptococcal pharyngitis may curb inappropriate outpatient antibiotic prescribing. However, variance in pharmacy practice statues and the application of CLIA across states stifle collaboration. CONCLUSION CLIA-waived POCT services for infectious diseases are a means for pharmacists, public health professionals, and prescribers to collaboratively combat antibiotic resistance and improve community health.
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Affiliation(s)
- Paul O Gubbins
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy at Missouri State University, Springfield, Missouri (Dr Gubbins); Ferris State University College of Pharmacy, Kalamazoo, Michigan (Dr Klepser); Idaho Board of Pharmacy, Boise, Idaho (Dr Adams); University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York (Dr Jacobs); Drake University College of Pharmacy and Health Sciences, Des Moines, Iowa (Dr Percival); Oregon State University/Oregon Health & Science University, Portland, Oregon (Dr Tallman)
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Demoré B, Tebano G, Gravoulet J, Wilcke C, Ruspini E, Birgé J, Boivin JM, Hénard S, Dieterling A, Munerol L, Husson J, Rabaud C, Pulcini C, Malblanc S. Rapid antigen test use for the management of group A streptococcal pharyngitis in community pharmacies. Eur J Clin Microbiol Infect Dis 2018; 37:1637-1645. [PMID: 29876774 DOI: 10.1007/s10096-018-3293-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 05/28/2018] [Indexed: 10/14/2022]
Abstract
Despite group A streptococci being an infrequent cause of pharyngitis in adult outpatients, sore throat remains a common indication for antibiotic prescription. This prospective multicentre non-randomised study describes a community pharmacy-based antimicrobial stewardship intervention consisting in the implementation of rapid antigen testing (RAT) for the management of adults with sore throat. Trained pharmacists triaged patients presenting with symptoms of pharyngitis using the modified Centor score. Those at risk for streptococcal infection were tested with RAT. Patients with a positive RAT were invited to consult a physician, whereas others were offered a symptomatic treatment. All patients received educational leaflets and were asked to fill in a follow-up form 7 days later. Ninety-eight pharmacies in one French region participated, and 559 patients were included over 6 months. RAT was proposed in 367 (65.7%) cases, and it was positive in 28 (8.3%). The follow-up form was returned by 140 (38.5%) participants. Of these, 10/10 patients with positive RAT further consulted a physician and were prescribed an antibiotic treatment, whereas 96.5% (110/114) of patients with negative results and not having any other reason to seek for doctor's advice did not consult. All participants found the intervention useful. Pharmacists spent 6-15 min to perform the intervention, and 98.6% (73/74) of pharmacists giving a feedback declared to be ready to implement this intervention in daily practice, if endorsed and reimbursed. Our results suggest that a pharmacy-based programme for the management of sore throat is feasible and could increase adherence to guidelines.
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Affiliation(s)
- Béatrice Demoré
- Pharmacie Brabois Adultes, CHRU Nancy, Nancy, France.,Université de Lorraine, UMR 7565 (SRSMC) CNRS, Nancy, France.,ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Gianpiero Tebano
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France. .,Université de Lorraine, APEMAC, F-54000, Nancy, France.
| | - Julien Gravoulet
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France.,Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Christophe Wilcke
- Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Eric Ruspini
- Union Régionale des Professionnels de Santé Pharmaciens du Grand Est, 4 rue Piroux, Nancy, France
| | - Jacques Birgé
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Jean-Marc Boivin
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France
| | - Sandrine Hénard
- Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Annick Dieterling
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
| | - Lidiana Munerol
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
| | - Julie Husson
- Département Analyse des Données de Santé, Agence Régionale de Santé du Grand Est. Direction de la Qualité et de la Performance, Nancy, France
| | - Christian Rabaud
- ANTIBIOLOR, CHRU Nancy, Réseau Lorrain d'Antibiologie, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU Nancy, F-54000, Nancy, France
| | - Sophie Malblanc
- Agence Régionale de Santé du Grand Est. Direction de la Santé Publique, Nancy, France
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Adams AJ, Dering-Anderson A, Klepser ME, Klepser D. The Roles of Pharmacy Schools in Bridging the Gap Between Law and Practice. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2018; 82:6577. [PMID: 29867246 PMCID: PMC5972855 DOI: 10.5688/ajpe6577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/20/2017] [Indexed: 05/30/2023]
Abstract
Progressive pharmacy laws do not always lead to progressive pharmacy practice. Progressive laws are necessary, but not sufficient for pharmacy services to take off in practice. Pharmacy schools can play critical roles by working collaboratively with community pharmacies to close the gap between law and practice. Our experiences launching pharmacy-based point-of-care testing services in community pharmacy settings illustrate some of the roles schools can play, including: developing and providing standardized training, developing template protocols, providing workflow support, sparking collaboration across pharmacies, providing policy support, and conducting research.
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Affiliation(s)
| | | | | | - Donald Klepser
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska
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Klepser DG, Klepser ME. Point-of-care testing in the pharmacy: how is the field evolving? Expert Rev Mol Diagn 2017; 18:5-6. [PMID: 29034791 DOI: 10.1080/14737159.2018.1392240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Donald G Klepser
- a College of Pharmacy , University of Nebraska Medical Center , Omaha , NE , USA
| | - Michael E Klepser
- b College of Pharmacy , Ferris State University , Big Rapids , MI , USA
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48
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Steltenpohl EA, Barry BK, Coley KC, McGivney MS, Olenak JL, Berenbrok LA. Point-of-Care Testing in Community Pharmacies: Keys to Success From Pennsylvania Pharmacists. J Pharm Pract 2017; 31:629-635. [PMID: 29034781 DOI: 10.1177/0897190017735243] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical Laboratory Improvement Amendments (CLIA)-waived tests allow for quick, accurate, and noninvasive laboratory testing. Community pharmacists utilize CLIA-waived tests to provide clinical services such as point-of-care (POC) testing to help manage chronic disease and acute illness. OBJECTIVE To identify key themes in the successful delivery of POC testing services by community pharmacists in Pennsylvania. RESULTS An initial search identified 51 Pennsylvania pharmacies with a CLIA waiver. Of these, five independent pharmacies met inclusion criteria, three of which completed interviews. The remaining 38 chain pharmacies were represented by three interviews. In total, five key themes were identified as essential to POC testing services: (1) utilize state resources and professional connections to navigate federal and state regulations, (2) establish relationships with physician partners (3) offer tests that are meaningful to patients and their physicians, (4) evaluate financial impact, workflow adaptations, and marketing approaches when implementing POC testing services, and (5) focus on individualized attention and convenience of community pharmacy-based POC testing to improve patient satisfaction. CONCLUSION Successful POC testing services in community pharmacy practice rely on utilizing resources, partnering with known physicians, selecting meaningful tests for patients, and analyzing finances, workflow, and marketing to provide individualized attention and convenient care.
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Affiliation(s)
- Emily A Steltenpohl
- 1 University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA
| | - Brandon K Barry
- 1 University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA
| | - Kim C Coley
- 1 University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA
| | - Melissa S McGivney
- 1 University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA
| | - Julie L Olenak
- 2 Wilkes University Nesbitt School of Pharmacy, Department of Pharmacy Practice, Wilkes Barre, PA, USA
| | - Lucas A Berenbrok
- 1 University of Pittsburgh School of Pharmacy, Department of Pharmacy and Therapeutics, Pittsburgh, PA, USA
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49
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Hohmeier KC, Spivey CA, Boldin S, Moore TB, Chisholm-Burns M. Implementation of a health information exchange into community pharmacy workflow. J Am Pharm Assoc (2003) 2017; 57:608-615. [DOI: 10.1016/j.japh.2017.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 05/11/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
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50
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Outpatient antibiotic stewardship: Interventions and opportunities. J Am Pharm Assoc (2003) 2017; 57:464-473. [DOI: 10.1016/j.japh.2017.03.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 03/07/2017] [Accepted: 03/31/2017] [Indexed: 01/10/2023]
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