Access to Community Pharmacies: A Nation-Wide Geographic Information Systems Cross-sectional Analysis

Development of a physical activity prescription course in a Doctor of Pharmacy program

Pharmacists are increasingly becoming the healthcare professional who interacts most regularly with patients who have diseases or disorders for which exercise is an effective and recommended treatment. With the relative scarcity of clinical exercise physiologists in the United States, pharmacists are expected to provide lifestyle advice to their patients, especially in community (i.e. retail) pharmacy settings, but student pharmacists typically receive no formal or informal training in exercise physiology and prescription. To address this deficit, an elective course was developed to provide student pharmacists with the knowledge and skill set that will enable them to apply evidence-based physical activity guidelines in the pharmacy. The course utilized the Exercise is Medicine resources for chronic diseases and disorders that are routinely encountered in community pharmacies, in addition to analysis of interactions between exercise and medications commonly prescribed for these conditions. After completion of the course, students reported being significantly more comfortable discussing physical activity with their patients compared to the start of the course (P < 0.001). Similarly, at the end of the course, 99% of students reported that they felt confident in their ability to apply evidence-based recommendations of common diseases and disorders to their patients. Postcourse student evaluations clearly demonstrated that student pharmacists viewed the course positively and as essential in their professional training. These data highlight the feasibility and efficacy of improving self-perceptions for the provision of physical activity recommendations via an elective course in physical activity prescription in a Doctor of Pharmacy program.NEW & NOTEWORTHY This study describes a new elective course in physical activity prescription for Doctor of Pharmacy students. After completing the course, students reported improved self-perceptions for the provision of physical activity recommendations. This course fills a gap in pharmacy education and this study provides future directions to improve training in lifestyle modifications.

Evaluation of the participation of community pharmacists in family planning services: A nonrandomized controlled trial

BACKGROUND

Community pharmacists (CPs) are increasingly participating in family planning services (FPS) in different health systems but the underpinnings of effectiveness in these services remain poorly understood and rarely documented. Objectives This study examined knowledge, attitude and practice (KAP) of FPS among CPs and assessed the impact of an intervention on these indices.

METHODS

A nonrandomized controlled trial was conducted using two equivalent groups (n = 61 each) of randomly-selected CPs in Southwestern Nigeria. Intervention comprised a training package for the intervention group followed by a 2-month monitoring of participants' practices. Pre- and post-intervention data were collected using validated questionnaire and analyzed using appropriate descriptive (frequency, percentages, mean) and inferential statistics including chi-square test to examine association between categorical variables, and t-test to compare differences between means at alpha level of 0.05 for all statistical tests.

RESULTS

Pre-intervention knowledge of FPS in both groups was poor with no significant difference in their mean scores [t (120) = 0.34; p = 0.74]. Post-intervention, 79% of intervention group demonstrated good knowledge (controls remained poor), with significant difference in mean knowledge scores across the groups [t (120) = -33.59; p < 0.05*]. Pre-intervention attitude in both control (97%) and intervention group (95%) were negative. Post-intervention, 93% of intervention group exhibited positive attitude (controls remained negative), Mean difference 72.8 [t (120) = -77.21; p < 0.05*]. Preintervention practice scores were poor in control (92%) and intervention (90%) groups. Post-intervention, 83.6% of intervention group had good practice scores (controls remained poor), Mean difference 48.9 [t (120) = -31.0; p < 0.05*].

CONCLUSION

Pre-intervention scores for KAP of FPS were poor among respondents. All the indices were significantly improved by the study intervention. Policy reforms are recommended to train CPs in the provision of FPS for enhanced reproductive health services.

Access to medications for opioid use disorder for formerly incarcerated individuals during community reentry: a mini narrative review

Medications for opioid use disorder (MOUD) are especially important for formerly incarcerated individuals with opioid use disorder (OUD) and can reduce the risk of re-arrest and overdose during community reentry. Unfortunately, few formerly incarcerated individuals are able to access MOUD within the community, missing a critical tool for rehabilitation. A mini narrative review was conducted to highlight the published work that has been done to improve access to MOUD for formerly incarcerated individuals during reentry. The results yielded 15 records describing intervention evaluations, program descriptions, and research in progress. Most work is ongoing, showing promise that researchers have identified the importance of this problem. However additional research should be done to include other stakeholders and address the limitations of existing interventions and programs. Continued efforts can help ensure that formerly incarcerated individuals can safely and successfully reintegrate into society.

Revealing rural motivations in pharmacy students pursuing a graduate certificate program

INTRODUCTION

To assist recruitment and retention efforts and influence the need for an increased supply of future rural pharmacists, this study examines perceptions and key motivators of pharmacy students who chose to participate in the Rural Pharmacy Health Certificate (RPHC) program and pursue pathways to rural practice.

METHODS

We interviewed six RPHC students prior to or shortly after beginning their first semester in the RPHC program. Interview questions assessed applicants' reasons for pursuing the RPHC, perceptions of living in and providing healthcare in rural and small communities, awareness of barriers and health disparities in rural areas, and qualities needed to be a successful rural pharmacist. We analyzed data with the Sort and Sift, Think and Shift method, a common approach to qualitative data analysis.

RESULTS

Interest in pursuing rural pharmacy grew out of growing up in a rural area, as well as a desire to serve and help others. Students expected that completing the RPHC would strengthen their skillsets to provide the best care by addressing barriers such as difficulty accessing care and health literacy. Being a learner of one's community was the primary quality identified as necessary to be a successful rural pharmacist.

CONCLUSION

This study identified primary motivators and perceptions that led students to pursue a rural health program at one US pharmacy school. The results can be used to identify and train good candidates for rural pharmacy practice, strengthening the rural pharmacy workforce to better meet communities' needs.

ASAP: A pharmacy-level intervention to increase nonprescription syringe sales to reduce bloodborne illnesses

BACKGROUND

Pharmacy syringe sales are effective structural interventions to reduce bloodborne illnesses in populations, and are legal in all but two states. Yet evidence indicates reduced syringe sales in recent years. This study was designed as a feasibility test of an intervention to promote syringe sales by pharmacies in Arizona.

METHODS

A four-month pilot among three Arizona pharmacies measured feasibility and acceptability through monthly surveys to 18 enrolled pharmacy staff members.

RESULTS

Pharmacy staff reported increased ease of dispensing syringes across the study. Rankings of syringe dispensing as 'easiest' among 6 measured pharmacy practices increased from 38.9 % at baseline to 50.1 % post intervention module training, and to 83.3 % at pilot conclusion. The majority (72.2 %) of pharmacy staff agreed that intervention materials were easy to use. Over 70 % indicated that the intervention was influential in their "being more open to selling syringes without a prescription to someone who might use them for illicit drug use," and 61.1 % reported that in the future, they were highly likely to dispense syringes to customers who would use them to inject drugs. A vast majority (92 %) reported being likely to dispense subsidized naloxone if available to their pharmacy at no cost.

CONCLUSIONS

An education-based intervention was found to be feasible and acceptable to pharmacy staff and had an observed impact on perceptions of ease and likelihood of dispensing syringes without a prescription to people who may use them to inject drugs.

Implementing Maximum Fair Price Without Hurting Pharmacies

This Viewpoint discusses challenges pharmacies may face under the Inflation Reduction Act and steps that can be taken to prevent unintended consequences.

"I go out of my way to give them an extra smile now:" A study of pharmacists who participated in Respond to Prevent, a community pharmacy intervention to accelerate provision of harm reduction materials

BACKGROUND

Community pharmacies are well-positioned to improve the health of people with opioid use disorder and who use drugs by providing naloxone and other essential public health supplies. Respond to Prevent (R2P) is a clinical trial which sought to accelerate provision of harm reduction materials through a multicomponent intervention that included in-store materials, online training, and academic detailing.

OBJECTIVES

The objective of this study was to explore pharmacists' attitudes, knowledge, and experiences in providing naloxone, dispensing buprenorphine, and selling nonprescription syringes following participation in the R2P program.

METHODS

Two online asynchronous focus groups were conducted with community-based chain pharmacists across Massachusetts, New Hampshire, Oregon, and Washington who had participated in the R2P program. Participants accessed an online repository of group interview items and responded to questions over a short period. Each pharmacist participated anonymously for approximately 30 min over 2 ½ days. Pharmacists answered questions on experiences with pharmacy-based harm reduction care and R2P intervention implementation barriers and facilitators. Qualitative data analysis was conducted by a multidisciplinary team using an immersion-crystallization approach.

RESULTS

A total of 32 pharmacists participated in the two focus groups. Most participants were female (n = 18, 56%), non-Hispanic (n = 29, 91%), and white (n = 17, 53%). Four major themes were identified related to (1) addressing bias and stigma toward people with opioid use disorder and who use drugs, (2) familiarity and comfort with naloxone provision, (3) perspective and practice shifts in nonprescription syringe sales, (4) structural challenges to harm reduction care in the pharmacy.

CONCLUSIONS

Community pharmacists across the four states identified attitudes, knowledge, and experiences that create barriers to providing care to people with opioid use disorder and who use drugs. R2P approaches and tools were effective at reducing stigma and changing attitudes but were less effective at addressing structural challenges from the pharmacists' perspective.

Perspectives Among Health Care Providers and People with HIV on the Implementation of Long-Acting Injectable Cabotegravir/Rilpivirine for Antiretroviral Therapy in Florida

Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) for antiretroviral therapy (ART) could benefit many people with HIV (PWH). However, its impact will largely be determined by providers' willingness to prescribe it and PWH's willingness to take it. This study explores the perceived barriers and facilitators of LAI CAB/RPV implementation among PWH and HIV care providers in Florida, a high prevalence setting. Semi-structured qualitative interviews were conducted in English with 16 PWH (50% non-Hispanic White, 50% cis men, and 94% on oral ART) and 11 providers (27% non-Hispanic Black, 27% Hispanic, 73% cis women, and 64% prescribed LAI CAB/RPV) throughout the state. Recruitment occurred between October 2022 and October 2023 from HIV clinics. Interviews were recorded, professionally transcribed, and then double coded using thematic analysis. The Consolidated Framework for Implementation Research guided the interview guide and coding. While PWH viewed LAI CAB/RPV as effective, predominant barriers included administration via injection, challenges of attending more clinic visits, and a feeling that this made HIV the center of one's life. Providers additionally expressed concerns about the development of integrase resistance. Barriers noted by PWH and providers outside of the clinic included transportation, stigma, access inequities, and payor issues. Within clinics, providers identified the need for extra staffing and the increased burden on existing staff as barriers. These barriers decreased the perceived need for LAI CAB/RPV among PWH and providers, especially with the high effectiveness of oral ART. Many of the identified barriers occur outside of the clinic and will likely apply to other novel long-acting ART options.

Federal Retail Pharmacy Program Contributions to Bivalent mRNA COVID-19 Vaccinations Across Sociodemographic Characteristics - United States, September 1, 2022-September 30, 2023

The Federal Retail Pharmacy Program (FRPP) facilitated integration of pharmacies as partners in national efforts to scale up vaccination capacity during the COVID-19 pandemic emergency response. To evaluate FRPP's contribution to vaccination efforts across various sociodemographic groups, data on COVID-19 bivalent mRNA vaccine doses administered during September 1, 2022-September 30, 2023, were evaluated from two sources: 1) FRPP data reported directly to CDC and 2) jurisdictional immunization information systems data reported to CDC from all 50 states, the District of Columbia, U.S. territories, and freely associated states. Among 59.8 million COVID-19 bivalent vaccine doses administered in the United States during this period, 40.5 million (67.7%) were administered by FRPP partners. The proportion of COVID-19 bivalent doses administered by FRPP partners ranged from 5.9% among children aged 6 months-4 years to 70.6% among adults aged 18-49 years. Among some racial and ethnic minority groups (e.g., Hispanic or Latino, non-Hispanic Black or African American, non-Hispanic Native Hawaiian or other Pacific Islander, and non-Hispanic Asian persons), ≥45% of COVID-19 bivalent vaccine doses were administered by FRPP partners. Further, in urban and rural areas, FRPP partners administered 81.6% and 60.0% of bivalent vaccine doses, respectively. The FRPP partnership administered approximately two thirds of all bivalent COVID-19 vaccine doses in the United States and provided vaccine access for persons across a wide range of sociodemographic groups, demonstrating that this program could serve as a model to address vaccination services needs for routine vaccines and to provide health services in other public health emergencies.

The Role of Community Pharmacies in Providing Access to HIV Post-exposure Prophylaxis (PEP)

HIV affects an estimated 1.2 million individuals in the United States and is disproportionately concentrated among African Americans, Latinos, and people of multiple races. Post-exposure prophylaxis (PEP) substantially decreases HIV transmission when started within 72 h after exposure, but problems of accessibility have hindered its widespread usage in communities at risk for HIV infection. Pharmacy-initiated PEP access was first permitted in New York City in 2017, allowing pharmacists to provide a 7-day supply of PEP without a prescription for consumers at high risk for HIV infection. It was expected that the broad reach and accessibility of community pharmacies would increase timely access to PEP for all individuals, especially those who already face significant barriers to accessing the healthcare system. Since then, eleven other states have followed suit and expanded the scope of outpatient pharmacy practice in order to increase the availability of HIV PEP but prescribing laws in over 75% of the US have not been changed. Much of the existing literature on HIV prevention focuses on PrEP access barriers with limited information on PEP access in the US. In this paper, we review the current status of pharmacist-initiated PEP in the US as part of the End the HIV Epidemic (EHE) initiative.

Locations and characteristics of pharmacy deserts in the United States: a geospatial study

Pharmacies are important health care access points, but no national map currently exists of where pharmacy deserts are located. This cross-sectional study used pharmacy address data and Census Bureau surveys to define pharmacy deserts at the census tract level in all 50 US states and the District of Columbia. We also compared sociodemographic characteristics of pharmacy desert vs non-pharmacy desert communities. Nationally, 15.8 million (4.7%) of all people in the United States live in pharmacy deserts, spanning urban and rural settings in all 50 states. On average, communities that are pharmacy deserts have a higher proportion of people who have a high school education or less, have no health insurance, have low self-reported English ability, have an ambulatory disability, and identify as a racial or ethnic minority. While, on average, pharmacies are the most accessible health care setting in the United States, many people still do not have access to them. Further, the people living in pharmacy deserts are often marginalized groups who have historically faced structural barriers to health care. This study demonstrates a need to improve access to pharmacies and pharmacy services to advance health equity.

Engaging community pharmacies in practice-based research: Lessons from opioid-focused research

There is an established need to translate evidence-based practices into real-world practice. Community pharmacists and their corresponding pharmacies are well-positioned to be effective partners as researchers seek to study and implement practice-based research. Challenges exist when partnering with community pharmacies which can vary based on the study type, the nature of the community pharmacy, and stakeholder groups (i.e., patients, staff, leadership, physicians). This commentary seeks to describe these challenges and provide recommendations that can help mitigate and/or overcome these challenges. Recommendations are provided for team structure, communication, research tools/technology, motivational factors, workflow, and sustainability. These recommendations are based on the authors' experience in partnering with community pharmacy for opioid-related research in a variety of study types, states, and pharmacy environments.

The Cost of Safe Injection: Insights on Nonprescription Syringe Price Variability From Systematic Secret Shopping

BACKGROUND

Although the sale of nonprescription syringes in pharmacies is legal in most states, people who inject drugs (PWID) continue to face obstacles to syringe purchase like stigma, prohibitive costs, restrictive policies, and stocking issues. We examined the consistency of syringe pricing as another possible barrier.

METHODS

We analyzed data on syringe prices and other relevant variables from 153 unique secret shopper visits to 2 retail chain pharmacies in Massachusetts (MA), New Hampshire (NH), Oregon (OR), and Washington (WA) as part of the fidelity component of a large pharmacy-focused intervention study. Pretax prices from purchases made between August 2019 and May 2021 were adjusted for inflation to 2022 dollars, and a linear regression of the price of a 10-pack of syringes was constructed to examine the determinants of syringe pricing.

RESULTS

The average real price of a 10-pack of syringes across all states was $4.53 (SD = 0.99), with wide variability between pharmacies (max = $11.44, min = $1.70) and between states (mean OR = $5.76, WA = $4.74, MA = $4.33, NH = $4.30). Forty-seven percent (n = 72) of the purchases were taxed despite syringes being tax exempt in MA and WA, and not having a sales tax in NH or OR. The results of the regression suggest that certain needle gauges were associated with lower overall prices, while 1 pharmacy chain and 2 syringe brands were associated with higher overall prices.

CONCLUSIONS

The high variability in syringe pricing presents another barrier to pharmacy-based syringe access since high prices may leave PWID no choice but to reuse or share needles, especially in areas with limited alternatives or without a syringe service program. Leadership from healthcare systems, pharmacy chains, and state and local policymakers is essential to reduce stigma and to implement policies that streamline syringe purchases, eliminate the taxation of exempt syringes in accordance with state laws, and reduce the variation in syringe prices.

Closing the Tobacco Treatment Gap: A Qualitative Study of Tobacco Cessation Service Implementation in Community Pharmacies

Tobacco use remains a leading preventable cause of morbidity and mortality, with pharmacotherapy and counseling recognized as effective cessation aids. Yet, the potential role of pharmacists and pharmacy technicians in tobacco cessation services is underutilized. This study explores the integration of such services in community pharmacies, identifying facilitators and barriers to their implementation. A qualitative study was conducted across seven community pharmacies in California that were affiliated with the Community Pharmacy Enhanced Services Network. Participants included 22 pharmacists and 26 pharmacy technicians/clerks who completed tobacco cessation training. Data were collected through semi-structured interviews, focusing on experiences with implementing cessation services. The analysis was guided by Rogers' Diffusion of Innovations Theory. MAXQDA software was used for data management and thematic analysis. Sixteen pharmacy personnel participated in the study, highlighting key themes around the integration of cessation services. Compatibility with existing workflows, the importance of staff buy-in, and the crucial role of pharmacy technicians emerged as significant facilitators. Challenges included the complexity of billing for services, software limitations for documenting tobacco use and cessation interventions, and gaps in training for handling complex patient cases. Despite these barriers, pharmacies successfully initiated cessation services, with variations in service delivery and follow-up practices. Community pharmacies represent viable settings for delivering tobacco cessation services, with pharmacists and technicians playing pivotal roles. However, systemic changes are needed to address challenges related to billing, documentation, and training. Enhancing the integration of cessation services in community pharmacies could significantly impact public health by increasing access to effective cessation support.

Views of the Pharmacists' Role in HPV Vaccinations: A Qualitative Study in Tennessee

The Human Papillomavirus (HPV) is a frequently occurring sexually transmitted infection in adults and is associated with various cancers that can affect both males and females. Recently, the Advisory Committee on Immunization Practices (ACIP) expanded its recommendations for the HPV vaccine to include patients aged 27-45 years with shared clinical decision-making. A commonly reported obstacle to receiving the HPV vaccine among adults is a lack of healthcare provider recommendations. Considering the suboptimal HPV vaccine coverage figures and noting that the vast majority of hesitancy research has been conducted among children and adolescents, limited research is available on the adult perception of HPV vaccination in pharmacies. This study focuses on understanding adults' opinions and perceptions regarding the role of pharmacists in the uptake of the HPV vaccine and awareness of its availability in the pharmacy setting.

METHODS

After receiving approval from the Institutional Review Board (IRB), the qualitative study was initiated using virtual focus groups (FGs). Concepts from the Transtheoretical Model, the Health Belief Model, and the Social Cognitive Theory guided the study design. The corpus of data was collected in 2021 and 2022 by two researchers, and a third party transcribed the FGs to avoid any biases. The data were analyzed using Braun and Clarke's Thematic Analysis.

RESULTS

Out of 35 subjects that participated in six FGDs, most identified as female, with ages ranging from 18 to 45 years. The following four themes emerged: (1) HPV vaccine awareness; (2) stigmas leading to reduced education and vaccination rates; (3) education preferences; (4) follow-up in vaccination series reminders and preferences.

CONCLUSION

Participants' views of the HPV vaccine and the ability to receive the vaccine in a pharmacy are influenced by a myriad of factors. Common factors include improved awareness, preferences for educational modalities, avoiding stigmas associated with HPV vaccination, combating gender-focused biases, and preferences for the location of vaccination. These barriers provide opportunities for pharmacists to promote and enhance vaccine uptake.

Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report

BACKGROUND

The number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies' ubiquity and pharmacists' extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education.

OBJECTIVE

In 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team's control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the "file-drawer" (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors' hypotheses.

METHODS

This paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies.

RESULTS

Retrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive.

CONCLUSIONS

Community pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/42373.

Association Between Pharmacy Proximity With Cardiovascular Medication Use and Risk Factor Control in the United States

BACKGROUND

Poor neighborhood-level access to health care, including community pharmacies, contributes to cardiovascular disparities in the United States. The authors quantified the association between pharmacy proximity, antihypertensive and statin use, and blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) among a large, diverse US cohort.

METHODS AND RESULTS

A cross-sectional analysis of Black and White participants in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) study during 2013 to 2016 was conducted. The authors designated pharmacy proximity by census tract using road network analysis with population-weighted centroids within a 10-minute drive time, with 5- and 20-minute sensitivity analyses. Pill bottle review measured medication use, and BP and LDL-C were assessed using standard methods. Poisson regression was used to quantify the association between pharmacy proximity with medication use and BP control, and linear regression for LDL-C. Among 16 150 REGARDS participants between 2013 and 2016, 8319 (51.5%) and 8569 (53.1%) had an indication for antihypertensive and statin medication, respectively, and pharmacy proximity data. The authors did not find a consistent association between living in a census tract with higher pharmacy proximity and antihypertensive medication use, BP control, or statin medication use and LDL-C levels, regardless of whether the area was rural, suburban, or urban. Results were similar among the 5- and 20-minute drive-time analyses.

CONCLUSIONS

Living in a low pharmacy proximity census tract may be associated with antihypertensive and statin medication use, or with BP control and LDL-C levels. Although, in this US cohort, outcomes were similar for adults living in high or low pharmacy proximity census tracts.

Assessing community pharmacy services in health professional shortage areas across Wisconsin

BACKGROUND

Primary care health professional shortage areas (HPSAs) lack sufficient primary care providers to meet their health care needs, which contributes to worse health outcomes within underserved populations. Community pharmacies are commonly located in HPSAs and provide nondispensing services that can help address unmet health care needs. However, there is limited data on the nature, scope, and reimbursement for community pharmacy services.

OBJECTIVES

Using survey data from the state of Wisconsin, this study compares the prevalence of and reimbursement for services provided by community pharmacies in primary care HPSAs and non-HPSAs and describes barriers to pharmacy service implementation.

METHODS

A survey tool on pharmacy services, reimbursement, and barriers to service implementation was developed, pilot tested, and administered to every community pharmacy in Wisconsin. Data were collected via mail and online over two waves of survey administration from November 2021 to May 2022. Pearson's chi-squared and t tests were used to compare the prevalence of and reimbursement for services between HPSA and non-HPSA pharmacies. Content analysis was used to identify themes that described barriers to pharmacy service implementation.

RESULTS

Responses were received from 287 of 774 eligible community pharmacies (37.1%). HPSA pharmacies were significantly more likely to be in rural areas. Regardless of pharmacy location, community pharmacies reported commonly providing a variety of services, but reimbursement for these services was considerably less frequent. The prevalence of reimbursement was <50% for two-thirds of services. Pharmacy staffing, time, and financial issues were the most commonly reported barriers to service implementation.

CONCLUSIONS

Community pharmacies provide a diverse set of services to meet the health care needs of their patients, but often do so with inadequate staffing or reimbursement. Action is needed to support community pharmacies in meeting the health care needs of their communities and to ensure patient access to medications and pharmacy services.

Access to community pharmacies based on drive time and by rurality across the contiguous United States

BACKGROUND

Considering that mail-order pharmacy use remains low in the United States, geographic accessibility of community pharmacies (pharmacy access) can have an outsized impact on a community's access to services and care, especially among rural residents. However, previous measurements of pharmacy access rely on methods that do not capture all aspects of geographic access.

OBJECTIVES

This study aimed to measure pharmacy access across the contiguous United States and by rural, suburban, and urban areas using drive-time analysis and an improved methodological approach.

METHODS

The 2-step floating catchment area method was used to measure pharmacy access by considering the supply capacity of pharmacies, population demand for pharmacies, and the interaction between them within a reasonable travel time range. This method is a methodologically improved approach compared with previous methods for measuring geographic access. Network analysis was used to measure drive time from the population-weighted centroids of census tracts to the geocoded location of community pharmacies. Census tract-level pharmacy access was measured using a 10- and 20-minute drive time. Census tracts were also categorized based on population per square mile as rural (< 1000), suburban (1000-3000), and urban (> 3000).

RESULTS

Across the contiguous United States, 79.9% and 91.1% of census tracts had access to at least 1 pharmacy per 10,000 people within a 10- and 20-minute drive time, respectively. Rural census tracts had the lowest share of access to at least 1 pharmacy per 10,000 people compared with suburban and urban tracts and for both drive times.

CONCLUSION

Community pharmacies are highly accessible health care access points, specifically in urban and suburban areas. Pharmacies should be considered to expand access to services with limited geographic accessibility such as treatment programs for opioid use disorders, primary care, and healthy foods.

Pharmacist provision of medication abortion: A pilot study

OBJECTIVES

This study aimed to perform a "proof of concept" pilot and assess patient satisfaction of pharmacist provision of medication abortion utilizing an implementation toolkit.

STUDY DESIGN

Pharmacists completed an online and in-person training followed by an online assessment prior to participating in the pilot. Pharmacists provided medication abortion care using a "no-test" protocol and an implementation toolkit. Participants were administered 200 mg of mifepristone orally on the day of their abortion visit and instructed to take 800 mcg of misoprostol buccally 24 to 48 hours later (with an additional 800 mcg buccally 4 hours after the first dose for patients 63-70 days' gestation). Visits were completed in person in a private room adjacent to the pharmacy. We assessed the rate of completed abortions and any complications. Following their abortion, patients completed a brief interviewer-administered survey and semistructured qualitative interview.

RESULTS

Ten patients completed medication abortion visits. Nine of 10 participants had complete abortions. One participant identified that she did not pass her pregnancy and underwent an in-office aspiration. One participant visited an emergency department for pain and received pain medication. No serious adverse events occurred. All patients completed the postabortion survey, and all were "very satisfied" with their abortion experience. Nine patients completed postabortion interviews.

CONCLUSIONS

In this pilot study, pharmacists were successful at providing medication abortion to patients. Satisfaction was high, and complications were uncommon.

IMPLICATIONS

Patients were highly satisfied with pharmacist provision of medication abortion and are likely to utilize this service if available.

Addressing quality medication use among migrant patients: Establishment of an organization to provide culturally competent medication care

As the global landscape continues to witness an increase in migration, the healthcare community faces an evolving challenge: the provision of quality medication care to migrant patients. Language barriers, cultural differences, and a lack of understanding of the local healthcare system can often impede the effective management of medications and access to healthcare services among migrant populations. Pharmacists, as medication experts, are dignified to make a substantial impact in bridging the gap between migrants and quality healthcare. Their expertise in medication management, accessibility, and counseling positions them as critical healthcare providers for this patient population. Pharmacies and pharmacists can serve as trusted hubs where migrants receive not only essential medications but also culturally sensitive support in navigating the healthcare system. This commentary article highlights the critical importance of culturally competent medication care for migrant patients and the central role that pharmacists can play in this endeavor. By establishing organization dedicated to this cause lead by pharmacists, we can not only address an urgent healthcare concern but also set a precedent for a healthcare system that values inclusivity, cultural competence, and equitable access to quality medication care for all, regardless of their cultural background.

Spatial accessibility and travel to pharmacy by type in the Detroit region

BACKGROUND

Community pharmacies are a critical part of the health care provision system. Yet less is understood about the spatial accessibility to pharmacies and how people travel to reach these services.

OBJECTIVES

This study compared spatial accessibility and actual travel to different types of pharmacies among selected neighborhoods in the Detroit region.

METHODS

Three types of neighborhoods were selected and compared, including two lower income Black urban neighborhoods of high-density and four upper income White suburbs (two of low density and two of high density). Spatial accessibility was computed by pharmacy type and compared among neighborhoods using ANOVA. Pharmacy trips reported in a travel survey were geocoded and linked with community pharmacies in a list generated from ReferenceUSA business data. Destination choices were mapped and the relationship between spatial accessibility and actual distance traveled was examined using ordinary least squares regressions.

RESULTS

On average, urban residents in Detroit had higher access to local independent pharmacies (0.74 miles to the nearest one) but relatively lower access to national chains (1.35 miles to the nearest one), which most residents relied on. Urban residents also tended to shop around more for services even among national chains. In fact, they bypassed nearby local independent pharmacies and traveled long distances to use farther pharmacies, primarily national chains. The average trip distance to pharmacy was 2.1 miles for urban residents, but only 1.1 miles and 1.5 miles for residents in high-density suburbs and low-density suburbs, respectively.

CONCLUSION

Supposedly good spatial access considering all pharmacies together may mask excessive burden in reaching the pharmacy services needed in low-income minority urban communities, as shown in the case of Detroit. Thus, when mapping pharmacy deserts, it is important to distinguish spatial accessibility among different pharmacy types.

Despair and hope: Is the retail community pharmacy workforce in danger of becoming a monopsony labor market?

OBJECTIVE

Mergers of big chain retail community pharmacies can affect the competitiveness of the pharmacy workforce to negotiate better wages and work conditions. However, it is unclear whether these types of mergers are generalizable to the U.S. pharmacy workforce. We should observe this effect when comparing annual wage trends between retail community pharmacy workers and nonretail community pharmacy workers. In the absence of this effect, annual wage trends would be similar. To examine this theory, annual wage trends for community pharmacy workers were compared with hospital pharmacy workers between 2012 and 2022.

DESIGN, SETTING AND PARTICIPANTS

A serial cross-sectional study was performed to compare the annual wages between retail community pharmacy workers and hospital pharmacy workers between 2012 and 2022 using data from the U.S. Bureau of Labor and Statistics (BLS). Pharmacy workforce was categorized as pharmacists, pharmacy technicians, and pharmacy aides (clerks) and grouped into retail or hospital pharmacy settings based on the North American Industry Classification System. Pharmacy workers' annual wages were based on the U.S. BLS Quarterly Census of Employment and Wages data.

OUTCOME MEASURES

Annual wages.

RESULTS

Between 2012 and 2022, statistically significant annual wage reduction was greater among pharmacists in the retail than pharmacists in the hospital setting by -$1974 (95% CI -$2921 to -$1026) per year. However, these trends were not statistically significant among pharmacy technicians and pharmacy aides. Pharmacy technicians in the retail and hospital settings had a 3.4% and 7.0% increase in average annual wages, respectively. Pharmacy aides in the retail and hospital settings had a 16.8% and 21.6% increase in average annual wages, respectively.

CONCLUSION

Although pharmacists' annual wages decreased, it is unclear whether this was caused by the monopsony labor market. These findings suggest that there may be inefficiencies in the retail community pharmacy labor market, which may stimulate policies to improve pharmacy workforce conditions and patient safety.

Report of the 2023 AACP Council of Deans Taskforce on Pharmacy Research and Scholarship

OBJECTIVE

The objective of this review is to provide the conclusions from the American Association of Colleges of Pharmacy (AACP) Council of Deans (COD) Taskforce on Research and Scholarship.

FINDINGS

The charges and the findings of the committee are: (1) Define the scholarship needs/opportunities to strengthen the outputs. The committee recommends that AACP update its definitions of research/scholarship to include discovery, integration, application/practice, and teaching/learning. A deployed survey demonstrated a high Special Interest Groups research/scholarship interest. (2) Assemble a toolkit of grant and scholarship resources to assist colleges/schools. The AACP should update the existing funding opportunity listing and combine it with additional resources. (3) Create a framework for effective research collaboration and mentorship. The AACP should identify key areas of pharmacy research and experts to serve as mentors and to meet with external stakeholders. (4) and (5) Consider the need for and purpose of a COD standing committee for research and scholarship. Explore the value of a formal research dean's subcommittee. It was recommended that AACP form a research/scholarship committee or Special Interest Groups and create the Pharmacy Scholarship, Research, and Graduate Education pre-meeting to the Interim Meeting. (6) Identify key statements/outputs of the COD that need to be prepared for publication/sharing. We recommended the key statement/outputs in the areas of discovery, integration, application/practice, and teaching and learning.

SUMMARY

The taskforce reviewed the state of research and scholarship across the Academy and provided recommendations with the goal of advancing research across all areas of the pharmacy profession.

Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce

This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.

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

BACKGROUND

We aimed to understand U.S. adults' willingness to use a pharmacy-based fecal immunochemical test (FIT) distribution service for routine colorectal cancer screening called PharmFIT using Diffusion of Innovation Theory, evaluating patient's appraisals of the program's relative advantage, compatibility, and complexity.

METHODS

From March to April 2021, we conducted a national online survey of 1,045 U.S. adults ages 45 to 75. We identified correlates of patient willingness to use PharmFIT using structural equation modeling.

RESULTS

Most respondents (72%) were willing to get a FIT from their pharmacy for their regular colorectal cancer screening. Respondents were more willing to participate in PharmFIT if they perceived higher relative advantage ($\hat{\beta}$= 0.184; confidence interval, CI95%: 0.055-0.325) and perceived higher compatibility ($\hat{\beta}$ = 0.422; CI95%: 0.253-0.599) to get screened in a pharmacy, had longer travel times to their primary health care provider ($\hat{\beta}$ = 0.007; CI95%: 0.004-0.010). Respondents were less willing to participate in PharmFIT if they were 65 years or older ($\hat{\beta}$ = -0.220; CI95%: -0.362 to -0.070).

CONCLUSIONS

Most U.S. adults would be willing to participate in PharmFIT for their routine colorectal cancer screening. Patient perceptions of the relative advantage and compatibility of PharmFIT were strongly associated with their willingness to use PharmFIT. Pharmacies should account for patient preferences for these two traits of PharmFIT to increase adoption and use.

IMPACT

Pharmacy-based colorectal cancer screening may be a viable public health strategy to significantly increase equitable access to screening for U.S. residents.

Clinical Risk and Outpatient Therapy Utilization for COVID-19 in the Medicare Population

Importance

Multiple therapies are available for outpatient treatment of COVID-19 that are highly effective at preventing hospitalization and mortality. Although racial and socioeconomic disparities in use of these therapies have been documented, limited evidence exists on what factors explain differences in use and the potential public health relevance of these differences.

Objective

To assess COVID-19 outpatient treatment utilization in the Medicare population and simulate the potential outcome of allocating treatment according to patient risk for severe COVID-19.

Design, Setting, and Participants

This cross-sectional study included patients enrolled in Medicare in 2022 across the US, identified with 100% Medicare fee-for-service claims.

Main Outcomes and Measures

The primary outcome was any COVID-19 outpatient therapy utilization. Secondary outcomes included COVID-19 testing, ambulatory visits, and hospitalization. Differences in outcomes were estimated based on patient demographics, treatment contraindications, and a composite risk score for mortality after COVID-19 based on demographics and comorbidities. A simulation of reallocating COVID-19 treatment, particularly with nirmatrelvir, to those at high risk of severe disease was performed, and the potential COVID-19 hospitalizations and mortality outcomes were assessed.

Results

In 2022, 6.0% of 20 026 910 beneficiaries received outpatient COVID-19 treatment, 40.5% of which had no associated COVID-19 diagnosis within 10 days. Patients with higher risk for severe disease received less outpatient treatment, such as 6.4% of those aged 65 to 69 years compared with 4.9% of those 90 years and older (adjusted odds ratio [aOR], 0.64 [95% CI, 0.62-0.65]) and 6.4% of White patients compared with 3.0% of Black patients (aOR, 0.56 [95% CI, 0.54-0.58]). In the highest COVID-19 severity risk quintile, 2.6% were hospitalized for COVID-19 and 4.9% received outpatient treatment, compared with 0.2% and 7.5% in the lowest quintile. These patterns were similar among patients with a documented COVID-19 diagnosis, those with no claims for vaccination, and patients who are insured with Medicare Advantage. Differences were not explained by variable COVID-19 testing, ambulatory visits, or treatment contraindications. Reallocation of 2022 outpatient COVID-19 treatment, particularly with nirmatrelvir, based on risk for severe COVID-19 would have averted 16 503 COVID-19 deaths (16.3%) in the sample.

Conclusion

In this cross-sectional study, outpatient COVID-19 treatment was disproportionately accessed by beneficiaries at lower risk for severe infection, undermining its potential public health benefit. Undertreatment was not driven by lack of clinical access or treatment contraindications.

Pharmacy staff-reported adaptations to naloxone provision and over-the-counter (OTC) syringe sales during the COVID-19 pandemic: Experiences across multiple states and 2 pharmacy chains

BACKGROUND

Access to harm reduction materials was greatly disrupted during coronavirus disease 2019 (COVID-19). Community pharmacies often continued provision of harm reduction materials as part of their usual operations during the pandemic, but little is known about what, if any, adaptations were made and the perceived impact of these actions from the perspective of pharmacy staff.

OBJECTIVES

We explored how pharmacy staff across 4 states in 2 major pharmacy chains adapted to the COVID-19 pandemic for ongoing naloxone and over-the-counter (OTC) syringe access and how staff perceived the pandemic affected drug use in the community they served and their pharmacy's volume of syringe sales and naloxone provision.

METHODS

We analyzed 134 pharmacy staff responses to a 12-month follow-up assessment for an educational intervention conducted in 2 pharmacy chains in Oregon, Washington, Massachusetts, and New Hampshire. Respondents answered closed- and open-ended questions collected online from July 2020 to February 2022. Questions measured prevalence of adaptations and perceived uptake of naloxone and OTC syringe services. Descriptive statistics summarized adaptations and perceived impact and chi-square tests explored differences by state and pharmacy chain. Open-ended responses were reviewed and analyzed to identify summary points and themes.

RESULTS

With few differences by state or pharmacy chain detected, pharmacy staff reported more naloxone mailing, requests by phone, streamlined counseling, and drive-thru provision adaptations to OTC syringe sales and naloxone provision during the pandemic. Most staff perceived adaptations as increasing or maintaining naloxone provision and OTC syringe sales. Respondents described specific aspects of the pharmacy that contributed to successful adaptations, including tailoring to specific product demand, inventory levels, drive-thru access, and a perception of extraordinary public health need at a time of and in places affected by the opioid crisis.

CONCLUSIONS

Pharmacy OTC syringe and naloxone access continued during the COVID-19 pandemic through streamlining workflows and innovating no-contact harm reduction services, reinforcing pharmacy's public health role.

Assessing pharmacist and clinician perspectives on pharmacist-prescribed hormonal contraceptives

BACKGROUND

After the Dobbs et al. ruling in June 2022 by the U.S. Supreme Court eliminated the federal right to abortion care, concerns about access to reproductive health have been elevated. Barriers to contraception use consist of knowledge deficits, unfavorable legal rulings, cost and insurance coverage, unnecessary medical practices, and health care inequities. Pharmacists are the most accessible health care providers who are positioned to mitigate these barriers and expand reproductive health access through scope of practice expansion. The American College of Obstetricians and Gynecologists has expressed their support for pharmacists prescribing hormonal contraceptives. As of October 2022, 22 states and jurisdictions have a protocol in place to allow for autonomous prescribing of hormonal contraceptives by pharmacists.

OBJECTIVE

The objective of this study was to simultaneously assess pharmacist and clinician perspectives of all ages and sexual identities, on pharmacist-prescribed hormonal contraceptives and barriers faced in accessing contraception.

METHODS

The researchers conducted an institutional review board-approved observational study via a cross-sectional survey distributed to licensed pharmacists and clinicians from October 2022 to February 2023. The survey population included those who were 18 years or older, English speaking, and recruited both in person and through e-mail listservs. The survey assessed barriers to contraception access, perspectives toward pharmacist-prescribed hormonal contraception, likelihood of receiving pharmacist-prescribed hormonal contraception, and pharmacist comfort with prescribing hormonal contraceptives.

RESULTS

Nearly 38% of respondents reported having ever experienced ≥ 1 barrier in accessing contraception, which were having a time barrier or delay in appointment, a cost or copay barrier, and/or lacking an obstetrician/gynecologist. Eighty-one percent of all respondents agreed or strongly agreed with pharmacist-prescribed hormonal contraception. Sixty-one percent of pharmacists said they are either very or somewhat comfortable prescribing hormonal contraception. Pharmacists' most commonly reported concerns were payment for services, lack of access to patient medical records, and patient safety.

CONCLUSIONS

After Dobbs et al., most pharmacists and clinicians in Rhode Island support pharmacist-prescribed hormonal contraceptives and the most frequently reported barriers faced in accessing contraception may be overcome through pharmacist prescribing. The information and data gathered from this study supported legislation for pharmacist prescriptive authority for hormonal contraception in Rhode Island.

First Experiences with Over-the-Counter Hearing Aids for Mild-to-Moderate Hearing Loss: A Case Report

This patient case report describes a first experience in late 2022 and early 2023 with over-the-counter (OTC) hearing aids for a 71-year-old male with self-perceived, age-related hearing loss. The patient reported no "red flag" medical conditions that would preclude him from safely using an OTC hearing aid device. After also meeting inclusionary criteria required to be printed on the device label, the patient was offered FDA registered OTC hearing aids. The first device pair was returned due to malfunction. The second device pair was an in-the-canal style, black in color, and powered by disposable batteries. He required help setting up the device from his spouse, an audiologist, and a pharmacist. Improved scores on the Self-Assessment of Communication and Significant Other Assessment of Communication were noted from the patient and his spouse. The patient continued to use the second device pair for 6 months after first use with no additional help. Our experience supports the pharmacist's role in identifying appropriate candidates for OTC hearing aids, helping patients select a device, and supporting device setup and self-fitting processes at community pharmacies. Further experiences are needed to demonstrate how pharmacists can support OTC hearing aid purchases at community pharmacies.

Trends, Capacity Growth, and Current State of Community Pharmacies in Saudi Arabia: Findings and Implications of a 16-Year Retrospective Study

Purpose

Community pharmacies provide access to medicines and pharmaceutical services. Consequently, adequate availability and sufficient workforce capacity must be ensured for effective healthcare delivery. This study assessed the community pharmacy sector in Saudi Arabia, including density, workforce capacity, and evolution from 2007 to 2022.

Methods

This retrospective study measured community pharmacy infrastructure and workforce capacity using international indicators and standardized measures, including community pharmacy and community pharmacist density per 10,000 people and ratio of community pharmacists per pharmacy. Several data sources and platforms were used to collect the data including the Ministry of Health, Saudi General Authority for Statistics, and Ministry of Human Resources and Social Development.

Results

The number of community pharmacies increased by 89.30%, from 5466 in 2007 to 10,347 in 2022, and density increased from 2.25 to 3.22. However, density varied by region, from 3.97 to 1.95. The number of community pharmacists increased by 98.02%, from 10,932 in 2007 to 21,648 in 2022, and community pharmacist density increased from 4.51 to 6.73. However, the ratio of community pharmacists per pharmacy remained unchanged (2.0 in 2007 and 2.1 in 2022). Female pharmacists were first issued licenses to practice in community pharmacies in 2016, and the proportion of female pharmacists to total increased from 0.29% (n=42) in 2016 to 10.95% (n=2370) in 2022. The nationalization policy for community pharmacies was implemented in 2020, and the proportion of Saudi pharmacists increased from 3.08% (n=581) in 2019 to 19.90% (n=4306) in 2022, while proportion of expatriate pharmacists decreased from 96.92% (n=18,292) to 80.10% (n=17,342).

Conclusion

The findings showed that the community pharmacy sector in Saudi Arabia recently experienced substantial growth comparable to high-income countries. However, further improvements are required in some regions to increase community pharmacy density. Moreover, the ratio of pharmacists per pharmacy should be improved to meet the healthcare system needs.

Addressing COVID-19 vaccine hesitancy in rural community pharmacies: a protocol for a stepped wedge randomized clinical trial

BACKGROUND

Uptake of COVID-19 vaccines remains problematically low in the USA, especially in rural areas. COVID-19 vaccine hesitancy is associated with lower uptake, which translates to higher susceptibility to SARS-CoV-2 variants in communities where vaccination coverage is low. Because community pharmacists are among the most accessible and trusted health professionals in rural areas, this randomized clinical trial will examine implementation strategies to support rural pharmacists in delivering an adapted evidence-based intervention to reduce COVID-19 vaccine hesitancy.

METHODS

We will use an incomplete stepped wedge trial design in which we will randomize 30 rural pharmacies (unit of analysis) to determine the effectiveness and incremental cost-effectiveness of a standard implementation approach (consisting of online training that describes the vaccine hesitancy intervention, live webinar, and resource website) compared to adding on a virtual facilitation approach (provided by a trained facilitator in support of the delivery of the vaccine hesitancy counseling intervention by pharmacists). The intervention (ASORT) has been adapted from an evidence-based vaccine communication intervention for HPV vaccines through a partnership with rural pharmacies in a practice-based research network in seven southern US states. ASORT teaches pharmacists how to identify persons eligible for COVID-19 vaccination (including a booster), solicit and address vaccine concerns in a non-confrontational way, recommend the vaccine, and repeat the steps later if needed. The primary trial outcome is fidelity to the ASORT intervention, which will be determined through ratings of recordings of pharmacists delivering the intervention. The secondary outcome is the effectiveness of the intervention, determined by rates of patients who agree to be vaccinated after receiving the intervention. Other secondary outcomes include feasibility, acceptability, adoption, reach, and cost. Cost-effectiveness and budget impact analyses will be conducted to maximize the potential for future dissemination and sustainability. Mixed methods will provide triangulation, expansion, and explanation of quantitative findings.

DISCUSSION

This trial contributes to a growing evidence base on vaccine hesitancy interventions and virtual-only facilitation of evidenced-based practices in community health settings. The trial will provide the first estimate of the relative value of different implementation strategies in pharmacy settings.

TRIAL REGISTRATION

NCT05926544 (clinicaltrials.gov); 07/03/2023.

Patient preferences for the design of a pharmacy-based colorectal cancer screening program

PURPOSE

To assess preferences for design of a pharmacy-based colorectal cancer (CRC) screening program (PharmFIT™) among screening-eligible adults in the United States (US) and explore the impact of rurality on pharmacy use patterns (e.g., pharmacy type, prescription pick-up preference, service quality rating).

METHODS

We conducted a national online survey of non-institutionalized US adults through panels managed by Qualtrics, a survey research company. A total of 1,045 adults (response rate 62%) completed the survey between March and April 2021. Sampling quotas matched respondents to the 2010 US Census and oversampled rural residents. We assessed pharmacy use patterns by rurality and design preferences for learning about PharmFIT™; receiving a FIT kit from a pharmacy; and completing and returning the FIT kit.

RESULTS

Pharmacy use patterns varied, with some notable differences across rurality. Rural respondents used local, independently owned pharmacies more than non-rural respondents (20.4%, 6.3%, p < 0.001) and rated pharmacy service quality higher than non-rural respondents. Non-rural respondents preferred digital communication to learn about PharmFIT™ (36% vs 47%; p < 0.001) as well as digital FIT counseling (41% vs 49%; p = 0.02) more frequently than rural participants. Preferences for receiving and returning FITs were associated with pharmacy use patterns: respondents who pick up prescriptions in-person preferred to get their FIT (OR 7.7; 5.3-11.2) and return it in-person at the pharmacy (OR 1.7; 1.1-2.4).

CONCLUSION

Pharmacies are highly accessible and could be useful for expanding access to CRC screening services. Local context and pharmacy use patterns should be considered in the design and implementation of PharmFIT™.

Assessing suboxone access in community pharmacies: Secret shopper model

Objective

To assess whether Maryland community pharmacies had Suboxone available for dispensing.

Methods

This cross-sectional study used a secret shopper model to contact public-facing community pharmacies in Maryland. The secret shopper, guided by a script, asked whether a prescription for Suboxone was available for the same or next day pick-up. A small convenience sample of pharmacies who did not have Suboxone available received an in-person visit to inquire about medication availability and dispensing barriers.

Results

After contacting 99% (n = 1046) of Maryland public-facing pharmacies, Suboxone was confirmed available for immediate pick-up in 31% (n = 326). The remaining did not have, would not disclose, or had limited access (existing patients or specific providers only). Significant differences in Suboxone availability were found for National Capital vs. Baltimore metro region and when pharmacist asked questions vs. no questions. Of the 11 pharmacy visits completed, 10 said they had Suboxone currently in stock, with one clarifying medication was for existing patients only.

Conclusion

About 69% of patients may face challenges when calling to find out whether they can obtain Suboxone in Maryland pharmacies. Better patient education and more thorough pharmacy-level investigation of system and workflow barriers could offer solutions.

Patient awareness, perceptions, and attitudes towards pharmacists prescribing tobacco cessation medications

BACKGROUND

Recent legislative advances now permit pharmacists to prescribe tobacco cessation medications in 17 states. While national initiatives are underway to prepare the pharmacy profession for this expanded role, patient perceptions of this role have not been explored.

OBJECTIVE

The objective of this study was to characterize patient perceptions, attitudes, and awareness of pharmacists prescribing for tobacco cessation medications.

METHODS

A cross-sectional survey of English and Spanish-speaking patients was conducted at 12 locations of a federally-qualified health center in Northwest Indiana. Survey measures assessed sociodemographics, tobacco use history and interest in quitting, prior interactions with pharmacists and awareness of pharmacists' ability to prescribe tobacco cessation medications, and perceptions of pharmacists assisting with cessation. The Theory of Planned Behavior (TPB) served as a framework for item development. Multivariable logistic regression was used for modeling.

RESULTS

A total of 2082 individuals (1878 English, 204 Spanish) completed the survey (42.4%). Among current users (n = 592; 28.4%), 46.2% had made a quit attempt in the past year, and 41.0% reported having used a tobacco cessation medication in the past. Over half (60.5%) of current users would be comfortable talking with a pharmacist about quitting, 31.9% intended to talk with a pharmacist about quitting, and 31.7% intended to ask a pharmacist to prescribe a medicine to help with quitting. In multivariable modeling, intention to (a) talk with a pharmacist about quitting and (b) ask a pharmacist to prescribe a medication were significantly associated with TPB constructs. Current tobacco users were receptive to pharmacist-facilitated assistance with quitting, including prescribing of tobacco cessation medications.

CONCLUSIONS

Patients' attitudes, subjective norms, and perceived behavioral control, from the Theory of Planned Behavior, were important predictors of intention to engage with pharmacists for quitting and intention to ask a pharmacist to prescribe a cessation medication.

Reaching adults who smoke cigarettes in rural Appalachia: Rationale, design & analysis plan for a mixed-methods study disseminating pharmacy-delivered cessation treatment

INTRODUCTION

Unlike other U.S. geographical regions, cigarette smoking prevalence remains stagnant in rural Appalachia. One avenue for reaching rural residents with evidence-based smoking cessation treatments could be utilizing community pharmacists. This paper describes the design, rationale, and analysis plan for a mixed-method study that will determine combinations of cessation treatment components that can be integrated within community pharmacies in rural Appalachia. The aim is to quantify the individual and synergistic effects of five highly disseminable and sustainable cessation components in a factorial experiment.

METHODS

This sequential, mixed-method research design, based on the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, will use a randomized controlled trial with a 25 fully crossed factorial design (32 treatment combinations) to test, alone and in combination, the most effective evidence-based cessation components: (1) QuitAid (yes vs. no) (2) tobacco quit line (yes vs. no) (3) SmokefreeTXT (yes vs. no) (4) combination NRT lozenge + NRT patch (vs. NRT patch alone), and (5) eight weeks of NRT (vs. standard four weeks).

RESULTS

Logistic regression will model abstinence at six-months, including indicators for the five treatment factors and all two-way interactions between the treatment factors. Demographic and smoking history variables will be considered to assess potential effect modification. Poisson regression will model quit attempts and percent of adherence to treatment components as secondary outcomes.

CONCLUSION

This study will provide foundational evidence on how community pharmacies in medically underserved, rural regions can be leveraged to increase utilization of existing evidence-based tobacco cessation resources for treating tobacco dependence.

CLINICAL TRIALS

NCT05660525.

The US Federal Retail Pharmacy Program: Optimizing COVID-19 Vaccine Delivery Through a Strategic Public-Private Partnership

To help achieve the initial goal of providing universal COVID-19 vaccine access to approximately 258 million adults in 62 US jurisdictions, the federal government launched the Federal Retail Pharmacy Program (FRPP) on February 11, 2021. We describe FRPP's collaboration among the federal government, US jurisdictions, federal entity partners, and 21 national chain and independent pharmacy networks to provide large-scale access to COVID-19 vaccines, particularly in communities disproportionately affected by COVID-19 (eg, people aged ≥65 years, people from racial and ethnic minority groups). FRPP initially provided 10 000 vaccination sites for people to access COVID-19 vaccines, which was increased to >35 000 vaccination sites by May 2021 and sustained through January 31, 2022. From February 11, 2021, through January 31, 2022, FRPP vaccination sites received 293 million doses and administered 219 million doses, representing 45% of all COVID-19 immunizations provided nationwide (38% of all first doses, 72% of all booster doses). This unprecedented public-private partnership allowed the federal government to rapidly adapt and scale up an equitable vaccination program to reach adults, later expanding access to vaccine-eligible children, during the COVID-19 pandemic. As the largest federal COVID-19 vaccination program, FRPP exemplifies how public-private partnerships can expand access to immunizations during a public health emergency. Pharmacies can help meet critical national public health goals by serving as convenient access points for sustained health services. Lessons learned from this effort-including the importance of strong coordination and communication, efficient reporting systems and data quality, and increasing access to and demand for vaccine, among others-may help improve future immunization programs and support health system resiliency, emphasizing community-level access and health equity during public health emergencies.

Cost-Effectiveness of Pharmacist Prescribing for Managing Hypertension in the United States

Importance

Pharmacist-led interventions can significantly improve blood pressure (BP) control. The long-term cost-effectiveness of pharmacist-prescribing interventions implemented on a large scale in the US remains unclear.

Objective

To estimate the cost-effectiveness of implementing a pharmacist-prescribing intervention to improve BP control in the US.

Design, Setting, and Participants

This economic evaluation included a 5-state Markov model based on the pharmacist-prescribing intervention used in The Alberta Clinical Trial in Optimizing Hypertension (or RxACTION) (2009 to 2013). In the trial, control group patients received an active intervention, including a BP wallet card, education, and usual care. Data were analyzed from January to June 2023.

Main Outcomes and Measures

Cardiovascular (CV) events, end-stage kidney disease events, life years, quality-adjusted life years (QALYs), lifetime costs, and lifetime incremental cost-effectiveness ratio (ICER). CV risk was calculated using Framingham risk equations. Costs were based on the reimbursement rate for level 1 encounters, medication costs from published literature, and event costs from national surveys and pricing data sets. Quality of life was determined using a published catalog of EQ-5D utility values. One-way sensitivity analyses were used to assess alternative reimbursement values, a reduced time horizon of 5 years, alternative assumptions for BP reduction, and the assumption of no benefit to the intervention after 10 years. The model was expanded to the US population to estimate population-level cost and health impacts.

Results

Assumed demographics were mean (SD) age, 64 (12.5) years, 121 (49%) male, and a mean (SD) baseline BP of 150/84 (13.9/11.5) mm Hg. Over a 30-year time horizon, the pharmacist-prescribing intervention yielded 2100 fewer cases of CV disease and 8 fewer cases of kidney disease per 10 000 patients. The intervention was also associated with 0.34 (2.5th-97.5th percentiles, 0.23-0.45) additional life years and 0.62 (2.5th-97.5th percentiles, 0.53-0.73) additional QALYs. The cost savings were $10 162 (2.5th-97.5th percentiles, $6636-$13 581) per person due to fewer CV events with the pharmacist-prescribing intervention, even after the cost of the visits and medication adjustments. The intervention continued to produce benefits in more conservative analyses despite increased costs as the ICER ranged from $2093 to $24 076. At the population level, a 50% intervention uptake was associated with a $1.137 trillion in cost savings and would save an estimated 30.2 million life years over 30 years.

Conclusion and Relevance

These findings suggest that a pharmacist-prescribing intervention to improve BP control may provide high economic value. The necessary tools and resources are readily available to implement pharmacist-prescribing interventions across the US; however, reimbursement limitations remain a barrier.

Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California

Background

Pharmacies are a promising setting through which to expand access to human immunodeficiency virus (HIV) prevention, including pre-exposure and post-exposure prophylaxis (PrEP and PEP, respectively). We aimed to evaluate and inform the implementation of California's Senate Bill 159 (2019), allowing pharmacists to independently prescribe PrEP and PEP.

Methods

From October through December 2022, we conducted a cross-sectional study of 919 California pharmacists and pharmacy students, primarily recruited via the email listservs of professional organizations. Participants completed an online survey assessing the implementation of pharmacist-initiated PrEP/PEP, including knowledge, attitudes, practices, perceived barriers, and implementation preferences elicited through a discrete choice experiment.

Results

Among 919 participants (84% practicing pharmacists, 43% in community pharmacies), 11% and 13% reported that pharmacists at their pharmacy initiate PrEP and PEP, respectively. Most believed that pharmacist-initiated PrEP/PEP is important (96%) and were willing to provide PrEP (81%); fewer (27%) had PrEP/PEP training. Common implementation barriers were lack of staff/time and payment for pharmacist services. Participants preferred PrEP implementation models with in-pharmacy rapid oral HIV testing and pharmacists specifically hired to provide PrEP services.

Conclusions

Despite pharmacists' supportive attitudes, Senate Bill 159 implementation in California pharmacies remains limited, in part due to policy-level and organizational-level barriers. Ensuring PrEP/PEP-related payment for services and sufficient workforce capacity is key to leveraging pharmacists' role in HIV prevention.

Georgia community pharmacies and clinics: An evaluation of health outcomes and care access

BACKGROUND

Care access remains a major social determinant of health. Safety net clinics may not be numerically sufficient to meet the health care demand for vulnerable populations. Community pharmacists remain a trusted health care provider and serve as first-line care access points. To date, Georgia care access points by safety net clinics and community pharmacies have not been compared.

OBJECTIVES

This study sought to evaluate care access across Georgia. County health outcomes and health factor rankings were compared with mortality prevalence of respiratory disease, diabetes mellitus, kidney disease, and a composite of ambulatory care sensitive conditions emergency department (ER) utilization and hospital discharge. In addition, this study sought to determine whether care access points improve if community pharmacies were to provide primary care services.

DESIGN AND OUTCOME MEASURES

Geographic information systems mapping was used to locate safety net clinics and community pharmacies. Care access difference was analyzed using a 2-sample t test and health outcomes and rankings were evaluated using ordinary least square regression analysis.

RESULTS

A significant difference in care access points was found between safety net clinics and community pharmacies across the state of Georgia (P < 0.05). Mortality prevalence for respiratory disease (P < 0.01), diabetes mellitus (P < 0.1), kidney disease (P < 0.05), ER utilization (P < 0.01), and hospital discharge (P < 0.01) was lower in counties in the top 50% than the bottom 50% health outcome ranking and health factor ranking. Approximately 95% of counties (n = 151) would experience more than a 50% increase in primary care access points by way of community pharmacies.

CONCLUSION

Community pharmacies are well positioned to address primary care disease states, reduce health care resource strain, and decrease preventable health care resource utilization. Leveraging pharmacists to provide primary care services can address care access issues and may improve care quality and reduce preventable hospitalizations and ER utilization in Georgia.

Status of Patient Safety Culture in Community Pharmacy Settings: A Systematic Review

OBJECTIVES

This systematic aimed to understand the global status using the results of survey studies based on the Community Pharmacy Survey on Patient Safety Culture and set the directions of development in terms of the patient safety culture of community pharmacies.

METHODS

Electronic searches were performed in EMBASE, MEDLINE, PubMed, and CINAHL databases by using the words "patient safety," "culture," and "community pharmacy" with synonyms or associated words in the original English language research articles published between January 1, 2012, and March 2, 2023. This systematic review was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Eleven surveys from 10 countries were selected. Five studies were conducted on pharmacists, whereas 6 studies were carried out on all pharmacy staff members such as pharmacists, technicians, clerks, and pharmacy students on apprenticeship. There was a considerable variation in the positive response rates across the dimensions of all the surveys. The highest positive response score was demonstrated for "teamwork" and "patient counseling," whereas the "staffing, work pressure, and pace" dimension was essential for improving patient safety culture in community pharmacy settings. For overall rating of the pharmacy on patient safety, 84.8% of pharmacy staff members gave good, very good, or excellent as their responses.

CONCLUSIONS

Despite the differences among studies, findings of this study are expected to be used as valuable evidence to develop patient safety improvement strategies after reflecting each country's health care setting or community pharmacy practice. Furthermore, the results would offer meaningful assistance to achieve the goals of global campaigns such as the World Health Organization Patient Safety Challenge.

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy

In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse's National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.

Impact of a health and wellness IPPE focused on immunizations and health assessments

BACKGROUND AND PURPOSE

Health and wellness principles are included in pharmacy education outcomes and standards, supporting the importance of integrating these concepts within pharmacy curricula. The objective of this study was to describe the development, implementation, and assessment of an intensive community pharmacy-based health and wellness introductory pharmacy practice experience (IPPE) focused on immunizations and health assessments.

EDUCATIONAL ACTIVITY AND SETTING

The health and wellness IPPE was a required, one-week rotation developed to provide second-year student pharmacists with direct patient care opportunities to reinforce knowledge, skills, and abilities related to health and wellness principles. Students administered immunizations, performed hypertension and diabetes assessments, and provided education to patients at community pharmacy training sites. Students completed pre- and post-rotation self-assessments. Preceptors completed individual summative student performance evaluations and were surveyed to obtain IPPE feedback.

FINDINGS

One hundred forty-seven students completed the IPPE across 89 sites. The pre-post analysis of student self-assessment results found statistically significant improvement in student confidence across all survey items. The largest improvements were found within the immunization items, specifically for preparing and administering immunizations. Ninety-nine percent of students agreed or strongly agreed participation in IPPE activities improved their ability to contribute to patient care. Qualitative analysis revealed students gained confidence and skills after practicing in a real-world setting.

SUMMARY

The integration of the health and wellness IPPE within the curriculum resulted in increased student confidence in providing preventative care services. This study provides a solution to integrating health and wellness principles into pharmacy curricula to meet accreditation standards.

Cost Evaluation of Professional Services in a Rural Community Pharmacy: A Monocentric Exploratory Approach

The increasing pressure on healthcare systems (HCSs) is a cause for concern worldwide. Rising costs, uncertainty about sustainability, and aging populations are the main issues that make it challenging to allocate scarce resources to the needs of HCSs. Clinical professional pharmacy services (PSs) have been shown to help alleviate system stress and to reach the entire population, although a cost of provision is borne. The objective of this study was to evaluate the provision costs of three PSs, a medicine-dispensing service (MDS), a multicompartmental compliance aid system service (MCAS), and a cognitive impairment screening service (CISS), in a rural community pharmacy. A cost analysis was performed using a time-driven activity-based costing model. The time dedicated to PS provision was appropriately recorded, and the corresponding expenses were extracted from the accounting records. A provision time of 4.80 min and a cost of EUR 2.24 were estimated for the MDS, while 18.33 min and EUR 8.73 were calculated for the MCAS, and 122.20 min and EUR 56.72 were calculated for the CISS. The total provision time represented 85% of the pharmacist's effective working time. Tailored cost analysis is a useful tool for making decisions on the implementation of a PS. Larger studies including a variety of pharmacies and locations are necessary to accurately assess costs and engage in discussions on funding and remuneration.

Mindfulness-Based Stress Reduction (MBSR) for Chronic Pain Management in the Community Pharmacy Setting: A Cross-Sectional Survey of the General Public's Knowledge and Perceptions

Patient access to mindfulness-based stress reduction (MBSR), a complementary and integrative health approach that is proven to reduce chronic pain, can be increased via community pharmacy-based implementation. However, the general public's awareness and preferences regarding MBSR as a treatment option for chronic pain, including provider roles (pharmacist vs. non-pharmacist), are unclear. Therefore, the purpose of this study was to assess the U.S. general public's knowledge, attitudes, barriers, and programmatic preferences regarding MBSR for chronic pain management, particularly in the community pharmacy setting. A cross-sectional, anonymous online survey was distributed to U.S. adults ≥18 years via the Amazon Mechanical Turk (MTurk) online survey platform. The survey instrument was informed by Anderson's framework for health service utilization. Measures were assessed using multiple-choice and 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Primary outcome measures included: (1) knowledge and awareness of MBSR (12-items); (2) confidence in seeking out MBSR for pain (5-items); (3) barriers to receiving MBSR (11-items); (4) beliefs about MBSR in general (12-items); (5) beliefs about community pharmacy-delivered MBSR (15-items); and (6) preferences for MBSR classes/programs (6-items). Outcomes were analyzed using descriptive statistics, and influential factors associated with mean beliefs regarding community pharmacy-delivered MBSR for chronic pain management were assessed via multiple linear regression. Of the 302 survey respondents, the majority were white (79.1%) and female (50.7%), with a mean age of 44.65 years. Respondents' self-rated MBSR knowledge (mean [SD] scale score: 2.30 [0.68]) and confidence (2.65 [0.87]) were low, although perceived barriers to access were low overall (2.22 [0.53]). Beliefs regarding the use of MBSR for treatment of chronic pain were positive in general (3.67 [0.71]), but more negative regarding community pharmacy-delivered MBSR (2.38 [0.56]). Confidence in seeking out MBSR (β = 0.297, 95% CI = 0.219 to 0.375; p < 0.001) and current opioid use (β = 0.419, 95% CI = 0.147 to 0.690; p = 0.003) were positively associated with beliefs regarding pharmacy-delivered MBSR, while annual household income (β = -0.124, 95% CI = -0.244 to -0.004; p = 0.043) and level of bodily pain (β = -0.149, 95% CI = -0.291 to -0.008; p = 0.039) exerted statistically significant negative influences. Respondents preferred a hybrid MBSR class format including both online and in-person components (29.7%) as well as both group and individual session options (43.7%). In conclusion, further education is necessary to increase the public's perception of community pharmacies as a resource for complementary and integrative health.

Is now our time? History to provider status for allied health professions and the path for pharmacists

The designation of health care providers is limited to physicians, physician assistants, nurse practitioners, certified nurse midwives, nurse anesthetists, clinical psychologists, dietitians, and social workers. Pharmacists are not federally recognized health care providers and, therefore, are not eligible for cognitive service reimbursements. This commentary explains the intentions of adding pharmacists as Medicare Part B providers, evaluates current state pharmacist provider status, and calls pharmacists, technicians, and other key stakeholders to advocate on behalf of the profession of pharmacy. If federal provider status is granted to pharmacists, patients will gain better access to care, health spending will decline, and physician lead care teams will have an expert in medications readily available for consultation or other medication-related needs. Reimbursement would provide more resources to administer these needed services to more patients in areas with limited access to health care resources.

Cross-Training Pharmacy Professionals as Community Health Workers

Community health workers (CHWs) are health professionals that connect the populations they serve to health services. They play a valuable role in assessing patients' needs, linking patients with health and human resources, educating patients toward achieving optimal health, and advocating for their patients to have accessible resources to improve their health and wellbeing. Pharmacies are readily accessible and frequently utilized health locations that could employ CHWs. We describe a program to cross-train pharmacy professionals as CHWs. Pharmacy professionals were recruited to sign up for a 13-week CHW core competencies course that was offered in partnership with the state university Continuing Education Workforce Training. From March 2022 to June 2023, 23 pharmacy professionals completed the course. Post-course and program evaluations were completed by 10 participants, and they showed positive responses to their participation in the program. Participants appreciated learning the role of a CHW, and noted increased skills, and awareness of additional tools and resources. Participants reported 47 referrals to chronic disease programs and community resources. The program pilot results show successful partnerships for cross-training pharmacy professionals as CHWs. Cross-trained pharmacy professionals provide benefits to the communities they serve, by being a valuable resource for their patients.

Evaluating healthcare professionals' perceptions of dispensing separation and sale of pharmacy medicine in Brunei Darussalam

BACKGROUND

Pharmacy medicine (P) is obtained exclusively from a pharmacy under the supervision of a pharmacist. This study aims to understand the perception of healthcare professionals towards the dispensing separation, as well as the dispensing of pharmacy medicine by community pharmacies to enhance patient health outcomes in Brunei Darussalam.

METHODS

A cross-sectional study was conducted between 1st March 2023 and 20th April 2023 among healthcare professionals. A newly designed and validated questionnaire was used. Its face and content validity, along with internal consistency, was adequately established. Convenient sampling was employed to recruit participants for the study. Statistical analysis using one-way ANOVA was performed, considering a p-value < 0.05 as statistically significant.

RESULTS

The study compiled data from 108 participants, comprising doctors (38.9%) and pharmacy technicians (45.4%). Approximately 28.7% of respondents had 11-20 years of healthcare experience, while 25.9% had less than 5 years. Nearly all respondents (98.1%) agreed on the vital role pharmacists and pharmacy technicians play in prescription checks. A significant number of participants (93.5%) agreed that Brunei's current medicine dispensing system needs improvement. The mean total score for the perception of medicine dispensing in Brunei was 3.79 ± 1.103. A statistically significant difference was found between the perception score and the respondents' profession (p = 0.018), but not with their age, experience, or place of work. Respondents' awareness score showed no statistically significant correlation with their profession, age, experience, or place of work.

CONCLUSION

The study underscores the necessity for more patient-centered care in community pharmacies in Brunei Darussalam. The country's healthcare professionals should recognize the potential advantages of expanding pharmacy services. However, to implement these services successfully, regulatory restrictions and infrastructure limitations must be addressed.

Primary care provider perspectives on the role of community pharmacy in colorectal cancer screening: a qualitative study

BACKGROUND

The United States Preventive Services Task Force (USPSTF) lists 32 grade A or B recommended preventive services for non-pregnant United States (US) adults, including colorectal cancer screening (CRC). Little guidance is given on how to implement these services with consistency and fidelity in primary care. Given limited patient visit time and competing demands, primary care providers (PCPs) tend to prioritize a small subset of these recommendations. Completion rates of some of these services, including CRC screening, are suboptimal. Expanding delivery of preventive services to other healthcare providers, where possible, can improve access and uptake, particularly in medically underserved areas or populations. Fecal immunochemical testing (FIT) (at-home, stool-based testing) for CRC screening can be distributed and resulted without PCP involvement. Pharmacists have long delivered preventive services (e.g., influenza vaccination) and may be a good option for expanding CRC screening delivery using FIT, but it is not clear how PCPs would perceive this expansion.

METHODS

We used semi-structured interviews with PCPs in North Carolina and Washington state to assess perceptions and recommendations for a potential pharmacy-based FIT distribution program (PharmFIT™). Transcripts were coded and analyzed using a hybrid inductive-deductive content analysis guided by the Consolidated Framework for Implementation Research (CFIR) to elucidate potential multi-level facilitators of and barriers to implementation of PharmFIT™.

RESULTS

We completed 30 interviews with PCPs in North Carolina (N = 12) and Washington state (N = 18). PCPs in both states were largely accepting of PharmFIT™, with several important considerations. First, PCPs felt that pharmacists should receive appropriate training for identifying patients eligible and due for FIT screening. Second, a clear understanding of responsibility for tracking tests, communication, and, particularly, follow-up of positive test results should be established and followed. Finally, clear electronic workflows should be established for relay of test result information between the pharmacy and the primary care clinic.

CONCLUSION

If the conditions are met regarding pharmacist training, follow-up for positive FITs, and transfer of documentation, PCPs are likely to support PharmFIT™ as a way for their patients to obtain and complete CRC screening using FIT.

Usability Evaluation of a Community Pharmacy Health Information Exchange Interface Prototype

OBJECTIVE

Few community pharmacies have access to health information exchange (HIE) data. We conducted a first-of-its-kind usability evaluation of an HIE interface prototype (referred to throughout as the "HIE-Pioneer mock-up") developed with pharmacists and pharmacy technicians to aid future implementation in community pharmacies.

METHODS

Community pharmacists and pharmacy technicians were recruited to complete usability evaluations with the HIE-Pioneer mock-up. Each usability evaluation lasted up to 60 minutes. System usability scale (SUS) scores were collected from each participant following each usability evaluation session and summarized with descriptive statistics. Usability evaluation videos were reviewed for common usability attributes, such as the impact of identified usability problems, learnability, and efficiency. Time on task, task success rates, and prototype utilization were also recorded.

RESULTS

Sixteen total participants completed usability testing across three community pharmacies. The average SUS score was 69.7 (scale 0-100, where 100 is the best), with pharmacists on average reporting higher satisfaction than technicians (74.1 vs. 65.3, respectively). Altogether, we identified 23 distinct usability problems. Key problems identified included needed clarification in tool label names and accessibility of HIE links within the existing workflow. Overall, the usability of the HIE-Pioneer mock-up generally fostered pharmacy professionals' ease of learning and efficiency.

CONCLUSION

Our study identified key areas, and potential solutions, to improve the usability of the HIE-Pioneer mock-up. Overall, pharmacy professionals viewed the HIE-Pioneer mock-up positively, with good satisfaction ratings. The HIE-Pioneer mock-up provides a blueprint for future HIE implementation in community pharmacy settings, which would increase community pharmacy teams' access to HIE data nationwide. Community pharmacy access to bi-directional HIE is expected to improve communication among more health care professionals involved in patient care and equip pharmacy professionals with needed information for improved clinical decision-making.