Essential services: Quantifying the contributions of America's pharmacists in COVID-19 clinical interventions

Impact of COVID-19 on Scholarly Outcomes of Pharmacy Practice Faculty by Gender and Academic Rank

OBJECTIVE

To determine how the COVID-19 pandemic impacted the scholarly outcomes of pharmacy practice faculty and whether the impact varied by gender and academic rank.

METHODS

Pharmacy practice faculty from the top 50 National Institutes of Health-funded schools of pharmacy (2018-2021) were included. Faculty whose gender was indeterminable with Gender API or who had no Scopus record were excluded. Publications before and during the pandemic (2018-2019 and 2020-2021, respectively) were obtained from Scopus. Primary outcomes included scholarly activity (probability of publishing) and scholarly output (number of documents published). The secondary outcomes were fractional scholarly output and collaboration coefficient. Data were analyzed using generalized linear mixed-effects models, with fixed effects including pandemic, rank, and gender. Interaction effects were only included in final models if statistically significant.

RESULTS

Faculty included were 1081 (61.2% women: 31.4%, 40.0%, and 28.7% assistant, associate, and professors, respectively). Unique documents published increased from 2428 to 2737 during the pandemic. There was a significant pandemic-rank interaction in scholarly activity, whereas scholarly output had both pandemic-rank and pandemic-gender interactions. Men had higher scholarly output vs women across all ranks, in both periods. During the pandemic, scholarly output increased among all assistants and associates, but among professors, men had no change, whereas women had a decrease.

CONCLUSION

The pandemic effect on pharmacy practice faculty scholarly outcomes varied across gender and academic ranks. Institutions should implement initiatives to mitigate the extant gender gap in scholarly output that persisted during the pandemic, as it may impact career progression, tenure prospects, and retention.

Evaluating concurrency and gaps between self-report and vaccine card data for COVID-19 vaccination

We compared self-reported vaccination to vaccine card data to assess concurrency in a sample of Black young adults in Georgia, Alabama, and North Carolina. We described vaccine card versus self-reported data over time and examined discrepancies in reporting between these two sources. Results indicated strong currency suggesting collection of self-reported data may be an acceptable proxy to requiring official vaccine documentation. However, since 58 % of participants did not upload a vaccine card, finding should be applied with caution. Minor differences were found and were generally due to boosters that were self-reported but were not on cards. The discrepancy in number of vaccines and boosters was likely because COVID-19 vaccination has become routine and vaccine cards are not being updated regularly. At this stage in the pandemic and for other vaccinations that become routine and are administered at pharmacies, self-report may be a reliable indication of the number of vaccinations received.

The role of community pharmacists in point-of-care testing and treatment for influenza and Group A Streptococcus -a narrative review using Ecological Systems Theory

BACKGROUND

Point-of-care testing (POCT) is a valuable diagnostic approach for identifying pathogens such as Group A Streptococcus (GAS) and influenza. Early detection through POCT allows for timely initiation of appropriate treatments improving public health outcomes and minimizing antibiotic misuse. Community pharmacists are well positioned to offer POCT and treatment, but they face significant system level barriers to widespread implementation and reach.

METHODS

This narrative review employs Ecological Systems Theory to examine the role of community pharmacists in the implementation of POCT and subsequent treatment for respiratory infections and synthesize findings from a range of studies at different levels of the system. Medline was used to identify articles with MESH headings of rapid diagnostic tests and community pharmacists. Articles were reviewed and used to inform the synthesis. Additional articles were identified using free-text search to fill gaps in the domains.

RESULTS

The review indicates that community pharmacists are well-positioned to provide POCT for respiratory infections, addressing barriers such as appointment availability, scheduling difficulties, and distance to primary care facilities. The accessibility of neighborhood pharmacies can significantly reduce health disparities by offering timely testing and treatment options. Studies demonstrate that early intervention facilitated by POCT in pharmacies leads to better health outcomes and more efficient use of antibiotics and antivirals.

CONCLUSIONS

Community pharmacists play a crucial role in expanding access to POCT and treatment for respiratory infections, particularly in underserved areas. Their involvement can lead to improved public health outcomes by ensuring early and appropriate treatment. Future research should focus on overcoming barriers to POCT implementation in pharmacies and further quantifying the impact on health disparities and treatment efficacy. The integration of POCT services in community pharmacies represents a significant advancement in public health strategy, enhancing the overall healthcare delivery system.

Vulnerability Index Approach to Identify Pharmacy Deserts and Keystone Pharmacies

Importance

Community pharmacies are crucial for public health, providing essential services such as medication dispensing, vaccinations, and point-of-care testing. Addressing disparities in pharmacy access, particularly in underserved rural and low-income areas, is critical for health equity.

Objective

To identify areas in the US at risk of becoming pharmacy deserts through the development of a novel pharmacy vulnerability index.

Design, Setting, and Participants

This population-based cross-sectional study in the contiguous 48 states performed geographic information systems analysis of pharmacy data from the National Council for Prescription Drug Programs (NCPDP) dataQ. Participants included all open-door pharmacies (community or retail pharmacies open to the general public without restrictions on who can access its services) in the US as of February 2024. Statistical analysis was performed from July to August 2024.

Exposure

The primary exposure was travel time to pharmacies across the US.

Main Outcomes and Measures

A pharmacy desert was defined as a census tract where the travel time to the nearest pharmacy exceeds the supermarket access time for that region and urbanicity level. Building on this definition, a pharmacy vulnerability index was developed, which indicates the number of pharmacies that would need to close for a census tract to become a pharmacy desert. Tracts with a pharmacy vulnerability index of 1, depending solely on a single pharmacy for access, were identified as at risk of becoming deserts. Subpopulation totals and percentages living in pharmacy deserts or relying on keystone pharmacies were computed, and then stratified by urbanicity and race.

Results

Among 321.3 million individuals (39.7 million [12.3%] Black, 59.0 million [18.2%] Hispanic, 195.0 million [60.3%] White) in the contiguous US, 57.1 million (17.7%) were identified as living in pharmacy deserts, with 28.9 million (8.9%) additionally relying on a single pharmacy for access. Small rural areas were particularly affected, with a higher dependency on single pharmacies (4.1 million individuals [14.3%]).

Conclusions and Relevance

In this cross-sectional study of pharmacy access in the US, significant disparities in pharmacy access were identified, especially pronounced in small rural areas. Targeted policy interventions, such as incremental reimbursement rates or other monetary incentives, are needed to ensure the financial sustainability of pharmacies that serve as the sole source of pharmacy services in at-risk areas.

The role of pharmacy in promoting public health: Pharmacy and public health in 2050

From 2000 to 2025, the profession of pharmacy expanded into vaccinations, point-of-care testing, and chronic disease prevention and management. In the next 25 years, pharmacy will continue to advance in new ways. This paper focuses on expanded roles of community and ambulatory care pharmacy to more directly improve public health. Built around the ten essential services of public health, this paper calls upon the profession of pharmacy to stretch beyond traditional roles to assume roles that would strengthen the public health workforce and make seminal contributions to improved population health. Barriers to be overcome in pursuit of that future are also addressed. The paper will conclude with a public health-focused call to pharmacy.

Pharmacists' answer to the COVID-19 pandemic: Contribution of the Federal Retail Pharmacy Program to COVID-19 vaccination across sociodemographic characteristics-United States

BACKGROUND

The Federal Retail Pharmacy Program (FRPP) integrated pharmacies as partners in the national effort to maximize vaccination during the COVID-19 public health emergency.

OBJECTIVE

The objective of this study was to quantify the contribution of pharmacies participating in FRPP to COVID-19 vaccination efforts during December 2020-September 2023 across sociodemographic groups in the United States.

METHODS

Data on COVID-19 vaccine doses administered reported to Centers for Disease Control and Prevention by FRPP and jurisdictional immunization information systems of all 50 states, the District of Columbia, and U.S. territories were analyzed to estimate FRPP contributions.

RESULTS

Approximately 314.9 million COVID-19 vaccine doses were administered by FRPP throughout this period, constituting 48.9% of all COVID-19 vaccine doses administered. FRPP contributions to COVID-19 vaccination ranged from 12.9% to 56.8% for persons aged 6 months-4 years and 12-17 years, respectively. FRPP made the highest contribution to administering COVID-19 doses to Non-Hispanic Asian (48.7%) and Hispanic/Latino (49.8%) persons. The proportion of COVID-19 doses given by FRPP pharmacies was found to be higher in urban areas (57%) compared with rural areas (45%).

CONCLUSION

FRPP administered a substantial proportion of COVID-19 vaccine doses in the United States and provided vaccine access for persons across a wide range of groups. Pharmacies can complement vaccination efforts during public health emergency situations and in routine vaccination programs.

"It was a good opportunity for us to be in touch with public health": Independent community pharmacists' experiences working with public health before and during COVID-19

PURPOSE

Pharmacies have been a significant part of improving population health since before the COVID-19 pandemic. However, little is known about the working relationships between pharmacies and public health entities. This exploratory study describes independent community pharmacists' perceptions during COVID-19 of both pre-existing and newly created relationships with public health.

METHODS

This paper is based on 42 qualitative interviews conducted as part of a broader study on North Dakota pharmacy's role in the COVID-19 pandemic. Authors analyzed interview data both deductively (based on a priori interview questions) and inductively (based on emergent themes). We used key quotes to map working relationships between pharmacy and public health on two axes: personal interactions and service provision.

FINDINGS

Interviewees worked at 42 pharmacies (21 urban and 21 rural) and described relationships with public health entities that fell into four categories: (i) service provision with personal interactions predating the pandemic; (ii) service provision without personal interactions predating the pandemic; (iii) personal interactions that evolved during the pandemic; and (iv) service provision that evolved during the pandemic. Rural pharmacists described personal interactions and pre-pandemic service provision more often than urban pharmacists. Most urban pharmacists developed working relationships with public health entities solely because of the pandemic.

CONCLUSIONS

This study begins mapping the range of relationships that can exist between community pharmacies and public health entities. Our data suggest it may be possible to leverage pharmacists to extend public health's reach and improve the health of medically underserved, rural populations.

Act for the future of community pharmacy

Community pharmacies serve as a vital gateway to primary care and public health, offering face-to-face pharmacist expert care to assure safe and effective medication use. However, they are disappearing at an alarming rate, with 20%-30% of all community pharmacy locations projected to close within the next year. The objective of this commentary is to highlight the critical need for systemic reforms and collective action within our profession to address the unique challenges faced by community pharmacies, ensuring their sustainability and continued role in providing essential health care services for patients. Key issues and evidence are provided to help pharmacy professionals better articulate why pharmacy closures are happening now and how we can work toward a transformed future. Pharmacy closures stem from an unsustainable business model characterized by declining reimbursement for prescription medications, opaque and anticompetitive pricing practices of pharmacy benefit managers, and limited reimbursement for clinical services. Among these challenges, our profession has the opportunity to create a future for community pharmacy where every person has local access to pharmacist expert care and medications through sustainable, integrated community pharmacy practice. Our profession must embrace community pharmacy teams' role in patient care, champion opportunities to integrate community pharmacists and their support staff as members of the health care team, and advocate for payment transparency and transformation. Creating this future will take all pharmacists and all pharmacy professionals.

Stars, stripes and scripts: Innovations and challenges in US pharmacy

Pharmacy practice in the United States has evolved, transitioning from simple dispensing to complex compounding and medication management. Pharmacists play important roles across many sectors, including clinical care, pharmaceutical industry, insurance companies, and public health. Pharmacists optimize therapy, improve patient outcomes, and reduce healthcare costs. However, the profession faces challenges such as burnout, understaffing and declining insurance reimbursements, particularly in independent pharmacies. Pharmacy Benefit Managers (PBMs) have exacerbated these issues, controlling drug prices and reducing pharmacy profitability through opaque pricing and monopolistic practices. Recent legislative efforts in states like New York have aimed to curb PBM influence, however issues persist, and nationwide legislation is lacking. The future of pharmacy depends on addressing these challenges through unified lobbying and proactive reform. Despite these hurdles, scope of practice and innovation within the field continues to grow, offering hope for a revitalized pharmacy landscape.

Update and narrative review of avian influenza (H5N1) infection in adult patients

The avian influenza is a serious infection caused by influenza virus that is native to birds. Avian influenza remains a global challenge due to high transmission and mortality rates. The highly pathogenic strain of H5N1 resulted in significant outbreaks and deaths globally since the late 1800s. The most recent outbreaks in wild birds, domestic birds, and cows with some genetic variations and mutations among H5N1 strains has raised major concerns about potential transmission and public health risks. Symptoms range from asymptomatic to mild flu-like illness to severe illness that requires hospitalization. There are multiple vaccines in development for humans to protect against avian influenza, specifically the H5N1 virus. This includes a cell-based vaccine approved by the FDA for people aged 6 months and older who are at higher risk of exposure to the H5N1 virus called Audenz. Chemoprophylaxis against avian influenza following a suspected exposure should be started as soon as possible or no later than 48 h, and it is recommended to be continued for 7 days. The majority of avian influenza viruses are susceptible to neuraminidase inhibitors and cap-dependent endonuclease inhibitor. Neuraminidase inhibitors are the mainstay of the avian influenza treatment and includes oseltamivir, peramivir, and zanamivir. Baloxavir marboxil is a cap-dependent endonuclease inhibitor. This clinical review aims to highlight the background, epidemiology, clinical presentation, complications and current treatment and prevention strategies for avian influenza H5N1.

Vaccination Knowledge, Attitudes, Perceptions, and Educational Needs of Pharmacists in Singapore: A Cross-Sectional Study

BACKGROUND

Singapore's adult vaccination coverage is suboptimal, and this can be attributed to a lack of vaccination recommendations and misconceptions. Studies have explored pharmacists' vaccination knowledge, attitudes, and practice behaviour overseas but limited information about pharmacists in Singapore is available. This study aims to investigate pharmacists' vaccination knowledge, attitudes towards providing vaccination services, and their educational needs.

METHODS

A cross-sectional study was conducted on pharmacists in various practice settings using an anonymous online survey.

RESULTS

Pharmacists' vaccination knowledge (median: 2; IQR: 1-3), confidence in providing vaccination services (median: 6; IQR: 5-8), and frequency of providing vaccination services (median: 2; IQR: 1-3) were only average. However, 74.3% of pharmacists agreed that they play an important role as vaccine advocates. Apparent differences in knowledge level (p = 0.008), confidence level (p = 0.001), attitude (p < 0.001), and the frequency of educating patients (p = 0.001) and recommending vaccinations (p < 0.001) were observed among pharmacists from different practice settings. The main barriers identified were discomfort with giving injections (38.5%) and a lack of skills or knowledge (28.3%) at the point of survey.

CONCLUSIONS

Pharmacists see the importance of their role as vaccine advocates. However, their vaccination knowledge, confidence in providing vaccination services, and practice behaviours are only average due to inadequate training. Continuous professional education is required to increase pharmacists' readiness to provide vaccination services.

A Mixed Methods Evaluation of Pharmacists' Readiness to Provide Long-Acting Injectable HIV Pre-exposure Prophylaxis in California

BACKGROUND

Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP.

METHODS

In 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP.

RESULTS

Half of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services.

CONCLUSION

Pharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.

Leveraging Community Pharmacies to Address Social Needs: A Promising Practice to Improve Healthcare Quality

Emerging research suggests that chronic conditions such as cardiovascular disease, diabetes, and asthma are often mediated by adverse social conditions that complicate their management. These conditions include circumstances such as lack of affordable housing, food insecurity, barriers to safe and reliable transportation, structural racism, and unequal access to healthcare or higher education. Although health systems cannot independently solve these problems, their infrastructure, funding resources, and well-trained workforce can be realigned to better address social needs created by them. For example, community pharmacies and the professionals they employ can be utilized and are well-positioned to deliver balanced, individualized clinical services, with a focus on the whole person. Because they have deep roots and presence in the community, especially in under-resourced neighborhoods, community pharmacies (independent and chain) represent local entities that community members recognize and trust. In this article, we provide case examples from California, United States, to illustrate and explore how community pharmacies can be leveraged to address patient social needs as part of their core responsibilities and overall strategy to improve healthcare quality.

Focused Preceptor Feedback Assessing Student Pharmacists' Ability to Administer Pediatric Immunizations

OBJECTIVE

To evaluate experiential pharmacy preceptor perceptions of student pharmacists' ability to administer pediatric immunizations.

METHODS

Semi-structured, qualitative key informant interviews using the Outcomes Evaluation Framework were conducted with 10 pharmacist preceptors in outpatient community pharmacies where pediatric immunizations were provided. Interviews were audio-recorded, transcribed, and deidentified prior to analysis by the research team. Qualitative analysis and thematic coding procedures were used to identify relevant themes.

RESULTS

Saturation was met after 10 pharmacists participated. All stated that it was beneficial for student pharmacists to administer pediatric vaccines if trained in proper technique. Participants acknowledged that the training students currently receive in immunization administration within the PharmD curriculum is valuable but did identify general confidence and child-comforting techniques during and after vaccination as areas of improvement for students. Just-in-time training, preceptor coaching, and hands-on practice outside of the didactic curriculum were utilized to help build confidence. Barriers to the implementation or expansion of pediatric immunization delivered by students in community pharmacies were identified as competing priorities, time, and reimbursement.

CONCLUSION

Student pharmacists can be helpful in easing the challenges of incorporating pediatric immunization services into the community pharmacy setting. Results demonstrate that the integration of student pharmacists into these services is beneficial. Pediatric immunizations are still relatively new to many pharmacists and specific training for pediatric immunization administration may not be integrated into all Doctor of Pharmacy curricula but the experiential education of pediatric immunization training can be beneficial to help prepare student pharmacists for hands-on practice.

Pharmacist-community-based organization collaboration to address health-related social needs

BACKGROUND

Community-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use.

OBJECTIVES

To develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications.

METHODS

Two different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses.

RESULTS

The CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel.

CONCLUSION

Both pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.

A qualitative analysis of student pharmacists' perceptions working in community settings during the COVID-19 pandemic

INTRODUCTION

Student pharmacists made a considerable contribution to healthcare provision and public health efforts during the COVID-19 pandemic. However, little is known about student pharmacists' experiences working in community pharmacy during the COVID-19 pandemic. This study aimed to describe the perceived impact of the COVID-19 pandemic on student pharmacists working in community-based pharmacy settings.

METHODS

Semi-structured interviews were conducted in Spring 2023 with student pharmacists enrolled in the Doctor of Pharmacy program at the University of Arizona R. Ken Coit College of Pharmacy who also worked at a community pharmacy during the COVID-19 pandemic. Students were asked five core questions with additional probing questions as necessary. Students were also asked to provide three words that described their experience working in community pharmacy through the COVID-19 pandemic. Interviews were audio-recorded and transcribed, then coded by two independent reviewers with differences resolved through consensus.

RESULTS

Eighteen students participated in a semi-structured interview. Four key themes were identified: (1) health and wellness of self and others; (2) education (online didactic and experiential) and work experience; (3) pharmacy workforce; and (4) appreciation and value of the pharmacy profession. The most common words to describe working in community pharmacy through the COVID-19 pandemic were stressful (n = 7) and rewarding (n = 5).

CONCLUSIONS

This study offers some insight into the experiences of student pharmacists from one United States school of pharmacy working in community pharmacy during the COVID-19 pandemic. Future work is warranted to assess the long-term impact on student pharmacist wellbeing, education, work experience, and appreciation of the profession.

Regulating Pharmacist Clinical Services: Is Legal Silence Golden or Deafening?

In the United States, the scope of practice of pharmacists is determined primarily at the state level. Not all state laws expressly permit or prohibit pharmacists from providing certain services; in between is a grey area of legal silence. Does legal silence permit pharmacists to perform a service that is not specifically permitted, but not expressly prohibited? Point-of-care testing provides a useful case study in legal silence: there are 1536 pharmacies currently holding a CLIA-waiver to administer tests in states reporting that pharmacists are not expressly permitted to administer tests. Legal silence may even provide a better framework for pharmacy based testing as it is naturally inclusive of any point-of-care test and no laws need updated when a new test comes to the market. Other health professions navigate this legal silence by governing according to a "standard of care." Rather than specifying a list of services a health professional can or cannot provide in law, it provides a flexible framework for the health professional to provide any service that other similarly situated health professionals would provide in the same or similar situation. A standard of care regulatory framework should thus be the target of the pharmacy profession in order to advance patient care.

Examining the potential of pharmacies to expand pre-exposure prophylaxis access along Georgia's fixed-route public transit: A geospatial analysis

BACKGROUND

Despite accounting for more than half of new Human Immunodeficiency Virus diagnoses in the United States, the South has fewer than 30% of all pre-exposure prophylaxis users. Pre-exposure prophylaxis access geospatial analyses have focused on drive time but analyses along public transit routes have not been evaluated. Given the proximity to pharmacists and pharmacies, involvement in pre-exposure prophylaxis services may increase access and uptake of this preventative health need.

OBJECTIVE

The objectives were to compare the rate of pre-exposure prophylaxis uptake between Georgia counties with and without public transit, to assess the geospatial accessibility of services along public transit, and to evaluate the potential impact of expanding pre-exposure prophylaxis services to community pharmacies.

METHODS

Pre-exposure prophylaxis uptake rates between counties with and without public transit were compared using the Mann-Whitney U test. Geospatial analysis was performed using ArcGIS Pro and Geoda. The Pearson correlation coefficient was used to determine the relationship between pre-exposure prophylaxis uptake rates and population and county characteristics. Spatial analysis was completed to uncover predictors for pre-exposure prophylaxis uptake rates. Increased access to pre-exposure prophylaxis along public transit was calculated by reporting the number of counties that would experience at least a 50% increase in pre-exposure prophylaxis access through community pharmacies.

RESULTS

Pre-exposure prophylaxis uptake is significantly higher in Georgia counties with versus without public transit (P < 0.001). Pre-exposure prophylaxis rate is positively correlated with the accessibility of community pharmacies and pre-exposure prophylaxis clinics along fixed-route public transit (R2 = 0.524). Among pre-exposure prophylaxis clinics, 44% are inaccessible by public transit alone. Community pharmacies are significantly more widely distributed and accessible along public transit routes than pre-exposure prophylaxis clinics.

CONCLUSION

Transportation remains a barrier to accessing pre-exposure prophylaxis. Georgia community pharmacies along public transit may serve as a solution to pre-exposure prophylaxis care access barriers.

Reprint of: Survey of Georgia community pharmacists' needs to engage in advanced community pharmacy services

BACKGROUND

Community pharmacists improve health, reduce fragmentation in care, lower health costs, and improve health outcomes. In Georgia, pharmacists are able to enter collaborative drug therapy management protocols, such as hypertension management, with a collaborating physician, which may allow pharmacists to provide advanced community pharmacy services (ACPS), however few Georgia pharmacists have this licensure. No program(s) exist that empower pharmacists to successfully engage in ACPS across the state of Georgia nor trains pharmacists to successfully engage in collaborative practice.

OBJECTIVE

The goal of this project was to explore community pharmacists' perception, confidence, and engagement in ACPS and how this can improve access to care in Georgia.

METHODS

Six hundred one independent community pharmacists were sent an electronic survey May 13, 2022, with weekly email reminders through June 17, 2022. Results were analyzed with the independent sample t test. Thematic analysis was completed on open response survey questions.

RESULTS

Ninety responses were received (15% response rate). In the majority of survey outcomes, no differences were found in needs for success between rural versus urban pharmacists. Pharmacies with a smaller technician-to-pharmacists ≤2 (staffing) ratios identified billing for services as a higher priority need for success for them to confidently engage in ACPS (P = 0.012) while pharmacies with a higher technician-to-pharmacists >2 (staffing) ratio agreed a larger need was in optimization of current workflow to allow for advanced community pharmacy service incorporation (P = 0.034). All community pharmacists agreed they would require expansion in staffing and the qualities desired for additional hires to support ACPS include ambition, proficiency, and communication skills.

CONCLUSION

Numerous needs for success exist for community pharmacists to feel comfortable and confident to engage in ACPS. Addressing these needs may increase community pharmacist impact through increasing utilization of these services.

Assessing Public Awareness, Utilization and Satisfaction with Community Pharmacy Services

Background

The Saudi Community pharmacy sector has been changing towards patient-centred care rather than depending solely on dispensing medications. Accordingly, pharmacies can now provide many services that they previously could not offer. The aims of this study were to identify all pharmacy services provided in a community setting and to assess public awareness and utilization of and satisfaction with these services.

Methods

This was a cross-sectional study in which the authors first purposively visited community pharmacies to identify the services offered. Pharmacists were asked about pharmacy services currently provided to community. Fieldnotes were used to document pharmacists' responses. After identifying pharmacy services, a questionnaire was desgined and reviewed by experts in the field, piloted and approved by the Ethics Committee at King Faisal University, then disseminated via Google Forms. The satisfaction level with pharmacy services was assessed using a five-point Likert scale. Data were collected from 24 January 2023 to 2 March 2023.

Results

Eighteen community pharmacies offering 17 different services were visited across Alahsa Governorate. The number of participants who completed the questionnaire was 350. Of those (232 [66.3%]) were female, and the majority of the sample (80.5%) were younger than 40 years old. The majority of the participants were unaware of pharmacy services. Out of 17 services, six received a score of 50% or higher regarding participant awareness. The most utilized services were the medication dispensing service "Wasfaty" (250 [71.4%]), medication counselling provided by pharmacists (232 [66.3%]) and minor ailment service (231 [66%]). The overall satisfaction score for pharmacy services was 87.2%.

Conclusion

The majority of the participants were unaware of the full range of available pharmacy services. There is a potential for community pharmacists to fill the capacity gap in the healthcare system since, overall, the participants rated the pharmacies' clinical services as satisfactory. Commissioners of pharmacy services may consider extending the scope of community pharmacies to include services that best utilize the expertise of clinical pharmacists.

Pharmacy-based CLIA-waived testing in the United States: Trends, impact, and the road ahead

BACKGROUND

Federal authorization of the use of Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived point-of-care tests for SARS-CoV-2 by pharmacists during the pandemic resulted in a dramatic rise in the number of community pharmacies that became CLIA-waived test sites. Now as we exit the pandemic, the wide-ranging expansion of the scope of practice facilitated currently by the PREP Act is set to expire in fall 2024. As a result, American pharmacists' ability to offer CLIA-waived testing services will revert to a patchwork of state laws.

OBJECTIVE

This study aims to examine both the number of pharmacies in the United States with CLIA Certificates of Waiver before and after the SARS-CoV-2 pandemic and the state-by-state differences in the percentage of pharmacies with CLIA Certificates of Waiver.

METHODS

Data were collected from the U.S. Centers for Disease Control and Prevention CLIA Laboratory Search website on May 3rd, 2015, August 4th, 2019, November 26th, 2020, October 6th, 2021, November 23rd, 2022, and December 4th, 2023. The website allows for the exportation of demographic data on all CLIA-waived facilities by state.

RESULTS

The total number of pharmacies with a CLIA-waiver grew from 10,626 (17.9%) locations in 2015 to 12,157 (21.4%) locations in 2019, to 15,671 (27.6%) locations in 2020, and to 29,011 (51.6%) locations in 2023. States demonstrated considerable variability in the percentage of pharmacies possessing a CLIA certificate of waiver in 2023, with a range of 10.7%-87.9%.

CONCLUSIONS

Use of CLIA-waived tests in pharmacies has grown by 140% since 2019. The time period from 2019 to 2021 witnessed a 92.5% increase in pharmacies that possessed a certificate of waiver which was largely driven by the pandemic. Interestingly, from 2021 to 2023 the was continued growth in the market of 31.6%. This suggests that pharmacies continue to see opportunity in offering CLIA-waived testing services beyond those that had been extended as a result of the pandemic.

Pharmacist assessments and care to improve adult vaccination rates: A report from project IMPACT vaccine confidence

BACKGROUND

Neglect of vaccination needs among adults results in a needless burden of hospitalization, suffering, and death. America's community pharmacists deliver a substantial portion of adult vaccinations, yet many Americans still have unmet vaccination needs.

OBJECTIVES

This study evaluated rates of vaccine contraindications, acceptance, and willingness to be vaccinated among ambulatory adults.

PRACTICE DESCRIPTION

This was a prospective, multisite, multistate, observational study conducted in three waves between October 2021 and August 2023.

PRACTICE INNOVATION

Pharmacists conducted comprehensive vaccination need assessments.

EVALUATION METHODS

The primary outcomes were numbers of vaccination needs per participant and vaccinations administered, scheduled, or declined.

RESULTS

Pharmacists identified a mean of 1.8-2.2 unmet vaccination needs per adult assessed, more than in pilot studies. Participants had already received 61%-74% of vaccinations recommended for them hence 26%-39% of needs were unmet at baseline. The leading vaccination needs were COVID-19, influenza, zoster, tetanus-containing, and pneumococcal vaccines. From a baseline mean of 59.1% for these five vaccinations, pharmacists increased the mean percentage vaccinated to 73.2%. When an option for scheduling future vaccination was added to the process, declinations dropped from 46%-18%.

CONCLUSION

This study provides insight into adult vaccine acceptance, willingness, and declination behaviors not described elsewhere. Offering options for future vaccination reduced declination rates. Pharmacists resolved substantial proportions of adult vaccination needs. The signal that apportioning adult vaccines needed, but not received on day of assessment, across several months could help resolve unmet vaccination needs warrants additional research, especially with the rising number of vaccines recommended for adults.

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.

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.

Survey of Georgia community pharmacists' needs to engage in advanced community pharmacy services

BACKGROUND

Community pharmacists improve health, reduce fragmentation in care, lower health costs, and improve health outcomes. In Georgia, pharmacists are able to enter collaborative drug therapy management protocols, such as hypertension management, with a collaborating physician, which may allow pharmacists to provide advanced community pharmacy services (ACPS), however few Georgia pharmacists have this licensure. No program(s) exist that empower pharmacists to successfully engage in ACPS across the state of Georgia nor trains pharmacists to successfully engage in collaborative practice.

OBJECTIVE

The goal of this project was to explore community pharmacists' perception, confidence, and engagement in ACPS and how this can improve access to care in Georgia.

METHODS

Six hundred one independent community pharmacists were sent an electronic survey May 13, 2022, with weekly email reminders through June 17, 2022. Results were analyzed with the independent sample t test. Thematic analysis was completed on open response survey questions.

RESULTS

Ninety responses were received (15% response rate). In the majority of survey outcomes, no differences were found in needs for success between rural versus urban pharmacists. Pharmacies with a smaller technician-to-pharmacists ≤2 (staffing) ratios identified billing for services as a higher priority need for success for them to confidently engage in ACPS (P = 0.012) while pharmacies with a higher technician-to-pharmacists >2 (staffing) ratio agreed a larger need was in optimization of current workflow to allow for advanced community pharmacy service incorporation (P = 0.034). All community pharmacists agreed they would require expansion in staffing and the qualities desired for additional hires to support ACPS include ambition, proficiency, and communication skills.

CONCLUSION

Numerous needs for success exist for community pharmacists to feel comfortable and confident to engage in ACPS. Addressing these needs may increase community pharmacist impact through increasing utilization of these services.

Development of a Pharmacy Point-of-Dispensing Toolkit for Anthrax Post-Exposure Prophylaxis for Allegheny County Postal Workers

CONTEXT

The Centers for Disease Control and Prevention (CDC) and the US Postal Service (USPS) consider anthrax to be a potential threat to USPS workers. A county health department-owned pharmacy supports local USPS response in the event of an exposure. The pharmacy team identified the need to review and update the local anthrax response plan.

PROGRAM/POLICY

A Pharmacy Point-of-Dispensing Toolkit and response plan for initial 10-day post-exposure antibiotic prophylaxis was developed for use by a local health department in the event of a mass anthrax exposure at a US Post Office sorting facility. The pharmacist's role in medical countermeasures planning for anthrax exposure is also discussed to illustrate how pharmacists' medication expertise can be utilized.

EVALUATION

The CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning framework and inputs from an interprofessional stakeholder team were used to develop a Medical Countermeasures Response Plan and Implementation Toolkit for mass point-of-dispensing (POD) in the event of an anthrax exposure.

IMPLEMENTATION AND DISSEMINATION

Stakeholders attended a USPS Community Partner Training event where additional revisions to the toolkit were made. The toolkit and standing order are now implemented at the local health department to be reviewed and updated on a yearly basis by health department leadership.

DISCUSSION

Pharmacists can use their medication expertise and experience with patient education to design emergency response plans focused on increasing patient safety and medication adherence. Pharmacists should be involved in emergency response and medical countermeasures planning that involve medications.

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.

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.

Vaccination equity and the role of community pharmacy in the United States: A qualitative study

OBJECTIVES

To identify strategies community pharmacists utilized to support equitable vaccination in their communities.

STUDY DESIGN

Qualitative, descriptive design.

METHODS

Key informant interviews were conducted virtually via teleconference using a mix of purposeful and snowball sampling of Pennsylvania community pharmacy personnel who participated in COVID-19 vaccination efforts. Interviews were conducted from March until August 2022 when thematic saturation was reached. A qualitative, inductive thematic data analysis was utilized to identify major themes and strategies that emerged from the data.

RESULTS

Pharmacists utilized three philosophies: (1) prioritizing trust, (2) meeting people where they are at, and (3) building capacity within their teams and communities to create "safe spaces" for people to receive vaccinations. Nine discrete strategies used in practice exemplify how respondents implemented these philosophies: (1) Build Community Partnerships; (2) Establish Trust to Build Credibility; (3) Address Transportation Issues; (4) Provide Patient Education and Address Health Literacy Barriers; (5) Address Language Barriers; (6) Create a Safe and Accessible Space for Those with Individualized Needs; (7) Provide Patient-Centered and Culturally-Sensitive Care; (8) Train Staff on Health Equity and Patient Engagement; and (9) Advocate for Community Pharmacy Policy and Payment Reform. Definitions for these philosophies and key examples that illustrate how each strategy was employed in practice are provided.

CONCLUSION

The findings highlight unique strategies respondent community-based pharmacy teams use to contribute to equitable vaccination efforts in communities and further emphasizes the importance of their role in public health initiatives.

2022 national survey of immunizing community chain pharmacists: The case for codifying the PREP Act emergency authorities into practice

BACKGROUND

Pharmacy-based immunization services have expanded since the mid-1990s but still face multiple challenges. Amendments to the Public Readiness and Emergency Preparedness (PREP) Act broadened patient-care scope and the pool of eligible pharmacy personnel who could administer vaccinations. The expiration of these amendments in 2024 may threaten recent gains in vaccine and other health care access newly available through pharmacies.

OBJECTIVES

This study aimed to elicit community chain pharmacists' perspectives on immunization time demands, corporate guidance, data flow and information technology, workflow and workforce issues, and other newly provided services.

METHODS

A survey questionnaire was developed, pretested, and electronically administered in mid-2022 to a randomly sampled national database of pharmacists maintained by the American Pharmacists Association. Descriptive analyses of survey responses were performed and findings used to identify salient themes.

RESULTS

The survey collected 742 responses from a sample of 7845 community chain pharmacists (9.5% response rate). During the 2021-2022 influenza season, pharmacies administered on average 114 vaccinations daily (range 3-1000), mostly by appointment (51%). Pharmacists expressed somewhat greater preference for administering vaccinations (39%) than dispensing prescriptions (36%), and most (92%) considered it at least as important as other practice responsibilities. However, only 27% of pharmacists had adequate staff support and 67% spent more time addressing patients' vaccination confidence issues than before the pandemic. Most respondents (67%) had access to their patient's vaccination status, but only 51% said their company's computer system gave easy access. Only 49% considered corporate immunization feedback effective at enhancing their practice. Provision of nonvaccine services has expanded.

CONCLUSIONS

Frontline community chain pharmacists reportedly preferred administering vaccinations over dispensing prescriptions. The pandemic resulted in an increased responsibility among pharmacists as immunizers. Notwithstanding recent progress, pharmacists continue to face staffing, corporate guidance and feedback, information management, and other structural and process barriers to optimally provide comprehensive immunization services. Survey findings support making permanent and expanding the emergency authorities that pharmacists gained under the PREP Act.

Pharmacy on the front lines: A century of pandemic response in America

The history of American pharmacy contributions to pandemic responses can be described for five pandemics: 1918 (influenza A/H1N1 virus), 1957-1958 (H2N2 virus), 1968 (H3N2 virus), 2009 (H1N1pdm09 virus), and 2019-2023 (syndrome coronavirus-2 virus). Using historical surveillance data and published literature, this article provides opportunities to reflect on how the pharmacy profession played a role in preparedness and response.

Evaluation of technician immunization administration

OBJECTIVES

To (1) assess technician and supervising pharmacists' attitudes and perceptions toward technicians administering immunizations after a technician training initiative, (2) describe the public health impact of technician-administered COVID-19 immunizations, and (3) describe best practices for technician-administered immunizations.

DESIGN

A mixed-methods study collected quantitative and qualitative data.

SETTING AND PARTICIPANTS

Kentucky technicians who completed an immunization administration training, and their supervising pharmacists.

OUTCOME MEASURES

Surveys were administered to Kentucky technicians who completed immunization administration training between January and September 2021. Surveys assessed the effectiveness of the training, integration of technicians in the immunization workflow, and impact of technicians in their organization's immunization efforts. Similar surveys were deployed to supervising pharmacists. Response frequencies were recorded for each question and descriptive statistics were calculated for each item included in the survey. Key informant interviews were conducted with technicians and pharmacists to further explore study concepts, assess needs, and discuss best practices for implementation. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Fifty-seven technicians and 37 pharmacists responded to the survey. Technicians were easily integrated into community pharmacy immunization workflow that allowed for increased immunization administration. Ninety-four percent of supervising pharmacists and 98% of technicians supported the use of technicians in the immunization workflow beyond the pandemic. Twenty-seven interviews were conducted. Major themes that emerged from the data included using the "right" technicians, role delineation and collaboration, policies, logistics, financial implications, and public health impact.

CONCLUSION

The utilization of pharmacy technicians in administration helped to accelerate the immunization process, alleviate the burden on pharmacists and other health care professionals, and ensure widespread vaccine distribution to combat the pandemic.

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.

Preparedness for a pandemic: Independent community pharmacists' experiences delivering COVID-19 vaccines

OBJECTIVE

To identify the experiences and preparedness for independent community pharmacies to deliver COVID-19 vaccines.

DESIGN

A mixed-methods study collected quantitative and qualitative data.

SETTING AND PARTICIPANTS

Every independent community pharmacy providing COVID-19 vaccines in North Dakota.

OUTCOME MEASURES

During state-required site visits, quantitative data determined by a Centers for Disease Control and Prevention (CDC)-developed reviewer guide were collected on each pharmacy's preparedness on vaccine provision and quality assurance to provide COVID-19 vaccines. Qualitative data to describe the lived experiences of pharmacists were collected through site visit documentation and semistructured interviews with participating pharmacists.

RESULTS

Fifty-two pharmacies received site visits. All visited pharmacies met full compliance with CDC's reviewer guide for billing and documentation of vaccine, vaccine procedures, recipient communication, and handling of ancillary supplies. Pharmacies varied in their compliance of vaccine storage and handling requirements. Forty-three interviews yielded 4 main themes about pharmacies' role in vaccination during the pandemic: (1) professional role, (2) accessibility, (3) patient relations, and (4) community role.

CONCLUSION

Site visits demonstrated that independent community pharmacies were prepared to provide COVID-19 vaccines in response to public need, despite varying degrees of experience with and provision of routine immunizations. Interviews revealed that pharmacists recognized their important contribution to COVID-19 vaccine provision efforts.

Role of independent versus chain pharmacies in providing pharmacy access: a nationwide, individual-level geographic information systems analysis

Pharmacy accessibility is critical for equity in medication access and is jeopardized by pharmacy closures, which disproportionately affect independent pharmacies. We conducted a geographic information systems analysis to quantify how many individuals across the US do not have optimal pharmacy access or solely rely on independent pharmacies for access. We generated service areas of pharmacies using OpenStreetMap data. For each individual in a 30% random sample of the 2020 RTI US Household Synthetic Population™ (n=90,778,132), we defined optimal pharmacy access as having a driving distance to the closest pharmacy ≤2 miles in urban counties, ≤5 miles in suburban counties, and ≤10 miles in rural counties. Individuals were then categorized according to their access to chain and independent pharmacies. Five percent of the sample or ~15.1 million individuals nationwide relied on independent pharmacies for optimal access. Individuals relying on independent pharmacies for optimal access were more likely to live in rural areas, be 65 years or older, and belong to low-income households. Another 19.5% of individuals in the sample did not have optimal pharmacy access, which corresponds to 59.0 million individuals nationwide. Our findings demonstrate that independent pharmacies play a critical role in ensuring equity in pharmacy access.

Pharmacists Maintain Consistency and Trust During a Pandemic

Pharmacists, physicians, and nurses have been viewed as needed and trustworthy members of the community for years. During the COVID-19 pandemic, pharmacists' authority was recognized and expanded to include provi-sion of essential services beyond traditional medication expertise and pharmacy operations. This authority needs to be maintained post-pandemic to provide maximum benefit to patients.

Death and Disability Reported with Cases of Vaccine Anaphylaxis Stratified by Administration Setting: An Analysis of the Vaccine Adverse Event Reporting System from 2017 to 2022

The serious nature of post-vaccination anaphylaxis requires healthcare professionals to be adequately trained to respond to these hypersensitivity emergencies. The aim of this study was to compare outcomes reported with cases of vaccine anaphylaxis stratified by administration setting. We queried reports in the Vaccine Adverse Event Reporting System (VAERS) database from 2017 to 2022 and identified cases involving anaphylaxis with an onset within one day of vaccine administration. The primary outcome was the combined prevalence of death or disability for each setting while the secondary outcome was the prevalence of hospitalization. Adjusted (age, sex, prior history of allergy, vaccine type) odds ratios (aOR) and associated 95% confidence intervals (CI) were calculated using logistic regression analysis. A total of 2041 cases of anaphylaxis comprised the primary study cohort with representation in the sample from all 50 US states and the District of Columbia. The mean age was 43.3 ± 17.5 years, and most cases involved women (79.9%). Cases of anaphylaxis were reported after receiving a coronavirus vaccine (85.2%), influenza vaccine (5.9%), tetanus vaccine (2.2%), zoster vaccine (1.6%), measles vaccine (0.7%), and other vaccine (4.5%). Outcomes associated with reports of vaccine anaphylaxis included 35 cases of death and disability and 219 hospitalizations. Compared with all other settings, the aOR of death and disability when anaphylaxis occurred was 1.92 (95% CI, 0.86-4.54) in a medical provider's office, 0.85 (95% CI, 0.26-2.43) in a pharmacy and 1.01 (95% CI, 0.15-3.94) in a public health clinic. Compared with all other settings, the aOR of hospitalization when anaphylaxis occurred was 1.02 (95% CI, 0.71-1.47) in a medical provider's office, 1.06 (95% CI, 0.72-1.54) in a pharmacy, and 1.12 (95% CI, 0.61-1.93) in a public health clinic. An analysis of a national database across six years revealed no significant differences in the odds of death/disability and odds of hospitalization associated with post-vaccination anaphylaxis in the medical office, pharmacy, and public health clinic compared with all other settings. This study expands our understanding of the safety of immunization services and reinforces that all settings must be prepared to respond to such an emergency.