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AlMahasis SO, Fox B, Ha D, Qian J, Wang CH, Westrick SC. Pharmacy-based immunization in rural USA during the COVID-19 pandemic: A survey of community pharmacists from five southeastern states. Vaccine 2023; 41:2503-2513. [PMID: 36898932 PMCID: PMC9988709 DOI: 10.1016/j.vaccine.2023.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/09/2023]
Abstract
INTRODUCTION Immunization rates for seasonal and non-seasonal vaccines dropped during the COVID-19 pandemic. Little is known about the extent to which community pharmacies in the USA continued to serve as immunization sites during the pandemic. This study compared 1) the types and perceived changes in non-COVID-19 vaccine doses administered at rural community pharmacies in 2020 (during the pandemic) to 2019 (pre-pandemic) and 2) the delivery of non-COVID-19 immunization services in 2020 to 2019. METHODS A mixed-mode (paper/electronic) survey of a convenience sample of 385 community pharmacies operating in rural settings and have administered ≥1 vaccine in 2019 and 2020 was distributed in May-August 2021. Survey development was informed by relevant literature, pre-tested with three individuals, and pilot-tested with 20 pharmacists. Non-response bias was assessed, and survey responses were analyzed using descriptive and bivariate statistics. RESULTS Of the 385 community pharmacies, 86 qualified pharmacies completed the survey (Response Rate = 23.8%). The percentage of pharmacies offering a given vaccine in 2019 and 2020 were similar; with one exception, a higher percentage of pharmacies reported having MMR administered for adults in the pharmacy in 2020 (McNemar's test; p-value = 0.0253). For each given vaccine, the majority of respondents did not perceive a change in the number of doses administered in 2020 compared to 2019. Further, the majority reported no difference in how they delivered immunization services during and pre-pandemic. However, a small percentage of respondents (6.0-22.0%) adapted their services by adopting several measures to ensure the safety and continuity of immunizations during the pandemic. CONCLUSION Findings highlight the importance of community pharmacies as immunization sites during the pandemic. Community pharmacies continued immunization delivery at community pharmacies during the pandemic with almost no noticeable change to types and doses of vaccines compared to pre-pandemic nor the process of vaccine delivery.
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Affiliation(s)
- Sura O AlMahasis
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA; Social & Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, USA
| | - Brent Fox
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - David Ha
- Stanford Health Care, Stanford, CA, USA; Stanford University, Stanford, CA, USA
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA
| | - Chih-Hsuan Wang
- Department of Educational Research, Measurement, and Assessment, Auburn University, Auburn, AL, USA
| | - Salisa C Westrick
- Department of Health Outcomes Research and Policy, Harrison College of Pharmacy, Auburn University, Auburn, AL, USA.
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Hughes HM, Nizami H, Polanco JS, Poulson J, Cai A, Mittal R, Su L, Jain P, Jain R. A concerning trend in geriatric pharmacy that merits evidence-based intervention. Proc AMIA Symp 2022; 35:480-484. [DOI: 10.1080/08998280.2022.2074211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
| | - Hamasah Nizami
- School of Medicine, American University of Integrative Sciences, St. Michael, Barbados
| | | | - Jessica Poulson
- School of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Alice Cai
- School of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Rea Mittal
- School of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | - Lilly Su
- School of Medicine, Pennsylvania State College of Medicine, Hershey, Pennsylvania
| | | | - Rohit Jain
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
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Chen WH, Lee PC, Chiang SC, Chang YL, Chen TJ, Chou LF, Hwang SJ. Pharmacist Workforce at Primary Care Clinics: A Nationwide Survey in Taiwan. Healthcare (Basel) 2021; 9:healthcare9070863. [PMID: 34356241 PMCID: PMC8306307 DOI: 10.3390/healthcare9070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
Although dispensing is usually separated from prescribing in healthcare service delivery worldwide, primary care clinics in some countries can hire pharmacists to offer in-house dispensing or point-of-care dispensing for patients’ convenience. This study aimed to provide a general overview of pharmacists working at primary care clinics in Taiwan. Special attention was paid to clarifying the relationship by location, scale, and specialty of clinics. The data source was the Government’s open database in Taiwan. In our study, a total of 8688 pharmacists were hired in 6020 (52.1%) 11,546 clinics. The result revealed significant differences in the number of pharmacists at different specialty clinics among levels of urbanization. Group practices did not have a higher probability of hiring pharmacists than solo practices. There was a higher prevalence of pharmacists practicing in clinics of non surgery-related specialties than in surgery-related specialties. Although the strict separation policy of dispensing and prescribing has been implemented for 2 decades in Taiwan, most primary care clinics seem to circumvent the regulation by hiring pharmacists to maintain dominant roles in dispensing drugs and retaining the financial benefits from drugs. More in-depth analyses are required to study the impact on pharmacies and the quality of pharmaceutical care.
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Affiliation(s)
- Wei-Ho Chen
- Department of Medical Education, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan;
| | - Pei-Chen Lee
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan; (P.-C.L.); (Y.-L.C.)
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - Shu-Chiung Chiang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11217, Taiwan;
| | - Yuh-Lih Chang
- Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan; (P.-C.L.); (Y.-L.C.)
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No. 155, Sec. 2, Linong Street, Taipei 11217, Taiwan;
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan;
- Big Data Center, Department of Medical Research, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan
- Correspondence: ; Tel.: +886-2-2875-7458; Fax: +886-2-2873-7901
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei 116, Taiwan;
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 11217, Taiwan;
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Sisson ML, McMahan KB, Chichester KR, Galbraith JW, Cropsey KL. Attitudes and availability: A comparison of naloxone dispensing across chain and independent pharmacies in rural and urban areas in Alabama. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:229-235. [PMID: 31698165 DOI: 10.1016/j.drugpo.2019.09.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/27/2019] [Accepted: 09/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Fatal opioid overdoses remain the leading cause of accidental deaths in the United States, which have contributed to implementation of standing order laws that allow pharmacists to dispense naloxone to patients. Although pharmacy distribution of naloxone is a promising approach to increase access to this intervention, understanding barriers preventing greater uptake of this service is needed. METHODS Data for the current study were collected via telephone survey assessing the availability of various formulations of naloxone at chain and independent pharmacies in rural and urban areas in Birmingham, Alabama (N = 222). Pharmacists' attitudes toward naloxone and potential barriers of pharmacy naloxone distribution were also assessed. One-way analysis of variance (ANOVA) and logistic regression analyses were utilized to examine differences in stocking of naloxone in chain and independent pharmacies and to determine predictors of the number of kits dispensed by pharmacies. RESULTS Independent pharmacies were less likely to have naloxone in stock, especially those in rural areas. Furthermore, rural pharmacies required more time to obtain all four formulations of naloxone, and offered less extensive training on naloxone use. Pharmacists endorsing the belief that naloxone allows avoidance of emergent treatment in an overdose situation was associated with fewer dispensed kits by the pharmacies. Over 80% of pharmacists endorsed at least one negative belief about naloxone (e.g., allowing riskier opioid use). Pharmacists noted cost to patients and the pharmacy as contributing to not dispensing more naloxone kits. CONCLUSION The current study demonstrates the lower availability of naloxone stocked at pharmacies in independent versus chain pharmacies, particularly in rural communities. This study also highlights several barriers preventing greater naloxone dispensing including pharmacists' attitudes and costs of naloxone. The potential benefit of standing order laws is not being fully actualized due to the structural and attitudinal barriers identified in this study. Strategies to increase naloxone access through pharmacy dispensing are discussed.
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Affiliation(s)
- Michelle L Sisson
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Kristina B McMahan
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Keith R Chichester
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - James W Galbraith
- Department of Emergency Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, United States
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States.
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Bakhireva LN, Bautista A, Cano S, Shrestha S, Bachyrycz AM, Cruz TH. Barriers and facilitators to dispensing of intranasal naloxone by pharmacists. Subst Abus 2017; 39:331-341. [PMID: 29043922 DOI: 10.1080/08897077.2017.1391924] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although misuse of prescription opioids has reached epidemic proportions, pharmacy-based preventive services to combat this epidemic are limited. The aims of this study were to identify barriers and facilitators to the dispensing of intranasal naloxone (INN) by pharmacists in New Mexico. METHODS For this mixed-methods study, a qualitative component (focus group) informed the development of a quantitative component (electronic survey) distributed to all pharmacists registered with the New Mexico Board of Pharmacy and practicing in the state. A 46-item survey included questions about pharmacists' concerns regarding dispensing INN, barriers and facilitators to dispensing INN, efforts needed to increase availability and utilization of pharmacist-dispensed INN, and characteristics of respondents and their pharmacies. RESULTS Pharmacists from all geographical regions and all types of pharmacy settings were represented in the sample (final N = 390, participation rate 23.5%, including a subset of 182 community pharmacists). The main barriers identified were (1) out-of-pocket costs for patients; (2) time constraints for pharmacists; and (3) inadequate reimbursement for pharmacists. The main facilitators were (1) increased awareness among opioid-using patients and family members about the need for INN; (2) additional education to the general public; and (3) additional training for pharmacists on how to initiate discussions about INN with high-risk patients. Some community pharmacists were concerned that INN dispensing would promote opioid abuse (16.5%) and attract undesirable clientele (14.3%). In a multivariable logistic regression analysis of a community pharmacy subset, a higher number of concerns about INN (odds ratio [OR] = 0.87; 95% confidence interval [CI]: 0.82-0.93) and a pharmacy setting in a chain grocery or a "big box" store (OR = 0.38; 95% CI: 0.16-0.92) were associated with decreased odds of dispensing INN. CONCLUSIONS Effective intervention strategies for increasing dispensing of intranasal naloxone by pharmacists should focus on pharmacists' concerns, include education to multiple audiences, and address provider-level, system-level, and society-level barriers.
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Affiliation(s)
- Ludmila N Bakhireva
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA.,b Department of Family and Community Medicine , School of Medicine, University of New Mexico , Albuquerque , New Mexico , USA
| | - Adriana Bautista
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA
| | - Sandra Cano
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA
| | - Shikhar Shrestha
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA
| | - Amy M Bachyrycz
- a Department of Pharmacy Practice and Administrative Sciences , College of Pharmacy, University of New Mexico , Albuquerque , New Mexico , USA
| | - Theresa H Cruz
- c Department of Pediatrics , School of Medicine, University of New Mexico , Albuquerque , New Mexico , USA
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Martin SL, Desrosiers C. Diversion Alert: 1-Year Evaluation Across Northern New England, 2013-2014. Prev Chronic Dis 2016; 13:E159. [PMID: 27880633 PMCID: PMC5127172 DOI: 10.5888/pcd13.160229] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This report describes Diversion Alert, a unique online tool aimed at reducing misuse and diversion of prescription drugs, and reports the results of a 1-year evaluation of Diversion Alert’s impact in Maine. We used a quasi-experimental research design to compare survey data in Maine with those of neighboring states (New Hampshire and Vermont, 2013 and 2014). Compared with their counterparts in New Hampshire and Vermont who did not use Diversion Alert, prescribers and pharmacists in Maine who used Diversion Alert increased their communication with patients and other providers involved in their patients’ care, became aware of patients arrested for prescription drugs possession or diversion, used best practices associated with prevention or detection of addiction and diversion more frequently, and attributed positive changes in their prescribing practices to Diversion Alert. In combination with other state and federal programs, Diversion Alert may be an effective tool to help prevent the misuse of opioid medications.
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Piper BJ, Desrosiers CE, Lipovsky JW, Rodney MA, Baker RP, McCall KL, Nichols SD, Martin SL. Use and Misuse of Opioids in Maine: Results From Pharmacists, the Prescription Monitoring, and the Diversion Alert Programs. J Stud Alcohol Drugs 2016; 77:556-65. [PMID: 27340958 PMCID: PMC4987068 DOI: 10.15288/jsad.2016.77.556] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Although opioids have substantial efficacy for acute pain management, escalation to opioid misuse and abuse is a persistent concern. This report assesses the current status of the opioid epidemic in Maine using three complementary data sets. METHOD A representative sample of pharmacists (N = 275) completed an online survey regarding the extent that opioids affected their practice. A county-level analysis of opioid prescriptions (N = 1.22 million) reported to the Maine Prescription Monitoring Program (M-PMP) in 2014 and the agents implicated in arrests as reported to the Maine Diversion Alert Program (DAP, N = 2,700) in 2014/15 also was completed. RESULTS A significantly greater number of pharmacists agreed that opioid misuse (85.9%), rather than diversion (76.8%) or access (54.2%), was a concern. Only half (56.2%) reported use of the M-PMP. Opioids were dispensed to 22.4% of residents (37.7% of women in their 80s). This was enough to supply everyone in Maine with a 16.1-day supply. Buprenorphine accounted for almost half of opioid prescriptions to young adults (46.3% women, 49.3% men). Arrests increased by 13.3% from 2014 to 2015, and the proportion of arrests that involved prescription opioids decreased while those involving stimulants and heroin were elevated. CONCLUSIONS Pharmacists are very aware of the potential for opioid misuse, but many do not consistently use the M-PMP. There continues to be substantial legitimate use, as well as criminal activity, involving oxycodone and other prescription opioids. Continued vigilance and use of tools like the PMP and DAP are necessary to minimize nonmedical use of opioids in Maine.
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Affiliation(s)
- Brian J. Piper
- Department of Psychology, Bowdoin College, Brunswick, Maine,Department of Molecular & Biomedical Sciences, University of Maine, Orono, Maine,Husson University School of Pharmacy, Bangor, Maine,Correspondence may be sent to Brian J. Piper at 221 Kanbar Hall, Department of Psychology, Bowdoin College, Brunswick, ME 04011, or via email at: or
| | | | - John W. Lipovsky
- Maine Office of Mental Health and Substance Abuse Services, Augusta, Maine
| | | | | | | | - Stephanie D. Nichols
- Husson University School of Pharmacy, Bangor, Maine,Maine Medical Center, Portland, Maine
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