Provision of Clinical Preventive Services by Community Pharmacists

Leveraging Pharmacy Education through a Train-the-Trainer Model to Enhance Breast Cancer Literacy in Rural Communities

Rural versus urban communities experience disproportionate challenges in breast cancer outcomes, with higher breast cancer mortality and later stage disease presentation, despite similar diagnosis rates. These disparities are driven by structural barriers, including rural hospital closures, transportation difficulties, and limited access to oncology specialists. This study evaluated a train-the-trainer program designed to equip PharmD students located at a pharmacy school in a rural county in South Carolina with breast cancer education training, leveraging the pharmacists' position as accessible healthcare professionals in rural communities. Training focused on breast cancer risk factors, prevention, screening, genetics, staging, and treatment options. Effectiveness was measured through pre- and post-workshop confidence surveys and knowledge assessments. Results showed significant improvement in student confidence across educational domains, with average scores increasing from 6.30 to 8.59 (p<0.0001). Understanding of screening guidelines (mean difference: 4.30; p-value: <.0001) and target therapy options showed the greatest improvement (mean difference: 3.65; p-value: <.0001), while knowledge of BRCA gene inheritance showed the smallest change (mean difference: 0.369; p-value: ns), suggesting some pre-existing awareness but limited understanding of its clinical applications. Overall, this pilot program demonstrates how pharmacy education can address healthcare disparities in rural communities. By preparing pharmacists to deliver accurate breast cancer education and to increase rural patient agency, this model creates a sustainable approach to improving health literacy in medically underserved areas. Future research could further expand this model to include diverse healthcare professionals and incorporate long-term impact assessments in community settings.

A study protocol for exploring and implementing a surgical pharmaceutical service model in drug treatment management for patients with osteoporosis fracture in China

Background

Osteoporotic fractures are serious consequences of osteoporosis, which is a condition that can be prevented through effective therapeutic strategies, including the use of anti-osteoporotic medications. However, a significant treatment gap exists in elderly patients with osteoporotic fractures. A multicenter study conducted in China reported that only 20% of elderly patients with hip fractures received appropriate pharmacotherapy post-fracture. This lack of treatment resulted in an increased risk of refracture associated with osteoporosis. Pharmacist-led interventions have proven essential in medication management for osteoporosis and related fractures, potentially bridging the treatment gap. Accordingly, a protocol was developed to assess the impact of pharmacist-led interventions on increasing the continuation rates of anti-osteoporotic drugs and reducing the risk of refracture in patients with osteoporotic fracture, compared to no interventions (grant number: YCTJ-2023-15).

Methods and analysis

This study is a single-center, prospective, and randomized controlled trial. The targeted participants in this protocol were patients aged above 50 years who had been diagnosed with osteoporotic fractures in China. Eligible participants were randomized into intervention and control groups in a 1:1 ratio using a dynamic stratified block randomization method. The control group received standard care, and the intervention group received standard care combined with pharmacist-led care. The intervention group received comprehensive pharmacist-led interventions, including pharmaceutical ward rounds and medication reconciliation, refracture risk evaluation, recommendations to physicians, patient education, and counseling. A 2-year follow-up was conducted to evaluate the outcomes between groups through telephone interviews, pharmaceutical clinics, and e-hospital pharmacy practice. The primary outcome is the ongoing treatment rates of anti-osteoporotic drugs. The treatment rates are defined as the ratio of patients who remain on anti-osteoporotic medications at each follow-up visit to the total number of enrolled participants. Secondary outcomes include treatment initiation rates, medication adherence, re-fractures, and use of drugs that increase fall risk, the frequency of bone mineral density (BMD) assessments, the incidence of inappropriate medication use, adverse drug reactions (ADRs), and patient satisfaction with osteoporotic fracture treatment. Refracture rates were evaluated through a 2-year follow-up, while BMD were measured at baseline, 1 year, and 2 years using dual-energy X-ray absorptiometry (DXA). ADRs and the inappropriate use of medication were monitored through self-reports and medication reconciliation. Patient satisfaction were assessed using the Treatment Satisfaction Questionnaire for Medication version II (TSQM-II). Ethical approval was obtained from the Committee of Ethics of the First Affiliated Hospital of Shantou University Medical College (approval number: B-2023-194). The statistical analysis was performed using Statistics Package for the Social Science (SPSS), version 23.0.

Discussion

We hypothesize that analyzing pharmacists-led interventions provide valuable insights into how pharmacists improve treatment outcomes for patients with osteoporotic fractures. This study aims to address the existing knowledge gap regarding the effectiveness of pharmacist-led interventions in improving the management of osteoporotic fractures in China.

The impact of community pharmacies on equity in access to professional rapid antigen testing for SARS-CoV-2 in Portugal

INTRODUCTION

Amid the COVID-19 pandemic, various public health measures were adopted to reduce the transmission risk, including the full reimbursement of SARS-CoV-2 professional rapid antigen detection tests (Ag-RDT) conducted in clinical pathology laboratories, community pharmacies (CPs), and other authorized entities. This study aimed to assess the impact of integrating CPs into the Portuguese National Health Service (NHS) testing strategy on the capacity of professional Ag-RDT delivery, and to compare the equity in testing access with and without CPs participation.

METHODS

This analytical cross-sectional study assessed the impact of adding CPs into the testing strategy based on two main outcomes by municipality: (i) average distance (in Kilometres) of the population to the nearest Ag-RDT site; and (ii) the average number of weekly hours available to testing per 1,000 inhabitants, as of January 31, 2022. Two scenarios were considered: with and without CPs. Access inequalities were evaluated using Lorenz curves and Gini coefficients. A subgroup inequality analysis was conducted based on three socio-demographic indicators: population density, aging index, and per capita purchasing power index.

RESULTS

A total of 1,369 (65.1 %) pharmacies and 735 (34.9 %) laboratories and other entities provided free Ag-RDT to the population. The average distance to the nearest Ag-RDT location was 3.7 km, which decreased to 1.8 km with the inclusion of CPs. Overall, there were 11.5 weekly hours per 1,000 inhabitants available for testing with CPs, compared to 2.1 h without CPs (p < 0.0001). The Gini coefficient for distance distribution decreased from 0.50 to 0.42 with CPs inclusion (-16.8 %). For the distribution of weekly hours, the Gini coefficient decreased from 0.42 to 0.26 (-38.6 %). The reduction was higher in municipalities with lower population density (-43.3 %), higher aging index (-51.3 %), and lower per capita purchasing power index (-54.6 %).

CONCLUSIONS

Pharmacies play a crucial role in mitigating geographical and socioeconomic inequalities in healthcare access. Without CPs, the provision of Ag-RDT services would result in significant territorial gaps, exacerbating disparities among already vulnerable population groups.

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.

Patient-Centred Counselling Tools for Dispensing Contraceptives in Community Pharmacy Settings: A Systematic Review

Background

The patient-centred counselling tools are a comprehensive resource to assist community pharmacists in providing effective treatment choices and assisting with decision-making.

Aim

To identify and select suitable tools community pharmacists use with targeted patient-centred outcomes for dispensing contraceptives.

Methods

Five electronic databases, Web of Science, Cochrane Library, PubMed, Scopus, and Google Scholar as additional sources for published and unpublished studies, were searched to identify literature for contraceptive tools or strategies for pharmacists to decide on contraceptive choice and dispensing by pharmacist. Studies involving pharmacists or tools suitable for pharmacists from any country, published since 1990 were considered.

Results

A total of 21 publications met the inclusion criteria. Robvis' tool was used for visualizing the risk of bias for each result. There were three studies that used the tools specifically by community pharmacists and others focused on general family planning users and pharmacists. The suitability of patient-centred interventions in community pharmacy settings was further evaluated.

Conclusion

The evidence for special tools for pharmacists for dispensing contraceptives in community settings is limited and further research is needed to develop and evaluate novel interventions for pharmacists in community settings.

Advancing Pharmaceutical Care in Community Pharmacies in Poland: A Blueprint for Enhanced Patient Care Quality

Background: This article reviews the current state of pharmaceutical care in community pharmacies in Poland and proposes a collaborative framework for its advancement. While pharmaceutical care has evolved significantly worldwide, with Europe leading the way, Poland has lagged in its development. Although Polish pharmacists are well-qualified and community pharmacies are numerous, pharmaceutical care remains underdeveloped. Methods: We conducted a literature review and analyzed case studies from European countries with advanced pharmaceutical services. Based on these findings, we collaborated with policy makers, commissioners, and academics to develop a framework for enhancing pharmaceutical care in Poland. The plan emphasizes integrating seven key services into Polish community pharmacies. Results: Our proposed framework outlines seven essential pharmaceutical services: medicine use reviews, new medicine services, minor ailment services, repeat prescription services, integrated prevention programs, cardiovascular disease prevention programs, and vaccination programs. Evidence from other European countries suggests that implementing these services could significantly improve health outcomes and patient quality of life. This is particularly important in light of Poland's ageing population, the rising prevalence of chronic diseases, and the healthcare system's increasing burden due to polypharmacy. Conclusions: The proposed framework presents a practical and collaborative approach to advancing pharmaceutical care in Poland. By adopting these key services, community pharmacies could play a more integral role in improving patient care quality and alleviating pressure on the broader healthcare system.

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.

Physical activity promotion in the community pharmacy: An opportunity for an expanded role?

BACKGROUND

Physical inactivity is a major risk factor for the development of chronic diseases, and it is increasingly prevalent in the Portuguese population. Pharmacists' role in promoting physical activity (PA) is still not well established, although health promotion is foreseen by law in Portugal. Competing tasks and location where the pharmacy is embedded can hinder this promotion in their daily practice.

OBJECTIVE

The aim of this study was to identify the main barriers and facilitators of physical activity promotion (PAP) in Portuguese community pharmacies and explore possible pathways for future implementation of physical activity promotion.

METHODS

In-depth, semi-structured interviews were conducted with purposively enrolled community pharmacists. Participant recruitment was aligned with data saturation. Data analysis comprised a mixed model of a deductive theme mapping strategy using the Theoretical Domains Framework (TDF) for the behaviour of promoting physical activity and an inductive approach for any other relevant themes and which might influence PA promotion.

RESULTS

Data saturation was reached at eleven interviews. Barriers and facilitators for the behaviour of promoting PA were identified from 11 out of the 14 TDF domains. Following an inductive approach, other emerging codes were clustered in additional seven major themes. Highlighted barriers focused on domains #1 - Knowledge, #10 - Memory, Attention and Decision Processes and #13 - Environmental Context and Resources. Community mapping, establishment of remuneration models and the use of digital technologies were suggested as additional potential contributors to scale up PAP.

CONCLUSION

Community pharmacists are well placed inside their communities to serve as a focal point for signposting, engagement with other healthcare professionals and community resources and activities organized by the pharmacy itself. Pharmacists should be supported in being knowledgeable, aware, and available when promoting PA in their daily counseling.

Pharmacist-led biometric screenings: A retrospective chart review in a community pharmacy

BACKGROUND

Biometric screenings have gained popularity in employer-based wellness programs and are increasingly offered at community pharmacies.

OBJECTIVE

This study aimed to analyze biometric screening data collected at a community pharmacy in North Alabama to examine the prevalence of risk factors and the role of pharmacist-led screenings in identifying at-risk individuals and facilitating referrals to primary care providers.

METHODS

A retrospective chart review was conducted using biometric screening data collected between 2020 and 2021. Descriptive statistics were calculated to analyze the data.

RESULTS

A total of 801 patients were included in the analysis. The mean age was 45.4 years, and 56.2 % were female. The mean systolic blood pressure was 132 mmHg, and the mean diastolic blood pressure was 84 mmHg. Mean total cholesterol was 174 mg/dL, and the mean blood glucose was 109 mg/dL. Mean BMI was 35.1 kg/m2. Among the screened patients, 22.5 % were referred to a primary care provider due to an elevated level of at least one of the measured variables, with BMI being the most common reason for referral.

CONCLUSION

This study provides valuable insights into the prevalence of risk factors in a population undergoing pharmacist-led biometric screenings in a community pharmacy. The findings emphasize the important role of pharmacists in identifying at-risk individuals and facilitating appropriate referrals to primary care. Further research is needed to evaluate the long-term impact of these referrals and explore the feasibility of similar programs in diverse healthcare settings.

Identification of Factors Necessary for Gatekeeper of Overdose

Overdose has become a global social problem. The Japanese government requires gatekeeper training to detect and prevent indicators of overdose and suicide. However, knowledge of necessary factors for the gatekeeper of overdose (patient intervention) is limited. This study aimed to investigate the characteristics of individuals who experienced intervening persons expected to overdose, and to identify the factors required of gatekeepers. A Google form was used to survey 298 pharmacists and registered sellers in Japan. We searched for factors by logistic analysis. Knowledge of prescription drugs used for overdose was higher among pharmacists than among registered sellers. Conversely, pharmacists and registered sellers had similar knowledge about OTC drugs. Overall multivariate logistic regression analysis revealed countermeasures against overdose at their workplace (odds ratio (OR): 4.01, 95% confidence interval (CI): 2.25-7.15, p < 0.01) and knowledge that overdose is on the rise (OR: 1.93, 95% CI: 1.04-3.69, p < 0.05) to be significantly associated with intervention experience as a gatekeeper. Countermeasures against overdose at their workplace (OR: 2.40, 95% CI: 1.10-5.25, p < 0.05) in pharmacists and years of work experience (OR: 1.13, 95% CI: 1.04-1.24, p < 0.05), countermeasure against overdose at their workplace (OR: 3.43, 95% CI: 1.18-10.0, p < 0.05), and willingness to participate in study sessions and workshops on overdose (OR: 3.50, 95% CI: 1.51-8.10, p < 0.05) in registered seller were significantly associated with intervention experience as a gatekeeper. These results are useful evidences for countermeasures and gatekeeper training for overdose at pharmacies and drugstores in the community.

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.

Assessing the effects of pharmacist education on colorectal cancer screening and access to a stool-based DNA test

BACKGROUND

Colorectal cancer is the third most common cancer and is anticipated to cause 52,580 deaths in 2022 in the United States. Despite the effectiveness of colorectal cancer screening (CRCS), only 74% of adults eligible for CRCS complete the screening. Community pharmacists are well positioned to provide preventive care education and recommendations to the general population.

OBJECTIVES

This study aimed to evaluate overall participants' knowledge, perceptions, and barriers on CRCS before and after receiving pharmacist-led education in the outpatient, community pharmacy setting and to assess the impact of pharmacist intervention on screening uptake with the stool-based DNA test.

METHODS

A 16-item prequestionnaire/postquestionnaire was administered by clinical pharmacists in a grocery store pharmacy chain in the Kansas City area. The questionnaire assessed participants' knowledge, perceptions, barriers, CRCS intentions, and demographics. After completing the prequestionnaire, participants received verbal and written education. For those participants interested in the stool-based DNA test, a facsimile transmission was sent to the participant's provider. The postquestionnaire was administered by the pharmacist coach at visit two 6 to 10 weeks later. Participant demographics were assessed using descriptive statistics. Wilcoxon signed rank test was used to assess prechanges/postchanges in perceptions, awareness, and knowledge. We reported the stool-based DNA test completion rate as an overall percentage.

RESULTS

Participants' knowledge of CRCS reached statistical significance after pharmacist-led education (score 4.5-6, P = 0.003). There was no change in perception pre/post. The 3 most common reported barriers were cost of screening, not being concerned with colon cancer, and lack of follow-up from a physician. Of 42 participants, 23 (54.8%) were indicated for CRCS and 4 (17%) completed screening during the study.

CONCLUSION

Not all eligible participants completed CRCS, but pharmacists improved participants' knowledge of CRCS.

Pharmacist interventions in osteoporosis management: a systematic review

Internationally, there is an osteoporosis treatment gap, which pharmacists may assist in closing. This review identifies pharmacist interventions for improving osteoporosis management and evaluates their effectiveness. Pharmacist interventions are shown to improve osteoporosis management in terms of increasing investigation and treatment commencement and osteoporosis therapy adherence.

INTRODUCTION

This review identifies pharmacist interventions for improving osteoporosis management and evaluates their effectiveness.

METHODS

A literature search using PubMed, Embase, International Pharmaceutical Abstracts, and Cumulative Index to Nursing and Allied Health Literature was undertaken from database inception to June 2022. Randomised controlled trials were eligible, if they included adults diagnosed with or at risk of osteoporosis and assessed pharmacist interventions to improve osteoporosis management. Outcomes regarding investigation, treatment, adherence and patient knowledge were evaluated using qualitative analysis. The quality of included studies was assessed using the Critical Appraisal Skills Programme checklists and the Cochrane Collaboration tool to assess the risk of bias (Rob 2.0).

RESULTS

Sixteen articles (12 different studies) with a total of 16,307 participants, published between 2005 and 2018 were included. Pharmacist interventions were classified into two categories, those targeting investigation and treatment (n = 10) and those targeting adherence (n = 2). The impact of the intervention on patient knowledge was considered by studies targeting both investigation and treatment (n = 2) and adherence (n = 1). Pharmacist interventions demonstrated benefit for all outcomes; however, the extent to which conclusions can be drawn on their effectiveness is limited by the heterogeneity of interventions employed and methodological issues identified. Patient education and counselling were identified as a cornerstone of pharmacist interventions targeting both investigation and treatment and adherence, along with the importance of pharmacist and physician collaboration.

CONCLUSION

Pharmacist interventions show promise for improving osteoporosis management. The potential for pharmacists to contribute to closing the osteoporosis treatment gap through undertaking population screening has been identified.

Pilot implementation of the PharmNet naloxone program in an independent pharmacy

BACKGROUND

The U.S. overdose epidemic has continued to escalate with more than 100,000 deaths per year in the past several years, most of which involve opioids. Widespread availability of naloxone is part of a national solution to the crisis, and community pharmacies are well-poised to facilitate such distribution and provide additional harm reduction services.

OBJECTIVES

The primary objectives of this study were to (a) examine the usability of each of the separate intervention components prepared for PharmNet, (b) observe intervention fidelity through regularly scheduled site visits, and (c) explore the association between PharmNet implementation and the volume of naloxone sales and distribution in the pilot site.

PRACTICE DESCRIPTION

Here, we describe a carefully designed and tailored pharmacy harm reduction intervention called PharmNet that is designed to maximize harm reduction impact while minimizing utilization of pharmacist resources. It is a pragmatic awareness, service provision, and referral program that was developed through careful, iterative feasibility studies with pharmacists.

PRACTICE INNOVATION

PharmNet procedures include tools and steps to create awareness (e.g., yard signs and messaging for patients, reminder tools for pharmacists), facilitation of naloxone delivery from nonprofits, and provision of referral cards featuring local resources.

EVALUATION METHODS

Evaluation included direct data collection and randomly scheduled fidelity site visits.

RESULTS

The intervention was associated with an increase of 3.33 naloxone doses/mo being dispensed at cost (34.4% relative increase) and an overall increase of 9.33 naloxone doses/mo being dispensed via any mechanism (96.48% relative increase). Around 2.85 referral cards were issued to patients daily. Intervention fidelity was moderate, and the study provides valuable information for how to modify the study prior to a randomized trial.

CONCLUSION

With modifications informed by this pilot study, the PharmNet intervention merits a randomized trial to determine whether it causes increased naloxone dispensing in independent community pharmacies.

The PharmNet Harm Reduction Intervention for Community Pharmacies: Protocol for a Pilot Randomized Controlled Trial

Background

The overdose epidemic in the United States has continued to worsen despite substantial efforts to mitigate its harms. The opioid antagonist naloxone has been identified as a key means of reducing the prevalence of fatal overdoses. An important evidence-based approach to optimizing naloxone’s impact is to seed it throughout the community, because bystanders are often able to reverse overdoses more quickly than first responders and sometimes are the only possible means of overdose reversal. As part of a multipronged approach to distributing naloxone nationwide, community pharmacies have been identified as ideal venues for naloxone dispensing, especially under standing orders. However, dispensing rates remain surprisingly low, and there is a need to understand how best to engage community pharmacies in naloxone-based harm reduction services.

Objective

The objective of this trial is to determine whether a tailored, pragmatic pharmacy intervention (PharmNet) results in greater naloxone dispensing relative to baseline (the prior 3 months) compared to a control condition. This pilot trial is intended to determine whether it is appropriate to invest the substantial resources that would be required to conduct a full-scale, randomized controlled study of PharmNet.

Methods

We will conduct a 3-month randomized controlled pilot trial consisting of 2 parallel groups with a 4:3 allocation ratio. A group of 7 independent pharmacies from rural areas in Indiana will be randomly assigned to either the PharmNet intervention arm (n=4) or the control arm (n=3). The primary outcome will be overall naloxone dispensing (both at cost and free), and secondary outcomes will include the distribution of referral cards and multiple variables at the level of individual staff members. Dispensing data will be collected for the 3 months prior to the intervention and the 3 months of the intervention, and all other data will be collected using a pretest-posttest design. The primary analysis will be a generalized linear mixed model with a Poisson distribution with fixed effects for group, time, and their interaction and a random effect for pharmacy ID to account for repeated measures within pharmacies.

Results

This study was approved by the Indiana University institutional review board in 2 phases (August 2, 2021, and April 26, 2022) and was funded by the Indiana University Grand Challenge: Responding to the Addictions Crisis.

Conclusions

If this study produces evidence that the PharmNet intervention results in increased naloxone dispensing relative to control pharmacies, it will be both appropriate and important to study it in a large, full-scale randomized controlled trial.

International Registered Report Identifier (IRRID)

PRR1-10.2196/42373

Transformational strategies for optimizing use of medications and related therapies through us pharmacists and pharmacies: Findings from a national study

SETTING

Nonoptimized medication therapies (NOMTs) are associated with likely avoidable illnesses and mortality affecting millions of people and costing an estimated $528 billion per year in excess health spending in the United States. The coronavirus disease 2019 (COVID-19) pandemic brought into focus barriers limiting the ability of U.S. pharmacists and pharmacies to provide services that can reduce NOMTs and improve U.S. population health.

OBJECTIVES

This National Science Foundation Center for Health Organization Transformation study explored potential strategies that U.S. pharmacists, pharmacies, and their partners could implement to reduce NOMTs while also delivering other forms of value to U.S. populations from 2021 to 2025 (during and after the COVID-19 pandemic).

DESIGN

A panel of senior leaders representing the U.S. pharmacist and pharmacy sector participated in a 4-round Delphi process to identify unmet needs, barriers, change drivers, and priority strategies for meeting those needs. Data were gathered and analyzed by public health researchers, most of whom are outside the pharmacist and pharmacy sector.

RESULTS

A comprehensive set of evidence-based strategies with potential to reduce NOMTs, protect and improve population health and well-being, and strengthen the sector were identified. Four transformational strategies were recommended: comprehensive payment and practice transformation, strengthening pharmacy data interoperability infrastructure, development of unifying measurement and management mechanisms, and development of a more robust national research infrastructure. Strengthening health equity was a cross-cutting strategy affecting all areas.

CONCLUSION

The results may be of interest to policy makers, pharmacists, pharmacies, physicians, nurses and other clinicians, pharmaceutical firms, plan sponsors, plans, health systems, clinics, aging care, digital technology companies, and others interested in optimizing outcomes from medications and related therapies for U.S.

POPULATIONS

A community-based partnership collaborative practice agreement project to disseminate and implement evidence-based practices in community pharmacy

BACKGROUND AND PURPOSE

The objective of this study is to explore the impact of an educational intervention including (1) collaborative practice agreement (CPA)-focused lecture and (2) a student project in partnership with a community-based pharmacy on dissemination and implementation of CPAs in community pharmacy practice.

EDUCATIONAL ACTIVITY AND SETTING

A CPA-focused classroom lecture and related project were given to five sequential years of second-year pharmacy students enrolled in a community pharmacy elective course. Community pharmacist feedback provided at the completion of the project was compared to present-day data collected via telephone survey. Responses for each survey question were summarized using frequencies, and chi-square analysis was conducted to assess the association between pharmacist perceptions at the time of the project vs. the present day.

FINDINGS

Forty-seven projects representing 47 unique CPAs were completed over five sequential years of the course. The most commonly targeted disease states by CPAs were influenza/streptococcus pharyngitis (25.5%), therapeutic interchange (6.4%), oral contraceptives (6.4%), and tobacco cessation (6.4%). Pharmacists noted that students facilitated their progress toward CPA implementation by serving as a means for CPA law education (23.4%) and by saving time in CPA development (12.8%).

SUMMARY

This study demonstrated that a student project partnering with a local community pharmacy improved knowledge dissemination but did not have any direct impact on implementation of CPAs in a community pharmacy. However, students may have a role in dissemination and implementation of evidence-based practices, such as CPAs, when appropriately matched to setting-specific implementation barriers.

"The gatekeepers in prevention": Community pharmacist perceptions of their role in the opioid epidemic

BACKGROUND

Community pharmacists are at the frontline of patient care, yet their role in the opioid epidemic remains unclear. This qualitative study examines the perception of community pharmacists about their role in the opioid epidemic and challenges to fulfilling this role. Methods: A secondary analysis of cross-sectional survey data from an Indiana census of community managing pharmacists was conducted. Qualitative data were coded using a priori and emergent themes. A priori categories included the perceived role of pharmacists in the opioid epidemic and perception of practice barriers. Results: A total of 215 Indiana community managing pharmacists participated in this study. Pharmacists understood themselves as gatekeepers in preventing opioid misuse and overdose. Reported pharmacy practices included providing patient education and communicating with prescribers. Challenges to fulfilling this role included pharmacy structure and operation, lack of patient and provider clarity about pharmacist scope of practice, and pharmacist perception that that there is no available discretionary time to support additional services. Conclusion: Pharmacists believe they have a vital role in combatting opioid misuse and overdose but are hampered by structural aspects of pharmacy practice and lack of recognition of their role. Pharmacy associations and policy partners are encouraged to identify opportunities to address these barriers.

Factors influencing implementation of personalized prevention plans among annual wellness visit patients using the theory of planned behavior: A quantitative study

BACKGROUND

The Affordable Care Act provides Medicare Part B beneficiaries access to cost-free Annual Wellness Visits (AWVs). Patients receive health behavior recommendations from a Personalized Prevention Plan (PPP) during AWV encounters.

AIMS

To identify factors clinical pharmacists can use to influence adoption of PPPs in primary care practices.

METHOD

Utilizing a cross-sectional design, 77 Medicare patients (mean age 74.05 ± 8.04 years) presenting for subsequent AWV completed a theory of planned behavior (TPB) based questionnaire at two primary care practices.

RESULTS

66.2% reported they were in the process of implementing PPPs and 51.9% reported implementing recommendations in the previous 12 months. TPB constructs accounted for 35.8% (p < .001) of the variation in intention, with subjective norm (SN) (β = 0.359, p = 0.004) as the strongest determinant, followed by attitude (β = 0.195, p = 0.093), and perceived behavioral control (PBC) (β = 0.103, p = 0.384). Intention accounted for 27.1% of the variance for implementing PPPs and was not a significant determinant (β = 0.047, p = 0.917). Addition of past behavior with TPB constructs significantly improved the predictability of the TPB model, accounted for 55% of the variation in intention (p < .001), and demonstrated a significant positive influence (β = 0.636, p < 0.001) on future PPP implementations.

DISCUSSION

This study demonstrates utility of the TPB in predicting implementation of PPPs.

CONCLUSIONS

Clinical pharmacists positioned as providers of AWVs can strengthen intention to adopt PPPs by integrating referents into AWV processes, and evaluating past behavior trends to improve future PPP implementation.

Community Pharmacists Roles During the COVID-19 Pandemic

The aim of this paper is to review the roles that community pharmacists in the United States (US) can play to support public health measures during the current severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic (COVID-19). Community pharmacists in the US are highly visible and accessible to the public and have long been regarded as a source for immunization services as well as other public health activities. In the US, the scope of pharmacy practice continues to expand and incorporate various health services on a state-by-state level. For the purposes of this article, a PubMed literature search was undertaken to identify published articles on SARS-CoV-2, COVID-19, pharmacist- and pharmacy-based immunization and other public health care activities in the US in order to identify and discuss roles that community pharmacists can play during this pandemic including as vaccinators, screeners and testers. In conclusion, community pharmacists are knowledgeable and capable providers of public health services and are easily accessible and well regarded by the public. The incorporation of community pharmacists into this nation's COVID-19 pandemic response plan can help aid recovery efforts in the US.

Community Pharmacy Operations in Puerto Rico During the 2017 Hurricane Season: A Descriptive Analysis of Rx Open Data

OBJECTIVES

This article aims to: (1) describe the 'Return to Open Pharmacy Operations' in Puerto Rico following the hurricanes Irma and Maria in the 2017 hurricane season, and (2) compare the recovery rate (Return to Open Pharmacy Operations) during the 2017 hurricane season between the US Commonwealth of Puerto Rico and the state of Florida.

METHODS

We performed a cross-sectional study of pharmacy operations in Puerto Rico utilizing Rx Open data for pharmacies in Puerto Rico during the 2017 hurricane season. To compare open rates of pharmacy operations over time in different contexts, we also analyzed Rx Open data for the state of Florida for Hurricane Irma.

RESULTS

Only 11.1% of pharmacies remained open in Puerto Rico 3 days after Hurricane Maria made landfall, and Puerto Rico pharmacy operations recovered slowly, at an average daily rate of 3.9% before reaching pre-landfall baseline operations. Puerto Rico pharmacy operations after Hurricane Maria recovered 10 times slower on average, compared to pharmacy operations in Florida after Hurricane Irma which reached baseline operations less than 1 week following Hurricane Irma's landfall.

CONCLUSION

Our results demonstrate the unique severity of Hurricane Maria's impacts on Puerto Rico's health system.

Awareness is the first step: What Ghanaian community pharmacists know about cancer

OBJECTIVES

The goal of this study was to access the knowledge of a representative sample of community pharmacists in Ghana on general cancer, risk factors, signs and symptom and most common cancer counseling points known to community pharmacists.

METHODS

A structured online questionnaire was administered to 435 registered community pharmacists in the sixteen regions of Ghana.Key findings: Mean score for knowledge of cancer among community pharmacists was 6.8 ± 1.61 points out of a maximum score of 15 points, categorizing the overall knowledge as inadequate. The overall assessment of pharmacists' knowledge revealed that 74.6% of the participants had inadequate level of knowledge on cancer. Mean score for knowledge of cancer signs and symptoms among community pharmacists was 3.55 ± 1.85 out of a maximum score of 7 points, categorizing the overall knowledge as inadequate. The overall evaluation indicated that 79.03% of pharmacists had inadequate knowledge of signs and symptoms cancer. Mean score for knowledge of risk factors of cancer among community pharmacists was 5.25 ± 1.15 out of a maximum score of 12 points, categorizing the overall knowledge as inadequate. The overall assessment of the knowledge score indicates that 70.34% of pharmacists had inadequate knowledge about causes and risk factors of cancer. Almost all participating pharmacists (96.5%) recommended counselling point was avoidance of smoking as a cancer preventive measure. An inverse significant correlation was found between age and knowledge scores of signs and symptoms of cancer (r = -0.077, P = 0.038). There was a statistically significant relationship between pharmacists' level of knowledge on cancer (whether adequate or inadequate) and the cancer items.

CONCLUSIONS

Knowledge of cancer, its signs and symptoms and its risk factors were inadequate among community pharmacists in Ghana. Efforts should be made to improve knowledge of community pharmacists on cancer through continuous education. Also, undergraduate pharmacy training in oncology should encourage to close knowledge gap of community pharmacists on cancer.

Stigma of Opioid Use Disorder and Its Indirect Effects on Student Pharmacists' Perceptions and Attitudes

OBJECTIVES

Pharmacists play a vital role in serving patients during the ongoing nationwide opioid epidemic, and so it is also critical to educate the next generation of pharmacists on opioids and opioid use disorder (OUD). The primary objective of this study was to quantitatively characterize student perceptions of opioid use and the stigma associated with OUD. Secondary aims were to determine whether differences in perceptions exist based upon the student's year in the Doctor of Pharmacy program or employment in a community pharmacy.

METHODS

First-, second-, third-, and fourth-year student pharmacists voluntarily completed an electronic survey regarding perceptions of opioid use and stigma associated with OUD.

RESULTS

Of the 9 survey items, students were most uncomfortable referring patients to community resources for addiction support and/or treatment (25.3% comfortable or very comfortable). Students working in a community pharmacy were significantly more comfortable talking to patients attempting to refill opioids early and providing opioid counseling as compared to their peers not working in community pharmacy. Fourth-year students reported a higher level of comfort talking to a patient attempting to refill an opioid prescription early, counseling a patient on an opioid prescription, and providing information about alternatives to opioids. Third-year students responded most favorably to the items regarding how well the curriculum has prepared them to interact with patients taking opioids and those with OUD.

CONCLUSIONS

These findings reveal that students are comfortable counseling on opioids and discussing alternative options. Differences in perceptions were observed based upon the student's year in the program and whether or not they were employed in a community pharmacy setting.

Attitudes about community pharmacy access to HIV prevention medications in California

OBJECTIVE

Increasing access to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) is a high priority for the Ending the HIV Epidemic Initiative. Expanding access to PrEP and PEP through a variety of health care settings, including community pharmacies, may increase access in communities most in need. California is the first state to allow community pharmacists to furnish PrEP and PEP directly to consumers. Our objective was to assess attitudes among key stakeholders about a California policy to allow community pharmacists to furnish HIV PrEP and PEP.

METHODS

We conducted a qualitative case study with key pharmacy stakeholders. Semistructured phone interviews were audio-recorded and transcribed verbatim. We generated analytical memos for each interview and working with these analytical memos, we conducted a constant comparison across cases to identify commonalities and differences.

RESULTS

We launched the study in October 2018 and interviewed pharmacists (n = 7) working in a variety of settings, including retail-, clinic-, and community-based pharmacies. We also interviewed medical providers (n = 2) working in high-volume PrEP clinics and sought input from representatives of large retail chain pharmacies (n = 2). Overall, pharmacists and medical provider informants shared similar opinions about the central benefits as well as the key challenges related to pharmacist-delivered PrEP and PEP services. Benefits included: community pharmacists are widely accessible, PrEP and PEP protocols are similar to other preventative medications, policy may lead to efficiencies in the health care workforce, and community pharmacists are authorities on medication adherence. Challenges included: implementation issues may limit pharmacist involvement, and missed opportunities to diagnose and treat other health conditions.

CONCLUSION

This study characterizes the types of benefits and challenges that can be expected when PrEP and PEP prescribing privileges are extended to community pharmacists. This information may be useful to policymakers and other stakeholders considering legislation to permit direct prescription of PrEP and PEP by pharmacists.

Continuous Stakeholder Engagement: Expanding the Role of Pharmacists in Prevention of Type 2 Diabetes Through the National Diabetes Prevention Program

The pharmacy sector is a key partner in the National Diabetes Prevention Program (National DPP), as pharmacists frequently care for patients at high risk for type 2 diabetes. The Centers for Disease Control and Prevention aimed to increase pharmacist involvement in the program by leveraging partnerships with national pharmacy stakeholders. Continuous stakeholder engagement helped us to better understand the pharmacy sector and its needs. With stakeholders, we developed a guide and promotional campaign. By following a systematic process and including key stakeholders at every step of development, we successfully engaged these valuable partners in national type 2 diabetes prevention efforts. More pharmacy sites (n = 87) are now offering the National DPP lifestyle change program compared to before release of the guide (n = 27).

Essential Role of Pharmacists in Asthma Care and Management

Asthma, a chronic respiratory disease characterized by chronic airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, poses a substantial economic burden on patients and caregivers alike. Moreover, the heterogeneous nature of the disease and the presence of various phenotypes make the treatment of asthma challenging and nuanced. Despite the availability of several approved pharmacological treatments, approximately half of patients with asthma in the United States experienced exacerbations in 2016, highlighting the need for effective add-on treatments. Furthermore, asthma control remains suboptimal due to low adherence to medications, poor inhaler technique, and several patient-related factors. Importantly, the primary care setting, in which pharmacists play an integral role, represents a critical environment for providing long-term follow-up care for the effective management of chronic diseases, such as asthma. Pharmacists are uniquely positioned to ensure optimal clinical outcomes in patients with asthma since they have the clinical expertise to educate patients on their disease state and the role of asthma medications, provide training on inhalation technique, address patients’ concerns about potential side effects of medications, and improve adherence to therapy. Therefore, in this review article, we discuss the overall role of pharmacists in effective asthma care and management.

The Role of Pharmacist in the Health Care System: Current Scenario in India

Pharmacists are society's specialists on drugs. The Pharmacist of today is a drug-maker, drug-dispenser, drug-custodian, patient-counselor, drug-researcher, and drug-educator and above all an honest and patriotic citizen. The techno-proficient foundation of the drug expert gives him/her the certainty of providing services with a moral way to deal with the satisfaction of patients. The consecrated qualities are required to be cherished and professed by the pharmacist. Pharmacists assume a significant job in giving health care services, benefits by means of community pharmacy services in rural areas where physicians are not accessible or where physician services are unreasonably expensive for meeting the health care necessities. The paper at that point recognizes how pharmacists give expanded services, identifies key challenges and barriers, and suggests rules and regulations that could help secure open doors for pharmacists to play out an extended job.

The Potential Role of the Pharmacist in Supporting Patients with Depression - A Literature-Based Point of View

OBJECTIVE

The current article is aimed at identifying the best practice for counseling around depression in community and outpatient pharmacies, resulting in a draft guideline, proposing key steps and an algorithm for integration of community pharmacists into care for patients with depression.

METHODS

A literature review was performed followed by a detailed analysis, for the purpose of creation a short draft document used as a basis for creation of a guideline for pharmaceutical care for patients with depression. The technological scheme PRISMA flow diagram was applied. The paper is based on current knowledge, taking into consideration already published articles, guidelines, and recommendations about pharmaceutical care for patients with depression, giving a basis for further studies.

RESULTS

This paper includes two main sections: 1) depression - a short description of the main symptoms, risk factors and pharmacotherapy guidelines available in Bulgaria important for the purposes of ensuring qualitative community-based pharmaceutical care; and 2) the pharmacists' role in providing high-quality care - the main aspects of pharmaceutical care for patients with depression with specific examples.

CONCLUSION

The involvement of pharmacists in supporting depressive patients is crucial taking into account the specific characteristics of the pharmacological treatment: delayed onset of clinical results, risks in case of sudden pharmacotherapy abruption without physician consultation, multiple adverse drug reactions and drug-drug, drug-food and drug-alcohol interactions, etc. The current article could also be used as an initial document for creating a methodological guideline for providing pharmaceutical care services for patients with depression.

Pharmacy-based pre-exposure prophylaxis support among pharmacists and men who have sex with men

OBJECTIVE

To understand the perceptions and support for pharmacy-based pre-exposure prophylaxis (PrEP) delivery among pharmacists and men who have sex with men (MSM).

DESIGN

A qualitative study from April 2017 to December 2018.

SETTING AND PARTICIPANTS

The researchers used purposive sampling to identify MSM participants and AIDSVu to identify pharmacists in high-human immunodeficiency virus (HIV) zip codes in the metropolitan Atlanta area. Eight MSM and 6 pharmacists consented to participate in the study.

OUTCOME MEASURES

Perceptions and support for PrEP delivery in pharmacies.

RESULTS

Both MSM and pharmacists expressed strong support for in-pharmacy PrEP screening and dissemination. MSM reported that pharmacies were more convenient and accessible compared with physician's offices. However, they also noted that privacy and training of pharmacy staff were important for them to consider being screened for PrEP in a pharmacy. Pharmacists also believed training was important and felt comfortable counseling on HIV prevention for their current patients.

CONCLUSION

These data support early evidence that pharmacies are a promising venue to improve PrEP access for MSM. To implement PrEP screening in pharmacies, proper training of pharmacy staff and a designated space to ensure privacy are critical. Future studies should test the feasibility of screening for PrEP in pharmacies for black MSM.

Ohio Community Pharmacist Provision of Clinical Preventive Services

OBJECTIVE

The primary objective of this study was to assess whether Ohio community pharmacists currently provide certain evidencebased clinical preventive services. Secondary objectives were to explore whether there were any differences in provision of services based on respondent education, position, employment status, location, practice setting, or years in practice and to gather information on how pharmacists provide specific services, barriers to providing specific services, pharmacists' perceptions on specific services needed in their patient population, and pharmacists' interests in providing services if not already doing so.

METHODS

A random sample of 500 community pharmacists licensed in Ohio received a Qualtrics survey via email assessing current practices and perspectives regarding clinical preventive services. The U.S. Preventive Services Task Force (USPSTF) "A" and "B" recommended services that can be provided in a community pharmacy served as the framework for the survey questions. Reminders were sent every 3-4 days; data collection continued for a month. The study was IRB-approved.

RESULTS

Ninety-three responses were included in the final analysis (18.9% response rate). Approximately 63% of respondents were female; 51.6% held a Doctor of Pharmacy degree. Only 21.5% of respondents were familiar with the USPSTF. However, many respondents were providing clinical preventive services in their pharmacy; the most common were blood pressure screening (51.6%), tobacco use screening or counseling (43%), and diet and/or physical activity counseling (22.6%). These services were provided in varied ways including patient counseling, medication therapy management sessions, screening events, and health fairs. Those who are not currently providing services showed interest in developing them. Pharmacists reported barriers such as lack of time, staff, and reimbursement by patients or third-party payers.

CONCLUSION

Many surveyed community pharmacists in Ohio reported providing clinical preventive services in a variety of ways. Many pharmacists who did not provide these services indicated an interest developing such services. Staffing concerns, time constraints, and a lack of reimbursement by patients and third-party payers were reported as barriers by community pharmacists in providing these services. As many respondents reported being unfamiliar with USPSTF recommendations, the opportunity to educate pharmacist on these recommendations and potentially increase their activity in these prevention activities exists.

Ohio Community Pharmacist Interest and Participation in Community-Clinical Linkages

BACKGROUND

Community-clinical linkages have been promoted as a means to improve population health. The community pharmacy is an ideal location for these partnerships to occur due to the expertise of the community pharmacist. While the need for these partnerships exists, there are limited data regarding community pharmacists' current participation in such programs.

OBJECTIVE

The purpose of this analysis was to assess Ohio community pharmacists' involvement and interest in community-clinical linkages.

METHODS

An electronic survey tool containing 26 questions was developed to assess Ohio community pharmacists' participation in community-clinical linkages and interest to develop such partnerships. The tool was sent via email to a random sample of 500 pharmacists registered in Ohio and practicing in a community setting. Chi-square or Fisher exact nonparametric statistical tests were used as appropriate to identify whether there were any significant differences in current partnership or interest to partner with a prescriber who refers patients to their community pharmacy based on education (Bachelor of Science or Doctor of Pharmacy degree) or pharmacy location (urban, suburban, or rural).

RESULTS

Nine emails were undeliverable, leaving a sample of 491 pharmacists. Ninety-three (19%) responded to the survey. Sixteen respondents (17%) indicated that they currently partner with a prescriber who refers patients to their pharmacy for assistance with medications or chronic disease state management; this practice was more often reported in urban settings (p=0.022). Of those not currently participating in such a partnership, 53 (57%) were interested in developing one. Thirty-two respondents (34%) reported providing referrals for at least 1 type of screening or counseling service. For some types of services, pharmacists reported that they provide the service in the pharmacy and/or were interested to develop the service in the pharmacy rather than provide a referral. However, for any given service there were a number of pharmacists who expressed interest in providing referrals although they were not currently doing so.

CONCLUSION

This sample of Ohio community pharmacists reported limited participation in community-clinical linkages but interest to develop them. Further studies should explore the pharmacists' role and impact in such programs.

Pharmacists’ Utilization of Information Sources Related to Community and Population Needs in the Upper Midwest and Associations with Continuing Professional Education

Background: To investigate information sources utilized in pharmacists’ assessment of population-based health needs and/or community changes; and the association between information sources utilized and reported completion of continuing professional education topics. Methods: In 2017; licensed pharmacists (n = 1124) in North Dakota; South Dakota; Minnesota; Iowa; and Nebraska completed a questionnaire on continuing professional education and information sources on population-based health needs and community changes. Data were entered; cleaned and imported into Stata 11.1. Census Bureau county-level population density data were used to classify local area characteristics. Descriptive statistics and multivariate logistic regression analyses were performed. Results: Most sources of primary; county-level data on population-based health needs or community changes were minimally utilized. Pharmacists in more rural areas were statistically more likely to use local health professionals; local non-health professionals; and/or the state health department compared to pharmacists in less rural areas. Pharmacists reporting higher use of population-based information sources were more likely to have completed continuing education in the past 12 months for all 21 surveyed topics; 13 significantly so. Conclusions: There is a reliance of pharmacists on information from local health and non-health professionals for information on population-based health needs and/or community changes. Utilization of health departments and other primary information sources was associated with increased rates of completion of an array of continuing professional education topics. Expanding utilization of evidence-driven information sources would improve pharmacists’ ability to better identify and respond to population-based health needs and/or community changes through programs and services offered; and tailor continuing professional education to population-based health needs.

Impact of community pharmacist-provided preventive services on clinical, utilization, and economic outcomes: An umbrella review

Preventable diseases and late diagnosis of disease impose great clinical and economic burden for health care systems, especially in the current juncture of rising medical expenditures. Under these circumstances, community pharmacies have been identified as accessible venues to receive preventive services. This umbrella review aims to examine existing evidence on the impact of community pharmacist-provided preventive services on clinical, utilization, and economic outcomes in the United States (US). We included systematic reviews, narrative reviews and meta-analyses published in English between January 2007 and October 2017. Of 2742 references identified by our search strategy, a total of 13 research syntheses met our inclusion criteria. Included reviews showed that community pharmacists are effective at increasing immunization rates, supporting smoking cessation, managing hormonal contraception therapies, and identifying patients at high risk for certain diseases. Moreover, evidence suggests that community pharmacies are especially well-positioned for the provision of preventive services due to their convenient location and extended hours of operation. There is general agreement on the positive impact of community pharmacists in increasing access to preventive health, particularly among patients who otherwise would not be reached by other healthcare providers. The provision of preventive services at US community pharmacies is feasible and effective, and has potential for improving patient outcomes and health system efficiency. However, high-quality evidence is still lacking. As the healthcare landscape shifts towards a value-based framework, it will be important to conduct robust studies that further evaluate the impact of community pharmacist-provided preventive services on utilization and economic outcomes.

Community pharmacist-led clinical services: physician's understanding, perceptions and readiness to collaborate in a Midwestern state in the United States

OBJECTIVES

Many pharmacists are actively enhancing their role in the delivery of health care by offering a variety of pharmacist-led clinical services. The delivery of these services within community pharmacies can contribute to overcoming the cost and accessibility challenges currently facing U.S. health care, especially when pharmacist-physician collaborative efforts are utilized. The study purpose was to identify general and family practice physicians' awareness of pharmacists' delivery of clinical services, uncover their perceived barriers to collaboration with community pharmacists, and collect their input on how to overcome such barriers in order to better understand how pharmacist-led clinical services can be integrated, improved and more widely utilized as a healthcare delivery mechanism.

METHODS

Semi-structured interviews were performed at the physicians' place of practice to assess (1) family practice and internal medicine physicians' knowledge of pharmacists' education, clinical training, and role in the healthcare team; (2) their perceptions and barriers towards pharmacist-delivered clinical services and physician-pharmacist collaboration; and (3) their recommendations to improve physician-pharmacist collaboration. The data were analysed qualitatively to identify and categorize themes.

KEY FINDINGS

Thirteen physicians were interviewed. While nearly all physicians were aware of pharmacists' level of education, most were not aware of the level of clinical training pharmacists receive. Only half of the physicians were able to provide a definition or example of collaborative practice agreements, although most recognized value and benefit when the definition and examples were provided to them. The commonly perceived barriers for collaboration were concern over loss of communication, hesitancy to relinquish control and lack of confidence in pharmacists' clinical judgement.

CONCLUSION

The study results emphasize the need to develop strategies to improve collaborative relationships between physicians and pharmacists. To encourage collaboration, pharmacists must take a proactive approach to increasing awareness of their clinical knowledge and training, the benefits and value of collaborative practice and the opportunities for it.

Rural Disparities in Alzheimer's Disease-Related Community Pharmacy Care in the United States

PURPOSE

To examine the relationship between area population density and community pharmacy-based Alzheimer's Disease (AD)-related services: pharmacists' medication knowledge and counseling, immunizations, and in-stock cognitive enhancers in 3 predominantly rural regions of the United States.

METHODS

A standardized interview was administered by telephone to a 100% sample of community pharmacies in 3 areas: Northern California/Southern Oregon (n = 206), North and South Dakota (n = 278), and West Virginia (n = 420). Key study outcomes included: pharmacists' medication knowledge, availability of immunization services, and cognitive enhancers in stock. Respondents were classified by population density (persons/mi² ) by pharmacy location to evaluate the relationship between rurality and AD-related pharmacy services. Chi-squared and logistic regression analyses were performed using Stata 10.1.

FINDINGS

Pharmacies in more rural areas (50.1-100.0, 25.1-50.0, and ≤25.0 persons/mi² ) were about 50% less likely to offer immunizations (95% CI: 0.32-0.91; 0.32-0.76; 0.28-0.80, respectively) compared to the least rural areas (>100.0 persons/mi² ). Compared to the least rural areas, pharmacists in the most rural areas (≤25.0 persons/mi² ) were less likely to name ≥2 gastrointestinal adverse effects of donepezil (OR = 0.50, 95% CI: 0.31-0.82) or have memantine XR 28 mg (OR = 0.61, 95% CI: 0.41-0.89) and other surveyed medications (OR = 0.57, 95% CI: 0.39-0.82) in stock.

CONCLUSIONS

We found disparities in AD-related services in community pharmacies located in more rural counties, wherein individuals with AD and their caregivers may face barriers to obtaining quality pharmaceutical care. There is a need to strengthen pharmacists' knowledge and improve pharmacy services to reduce disparities.

Medical Students' Perceptions on the Role of Pharmacists

BACKGROUND:

Over the last decade, the pharmacists' role in health-care services has evolved and expanded to include more direct patient care and disease management services.

OBJECTIVE:

To evaluate medical students' perceptions on pharmacists, their role in health care, and demographic or experiential factors that influenced the medical students' opinions.

METHODS:

Medical students, at a Midwest, academic medical center, were solicited to complete a cross-sectional, web-based survey consisting of 3 domains: basic demographics, knowledge of the pharmacy profession, and opinions of pharmacists.

RESULTS:

Participants supported pharmacists' role in recommending and monitoring drug therapy. However, participants did not support pharmacists' role in performing physical examinations, health screenings, or managing patients with chronic diseases. The main factors that influenced perceptions of pharmacists were female gender and frequent (weekly or more) interaction with a pharmacist or pharmacy student. Neither year in medical school nor participation in intercollaborative practice significantly influenced perceptions of pharmacists.

CONCLUSION:

This survey highlights the need to improve the education medical students receive about pharmacists' contribution to the health-care team and the importance of increasing the interaction between medical students and pharmacists or pharmacy students to enhance interprofessional collaboration.

Community Pharmacists' Knowledge Regarding Donepezil Averse Effects and Self-Care Recommendations for Insomnia for Persons with AD

Alzheimer's disease (AD) impacts millions of individuals worldwide. Since no cure is currently available, acetylcholinesterase inhibitors are symptomatic therapy. This study assessed community pharmacists' knowledge regarding donepezil adverse effects (AEs) and self-care recommendations for insomnia management for persons with AD treated with rivastigmine. This is a cross-sectional, standardized telephone survey of community pharmacists (n = 862) in three study areas: West Virginia, North Dakota/South Dakota, and Southern Oregon/Northern California. Pharmacists' degree, sex, and pharmacists' AD-related knowledge were assessed. In-stock availability of donepezil and rivastigmine formulations was assessed. Analyses were performed using Stata 10.1. Only 31.4% pharmacists were able to name ≥2 donepezil AEs. Only four donepezil AEs were named by at least 13% of pharmacists: nausea (36.1%), dizziness (25.1%), diarrhea (15.0%), and vomiting (13.9%). All other AEs were named by fewer than 7% of respondents. Only 62.9% of pharmacists (n = 542) provided appropriate recommendations: melatonin (40.3%), referral to physician (22.0%), or sleep hygiene (0.6%). Over 12% of pharmacists (n = 107) provided inappropriate recommendations (anticholinergic agent or valerian root) and 21.5% of pharmacists were unable to provide any recommendation. We identified significant gaps in community pharmacists' knowledge regarding donepezil AEs and non-prescription insomnia recommendation needing significant improvement to ensure high-quality AD-related care.