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Adams AJ, Frost TP, Parker J, Johanson E. Reply to "Quantitative and qualitative survey feedback of pharmacists regarding current and prospective licensure models.". J Am Pharm Assoc (2003) 2024:102088. [PMID: 38588800 DOI: 10.1016/j.japh.2024.102088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
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Adams AJ, Klepser ME. Pharmacist Prescribing Models for HIV Pre-exposure and Post-exposure Prophylaxis. Ann Pharmacother 2024; 58:434-440. [PMID: 37480245 DOI: 10.1177/10600280231187171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
State strategies for pharmacist prescribing exist on a continuum from most restrictive to least restrictive. Using human immunodeficiency virus (HIV) pre-exposure prophylaxis and post-exposure prophylaxis as a case study, there are 3 viable pharmacist prescribing models: (1) population-based collaborative practice agreements; (2) government protocols; and (3) standard of care prescribing. The advantages and disadvantages of these 3 models are reviewed.
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Affiliation(s)
- Alex J Adams
- Division of Financial Management, Idaho, Boise, ID, USA
| | - Michael E Klepser
- College of Pharmacy, Ferris State University, Grand Rapids, MI, USA
- Collaboration to Harmonize Antimicrobial Registry Measures, Grand Rapids, MI, USA
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Adams AJ, Eid DD. Toward collaborative practice, not collaborative practice agreements. Am J Health Syst Pharm 2024; 81:e157-e158. [PMID: 37948606 DOI: 10.1093/ajhp/zxad280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, Eagle, ID, USA
| | - Deeb D Eid
- Ferris State University College of Pharmacy, Grand Rapids, MI, USA
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Zalupski B, Elroumi Z, Klepser DG, Klepser NS, Adams AJ, Klepser ME. Pharmacy-based CLIA-waived testing in the United States: Trends, impact, and the road ahead. Res Social Adm Pharm 2024:S1551-7411(24)00089-5. [PMID: 38519341 DOI: 10.1016/j.sapharm.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Federal authorization of the use of Clinical Laboratory Improvement Amendments of 1988 (CLIA) waived point-of-care tests for SARS-CoV-2 by pharmacists during the pandemic resulted in a dramatic rise in the number of community pharmacies that became CLIA-waived test sites. Now as we exit the pandemic, the wide-ranging expansion of the scope of practice facilitated currently by the PREP Act is set to expire in fall 2024. As a result, American pharmacists' ability to offer CLIA-waived testing services will revert to a patchwork of state laws. OBJECTIVE This study aims to examine both the number of pharmacies in the United States with CLIA Certificates of Waiver before and after the SARS-CoV-2 pandemic and the state-by-state differences in the percentage of pharmacies with CLIA Certificates of Waiver. METHODS Data were collected from the U.S. Centers for Disease Control and Prevention CLIA Laboratory Search website on May 3rd, 2015, August 4th, 2019, November 26th, 2020, October 6th, 2021, November 23rd, 2022, and December 4th, 2023. The website allows for the exportation of demographic data on all CLIA-waived facilities by state. RESULTS The total number of pharmacies with a CLIA-waiver grew from 10,626 (17.9%) locations in 2015 to 12,157 (21.4%) locations in 2019, to 15,671 (27.6%) locations in 2020, and to 29,011 (51.6%) locations in 2023. States demonstrated considerable variability in the percentage of pharmacies possessing a CLIA certificate of waiver in 2023, with a range of 10.7%-87.9%. CONCLUSIONS Use of CLIA-waived tests in pharmacies has grown by 140% since 2019. The time period from 2019 to 2021 witnessed a 92.5% increase in pharmacies that possessed a certificate of waiver which was largely driven by the pandemic. Interestingly, from 2021 to 2023 the was continued growth in the market of 31.6%. This suggests that pharmacies continue to see opportunity in offering CLIA-waived testing services beyond those that had been extended as a result of the pandemic.
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Affiliation(s)
- Ben Zalupski
- Ferris State University College of Pharmacy, 25 Michigan Street NE Suite 7000, Grand Rapids, MI 49503, USA.
| | - Zeina Elroumi
- Ferris State University College of Pharmacy, 25 Michigan Street NE Suite 7000, Grand Rapids, MI 49503, USA.
| | - Donald G Klepser
- University of Nebraska Medical Center College of Pharmacy, 986145 Nebraska Medical Center, Omaha, NE 68198-6145, USA.
| | - Nicklas S Klepser
- Ichan School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY 10029, USA.
| | - Alex J Adams
- Idaho Division of Financial Management, Boise, ID 83701, USA.
| | - Michael E Klepser
- Ferris State University College of Pharmacy, 25 Michigan Street NE Suite 7000, Grand Rapids, MI 49503, USA.
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Adams AJ, Chopski NL, Adams JA. How to implement a "standard of care" regulatory model for pharmacists. J Am Pharm Assoc (2003) 2024:102034. [PMID: 38354978 DOI: 10.1016/j.japh.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 01/27/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
National pharmacy associations have increasingly explored regulation according to a "standard of care." In such a model, pharmacists can provide a wide range of clinical services aligned with their education and training. Based on Idaho's experience implementing this model, there are five critical steps states must take to enact a standard of care: 1) Adopt a broad definition of "practice of pharmacy;" 2) Allow elasticity for practice innovation over time; 3) Decide which limited instances still necessitate prescriptive regulation; 4) Eliminate all unnecessary regulations; and 5) Strengthen accountability for deviations from the standard of care. States wishing to adopt a standard of care approach can follow this five-step process to enhance patient care and mitigate the lag that is otherwise constant between laws and practice.
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Castillo NA, James WR, Santos RO, Rezek R, Cerveny D, Boucek RE, Adams AJ, Goldberg T, Campbell L, Perez AU, Schmitter-Soto JJ, Lewis JP, Fick J, Brodin T, Rehage JS. Understanding pharmaceutical exposure and the potential for effects in marine biota: A survey of bonefish (Albula vulpes) across the Caribbean Basin. Chemosphere 2024; 349:140949. [PMID: 38096990 DOI: 10.1016/j.chemosphere.2023.140949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/22/2023]
Abstract
Most research on pharmaceutical presence in the environment to date has focused on smaller scale assessments of freshwater and riverine systems, relying mainly on assays of water samples, while studies in marine ecosystems and of exposed biota are sparse. This study investigated the pharmaceutical burden in bonefish (Albula vulpes), an important recreational and artisanal fishery, to quantify pharmaceutical exposure throughout the Caribbean Basin. We sampled 74 bonefish from five regions, and analyzed them for 102 pharmaceuticals. We assessed the influence of sampling region on the number of pharmaceuticals, pharmaceutical assemblage, and risk of pharmacological effects. To evaluate the risk of pharmacological effects at the scale of the individual, we proposed a metric based on the human therapeutic plasma concentration (HTPC), comparing measured concentrations to a threshold of 1/3 the HTPC for each pharmaceutical. Every bonefish had at least one pharmaceutical, with an average of 4.9 and a maximum of 16 pharmaceuticals in one individual. At least one pharmaceutical was detected in exceedance of the 1/3 HTPC threshold in 39% of bonefish, with an average of 0.6 and a maximum of 11 pharmaceuticals exceeding in a Key West individual. The number of pharmaceuticals (49 detected in total) differed across regions, but the risk of pharmacological effects did not (23 pharmaceuticals exceeded the 1/3 HTPC threshold). The most common pharmaceuticals were venlafaxine (43 bonefish), atenolol (36), naloxone (27), codeine (27), and trimethoprim (24). Findings suggest that pharmaceutical detections and concentration may be independent, emphasizing the need to monitor risk to biota regardless of exposure diversity, and to focus on risk quantified at the individual level. This study supports the widespread presence of pharmaceuticals in marine systems and shows the utility of applying the HTPC to assess the potential for pharmacological effects, and thus quantify impact of exposure at large spatial scales.
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Affiliation(s)
- N A Castillo
- Earth and Environment Department, Institute of Environment, Florida International University, Miami, FL, USA.
| | - W R James
- Earth and Environment Department, Institute of Environment, Florida International University, Miami, FL, USA; Department of Biology, Institute of Environment, Florida International University, Miami, FL, USA
| | - R O Santos
- Department of Biology, Institute of Environment, Florida International University, Miami, FL, USA
| | - R Rezek
- Department of Marine Science, Coastal Carolina University, Conway, SC, USA
| | - D Cerveny
- Department of Wildlife, Fish and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden; Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, University of South Bohemia in Ceske Budejovice, Vodňany, Czech Republic
| | - R E Boucek
- Bonefish and Tarpon Trust, Miami, FL, USA
| | - A J Adams
- Bonefish and Tarpon Trust, Miami, FL, USA; Florida Atlantic University Harbor Branch Oceanographic Institute, Fort Pierce, FL, USA
| | - T Goldberg
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - L Campbell
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - A U Perez
- Bonefish and Tarpon Trust, Miami, FL, USA
| | - J J Schmitter-Soto
- Departmento de Sistemática y Ecología Acuática, El Colegio de la Frontera Sur, Chetumal, Mexico
| | - J P Lewis
- Bonefish and Tarpon Trust, Miami, FL, USA
| | - J Fick
- Department of Chemistry, Umeå University, Umeå, Sweden
| | - T Brodin
- Department of Wildlife, Fish and Environmental Studies, Swedish University of Agricultural Sciences, Umeå, Sweden
| | - J S Rehage
- Earth and Environment Department, Institute of Environment, Florida International University, Miami, FL, USA
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Adams AJ, Frost TP. Implementation of the California advanced practice pharmacist and the continued disappointment of tiered licensure. Explor Res Clin Soc Pharm 2023; 12:100353. [PMID: 37965248 PMCID: PMC10641243 DOI: 10.1016/j.rcsop.2023.100353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/07/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
The Advanced Practice Pharmacist (APh) designation in California was created via legislation 10 years ago. California pharmacists who meet certain criteria can be designated as an APh and unlock additional practice authority. Just 1065 pharmacists, or 2% of licensed California pharmacists, have obtained the APh designation through 2022. APhs did not report benefiting from the designation as it relates to expanded scope of practice. This experience of low uptake and minimal benefit mirrors the tiered licenses created by three other states. More recent legislation broadened the independent prescriptive authority of APhs, but this increased value proposition aligns with the practice authority adopted by other states who have imposed fewer barriers to entry. Given the track record observed to date, we doubt that tiered licensure will ever prove successful in the pharmacy profession. Instead, state policymakers and pharmacy advocates should consider adopting a "standard of care" regulatory approach to improve patient access to safe and beneficial pharmacist services.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management, Eagle, ID 83616, USA
| | - Tim P. Frost
- Idaho Division of Occupational and Professional Licenses, Boise, ID, USA
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Abstract
Boards of pharmacy have the authority to discipline licensees whose actions fall short of practice standards. Disciplinary action may include license suspension, revocation, practice restrictions, fines and reprimands. Once discipline is levied against a board of pharmacy licensee, it is usually part of the licensee's permanent record. At least four states have created a pathway for individuals to seek expungement of previous disciplinary actions levied by a board of pharmacy. These states have variations on what violations may be expunged and when. Given the evolving approach to the regulation of pharmacists, more states may want to consider expungement pathways in the years ahead.
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Adams AJ, Frost TP, Eid D. The Basis for Elimination of the Jurisprudence Examination as a Condition of Pharmacist Licensure in Idaho. Am J Pharm Educ 2023; 87:100119. [PMID: 37852688 DOI: 10.1016/j.ajpe.2023.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/04/2023] [Accepted: 04/09/2023] [Indexed: 10/20/2023]
Abstract
Some national pharmacy associations have recently joined in advocacy for a more portable pharmacist license. One impediment to accomplishing this is the state-specific nature of the pharmacy jurisprudence examination, leading to calls for the exploration of alternatives to, or outright elimination of, such examinations. This manuscript reviews the rationale for the elimination of the pharmacy jurisprudence examination in Idaho. The Idaho Board of Pharmacy reviewed the absence of similar jurisprudence examinations in other health professions, the role schools of pharmacy and employers play in preparing pharmacists for lawful practice, and how the adoption of a "standard of care" regulatory model changed thinking about the need for a jurisprudence examination. Idaho eliminated the examination in 2018, and no evidence demonstrating a public safety impact has yet materialized, while the number of Idaho licensed pharmacists has grown at a higher rate than its border states. State boards of pharmacy are in a position to decide whether keeping the pharmacy jurisprudence examination is necessary, and this manuscript reviews key considerations for other states.
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Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, Eagle, ID, USA.
| | - Timothy P Frost
- Idaho Division of Occupational and Professional Licenses, Boise, ID, USA
| | - Deeb Eid
- Ferris State University College of Pharmacy (Affiliate Preceptor), Grand Rapids, MI, USA
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Adams AJ, Weaver KK, Adams JA. Revisiting the continuum of pharmacist prescriptive authority. J Am Pharm Assoc (2003) 2023; 63:1508-1514. [PMID: 37414281 DOI: 10.1016/j.japh.2023.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/21/2023] [Accepted: 06/29/2023] [Indexed: 07/08/2023]
Abstract
Pharmacists in all states have prescriptive authority in some form. We identify two broad categories of pharmacist prescribing: dependent and independent. There are gradients within these broad categories that allow us to chart pharmacist prescribing on a continuum from most restrictive to least restrictive. Independent prescribing has seen the most innovation in recent years at the state level, with at least three states adopting a "standard of care" prescribing framework that allows pharmacists to exercise broad prescriptive authority including for conditions that require a diagnosis. Each of the approaches to pharmacist prescriptive authority have perceived advantages and disadvantages as it relates to improving patient care.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management, Eagle, Idaho
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Adams JA, Chopski NL, Adams AJ. Opportunities for pharmacist prescriptive authority of buprenorphine following passage of the Mainstreaming Addiction Treatment (MAT) Act. J Am Pharm Assoc (2003) 2023; 63:1495-1499. [PMID: 37295494 DOI: 10.1016/j.japh.2023.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
In December 2022, Congress passed the Mainstreaming Addiction Treatment Act, which removed the federal legal barrier to pharmacist buprenorphine prescribing. As a result, each state can now decide whether or not to allow pharmacists to prescribe buprenorphine as an additional access point to reduce fatal opioid overdoses. At least 10 states allow pharmacists to prescribe controlled substances under collaborative practice agreements. Two states (California and Idaho) have also created pathways for independent prescribing of buprenorphine by pharmacists. Additional states should seek to enable pharmacists to prescribe buprenorphine to increase access to a proven beneficial treatment and help reduce fatal opioid overdoses.
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Adams AJ. Regulating Pharmacist Clinical Services: Is Legal Silence Golden or Deafening? J Pharm Pract 2023:8971900231199283. [PMID: 37646272 DOI: 10.1177/08971900231199283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In the United States, the scope of practice of pharmacists is determined primarily at the state level. Not all state laws expressly permit or prohibit pharmacists from providing certain services; in between is a grey area of legal silence. Does legal silence permit pharmacists to perform a service that is not specifically permitted, but not expressly prohibited? Point-of-care testing provides a useful case study in legal silence: there are 1536 pharmacies currently holding a CLIA-waiver to administer tests in states reporting that pharmacists are not expressly permitted to administer tests. Legal silence may even provide a better framework for pharmacy based testing as it is naturally inclusive of any point-of-care test and no laws need updated when a new test comes to the market. Other health professions navigate this legal silence by governing according to a "standard of care." Rather than specifying a list of services a health professional can or cannot provide in law, it provides a flexible framework for the health professional to provide any service that other similarly situated health professionals would provide in the same or similar situation. A standard of care regulatory framework should thus be the target of the pharmacy profession in order to advance patient care.
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Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, Eagle, ID, USA
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Adams AJ. Extending COVID-19 Pharmacy Technician Duties: Impact on Safety and Pharmacist Jobs. J Pharm Technol 2023; 39:134-138. [PMID: 37323767 PMCID: PMC10209718 DOI: 10.1177/87551225231172343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
Background: The 2019 coronavirus pandemic (COVID-19) led to an expanded scope of practice for pharmacy technicians. As the pandemic wanes, state governments are faced with the decision of whether or not to make permanent the authority of pharmacy technicians to perform extended duties. Objective: Determine the impacts on patient safety and job market demands preadoption and postadoption of Idaho's expanded technician duties in 2017 as a natural experiment for expanded technician duties. Methods: Data from the National Practitioner Data Bank (NPDB) is used to explore patient safety outcomes in Idaho preadoption and postadoption and as compared with its border states. Data from Pharmacy Demand Reports is used to compare job postings in Idaho and its border state, and National Association of Boards of Pharmacy census data are used to compare growth in the number of pharmacists and technicians in Idaho and its border states over time. Results: For Idaho pharmacists, the average number of disciplinary actions reported against both pharmacists and technicians dropped after implementation of expanded technician duties. Idaho also had a lower rate of discipline for pharmacists and technicians than its border states. Idaho had the third highest job postings for pharmacists and the second highest for technicians among its border states. Idaho also had the largest growth in the number of licensed pharmacists and technicians of the observed states in the study period. Conclusion: Available statewide data from Idaho as compared with its border states suggests that expanded technician duties did not adversely impact patient safety outcomes or the pharmacist job market. Additional states may wish to expand pharmacy technician duties in the years ahead.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management, Eagle, ID, USA
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Adams AJ, Eid DD. Federal pharmacist Paxlovid prescribing authority: A model policy or impediment to optimal care? Explor Res Clin Soc Pharm 2023; 9:100244. [PMID: 36945228 PMCID: PMC10011027 DOI: 10.1016/j.rcsop.2023.100244] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
The U.S federal government leveraged emergency authority to allow pharmacists to prescribe Paxlovid (nirmatrelvir and ritonavir) during the COVID-19 pandemic. While heralded by pharmacy associations, the FDA framework included restrictions that arguably ran counter to clinical guidelines and evidence-based research and recommendations. These restrictions will limit the utility of pharmacist prescriptive authority for Paxlovid in practice. The experience of Paxlovid prescribing and a similar recent federal action illustrate the challenges inherent in federal oversight of pharmacist prescriptive authority. While initially more difficult to navigate for stakeholders, working with state legislatures and state boards of pharmacy has much stronger long-term potential to enable broad pharmacist prescriptive authority and benefit patient care. This commentary uses Idaho's pharmacist prescribing regulations as a comparison to the federal actions.
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Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, Eagle, ID 83616, United States of America
| | - Deeb D Eid
- Ferris State University College of Pharmacy, Affiliate Preceptor, Grand Rapids, MI 49501, United States of America
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Adams AJ. Facilitating multistate pharmacy practice: streamlining continuing pharmacy education requirements. J Am Pharm Assoc (2003) 2023; 63:731-735. [PMID: 36894433 DOI: 10.1016/j.japh.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 02/11/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
A major regulatory impediment to achieving multistate pharmacist licensure is state-specific Continuing Pharmacy Education (CPE) mandates. States vary on CPE requirements in 6 key domains, presenting a potentially significant administrative burden for multistate pharmacists. In the short term, replicating the nursing compact model of CPE regulation is the most viable model for the pharmacy profession. In this model, a pharmacist would have to follow just the CPE requirements for the state where the pharmacist maintains primary residence, and maintenance of this home state license would be automatically recognized by other states in which the pharmacist practices.
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Adams AJ, Bright D, Adams J. Pharmacy technician-administered immunizations: A five-year review. J Am Pharm Assoc (2003) 2021; 62:419-423. [PMID: 34857489 PMCID: PMC8590632 DOI: 10.1016/j.japh.2021.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 11/04/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
In October 2020, the U.S. Department of Health and Human Services (HHS) issued guidance authorizing trained pharmacy technicians in all states to administer immunizations. Given that this action is temporary, it will be necessary for states to adopt their own legislation or regulations to sustain these efforts beyond the coronavirus pandemic. At least 11 different immunization administration training programs have emerged for pharmacy technicians. An increasing number of publications have emerged on pharmacy technician immunization administration, demonstrating the ability to train technicians and have them safely administer immunizations in practice. Supervising pharmacists reported initial hesitancy but strong acceptance of delegating this task after experience in practice. States should look to expand and make permanent the authority of pharmacy technicians to ensure these benefits can continue to be realized after the HHS guidance expires.
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Abstract
COVID-19 spurred rapid expansion of pharmacy-based point-of-care testing (POCT). This growth was aided, in part, by federal guidance that removed state-level regulatory uncertainty surrounding the ability of pharmacists to administer, interpret, and act on the results of tests. Surveys suggest there is considerable confusion about the legality of these services by state regulators. To ensure the sustainability of POCT services over time, states should consider adopting a standard of care approach to regulation, allowing a flexible framework for practice innovation and expansion over time.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management
- Corresponding author: Alex J. Adams, PharmD, MPH Idaho Division of Financial Management, Boise, ID
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Affiliation(s)
- Alex J Adams
- Administrator, Idaho Division of Financial Management
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Adams AJ, Frost TP. Pathways to pharmacist prescriptive authority: Do decentralized models for expanded prescribing work? Res Social Adm Pharm 2021; 18:2695-2699. [PMID: 34321187 DOI: 10.1016/j.sapharm.2021.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Scope of practice decisions, such as granting pharmacists independent prescriptive authority, are governed at the state level and are often contentious debates. Five states - Florida (FL), New Mexico (NM), Colorado (CO), Idaho (ID), and Oregon (OR) -- have created structures that can theoretically expand independent prescriptive authority through decentralized approaches rather than needing the legislature to approve each drug that pharmacists may prescribe. These approaches have the potential advantage of allowing the states to expand independent pharmacist prescriptive authority to address public health needs more quickly. Four distinct models have been identified from most to least restrictive in practice: 1) medical veto; 2) interdisciplinary committee; 3) board of pharmacy; and 4) pharmacist-determined. These models have generally focused on postdiagnostic and preventive care by pharmacists. In terms of enabling broad pharmacist prescribing, only two of these models have demonstrated success: board of pharmacy and pharmacist-determined. Pharmacy and public health stakeholders considering similar legislation in their own states should consider the success of these decentralized models prior to enacting legislation.
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Affiliation(s)
- Alex J Adams
- Idaho Division of Financial Management, 4537 N Molly Way, Meridian, ID, 83646, USA.
| | - Timothy P Frost
- Idaho Division of Occupational and Professional Licenses, Boise, ID, 83701, USA
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Klepser DG, Klepser NS, Adams JL, Adams AJ, Klepser ME. The impact of the COVID-19 pandemic on addressing common barriers to pharmacy-based point-of-care testing. Expert Rev Mol Diagn 2021; 21:751-755. [PMID: 34130575 DOI: 10.1080/14737159.2021.1944105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Pharmacy-based point-of-care testing has long had the potential to improve patient access to timely care, but adoption has been slowed by financial and regulatory barriers. The COVID-19 pandemic reduced or temporarily eliminated many of the barriers to pharmacy-based testing. This review examines how the changes brought on by may impact pharmacy-based testing after the pandemic.Areas covered: This review searched peer-reviewed, lay, and regulatory literature to explore the implementation of pharmacy-based COVID-19 testing. This includes a review of regulatory and financial changes that removed barriers to testing. Additionally, it reviews the literature related to the growth of pharmacy-based testing.Expert opinion: It is clear that the COVID-19 pandemic created an awareness and opportunity for pharmacy-based point-of-care testing. The changes made in response to the pandemic have the potential to increase the role of pharmacy-based testing, but additional regulatory changes and wider pharmacy adoption are still needed to maximize the value of such services.
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Affiliation(s)
- Donald G Klepser
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Jennifer L Adams
- College of Pharmacy, Idaho State University, Meridian, Idaho, USA
| | - Alex J Adams
- Financial Management, Idaho Division of Financial Management, Boise, Idaho, USA
| | - Michael E Klepser
- Pharmacy Practice, College of Pharmacy, Ferris State University, Kalamazoo, Michigan, USA
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Abstract
The diagnosis of acne is typically straightforward and based on physical signs and symptoms. Some jurisdictions in Canada, the United Kingdom, and United States have enabled a pharmacist treatment model to diagnose and manage patients with mild acne using prescription medications. Studies have found the model to be safe and effective, while simultaneously increasing more timely access to care for patients which may reduce the potential adverse impacts of acne. Further, use of a standardized protocol may alleviate some of the concerns expressed over the model. This paper summarize answers to frequent questions to help policymakers consider the objective evidence for their jurisdiction.
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Abstract
Pharmacy has traditionally been a highly regulated profession. In a recent study, the state with the largest pharmacy regulatory word count had 6.7 times as many words as the state with the lowest word count. Given the wide variation in state pharmacy regulations, this paper seeks to spark discussion on how we can assess public safety outcomes in states based on the overall volume of pharmacy regulation with a focus on: 1) fitness to practice; 2) controlled substance outcomes; and 3) compounding safety. In examining these categories, existing data sources are limited and suboptimal, though formal disciplinary actions against pharmacy licensees are very infrequent. Thus, it seems preferable for states to have a regulatory framework that allows boards of pharmacy to deal with the rare public safety issues that occur, while not holding back the vast majority of pharmacists from practicing to the top of their education and training.
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Affiliation(s)
- Alex J. Adams
- Administrator, Idaho Division of Financial Management
| | - Jennifer Adams
- Associate Dean for Academic Affairs, Idaho State University
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Klepser NS, Klepser DG, Adams JL, Adams AJ, Klepser ME. Impact of COVID-19 on prevalence of community pharmacies as CLIA-Waived facilities. Res Social Adm Pharm 2020; 17:1574-1578. [PMID: 33342702 PMCID: PMC7737532 DOI: 10.1016/j.sapharm.2020.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
Background The Clinical Laboratory Improvement Amendments of 1988 (CLIA) enabled greater access to low-risk tests by allowing their use in facilities with a Certificate of Waiver in the U.S. Recently, the 2019 novel coronavirus (COVID-19) pandemic has shined a spotlight on CLIA-waived diagnostic testing. To meet this increased patient demand for diagnostic testing, the U.S. Department of Health and Human Services (HHS) authorized licensed pharmacists to order and administer FDA authorized COVID-19 tests. Objective This study aims to update the previous national benching report and examine both the number of pharmacies in the United States with CLIA Certificates of Waiver before and after the SARS-CoV-2 pandemic and the state-by-state differences in the percentage of pharmacies with CLIA Certificates of Waiver. Methods Data were collected from the U.S. Centers for Disease Control and Prevention CLIA Laboratory Search website May 3rd, 2015, August 4th, 2019 and November 26th, 2020. The website allows for exportation of demographic data on all CLIA-waived facilities by state. Results Pharmacies exhibited the largest growth both in number (4865 new locations) and by percent (45%) of CLIA-waived facilities between 2015 and 2020. The total number of pharmacies with a CLIA-waiver grew from 10,626 (17.94%) locations in 2015 to 12,157 (21.43%) locations in 2019, to 15,671 (27.63%) locations in 2020. States demonstrated considerable variability in the percentage of pharmacies with a CLIA-waiver, with a range of 2.92%–56.52%. Conclusions Pharmacies have become an increasingly important location for patients to access CLIA-waived tests in the United States, now serving as the second largest provider of CLIA-waived tests by the total number of locations. Most of this growth occurred between 2019 and 2020 due to the COVID-19 pandemic, and concentrated efforts will be necessary to sustain this momentum.
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Affiliation(s)
| | - Donald G Klepser
- University of Nebraska Medical Center, College of Pharmacy, 981620 Nebraska Medical Center, Omaha, NE, 98198-6120, USA.
| | - Jennifer L Adams
- Idaho State University, College of Pharmacy, 1311, E. Central Dr., Meridian, ID, USA
| | - Alex J Adams
- Idaho Division of Financial Management, Boise, ID, USA
| | - Michael E Klepser
- Ferris State University, College of Pharmacy, 1000 Oakland St, Kalamazoo, MI, 49009, USA
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Adams AJ. Prescription Adaptation Services: A Win for Patients and Providers. Innov Pharm 2020; 11. [PMID: 34007646 PMCID: PMC8127108 DOI: 10.24926/iip.v11i4.3348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
"Prescription adaptation services" (PAS) refers to the ability of pharmacists "to adapt an existing prescription when, in their professional judgment, the action is intended to optimize the therapeutic outcome of treatment." If structured appropriately, PAS can provide a benefit in enhancing the timeliness of patient care, while reducing the administrative burden on both physicians and pharmacists. Moreover, it leverages the strengths of both health professions, specifically the medication expertise of pharmacists. Unfortunately, in most states it will require a change in regulations in order to enable PAS.
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Affiliation(s)
- Alex J Adams
- Former Executive Director, Idaho State Board of Pharmacy; Current Administrator, Idaho Division of Financial Management
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Abstract
Background The National Association of Boards of Pharmacy (NABP) recently established a task force to help states develop regulations based on “standards of care” rather than “prescriptive rule-based regulation.” This signals a shift in orthodoxy as pharmacy has traditionally been a highly regulated profession. A benchmark report on the pharmacy, nursing, and medical statutes and regulations in Idaho found that pharmacy had a higher overall word count, more overall restrictions, and had to be amended more frequently to keep pace with change. Objective To identify opportunities to make the transition to a “standard of care” regulatory model in pharmacy law, this manuscript attempts to quantify the regulatory burden for 10 Western U.S. states. Method The relevant statutes and regulations were gathered from each of the 10 states, and key measures were extracted, including word count, restrictions, exemptions, and the composition. Results States exhibited wide variation in overall regulatory burden as measured by word count (average of 65,882 words, SD=35,057). The top categories of pharmacy law are: 1) professional practice standards (25,249 ± 16,077 words); 2) facility standards (15,230 ± 10,240 words); and 3) licensing (11,412 ± 6,191 words). More than 65% of all pharmacy regulations are in rule adopted by board of pharmacy rather than in statutes passed by the legislature. Conclusions States exhibited major variation in total regulatory burden, with the largest contributors to cross-state variation being regulations related to professional practice standards and facility standards. This analysis suggests these two areas should be the primary targets of states looking to decrease regulatory burdens and that regulatory boards have a significant opportunity to remove regulatory burdens even in the absence of legislative action.
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Affiliation(s)
- Alex J Adams
- Former Executive Director, Idaho State Board of Pharmacy, Current Administrator, Idaho Division of Financial Management
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Abstract
To fully engage in the Pharmacists’ Patient Care Process, pharmacists must be able to (1) participate in a Collaborative Practice Agreement, (2) order and interpret laboratory tests, (3) prescribe certain medications, (4) adapt medications, (5) administer medications, and (6) effectively delegate tasks to support staff. Each of these activities is dependent on state scope of practice laws, but these laws are not binary. Various state-level restrictions allow us to view these activities on a continuum from more restrictive to less restrictive. This continuum will allow pharmacy and public health stakeholders to identify priorities for action in their states.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management, Boise, ID, USA
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Adams AJ. Eliminating the Board of Pharmacy’s Role in Designating a Pharmacist-in-Charge. Innov Pharm 2020; 11. [PMID: 34007636 PMCID: PMC8075149 DOI: 10.24926/iip.v11i3.3371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nearly all states require that each licensed pharmacy designate a pharmacist-in-charge (PIC). By law, the PIC typically has responsibility for all professional practice laws and facility standards laws and can be held accountable for such. However, the extent to which the PIC has actual authority over many facility standards varies by organization. This can seemingly put a target on the back of the PIC for decisions they wield little authority over. Idaho recently removed the legal references to the PIC, signaling that facilities are responsible for facility standards and insulating pharmacists from discipline for matters that are outside their control.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management
- Corresponding author: Alex J. Adams, PharmD, MPH, Former Executive Director, Idaho State Board of Pharmacy, Current Administrator, Idaho Division of Financial Management;
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Adams AJ, Chopski NL. Rethinking pharmacy regulation: Core elements of Idaho's transition to a "Standard of Care" approach. J Am Pharm Assoc (2003) 2020; 60:e109-e112. [PMID: 32782208 DOI: 10.1016/j.japh.2020.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/01/2022]
Abstract
The National Association of Boards of Pharmacy recently established a task force to explore the feasibility of developing regulations based on "standards of care" rather than "prescriptive rule-based regulation." The Board sought to update its professional practice standards by transitioning from prescriptive regulations to a "standard of care" model that harmonizes pharmacists education and training with their legal scope of practice. In doing so, the Board expanded practice authority to include prescription adaptation services and independent prescribing of certain drug classes. As the Board approached how to update its facility standards, it pursued 2 primary goals: (1) Make the regulations practice- and technology-agnostic; and (2) Enable decentralization of pharmacy functions to offsite locations. The Board achieved its goal of reducing overall word count and restrictions in its laws. The Board also created a more permissive professional practice standard rooted in a "standard of care" approach that is more closely aligned with the regulatory model employed by the medical and nursing professions.
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Abstract
Herpes labialis, commonly known as cold sores, is an infection of the mouth and surrounding area. Antiviral therapy can be used to block viral replication, which shortens the duration of symptoms, facilitates resolution of lesions, and lessens the risk of spreading the virus. Increasing access to antivirals targeted against herpes labialis by allowing assessment and prescribing by a pharmacist may decrease time to treatment for HSV-1, and improve patient satisfaction. Experience from Canada, Australia, New Zealand and the United States demonstrate that pharmacist management of cold sores has a safe track record and may be considered by other jurisdictions.
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Abstract
Pharmacists are licensed in all 50 states. As society becomes increasingly mobile and interconnected, several models of cross-state pharmacy practice have emerged, straining the current state-based system of licensure. The nursing profession has provided a model for license portability that offers 3 primary advantages over the current pharmacist licensure model while still protecting safety: (1) faster speed, (2) lower cost, and (3) reduced administrative burden. A hybrid approach for the pharmacy profession that builds off of the expedited license transfer model and adds a mutual recognition model is ideal.
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Affiliation(s)
- Alex J. Adams
- Idaho Division of Financial Management, Boise, ID, USA
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Adams AJ. Transitioning pharmacy to “standard of care” regulation: Analyzing how pharmacy regulates relative to medicine and nursing. Res Social Adm Pharm 2019; 15:1230-1235. [DOI: 10.1016/j.sapharm.2018.10.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/10/2018] [Accepted: 10/14/2018] [Indexed: 12/01/2022]
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Abstract
Objective Explore the intersection of the Pharmacists' Patient Care Process (PPCP) and state laws in order to identify laws that may impede the delivery of optimal patient care. Summary A review of the PPCP identified six areas in which state laws can limit full pharmacist engagement: 1) ordering and interpreting laboratory tests; 2) participating in a collaborative practice agreement; 3) independently prescribing certain medications; 4) independently adapting medications; 5) administering medications; and 6) effective delegation. A framework is put forth to organize how these scope of practice matters are interrelated. Conclusion For pharmacists to fully engage in the PPCP, state laws must enable full participation. By unleashing pharmacists to fully engage in the process, patient care delivery and outcomes can be improved, and total health care costs can be reduced.
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Affiliation(s)
- David Bright
- College of PharmacyFerris State UniversityBig Rapids, MI
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Vanderholm T, Klepser D, Adams AJ. State Approaches to Therapeutic Interchange in Community Pharmacy Settings: Legislative and Regulatory Authority. J Manag Care Spec Pharm 2019; 24:1260-1263. [PMID: 30479203 PMCID: PMC10397711 DOI: 10.18553/jmcp.2018.24.12.1260] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Therapeutic interchange is the act of switching a prescribed drug for another drug in the same therapeutic class that is believed to be therapeutically similar but may be chemically different. Therapeutic interchange is different from generic substitution in that it does not occur between therapeutically equivalent products; instead, products are substituted for those that are likely to have a substantially equivalent therapeutic effect generally at a lower cost. Therapeutic interchange is common in institutional settings across the United States but rarely occurs in community pharmacy settings without a pharmacist first contacting the original prescriber and requesting a new prescription in order to facilitate a change. As of 2018, Arkansas, Idaho, and Kentucky have passed laws to enable therapeutic interchange in community pharmacy settings. In general, these laws require the original prescriber to opt-in to allow therapeutic interchange, and the pharmacist generally must leverage the formulary of the patient's health plan to guide decision making within the same therapeutic class. These 3 states require that the pharmacist notify the original prescriber of any interchange in order to ensure a complete and accurate medication record. When appropriately structured, state laws enabling therapeutic interchange in community pharmacy settings allow pharmacists to use their medication expertise to save valuable time and enhance patient care while reducing health care costs. DISCLOSURES: No funding supported the writing of this article. The authors have nothing to disclose.
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Affiliation(s)
| | - Donald Klepser
- 2 College of Pharmacy, University of Nebraska Medical Center, Omaha
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Vanderholm T, Renner HM, Stolpe SF, Adams AJ. An Innovative Approach to Improving the Proposed CMS Star Rating "Statin Use in Persons with Diabetes". J Manag Care Spec Pharm 2019; 24:1126-1129. [PMID: 30362914 PMCID: PMC10398108 DOI: 10.18553/jmcp.2018.24.11.1126] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Statin Use in Persons with Diabetes (SUPD) measure has been adopted by the Centers for Medicare and Medicaid Services as a display measure for Medicare Part C and Part D plan sponsors and is slated for inclusion within the primary star rating measure set. As such, the measure has become a focal point for quality improvement efforts by many health plans. Current pharmacy-based interventions reported in the literature involve pharmacists recommending that a patient's provider issue a prescription for a statin; studies to date have not shown that this intervention has been effective for the majority of patients with diabetes. One innovative option is pharmacist prescriptive authority of statins for patients with diabetes. In such a model, a pharmacist identifies a patient with diabetes who is not on a statin, assesses the patient for contraindications and appropriateness of therapy, and works directly with the patient to close the gap in care. This solution could lead to earlier initiation of statin therapy and reduce the burdens associated with multiple communications with the patient's primary care provider. In 2018, Idaho became the first state to allow pharmacist prescribing to close the SUPD measure, with certain regulatory safeguards in place. DISCLOSURES: No funding supported the writing of this article. The authors have nothing to disclose.
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Affiliation(s)
| | - Hannah M Renner
- 2 Pharmacy and Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Samuel F Stolpe
- 3 Scientific Technology Corporation, San Francisco, California
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Desselle S, Hohmeier KC, Adams AJ, Hoh R, McKeirnan KC. Evolutions in Pharmacy Practice Welcome Change and Further Contemplation of Pharmacy Technician Roles and Supervision. J Contemp Pharm Pract 2018. [DOI: 10.37901/jcphp18-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Adams AJ, Desselle SP, McKeirnan KC. Pharmacy Technician-Administered Vaccines: On Perceptions and Practice Reality. Pharmacy (Basel) 2018; 6:pharmacy6040124. [PMID: 30501035 PMCID: PMC6306786 DOI: 10.3390/pharmacy6040124] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 12/20/2022] Open
Abstract
Doucette and Schommer recently surveyed U.S. community pharmacy technicians on their willingness to perform tasks including the administration of vaccines. They found that 47.1% of technicians reported they were “unwilling” to administer a vaccine, although this finding must be placed into proper context. The first nationwide survey of U.S. pharmacist perceptions on immunizations in 1998 revealed only 2.2% of pharmacist respondents had administered adult vaccines and only 0.9% had administered childhood vaccines. They also found pharmacists to be “slightly negative on administering immunizations” with many perceived barriers. Nonetheless, pharmacist-provided immunizations have been an unqualified public health success. The theory of planned behavior (TPB) predicts intention from attitude and perceived behavioral control, among other factors. Given low involvement, exposure, and perceived behavioral control to administer vaccinations, technicians’ attitudes or willingness to participate from the Doucette and Shommer study can be regarded as quite positive. Given the results of a successful pilot project in Idaho and that subjective norms and perceived behavioral control will likely shift upward, one can only expect technicians’ willingness to participate in vaccinations to become more favorable and ultimately become a success.
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Affiliation(s)
- Alex J Adams
- Idaho State Board of Pharmacy, Boise, ID 83646, USA.
| | - Shane P Desselle
- College of Pharmacy, Touro University California, 1310 Club Dr., Vallejo, CA 94592, USA.
| | - Kimberly C McKeirnan
- Center for Pharmacy Practice Research, College of Pharmacy and Pharmaceutical Sciences, Washington State University, Spokane, WA 99210, USA.
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Adams AJ, Desselle S, Austin Z, Fenn T. Pharmacy Technicians Are People, Too! Let's Consider Their Personal Outcomes Along With Other Pharmacy Outcomes. Ann Pharmacother 2018; 53:545-547. [PMID: 30453744 DOI: 10.1177/1060028018810316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Studies have found that expanded pharmacy technician roles can help "free up" pharmacist time, leading to role optimization. However, these studies and the positions taken by many are quite pharmacist-centric. We seem to have underestimated the importance of support staff in pharmacy operations. If research demonstrates that technicians can perform a function safely and effectively, that alone should compel the function's allowance in practice. Freeing up pharmacist time for higher-order care is a positive corollary to technician advancement, but it need not be a precondition for it.
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Affiliation(s)
- Alex J Adams
- 1 Idaho State Board of Pharmacy, Meridian, ID, USA
| | - Shane Desselle
- 2 Touro University College of Pharmacy, Vallejo, CA, USA
| | | | - Tess Fenn
- 4 Association of Pharmacy Technicians United Kingdom, London, England, UK
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Klepser ME, Adams AJ. Pharmacy-based management of influenza: lessons learned from research. Int J Pharm Pract 2018; 26:573-578. [PMID: 30265414 DOI: 10.1111/ijpp.12488] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/17/2018] [Indexed: 01/13/2023]
Abstract
Recently, several jurisdictions have pursued legislative and regulatory changes to allow pharmacy-based influenza management models in which pharmacists can initiate appropriate antiviral therapy in community pharmacy settings. While studies have been published in Canada, Japan, New Zealand, Norway and the United States, concerns have been expressed over pharmacist training, the accuracy of rapid influenza diagnostic tests, and the potential impact on antimicrobial resistance, among others. Studies have demonstrated that pharmacists provide safe and effective influenza management, with high rates of patient satisfaction, while maintaining or improving antimicrobial stewardship.
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Dering-Anderson AM, Adams AJ. Improving access to appropriate post-exposure doxycycline for Lyme disease prophylaxis: role for community pharmacies. J Antimicrob Chemother 2018; 73:3219-3220. [DOI: 10.1093/jac/dky361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Alex J Adams
- Idaho State Board of Pharmacy, 1199 Shoreline Lane, Boise, ID, USA
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Abstract
Pharmacists have provided travel health services in some capacity for more than 25 years. The ability of pharmacists to autonomously prescribe travel medications is growing. Three states (California, Idaho, and New Mexico) allow pharmacists to autonomously prescribe medications for international travel using the Centers for Disease Control and Prevention Yellow Book as a guide. Idaho also allows pharmacists to autonomously prescribe select medications appropriate to domestic travel (motion sickness prevention and Lyme disease prophylaxis), and Florida allows for the prescribing of drugs for motion sickness. Core elements from each state law including education, patient assessment, provider notification, and documentation are reviewed.
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Gubbins PO, Klepser ME, Adams AJ, Jacobs DM, Percival KM, Tallman GB. Potential for Pharmacy-Public Health Collaborations Using Pharmacy-Based Point-of-Care Testing Services for Infectious Diseases. J Public Health Manag Pract 2018; 23:593-600. [PMID: 27997479 DOI: 10.1097/phh.0000000000000482] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Health care professionals must continually identify collaborative ways to combat antibiotic resistance while improving community health and health care delivery. Clinical Laboratory Improvement Amendments of 1988 (CLIA)-waived point-of-care (POC) testing (POCT) services for infectious disease conducted in community pharmacies provide a means for pharmacists to collaborate with prescribers and/or public health officials combating antibiotic resistance while improving community health and health care delivery. OBJECTIVE To provide a comprehensive literature review that explores the potential for pharmacists to collaborate with public health professionals and prescribers using pharmacy-based CLIA-waived POCT services for infectious diseases. DESIGN Comprehensive literature review. SETTING PubMed and Google Scholar were searched for manuscripts and meeting abstracts for the following key words: infectious disease, community pharmacy, rapid diagnostic tests, rapid assay, and POC tests. INTERVENTION All relevant manuscripts and meeting abstracts utilizing POCT in community pharmacies for infectious disease were reviewed. OUTCOME MEASURE Information regarding the most contemporary evidence regarding CLIA-waived POC infectious diseases tests for infectious diseases and their use in community pharmacies was synthesized to highlight and identify opportunities to develop future collaborations using community pharmacy-based models for such services. RESULTS Evidence demonstrates that pharmacists in collaboration with other health care professionals can leverage their knowledge and accessibility to provide CLIA-waived POCT services for infectious diseases. Testing for influenza may augment health departments' surveillance efforts, help promote rationale antiviral use, and avoid unnecessary antimicrobial therapy. Services for human immunodeficiency virus infection raise infection status awareness, increase access to health care, and facilitate linkage to appropriate care. Testing for group A streptococcal pharyngitis may curb inappropriate outpatient antibiotic prescribing. However, variance in pharmacy practice statues and the application of CLIA across states stifle collaboration. CONCLUSION CLIA-waived POCT services for infectious diseases are a means for pharmacists, public health professionals, and prescribers to collaboratively combat antibiotic resistance and improve community health.
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Affiliation(s)
- Paul O Gubbins
- Division of Pharmacy Practice and Administration, University of Missouri-Kansas City School of Pharmacy at Missouri State University, Springfield, Missouri (Dr Gubbins); Ferris State University College of Pharmacy, Kalamazoo, Michigan (Dr Klepser); Idaho Board of Pharmacy, Boise, Idaho (Dr Adams); University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, New York (Dr Jacobs); Drake University College of Pharmacy and Health Sciences, Des Moines, Iowa (Dr Percival); Oregon State University/Oregon Health & Science University, Portland, Oregon (Dr Tallman)
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Adams AJ. Pharmacist delegation: An approach to pharmacy technician regulation. Res Social Adm Pharm 2018; 14:505. [DOI: 10.1016/j.sapharm.2018.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 01/14/2018] [Indexed: 11/16/2022]
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Adams AJ, Dering-Anderson A, Klepser ME, Klepser D. The Roles of Pharmacy Schools in Bridging the Gap Between Law and Practice. Am J Pharm Educ 2018; 82:6577. [PMID: 29867246 PMCID: PMC5972855 DOI: 10.5688/ajpe6577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/20/2017] [Indexed: 05/30/2023]
Abstract
Progressive pharmacy laws do not always lead to progressive pharmacy practice. Progressive laws are necessary, but not sufficient for pharmacy services to take off in practice. Pharmacy schools can play critical roles by working collaboratively with community pharmacies to close the gap between law and practice. Our experiences launching pharmacy-based point-of-care testing services in community pharmacy settings illustrate some of the roles schools can play, including: developing and providing standardized training, developing template protocols, providing workflow support, sparking collaboration across pharmacies, providing policy support, and conducting research.
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Affiliation(s)
| | | | | | - Donald Klepser
- University of Nebraska Medical Center, College of Pharmacy, Omaha, Nebraska
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Abstract
"Prescription adaptation services" refers to the ability of a pharmacist to autonomously "adapt" an existing prescription when the action is intended to optimize the therapeutic outcome. Adaptation services typically fall into 2 categories: (1) renewals and (2) changes. Renewals ensure continuity of care for patients and may be emergency renewals (typically 72 hours) or continuation-of-therapy renewals (typically 90 or more days). Changes include therapeutic substitutions or changes to quantity, formulation, route of administration, dose/interval, and completing missing information. With an appropriate framework in place, adaptation services can safely optimize medication therapy outcomes while promoting efficiencies.
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Adams AJ. Advancing technician practice: Deliberations of a regulatory board. Res Social Adm Pharm 2018; 14:1-5. [DOI: 10.1016/j.sapharm.2017.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 02/12/2017] [Indexed: 10/20/2022]
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Adams AJ. Medication synchronization: A regulatory approach to “short fills”. J Am Pharm Assoc (2003) 2017; 57:299-300. [DOI: 10.1016/j.japh.2017.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 02/11/2017] [Accepted: 02/14/2017] [Indexed: 10/19/2022]
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Abstract
Objective: Tech-check-tech (TCT) is a practice model in which pharmacy technicians with advanced training can perform final verification of prescriptions that have been previously reviewed for appropriateness by a pharmacist. Few states have adopted TCT in part because of the common view that this model is controversial among members of the profession. This article aims to summarize the existing research on pharmacist and technician perceptions of community pharmacy–based TCT. Data Sources: A literature review was conducted using MEDLINE (January 1990 to August 2016) and Google Scholar (January 1990 to August 2016) using the terms “tech* and check,” “tech-check-tech,” “checking technician,” and “accuracy checking tech*.” Data Synthesis: Of the 7 studies identified we found general agreement among both pharmacists and technicians that TCT in community pharmacy settings can be safely performed. This agreement persisted in studies of theoretical TCT models and in studies assessing participants in actual community-based TCT models. Pharmacists who had previously worked with a checking technician were generally more favorable toward TCT. Conclusion: Both pharmacists and technicians in community pharmacy settings generally perceived TCT to be safe, in both theoretical surveys and in surveys following actual TCT demonstration projects. These perceptions of safety align well with the actual outcomes achieved from community pharmacy TCT studies.
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Abstract
Objective: The benefit of a tech-check-tech (TCT) practice model in institutional settings has been well documented. To date, few studies have explored TCT beyond institutional settings. This article summarizes the existing evidence in community pharmacy–based TCT research with respect to dispensing accuracy and pharmacist time devoted to direct patient care. Data Sources: A literature review was conducted using MEDLINE (January 1990 to August 2016), Google Scholar (January 1990 to August 2016), and EMBASE (January 1990 to August 2016) using the terms “tech* and check,” “tech-check-tech,” “checking technician,” and “accuracy checking tech*”. Bibliographies were reviewed to identify additional relevant literature. Study Selection and Data Extraction: Studies were included if they analyzed TCT and were conducted in a community pharmacy practice site, inclusive of chain, independent, mass merchant, supermarket, and mail order pharmacies. Studies were excluded if the TCT practice model was conducted in an institutional or long-term care setting. Survey data on theoretical models of TCT in community pharmacy practice settings were also excluded. Data Synthesis: Over the past 14 years, 4 studies were identified indicating TCT has been performed safely and effectively in community settings. The studies demonstrate that trained community technicians perform as accurately as pharmacists and that TCT increased the amount of pharmacist time devoted to clinical activities. In the 2 studies that reported accuracy rates, pharmacy technicians performed at least as accurately as pharmacists (99.445 vs 99.73%, P = .484; 99.95 vs 99.74, P < .05). Furthermore, 3 of the studies reported gains in pharmacist time, with increases between 9.1% and 19.18% of pharmacist time for consultative services. Conclusions: The present studies demonstrate that TCT can be safe and effective in community pharmacy practice settings, with results similar to those found in institutional settings. It is anticipated more states will explore TCT in community settings in the years ahead as a strategy to improve patient care.
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