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Pain Physician May 2018Levels of prescription opioid (PO) dispensing have been rising in Canada - also in global comparison - since the mid-2000s, and are co-occurring with extensive...
BACKGROUND
Levels of prescription opioid (PO) dispensing have been rising in Canada - also in global comparison - since the mid-2000s, and are co-occurring with extensive PO-related morbidity and mortality. Previous analyses have demonstrated correlations between PO dispensing and related harm levels, yet also distinct heterogeneous interprovincial PO-dispensing patterns, in regards to quantities and individual PO formulations. Several system-level interventions have been implemented recently (since 2012) to address high PO-use levels and related harms in Canada; the effects of these interventions on PO-dispensing levels remain largely unexamined.
OBJECTIVES
Our aim was to examine over-time patterns and trends of levels of PO dispensing quantitatively (in defined daily doses [DDDs]) for 'strong' and 'weak' opioids and qualitatively (by individual PO formulations) by province and Canada total, for the period of 2005-2016.
METHODS
We examined annual PO-dispensing levels, by 'weak' and 'strong' POs (individual PO formulations, but excluding methadone), by province and for Canada total, from 2005-2016. Raw dispensing information for POs were obtained from IMSQuintiles CompuScript [new name: IQVIA], based on monthly retail dispensing data from a representative sample of community pharmacies covering about 80% of all dispensing episodes in Canada. These data were converted into annual dispensing values in DDDs (DDD/1,000 population/day), based on standard methodology, for the PO formulation groups of interest. Patterns and trends of 'strong' and 'weak' POs and individual PO formulations were examined descriptively, aided by segmented regression analyses to identify significant break-points in over-time trends. In addition, changes in 'strong'/'weak' PO dispensing ratios between 2005 and 2016 were examined.
RESULTS
'Weak' PO use remained largely stable across Canada over the study period. For 'strong' PO dispensing, half of the provinces featured consistent increases, while remaining provinces presented initial increases with subsequently reverting downward trends at divergent levels. Dispensing of individual 'strong' PO formulations varied interprovincially; specifically, substantial decreases for oxycodone co-occurred with increases in other 'strong' PO formulations. The dispensing ratios for 'strong'/'weak' POs increased significantly across jurisdictions between 2005 and 2016 (P < .05).
LIMITATIONS
Retail pharmacy-based data do not cover the total - but the large majority - of PO dispensing in Canada. There are limitations to DDD/1,000 population/day as a comparative measurement unit for PO dispensing. The causal contribution of interventions associated with changes in PO dispensing observed cannot be verified with the data available.
CONCLUSIONS
Heterogeneous trends for PO dispensing, driven mostly by variations in 'strong' PO use, continue to be observed provincially across Canada. Recent changes in PO dispensing are likely influenced by recent intervention efforts (e.g., PO de-scheduling, monitoring, guidelines) aiming to reduce PO-related harms, which, however, have shown limited impact on PO-dispensing levels to date.
KEY WORDS
Opioids, prescribing, dispensing, interventions, policy, population, monitoring, Canada.
Topics: Analgesics, Opioid; Canada; Databases, Factual; Humans; Pharmacies; Practice Patterns, Physicians'; Regression Analysis
PubMed: 29871366
DOI: No ID Found -
BMJ Sexual & Reproductive Health Jan 2022Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although...
BACKGROUND
Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although mostly used in explaining mortality associated with perinatal care, recent calls for research on induced abortion in Africa suggest that the Three Delays Model could be used to enhance understanding of women's experiences and access to induced abortion care.
METHODS
We conducted 47 face-to-face interviews with women who had experienced unsafe abortions, with formal abortion providers (abortion providers in hospitals) and with informal and non-legal abortion providers (pharmacy workers and herb sellers). Study participants were recruited from selected hospitals, community pharmacies and markets within the Ashanti region of Ghana. We drew on phenomenology to analyse the data.
FINDINGS
The first delay (in seeking care) occurred because of women's poor knowledge of pregnancy, the influence of religion, and as a result of women underestimating the seriousness of abortion complications. Factors including cost, provider attitudes, stigma, and the proximity of pharmacies to women's homes delayed their access to safe abortion and resulted in their experience of the second delay (in reaching a healthcare facility). The third delay (in receiving appropriate care) was a result of hospitals' non-prioritisation of abortion complications and a shortage of equipment, resulting in long hospital waiting times before treatment.
CONCLUSION
This study has shown the value of the Three Delays Model in illustrating women's experiences of unsafe abortions and ways of preventing the first, second and third delays in their access to care.
Topics: Abortion, Induced; Adult; Female; Ghana; Humans; Pharmacies; Pregnancy; Qualitative Research; Social Stigma
PubMed: 34272209
DOI: 10.1136/bmjsrh-2020-200903 -
Journal of the American Pharmacists... 2019Pharmacists have reported barriers in implementing medication therapy management (MTM) services into community pharmacy workflow. A community pharmacy grocery chain...
OBJECTIVES
Pharmacists have reported barriers in implementing medication therapy management (MTM) services into community pharmacy workflow. A community pharmacy grocery chain created an MTM training program with detailed workflow manual and templates intended as a turnkey operation for MTM implementation. To expand the use of this program, 20 community pharmacies were trained in January 2017. The objective of this study was to evaluate the adoption or actual implementation of the program's workflow and to determine barriers to implementation.
SETTING
Pharmacists and technicians who participated in the program were from 20 community pharmacies, including a chain pharmacy, multiple-independent pharmacies, and single-independent pharmacies, in Arkansas.
PRACTICE INNOVATION
The training program used a standardized process with documentation templates to implement a technician-driven workflow. The program required 1 pharmacist and 1 technician per pharmacy to attend an 8-hour live training session.
EVALUATION
Qualitative cross-sectional study using semistructured interviews with pharmacists and technicians 1 year after training session. One pharmacist and 1 technician from 12 pharmacies were invited. The interview guide included questions on how the program was implemented at their respective pharmacies and barriers to implementing the program. The interviews were recorded and transcribed, and transcripts were coded for common themes.
RESULTS
Seven pharmacists and 6 pharmacy technicians agreed to participate. The program was implemented without difficulty in all 7 pharmacies. Pharmacists and technicians reported that the program provided streamlined MTM workflow, expanded technicians' role, and improved confidence in providing services. Barriers to providing MTM services, despite the new workflow, included competing priorities and staffing.
CONCLUSION
The training program resulted in a variety of community pharmacies to successfully implement MTM services. Future studies should further explore sustainability and impact on financial and patient outcomes.
Topics: Arkansas; Community Pharmacy Services; Female; Humans; Male; Medication Therapy Management; Pharmacies; Pharmacists; Pharmacy Technicians; Professional Role; Workflow
PubMed: 31326039
DOI: 10.1016/j.japh.2019.06.014 -
Journal of the American Pharmacists... 2019The primary objective of this study was to identify and summarize the perspectives of managers, pharmacists, and pharmacy technicians regarding the implementation of the...
OBJECTIVES
The primary objective of this study was to identify and summarize the perspectives of managers, pharmacists, and pharmacy technicians regarding the implementation of the Optimizing Care Model and corresponding task delegation of final product verification to pharmacy technicians in the community pharmacy. A secondary objective was to better understand successes and concerns in implementing the model.
DESIGN
This qualitative research study employed the use of semistructured interviews. The authors served as coders and analyzed the transcripts with the use of inductive and deductive thematic analysis.
SETTING AND PARTICIPANTS
Key informants included managers, pharmacists, and pharmacy technicians participating in the Optimizing Care Model in community pharmacies across both chain and independent pharmacy settings in Iowa, Tennessee, and Wisconsin. Interviews were conducted via telephone.
RESULTS
The research team interviewed 14 participants. Six themes were identified: The Optimizing Care Model catalyzes patient care service delivery expansion in the community pharmacy setting, effectiveness is driven by "freed-up" pharmacist time compared with the traditional model, the model positively affects roles and job satisfaction of pharmacy personnel, technician engagement and ownership have a strong impact on the success and ramifications of the model, significant changes to pharmacy operations are necessary for successful implementation, and there are several factors ensuring successful implementation and sustaining of the Optimizing Care Model.
CONCLUSION
Various participants (pharmacists, managers, technicians) in a technician product verification program known as the Optimizing Care Model agreed that patient care delivery can be enhanced through the task delegation of final product verification to pharmacy technicians. Additional positive impacts on organizational and individual level outcomes were found, which included quality of work life, engagement, and commitment.
Topics: Community Pharmacy Services; Humans; Interviews as Topic; Iowa; Motivation; Patient Care; Pharmacies; Pharmacists; Pharmacy Technicians; Professional Role; Qualitative Research; Quality of Life; Tennessee; Wisconsin; Work Engagement
PubMed: 30940516
DOI: 10.1016/j.japh.2019.02.006 -
The New England Journal of Medicine Nov 2023
Review
Topics: Humans; Drug Costs; Insurance, Pharmaceutical Services; Pharmaceutical Services; Pharmacies; Pharmacy; Federal Government
PubMed: 37902281
DOI: 10.1056/NEJMp2309533 -
American Journal of Health-system... Sep 2019The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described.
PURPOSE
The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described.
SUMMARY
The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution.
CONCLUSION
Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.
Topics: Call Centers; Health Plan Implementation; Hospitals, University; Humans; Pharmacies; Pharmacists; Pharmacy Service, Hospital; Postal Service; Program Development; Program Evaluation; Workload
PubMed: 31418772
DOI: 10.1093/ajhp/zxz138 -
The Cochrane Database of Systematic... Aug 2016Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as... (Review)
Review
BACKGROUND
Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review.
OBJECTIVES
To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries.
SEARCH METHODS
For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant articles, WHO International Clinical Trials Registry Platform, Clinicaltrials.gov, and various electronic databases of grey literature.
SELECTION CRITERIA
Randomised trials, non-randomised trials, interrupted time series studies, or controlled before-after studies.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed study eligibility and extracted data, comparing their results and resolving discrepancies by consensus. We expressed study results as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI), where appropriate, and assessed the certainty of the evidence using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). We did not conduct meta-analysis because of heterogeneity of interventions and study designs.
MAIN RESULTS
We identified 20,177 records, 50 of them potentially eligible. We excluded 39 potentially eligible studies because they did not involve a rigorous evaluation of training, regulation, or co-ordination of private for-profit healthcare providers in LMICs; five studies identified after the review was submitted are awaiting assessment; and six studies met our inclusion criteria. Two included studies assessed training alone; one assessed regulation alone; three assessed a multifaceted intervention involving training and regulation; and none assessed co-ordination. All six included studies targeted private for-profit pharmacy workers in Africa and Asia.Three studies found that training probably increases sale of oral rehydration solution (one trial in Kenya, 106 pharmacies: RR 3.04, 95% CI 1.37 to 6.75; and one trial in Indonesia, 87 pharmacies: RR 1.41, 95% CI 1.03 to 1.93) and dispensing of anti-malarial drugs (one trial in Kenya, 293 pharmacies: RR 8.76, 95% CI 0.94 to 81.81); moderate-certainty evidence.One study conducted in the Lao People's Democratic Republic shows that regulation of the distribution and sale of registered pharmaceutical products may improve composite pharmacy indicators (one trial, 115 pharmacies: improvements in four of six pharmacy indicators; low-certainty evidence).The outcome in three multifaceted intervention studies was the quality of pharmacy practice; including the ability to ask questions, give advice, and provide appropriate treatment. The trials applied regulation, training, and peer influence in sequence; and the study design does not permit separation of the effects of the different interventions. Two trials conducted among 136 pharmacies in Vietnam found that the multifaceted intervention may improve the quality of pharmacy practice; but the third study, involving 146 pharmacies in Vietnam and Thailand, found that the intervention may have little or no effects on the quality of pharmacy practice (low-certainty evidence).Only two studies (both conducted in Vietnam) reported cost data, with no rigorous assessment of the economic implications of implementing the interventions in resource-constrained settings. No study reported data on equity, mortality, morbidity, adverse effects, satisfaction, or attitudes.
AUTHORS' CONCLUSIONS
Training probably improves quality of care (i.e. adherence to recommended practice), regulation may improve quality of care, and we are uncertain about the effects of co-ordination on quality of private for-profit healthcare services in LMICs. The likelihood that further research will find the effect of training to be substantially different from the results of this review is moderate; implying that monitoring of the impact is likely to be needed if training is implemented. The low certainty of the evidence for regulation implies that the likelihood of further research finding the effect of regulation to be substantially different from the results of this review is high. Therefore, an impact evaluation is warranted if government regulation of private for-profit providers is implemented in LMICs. Rigorous evaluations of these interventions should also assess other outcomes such as impacts on equity, cost implications, mortality, morbidity, and adverse effects.
Topics: Developing Countries; Government Regulation; Health Personnel; Health Services; Humans; Indonesia; Kenya; Laos; Pharmacies; Private Sector; Quality Improvement; Randomized Controlled Trials as Topic; Thailand; Vietnam
PubMed: 27510030
DOI: 10.1002/14651858.CD009855.pub2 -
BMC Health Services Research May 2016Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of...
BACKGROUND
Research has shown that the current practice of pharmacy staff when providing self-medication consultations in Indonesia is suboptimal. To improve the performance of pharmacy staff when providing self-medication consultations in community pharmacies, the factors that influence current practice need to be understood. The aim of this study is to identify the factors that influence current practice of pharmacy staff when handling self-medication consultations in Eastern Indonesian community pharmacies.
METHODS
Fifteen in-depth interviews were conducted with pharmacists, pharmacy technicians, pharmacy owners, and counter attendants. Thematic analysis was used to generate findings.
RESULTS
The current practice of pharmacy staff when handling self-medication consultations is directly influenced by the professionalism of pharmacy staff and patient responses to the consultations. These factors are in turn affected by the organisational context of the pharmacy and the external pharmacy environment. The organisational context of the pharmacy includes staffing, staff affordability, and the availability of time and facilities in which to provide consultations. The external pharmacy environment includes the number of trained pharmacy staff in the research setting, the relevance of pharmacy education to the needs of pharmacy practice, the support offered by the Indonesian Pharmacists Association, a competitive business environment, and the policy environment.
CONCLUSION
Complex and inter-related factors influence the current practice of pharmacy staff when providing self-medication consultations in community pharmacies in this research setting. Multiple strategies will be required to improve consultation practices.
Topics: Adult; Community Pharmacy Services; Humans; Indonesia; Middle Aged; Pharmacies; Pharmacists; Professional Practice; Qualitative Research; Referral and Consultation; Self Medication
PubMed: 27178346
DOI: 10.1186/s12913-016-1425-3 -
American Heart Journal Dec 2018Pharmaceutical benefit managers (PBMs) are playing an increasingly important role in establishing access to pharmaceutical products for patients. PBMs set retail prices... (Review)
Review
Pharmaceutical benefit managers (PBMs) are playing an increasingly important role in establishing access to pharmaceutical products for patients. PBMs set retail prices for pharmaceutical products, negotiate "rebates" from manufacturers based on total sales volume of products, and achieve several types of postsale price concessions and payments from pharmacies. All of these activities describe a complex flow of funds that has not been transparent to clinicians or to patients. In this article, we describe these terms and processes to better understand how pharmaceutical products are financed in the United States. In 2016, US pharmaceutical manufacturers reported gross pharmaceutical sales of $462 billion and net pharmaceutical sales of $318 billion. The difference between gross and net sales is largely due to the different "payments" from manufacturers to PBMs and other intermediaries in the marketplace. We examine the flow of funds through the US pharmaceutical distribution system over time using data from the annual reports of 13 major pharmaceutical manufacturers for the period 2011-2016. Overall, we find that net revenues for our sample of firms grew by an average of 2.7% annually between 2011 and 2016, whereas rebates and other payments increased by 15% annually over the same period. Our examination of the pharmaceutical market reveals the enormous scale of payments from pharmaceutical manufacturers to intermediaries. We observed that these payments have been growing disproportionally to manufacturer net income over the past 5 years. We also found a lack of transparency regarding the flow of funds through intermediaries. This entire marketplace is now the subject of intense public debate.
Topics: Drug Costs; Drug Industry; Health Policy; Humans; Marketing of Health Services; Pharmacies; United States
PubMed: 30447542
DOI: 10.1016/j.ahj.2018.08.006 -
BMC Health Services Research Jul 2020Unintended pregnancy occurs due to incorrect or inconsistent use of a contraception method. Such pregnancies can create an economic burden on the family, society and...
BACKGROUND
Unintended pregnancy occurs due to incorrect or inconsistent use of a contraception method. Such pregnancies can create an economic burden on the family, society and nation as a whole. Unintended pregnancy is the underlying cause of abortion which can also result in infertility and maternal death. Adequate knowledge of emergency contraceptive pills (ECPs) and positive attitudes among the community pharmacy practitioners (CPPs) is a prerequisite for timely access of ECP, thus ultimately lessening the incidence of unintended pregnancies. This study intended to explore the knowledge, attitude and practice of CPPs toward ECPs in Kathmandu valley.
METHODS
Cross-sectional study conducted in community pharmacies located in three districts of Kathmandu valley. A convenience sampling method was employed to interview CPPs in 227 community pharmacies using a validated questionnaire. Questionnaire assessed the demographic characteristics; knowledge, attitude and dispensing practice of the CPPs. Data were subjected to descriptive and inferential analysis using SPSS 18 (SPSS Inc., Chicago, IL, USA).
RESULTS
Approximately 75% of respondents had a good practice on dispensing ECPs, and 70% of them counselled all the users. A significant association (p-value< 0.05) was obtained between the dispensing practice of respondents and their knowledge level. ECP related knowledge was higher among the age group 40-49 years, BPharm degree holders with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. After adjusting the possible confounder variables, age, degree and district of pharmacy were significantly associated with knowledge. Similarly, respondents' practice towards ECP was higher among the age group 40-49 years with experience above 10 years and community pharmacies located inside the city and in the Kathmandu district. Adjusted for other variables, only community pharmacies located at Kathmandu district was significantly associated with the practice.
CONCLUSION
CPPs lacked specific important information on ECP and opined against its' availability as an over-the-counter drug, despite good overall knowledge and positive attitude. Many thought that ECP without prescription would increase promiscuity towards sexual behaviour and result in unsafe sex along with its' repeated use. Hence, training and proper counselling strategies should be afoot to refine the delivery of service by CPPs.
Topics: Adult; Chicago; Contraceptives, Postcoital; Cross-Sectional Studies; Demography; Female; Health Knowledge, Attitudes, Practice; Humans; Nonprescription Drugs; Pharmacies; Pharmacists; Surveys and Questionnaires
PubMed: 32727462
DOI: 10.1186/s12913-020-05543-5