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Journal of Managed Care & Specialty... Jun 2020Improving medication adherence can reduce health care spending, and studies have demonstrated community pharmacists can positively affect adherence through the provision...
BACKGROUND
Improving medication adherence can reduce health care spending, and studies have demonstrated community pharmacists can positively affect adherence through the provision of enhanced services. The North Carolina (NC) Community Pharmacy Enhanced Services Network (CPESN) was formed in early 2014 with the goal of enhancing the care provided through its network pharmacies.
OBJECTIVE
To evaluate differences in medication adherence performance scores between pharmacies that participated in the NC-CPESN and control pharmacies in NC that did not.
METHODS
Medication adherence performance data for statins, renin-angiotensin system antagonists, oral diabetes medications, and a custom multiple chronic medication measure were gathered from quarterly reports between December 2014 and September 2016. Data for these quarterly reports were derived from NC Medicaid claims. These data were combined with pharmacy demographics and service offerings data from the National Council on Prescription Drug Plans dataQ database. Descriptive statistics were used to evaluate differences in demographics and service offerings between study cohorts. Generalized estimating equations were used to evaluate the relationship between medication adherence and pharmacy cohorts, demographics, and service offerings.
RESULTS
There were 267 enhanced services pharmacies and 1,872 control pharmacies included in this analysis. Enhanced services pharmacies were much more likely to be independent pharmacies, located in rural counties, offer multidose compliance packaging, and offer delivery services, but were less likely to offer 24-hour emergency services. Persistently higher adherences scores were observed for enhanced services pharmacies, with differences across measures ranging from 3.0% to 7.2% ( < 0.001). In multivariable models, the difference between enhanced services and control pharmacies was explained by differences in offerings of multidose compliance packaging and delivery services, which were associated with 3.4%-8.2% and 3.3%-4.0% improvements in adherence, respectively ( < 0.001).
CONCLUSIONS
This study found that enhanced services pharmacies had greater adherence performance scores for the NC Medicaid population. These differences appear to be due to CPESN enhanced services pharmacies' offering of multidose compliance packaging and delivery. Future work is needed to expand this analysis to other populations, as well as to explore the relationship between delivery and adherence.
DISCLOSURES
The project described was supported by Funding Opportunity Number 1C12013003897 from the U.S Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents provided are solely the responsibility of the authors and do not necessarily represent the official views of HHS or any of its agencies. Ulrick reports consulting fees from Pharmacy Quality Solutions, unrelated to this work. Bhosle is an employee of Community Care of North Carolina, the not-for-profit company that sponsored the North Carolina enhanced services pharmacy network, and CPESN USA, a for-profit company that developed out of the original grant-funded project. Farley has nothing to disclose.
Topics: Community Networks; Community Pharmacy Services; Cross-Sectional Studies; Medicaid; Medication Adherence; Models, Statistical; Multivariate Analysis; North Carolina; Pharmacies; Prescription Drugs; Retrospective Studies; United States
PubMed: 32463769
DOI: 10.18553/jmcp.2020.26.6.718 -
Systematic Reviews Nov 2019Pharmacy interventions are a subset of public health interventions and its research is usually performed within the scope of a trial. The economic evaluation of pharmacy... (Review)
Review
BACKGROUND
Pharmacy interventions are a subset of public health interventions and its research is usually performed within the scope of a trial. The economic evaluation of pharmacy interventions requires certain considerations which have some similarities to those of public health interventions and to economic evaluations alongside trials. The objective of this research is to perform an overview of systematic reviews of economic evaluations of pharmacy services and triangulate results with recommendations for economic evaluations of both public health interventions and alongside trials.
METHODS
(1) Exploratory review of recommendations on the economic evaluation of public health interventions, (2) exploratory review of recommendations for conducting economic evaluations alongside trials, (3) overview of systematic reviews of economic evaluations of pharmacy interventions (protocol registered with PROSPERO 2016 outlining information sources, inclusion criteria, appraisal of reviews and synthesis methods).
RESULTS
Fourteen systematic reviews containing 75 index publications were included. Reviews reported favorable economic findings for 71% of studies with full economic evaluations. The types of economic analysis are diverse. Two critical quality domains are absent from most reviews. Key findings include the following: certain types of risk of bias, wider scope of study designs, and most economic quality criteria met but some issues unresolved or unclear. Triangulation revealed additional gaps. Limitations include choice of critical quality domains and potential biases in the overview process.
CONCLUSIONS
Economic evaluations of pharmacy-based public health interventions seem to follow most economic quality criteria, but there are still some issues in certain key areas to improve. These findings may assist in improving the design of pilot trials of economic evaluations in pharmacy, leading to robust evidence for payers. Based on the findings, we propose a methodological approach for the economic evaluation of pharmacy-based public health interventions.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42016032768.
Topics: Humans; Cost-Benefit Analysis; Pharmaceutical Services; Pharmacies; Public Health Practice; Systematic Reviews as Topic
PubMed: 31711541
DOI: 10.1186/s13643-019-1177-3 -
Journal of Aging & Social Policy Jan 2024Medications and pharmacy services are critical to post-acute care (PAC) in skilled nursing facilities (SNFs), yet little is known about the long-term care (LTC)...
Medications and pharmacy services are critical to post-acute care (PAC) in skilled nursing facilities (SNFs), yet little is known about the long-term care (LTC) pharmacies that provide them. We estimated the market shares of LTC pharmacies and how SNFs differed between pharmacies. This cross-sectional study used data from SNFs that provided PAC services in Rhode Island (RI) in 2019. We applied the parametric g-formula to compare SNF pharmacy-related deficiencies and medication use measures between LTC pharmacies while standardizing for SNF membership in a chain and number of beds. Among 75 SNFs, 68 (91%) were served by either Omnicare ( = 32, 43%) or PharMerica ( = 36, 48%), and 7 (9%) by other LTC pharmacies. After covariate adjustment, PharMerica SNFs had the lowest prevalences of any pharmacy-related deficiency (PharMerica, 63.2%; Omnicare, 80.2%; other LTC pharmacy, 69.1%) and antianxiety medication use (PharMerica, 9.7%; Omnicare, 13.6%; other LTC pharmacy, 13.5%), but estimates were imprecise. The RI market is highly concentrated between LTC pharmacies. If similarly high LTC pharmacy market concentration exists nationally, there is enormous promise for efficiently delivering interventions to improve medication management in SNFs. However, it may also present a risk of harm if policies do not maintain sufficient competition and innovation is stifled.
Topics: Humans; United States; Long-Term Care; Skilled Nursing Facilities; Pharmacies; Cross-Sectional Studies; Pharmaceutical Services; Pharmacy
PubMed: 36841755
DOI: 10.1080/08959420.2023.2182997 -
Journal of the American Pharmacists... 20161) To measure the general perceptions and attitudes of community pharmacy residents toward transgender patients and health; 2) to identify gaps in didactic education...
OBJECTIVES
1) To measure the general perceptions and attitudes of community pharmacy residents toward transgender patients and health; 2) to identify gaps in didactic education regarding transgender health care among residents; and 3) to evaluate residents' level of support for pharmacists receiving education in transgender health care.
METHODS
This study was a cross-sectional survey delivered online. Community residency directors were e-mailed a cover letter and a 34-question online survey. The directors were asked to forward the survey to their residents for completion within 4 weeks. Responses were anonymous with no identifiers collected on the survey. Survey responses used a combination of open-response, multiple-choice, and Likert-scale questions aimed at gathering respondents' demographic information, perceptions of managing transgender patients and the need for receiving additional education in transgender health care.
RESULTS
Overall, the results of the survey indicated that community pharmacy residents support integrating transgender health management into pharmacy education and recognize that the overwhelming barriers to care for these patients include discrimination and lack of provider knowledge. Significant findings include: 82.7% of community residents think that community pharmacists play an important role in providing care for transgender patients; 98.2% think that they have a responsibility to treat transgender patients; and 71.4% were not educated about transgender patient issues in pharmacy school. Only 36.2% of community residents felt confident in their ability to treat transgender patients.
CONCLUSION
Community pharmacy residents list discrimination and lack of provider knowledge as the major barriers to care for transgender patients. Residents do not feel confident in their ability to treat and manage transgender patients. The majority of residents were not educated about transgender patient issues while in pharmacy school and think that community pharmacists need more education in this area. Residents support integrating transgender health education into continuing education programs and pharmacy school curricula.
Topics: Adult; Attitude of Health Personnel; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Health Status; Humans; Male; Perception; Pharmacies; Pharmacy Residencies; Social Discrimination; Transgender Persons; Young Adult
PubMed: 27245854
DOI: 10.1016/j.japh.2016.03.008 -
The Journal of Adolescent Health :... Feb 2019To evaluate the availability and accessibility of emergency contraception (EC) to adolescents in U.S. pharmacies across four Southwestern states, 3 years after the...
PURPOSE
To evaluate the availability and accessibility of emergency contraception (EC) to adolescents in U.S. pharmacies across four Southwestern states, 3 years after the federal Food and Drug Administration (FDA) removed age restrictions for over-the-counter sales of levonorgestrel-only pills.
METHODS
Using a mystery-caller approach, we trained male and female data collectors to phone pharmacies posing as 16-year-olds who wanted to prevent a pregnancy after recent unprotected sex. From April to May 2016, they called 1,475 randomly selected retail pharmacies in Arizona, California, New Mexico, and Utah and completed an online survey about their experience. Caller data were analyzed by state and pharmacy type (i.e., national chains, regional outlets, and individually owned outlets).
RESULTS
Of pharmacies contacted, 80.6% had EC available at the time of the call. Availability of EC varied by state (p < .01) and pharmacy type (p < .01), but not by rural/urban location. Even where EC was available, pharmacy personnel often hindered youths' access to EC by mentioning incorrect point-of-sale restrictions, keeping EC in restrictive store locations, or asking personal questions. Individually owned outlets presented significantly more barriers than larger chains. Overall, EC was completely accessible to an adolescent caller in only 28% of pharmacies. Lower EC accessibility was found in states with higher teen pregnancy rates.
CONCLUSIONS
This study found that EC is still not sufficiently available or accessible to adolescents in Southwestern states. Differences in accessibility vary significantly by state and pharmacy type and may be a contributor to teen pregnancy rates.
Topics: Adolescent; Contraception, Postcoital; Contraceptive Agents, Female; Cross-Sectional Studies; Female; Health Services Accessibility; Humans; Levonorgestrel; Nonprescription Drugs; Pharmacies; Pregnancy; Pregnancy in Adolescence; Southwestern United States; Young Adult
PubMed: 30661517
DOI: 10.1016/j.jadohealth.2018.08.030 -
Lancet (London, England) Feb 2020
Topics: Drug Industry; Drug Substitution; Europe; European Union; Health Care Surveys; Humans; Pharmaceutical Preparations; Pharmacies; Prescription Drugs
PubMed: 32061283
DOI: 10.1016/S0140-6736(20)30354-8 -
Medicinski Glasnik : Official... Aug 2021Aim To present the regulations governing the operation of pharmacies in Bosnia and Herzegovina over the Austro-Hungarian rule (1878-1918). Methods Qualitative secondary...
Aim To present the regulations governing the operation of pharmacies in Bosnia and Herzegovina over the Austro-Hungarian rule (1878-1918). Methods Qualitative secondary data analysis was used. Results The Austro-Hungarian government had found poor population's health, insufficient health facilities and qualified staff. For a long time, population was treated by old methods of medicine and pharmacy, and directed to folk doctors, healers and herbalists. As early as 1879, orders requesting mandatory possession of a university diploma to practice pharmacy and medicine, thus taking the initial steps to combat quackery. The production and dispensing of medicines became the exclusive competence of pharmacists. The Law on Pharmacies adopted in 1907 comprehensively regulated the apothecary activity. Pharmacy Gremium was founded, the first association of pharmacists with the task of protecting professional interests. All types of quackery were explicitly forbidden to pharmacy staff. Apothecary activity was regulated as a craft, not as a health activity. During this period, pharmacy became a regulated profession with educated and qualified personnel. The number of public pharmacies and qualified staff was growing. In 1878 only one graduated pharmacist was found, while in 1910 in 47 pharmacies there were 79 pharmacy staff. At the end of 1918, the masters of pharmacy were the owners of 48 pharmacies, in 38 cities. Conclusion All enacted regulations contributed to the development and improvement of the apothecary activity over the observed period, and laid the foundations for the future development of the profession.
Topics: Bosnia and Herzegovina; Humans; Hungary; Pharmacies; Pharmacists
PubMed: 33871220
DOI: 10.17392/1355-21 -
BMC Health Services Research Jul 2022Assess whether full-scale simulation exercises improved hospital pharmacies' disaster preparedness.
PURPOSE
Assess whether full-scale simulation exercises improved hospital pharmacies' disaster preparedness.
METHODS
Swiss hospital pharmacies performed successive full-scale simulation exercises at least four months apart. An interprofessional team created two scenarios, each representing credible regional-scale disasters involving approximately fifty casualties (a major road accident and a terrorist attack). Four exercise assessors used appraisal forms to evaluate participants' actions and responses during the simulation (rating them using five-point Likert scales).
RESULTS
Four hospital pharmacies performed two full-scale simulation exercises each. Differences between exercises one and two were observed. On average, the four hospitals accomplished 69% ± 6% of the actions expected of them during exercise one. The mean rate of expected actions accomplished increased to 84% ± 7% (p < 0.005) during exercise two. Moreover, the average quality of actions improved from 3.0/5 to 3.6/5 (p = 0.01), and the time required to gather a crisis management team drastically decreased between simulations (from 23 to 5 min). The main challenges were communication (reformulation) and crisis management. Simulation exercise number one resulted in three hospital pharmacies creating disaster action plans and the fourth improving its already existing plan.
CONCLUSION
This study highlighted the value of carrying out full-scale disaster simulations for hospital pharmacies as they improved overall institutional preparedness and increased staff awareness. The number of expected actions accomplished increased significantly. In the future, large-scale studies and concept dissemination are warranted.
Topics: Disaster Planning; Disasters; Hospitals; Humans; Pharmacies
PubMed: 35780151
DOI: 10.1186/s12913-022-08230-9 -
JCO Oncology Practice May 2020
Topics: Humans; Pharmaceutical Services; Pharmacies; Pharmacy
PubMed: 32396794
DOI: 10.1200/OP.20.00194 -
Pharmacist health coaching in Australian community pharmacies: What do pharmacy professionals think?Health & Social Care in the Community Jul 2020Health coaching is a service provided to patients by healthcare professionals for the purposes of disease management and health risk prevention. Internationally,...
Health coaching is a service provided to patients by healthcare professionals for the purposes of disease management and health risk prevention. Internationally, pharmacist health coaching services provided to patients with chronic health conditions have produced beneficial health outcomes. Despite this, the service is not currently provided within Australian community pharmacies. This study evaluates the knowledge, opinions and attitudes of leaders within the pharmacy profession about the concept of health coaching as a service in community pharmacy. Semi-structured interviews with leaders in the pharmacy profession were carried out. Pharmacy leaders were interviewed until data saturation was reached; 10 pharmacists were interviewed. The interviews were transcribed verbatim and analysed thematically; extracts from the transcripts were compared and categorised to establish themes and subcategories. Analysis of the transcripts indicated the emergence of two main themes and 10 subcategories. The main themes were as follows: 'positive view of health coaching in Australian community pharmacy' and 'barriers to integrating health coaching into Australian community pharmacy'. There was an overall perception that health coaching within community pharmacies would be valued by the Australian community. Interviewees held differing perceptions of pharmacists' capability to effectively coach pharmacy clients and suggested that the main impediments to its introduction related to remuneration for the service. The findings indicated that there is a potential for pharmacists to provide a health coaching service in community pharmacies, but that remuneration is a fundamental barrier. The research also indicated the need to clearly identify the knowledge, skills and attitudes needed to health coach and to identify whether potential gaps in the competencies of Australian community pharmacists exist.
Topics: Attitude of Health Personnel; Australia; Community Pharmacy Services; Female; Humans; Male; Mentoring; Middle Aged; Patient Education as Topic; Pharmacies; Pharmacists; Professional Role; Professional-Patient Relations
PubMed: 32020737
DOI: 10.1111/hsc.12952