-
PloS One 2018Limited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and...
OBJECTIVES
Limited studies have investigated geographic accessibility to a nearby community pharmacy for elderly which is an essential determinant of the access to medications and pharmacy services. This research identified pharmacy deserts and investigated availability of different types of community pharmacies and their services for elderly enrolled in a State Pharmaceutical Assistance Program (SPAP).
METHODS
The state of Pennsylvania in the US was used as a case to demonstrate the geographic accessibility to community pharmacy and services for elderly enrolled in SPAP. The locations of community pharmacies and households of elderly enrolled in SPAP were derived from Pharmaceutical Assistance Contract for the Elderly programs' database. The street addresses were geocoded and the distance to a nearby community pharmacy was calculated for study sample using the haversine formula. The demographic and geographic data were aggregated to Census Tracts and pharmacy deserts were identified using the predefined criteria. Descriptive statistical analysis was used to determine whether there are statistical differences in the socio-demographic profiles and distribution of different types of community pharmacies and their services in pharmacy deserts and non-deserts. This research used hot spot analyses at county level to identify clusters of pharmacy deserts, areas with high concentration of different racial/ethnic groups and clusters of high densities of chain and independent pharmacies.
RESULTS
The Spatial analysis revealed that 39% and 61% Census Tracts in Pennsylvania were pharmacy deserts and non-deserts respectively (p < 0.001). Pharmacy deserts were found to have significantly more females, married and white elderly and fewer blacks and Hispanics compared to pharmacy non-deserts. Pharmacy deserts had significantly fewer chain and independent pharmacies and less delivery and 24-hour services in pharmacies than pharmacy non-deserts. Hot spot analyses showed that clusters of pharmacy deserts were more concentrated in southcentral, northwest and northeast regions of the state which represent rural areas and overlapped with clusters of high concentration of white individuals.
CONCLUSIONS
The findings suggest that urban-rural inequality, racial/ethnic disparity and differences in availability of pharmacies and their services exist between pharmacy deserts and non-deserts. The methodological approach and analyses used in this study can also be applied to other public health programs to evaluate the coverage and breadth of public health services.
Topics: Aged; Aged, 80 and over; Community Pharmacy Services; Cross-Sectional Studies; Female; Health Services Accessibility; Humans; Male; Medical Assistance; National Health Programs; Pennsylvania; Pharmacies; Rural Population; Socioeconomic Factors; Spatial Analysis; United States
PubMed: 29864159
DOI: 10.1371/journal.pone.0198173 -
Medical Archives (Sarajevo, Bosnia and... Dec 2017After the collapse of the Arab rule, the Arab territorial expanses and cultural heritage were taken over by the Turks. Although scientific progress in the Turkish period... (Review)
Review
After the collapse of the Arab rule, the Arab territorial expanses and cultural heritage were taken over by the Turks. Although scientific progress in the Turkish period slowed down due to numerous unfavorable political-economic and other circumstances. Thanks to the Turks, Arabic culture and useful Islamic principles expanded to the territory of our homeland of Bosnia and Herzegovina (B&H). Significant role in the transfer of Arabic pharmaceutical knowledge was also attributed to the Sephardic Jews who, with their arrival, continued to perform their attar activities, which were largely based on Arab achievements. However, insufficiently elaborated, rich funds of oriental medical and pharmaceutical handwriting testify that Oriental science has nurtured in these areas as well, and that the Arabic component in a specific way was intertwined with other cultures and traditions of B&H. The Franciscan monasteries in Bosnia and Herzegovina have museums which contain important exhibits and libraries rich in books, among which many from the field of medicine and pharmacy. Muslim mosques, also, had small libraries with Arabic books used for spreading medical knowledge. The second category was folk doctors and practitioners who were on disposition to the people of any religion. Some of them listened to lectures in medicine during the studies of theology and philosophy. However, most did not have any medical education, but by reading books and teaching experience they made their own recipe collection. Special books, called "Ljekaruše" (Books of recipes) were also born during the study when they came into contact with an even larger number of health books. However, it should not be neglected that a lot of them contained folk medicines that were used in some environments depending on the habits and available herbs. Although it has been proven that many recipes from Ljekaruše are pharmacologically and medically justified, one should not ignore the knowledge and skill behind them. The true flowering of medicine in B&H happening thanks to graduate doctors in Italy, Austria, Hungary, Turkey, etc. Through their action, in a short time, they greatly improved health in B&H, educated the population. The Franciscans were important because they opened the first open-air clinics, the first pharmacies, and wrote the first pharmacopoeia and regulations for the work of health care institutions. Numerous works preserved in monasteries have mostly brought about the study in only one or two copies. Their contribution to the development of health care and the prevention of illness and treatment of the population in B&H during that period is very significant.
Topics: Bosnia and Herzegovina; Culture; Delivery of Health Care; History of Pharmacy; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, Medieval; Humans; Islam; Medicine, Arabic; Ottoman Empire; Pharmacies; Reference Books, Medical; Turkey
PubMed: 29416207
DOI: 10.5455/medarh.2017.71.439-448 -
Health Care Management Science Sep 2023Drug shortages are a global and complex issue having negative impacts on patients, pharmacists, and the broader health care system. Using sales data from 22 Canadian...
Drug shortages are a global and complex issue having negative impacts on patients, pharmacists, and the broader health care system. Using sales data from 22 Canadian pharmacies and historical drug shortage data, we built machine learning models predicting shortages for the majority of the drugs in the most-dispensed interchangeable groups in Canada. When breaking drug shortages into four classes (none, low, medium, high), we were able to correctly predict the shortage class with 69% accuracy and a kappa value of 0.44, one month in advance, without access to any inventory data from drug manufacturers and suppliers. We also predicted 59% of the shortages deemed to be most impactful (given the demand for the drugs and the potential lack of interchangeable options). The models consider many variables, including the average days of a drug supply per patient, the total days of a drug supply, previous shortages, and the hierarchy of drugs within different drug groups and therapeutic classes. Once in production, the models will allow pharmacists to optimize their orders and inventories, and ultimately reduce the impact of drug shortages on their patients and operations.
Topics: Humans; Pharmacies; Canada; Pharmacy Service, Hospital; Pharmacy; Machine Learning
PubMed: 36913071
DOI: 10.1007/s10729-022-09627-y -
JAMA Network Open Apr 2019It is unknown whether and how pharmacy closures alter medication adherence.
IMPORTANCE
It is unknown whether and how pharmacy closures alter medication adherence.
OBJECTIVE
To examine the association between pharmacy closures and adherence to statins, β-blockers, and oral anticoagulants among adults 50 years or older in the United States.
DESIGN, SETTING, AND PARTICIPANTS
In this retrospective cohort study, comparative interrupted time series analyses were performed using a nationally representative 5% random sample of anonymized, longitudinal, individual-level pharmacy claims from IQVIA LRx LifeLink. Analyses included all prescription claims for individuals followed up between January 1, 2011, and December 31, 2016. Separate cohorts were derived for users of statins, β-blockers, and oral anticoagulants. The differential association of pharmacy closure was examined as a function of baseline adherence, pharmacy, and individual characteristics.
MAIN OUTCOMES AND MEASURES
Difference in monthly adherence, measured as proportion of days covered, during 12-month baseline and follow-up periods among patients using a pharmacy that subsequently closed (closure cohort) compared with their counterparts (control cohort).
RESULTS
Among 3 089 803 individuals filling at least 1 statin prescription between January 1, 2011, and December 31, 2016 (mean [SD] age, 66.3 [9.3] years; 52.0% female), 3.0% (n = 92 287) filled at a pharmacy that subsequently closed. Before closure, monthly adherence was similar in the closure and control cohorts (mean [SD], 70.5% [26.7%] vs 70.7% [26.5%]). In multivariable models, individuals filling at pharmacies that closed experienced an immediate and significant decline (on average, an absolute change of -5.90%; 95% CI, -6.12% to -5.69%) in statin adherence during the first 3 months after closure compared with their counterparts. This difference persisted over 12 months of follow-up. A similar decline in adherence was observed when examining cohorts using β-blockers (-5.71%; 95% CI, -5.96% to -5.46%) or oral anticoagulants (-5.63%; 95% CI, -6.24% to -5.01%). The mean association of pharmacy closure with adherence was greater among individuals using independent pharmacies (-7.89%; 95% CI, -8.32% to -7.47%) or living in neighborhoods with fewer pharmacies (-7.98%; 95% CI, -8.50% to -7.47%) compared with their counterparts.
CONCLUSIONS AND RELEVANCE
Pharmacy closures are associated with persistent, clinically significant declines in adherence to cardiovascular medications among older adults in the United States. Efforts to reduce nonadherence to prescription medications should consider the role of pharmacy closures, especially among patients at highest risk.
Topics: Aged; Cardiovascular Agents; Cardiovascular Diseases; Female; Health Services Accessibility; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Interrupted Time Series Analysis; Male; Medication Adherence; Middle Aged; Pharmacies; Retrospective Studies; United States
PubMed: 31002324
DOI: 10.1001/jamanetworkopen.2019.2606 -
Pharmacy-Based Infectious Disease Management Programs Incorporating CLIA-Waived Point-of-Care Tests.Journal of Clinical Microbiology Apr 2020There are roughly 48,000 deaths caused by influenza annually and an estimated 200,000 people who have undiagnosed human immunodeficiency virus (HIV). These are examples... (Review)
Review
There are roughly 48,000 deaths caused by influenza annually and an estimated 200,000 people who have undiagnosed human immunodeficiency virus (HIV). These are examples of acute and chronic illnesses that can be identified by employing a CLIA-waived test. Pharmacies across the country have been incorporating CLIA-waived point-of-care tests (POCT) into disease screening and management programs offered in the pharmacy. The rationale behind these programs is discussed. Additionally, a summary of clinical data for some of these programs in the infectious disease arena is provided. Finally, we discuss the future potential for CLIA-waived POCT-based programs in community pharmacies.
Topics: Community Pharmacy Services; Disease Management; Humans; Pharmacies; Pharmacy; Point-of-Care Systems; Point-of-Care Testing
PubMed: 32075903
DOI: 10.1128/JCM.00726-19 -
PloS One 2018This is the first exploration of service providers' attitudes and beliefs of quality and quality improvement in the community pharmacy setting in the UK.
INTRODUCTION
This is the first exploration of service providers' attitudes and beliefs of quality and quality improvement in the community pharmacy setting in the UK.
MATERIALS AND METHODS
A series of interviews and focus groups was conducted with stakeholders from the pharmacy profession in the UK. Interviews were semi-structured and conducted face-to-face or by telephone. Focus groups were conducted with naturally-occurring groups i.e. at pharmacy conferences. Interviews and focus groups were audio-recorded, transcribed and analysed systematically using an interpretive approach.
RESULTS
Forty-two individuals participated across four focus groups and four interviews. A maximum variation sample was achieved in terms of pharmacist and pharmacy characteristics. Participants were generally positive about the need for quality and quality improvement and provided multifaceted and interlinked interpretations of quality and acknowledged its dynamic nature "quality moves forward". The challenge of standardising practice whilst providing person-centred care emerged: "you don't want to lose the personal touch, but you can't have people having a variable experience and one day it's fantastic and the next day it isn't". A variety of quality measurement methods were identified including direct observation (by internal and external agents) and feedback (mystery shoppers, colleagues, regulatory inspectors, service users), suggesting that standardisation was also needed in terms of future quality measurement. There was a tendency to report negative events as triggers for improvement. Future initiatives could adopt more positive approaches including positive deviants "There's nothing more powerful than people who've come up with something really good sharing it with their other colleagues".
DISCUSSION
The results are being used to develop and evaluate future quality improvement initiatives in this sector. These are likely to be targeted at organisational, team and individual levels.
Topics: Attitude of Health Personnel; Community Pharmacy Services; Female; Focus Groups; Humans; Male; Pharmacies; Pharmacists; Quality Improvement; United Kingdom
PubMed: 30036368
DOI: 10.1371/journal.pone.0200610 -
BMJ Open Jun 2019Although tobacco is the leading preventable cause of death in the USA, it is routinely sold in pharmacies. In 2008, San Francisco became the first city in the USA to... (Observational Study)
Observational Study
OBJECTIVES
Although tobacco is the leading preventable cause of death in the USA, it is routinely sold in pharmacies. In 2008, San Francisco became the first city in the USA to pass a tobacco-free pharmacy ordinance. Over the next decade, 171 municipalities enacted similar policies, and in 2018, Massachusetts banned tobacco sales in pharmacies. Our objective was to assess the perceived effects of tobacco-free pharmacy policies on displays, sales, customer visits and counselling.
DESIGN
Observational study and survey.
SETTING
In 2017, we visited Walgreens and CVS stores in San Francisco and nearby San Jose, which allows tobacco sales, to assess placement of tobacco and over-the-counter tobacco cessation products (nicotine replacement therapy or NRT). We surveyed an employee at each site regarding the impact that tobacco-free pharmacy policies had had on customer traffic and sales of NRT.
PARTICIPANTS
We obtained display data from 72 pharmacies and collected surveys from 55 employees (76% response rate).
RESULTS
A majority of respondents at tobacco-free pharmacies (55%) reported that the policy had not affected customer visits. In comparison, 70% of respondents at tobacco-selling pharmacies believed that eliminating tobacco sales would reduce the number of customers visiting their stores. Pharmacies that were tobacco free and those that sold tobacco reported comparable displays, sales and counselling for NRT.
CONCLUSIONS
Pharmacies operating under tobacco-free policies did not report reduced customer visits. Greater awareness of this outcome could help pharmacies implement public health recommendations to eliminate tobacco sales.
Topics: California; Commerce; Cross-Sectional Studies; Humans; Licensure; Pharmacies; Public Policy; San Francisco; Smoking; Tobacco Products; Tobacco Use Cessation Devices; Tobacco, Smokeless
PubMed: 31203236
DOI: 10.1136/bmjopen-2018-025603 -
BMJ Sexual & Reproductive Health Jan 2022
Topics: Contraception; Female; Humans; Pharmacies; Pharmacists; Prescriptions; Progestins
PubMed: 34127517
DOI: 10.1136/bmjsrh-2021-201206 -
American Journal of Health-system... Nov 2022The college of pharmacy has operated pharmacies on campus for over 26 years. Employees and patients are users of the pharmacies; however, utilization across the campus...
PURPOSE
The college of pharmacy has operated pharmacies on campus for over 26 years. Employees and patients are users of the pharmacies; however, utilization across the campus has been limited. This paper describes a process, as well as results, that was used to gather input from employees on a large university health sciences center campus on pharmacy needs and related behaviors on campus pharmacy utilization.
METHODS
Two focus groups of staff and 4 focus groups of prescribers were conducted over 1 month. Participants were selected through purposive sampling via email within an academic health sciences center campus over a 1-month period. The sessions were moderated by one investigator using a preconstructed discussion guide and lasted 1 hour. Two additional investigators observed sessions for nonverbal communication; all sessions were audio recorded for subsequent transcription. An open-coding process was performed on verbatim transcripts using NVivo12. The investigator team then developed, refined, and grouped themes during subsequent group discussions.
RESULTS
A total of 44 participants took part in 6 focus groups. Participants included prescribers (physicians, nurses, physician assistants) and staff (nonprescribers). Two major themes identified were (1) factors related to on-campus pharmacies and (2) qualities valued in a pharmacy. There was an equal split (8% for each group) on awareness of the on-campus pharmacies. Almost 11% of participants commented on the accessibility of a pharmacy being a quality valued in a pharmacy.
CONCLUSION
Focus groups provided insights for the administration team regarding additional value-added services that would be helpful for the campus community, as well as various approaches to increase utilization of the on-campus pharmacies. Focus group methodology is an effective approach to engage employees of a large university campus to garner new ideas to enhance existing policies or services, as well as to gather thoughts on preliminary strategic plans before implementation.
Topics: Humans; Pharmacies; Pharmacists; Outpatients; Pharmaceutical Services; Pharmacy; Community Pharmacy Services
PubMed: 35980283
DOI: 10.1093/ajhp/zxac232 -
PloS One 2020Access to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of...
BACKGROUND
Access to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda.
METHODS
A survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data.
FINDINGS
Prices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector.
CONCLUSION
In Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda.
Topics: Costs and Cost Analysis; Drugs, Essential; Drugs, Generic; Global Health; Health Facilities; Health Services Accessibility; Humans; Pharmacies; Private Sector; Public Sector; Rwanda; Surveys and Questionnaires
PubMed: 32745100
DOI: 10.1371/journal.pone.0236411