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Medical Humanities Dec 2023The internet enables access to information and the purchasing of medical products of various quality and legality. Research and regulatory attention have focused on the...
The internet enables access to information and the purchasing of medical products of various quality and legality. Research and regulatory attention have focused on the trafficking of illicit substances, potential physical harms of pharmaceuticals, and possibilities like financial fraud. However, there is far less attention paid to antibiotics and other antimicrobials used to treat infections. With online pharmacies affording greater access, caution around antibiotic use is needed due to the increasing health risks of antimicrobial resistance (AMR). The COVID-19 pandemic has helped to normalise digital healthcare and contactless prescribing, amplifying the need for caution. Little is known of how antibiotics are consumed via digital pharmacy and implications for AMR prevention. To expand insight for AMR prevention policy in Australia and internationally, we use digital ethnographic methods to explore how digital pharmacies function in the context of health advice and policy related to AMR, commonly described as antimicrobial stewardship. We find that digital pharmacy marketplaces constitute 'pastiche medicine'. They curate access to pharmaceutical and information products that emulate biomedical authority combined with emphasis on the 'self-assembly' of healthcare. Pastiche medicine empowers the consumer but borrows biomedical expertise about antibiotics, untethering these goods from critical medicine information, and from AMR prevention strategies. We reflect on the implications of pastiche medicine for AMR policy, what the antibiotics case contributes to wider critical scholarship on digital pharmacy, and how medical humanities research might consider researching online consumption in future.
Topics: Humans; Anti-Bacterial Agents; Pharmacies; Pandemics; Pharmacy; Medicine
PubMed: 37524441
DOI: 10.1136/medhum-2022-012574 -
The International Journal of Pharmacy... Feb 2024To explore pharmacy users' perceptions of current and future provision of community pharmacy services in England.
OBJECTIVE
To explore pharmacy users' perceptions of current and future provision of community pharmacy services in England.
METHODS
Qualitative, reconvened focus groups were conducted with community pharmacy users. An initial focus group explored preliminary views. Participants were then given an evidence brief describing community pharmacy before a reconvened focus group two weeks later. Transcripts were analysed using inductive thematic analysis.
KEY FINDINGS
Eleven individuals participated across two reconvened focus groups. Participants valued community pharmacies and staff, but lacked awareness of their services and roles: '… I don't think the general public is aware of all of this … it gives you a very different perspective'. Urgent care and long-term conditions management were identified as suitable for future development, facilitated by training, closer collaboration with general practices, shared access to health records, and premises with more space and confidentiality: 'I still think of it as a retail space more than as a health service'. Concerns were expressed about working conditions in community pharmacy and unplanned closures: 'doesn't sound like a great place to work'. Participants anticipated greater use of technology but did not want this to replace face-to-face contact with pharmacy staff: 'I am not saying it's inaccurate, it is so remote and impersonal'.
CONCLUSIONS
Pharmacy users would value a greater role for community pharmacy in addressing the challenges currently faced by the health service in England, provided that their concerns on a range of issues are addressed.
Topics: Humans; Focus Groups; Pharmacies; Motivation; Pharmacists; England; Community Pharmacy Services; Pharmacy
PubMed: 37978897
DOI: 10.1093/ijpp/riad082 -
Journal of the American Pharmacists... 2024Pharmacists' and pharmacy technicians' stress and job turnover are at an all-time high. Both intrinsic motivations and extrinsic rewards play key roles in workplace...
BACKGROUND
Pharmacists' and pharmacy technicians' stress and job turnover are at an all-time high. Both intrinsic motivations and extrinsic rewards play key roles in workplace satisfaction. Differences in workplace satisfaction have been identified when comparing chain pharmacies, independent pharmacies, and health systems work settings.
OBJECTIVES
Cognitive evaluation theory was applied to explore the influence of intrinsic motivations and extrinsic rewards on both pharmacists' and pharmacy technicians' perceptions of motivations and rewards across various workplace settings.
METHODS
A 92-item questionnaire was administered to 129 pharmacists and 111 pharmacy technicians. Participants were primarily recruited at a state pharmacy association annual meeting and via online forums. The questionnaire captured participant demographics including role and work setting (i.e., chain, independent, or health systems), demographic variables, and perceptions about work including autonomy, competence, relationships, pay satisfaction, and benefit satisfaction.
RESULTS
A 2-way multivariate analysis of covariance was conducted to test hypothesized differences by role (pharmacist or pharmacy technician) and setting (chain, independent, or health systems). Results show pharmacy personnel in independent and hospital systems settings felt more positive about relationships, competence, pay satisfaction, and benefit satisfaction than those in chain settings. There were no role differences between pharmacists and pharmacy technicians on these outcomes.
DISCUSSION
These findings highlight challenges of working in chain pharmacy environments. Results reveal that although pay does not differ across work settings, feelings about both the work and compensation satisfaction do vary across settings. Because role did not drive these relationships, this suggests a need to attend to working conditions for pharmacy personnel.
CONCLUSION
Intrinsic motivation elements of competence and relationships are statistically different among employment settings. Relationships and feelings of competence are perceived more favorably in independent and health systems, rather than chain settings. More studies on intrinsic motivations of pharmacy employees within these settings are needed.
Topics: Humans; Motivation; Pharmacies; Pharmaceutical Services; Pharmacists; Pharmacy Technicians; Pharmacy; Job Satisfaction
PubMed: 37940102
DOI: 10.1016/j.japh.2023.11.008 -
Hospital Pharmacy Aug 2024Each month, subscribers to receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to... (Review)
Review
Each month, subscribers to receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing in-services. A comprehensive target drug utilization evaluation/medication use evaluation (DUE/MUE) is also provided each month. With a subscription, the monographs are available online to subscribers. Monographs can be customized to meet the needs of a facility. Through the cooperation of publishes selected reviews in this column. For more information about , contact Wolters Kluwer customer service at 866-397-3433.
PubMed: 38919758
DOI: 10.1177/00185787241236439 -
Journal of the American Medical... Dec 2023Clinical decision support systems (CDSS) were implemented in community pharmacies over 40 years ago. However, unlike CDSS studies in other health settings, few studies... (Review)
Review
OBJECTIVE
Clinical decision support systems (CDSS) were implemented in community pharmacies over 40 years ago. However, unlike CDSS studies in other health settings, few studies have been undertaken to evaluate and improve their use in community pharmacies, where billions of prescriptions are filled every year. The aim of this scoping review is to summarize what research has been done surrounding CDSS in community pharmacies and call for rigorous research in this area.
MATERIALS AND METHODS
Six databases were searched using a combination of controlled vocabulary and keywords relating to community pharmacy and CDSS. After deduplicating the initial search results, 2 independent reviewers conducted title/abstract screening and full-text review. Then, the selected studies were synthesized in terms of investigational/clinical focuses.
RESULTS
The selected 21 studies investigated the perception of and response to CDSS alerts (n = 7), the impact of CDSS alerts (n = 7), and drug-drug interaction (DDI) alerts (n = 8). Three causes of the failures to prevent DDIs of clinical importance have been noted: the perception of and response to a high volume of DDI alerts, a suboptimal performance of CDSS, and a dearth of sociotechnical considerations for managing workload and workflow. Additionally, 7 studies emphasized the importance of utilizing CDSS for a specific clinical focus, ie, antibiotics, diabetes, opioids, and vaccinations.
CONCLUSION
Despite the range of topics dealt in the last 30 years, this scoping review confirms that research on CDSS in community pharmacies is limited and disjointed, lacking a comprehensive approach to highlight areas for improvement and ways to optimize CDSS utilization.
Topics: Decision Support Systems, Clinical; Pharmacies; Drug Interactions; Workload; Prescriptions
PubMed: 37875066
DOI: 10.1093/jamia/ocad208 -
BMJ Global Health Jul 2023
Topics: Humans; Tuberculosis; Pharmaceutical Services; Pharmacies; Pharmacy
PubMed: 37474278
DOI: 10.1136/bmjgh-2023-013104 -
JAMA Health Forum Nov 2023Pharmacy benefit managers (PBMs) play a major role in the provision of pharmacy services by acting as intermediaries between pharmacies, plan sponsors (insurance...
IMPORTANCE
Pharmacy benefit managers (PBMs) play a major role in the provision of pharmacy services by acting as intermediaries between pharmacies, plan sponsors (insurance companies and employers), pharmaceutical manufacturers, and drug wholesalers. As their role and visibility have increased, PBMs have come under increased scrutiny from policymakers. However, no prior literature has systematically described the history, business practices, and policymaking of PBMs.
OBJECTIVE
To provide an overview of the PBM industry, including its history, the evolution of services provided by PBMs, an assessment of the current policy landscape, and analysis of how proposed policies could affect PBM practices and patient care.
EVIDENCE
This work reviews historical events; previous and current industry practices and publications; prior academic literature, existing statutes, regulations, and court cases; and recent legislative reforms and agency actions regarding PBMs.
FINDINGS
Pharmacy benefit managers evolved in parallel with the pharmaceutical manufacturing and health insurance industries. The evolution of the PBM industry has been characterized by horizontal and vertical integration and market concentration. The PBM provides 5 key functions: formulary design, utilization management, price negotiation, pharmacy network formation, and mail order pharmacy services. Criticism of the PBM industry centers around the lack of competition, pricing, agency problems, and lack of transparency. Legislation to address these concerns has been introduced at the state and federal levels, but the potential for these policies to address concerns about PBMs is unknown and may be eclipsed by private sector responses.
CONCLUSIONS AND RELEVANCE
Pharmacy benefit managers are intermediaries in the pharmaceutical supply chain and perform multiple roles in the management and distribution of pharmaceuticals to patients. When regulating PBMs, it is important to adopt policies that address market failure problems by improving PBM competition as opposed to policies designed to serve the narrow financial interests of other market participants (eg, pharmacies, pharmaceutical manufacturers) without meeting the needs of consumers.
Topics: Humans; Pharmacies; Insurance, Pharmaceutical Services; Pharmaceutical Services; Policy; Pharmacy; Pharmaceutical Preparations
PubMed: 37921745
DOI: 10.1001/jamahealthforum.2023.3804 -
Journal of the American Pharmacists... 2023No published data exist regarding per diem pay differences between the 50 United States Boards of Pharmacy.
BACKGROUND
No published data exist regarding per diem pay differences between the 50 United States Boards of Pharmacy.
OBJECTIVES
The purpose of this study was to quantify and compare the per diem pay rate of Board of Pharmacy members for each state in the U.S. Compensation for mileage and meals, as well as demographic information regarding U.S. Board of Pharmacy members, was also evaluated.
METHODS
In June 2022, each state Board of Pharmacy was contacted to gather data including per diem pay, mileage and meal compensation, number of meetings per year, number and gender of Board members, length of appointment, and regulatory statutes.
RESULTS
The average per diem pay for Board members was $75.86 (median = $50.00, range = $0.00-$250.00, n = 48 states). Most states report paying Board members for mileage (95.1%, n = 39 of 41) and meals (80.0%, n = 28 of 35). On average, Boards are composed of 8.3 members (median = 7.5, range = 5-17, n = 50), meet 8.3 times annually (median = 8, range = 3-16, n = 47), and have a 4.5-year length of appointment (median = 4, range = 3-6, n = 47). Men represented 61.2% of occupied Board positions, and pharmacists accounted for 74.2% of all positions. The average year for per diem pay statute update was 2002.
CONCLUSION
The per diem pay for U.S. Board of Pharmacy members varies from state to state, ranging from unpaid (n = 8 states) up to $250.00 per diem. Fair compensation, increased pharmacy technician and women representation, and more timely pharmacy statute updates are necessary in order to achieve inclusion, diversity, and equity across state Boards of Pharmacy.
Topics: Male; United States; Humans; Female; Pharmacy; Pharmaceutical Services; Pharmacies; Pharmacists; Pharmacy Technicians
PubMed: 37149140
DOI: 10.1016/j.japh.2023.04.026 -
The Lancet. Infectious Diseases Sep 2023This mixed-method systemic review estimated the pooled prevalence of non-prescription antibiotic dispensing in community pharmacies worldwide and identified associated... (Review)
Review
This mixed-method systemic review estimated the pooled prevalence of non-prescription antibiotic dispensing in community pharmacies worldwide and identified associated factors influencing the practice. 162 studies covering 52 countries were included. The pooled prevalence of community pharmacy non-prescription antibiotic dispensing was 63·4% (95% CI 59·6-67·1). The prevalence was significantly higher in low-income countries than in high-income countries. Additionally, the situation of dispensing antibiotics without prescriptions has not improved over time in the past two decades. Quantitative studies showed that pharmacies located in poorer economic areas, pharmacy staff who were also the pharmacy owners, and private pharmacies were more likely to dispense non-prescription antibiotics. Qualitative findings suggested four major factors driving antibiotics being dispensed without a prescription. First, strong customer demand for non-prescription antibiotics and a lack of relevant knowledge; second, pharmacy staff motivated by financial or personal viewpoints; third, alternative health-care services being expensive or inconvenient, or having irregular prescribing practices; and finally, weak social, industry, and legal regulation. The current antibiotic stewardship needs to be strengthened.
Topics: Humans; Anti-Bacterial Agents; Pharmacies; Drug Prescriptions; Community Pharmacy Services; Pharmacists
PubMed: 37105212
DOI: 10.1016/S1473-3099(23)00130-5 -
Currents in Pharmacy Teaching & Learning Aug 2023Flip the Pharmacy (FtP) helps community pharmacies "flip" from dispensing- to patient-centered care models with assistance from practice transformation coaches...
BACKGROUND AND PURPOSE
Flip the Pharmacy (FtP) helps community pharmacies "flip" from dispensing- to patient-centered care models with assistance from practice transformation coaches ("coaches"). Purdue University College of Pharmacy created a novel advanced pharmacy practice experience (APPE) positioning students to serve as FtP coaches with oversight from four faculty coaches. This communication describes the APPE's design, characterizes preliminary student coaching outcomes, and identifies the APPE's strengths and limitations.
EDUCATIONAL ACTIVITY AND SETTING
Twelve pharmacies were coached by APPE students. The APPE was designed to enhance student knowledge and skills in the scaled implementation of advanced patient care services through structured weekly activities: Week 1, student orientation and training; Week 2, preparing for pharmacy visits; and Weeks 3 and 4, conducting pharmacy visits. Students also performed recurring tasks each week, including managing social media accounts.
FINDINGS
Twenty-eight students completed the APPE. Students conducted 81 in-person and 105 virtual visits. Faculty coaches were estimated to need 40 to 50 hours each month for coaching-related activities; involving student coaches reduced faculty coach time by approximately 50%, with faculty spending 20 hours on average per month vs. students spending 50.84 hours. APPE strengths included intentional weekly structuring and oversight and careful student transitions; limitations included minimal pharmacy vendor knowledge and limited rapport-building with pharmacies.
SUMMARY
Early experiences demonstrated several benefits, including optimized faculty coach time and student exposure to practice transformation. Future endeavors to implement similar APPEs should incorporate strategies to enhance pharmacy vendor knowledge and strengthen relationship-building with participating pharmacies.
Topics: Humans; Pharmacies; Education, Pharmacy; Pharmaceutical Services; Curriculum; Pharmacy; Students, Pharmacy
PubMed: 37500304
DOI: 10.1016/j.cptl.2023.07.005