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The Senior Care Pharmacist Sep 2023Community pharmacists play an important role in providing many essential services to older adult patients. This study aimed to assess participants' awareness and...
Community pharmacists play an important role in providing many essential services to older adult patients. This study aimed to assess participants' awareness and utilization of current services provided by the community pharmacy and to identify preferences for innovative strategies and services related to healthy aging. This is community-based research using interviews with older people in community pharmacies. Student pharmacists performed the interviews, asking 11 questions developed by the research team. The interview questions included services currently provided by the community pharmacy to determine patient awareness and use. One-on-one structured interviews with participants 50 years of age and older were conducted at community pharmacies in Arizona. A total of 53 older people (54.7% female) participated, with most patients knowledgeable about current pharmacy services and 69.7% using at least one service. When asked if they would participate in innovative services, more than half of those interviewed (56.6%) were interested in medication side effect screening and education, and 54.7% would want to participate in medication review with drug interaction screening. Almost half were interested in lifestyle education for healthy aging in nutrition and physical activities (49.1%) and medication disposal (47.2%). Most participants preferred to communicate in person with their pharmacists, but some showed interest in mobile phone texts and calls. Community pharmacies may be a viable setting to provide novel services to promote healthy aging among older people, particularly medication side effect and drug interaction screenings and education.
Topics: Humans; Female; Aged; Male; Pharmacies; Arizona; Drug-Related Side Effects and Adverse Reactions; Exercise; Pharmaceutical Services
PubMed: 37612848
DOI: 10.4140/TCP.n.2023.378 -
Journal of the American Pharmacists... 2023Addressing social needs (such as lack of adequate housing, food, and transportation) has been shown to improve medication adherence and overall patient outcomes....
BACKGROUND
Addressing social needs (such as lack of adequate housing, food, and transportation) has been shown to improve medication adherence and overall patient outcomes. However, screening for social needs during routine patient care can be challenging due to lack of knowledge of social resources and adequate training.
OBJECTIVES
The primary objective of this study is to explore the comfort and confidence of community pharmacy personnel in a chain community pharmacy when discussing social determinants of health (SDOH) with patients. A secondary objective of this study was to assess the impact of a targeted continuing pharmacy education program in this area.
METHODS
Baseline confidence and comfort were measured through a brief online survey consisting of Likert scale questions regarding various aspects of SDOH (e.g., importance and benefit, knowledge of social resources, relevant training, workflow feasibility). Subgroup analysis of respondent characteristics was conducted to examine differences between respondent demographics. A targeted training was piloted, and an optional posttraining survey was administered.
RESULTS
The baseline survey was completed by 157 pharmacists (n = 141, 90%) and pharmacy technicians (n = 16, 10%). Overall, the pharmacy personnel surveyed lacked confidence and comfort when conducting screenings for social needs. There was not a statistically significant difference in comfort or confidence between roles; however, subgroup analysis revealed trends and significant differences between respondent demographics. The largest gaps identified were lack of knowledge of social resources, inadequate training, and workflow concerns. Respondents of the posttraining survey (n = 38, response rate = 51%) reported significantly higher comfort and confidence than the baseline.
CONCLUSION
Practicing community pharmacy personnel lack confidence and comfort in screening patients for social needs at baseline. More research is needed to determine if pharmacists or technicians may be better equipped to implement social needs screenings in community pharmacy practice. Common barriers may be alleviated with targeted training programs to address these concerns.
Topics: Humans; Pilot Projects; Pharmacies; Community Pharmacy Services; Pharmacy; Pharmacists; Pharmacy Technicians
PubMed: 36863964
DOI: 10.1016/j.japh.2023.02.003 -
Applied Clinical Informatics Aug 2023Few community pharmacies have access to health information exchange (HIE) data. We conducted a first-of-its-kind usability evaluation of an HIE interface prototype...
OBJECTIVE
Few community pharmacies have access to health information exchange (HIE) data. We conducted a first-of-its-kind usability evaluation of an HIE interface prototype (referred to throughout as the "HIE-Pioneer mock-up") developed with pharmacists and pharmacy technicians to aid future implementation in community pharmacies.
METHODS
Community pharmacists and pharmacy technicians were recruited to complete usability evaluations with the HIE-Pioneer mock-up. Each usability evaluation lasted up to 60 minutes. System usability scale (SUS) scores were collected from each participant following each usability evaluation session and summarized with descriptive statistics. Usability evaluation videos were reviewed for common usability attributes, such as the impact of identified usability problems, learnability, and efficiency. Time on task, task success rates, and prototype utilization were also recorded.
RESULTS
Sixteen total participants completed usability testing across three community pharmacies. The average SUS score was 69.7 (scale 0-100, where 100 is the best), with pharmacists on average reporting higher satisfaction than technicians (74.1 vs. 65.3, respectively). Altogether, we identified 23 distinct usability problems. Key problems identified included needed clarification in tool label names and accessibility of HIE links within the existing workflow. Overall, the usability of the HIE-Pioneer mock-up generally fostered pharmacy professionals' ease of learning and efficiency.
CONCLUSION
Our study identified key areas, and potential solutions, to improve the usability of the HIE-Pioneer mock-up. Overall, pharmacy professionals viewed the HIE-Pioneer mock-up positively, with good satisfaction ratings. The HIE-Pioneer mock-up provides a blueprint for future HIE implementation in community pharmacy settings, which would increase community pharmacy teams' access to HIE data nationwide. Community pharmacy access to bi-directional HIE is expected to improve communication among more health care professionals involved in patient care and equip pharmacy professionals with needed information for improved clinical decision-making.
Topics: Humans; Health Information Exchange; Pharmacies; Community Pharmacy Services; Patient Care; Pharmacists
PubMed: 37527792
DOI: 10.1055/a-2145-6980 -
Exploratory Research in Clinical and... Dec 2023Spain is a European country with over 47.5 million inhabitants and a public National Health System model (i.e. SNS or "") that provides universal coverage to residents...
Spain is a European country with over 47.5 million inhabitants and a public National Health System model (i.e. SNS or "") that provides universal coverage to residents and non-residents. The system is funded primarily by general taxes, and it is managed by the 17 regions that have responsibility for the provision and management of healthcare services in their respective territories. The health system recognizes self-care as an important element where individuals have an important role to play in maintaining their own health and preventing illness. In addition, there are non-governmental organizations that promote self-care and provide resources and support to individuals and health professionals. Over 55 thousand pharmacists work in 22,198 community pharmacies distributed throughout the Spanish territory. Pharmacies are the only setting that provide non-prescription medications, which is one of the most used tools for self-care. In addition, they provide a range of Primary Care services to improve patient outcomes and the efficiency of the SNS. This paper includes a description and a classification of the community pharmacy services following the seven pillars of self-care established by the International Self-Care Foundation:-Related to pillars 1 to 4 and 6, Spanish community pharmacists provide health promotion, health education, health information and nutritional assessment.-In relation to pillar 5, the services offered are HIV and syphilis screening, colorectal and cervix cancer screening, SARS-CoV-2 screening test and communication, diabetes, high blood pressure and hypercholesterolemia screening. Regarding the programs for avoiding/stopping drug use: methadone supply, syringe exchange and smoking cessation. Another important service is immunization. Spanish community pharmacists are not legally allowed to vaccinate; however, they contribute through education, or vaccines supply, among others.-For the pillar 7, community pharmacists provide services such as a minor ailment service, an adherence service or a network to actively monitor medication safety (sentinel pharmacies).-Many of the pharmacy services related to self-care have been defined and classified at a national level; however, not all community pharmacies provide them while only some services are funded by the regional health systems.
PubMed: 37841580
DOI: 10.1016/j.rcsop.2023.100337 -
Journal of the American Pharmacists... 2024Community pharmacies are a critical part of the health care provision system. Yet less is understood about the spatial accessibility to pharmacies and how people travel...
BACKGROUND
Community pharmacies are a critical part of the health care provision system. Yet less is understood about the spatial accessibility to pharmacies and how people travel to reach these services.
OBJECTIVES
This study compared spatial accessibility and actual travel to different types of pharmacies among selected neighborhoods in the Detroit region.
METHODS
Three types of neighborhoods were selected and compared, including two lower income Black urban neighborhoods of high-density and four upper income White suburbs (two of low density and two of high density). Spatial accessibility was computed by pharmacy type and compared among neighborhoods using ANOVA. Pharmacy trips reported in a travel survey were geocoded and linked with community pharmacies in a list generated from ReferenceUSA business data. Destination choices were mapped and the relationship between spatial accessibility and actual distance traveled was examined using ordinary least squares regressions.
RESULTS
On average, urban residents in Detroit had higher access to local independent pharmacies (0.74 miles to the nearest one) but relatively lower access to national chains (1.35 miles to the nearest one), which most residents relied on. Urban residents also tended to shop around more for services even among national chains. In fact, they bypassed nearby local independent pharmacies and traveled long distances to use farther pharmacies, primarily national chains. The average trip distance to pharmacy was 2.1 miles for urban residents, but only 1.1 miles and 1.5 miles for residents in high-density suburbs and low-density suburbs, respectively.
CONCLUSION
Supposedly good spatial access considering all pharmacies together may mask excessive burden in reaching the pharmacy services needed in low-income minority urban communities, as shown in the case of Detroit. Thus, when mapping pharmacy deserts, it is important to distinguish spatial accessibility among different pharmacy types.
Topics: Humans; Michigan; Health Services Accessibility; Travel; Community Pharmacy Services; Pharmacies; Residence Characteristics; Urban Population; Poverty; Black or African American; White People
PubMed: 38401841
DOI: 10.1016/j.japh.2024.102052 -
The Canadian Journal of Hospital... 2023Pharmacists in the province of Alberta may apply for additional prescribing authorization (APA), which allows them to independently prescribe medications. Currently, no...
BACKGROUND
Pharmacists in the province of Alberta may apply for additional prescribing authorization (APA), which allows them to independently prescribe medications. Currently, no literature exists about pharmacist prescribing for inpatients at the time of discharge.
OBJECTIVES
The primary objective was to report the proportion of patients for whom inpatient pharmacists with APA prescribed at discharge across Alberta, Canada. Secondary objectives were to describe discharge interventions other than prescribing that were provided, enablers of and barriers to discharge prescribing, and differences in discharge prescribing by facility or population type, clinical area, and health care charting system.
METHODS
A descriptive, cross-sectional web-based survey of inpatient pharmacists with APA across Alberta was conducted over a 6-week period in early 2022.
RESULTS
A total of 104 respondents met the inclusion criteria. Under half (45/102, 44.1%) of the participants reported prescribing at discharge. Those that reported prescribing at discharge did so for only a median 14.5% of their patients. The most common enabler of discharge prescribing was a supportive care team, and the most common barrier was the presence of other prescribers. Pharmacists who did not report prescribing at discharge selected "discomfort with being responsible for the prescription" and "fear of professional liability" as barriers more often than those who did report discharge prescribing (51.0% [26/51] vs 33.3% [13/39] and 43.1% [22/51] vs 25.6% [10/39], respectively). The proportion of pharmacists who reported prescribing at discharge was greater with increasing population/facility size (30% [6/20] of pharmacists in settings that served small populations vs 50% [29/58] of those in settings that served large populations).
CONCLUSIONS
Inpatient pharmacists who use APA at discharge reported prescribing for only a minority of patients, and discharge prescribing practices varied widely across the province. Future areas of research include how pharmacists can overcome barriers to prescribing at discharge.
PubMed: 37767376
DOI: 10.4212/cjhp.3346 -
Frontiers in Public Health 2023Primary care is an essential component of any health system, but building high-quality primary care has proven to be a challenge for most developing countries. Among the...
INTRODUCTION
Primary care is an essential component of any health system, but building high-quality primary care has proven to be a challenge for most developing countries. Among the multiplicity of providers in South Asia, one of the most ubiquitous channels through which not only medicines are obtained but also primary care advice is sought is the neighborhood pharmacy. There are widespread availability of pharmacies in South Asia. There is also good evidence that working with pharmacies in this way is a globally accepted idea, and there are several examples of countries, such as France and Nigeria, that have integrated pharmacies into their primary care systems and entrusted them with significant responsibilities.
METHODS
In this paper, we explore the potential of this channel as a formal primary care provider, with a particular focus on the South Asian context, by examining how pharmacies perform against the seven of (i) first contact care, (ii) continuity of care, (iii) comprehensiveness, (iv) coordination, (v) family centredness, (vi) cultural competency, and (vii) community orientation. In the paper, we use data on pharmacies from four pharmacy-related interventions, one from Bangladesh and three from India, to carry out our analysis using the Qualitative Comparative Analysis (QCA) framework.
RESULTS
We find that even in the South Asian context, pharmacies provide several components of good primary care. As expected, they demonstrate a strong orientation toward the community in which they are located and are able to provide first-contact care. However, we find no direct evidence that they are able to offer continuity of care or bring to bear family-centredness and cultural competency when dealing with their patients. It is encouraging, however, that while there is no formal evidence of this in any of the interventions, multiple anecdotal examples suggest that pharmacists do indeed do much of this, but perhaps in an informal and inconsistent manner.
DISCUSSION
The evidence from these studies provides support for the view that pharmacies have many of the inherent characteristics needed to become an effective primary care channel and already play an important role in providing access to health information and care. However, it is also clear from the research that without additional training and access to tools, pharmacies will not have the competency or knowledge necessary to provide these services or even act as an effective gateway to other healthcare providers. To fully unlock this opportunity, therefore, any organization that wishes to engage with them will need to have the vision and patience to work with this network for an extended period of time and not merely aspire for incremental improvements but have a strategy in place that fundamentally changes the capabilities and the roles that pharmacies can play.
Topics: Humans; Pharmacies; Pharmacy; Pharmacists; Asia, Southern; Primary Health Care
PubMed: 37693714
DOI: 10.3389/fpubh.2023.1221439 -
Journal of the American Pharmacists... 2024Rates of sexually transmitted infections (STIs) are rising despite significant management efforts in traditional healthcare settings. The growing number of individuals... (Review)
Review
BACKGROUND
Rates of sexually transmitted infections (STIs) are rising despite significant management efforts in traditional healthcare settings. The growing number of individuals affected by STIs demonstrates a gap in care. Pharmacy-based STI clinical services are a potential solution to improve care.
OBJECTIVE
To identify and summarize research about the implementation of pharmacy-based STI services, focusing on program characteristics, barriers, facilitators, and pharmacist and patient experiences.
METHODS
A search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted for papers evaluating STI expanded-scope clinical services performed by regulated pharmacists in an outpatient/community pharmacy setting. Study setting, design, data collection method, outcomes, target infection, services offered, patient population, and barriers and facilitators are reported.
RESULTS
Twelve studies, 11 cross-sectional and 1 randomized control trial, were identified in this review. All studies focused on chlamydia, and two included gonorrhea and trichomoniasis or syphilis. Eleven services investigated STI screening, with four also offering treatment, and two offering partner treatment. Overall, patients reported positive experiences, found the services accessible, and trusted pharmacists. Pharmacists recognized the importance of STI services, were keen, and felt comfortable performing clinical tasks. Patients described convenience as a key facilitator, and concerns about privacy, particularly at the pharmacy counter, and the stigma and fear of judgement associated with STIs as primary barriers. For facilitators, pharmacists reported increased job satisfaction and a sense of relieving the burden on traditional STI services; for barriers, pharmacists highlighted patient recruitment, communication challenges, and lack of remuneration.
CONCLUSION
Research on pharmacy-based STI services includes predominately small-scale, cross-sectional studies, and focuses on chlamydia screening. Both patients and pharmacists perceive these services to be acceptable and feasible, though strategies addressing patient privacy and recruitment, pharmacist competency, training, and remuneration must be considered to support the success of pharmacy-based STI services.
Topics: Humans; Pharmacies; Cross-Sectional Studies; Systematic Reviews as Topic; Sexually Transmitted Diseases; Pharmacists; Pharmacy; Randomized Controlled Trials as Topic
PubMed: 38453662
DOI: 10.1016/j.japh.2023.10.029 -
Pediatric Blood & Cancer Sep 2023Children's Oncology Group (COG) pharmacists and pharmacy technicians from more than 200 COG-member institutions comprise the COG Pharmacy Discipline. Discipline members...
Children's Oncology Group (COG) pharmacists and pharmacy technicians from more than 200 COG-member institutions comprise the COG Pharmacy Discipline. Discipline members serve an essential role in the design and execution of COG clinical trials. Core activities include study drug management, study drug access, clinical trial operations, protocol harmonization, and direct patient care. Discipline members are also actively involved in continuing education, membership engagement, and research across other COG committees/domains. Future areas of committed growth for the discipline include pharmacogenomics, pharmacokinetics, pharmacoeconomics, pharmaceutics, and implementation science.
Topics: Humans; Child; Medical Oncology; Pharmacies; Drug Evaluation; Pharmacy; Pharmacists
PubMed: 37460409
DOI: 10.1002/pbc.30581 -
Translational Behavioral Medicine Dec 2023Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions...
Colorectal cancer (CRC) is a common and preventable cancer. CRC screening is underutilized, particularly within medically underserved communities. Most interventions aimed at increasing CRC screening are delivered through primary care clinics. Pharmacies are more accessible than traditional primary care settings and may be ideally suited for delivering CRC screening and increasing access. Fecal immunochemical test is an at-home, stool-based CRC screening test that could be distributed through pharmacies. The purpose of our study was to assess patient perspectives on receiving fecal immunochemical test-based CRC screening through pharmacies. We conducted semi-structured interviews with participants residing in North Carolina and Washington. Interviews explored acceptability and intervention design preferences for a pharmacy-based CRC screening program. The interview guide was informed by Andersen's Healthcare Utilization Model and the Theoretical Domains Framework. Interviews were conducted at the University of North Carolina at Chapel Hill and Fred Hutchinson Cancer Research Center, audio-recorded, and transcribed. Patients perceived a pharmacy-based CRC screening program to be highly acceptable, citing factors such as ease of pharmacy access and avoiding co-pays for an office visit. Some concerns about privacy and coordination with patients' primary care provider tempered acceptability. Trust and positive relationships with providers and pharmacists as well as seamless care across the CRC screening continuum also were viewed as important. Patients viewed pharmacy-based CRC screening as an acceptable option for CRC screening. To improve programmatic success, it will be important to ensure privacy, determine how communication between the pharmacy and the patient's provider will take place, and establish closed-loop care, particularly for patients with abnormal results.
Topics: Humans; Pharmacies; Early Detection of Cancer; Colorectal Neoplasms; Attitude of Health Personnel; Pharmacy
PubMed: 37756664
DOI: 10.1093/tbm/ibad057