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The Annals of Pharmacotherapy Jan 2020
Review
Topics: Education, Pharmacy; Humans; Implementation Science; Models, Organizational; Pharmaceutical Services; Pharmacies
PubMed: 31353925
DOI: 10.1177/1060028019867253 -
AIDS Research and Human Retroviruses Aug 2022HIV self-testing (HIVST) is a WHO-recommended strategy to increase testing, especially among key populations, men, and young adults. Between May and December 2019, a...
HIV self-testing (HIVST) is a WHO-recommended strategy to increase testing, especially among key populations, men, and young adults. Between May and December 2019, a pilot was implemented in Zambézia province, Mozambique, allowing clients to purchase HIV self-tests in 14 public/private pharmacies. The study assessed the strategy's acceptability and uptake. Pharmacy-based exit surveys were conducted among a random sample of clients, during the first three months of the pilot, independent of HIVST purchase. Another random sample of clients who bought an HIVST completed a survey 1-12 weeks after purchase. Chi-square and Mann-Whitney tests were used for the analysis, comparing clients who purchased an HIVST versus not. A total of 1,139 adults purchased 1,344 tests. Buyers were predominantly male (70%) and younger (52% between 15 and 34 years of age). Surveys were completed by 280 exiting pharmacy clients and 82 clients who purchased an HIVST. Main advantages were confidentiality and lack of need of a health provider visit, with main disadvantages being absence of nearby counseling and fear of results. No differences were seen between buyers and non-buyers for these factors. Among all undergoing HIVST, 71 (92%) perceived the instructions to be clear, however, 29 (38%) stated they would have benefitted from additional pre-test information or counseling. Ten (13%) reported following up at a nearby health facility to confirm results and/or receive care. Offering HIVST at public/private pharmacies was acceptable among people who traditionally tend to have a lower HIV testing coverage, such as men and young adults. However, additional resources and/or enhanced educational materials to address the lack of counseling, and linkage-to-care systems need to be put into place before scaling up this strategy.
Topics: Female; HIV Infections; HIV Testing; Humans; Male; Mass Screening; Mozambique; Pharmacies; Pharmacy; Self-Testing; Young Adult
PubMed: 35579964
DOI: 10.1089/AID.2021.0116 -
BMC Health Services Research Sep 2020Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their...
BACKGROUND
Pharmacy workers in Bangladesh play an important role in managing pregnancy complications by dispensing, counselling and selling drugs to pregnant women and their families. This study examined pharmacy workers' drug knowledge and practice for pre-eclampsia and eclampsia (PE/E) management, including antihypertensives and anticonvulsants, and determine factors associated with their knowledge.
METHODS
A cross-sectional survey with 382 pharmacy workers in public facilities (government) and private pharmacies and drug stores assessed their knowledge of antihypertensive and anticonvulsant drugs. 'Pharmacy workers' include personnel who work at pharmacies, pharmacists, family welfare visitors (FWVs), sub-assistant community medical officers (SACMOs), drug storekeepers. Exploratory and multivariate logistic models were used to describe association between knowledge of medicines used in pregnancy and demographic characteristics of pharmacy workers.
RESULTS
Overall, 53% pharmacy workers interviewed were drug store owners in private pharmacies while 27% FWVs/SACMOs, who are government service providers also work as drug prescribers and/or dispensers in public facility pharmacies. Majority of pharmacy workers had poor knowledge compared to correct knowledge on both antihypertensive (77.8% vs 22.3%; p < 0.001) and anticonvulsant drugs (MgSO) (82.2% vs 17.8%; p < 0.001). Multivariate analysis showed SACMOs and FWVs were greater than 4 times more likely to have correct knowledge on anti-hypertensives (AOR = 4.2, 95% CI:1.3-12.3, P < 0.01) and anticonvulsant drugs (AOR = 4.9, 95% CI:1.3-18.1, P < 0.01) compared to pharmacists. Pharmacy workers who had received training were more likely to have correct knowledge on antihypertensive and anticonvulsant drugs than those who had no training.
CONCLUSIONS
Pharmacy workers' knowledge and understanding of antihypertensive and anticonvulsant drugs, particularly for prevention and management of PE/E is limited in Bangladesh. Most pharmacies surveyed are private and staffed with unskilled workers with no formal training on drugs. Expansion of maternal and newborn health programs should consider providing additional skills training to pharmacy workers, as well as regulating these medicines at informal pharmacies to mitigate any harmful practices or adverse outcomes of unauthorized and incorrectly prescribed and used drugs. It is important that correct messaging and medicines are available as drug stores are often the first point of contact for most of the women and their families.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anticonvulsants; Antihypertensive Agents; Bangladesh; Cross-Sectional Studies; Eclampsia; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Pharmaceutical Services; Pharmacies; Pharmacists; Pre-Eclampsia; Pregnancy; Surveys and Questionnaires; Young Adult
PubMed: 32894121
DOI: 10.1186/s12913-020-05685-6 -
PloS One 2022To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community...
OBJECTIVES
To assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content.
METHODS
A cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated.
RESULTS
A total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35-39 and those with 6-10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively.
CONCLUSIONS
Information provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.
Topics: Computer Simulation; Humans; Patient Satisfaction; Pharmacies
PubMed: 35180273
DOI: 10.1371/journal.pone.0264224 -
Perspectives in Public Health Mar 2022This systematic review aimed to provide new insights into how pharmacy spaces, or the , are experienced by pharmacy service users and staff. The review sought to...
AIM
This systematic review aimed to provide new insights into how pharmacy spaces, or the , are experienced by pharmacy service users and staff. The review sought to identify environmental factors which may influence service users' and staff participation in community-based pharmacy health services.
METHOD
Ten databases were searched for English language publications, using a combination of search terms relating to pharmacy service users and staff; pharmacy spaces; and health and social care outcomes. Data from the final selected studies were extracted, thematically analysed using a narrative approach and the quality of each study assessed using the Integrated quality Criteria for the Review of Multiple Study designs (ICROMS).
RESULTS
80 articles reporting 80 studies published between 1994 and 2020 were identified; they were from 28 countries, involving around 3234 community pharmacies, 13,615 pharmacy service users, 5056 pharmacists and 78 pharmacy health staff. Most studies (94%) met the ICROMS minimum score, and half did not meet the mandatory quality criteria. Four themes likely to influence service users' and staff experiences of pharmacy health services were identified: (1) privacy; (2) experience of the physical environment; (3) professional image; and (4) risk of error.
CONCLUSION
To optimise the delivery and experience of pharmacy health services, these spaces should be made more engaging. Future applied research could focus on optimising inclusive pharmacy design features.
Topics: Community Pharmacy Services; Humans; Pharmacies; Pharmacists
PubMed: 35274562
DOI: 10.1177/17579139221080608 -
Research in Social & Administrative... Nov 2019Stakeholder engagement is an important component of the research process for improving the use and uptake of patient-centered health care innovations. Participatory...
BACKGROUND
Stakeholder engagement is an important component of the research process for improving the use and uptake of patient-centered health care innovations. Participatory design (PD), a method that utilizes the involvement of patients and other stakeholders, is well-suited for the design of multifaceted interventions in complex work systems, such as community pharmacies, that have diverse and dynamic end-users.
OBJECTIVE
The objective is to describe a blueprint for how to use PD when designing a community pharmacy intervention. This paper outlines the steps of PD and highlights the advantages and disadvantages of this method.
METHODS
PD is explained step-wise to underscore the considerations required of researchers unfamiliar with PD. This includes the development of a tailored PD approach, PD session preparatory work, data collection, and intervention development and evaluation. The stakeholders recruited for the community pharmacy intervention were pharmacy staff and older adult patients who received prescriptions at the pharmacy corporation in which the intervention was being implemented. The PD process was a series of six adaptive sessions: (1) problem identification, (2) solution generation, (3) convergence, (4) prototyping, (5) initial evaluation, and (6) formative evaluation.
RESULTS
A description of the PD process to design a community pharmacy intervention is provided. The process led to the development of a patient-centered prototype. The advantages of using PD included the opportunity to clarify problems faced by stakeholders, generation of novel solutions to incorporate into the intervention, and the ability to vet and fine-tune stakeholder design ideas in an iterative fashion. The insight gained was unprecedented and invaluable to the researchers. The biggest challenge of employing PD was the time-sensitive and time-intensive nature of developing each session, collecting data, and reflecting on the results in order to design subsequent sessions.
CONCLUSIONS
The PD process led to the development of a patient-centered prototype. PD enabled stakeholders to generate creative solutions and provide unique insight on addressing issues faced in healthcare redesign research and specifically in community pharmacies.
Topics: Humans; Patient Participation; Patient-Centered Care; Pharmacies; Stakeholder Participation
PubMed: 30509852
DOI: 10.1016/j.sapharm.2018.11.012 -
The Journal of Law, Medicine & Ethics :... 2023Pharmacy Benefit Managers (PBM) induce drug manufacturers to offer rebates to insurers and employers by denying coverage through formulary exclusions, impeding physician... (Review)
Review
Pharmacy Benefit Managers (PBM) induce drug manufacturers to offer rebates to insurers and employers by denying coverage through formulary exclusions, impeding physician prescription through prior authorization, and reducing patient drug use through cost sharing. As they tighten these access obstacles, PBMs reduce the net prices received by the manufacturers.
Topics: Humans; Pharmacy; Pharmacies; Insurance Carriers; Physicians
PubMed: 38433678
DOI: 10.1017/jme.2023.147 -
Research in Social & Administrative... Feb 2020Pharmacy technicians are vital to the operation of pharmacies, and national pharmacy associations have advocated for mandatory education and training requirements. While...
BACKGROUND
Pharmacy technicians are vital to the operation of pharmacies, and national pharmacy associations have advocated for mandatory education and training requirements. While these requirements may improve patient safety, there is a risk that laws and regulations which impose substantial education and training requirements on technicians could create barriers to entry which restrict the workforce and increase wages.
OBJECTIVE
This study has two objectives: 1) Describe changes in barriers to entry and wages over time; and 2) Evaluate the correlation between changing barriers to entry and pharmacy technician wages.
METHODS
Data come from Bureau of Labor Statistics Occupational Employment Statistics from 1997 to 2017 and National Association of Boards of Pharmacy Surveys of Pharmacy Law from 1997 to 2014. A barrier to entry was defined as adoption of registration, licensure, or certification. Wage data was adjusted to 2017 dollars using the Consumer Price Index. Ordinary least squares regression evaluated the correlation between the proportion of states which had at least one barrier to entry and wages. An interrupted time series model estimated the impact of adopting a barrier to entry on the trend in technician wages over time.
RESULTS
Technician wages increased between 1997 and 2007 but remained flat between 2008 and 2017. A strong correlation was observed between the proportion of states which had at least one barrier to entry and technician wages (R2 = 0.93, p < 0.0001). However, the interrupted time series models did not identify any relationship between adoption of a barrier to entry and the trend in technician wages (p = 0.363).
CONCLUSIONS
This research suggests adoption of legal/regulatory barriers to entry did not have a significant influence on the trend in technician wages over time. More research is needed to evaluate the impact of barriers to entry on non-wage practice variables, such as privileges and satisfaction.
Topics: Certification; Government Regulation; Humans; Legislation, Pharmacy; Pharmacies; Pharmacy; Pharmacy Technicians; Salaries and Fringe Benefits
PubMed: 31118139
DOI: 10.1016/j.sapharm.2019.05.003 -
PloS One 2020To evaluate the influence of pharmacists' dispensing workload (PDW) on pharmacy services as measured by prescription suggestion rate (PSR) and dispensing error rate... (Observational Study)
Observational Study
OBJECTIVE
To evaluate the influence of pharmacists' dispensing workload (PDW) on pharmacy services as measured by prescription suggestion rate (PSR) and dispensing error rate (DER).
METHOD
This was an observational study in northern and southern Taiwan's two largest medical centers, from 2012 to 2018. We calculated monthly PDW as number of prescriptions divided by number of pharmacist working days. We used monthly PSR and DER as outcome indicators for pharmacists' review and dispensing services, respectively. We used Poisson regression model with generalized estimation equation methods to evaluate the influence of PDW on PSR and DER.
RESULTS
The monthly mean of 463,587 (SD 32,898) prescriptions yielded mean PDW, PSR and DER of 52 (SD 3) prescriptions per pharmacist working days, 30 (SD 7) and 8 (SD 2) per 10,000 prescriptions monthly, respectively. There was significant negative impact of PDW on PSR (adjusted rate ratio, aRR: 0.9786; 95%CI: 0.9744-0.9829) and DER (aRR: 0.9567; 95%CI: 0.9477-0.9658). Stratified analyses by time periods (2012-2015 and 2016-2018) revealed the impact of PDW on PSR to be similar in both periods; but with positive association between PDW and DER in the more recent one (aRR: 1.0086, 95%CI: 1.0003-1.0169).
CONCLUSIONS
Reduced pharmacist workload was associated with re-allocation of pharmacy time to provide prescription suggestions and, more recently, decrease dispensing errors. Continuous efforts to maintain appropriate workload for pharmacists are recommended to ensure prescription quality.
Topics: Community Pharmacy Services; Humans; Pharmacies; Pharmacists; Pharmacy Technicians; Prescriptions; Taiwan; Workload
PubMed: 32315319
DOI: 10.1371/journal.pone.0231482 -
BMC Infectious Diseases Aug 2023Point-of-care testing (POCT) using rapid diagnostic tests for infectious disease can potentially guide appropriate use of antimicrobials, reduce antimicrobial... (Review)
Review
BACKGROUND
Point-of-care testing (POCT) using rapid diagnostic tests for infectious disease can potentially guide appropriate use of antimicrobials, reduce antimicrobial resistance, and economise use of healthcare resources. POCT implementation in private retail settings such as pharmacies and drug shops could lessen the burden on public healthcare. We performed a narrative review on studies of POCTs in low- and middle-income countries (LMICs), and explored uptake, impact on treatment, and feasibility of implementation.
METHODS
We searched MEDLINE/PubMed for interventional studies on the implementation of POCT for infectious diseases performed by personnel in private retail settings. Data were extracted and analysed by two independent reviewers.
RESULTS
Of the 848 studies retrieved, 23 were included in the review. Studies were on malaria (19/23), malaria and pneumonia (3/23) or respiratory tract infection (1/23). Nine randomised controlled studies, four controlled, non-randomised studies, five uncontrolled interventions, one interventional pre-post study, one cross-over interventional study and three retrospective analyses of RCTs were included. Study quality was poor. Overall, studies showed that POCT can be implemented successfully, leading to improvements in appropriate treatment as measured by outcomes like adherence to treatment guidelines. Despite some concerns by health workers, customers and shop providers were welcoming of POCT implementation in private retail settings. Main themes that arose from the review included the need for well-structured training with post-training certification covering guidelines for test-negative patients, integrated waste management, community sensitization and demand generation activities, financial remuneration and pricing schemes for providers, and formal linkage to healthcare and support.
CONCLUSION
Our review found evidence that POCT can be implemented successfully in private retail settings in LMICs, but comprehensive protocols are needed. High-quality randomised studies are needed to understand POCTs for infectious diseases other than malaria.
Topics: Humans; Health Facilities; Pharmacies; Pharmacy; Point-of-Care Testing; Retrospective Studies
PubMed: 37612636
DOI: 10.1186/s12879-023-08480-w