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Drug and Alcohol Dependence Jan 2021Research on socio-ecological factors that may impede or facilitate access to naloxone in pharmacies remains limited. This study investigated associations between...
BACKGROUND
Research on socio-ecological factors that may impede or facilitate access to naloxone in pharmacies remains limited. This study investigated associations between socio-ecological factors, pharmacy participation in the naloxone cost assistance program (NCAP), pharmacy characteristics and having naloxone in stock among pharmacies in New York City.
METHODS
Phone interviews were conducted with 662 pharmacies selected from the New York City Naloxone Standing Order List. Multi-level generalized linear modeling estimated associations between neighborhood racial and ethnic composition, poverty rates, overdose fatality rates, pharmacy participation in N-CAP, having private physical spaces within the pharmacy, knowledge of where to refer people to obtain naloxone and adjusted relative risk (aRR) that the pharmacy would have naloxone in stock.
RESULTS
Findings from this study supported several of the hypotheses. Greater neighborhood poverty was associated with a lower likelihood of carrying naloxone compared to neighborhoods with less poverty (aRR = .79, CI95 % = .69, .90, p < .001). Pharmacies that provided a private window for consultations (aRR = 1.34, CI95 % = 1.19, 1.51, p < .001), a private room (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001), and a private area (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001) were associated with a higher likelihood of carrying naloxone compared than those that did not.
CONCLUSIONS
Findings from this study suggest that community-level socioeconomic marginalization is a contributor to disparities in naloxone availability among pharmacies in New York City. Findings support harm reduction interventions tailored to the built environment of pharmacies that respect privacy to those seeking naloxone.
Topics: Drug Overdose; Ethnicity; Female; Harm Reduction; Humans; Male; Naloxone; New York City; Pharmaceutical Services; Pharmacies; Pharmacy; Racial Groups; Residence Characteristics; Standing Orders; Surveys and Questionnaires
PubMed: 33285392
DOI: 10.1016/j.drugalcdep.2020.108388 -
American Journal of Pharmaceutical... Oct 2017
Topics: Education, Pharmacy; Leadership; Pharmaceutical Services; Pharmacies; Pharmacy; Pharmacy Service, Hospital
PubMed: 29200455
DOI: 10.5688/ajpe6583 -
Revista de Saude Publica 2019To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic...
OBJECTIVE
To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market.
METHODS
This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price).
RESULTS
Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively.
CONCLUSIONS
Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.
Topics: Antihypertensive Agents; Brazil; Commerce; Community Pharmacy Services; Diabetes Mellitus; Drugs, Generic; Health Policy; Humans; Hypertension; Hypoglycemic Agents; Interrupted Time Series Analysis; Longitudinal Studies; National Health Programs; Pharmacies; Program Evaluation; Reference Values; Retrospective Studies; Time Factors
PubMed: 31644724
DOI: 10.11606/s1518-8787.2019053001237 -
Health & Place Jan 2021Tobacco retailer density is consistently associated with poor tobacco-use outcomes. The aim of this review was to synthesize the international evidence on density... (Review)
Review
Tobacco retailer density is consistently associated with poor tobacco-use outcomes. The aim of this review was to synthesize the international evidence on density reduction policies. Searches in multiple databases resulted in 31 studies covering various policy approaches evaluated for their impact on retailer density. Findings indicate that bans on tobacco sales in pharmacies reduced retailer density, but perhaps not equitably. Prohibiting sale of tobacco near schools produced greater density reductions in higher-risk neighborhoods. Policies in combination were most effective. Future studies should measure the impact of these policies on tobacco use. Density-reduction policies offer a promising approach to tobacco control.
Topics: Commerce; Humans; Pharmacies; Nicotiana; Tobacco Products; Tobacco Use
PubMed: 33526207
DOI: 10.1016/j.healthplace.2020.102342 -
BMJ Sexual & Reproductive Health Jan 2021
Topics: Adolescent; Contraception Behavior; Contraceptive Agents; Developing Countries; Family Planning Services; Female; Humans; Male; Pharmacies; Quality of Health Care; Self Care; Young Adult
PubMed: 32788181
DOI: 10.1136/bmjsrh-2020-200641 -
Journal of Managed Care Pharmacy : JMCP 2004The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing... (Review)
Review
BACKGROUND
The Omnibus Budget Reconciliation Act of 1990 offered the promise that prospective drug utilization review (pDUR) systems would improve the quality of drug prescribing and patient drug use. There is little evidence that this promise has been fulfilled. To the contrary, there is growing evidence that suboptimal use of drugs (in terms of preventable drug-related morbidity) is at least as costly as the prescription drugs themselves. Online computerized pDUR has been the subject of numerous critical examinations in the pharmacy and medical literature. Recent publications have sought to illustrate perceived shortcomings in the DUR systems currently in use.
OBJECTIVE
We focus on the state of the art with regard to pDUR, what is known about its effectiveness, and how emerging technologies may change pDUR and consider the work that may be needed to establish its effectiveness.
SUMMARY
A growing body of literature documents numerous problems and concerns with respect to the quality of DUR criteria, DUR alerts, and the response of health care professionals to these alerts. Problems with the current pDUR "system" can be grouped into those involving technical aspects (e.g., duplicate messaging from in-store and online systems, or message text limitations) and into those involving human aspects, specifically how pharmacists and other health care providers interpret and respond to potential drug therapy problem alerts generated by the electronic systems.
CONCLUSION
DUR is a quality assurance system that holds promise as a tool that, if implemented effectively, could enhance appropriate drug use. We believe a more systematic approach to DUR is needed. Evaluation and management of public and private pDUR systems must link documentation of processes of care, such as pharmacists. cognitive services, patient interventions, etc. To address technical aspects, we strongly recommend (a) a national effort to validate DUR screen criteria relying upon evidence-based studies and (b) adoption of a minimal set of.critical. pDUR screen criteria by pharmacy service providers and third-party intermediaries, including pharmacy benefit managers. To address the human component of pDUR systems, we advocate (a) adoption of performance standards for pharmacists and (b) explicit remuneration for time spent identifying and responding to drug therapy problems.
Topics: Drug Therapy; Drug Utilization Review; Humans; Pharmacies; United States
PubMed: 15369426
DOI: 10.18553/jmcp.2004.10.5.433 -
Research in Social & Administrative... Jun 2022Though medication reviews have shown positive patient outcomes, they are still not widely implemented in community pharmacies. Published reviews on their implementation... (Review)
Review
Experiences of key stakeholders with the implementation of medication reviews in community pharmacies: A systematic review using the Consolidated Framework for Implementation Research (CFIR).
BACKGROUND
Though medication reviews have shown positive patient outcomes, they are still not widely implemented in community pharmacies. Published reviews on their implementation often include several other pharmacy services, making them non-specific. Using the Consolidated Framework for Implementation Research (CFIR) to focus solely on the experiences of different stakeholders with the implementation of medication reviews will help to better understand relevant facilitators and barriers.
OBJECTIVES
To critically appraise, synthesise and present the available evidence on experiences of key stakeholders with the implementation of medication reviews and to identify barriers and facilitators to its implementation in community pharmacies.
METHODS
A systematic literature search was conducted in four databases for studies published in English, Spanish or German. Key search terms included: implementation, pharmac*, medication review, facilitator, barrier. Study selection, quality assessment and data extraction were performed by two independent reviewers. Findings were mapped directly against the constructs of the CFIR.
RESULTS
Out of 924 retrieved records 24 articles from 9 countries met the inclusion criteria. Key facilitators identified included pharmacists' openness to practice change and a high degree of patient satisfaction post medication review. Attracting patients to the service was stated as challenging due to an unawareness of the scope and potential benefit of a medication review. The dominant barrier was inadequate remuneration, as it impacted all additional resourcing and ultimately the viability of the service. Further barriers included difficult professional relationships with doctors and little mandate from health authorities. Most reports were from the employed pharmacists' perspective and concerned the inner setting, other perspectives were under-reported.
CONCLUSIONS
Results of this systematic review illustrate different stakeholders' experiences and add to the understanding of challenges in the implementation process. Nevertheless, findings also highlight how scarce reporting of external stakeholders' views is and that filling this gap can unveil hidden barriers and facilitators.
REGISTRATION
PROSPERO register (CRD 42019122836).
Topics: Humans; Medication Review; Pharmacies; Pharmacists
PubMed: 34420864
DOI: 10.1016/j.sapharm.2021.07.017 -
American Journal of Health-system... Oct 2022In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance....
In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.
Topics: Humans; Public Health; Pharmacies; Pharmacy; Pharmaceutical Services
PubMed: 35803592
DOI: 10.1093/ajhp/zxac187 -
Journal of the American Pharmacists... 2024According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription.
BACKGROUND
According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription.
OBJECTIVE
The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC.
METHODS
A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023. Trained "secret shoppers" enacted a standardized script and recorded whether naloxone was available and its cost. We examined the relationship between out-of-pocket naloxone cost, pharmacy type, and rurality.
RESULTS
Naloxone could be purchased in 53% of the pharmacies contacted; 26% incorrectly noting that naloxone could be filled only with a provider prescription and 21% did not sell naloxone. Naloxone availability by standing order was statistically different by pharmacy type (chain/independent) (χ = 20.58, df = 4, P value < 0.001), with a higher frequency of willingness to dispense according to the standing order by chain pharmacies in comparison to independent pharmacies. The average quoted cost for naloxone nasal spray at chain pharmacies was $84.69; the cost was significantly more ($113.54; P < 0.001) at independent pharmacies. Naloxone cost did not significantly differ by pharmacy rurality (F, = 2.38, P = 0.10).
CONCLUSION
Approximately half of NC community pharmacies audited dispense naloxone according to the statewide standing order, limiting same-day access to this life-saving medication. Costs were higher at independent pharmacies, which could be due to store-level policies. Future studies should further investigate these cost differences, especially as intranasal naloxone transitions from a prescription only to over-the-counter product.
Topics: Naloxone; North Carolina; Humans; Cross-Sectional Studies; Narcotic Antagonists; Health Services Accessibility; Community Pharmacy Services; Standing Orders; Pharmacies
PubMed: 38307248
DOI: 10.1016/j.japh.2024.01.017 -
Cadernos de Saude Publica 2022The provision of medicines in Brazil is marked by the predominance of private expenditures and supply in pharmacies and by the historically liberal regulation of retail...
The provision of medicines in Brazil is marked by the predominance of private expenditures and supply in pharmacies and by the historically liberal regulation of retail drug sales. The first two decades of the 21st century witnessed the expansion and concentration of the retail pharmaceutical sector and growing financialization of the health sector. The article analyzes the characteristics of financialization of Brazilian retail pharmaceutical companies, considering the following three crosscutting dimensions: ownership structure, financial/accounting, and political. Quantitative and qualitative data from various sources were analyzed including ownsership and account informations of the ten biggest Brazilian retail pharmacies chains and political action of four business associations. The information collected was stored in the source project database. The ownership structure dimension revealed verticalization, diversification, capitalization via financial and shareholding operations, intensification of mergers and acquisitions, opening of pharmacy branches, entry of investors, and changes in internal management and organization. The financial/accounting dimension revealed an increase in size (revenues, assets, net worth) and good performance (return on equity capital, capital turnover, and third-party capital) of the networks compared to Brazilian companies and health companies. The policy arena revealed both clashes and collaborations between representative associations and government (Executive, Legislative, and Judiciary), depending on the issue, with outcomes that were generally favorable to the pharmaceutical sector and leadership by the Brazilian Association of Pharmacy and Drugstore Networks (Abrafarma). The financialization of the retail pharmaceutical companies' accumulation pattern and the strengthening of their political action proved relevant for understanding the changes in the provision of medicines and in the pharmaceutical market.
Topics: Brazil; Humans; Pharmaceutical Preparations; Pharmaceutical Services; Pharmacies; Pharmacy
PubMed: 36043623
DOI: 10.1590/0102-311X00085420