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Menopause (New York, N.Y.) Sep 2019To analytically characterize the doses of estradiol and progesterone found in compounded combined forms of oral capsule and transdermal cream formulations, and determine...
OBJECTIVES
To analytically characterize the doses of estradiol and progesterone found in compounded combined forms of oral capsule and transdermal cream formulations, and determine the consistency of the hormone formulations within a batch.
METHODS
Prescriptions for combined estradiol/progesterone capsules (0.5 and 100 mg, respectively) and creams (0.5 and 100 mg/g, respectively) were sent to 15 custom-compounding pharmacies. Estradiol and progesterone levels were measured by radioimmunoassays. Hormone levels were measured in 2 capsules and 2 creams from each pharmacy; 10 capsules from 3 pharmacies; and top/middle/bottom layer of cream containers to assess consistency. The magnitude and sources of variation for the measurements were examined by analysis of variance models.
RESULTS
Thirteen pharmacies filled the prescriptions. Measured estradiol levels were 0.365 to 0.551 mg for capsules and 0.433 to 0.55 mg/g for creams, and progesterone levels were 90.8 to 135 mg for capsules and 93 to 118 mg/g for creams. Greater variations in estradiol levels were observed between pharmacies for estradiol in capsules than in creams; however, measured estradiol levels within pharmacies were more consistent in the capsules than the creams. Similar results were obtained for progesterone levels.
CONCLUSION
The variations in estradiol and progesterone levels observed in compounded hormone therapy formulations justify concerns regarding risks as a result of variability, which have been outlined by The North American Menopause Society, the American College of Obstetricians and Gynecologists, and the US Food and Drug Administration (FDA) in their statements regarding compounded hormone use. These data support the need for an US FDA-approved bioidentical hormone therapy. : Video Summary: Supplemental Digital Content 1, http://links.lww.com/MENO/A425.
Topics: Capsules; Drug Compounding; Estradiol; Estrogen Replacement Therapy; Female; Humans; Menopause; Pharmacies; Progesterone; Skin Cream; United States
PubMed: 31453957
DOI: 10.1097/GME.0000000000001356 -
JAMA Psychiatry Nov 2020Methadone maintenance is an effective treatment of opioid use disorder, but federal regulations in the US restrict methadone dispensing to opioid treatment programs...
IMPORTANCE
Methadone maintenance is an effective treatment of opioid use disorder, but federal regulations in the US restrict methadone dispensing to opioid treatment programs (OTPs). In Australia, Canada, and the UK, patients can obtain methadone maintenance from community pharmacies.
OBJECTIVE
To compare driving access to methadone maintenance treatment between OTP and pharmacy dispensing models.
DESIGN, SETTING, AND PARTICIPANTS
This descriptive cross-sectional study assessed driving times from census tract mean centers of population to OTPs and pharmacies. Census tracts from the 50 US states and the District of Columbia (based on the 2010 US Census) were included if their population was greater than 0, if their mean center of population (MCP) was within 3 miles of the road network, and if the 1-way driving times from the census tract MCP to both an OTP and a pharmacy were 12 hours or less. Data analyses were performed from November 15, 2019, to April 18, 2020.
MAIN OUTCOMES AND MEASURES
The primary outcome was the population-weighted mean driving time from census tract MCPs to OTPs and pharmacies in the US. Census tract MCPs are population-weighted geographic centroids of residents living in each census tract. Driving times were estimated using historical average driving speeds.
RESULTS
All 1682 unique locations of OTPs were included, and 69 475 unique pharmacy locations were included after geocoding. A total of 72 443 census tracts were included in the analysis. The mean population-weighted driving time from census tract MCPs was 20.4 minutes (95% CI, 20.3-20.6 minutes) to OTPs and 4.5 minutes (95% CI, 4.4-4.5 minutes) to pharmacies (P < .001). Differences in driving time, distance, and cost between 1-way trips ending at OTPs and pharmacies were largest in micropolitan and noncore counties.
CONCLUSIONS AND RELEVANCE
In this study, population-weighted mean driving times from US census tract MCPs were longer to OTPs than to pharmacies.
Topics: Ambulatory Care Facilities; Automobile Driving; Cross-Sectional Studies; Humans; Opiate Substitution Treatment; Pharmacies; Time Factors; United States
PubMed: 32667648
DOI: 10.1001/jamapsychiatry.2020.1624 -
Journal of Medical Internet Research Feb 2018One of the forerunners in electronic health, Finland has introduced electronic prescriptions (ePrescriptions) nationwide by law. This has led to significant changes for...
BACKGROUND
One of the forerunners in electronic health, Finland has introduced electronic prescriptions (ePrescriptions) nationwide by law. This has led to significant changes for pharmacy customers. Despite the worldwide ambition to develop ePrescription services, there are few reports of nationally adopted systems and particularly on the experiences of pharmacy customers.
OBJECTIVE
The aim of this study was to investigate Finnish pharmacy customers' (1) experiences with purchasing medicines with ePrescriptions; (2) experiences with renewing ePrescriptions and acting on behalf of someone else at the pharmacy; (3) ways in which customers keep up to date with their ePrescriptions; and (4) overall satisfaction with ePrescriptions.
METHODS
Questionnaires were distributed to 2913 pharmacy customers aged ≥18 years purchasing prescription medicines for themselves with an ePrescription in 18 community pharmacies across Finland in autumn 2015. Customers' experiences were explored with 10 structured questions. The data were stored in SPSS for Windows and subjected to descriptive analysis, chi-square, Fisher exact, Kolmogorov-Smirnov, the Mann-Whitney U, and Kruskal-Wallis tests.
RESULTS
Completed questionnaires were returned by 1288 customers, a response rate of 44.19% (1288/2913). The majority of the respondents did not encounter any problems during pharmacy visits (1161/1278, 90.85%) and were informed about the current status of their ePrescriptions after their medication was dispensed (1013/1276, 79.44%). Over half of the respondents had usually received a patient instruction sheet from their physician (752/1255, 59.92%), and nearly all of them regarded its content as clear (711/724, 98.2%). Half of the respondents had renewed their ePrescriptions through the pharmacy (645/1281, 50.35%), and one-third of them had acted on behalf of someone else with ePrescriptions (432/1280, 33.75%). Problems were rarely encountered in the renewal process (49/628, 7.8%) or when acting on behalf of another person (25/418, 6.0%) at the pharmacy. The most common way of keeping up to date with ePrescriptions was to ask at the pharmacy (631/1278, 49.37%). The vast majority of the respondents were satisfied with ePrescriptions as a whole (1221/1274, 95.84%).
CONCLUSIONS
Finnish pharmacy customers are satisfied with the recently implemented nationwide ePrescription system. They seldom have any difficulties purchasing medicines, renewing their ePrescriptions, or acting on behalf of someone else at the pharmacy. Customers usually keep up to date with their ePrescriptions by asking at the pharmacy. However, some customers are unaware of the practices or have difficulty keeping up to date with the status of their ePrescriptions. The provision of relevant information and assistance by health care professionals is therefore required to promote customers' adoption of the ePrescription system.
Topics: Adolescent; Adult; Aged; Consumer Behavior; Cross-Sectional Studies; Electronic Prescribing; Female; Finland; Humans; Male; Middle Aged; Pharmacies; Surveys and Questionnaires; Young Adult
PubMed: 29475826
DOI: 10.2196/jmir.9367 -
Medical Care Research and Review : MCRR Jun 2013Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of... (Review)
Review
Many studies have demonstrated the beneficial effects that pharmacist-provided patient care services can have on patient health outcomes. However, the effectiveness of patient care services delivered by pharmacists in community pharmacy settings, where organizational barriers may affect service implementation or limit effectiveness, remains unclear. The authors systematically reviewed the literature on the effectiveness of pharmacist-delivered patient care services in community pharmacy settings in the United States. Of the 749 articles retrieved, 21 were eligible for inclusion in the review. Information concerning 134 outcomes was extracted from the included articles. Of these, 50 (37.3%) demonstrated statistically significant, beneficial intervention effects. The percentage of studies reporting favorable findings ranged from 50% for blood pressure to 0% for lipids, safety outcomes, and quality of life. Our findings suggest that evidence supporting the effectiveness of pharmacist-provided direct patient care services delivered in the community pharmacy setting is more limited than in other settings.
Topics: Community Pharmacy Services; Humans; Patient Outcome Assessment; Pharmacies; Professional Role
PubMed: 23035056
DOI: 10.1177/1077558712459215 -
PloS One 2022Many students seem to find pharmacology learning very challenging due to the complexity and variety of drugs they have to study. The number of drugs the students have to...
OBJECTIVES
Many students seem to find pharmacology learning very challenging due to the complexity and variety of drugs they have to study. The number of drugs the students have to learn, the duration of time to learn the medications, and the evolving nature of diseases demanded learning beyond the classroom walls. This study explored and described nursing students' experiences in community and hospital-based pharmacy practice sites during their service-learning and its implications for pharmacology pedagogical practices.
METHODS
Kolb's learning theory provided the framework to explore nursing students' 48-hour service-learning experiences at community/hospital-based pharmacies in Belize and its implications for pharmacology pedagogy. The study utilized two qualitative approaches, reflective journals and focus group interviews, to collect data from 46 second-year nursing students. NVivo software and coding schemes were employed to analyze the data from the interviews and reflective journals.
RESULTS
Students reported learning medications, integrating classroom pharmacological knowledge at pharmacy practice sites, acquiring and enhancing communication skills, interpreting prescriptions, dispensing medications, drug calculations, taking inventory, doing vital signs, and patient education. In addition, students reported experiencing inter-professional relationships as healthcare team members. Anxiety was a major challenge experienced by many students at the beginning of the service-learning experience.
CONCLUSIONS
This study highlights the importance of experiential learning of pharmacology amongst second year nursing students, offering the opportunity to inform and support pharmacotherapeutics educators in designing strategies for more effective teaching of medications to nursing students. It also supports the addition of pharmacy placements to the nursing curriculum' as it shows that nursing students can learn medications, skills, and teamwork from experiential pharmacy site posting. Combining classroom instruction with pharmacy experiential service learning might be an effective complement for teaching nursing pharmacology.
Topics: Humans; Students, Nursing; Pharmacies; Belize; Education, Nursing, Baccalaureate; Hospitals
PubMed: 36327317
DOI: 10.1371/journal.pone.0276656 -
International Journal of Clinical... Feb 2018Background Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There...
Background Pharmacists are increasingly involved in patient care. This new role in a complex healthcare system with demanding patients may lead to moral dilemmas. There has been little research into pharmacy ethics, and existing data are limited by their retrospective nature and small sample sizes. A thematic overview of the moral dilemmas experienced by community pharmacists is still missing. Objective To make a thematic overview of moral dilemmas experienced in daily pharmacy practice. Setting Dutch community pharmacy. Methods Dutch community pharmacists wrote a narrative about a moral dilemma they had experienced in clinical practice. The narratives were analysed using qualitative content analysis to identify underlying themes. Main outcome measure Themes of moral dilemmas. Results Twenty-two themes were identified in 128 narratives. These moral dilemmas arose predominantly during pharmacists' contact with patients and other health professionals. The relationship between the pharmacist, patient and other health professionals was complicated by other parties, such as legal representatives, health insurance companies, and regulators. Conclusion The moral dilemmas experienced by community pharmacists are more diverse than previously reported. The main dilemmas arose in their professional contacts, frequently when their professional autonomy was challenged by the behaviour of patients and other health professionals.
Topics: Community Pharmacy Services; Ethics, Pharmacy; Female; Humans; Male; Morals; Narration; Pharmacies; Pharmacists
PubMed: 29159520
DOI: 10.1007/s11096-017-0561-0 -
Research in Social & Administrative... Jun 2024Emerging evidence suggests pharmacy-based point-of-care (POC) testing for acute respiratory infectious diseases is beneficial, but not widely implemented. A... (Review)
Review
Factors influencing Implementation of point-of-care testing for acute respiratory infectious diseases in community pharmacies: A scoping review using the Consolidated Framework for Implementation research.
BACKGROUND
Emerging evidence suggests pharmacy-based point-of-care (POC) testing for acute respiratory infectious diseases is beneficial, but not widely implemented. A theory-informed review to understand the factors influencing service Implementation is lacking.
OBJECTIVE
To examine the extent, range, and nature of research available on enablers and barriers to POC testing Implementation for infectious respiratory diseases in community pharmacies and identify their underpinning theoretical constructs using the Consolidated Framework for Implementation Research (CFIR).
METHODS
Scoping review guided by the JBI Manual for Evidence Synthesis. A comprehensive search from inception to June 28th, 2022 was conducted using Medline, Embase, CINAHL, Cochrane Library, and ProQuest dissertations without date or language restriction. Eligible articles investigated barriers and/or facilitators to strep throat, influenza, C-reactive protein, and COVID-19 POC testing in community pharmacies. Two reviewers independently performed title & abstract screening, full-text screening, and data extraction. Content analysis was conducted according to a pre-established Framework and concepts were mapped to the CFIR.
RESULTS
Forty-three studies were included. Most originated from the USA (n = 24; 56%) and investigated strep throat. The majority were testing/initial Implementation projects (n = 23; 54%) conducted in urban centers (n = 17; 40%). Thirty-six (84%) studies used quantitative methodology, while 6 (14%) were qualitative. Only four studies (9%) used theory to guide their inquiry. The 124 identified Implementation factors mapped onto 21 CFIR constructs, covering all 5 domains. The domain "Outer setting" (n = 35/43; 81%) was most prevalent as were the constructs "Patient needs and resources," (n = 21/43; 49%) "External policy & incentives," (n = 17/43; 40%) and "Relative advantage" (n = 17/43; 40%).
CONCLUSION
A large volume of research explores factors influencing the Implementation of pharmacy-based respiratory infectious disease POC testing services, but few studies use qualitative or theory-informed methods. Knowledge of the wide range of facilitators and barriers identified can help pharmacy managers and researchers design strategies to support successful service Implementation.
Topics: Humans; Point-of-Care Testing; Community Pharmacy Services; Respiratory Tract Infections; COVID-19; Pharmacies
PubMed: 38431516
DOI: 10.1016/j.sapharm.2024.02.009 -
PloS One 2021Evaluation of patients`satisfaction towards pharmacy services is of utmost importance to ensure the quality of care. It helps in identifying domains requiring...
BACKGROUND
Evaluation of patients`satisfaction towards pharmacy services is of utmost importance to ensure the quality of care. It helps in identifying domains requiring improvements to provide high quality pharmacy services to ensure the provision of enhanced pharmaceutical care. The current study aims to ascertain the extent of satisfaction towards pharmacy services among patients attending outpatient pharmacies in Kingdom of Saudi Arabia.
METHODS
A hospital-based cross-sectional study involving 746 patients attending outpatient pharmacies of various public hospitals was conducted from 01 January to 15 February 2020. Information on socio-demographic profile of the study subjects along with their satisfaction towards outpatient pharmacy was extracted by using a 23-items questionnaire. These questions were divided into two domains including 7 questions related to the pharmacy facilities (questions from 1F to 7F) and 8 questions for pharmacy services (questions from 1S to 8S), where F and S denotes facilities and services, respectively. The cumulative satisfaction score was estimated by a 5-item Likert scale with a maximum score of 5 for each item. The relationship between demographics and satisfaction scores was evaluated by using appropriate statistics.
RESULTS
There were 746 patients with male preponderance (58.8%). The overall satisfaction score was 2.97 ± 0.65. Satisfaction towards pharmacy services scored lower (mean score: 3.91 ± 0.77) than pharmacy facilities (mean score: 4.03 ± 0.66). Items related to patient`s counseling (3F, 2S, 3S, 6S) scored least during the analysis. Older patients (p = 0.006), male gender (p<0.001), Saudi nationality (0.035), patients attending primary care centers (p = 0.02), and patients with chronic illnesses were significantly associated with lower satisfaction score.
CONCLUSION
This study reported that the satisfaction level of patients attending outpatient pharmacies was low and differed among various socio-demographic groups. Approximately one-half of the patients were not satisfied with outpatient pharmacy services. These findings underscore the dire need for managerial interventions including the hiring of trained professionals, onsite training of pharmacy staff, initiation of clinical or patient centered pharmacy services, evaluation of patient`s response towards the services and appropriate controlling measures, irrespective to the type of hospitals.
Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Outpatients; Patient Satisfaction; Pharmacies; Pharmacists; Primary Health Care; Saudi Arabia; Surveys and Questionnaires; Young Adult
PubMed: 33793604
DOI: 10.1371/journal.pone.0247912 -
BMJ Sexual & Reproductive Health Jan 2022Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although...
BACKGROUND
Unsafe abortion is an important public health problem in Ghana, making significant contributions to the morbidity and mortality of reproductive-aged women. Although mostly used in explaining mortality associated with perinatal care, recent calls for research on induced abortion in Africa suggest that the Three Delays Model could be used to enhance understanding of women's experiences and access to induced abortion care.
METHODS
We conducted 47 face-to-face interviews with women who had experienced unsafe abortions, with formal abortion providers (abortion providers in hospitals) and with informal and non-legal abortion providers (pharmacy workers and herb sellers). Study participants were recruited from selected hospitals, community pharmacies and markets within the Ashanti region of Ghana. We drew on phenomenology to analyse the data.
FINDINGS
The first delay (in seeking care) occurred because of women's poor knowledge of pregnancy, the influence of religion, and as a result of women underestimating the seriousness of abortion complications. Factors including cost, provider attitudes, stigma, and the proximity of pharmacies to women's homes delayed their access to safe abortion and resulted in their experience of the second delay (in reaching a healthcare facility). The third delay (in receiving appropriate care) was a result of hospitals' non-prioritisation of abortion complications and a shortage of equipment, resulting in long hospital waiting times before treatment.
CONCLUSION
This study has shown the value of the Three Delays Model in illustrating women's experiences of unsafe abortions and ways of preventing the first, second and third delays in their access to care.
Topics: Abortion, Induced; Adult; Female; Ghana; Humans; Pharmacies; Pregnancy; Qualitative Research; Social Stigma
PubMed: 34272209
DOI: 10.1136/bmjsrh-2020-200903 -
Health Expectations : An International... Jun 2020Patient and public involvement and co-production are widely used, but nevertheless contested concepts in applied health research. There is much confusion about what they...
BACKGROUND
Patient and public involvement and co-production are widely used, but nevertheless contested concepts in applied health research. There is much confusion about what they are, how they might be undertaken and how they relate to each other. There are distinct challenges and particular gaps in public involvement in alcohol research, especially when the study focus is on health matters other than alcohol dependence.
OBJECTIVE
To explore how patient and public involvement and co-production have been interpreted and applied within a multi-disciplinary research programme in the development of a complex intervention on alcohol and medicine use in community pharmacies.
DESIGN
The paper presents the authors' critical reflection on a grounded example of how public involvement concepts have been translated into practice in the intervention development phase of a publicly funded research programme, noting its impact on the programme to date.
DISCUSSION
Co-production adds another layer of complexity in the development of a complex intervention. The research planning requirements for publicly funded research circumscribe the possibilities for co-production, including impacting on the possibility of stability and continuity over time.
Topics: Humans; Pharmacies; Research Design
PubMed: 32233053
DOI: 10.1111/hex.13046