California Pharmacists Research Articles

A Mixed Methods Evaluation of Pharmacists' Readiness to Provide Long-Acting Injectable HIV Pre-exposure Prophylaxis in California.

Pre-exposure prophylaxis (PrEP) uptake remains low among people who could benefit, some of whom may prefer alternatives to oral PrEP, such as long-acting injectable pre-exposure prophylaxis (LAI-PrEP). We evaluated the potential for LAI-PrEP provision in pharmacies through a mixed methods study of pharmacists in California, where Senate Bill 159 enables pharmacists to independently provide oral PrEP. In 2022-2023, we conducted an online cross-sectional survey of California pharmacists and pharmacy students (n = 919) and in-depth interviews with pharmacists (n = 30), both of which included modules assessing attitudes about PrEP provision. Using log-binomial regression, we estimated prevalence ratios (PRs) comparing survey participants' willingness to provide LAI-PrEP by pharmacy- and individual-level characteristics. Qualitative interview data were analyzed using Rapid Qualitative Analysis to identify factors that may affect pharmacists' provision of LAI-PrEP. Half of the survey participants (53%) indicated that they would be willing to administer LAI-PrEP using gluteal injection in their pharmacy. Willingness was higher among participants who worked in pharmacies that provided vaccinations or other injections (56% vs. 46%; PR: 1.2; 95% confidence interval: 1.0-1.4) and/or oral PrEP under Senate Bill 159 (65% vs. 51%; PR: 1.3; 95% confidence interval: 1.1-1.5) than among participants whose pharmacies did not. Interviewed participants reported barriers to LAI-PrEP provision, including the need for increased training and staffing, a private room for gluteal injections, better medication access, and payment for services. Pharmacies offer a promising setting for increased LAI-PrEP access. However, pharmacists may require additional training, resources, and policy changes to make implementation feasible.

Willingness of Pharmacists to Prescribe Medication Abortion in California

Nearly half of US states have restricted abortion access. Policy makers are exploring pathways to increase access to abortion and reproductive health care more broadly. Since 2016, California pharmacists could prescribe hormonal birth control, providing an opportunity to learn about the implementation of pharmacist-provided reproductive health care. To explore the feasibility of broadening pharmacist scope of practice to include prescribing medication abortion. A cross-sectional online survey was conducted from October 11 to December 20, 2022, among a convenience sample of California licensed community pharmacists to examine their attitudes toward, knowledge of, and confidence in prescribing hormonal birth control and reports of pharmacy-level practices. Descriptive analyses and log-binomial regression models were used to compare medication abortion and contraceptive provision attitudes by pharmacist and pharmacy characteristics. Among the 316 pharmacists included in the analysis who worked at community pharmacies across California (mean [SD] age, 40.9 [12.0] years; 169 of 285 [59.3%] cisgender women; and 159 of 272 [58.5%] non-Hispanic Asian individuals), most (193 of 280 [68.9%]) indicated willingness to prescribe medication abortion to pharmacy clients if allowed by law. However, less than half were confident in their knowledge of medication abortion (139 of 288 [48.3%]) or their ability to prescribe it (115 of 285 [40.4%]). Pharmacists who indicated that providing access to hormonal birth control as a prescribing provider was important (263 of 289 [91.0%]) and were confident in their ability to prescribe it (207 of 290 [71.4%]) were 3.96 (95% CI, 1.80-8.73) times and 2.44 (95% CI, 1.56-3.82) times more likely to be willing to prescribe medication abortion and to express confidence in doing so, respectively. Although most pharmacists held favorable attitudes toward hormonal birth control, less than half (144 of 308 [46.8%]) worked in a pharmacy that provided prescriptions for hormonal birth control, and 149 who did not reported barriers such as lack of knowledge or training (65 [43.6%]), insufficient staff or time to add new services (58 [38.9%]), and lack of coverage for services (50 [33.6%]). The findings of this cross-sectional survey study of California pharmacists suggest that most pharmacists were willing to prescribe medication abortion. However, future efforts to expand pharmacists' scope of practice should include training to increase knowledge and confidence in prescribing medication abortion. Pharmacy-level barriers to hormonal birth control prescription, such as insurance coverage for pharmacist effort, should also be addressed, as they may serve as barriers to medication abortion access.

Opportunities to Increase Access to HIV Prevention: Evaluating the Implementation of Pharmacist-Initiated Pre-exposure Prophylaxis in California.

Pharmacies are a promising setting through which to expand access to human immunodeficiency virus (HIV) prevention, including pre-exposure and post-exposure prophylaxis (PrEP and PEP, respectively). We aimed to evaluate and inform the implementation of California's Senate Bill 159 (2019), allowing pharmacists to independently prescribe PrEP and PEP. From October through December 2022, we conducted a cross-sectional study of 919 California pharmacists and pharmacy students, primarily recruited via the email listservs of professional organizations. Participants completed an online survey assessing the implementation of pharmacist-initiated PrEP/PEP, including knowledge, attitudes, practices, perceived barriers, and implementation preferences elicited through a discrete choice experiment. Among 919 participants (84% practicing pharmacists, 43% in community pharmacies), 11% and 13% reported that pharmacists at their pharmacy initiate PrEP and PEP, respectively. Most believed that pharmacist-initiated PrEP/PEP is important (96%) and were willing to provide PrEP (81%); fewer (27%) had PrEP/PEP training. Common implementation barriers were lack of staff/time and payment for pharmacist services. Participants preferred PrEP implementation models with in-pharmacy rapid oral HIV testing and pharmacists specifically hired to provide PrEP services. Despite pharmacists' supportive attitudes, Senate Bill 159 implementation in California pharmacies remains limited, in part due to policy-level and organizational-level barriers. Ensuring PrEP/PEP-related payment for services and sufficient workforce capacity is key to leveraging pharmacists' role in HIV prevention.

Implementation of the California advanced practice pharmacist and the continued disappointment of tiered licensure

The Advanced Practice Pharmacist (APh) designation in California was created via legislation 10 years ago. California pharmacists who meet certain criteria can be designated as an APh and unlock additional practice authority. Just 1065 pharmacists, or 2% of licensed California pharmacists, have obtained the APh designation through 2022. APhs did not report benefiting from the designation as it relates to expanded scope of practice. This experience of low uptake and minimal benefit mirrors the tiered licenses created by three other states. More recent legislation broadened the independent prescriptive authority of APhs, but this increased value proposition aligns with the practice authority adopted by other states who have imposed fewer barriers to entry. Given the track record observed to date, we doubt that tiered licensure will ever prove successful in the pharmacy profession. Instead, state policymakers and pharmacy advocates should consider adopting a “standard of care” regulatory approach to improve patient access to safe and beneficial pharmacist services.

Pharmacy access to contraception expands to more states

Since 2016, California pharmacists have had the authority to prescribe hormonal contraception. In 2017, the state of Colorado followed suit. Today, community pharmacists in 20 U.S. jurisdictions can prescribe birth control. In several other states, similar legislation is in progress, which would bring the tally to half of U.S. states where pharmacists can provide birth control directly to patients.

California pharmacist Mary Patricia Lee dies at 87

Mary Patricia (Pat) Lee, who led the pharmacy department at the University of California, San Diego (UCSD) Medical Center for 15 years, died July 20, 2020, at the age of 87. Her work included a focus on important pharmacy issues of the day, such as drug distribution technology, medication safety, and the development of cutting-edge clinical pharmacy programs. Philip Anderson, former director of drug information services at UCSD, recalled Lee as “the most interesting person I ever worked for.” “She was not only a director of pharmacy but a leader and an innovator,” Anderson said. “She understood how to accomplish advances for pharmacy at our medical center and guided our department from being competent to being a great department. Pat was also a mentor and good friend to me and others who worked for her.” Lee also had a rich and rewarding personal life. Anderson said Lee loved music, travel, and history; after retiring, she lived abroad, and she studied Italian to aid her research on documents from the Florence Cathedral.

End of Life Option Act Update

End of Life Option Act Update

The Vital Role of Pharmacy Professionals

The pandemic has reinforced the importance of the work that pharmacy professionals do. As the most accessible healthcare providers, pharmacists were often the first place patients turned when they needed to be tested for COVID-19. Now that vaccines are more readily available, pharmacies that are part of the federal retail pharmacy program administer nearly one million shots per day, compared to 67,000 at mass vaccination sites. And these numbers don’t even include the smaller pharmacies who aren’t part of the federal program.Pharmacists and their teams play a vital role in the health of our communities. From routine vaccinations to medication adherence, pharmacists are an integral part of the healthcare team. That’s why pharmacists should be free to provide the best care possible without being forced to meet profit-based quotas that can lead to unsafe practices and burnout.Here in California, CPhA is co-sponsoring SB 362 (Newman), which would prohibit these quotas. What’s most important is pharmacists’ ability to provide safe and effective care to patients. If you’re not located in California, I encourage you to reach out to your state pharmacy association to get involved and advocate for the profession. Pharmacy is stronger when we act as one profession, with one voice.Susan A. BonillaCEO, California Pharmacists Association

Community Pharmacists' Motivation and Barriers to Providing and Billing Patient Care Services.

Recently, California (CA) pharmacists’ scope of practice has expanded to include independently prescribing self-administered hormonal contraceptives, nicotine replacement therapy medications, travel health medications, routine vaccinations, naloxone hydrochloride, and HIV preexposure and postexposure prophylaxis. However, previous reports indicate that practicing within this expanded scope has remained limited. Therefore, a 26-item, web-based survey was emailed to CA community pharmacists to assess pharmacists’ knowledge, intent, and barriers to prescribing and billing for these patient care services. A total of 216 chain, supermarket-based, independent, mass merchant, and health-system outpatient pharmacists were included. The primary services provided and medications prescribed are for vaccinations and naloxone. Most pharmacists agree that engagement in and implementation of new strategies to enhance patients’ access to care is important. Common barriers include patient unawareness of pharmacist-provided services, lack of payment for services, and difficulty incorporating services within pharmacy workflow. Pharmacists are confident in their ability to provide patient care services but are less knowledgeable and confident about billing for them. Enhancing promotion of pharmacist-provided services to patients, developing strategies to efficiently incorporate them into the workflow, and payment models can help overcome barriers to providing these services.

California Community Pharmacist Preparedness in Ordering and Interpreting Laboratory Tests

Introduction The passage of Senate Bill 493 (SB 493) granted California pharmacists the ability to order and interpret lab tests without physician approval. Despite this legislation, not all pharmacists are aware of, or exercise, this authority. The goals of this study are to describe 1) pharmacists' willingness, 2) perceived factors influencing pharmacist preparedness, and 3) challenges and barriers to ordering laboratory tests in the community setting. Methods This is a prospective, descriptive survey study that was performed using online survey software from August 31, 2017, to October 4, 2017. An anonymous link was distributed to California pharmacists via California Society of Health-System Pharmacists (CSHP) and California Pharmacists Association (CPhA) email newsletters. Additionally, targeted interviews of pharmacists were conducted by phone to qualitatively assess barriers as well as successful practices. Institutional Review Board (IRB) approval was obtained prior to initiating the study. Results Sixty-six pharmacist respondents completed the online survey. The reported two biggest barriers to ordering lab tests identified by community pharmacists were 1) lack of available time and 2) compensation structure. Despite these barriers, most pharmacists were willing to order and interpret laboratory tests and accept the liability, regardless of a reimbursement guarantee. Conclusions Community pharmacists self-report preparedness to order and interpret laboratory tests. Barriers in carrying out this task include lack of staff, resources, compensation, and reimbursement structure.

Re-envisioning the Pharmacist's Role in the Era of Digital Health—CPhA's Inaugural Digital Health Conference

Digital health is rapidly evolving and promises to transform how health care is delivered and consumed. To explore advances at the intersection of health and technology and how pharmacy can embrace emerging modalities moving forward, the California Pharmacists Association (CPhA) hosted a Digital Health Conference on October 12 and 13, 2019, in Garden Grove, California. This conference provided an opportunity for pharmacists to gain a deeper understanding of the digital health ecosystem, explore opportunities, and share perspectives for leveraging digital health products to improve patient care. This commentary provides an overview of new and emerging digital health technologies, and a summary of the conference. It is not a comprehensive or systematic review of the field of digital health, rather its scope is limited to the key concepts and perspectives shared at the conference by presenters and participants. Table 1 provides information summarizing what is already known about this subject and what is added by this commentary. During the conference, pharmacists were introduced to definitions and concepts in digital health, discussed opportunities and challenges related to integration of digital health into existing health care infrastructures (including legal and regulatory frameworks, pharmacy practice models and payment), and explored educational needs to prepare pharmacists for their evolving roles. As digital health technologies are being integrated within the healthcare system, this conference aimed to focus on opportunities specific to pharmacy.

Emergency Contraception Access and Counseling in Urban Pharmacies: A Comparison between States with and without Pharmacist Prescribing.

Pharmacists are often the primary source of emergency contraception (EC) access and patient information. This study aims to identify differences in pharmacist-reported EC access and counseling between states which do or do not permit pharmacist-prescribed EC. This prospective, mystery caller study was completed in California (CA), which permits pharmacist-prescribed EC after completion of continuing education, and Georgia (GA), which does not. All community pharmacies that were open to the public in San Diego and San Francisco, CA, and Atlanta, GA were called by researchers who posed as adult females inquiring about EC via a structured script. Primary endpoints were EC availability and counseling. Statistical analyses completed with SPSS. Researchers called 395 pharmacies, 98.2% were reached and included. Regarding levonorgestrel (LNG), CA pharmacists more frequently discussed (CA 90.4% vs. GA 81.2%, p = 0.02), stocked (CA 89.5% vs. GA 67.8%, p < 0.01), and correctly indicated it “will work” or “will work but may be less effective” 4 days after intercourse (CA 67.5% vs. GA 17.5%, p < 0.01). Ulipristal was infrequently discussed (CA 22.6% vs. GA 3.4%, p < 0.01) and rarely stocked (CA 9.6% vs. GA 0.7%, p < 0.01). Pharmacists practicing in states which permit pharmacist-prescribed EC with completion of required continuing education may be associated with improved patient access to oral EC and more accurate patient counseling.

California pharmacist Sam Shimomura dies at 73 years

California pharmacist Sam Shimomura dies at 73 years

California Pharmacists' and Pharmacy Technicians' Opinions on Administration of Immunizations in Community Pharmacies by Pharmacy Technicians

Pharmacy technicians are prohibited from administering immunizations in California. This study sought to determine the opinions of California pharmacists and pharmacy technicians on the administration of immunizations in community pharmacies by pharmacy technicians. Both pharmacists and pharmacy technicians supported the authorization of pharmacy technicians to administer immunizations. Both believed that pharmacy technicians' assistance in administering immunizations would be beneficial.

The Proper Name

The Proper Name Valerie Rohy (bio) The first question was ordinary. When I was a kid in Southern California in the 1970s, I asked my mother why I was named Valerie. My mother said that before I was born, there was a senator who had twin daughters, one of whom was named Valerie. One night one of the sisters was killed by a stranger in their house. When my mother read about the incident in the newspaper, she thought, What a pretty name. I asked which of the twins was named Valerie. My mother said she couldn't remember. Though I'd later doubt that response, by then I didn't trust my memory either; it didn't seem possible that I recalled such a thing accurately. So I returned to the story in my forties in a state of uncertainty. I searched the internet using the words I remembered—senator, twins, murder, Valerie—and was astonished to find that everything my mother had told me was true. But because I was a little girl when my mother told the story, I had assumed that the twins were little girls. In reality, they were twenty-one, and the murdered daughter was Valerie Percy. Valerie Percy was the daughter of a Chicago businessman, Charles Percy, who was not yet a senator, but running for national office, which he later won. After her graduation from Cornell in June 1966, Valerie returned home to the wealthy enclave of Kenilworth, Illinois, to help with her father's campaign. On the morning of September 18, someone entered the house and killed her in her bedroom. The family, including her identical twin sister, Sharon, was asleep in the house, unaware. In September 1966 my mother was twenty-four years old; she would have read coverage of the Percy case in the Ithaca Journal and the Cornell Daily Sun, which covered the crime extensively due to Valerie Percy's Cornell connection. My mother had earned both her BA and MBA at Cornell; [End Page 275] my father was finishing his PhD in physics. They'd been married for a little over two years. She was a first-generation college student from a large family that had moved around the Connecticut River valley when she was a child; he was the son of a California pharmacist. My mother must have read the Percy articles in the apartment she and my father shared in an old farmhouse on Ellis Hollow Road in Ithaca. The Percy story ran daily for almost a week in the Ithaca Journal, alongside updates from Viet Nam and the NASA space program, as well as ads for Bass Weejuns, Salem menthols, hi-fi stereophonic sound, DuPont Dacron blazers, Ayn Rand books. The newspaper described Valerie Percy in diminutive terms: she was one of her father's "comely blonde twin daughters"; she was "gracious"; she "always wanted to do the right thing." On the other hand, one of her former professors said she was "exciting and stimulating to know." On the front page of the Cornell Daily Sun on September 19, 1966, she appears in a studio portrait, dark-eyed, demurely dressed, smiling slightly. She doesn't meet the camera's gaze—nor does she in the more candid, badly reproduced photograph in the same day's Ithaca Journal. The articles included graphic details: the Ithaca Journal said that Mrs. Percy had been "awakened by a moan." She found Valerie "dying of a crushed skull and more than a dozen stab wounds," and ran to activate the burglar alarm. By the time a doctor from the neighborhood arrived, it was too late. Writing this feels like a cruel repetition, but it's what my mother must have read. An investigation began immediately and soon involved the FBI. The Ithaca Journal offered updates on the Percy case well into 1967, revealing potential clues. Valerie's mother had caught a glimpse of the assailant, a white man, before he fled. There was no attempt at robbery. Police found bare footprints leading to a beach on Lake Michigan; a wet woolen glove; a green station wagon; a hole in the glass of a French door. Other items appeared later...

Exploring emergency contraception prescribing by pharmacists in California,

ObjectiveTo understand knowledge, current practices, barriers and facilitators for pharmacists prescribing emergency contraception (EC). Study DesignWe conducted a cross-sectional survey among California community pharmacists. We distributed the online survey, consisting of 34 close-ended questions, to members of the California Pharmacists Association via its email listserve. ResultsWe collected a survey response rate of 7%. Although 95% of respondents were aware of the statewide protocol allowing pharmacists to prescribe EC, only 36% of respondents reported prescribing EC in the previous year. Prescribing practices within the past year differed by type of pharmacy. We found no correlation between EC knowledge and prescribing practices. The most frequently reported facilitators of EC prescribing by pharmacists were the statewide protocol, a continuing education training program, and patient need or demand for EC. The most reported barriers to prescribing EC were lack of payment for pharmacist patient care services by insurers, increased responsibility or liability concerns, and time constraints. When asked about their intention to prescribe in the upcoming year, responses differed based on whether or not their pharmacies currently stocked EC. ConclusionThis exploratory study identifies key facilitators, such as the statewide protocol, and key barriers, such as lack of payment by insurance companies for pharmacist services. ImplicationsThe findings of this study could guide future multi-component implementation strategies such as academic detailing that specifically address concerns about increased responsibility, liability and time constraints. In addition, payment for pharmacist services could be addressed at a policy level since this was a barrier to pharmacist EC prescribing.

Medical Marijuana Knowledge and Attitudes: A Survey of the California Pharmacists Association.

Views on the medical efficacy and acceptability of marijuana have changed over the years. California was the first state permitting individuals to use medical marijuana. Even with a long history of use and widespread agreement around the effectiveness of medical marijuana, the literature is sparse about the role health care providers, including pharmacists, play in this interaction. The purpose of this article is to shed light on knowledge and attitudes of pharmacists regarding medical marijuana. We developed a survey for pharmacists about their level of knowledge and attitudes toward medical marijuana. The survey was distributed using SurveyMonkey. It consisted of 44 questions and an opportunity to provide comments. We collaborated with the California Pharmacists Association who provided a link to the survey in October 2017 to their members. Results from 474 responses indicate a majority of providers believe that marijuana has medical efficacy. Yet most providers report that they neither have much information about medical marijuana nor do they know where to get such information. One area of particular concern is the potential for drug interactions. Pharmacists would feel more comfortable discussing medical marijuana if it was approved by the Food and Drug Administration. Moreover, they believe more research needs to occur. The variance between California and federal policy leads to dysfunction among pharmacists providing information to patients. We believe federal policy should change.

Provision of Naloxone Without a Prescription by California Pharmacists 2 Years After Legislation Implementation

This study assesses the availability of pharmacist-furnished naloxone 2 years after implementation of legislation in California allowing provision of the drug without a physician’s prescription.

California pharmacists to ensure accuracy of high-risk patients' admission medication lists.

A new law in California aims to reduce errors in admission medication lists and thus make hospital care safer for patients at high risk for drug-related harm and readmission. The law, which goes into effect on January 1, 2019, requires pharmacy staff at hospitals with more than 100 beds to obtain

Examining the Attitudes and Beliefs of California Pharmacists Toward Dispensing Medications Intended to be Lethal

Objective: This study examined California pharmacists' attitudes and beliefs toward dispensing medications intended to be lethal. Method: A two-page survey instrument was administered in person and by mail to California-licensed pharmacists in 2016. The survey collected information on demographic characteristics (n=6 items), pharmacists' attitude toward their role in the End of Life Option Act (ELOA, n=16 items), knowledge of the Act (n=4 items), and one comment section. Pharmacists rated their attitudes on a five-point bipolar Likert scale ranging from strongly disagree (1) to strongly agree (5). Results: A total of 63 pharmacists responded, most of whom were male (n=32, 51%), considered themselves religious (n=41, 65.1%), and had an average age of 40.1 (SD=13.0) years. Only 30 (47.6%) respondents were willing to personally dispense a lethal dose of medication requested by a terminally ill patient with a valid prescription, while most agreed that they had the right to refuse to dispense a prescription intended to be lethal (n=56, 88.9%). Only 16 (25.4%) pharmacists reported having adequate knowledge to dispense and counsel on an ELOA drug. Most pharmacists called for more training on how to dispense and counsel patients about these lethal medications (n=54, 85.7%). Pharmacists' beliefs differed by whether they were religious or not (p&lt;0.05). Conclusion: Fewer than half of the pharmacists were willing to personally dispense a lethal dose of medication requested by a terminally ill patient with a valid prescription. California pharmacists do not have adequate knowledge concerning the End of Life Act. Further research on pharmacists' attitudes and beliefs is needed.