Chain Pharmacies Research Articles

Naloxone Availability and Cost After Transition to an Over-the-Counter Product

The US Food and Drug Administration approved Narcan, a nasal spray formulation of naloxone, for sale as an over-the-counter (OTC) medication in March 2023. The purpose of OTC approval was to improve naloxone accessibility to reduce opioid overdoses; however, research has not yet evaluated whether naloxone's availability and cost changed since this policy was implemented. To evaluate whether the accessibility and cost of naloxone at North Carolina community pharmacies changed after OTC naloxone became available and whether cost and availability varied by pharmacy type and urbanicity. This longitudinal telephone-based secret shopper survey study included a stratified sample of 202 North Carolina community pharmacies, including health department, independent, and chain pharmacies. There were 2 separate data collection efforts from March to April 2023 (before OTC naloxone could be sold at pharmacies) and November 2023 to January 2024 (after OTC naloxone was sold at pharmacies). OTC naloxone first became available for sale at community pharmacies in September 2023. The main outcomes were same-day availability of naloxone without a clinician-issued prescription and the quoted out-of-pocket cost for cash-paying patients. Data were collected from 192 pharmacies. Same-day naloxone availability increased from 42.2% (81 of 192) before OTC naloxone availability to 57.8% (111 of 192) after (P < .001). The mean (SD) quoted out-of-pocket cost decreased from $90.93 ($42.6) pre-OTC availability to $62.67 ($41.0) post-OTC availability (P < .001). Independent pharmacies had higher mean (SD) costs than chain pharmacies in both the pre-OTC phase ($109.47 [$37.90] vs $86.40 [$35.70]; P < .001) and post-OTC phase ($77.59 [$38.90] vs $57.74 [$35.90]; P = .004). Out-of-pocket costs did not differ by urbanicity in the pre-OTC phase; however, mean (SD) costs were higher at suburban ($88.67 [$66.80]) and rural ($65.43 [$35.00]) pharmacies compared with urban pharmacies ($53.58 [$29.00]) in the post-OTC phase (P = .003). The Food and Drug Administration's approval of OTC naloxone nasal spray contributed to an increase in pharmacy-based availability of naloxone and a reduction of its cost for cash-paying patients. Cost was higher at independent pharmacies compared with chain pharmacies and lower in urban pharmacies compared with suburban and rural pharmacies.

Potentially Inappropriate Use of Medication and Its Determinants Among Ambulatory Older Adults in Six Community Chain Pharmacies in Asmara, Eritrea: A Cross-Sectional Study Using the 2023 American Geriatric Society Beers Criteria®.

Potentially inappropriate medication (PIM) use is one of the main drug-related problems encountered in older adults. It is associated with adverse drug events, morbidity, mortality, increased economic costs, and negative effects on the quality of life that requires strict monitoring of prescriptions in older adults. Thus, the study aimed to assess potentially inappropriate medication use and its determinants among older adults. A cross-sectional study was conducted among all outpatient prescriptions dispensed to older adults (aged 65 years and above) in six community chain pharmacies in Asmara, Eritrea. Data were collected retrospectively, between June 16 and July 16, 2023. PIMs were detected using the 2023 American Geriatric Society (AGS) Beers Criteria®. Descriptive statistics and logistic regression analysis were performed using IBM SPSS® (Version-26.0). A total of 2680 outpatient prescriptions dispensed to older adults were included in this study. The prevalence of PIM among prescriptions was 18.1% (95% CI: 16.7, 19.6). Moreover, a total of 470 medications were found to be avoided in older adults. The most commonly prescribed PIMs were sulfonylureas (27.2%) and substituted alkylamines (16.2%). The prevalence of prescriptions containing medications to be used with caution in older adults was 13.2% (95% CI: 12.0, 14.5). Age (Adjusted Odds Ratio (AOR))=0.98, 95% CI: 0.97, 0.99), polypharmacy (AOR=2.77, 95% CI: 1.49, 5.15), and general practitioner prescriber (AOR=1.38, 95% CI: 1.11, 1.70) were significantly associated with PIMs. A considerable number of ambulatory older adults were exposed to PIMs which require a close attention by policymakers, program managers, and healthcare professionals.

Reducing economic burden through split-shared care model for people living with uncontrolled type 2 diabetes and polypharmacy: a multi-center randomized controlled trial

BackgroundInterprofessional collaborative care such as a split-shared care model involving family physicians and community pharmacists can reduce the economic burden of diabetes management. This study aimed to evaluate the economic outcome of a split-shared care model between family physicians and community pharmacists within a pharmacy chain in managing people with uncontrolled type 2 diabetes and polypharmacy.MethodThis was a multi-center, parallel arm, open label, randomized controlled trial comparing the direct and indirect economic outcomes of people who received collaborative care involving community pharmacists (intervention) versus those who received usual care without community pharmacist involvement (control). People with uncontrolled type 2 diabetes, defined as HbA1c > 7.0% and taking ≥ 5 chronic medications were included while people with missing baseline economic data (such as consultation costs, medication costs) were excluded. Direct medical costs were extracted from the institution’s financial database while indirect costs were calculated from self-reported gross income and productivity loss, using Work Productivity Activity Impairment Global Health questionnaire. Separate generalized linear models with log link function and gamma distribution were used to analyze changes in direct and indirect medical costs.ResultsA total of 175 patients (intervention = 70, control = 105) completed the trial and were included for analysis. The mean age of the participants was 66.9 (9.2) years, with majority being male and Chinese. The direct medical costs were significantly lower in the intervention than the control group over 6 months (intervention: -US$70.51, control: -US$47.66, p < 0.001). Medication cost was the main driver in both groups. There were no significant changes in productivity loss and indirect costs in both groups.ConclusionImplementation of split-shared visits with frontline community partners may reduce economic burden for patient with uncontrolled type 2 diabetes and polypharmacy.Trial registrationClinicaltrials.gov Reference Number: NCT03531944 (Date of registration: June 6, 2018).

Studying Health and Illness Experience using Linked Data (SHIELD): Empowering customers to donate shopping data for chronic pain research

Introduction &amp; BackgroundChronic pain is considered a priority in healthcare and a threat to well-being across the globe, it is thus crucial to accurately measure the national levels of pain conditions and their impacts on workplace productivity and well-being. Chronic pain has traditionally been studied in isolation with either self-reported survey data or standalone shopping records. The former are limited in scale and can be marred by response biases, while the latter lack ‘ground truths’: what research teams can measure are usually the purchase patterns of pain relief products, but neither the severity nor types of pain conditions. Objectives &amp; ApproachData donation tools offer a novel approach to study chronic pain by linking the two aspects and establish statistical relationships between medicine consumptions and the multiple facets of pain experience. In a survey, we asked participants (N = 953) to share their loyalty card data with us, which is made possible with the data portability tool provided by Tesco (i.e., the largest supermarket chain in the United Kingdom) as part of the General Data Protection Regulation (GDPR). Based on questions adopted from popular inventories used in health research (e.g., EQ5D Health States, ONS4 Well-being, WEMWBS scales), we also asked participants to report the details of their pain conditions, hours of employment, and both general and mental health states. This allowed us to associate chronic pain - both subjective and objective (i.e., reflected by medicine consumption) - with its economic and personal consequences. Data collection was conducted via research panel providers, thus should approximate national representativeness. Relevance to Digital FootprintsThis work links digital footprints data donated by individuals to self-reported survey data, also develops an infrastructure for these data to be collected and safely stored. Conclusions &amp; ImplicationsOne key value of this project is to pioneer a measure of chronic pain that can be applied to transactional records that are much bigger in scale in future analytic works. Our research team has access to an array of different digital footprints data, including longitudinal transactional data provided by a major pharmacy chain (~20 million customers and ~429 million baskets). In order to utilise these data to associate them with regional workplace productivity measures and well-being data released by the Office for National Statistics, a metric must be defined to extract the prevalence of chronic pain from shopping data, which is informed by the patterns found by the data donation project.

The “Ripple Effect”: The Effect of Family-Work Conflict on Mentor-protégé Relationship

ABSTRACT Drawing from conservation of resources theory, this research examines how and when mentors’ family – work conflict is related to protégés’ work outcomes (i.e. job performance and career satisfaction). We proposed mentors’ family – work conflict depleted their resources, thus had a negative influence on protégés’ work outcomes. Further, we addressed the mediating role of mentoring functions (i.e. career support, psychosocial support, and role modeling) and the moderating roles of mentors’ core self-evaluation and mentor – protégé relational quality. We tested the hypothesized moderated mediation model using time-lagged data from 162 mentor – protégé dyads in a large Chinese pharmacy chain company. The results demonstrated that (a) mentors’ family – work conflict was negatively associated with protégés’ work outcomes; (b) mentoring functions mediated this relationship; (c) mentors’ core self-evaluation and mentor – protégé relational quality moderated the main effect of mentors’ family – work conflict on mentoring functions and the indirect effect of mentors’ family – work conflict on protégés’ work outcomes via mentoring functions; and (d) the indirect effect was significant when mentors’ core self-evaluation or mentor – protégé relational quality was low. Important implications for management research are discussed.

Exposure of Pharmacists and Pharmacy Technicians to Violence in Community Pharmacies in Southeast Europe: Frequency and Ethical Considerations.

Pharmacists and pharmacy technicians working in community pharmacies are exposed to the risk of violence in their workplaces. Studies have shown that workplace violence is affecting their job satisfaction, productivity, and mental health. This study aims to identify the frequency of different types of violence, as well as the common perpetrators that community pharmacy staff in SEE (Southeast Europe) are dealing with. A cross-sectional study was conducted using an online questionnaire created for this purpose. Selected community pharmacies in Croatia, Serbia, Bosnia and Herzegovina, and Montenegro participated in this study. In total, 732 responses were collected from 24 pharmacy chains or independent pharmacies including all community pharmacy staff. More than 80% of pharmacists and pharmacy technicians reported having been exposed to verbal violence at the workplace, while more than 20% of them reported physical and sexual violence in the preceding 12 months. There were no statistically significant differences between pharmacists and pharmacy technicians, gender, age groups, or countries in relation to exposure to physical, verbal, and sexual violence. The most common perpetrators were identified as patients/clients. More than 90% of pharmacy staff reported they did not receive any kind of support from their employer nor any other help after experiencing a robbery. There is a need for a structured approach to addressing violence in pharmacies including organized support for pharmacy staff. Achieving quality patient care, despite dealing with violent individuals or situations daily, is one of the greatest ethical challenges for healthcare providers in community pharmacies to be empowered.

Antibiotic prescribing practice using WHO Access, Watch and Reserve classification and its determinants among outpatient prescriptions dispensed to elderly population in six community chain pharmacies in Asmara, Eritrea: a cross-sectional study

ObjectiveTo assess antibiotic prescribing practice and its determinants among outpatient prescriptions dispensed to the elderly population.DesignA prescription-based, cross-sectional study.SettingSix community chain pharmacies in Asmara, Eritrea.ParticipantsAll outpatient prescriptions dispensed to the...

Policies, adaptations, and ongoing challenges to naloxone, buprenorphine and nonprescription syringe access across four-states: Findings from an environmental scan and key informant interviews

BackgroundAs the US opioid-involved morbidity and mortality increase, uptake and implementation of evidence-based interventions remain key policy responses. Respond to Prevent was a multi-component, randomized trial implemented in four states and two large pharmacy chains with the aim of improving the pharmacy’s capacity to provide naloxone, dispense buprenorphine, and sell nonprescription syringes (NPS). We sought to provide context and assess how policies and organizational practices affect communities and pharmacies across the study states. MethodsUsing a multi-method approach we: 1) conducted an environmental scan of published literature and online materials spanning January 2015 to June 2021, 2) created timelines of key events pertaining to those policies and practices and 3) conducted semi-structured interviews with stakeholders (key informants) at the state and local levels (N=36) to provide further context for the policies and practices we discovered. ResultsKey informants discussed state policies, pharmacy policies and local practices that facilitated access to naloxone, buprenorphine and NPSs. Interviewees from all states spoke about the impact of naloxone standing orders, active partnerships with community-based harm reduction organizations, and some federal and state policies like Medicaid coverage for naloxone and buprenorphine, and buprenorphine telehealth permissions as key facilitators. They also discussed patient stigma, access in rural settings, and high cost of medications as barriers. ConclusionFindings underscore the important role harm reduction-related policies play in boosting and institutionalizing interventions in communities and pharmacies while also identifying structural barriers where more focused state and local attention is needed.

“That’s a tricky one”: Access to misoprostol for early pregnancy loss in retail pharmacies across Arizona

ObjectivesThis study aimed to describe the same-day availability of misoprostol for medical management of early pregnancy loss (EPL) at Arizona pharmacies. Study designWe performed a simulated-patient mixed methods study of Arizona pharmacies from October 2022 to February 2023, documenting misoprostol availability and describing pharmacy staff responses. ResultsOf 941 pharmacies included, 703 (75%) could fill a misoprostol prescription same day. Ability to fill prescriptions and reasons why the prescription could not be filled varied by pharmacy type. National chain pharmacies most frequently had misoprostol available but also most commonly reported policies restricting dispensing. ConclusionsBarriers exist to filling misoprostol prescriptions for early pregnancy loss in Arizona that could impact patient care.

Role of a unified preventive environment with the partici pation of pharmacy organizations in the fight against chronic non-communicable diseases

Relevance. Preserving and strengthening the health of the population is the most important task of the healthcare system, including pharmacy organizations. Therefore, it is important to unite the efforts of medical and pharmaceutical specialists to form a unified preventive environment in the region. This will make it possible to rationally distribute the resources of healthcare organizations in the fight against chronic non-communicable diseases and increase citizens’ satisfaction with accessible preventive care.Methodology. To achieve the goal and solve the assigned problems, content analysis, comparative and logical analysis, and observation and graphic methods were used. The objectives of this study were to obtain regulatory documentation data, the main strategies and recommendations of the World Health Organization in the field of protecting public health, the infrastructure of pharmacy organizations, and consumer opinion.Results. The study highlighted the main aspects of preventive activities, which are the actions of pharmaceutical specialists toward preserving public and individual health. The current state of preventive work of pharmacies in the Yaroslavl region has been studied, and the most common preventive services have been identified. The need for the formation of a unified preventive environment in the region with the participation of pharmacies is substantiated as one of the ways to improve the professional activities of pharmaceutical specialists in the prevention of chronic non-infectious diseases. A model of a unified preventive environment for the regional healthcare system was developed, indicating the general and specialized functions of the organizations. An assessment of the effectiveness of the implementation of preventive services in the activities of pharmacy organizations was conducted.Conclusion. An analysis of the current state of preventive activities of pharmacy chains indicates the potential of a pharmacy organization to implement a wider range of preventive services. Combining the efforts of healthcare professionals through the formation of a unified preventive environment with the participation of pharmacy organizations can provide a significant impetus in the fight against chronic non-communicable diseases.

Accessibility of Naloxone in Pharmacies Registered Under the Illinois Standing Order.

To expand access to naloxone, the state of Illinois implemented a standing order allowing registered pharmacies to dispense the drug without an individual prescription. To participate under the standing order, pharmacies were required to opt in through a formal registration process. In our study we aimed to evaluate the availability and price of naloxone at registered pharmacies. This was a prospective, de-identified, cross-sectional telephone survey. Trained interviewers posed as potential customers and used a standardized script to determine the availability of naloxone between February-December, 2019. The primary outcome was defined as a pharmacy indicating it carried naloxone, currently had naloxone in stock, and was able to dispense it without an individual prescription. Of 948 registered pharmacies, 886 (93.5%) were successfully contacted. Of those, 792 (83.4%) carried naloxone, 659 (74.4%) had naloxone in stock, and 472 (53.3%) allowed purchase without a prescription. Naloxone nasal spray (86.4%) was the formulation most commonly stocked. Chain pharmacies were more likely to carry naloxone (adjusted odds ratio [aOR] 3.16, 95% confidence interval [CI] 1.97-5.01, P < 0.01) and have naloxone in stock (aOR 2.72, 95% CI 1.76-4.20, P < 0.01), but no more likely to dispense it without a prescription. Pharmacies in higher population areas (aOR 0.99, 95% CI 0.99-0.99, P < 0.05) and rural areas adjacent to metropolitan areas (aOR 0.5, 95% CI 025-0.98, P < 0.05) were less likely to have naloxone available without a prescription. Associations of naloxone availability based on other urbanicity designations, overdose count, and overdose rate were not significant. Among pharmacies in Illinois that formally registered to dispense naloxone without a prescription, the availability of naloxone remains limited. Additional interventions may be needed to maximize the potential impact of a statewide standing order.

Current Perspectives, Practices, and Barriers Faced by Community Pharmacists Regarding Pharmaceutical Care Services for Diabetes Mellitus in the United Arab Emirates.

Providing accurate and sufficient information is a crucial requirement for delivering effective diabetes care, making it essential for community pharmacists to possess adequate knowledge of diabetes mellitus (DM) and its management. To investigate community pharmacists' level of expertise and engagement in providing counseling and health promotion services for individuals with DM in the United Arab Emirates (UAE). A cross-sectional study design was used. The community Pharmacies were chosen via random sampling and researchers then conducted face-to-face interviews with them using the structured questionnaire. The questionnaire included demographic data, 14 questions on the knowledge and 9 questions about the practice concerning pharmaceutical care for Diabetes Mellitus. The average age ± SD was 31 ± 6.3. Of the total 516 community pharmacists recruited in the study, 37.2% (n=192) were male and 62.8% (n=324) were female. The average knowledge score about DM prevention and management was 9.7 with a 95% confidence interval (CI) [9.5, 9.9] and the average practice score about DM prevention and management was 7.1 with a 95% confidence interval (CI) [6.9, 7.2]. Better knowledge scores were observed in chief pharmacists (OR 1.29; 95% CI 1.08-1.56), pharmacists with 6-10 Years of experience (OR 6.92; 95% CI 3.43-8.86), pharmacist with > 10 years of experience (OR 1.99; 95% CI 1.67-2.36), when the number of patients the pharmacist serve is 5-10 (OR 1.27; 95% CI 1.06-1.53) and being trained on DM prevention and management (OR 2.18; 95% CI 1.92-2.47). Similarly, better practice scores were observed in older participants (OR1.02; 95% CI 1.001-1.03), chain pharmacies (OR 1.42; 95% CI 1.20-1.68), chief pharmacists (OR 1.56; 95% CI 1.18-2.06), when the number of patients the pharmacists serve was 5-10 (OR 12.26; 95% CI 7.26-16.19), when the number of patients the pharmacists serve was 11-20 (OR 4.23; 95% CI 3.54-5.06) and being trained on DM prevention and management (OR 1.33; 95% CI 1.11-1.59). The most commonly reported barriers to providing counseling and health promotion services for diabetes mellitus (DM) in community pharmacies include a lack of coordination with other healthcare professionals (77%) and insufficient knowledge or clinical skills (68.7%). Our study revealed that community pharmacy staff members displayed a noteworthy level of involvement in providing pharmaceutical care services for patients with diabetes mellitus. Based on these findings, it is recommended to enhance pharmacy education by incorporating more advanced, evidence-based training and curricula focusing on disease management and appropriate therapies, particularly for diabetes.

Stocking and supplying naloxone: Findings from a representative sample of community pharmacies in Victoria, Australia.

Naloxone is an opioid receptor antagonist, which can rapidly reverse the effects of an opioid overdose. Community pharmacists may experience several barriers to stocking and supplying naloxone including a lack of confidence or knowledge and time constraints. The current study aimed to examine the extent to which Victorian community pharmacies stock and supply naloxone and determine specific characteristics associated with stocking naloxone. A representative sample of community pharmacists (n = 558) in Victoria, Australia, were contacted between October and November 2020 and invited to participate in an online survey. Data related to pharmacy- and pharmacist-related characteristics, including stocking and frequency of supplying naloxone in the past year. Multivariate logistic regression analysis was performed to examine the effect of various covariates on stocking naloxone. The sample comprised 265 pharmacists (response rate 47%). Most pharmacies were located in Melbourne (the capital city of Victoria, 59.6%) and were part of a pharmacy chain (61.5%). In total, 100 (38%) pharmacies stocked naloxone, a third of whom did not supply it in the past year. Pharmacies that provided opioid agonist treatment had 2.4 times higher odds of stocking naloxone (95% confidence interval 1.425-4.136; p = 0.001). Less than half of Victorian community pharmacies stock naloxone, with even fewer actually supplying it in the past year. Future efforts are needed to increase the number of pharmacies that stock naloxone and the frequency in which it is supplied, while also addressing possible barriers to stocking and supplying naloxone among community pharmacists.

Immediate and long-term effects of COVID-19 on antibiotic dispensing: increasing use of Watch antibiotics.

The coronavirus disease 2019 (COVID-19) pandemic affected antibiotic usage worldwide. However, there is limited data from Serbia. Dispensing of oral antibiotics in Serbian pharmacies was analyzed to calculate monthly and yearly changes between 2018-2021, and to explore immediate and long-term effects of COVID-19 on antibiotic dispensing during this period. The number of antibiotic packages dispensed from pharmacies during the study period was analyzed with a Chi-square test to assess the average change in annual dispensing, and an interrupted time-series analysis was used to evaluate the impact of the pandemic on antibiotic dispensing. The data from 2018-2021 were retrieved from the database of a large community pharmacy chain in Serbia. The average number of antibiotic packages dispensed per day and per pharmacy was higher in 2021 compared to 2018 by one package. However, the dispensing of macrolides increased significantly; 17.7% (2018) vs. 22.5% (2021) (p < 0.05). In general, an increase in antibiotic dispensing was detected during COVID-19 for total antibiotics (16.4%), Watch antibiotics (44.8%), third-generation cephalosporins (80.4%), macrolides (45.5%) and azithromycin (83.7%). However, the immediate effect of COVID-19 was a decrease in the dispensing of Watch antibiotics, penicillin, and third-generation cephalosporins (p < 0.05); and a notable long-term COVID-19 effect was an increase in the dispensing of azithromycin (p < 0.05). In spite of a relatively stable trend of total antibiotic dispensing before and during COVID-19 pandemic, the use of Watch antibiotics, third-generation cephalosporins, and macrolides (particularly azithromycin) showed an increasing trend in dispensing that should be optimized.

A survey of community pharmacists’ and healthcare advisors’ views and experiences on the provision of a Test and Treat Service for uncomplicated lower urinary tract infection in a retail pharmacy chain in Ireland

Abstract Introduction The use of Point of Care Testing (POCT) as an aid to guide antibiotic prescribing has been highlighted in Ireland’s second One Health National Action Plan on Antimicrobial Resistance 2021-2025 (iNAP2).[1] The role of community pharmacy is expanding with the introduction of antimicrobial stewardship (AMS) POCT strategies. Uncomplicated urinary tract infections (UTIs) are frequent and burdensome in the community. With antibiotic resistance on the rise amongst uropathogens, AMS efforts to reduce inappropriate antibiotic prescribing for urinary symptoms are paramount. Aim To evaluate community pharmacy staff views and experiences on the provision of a Cystitis Test-and-Treat Service for uncomplicated UTIs, while identifying opportunities for service improvement and expansion. Methods An electronic survey on Microsoft® Forms was distributed within a large retail pharmacy chain in Ireland during November 2021, with two reminders issued. Pharmacists and Healthcare advisors over the age of 18, working in 88 pharmacies that provided the Velieve Cystitis Test-and-Treat Service were eligible to participate. The survey was subdivided into participant demographics, local UTI information, views and experiences of participants on the Cystitis Test-and-Treat Service, the patient information leaflet and the training completed by pharmacy staff providing the service and included open-ended and closed-ended or Likert-scale questions. The survey was developed based on the literature and was revised following the contributions of pharmacy chain pharmacists and its Research Governance Committee who have a working knowledge of Service. Data were analysed using Microsoft® Excel and IBM® SPSS® statistics version 28.0. Qualitative data from the open-ended survey questions were analysed using thematic analysis. Results A total of 43 pharmacy staff (18 pharmacists and 25 healthcare advisors) participated in the study (overall participation rate of 10.2%). The majority of participants were female (83.7%) and most pharmacies were located in a town/suburb area (55.8%). The majority of participants (76.7%) estimated that service users with symptoms suggestive of UTI present to the pharmacy first, before visiting their GP. Participants believed that the Cystitis Test-and-Treat Service improved service user satisfaction in symptom management, reduced antimicrobial prescribing, alongside reduced general practitioner workload. High acceptability was attributed to the speed and convenience of the service, while time cost and time required explaining the service were identified as barriers. The associated smartphone application was identified as a service weakness. Participants recommended extended training on service user eligibility with perhaps training videos to improve overall confidence. While the low response rate and small sample size is a limitation of this study, the inclusion of participants from two differing pharmacy roles strengths the findings. Conclusion This study highlights that POCT are feasible AMS initiatives that enhance management of uncomplicated UTI and could be incorporated into community pharmacy practice. The perceived ‘poor public awareness of the service’ reported by the participants, suggests the need for increased promotion and advertising.

Exploring experiences and perspectives of inclusivity amongst community pharmacists in their practice: a survey study

Abstract Introduction Inclusive healthcare is an essential component of promoting sustainable good health and wellbeing. The General Pharmaceutical Council (GPhC) published their equality, diversity, and inclusivity (EDI) strategy 2021-2026 to tackle discrimination and reduce health inequalities;[1] however, there are still significant disparities in healthcare access and outcomes faced by minority groups. Discrimination leads to higher rates of distrust, non-adherence, and poorer physical and mental health outcomes.[2] Community pharmacists can break down barriers to healthcare, but must feel a sense of inclusion themselves. Aim To explore the experiences and perspectives of inclusivity amongst community pharmacists in their practice, including training, and to investigate inclusivity-related interventions available in pharmacies. Methods Following a pilot study with 14 pharmacists, an online survey using Google Forms was distributed via email to 335 community pharmacists (based on Raosoft calculator at 95% confidence interval) in multiple London boroughs within a two-month period. To maximise response rates, paper surveys were distributed in person to pharmacies. The survey comprised 48 mixed-style questions, and was divided into four sections: experiences of inclusivity and discrimination, inclusive services provided in the pharmacy, pharmacist training, and demographics. The data were analysed using descriptive and inferential statistics, using Microsoft Excel and SPSS. Results The response rate was 55% (n=184/335). 72% were &amp;lt;40 years old. 55% were men, 43% women and 2% identified as ‘Other’. 59% pharmacists were Asian, 7% Black (of any origin), 4% White and 32% ‘Other’ (including mixed heritage). 68% worked in independent pharmacies (&amp;lt;4 branches), 27% in small chains and 25% in large chains (&amp;gt;10 branches). 18% (n=33) self-reported they had experienced discrimination, primarily from patients (88%; n=29/33), with the majority experiencing racial discrimination (79%; n=26/33), followed by 30% (n=10/33) against age. A higher proportion (24%; n=44) experienced microaggressions and 25% (n=47) reported witnessing discrimination against a patient or colleague, with 98% (n=46/47) witnessing racial discrimination. Pharmacists who had experienced microaggression were statistically less likely to feel included in the workplace. Despite this, 86% (n=159) felt their services were inclusive. However, low levels of pharmacies offered sign language interpreters (3%; n=5), pictograms (11%; n=21), pronoun badges (13%; n=23) and hearing loop systems (19%, n=35), the latter of which large chain pharmacies were statistically more likely to provide. 43% (n=79) have completed some EDI training, but under a quarter of pharmacists undertook focused training, for example, identifying skin conditions on different skin tones (22%; n=17), or making services inclusive to the LGBTQ+ community (8%, n=6). Conclusion Although limited with a relatively small sample size, and limited but diverse geographical area, the findings suggest discrimination continues to persist in community pharmacy, especially related to race.[2] Accessible and culturally responsive resources such as discrimination reporting mechanisms are necessary. Although most pharmacists felt their services were inclusive, the findings demonstrate this was lacking in most pharmacies, with issues surrounding funding and structural barriers. Pharmacists must raise their awareness of simple, effective measures such as free pronoun badges but also require specific EDI training to fulfil their potential as inclusive practitioners.

A qualitative exploration of community pharmacists’ experiences of dispensing oral anti-cancer medications

Abstract Introduction Oral anti-cancer medications (OAMs) have revolutionised cancer care. OAMs have a convenient route of administration, which avoid infection and extravasation risks, and injection site reactions associated with intravenous access. In Ireland, OAMs are dispensed from community pharmacies by community pharmacists who often have a lack of specialist training, insufficient access to patient notes, and prescriptions inadequate to clinically verify a patient’s treatment. No research has been conducted in Ireland on this topic since 2012.[1] The huge growth in OAMs since then means that the community pharmacy environment for dispensing OAMs have likely changed significantly. Aim To explore community pharmacists’ experiences of dispensing OAMs in Ireland and identify areas of improvement within the current system. Methods Semi-structured interviews were conducted with sixteen community pharmacists registered with the Pharmaceutical Society of Ireland who had dispensed OAMs in a community pharmacy setting. Participants were recruited through convenience (n=3), purposive (n=7), and snowball (n=6) sampling. Interview guides were developed from published literature. Interviews were conducted face-to-face or through Microsoft Teams and were recorded. Recordings were transcribed verbatim. The transcripts were analysed using an inductive thematic analysis approach using NVivo 12. Results The majority of participants were female (11/16), aged &amp;lt;40 years (11/16), and worked in a small pharmacy chain (2-9 pharmacies; 11/16). Only a quarter of participants had training in specific training about OAMs (4/16). There were three themes identified: ‘Patient Benefit’, ‘Communication’, and ‘Infrastructure’. Participants acknowledged that community pharmacists have strong relationships with their patients that facilitate an environment that aided counselling and eliciting patient queries. At the same time, it was noted that it is more difficult to monitor adherence of anti-cancer medications taken at home. Communication with hospitals was identified as a barrier. Discharge information is often inadequate to verify prescriptions due to insufficient details on the prescription or poor legibility. This is compounded by the difficulty in contacting OAM prescribers. On a systems’ level, community pharmacists feel that there is little support or training given to allow them to dispense OAMs. Participants found that only with time and experience in dispensing OAMs did they gain expertise and confidence. Conclusion Community pharmacists have an important role in the management of patients treating their cancer with OAMs; however, many feel that there are difficulties communicating with other healthcare professionals about potential OAM issues and that the infrastructure and resources are not in place to maximise the benefit to patients. Provision of OAM-specific training, provision of adequate discharge information, and ability to directly communicate with prescribers and/or oncology pharmacists would increase the competence and confidence of community pharmacists to dispense OAMs safely. This would reduce the risk of dispensing errors, missed supportive medications, and unrecognised adverse drug reactions.

Examining Behavioral Biases in Discretionary Pricing: Evidence from Field and Lab Experiments

In theory, discretionary pricing enhances company performance by enabling managers to incorporate local information. However, in practice, managers may be prone to behavioral biases that can lead to suboptimal decisions. This paper investigates the effectiveness of discretionary pricing and behavioral elements on pricing decisions via field and lab experiments. Collaborating with a pharmacy chain retailer, we first analyzed a field experiment that delegated pricing authority to store managers. We find that managers began engaging in discretionary pricing after two months of experiment implementation and tended to raise the prices of high-priced drugs, resulting in significant sales and revenue losses. This effect was particularly prominent among less-experienced managers and in low-competition stores. We further designed a set of lab experiments to generalize our field observations and explore possible behavioral drivers. We requested lab participants to make pricing decisions under different information display scenarios and compared the average price adjustments between the direct display and click-to-view designs. We observe that participants also tended to raise product prices, and the magnitude of elevation was higher in the click-to-view group where the demand function information is less salient and accessible. Follow-up lab experiments support our field observations, suggesting that experience through repeated decisions and real-time feedback could alleviate the bias effect. Additionally, participants focused on high-priced products when given a list of items for discretionary pricing. Our results highlight the need to consider behavioral biases in human–algorithm collaborations and provide practical insights for improving information provision and training in discretionary settings.

Defining evidence requirements for a Development Framework for Pharmacists (DFP) in community pharmacy practice

Background: The Development Framework for Pharmacists (DFP) was implemented in a pharmacy chain to guide pharmacist development. Both pharmacists and their supervisors faced challenges in defining evidence and performance levels for Domain 1 (Expert professional practice) standards. This study explored these challenges in a community pharmacy setting. Methods: Three online focus group discussions (FGDs) involving a DFP workgroup member and representatives from community pharmacies and polyclinics were conducted. The FGDs were facilitated by guiding questions and evidences gathered from pharmacists who had attempted the DFP. The FGDs were recorded, transcribed, and coded thematically. Results: Participants viewed the DFP as relevant to community practice but suggested aligning DFP evidence examples with community pharmacists’ responsibilities. Key themes from the FGDs included: (1) The need for clear definitions for descriptors, especially when identical evidence was used for different standards; (2) Professional education can be Domain 1 evidence when skills learned are demonstrated in the workplace; (3) Potential inclusion of education and training activities in Domain 1. (4) The need for a criteria model to assess pharmacists’ performance level in various roles and situations; (5) Clarification regarding the term "group of patients" (6) Considering back-end work as Domain 1 evidence. Conclusion: Addressing the above themes could enhance DFP integration for community pharmacists.

Implementation of pharmacist-prescribed contraceptive services: A case series of early adopters

BackgroundThe objective of this study was to interview five early adopters of pharmacist-prescribed contraceptive services to gain insight into successful implementation, with a focus on each pharmacy’s approach, successes, challenges, lessons learned, and practice implications. Case summariesThe five pharmacists who were interviewed included men and women working for independent, chain, and hospital system pharmacies in rural, suburban, and urban areas in various states. Each pharmacy had a unique approach to implementation of pharmacist-prescribed contraceptive services and a variety of service features. The pharmacists were asked about their motivation for starting the service, implementation processes, financial justification, challenges, and successes. Similarities and differences in the intervention characteristics (processes), outer setting (factors outside of the pharmacy), inner setting (factors within the pharmacy), and individual characteristics were compared to determine lessons learned and practice implications for implementation of pharmacist-prescribed contraceptive services. Practice implicationsThe pharmacists interviewed encountered common challenges in implementing pharmacist-prescribed contraception services, including lack of community awareness, difficulty justifying the service financially, difficulty with time management, staying updated with changing regulations, and managing staff turnover. Successful contraception service implementation strategies included efficient workflow integration, financial justification of the service, and increasing community awareness of the service. ConclusionThese early adopter case studies can serve as a reference for pharmacists wanting to implement contraceptive services in their pharmacies. By incorporating lessons learned and anticipating challenges, more pharmacies may be able to offer contraceptive services, further increasing patient access to contraceptives.