Pharmacy Characteristics Research Articles

The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study.

In Taiwan's public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. This study aimed to investigate (1) Taiwanese pharmacists' knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19-related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual's KAP and corresponding perspectives toward the NBRS. A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists' KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument's internal consistency reliability was ascertained using Cronbach α (0.819), and its content validity was verified by field experts. Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19-related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19-testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan's COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises.

Adult Pharmacy Costs and Characteristics of Very High-Cost Prescription Drug Users in the United States, 2018–2022

Objective: This study sought to identify: (1) the demographic and clinical characteristics of very high-cost users (defined as patients with pharmaceutical expenditures that were equal to or greater than the 99th percentile), (2) whether or not these characteristics changed over time, (3) sociodemographic and clinical correlates of being very high-cost users, (4) the average pharmaceutical costs of very-high cost users, and (5) the therapeutic classes and medications that contributed to these high costs Background: There are growing public concerns about rising drug costs, in part due to increased availability, greater effectiveness, and market considerations. There is a concentrated portion of patients that accounts for a disproportionately large portion of pharmaceutical expenditures. Methods: A large serial cross-sectional study was conducted with De-identified, member-level pharmacy claims (n = 65,739,791) from a large, national pharmacy benefits manager from January 1, 2018 to December 31, 2022. The main outcome and measures were 2018–2022 pharmaceutical expenditures; amounts were adjusted for inflation to reflect 2022-dollar values. Results: Across the study period, the odds of being classified as a very high-cost user were 1.31 times as high for those 45–64 years old compared with those 18–44 years old (reference category); the odds were 1.42 times as high for males compared with females; 1.13 times as high before those identifying as non-Hispanic Black compared with non-Hispanic white; 1.11 times as high for those enrolled in a health care exchange plan compared with a commercial plan. In addition, very high-cost users lived in areas with higher social needs. Human immunodeficiency virus, inflammatory conditions, multiple sclerosis, and cancer accounted for the largest share of costs among this group. Conclusions: This study identified the unique characteristics of very high-cost pharmaceutical users and identified the top conditions and prescription drugs that drove high pharmaceutical expenditures among this population. These findings are essential to understanding rising pharmaceutical costs in the United States and can help identify the issues and solutions of specific cost drivers within our health care policies.

Correlates of stocking naloxone: a cross-sectional survey of community pharmacists.

Provision of take-home naloxone (THN) and overdose education reduces opioid-related mortality. In Australia, from July 2022, all Australian community pharmacies were eligible to supply naloxone for free through the nationalTHN Program. This study aimed to identify naloxone stocking rates and correlates of stocking naloxone across Australian pharmacies. Data were collected from a representative sample of Australian pharmacists in Victoria, New South Wales, Queensland and Western Australia via an online survey. Data collected included pharmacy and pharmacist characteristics and services offered within the pharmacy, including needle and syringe programs, opioid agonist treatment (OAT) and stocking naloxone. Binary probit regression analysis was used to identify correlates of stocking naloxone after controlling for key covariates. Data from 530 pharmacists were analysed. In total, 321 pharmacies (60.6%) reported stocking naloxone. Chain pharmacies and pharmacies that provided OAT had a greater probability of stocking naloxone (B = 0.307, 95%CI: [0.057, 0.556], and B = 0.543, 95%CI: [0.308, 0.777] respectively). Most (61.7%) pharmacists felt comfortable discussing overdose prevention with patients who use prescription opioids, and this comfort was associated with a higher probability of stocking naloxone (B = 0.392, 95%CI: 0.128, 0.655). Comfort discussing overdose prevention with people who use illicit opioids was lower (49.4%) and was not associated with stocking naloxone. There is scope to increase stocking of naloxone and comfort with overdose prevention, particularly through addressing comfort working with higher risk groups such as people who use illicit opioids.

Effects of Valproic Acid Supply Shortage on Pharmacy Operations in a Region of Japan.

Introduction Valproic Acid (VPA) is an essential drug in epilepsy treatment, yet it has faced supply instability in Japan. The extent of the VPA shortage and the associated increase in pharmacists' workload and collaboration with healthcare organizations remains unclear. This study investigates the potential effects of these disruptions on the roles of pharmacists. Methods A questionnaire was administered to pharmacies in Hachioji City, Japan. The survey addressed inventory management, patient complaints, and the potential effects on pharmacy operations during VPA supply instability. A chi-squared test of independence was conducted to compare the most unstable VPA supply period with the current supply situation. Supply stability according to pharmacy characteristics such as the number of prescriptions received per day and primary patient age group was also evaluated. Results Of the 42 pharmacies surveyed, 76.2% reported changes in prescription processing due to VPA supply issues. The main challenges were increased workload in inventory management and patient concerns regarding medication availability and quality. Pharmacies primarily serving clinical prescriptions and pediatric patients were the most affected by the supply instability. Discussion This study highlighted the potential effects of VPA supply instability on pharmacy operations. Pharmacists are expected to provide continuous treatment to patients through effective counseling and medication guidance to alleviate anxiety and concerns related to supply shortages.

Prescription and Dispensation of QT-Prolonging Medications in Individuals Receiving Hemodialysis

Individuals with dialysis-dependent kidney failure have numerous risk factors for medication-related adverse events, including receipt of care by multiple clinicians and initiation of some QT-prolonging medications with known risk of torsades de pointes (TdP), which is associated with higher risk of sudden cardiac death. Little is known about the prescription and dispensation patterns of QT-prolonging medications among people receiving dialysis, hindering efforts to reduce drug-related harm from these and other medications in this high-risk population. To examine prescription and dispensation patterns of QT-prolonging medications with known TdP risk and selected interacting medications prescribed to individuals receiving hemodialysis. This cross-sectional study included patients 60 years or older who were enrolled in Medicare Parts A, B, and D receiving in-center hemodialysis from January 1 to December 31, 2019. Analyses were conducted from October 20, 2022, to June 16, 2023. New-user prescriptions for the 7 most frequently filled QT-prolonging medications characterized by the timing of the new prescription relative to acute care encounters, the type of prescribing clinician and pharmacy that dispensed the medication, and concomitant use of selected medications known to interact with the 7 most frequently filled QT-prolonging medications with known TdP risk. The main outcomes were the frequencies of the most commonly filled and new-use episodes of QT-prolonging medications; the timing of medication fills relative to acute care events; prescribers and dispensing pharmacy characteristics for new use of medications; and the frequency and types of new-use episodes with concurrent use of potentially interacting medications. Of 20 761 individuals receiving hemodialysis in 2019 (mean [SD] age, 74 [7] years; 51.1% male), 10 992 (52.9%) filled a study drug prescription. Approximately 80% (from 78.6% for odansetron to 93.9% for escitalopram) of study drug new-use prescriptions occurred outside of an acute care event. Between 36.8% and 61.0% of individual prescriptions originated from general medicine clinicians. Between 16.4% and 26.2% of these prescriptions occurred with the use of another QT-prolonging medication. Most potentially interacting drugs were prescribed by different clinicians (46.3%-65.5%). In this cross-sectional study, QT-prolonging medications for individuals with dialysis-dependent kidney failure were commonly prescribed by nonnephrology clinicians and from nonacute settings. Prescriptions for potentially interacting medications often originated from different prescribers. Strategies aimed at minimizing high-risk medication-prescribing practices in the population undergoing dialysis are needed.

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.

Oral anticancer medicine interventions: A cross-sectional study in French community pharmacies.

The increasing number of oral anticancer medicines (OAMs) dispensed in community pharmacies and the associated challenges (misuse, management of side effects) give the community pharmacist (CP) a major role in the pharmacotherapeutic management of cancer patients. In France, as a response to these challenges, cancer outpatients can schedule a meeting with their CP to ensure the safe and effective use of OAMs. The objectives of this study were to evaluate the perspectives of these interventions regarding their implementation and the opinion of French CPs. A declarative survey and semi-structured interviews were conducted with CPs that dispensed at least one OAM between January 2021 and March 2022. The study was conducted between April and August 2022. Eighty-five CPs completed the survey. Of these pharmacists, 21% (n = 18) had already performed OAM interventions and 91% (n = 61) wanted to implement them. Lack of time, knowledge and training were the main barriers to implementation. No correlations were identified between the characteristics of community pharmacies and the likelihood of implementing OAM interventions. Considering that CPs seem willing to implement them and the favourable context in France, this observational study highlights the potential of OAM interventions to improve the management of cancer patients. Though further studies are required to better evaluate the implementation and the potential effects of these interventions, OAM interventions could be relevant strategies in other healthcare systems to secure the management of cancer patients through the involvement of the CP.

KETEPATAN REKOMENDASI PADA KASUS VIGNETTE SWAMEDIKASI SAKIT KEPALA OLEH APOTEKER DI APOTEK

Headache is a symptom which people often self-medicate and community pharmacies are often places where self-medicating patients with headache obtain the medicines. Therefore, community pharmacists played an important role in providing appropriate advice for these patients. A cross-sectional study design was used. A questionnaire consisting of (1) pharmacy and pharmacists characteristics, and (2) two vignette cases of headache (tension headache and migraine due to an oral contraceptive) was developed. Data was collected using a structured interview with community pharmacists in an East Javan district. Data was analysed using content analysis. Appropriate recommendation was determined based on the literature and expert panel opinion. The total population was 81 community pharmacists. Of these, 47 agreed to participate. Of 47 participating pharmacists, 36 (77%) and 23 (49%) pharmacists provided appropriate advice in the case of tension headache and migraine due to the use of an oral contraceptive respectively. Appropriate recommendation provided by pharmacists varied according to the cases. Optimization of pharmacists’ recommendation in a case of headache requiring medical referral is needed.

Factors Contributing to Pharmacies With Good Disaster Preparedness and the Activities of Their Prefectural Pharmaceutical Association: Pharmacies' resilience and associations.

Pharmacies have a particularly important responsibility to supply medicine to disaster victims in order to save lives. This study investigated the characteristics of pharmacies that are well prepared for disasters as well as the efforts of the prefectural pharmaceutical association (PPA) to which the pharmacies belong. Questionnaires on matters related to disaster preparedness were mailed to 50 randomly selected pharmacies in each of Japan's 47 prefectures as well as all 47 PPAs in Japan. Logistic regression analysis was performed to examine the association of pharmacy background and the activities of the PPA to which they belong with pharmacy disaster preparedness as well as the association with pharmacies' awareness of disaster preparedness. Pharmacies in prefectures that conducted disaster preparedness training at least three times a year were better prepared for disasters. In addition, pharmacies with high online utilization and high disaster-preparedness awareness were significantly more prepared for disasters. Pharmacies that can promptly provide medicine to disaster victims are considered to be well-prepared for disasters. The results suggest that pharmacy preparedness is also influenced by the disaster preparedness activities of their prefectures.

Evidence-Based Pharmaceutical Care in Community Pharmacies: A Survey of 595 French Pharmacists.

We assessed the use of evidence-based practice (EBP) among pharmacists working in community pharmacies in France and the factors linked to this practice. During 3 months in 2018, an online survey was sent to over 7000 active pharmacists and posted on pharmacists' social media sites. In total, 595 pharmacists completed the questionnaire. The responders were on average younger than the general population of community pharmacists. The 40-item questionnaire described four fictional clinical cases reflecting typical situations (conventional medicine and complementary and alternative medicine) encountered daily by community pharmacists. Multiple-choice responses were proposed and scored according to whether they reflected EBP. A high total score indicated behaviour in line with EBP. We observed 344/595 participants with a positive EBP score (57.8% [53.7-61.8%]). Univariate and multivariate analyses were used to evaluate factors that might explain adherence to EPB (the pharmacy's characteristics, the pharmacist's status, the mode of continuing education and sources of information). The majority relied on pharmaceutical industry and other biased and/or non-evidence-based sources, particularly concerning information on homeopathic products. The consultation of independent reviews, health agency recommendations and peer-reviewed scientific journals was associated with evidence-based decisions. In contrast, reliance on pharmaceutical industry documents, personal experience and informal handbooks was linked to lower EBP scores. The level of EBP use by French community pharmacists needs to be improved to ensure that good-quality, science-based advice is given to customers.

Adoption of electronic patient medication records in community pharmacies in the United Arab Emirates: A cross-sectional survey.

Access to accurate and relevant patient health information is crucial for community pharmacists to deliver high-quality care. The use of electronic patient medication records (e-PMR) in the United Arab Emirates (UAE) is currently limited to hospital settings, and community pharmacists do not have access to patient records. To evaluate the perceptions of community pharmacists regarding the potential benefits, barriers, and concerns associated with the implementation of the e-PMR system in community pharmacies in the UAE. A validated questionnaire was administered to a sample of licensed community pharmacists using proportionate random sampling. The survey was structured and consisted of 40 questions in four sections: characteristics of community pharmacists and pharmacies; perceived usefulness of e-PMR; perceived barriers; and concerns about the use of e-PMR. In total, 552 pharmacists filled out the questionnaire (82.1% response rate). The majority of participants somewhat or strongly agreed that e-PMR would reduce drug abuse (71.6%), dispensing errors (64.4%) and prescribing errors (69.0%), and believed that e-PMR would enhance pharmacists' ability to perform medication reviews (76.0%). Pharmacists in charge (adjusted odds ratio (AOR) = 2.5; 95% confidence interval (CI): 1.6-3.6), facing difficulty tracking the medical history of patients (AOR = 3.2; 95% CI: 2.8-3.9) and working in pharmacies providing telepharmacy services (AOR = 3.4; 95% CI: 2.7-3.8) were more likely to consider e-PMR useful. The implementation of the e-PMR system in community pharmacies has potential benefits for patient safety and medication therapy management in the UAE.

단골약국의 필요성과 단골약국에 기대하는 서비스

We wanted to examine people’s demands for a family pharmacy and expected services. We conducted webbased survey and recruited subjects by convenience sampling method. This cross-sectional survey, a 24-item questionnaire, inquired about subjective health problems, pharmacy use, desire to designate one's own family pharmacy, and decision considerations. The Mann-Whitney test, Kruskal-Wallis test, and logistic regression were used to detect these components. 68.8% of the 449 respondents were willing to name their family pharmacy. 89.9, 82.7, 81.3, and 78.6% of respondents agreed that a proximity to home, proximity to the medical institution they usually attend, good setting for counseling, and storage of a wide variety of medications were important pharmacy characteristics when choosing a family pharmacy. 93.3, 93.1, and 88.9% of respondents, respectively, evaluated a conscience, professionalism in pharmaceutical care, and counseling ability as essential pharmacist qualities. Regarding expected service from a family pharmacy, 52.8, 38.8, and 39.4% of respondents highly agreed on a comprehensive medication review, overall health-related counseling, and resolving queries regarding medicines or dietary supplements, respectively. Koreans generally want a family pharmacy, especially women and middle-aged people. To provide services, customers expect answers to various queries concerning medications; therefore, it is vital to be a highly conscientious and professional pharmacist and to create an environment conducive to counseling.

Factors associated with prescription drug monitoring program utilisation: a cross-sectional survey of community pharmacists.

Prescription drug monitoring programs (PDMP) are databases which collect prescribing and dispensing information for high-risk medicines, and are one approach to mitigate prescription opioid-related risks. To examine correlates of PDMP use under voluntary and mandatory conditions, among a representative sample of community pharmacists in Victoria, Australia. An online anonymous survey was conducted and collected data in relation to pharmacist and pharmacy characteristics, comfort in performing certain tasks, PDMP training and the frequency of PDMP use under voluntary and mandatory conditions. Multivariate logistic regression models were performed to determine the effect of each covariate on voluntary and mandatory PDMP use. In total, 265 pharmacists participated (response rate 47%). Under voluntary conditions, a quarter of pharmacists (24.9%) used the PDMP all the time, while half (51.7%) used the PDMP all of the time, once mandated. Pharmacies that stocked naloxone (OR: 1.96; 95% CI 1.11-3.45) and pharmacists that had attended formal PDMP training (OR: 1.78; 95% CI 1.05-3.05), were significantly associated with regular PDMP use under voluntary conditions. Under mandatory conditions, increased odds of PDMP use were associated with pharmacies that stocked naloxone (OR: 1.88; 95% CI 1.06-3.34). Pharmacists working in regional and rural areas had significantly lower odds (OR: 0.35; 95% CI 0.20-0.63) of always using the PDMP, as did pharmacists with > 15years' experience (OR: 0.24; 95% CI 0.11-0.51) once use was mandated. Given that PDMP utilisation was slower or less regular amongst pharmacists located in regional and rural areas, pharmacists with more years of experience and those not already supplying naloxone, targeted training aimed at these sub-populations may be beneficial.

Location, location, location: does providing public health services from community pharmacies contribute to tackling health inequalities?

Community pharmacies have long been advocated as an accessible source of advice on health improvement in communities. This cross-sectional study explored the association between provision of pharmacy public health services and factors that might influence the extent to which pharmacies contribute to tackling inequalities. Publically available data were used to explore the association between pharmacy public health service provision and pharmacy characteristics (socioeconomic deprivation, urbanity, opening hours and workload). Regression models were fitted to the number of service consultations. The association between the number of services provided and the mean number of consultations across each service was investigated using regression models. Pharmacies showed a propensity for being situated in areas of higher socioeconomic deprivation. There was no association between socioeconomic deprivation and number of service consultations a pharmacy provided. Clustering of pharmacies in less affluent areas led to over half of all public health service consultations being in the two most deprived quintiles. Providing healthcare services from pharmacies in more deprived areas does not mean the public use them or that pharmacies will prioritize their delivery. The higher prevalence of pharmacies in disadvantaged communities is an important factor in ensuring pharmacy services support reducing inequalities.

Public’s Preferences for Community Pharmacy Attributes and Their Perceptions Towards Pharmacist-led Minor Ailment Services in Malaysia

Introduction: The prospect of public accessing community pharmacies for minor ailment advice or treatment highly depends on the pharmacy attributes and their staff. This study aimed to investigate the extent to which community pharmacies are used as a source of minor illness management and the public’s relative preferences for pharmacy features. Methods: A cross-sectional survey among the public in Malaysia was carried out between August and December 2020. The validated self-administered questionnaires were distributed at several pharmacies and shared via email, Whatsapp group, and Facebook. Results: A total of 141 from 153 public respondents completed the survey. From the descriptive and inferential analysis, it was found that about a third of the public goes to a pharmacy for advice or treatment for minor illnesses. The vast majority of respondents had positive perceptions that community pharmacists are knowledgeable and qualified to offer advice or treatment for minor diseases. A significant positive relationship was observed between pharmacy characteristics’ scores and pharmacy staff and pharmacy services’ scores (p<0.001). The increase in pharmacy staff score significantly increased the pharmacy services’ score (p<0.001). Conclusion: The implications of the public acknowledging specific attributes were crucial in further supporting community pharmacists’ services, especially in the private practice setting.

Specialty pharmacy turnaround time impediments, facilitators, and good practices.

BACKGROUND: Patients receiving specialty medications have conditions that are often complex, high cost, and high need. Prompt treatment initiation is essential for the appropriate management of many conditions treated by specialty products. Improving the turnaround time (TAT) of specialty pharmacy prescriptions helps ensure patients receive the medication they need in the necessary time frame to optimize health outcomes. Despite a clinical justification for improved TAT, there is a gap in the literature describing what factors impact these times. OBJECTIVE: To determine factors that may influence specialty pharmacy TATs and to identify good practices that specialty pharmacies use to improve TAT. METHODS: This qualitative study used 4 focus groups with specialty pharmacy subject matter experts. Each focus group represented different specialty pharmacy types, including health system, payer-associated, retail chain, and independent specialty pharmacies. Attitudes, beliefs, and experiences regarding specialty pharmacy TAT were captured. Open-ended questions and prompts eliciting impediments, facilitators, and good practices associated with specialty pharmacy TAT were asked of participants. Data were analyzed thematically. RESULTS: Fifteen individuals participated across 4 focus groups: payer-associated (n = 4), independent (n = 3), health system (n = 5), and retail chain (n = 3) specialty pharmacies. Average TATs varied across specialty pharmacy type and by prescription type (clean vs intervention). Several interconnected themes were identified, including barriers with health benefits formulary management, prior authorization delays, differences in requirements between managed care organizations, and miscommunication with physicians, among others. Five subthemes were identified during the discussion of factors influencing TAT, including patient characteristics, pharmacy characteristics, provider characteristics, clinical situations, and health benefit design and formulary considerations. Pharmacy workflow improvements through technology integration are thought to improve TAT. In addition, participants noted facilitators including specialization among pharmacists and technicians in certain diseases, particularly hepatitis C and cancer. Some good practices included using patient financial advocates, technology integration, and a structured patient onboarding process, which were found to minimize delays caused by prior authorization, communication, and formularies. CONCLUSIONS: A multitude of factors impacting specialty pharmacy prescription TAT were identified. Multidisciplinary coordination between pharmacies, physicians, and managed care organizations is essential to ensure patients receive medications in the necessary time frame to optimize health outcomes. DISCLOSURES: This study was conducted with support from Pfizer.

Uncovering spatiotemporal pattern and geographical equity of pharmacies in Chinese cities from 2008 to 2018

ObjectivesSpatial equity is one of the essential indicators to measure service capacity of pharmacies. Previous studies have measured spatial equity of pharmacies by comparing pharmacy density, without explicitly incorporating any measures of spatial dimension. Data used in the past made it difficult to investigate pharmacies comprehensively within large geopolitical units, and was also untimely. Therefore, this study attempts to construct a pharmacy density index that takes into account a spatial dimension to investigate the geographical equity of pharmacies, supported by big data. MethodsWe constructed a Pharmacy Density Index (PDI) based on the Health Resource Density Index (HRDI). Based on 66,143 pharmacies' Points of Interest (POI), we used a pharmacy-population ratio and PDI to investigate spatiotemporal patterns of pharmacies in China. ResultsOur results indicated that POI effectively mitigates difficulties in data acquisition, and is suitable for surveys within large geographic boundaries. PDI integrates both population distribution and geographic distribution, showing great potential to assess spatial equity of medical facilities. Furthermore, the results indicated that from 2008–2018 the number of pharmacies per 10,000 residents increased from 0.5 to 3, with more than 85% of cities meeting or exceeding the standard recommended by the World Health Organisation (WHO). However, we also observed regional inequalities in terms of spatial distribution characteristics of pharmacies. ConclusionWe recommend that policymakers should apply PDI to measure local medical service capacity and use multiple sources of data to better triangulate and evaluate the equity of pharmacies.

Application and utility of geographic information systems in pharmacy specific health research: A scoping review.

Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data. The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research. During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies. After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n=36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n=6). Population density (58.3%; n=28), income indicators (43.8%; n=21) and minority community composition rates (41.7%; n=20) were the most used population variables. GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.

Factors associated with naloxone availability and dispensing through Michigan’s pharmacy standing order

ABSTRACT Background Pharmacy standing order policies allow pharmacists to dispense naloxone, thereby increasing access to naloxone. Objectives To describe pharmacy standing order participation and associations of pharmacy and community characteristics that predict naloxone availability and dispensing across eight counties in Michigan. Methods We conducted a telephone survey of 662 standing order pharmacies with a response rate of 81% (n = 539). Pharmacies were linked with census tract-level demographics, overdose fatality rates, and dispensing data. County maps were created to visualize pharmacy locations relative to fatality rates. Regression models analyzed associations between pharmacy type, neighborhood characteristics, fatality rates, and these outcomes: naloxone availability, having ever dispensed naloxone, and counts of naloxone dispensed. Results The prevalence of standing order pharmacies was 54% (n = 662/1231). Maps revealed areas with higher fatality rates had fewer pharmacies participating in the standing order or lacked any pharmacy access. Among standing order pharmacies surveyed, 85% (n = 458/539) had naloxone available and 82% had ever dispensed (n = 333/406). The mean out-of-pocket cost of Narcan® was $127.77 (SD: 23.93). National chains were more likely than regional chains to stock naloxone (AOR = 3.75, 95%CI = 1.77, 7.93) and to have ever dispensed naloxone (AOR 3.02, 95%CI = 1.21,7.57). Higher volume of naloxone dispensed was associated in neighborhoods with greater proportions of public health insurance (IRR = 1.38, 95%CI = 1.21, 1.58) and populations under 44 years old (IRR = 1.24, 95%CI = 1.04, 1.48). There was no association with neighborhood overdose fatality rates or race in regression models. Conclusion As deaths from the opioid epidemic continue to escalate, efforts to expand naloxone access through greater standing order pharmacy participation are warranted.

Determining the cause and frequency of prescription reworks in community pharmacies

Abstract Introduction When prescriptions are being processed in pharmacies and an activity occurs that requires the return to a previous procedural step to correct the process, this is known as ‘rework’ (1). This may include labelling errors or the incorrect dispensing of medications, and ultimately adds to pharmacists’ workload. Given that increasing community pharmacists’ workload negatively affects their job satisfaction, well-being, and patient care, it is vital that rework is minimised in everyday practice. To date, little is known regarding the prevalence of this rework phenomenon in community pharmacies or how this might be prevented. Aim To evaluate the cause and frequency of prescription rework in community pharmacies. Methods A data collection form was created for community pharmacists to self-record the instances and causes of prescription rework occurring in their workplace across a two-week period. After piloting the form with two pharmacists in different pharmacies, community pharmacists in Ireland were invited to participate in the study using convenience sampling and snowballing. Only participating pharmacists were aware of when data collection was occurring in their pharmacy to minimise the Hawthorne effect with other staff (2). Descriptive statistics were used to describe rework frequency according to the different causes, as well as the pharmacist and pharmacy characteristics. Results Eight participating pharmacists were recruited (four male and four female; median 4 years’ post-qualification experience) from five independent pharmacies and three chain pharmacies. In total, 325 reworks were recorded across 65 days between June 2021 and August 2021. Rework was recorded on 92.9% of the study days, with an average of 5 reworks/day – whereby the average per pharmacist ranged from 1.82 to 15 reworks/day. The data collection form’s pre-specified rework categories captured 91.7% of reworks, with the remainder assigned as ‘other’. The three most frequent rework categories were those due to labelling errors (22.8%), prepared prescriptions which required opening and repackaging (15.1%), and medication owed to patients (13.9%). The people involved in reworks included: pharmacists alone (33.5%), technicians alone (20.3%), pharmacists and technicians (14.8%), pharmacists and patients (10.2%), and pharmacists and prescribers (4%). Conclusion This study shows that rework happens regularly in community pharmacies and has provided an insight into the causes of rework in this setting. While individual pharmacist and pharmacy characteristics may have influenced rework frequency, it was not possible to conclusively establish these associations with the small sample size, due to the difficulty of recruiting pharmacists during the COVID-19 pandemic. These findings are valuable as they highlight areas where pharmacy staff can reduce rework and will help inform strategies to minimise this in future – thus reducing workload and facilitating more time for staff to focus on providing care to patients in community pharmacies. References (1) Nickman NA, Drews FA, Tyler LS, Kelly MP, Ragsdale RJ, Rim M. Use of multiple methods to measure impact of a centralized call center on academic health system community pharmacies. Am J Health Syst Pharm. 2019 Feb 21;76(6):353–9. (2) Sedgwick P, Greenwood N. Understanding the Hawthorne effect. BMJ. 2015 Sep 4;351:h4672.