Pharmacy Characteristics Research Articles

Online Pharmacies Selling Prescription Drugs: Systematic Review.

Introduction: The patronage of online pharmacies is rapidly growing, driven by the convenience and cheaper costs of purchasing prescription drugs electronically, especially under the lockdown situation. However, there are issues regarding the quality of the prescription drugs sold online and the legitimacy of online pharmacies. The use of prescription drugs without the supervision of a licensed health care practitioner may potentially harm consumers. Objectives: This systematic review was conducted to improve the body of knowledge on three main aspects of online pharmacies: (1) type and characteristics of the online pharmacies selling drugs; (2) the quality of pharmaceutical drugs purchased online; and (3) the characteristics of consumers of online pharmacies. Methods: Based on a pre-defined search strategy, PubMed and Scopus were utilised to search articles written in the English language published between January 2009 and February 2020. Studies focusing on the sale of prescription drugs were included. The terms used for the literature search were “online pharmacy”, “internet pharmacy”, “e-pharmacy”, “prescription”, “quality”, “medication safety”, and “counterfeit medicine”. These terms were used alone and in combination with Boolean operators. The institutional webpages including the World Health Organization (WHO) and the United States Food and Drug Administration (USFDA) were also examined for any additional studies. No methodological limitations in terms of study design were applied. A standardised data collection form was used to compile the data. Results: Based on the inclusion and exclusion criteria, a total of 46 articles were eligible and included in the final analysis. There were 27 articles on types and characteristic of online pharmacies, 13 articles on the quality of prescription drugs sold from online pharmacies, and 11 articles on consumers purchasing prescription drugs from online pharmacies. Readers should note that five articles discussed both the types and characteristics of online pharmacies, and the quality of the drugs sold from the outlets. The response rate (products received out of the number of orders) ranged from 20% to 100%, whereas the proportion of consumers buying prescription drugs online ranged from 2.3% to 13%. Reasons for online purchase of prescription drugs include the difficulty of obtaining a prescription for certain medications such as opioid analgesics, cheaper cost, since the costs associated with seeing a physician to obtain a prescription are reduced, and the need to obtain drugs such as opioid analgesics and benzodiazepine for misuse. Conclusions: Almost half of the online pharmacies are not properly regulated and fraudulent issues were uncovered. To address this issue, stricter regulation by World Health Organization and implementation should be carried out together with frequent monitoring of the licensure system and pharmacy verification on every online pharmacy, this would reduce the number of illegal or illegitimate online pharmacy.

North Carolina Pharmacists’ Support for Hormonal Contraception Prescription Status Change

Background Pharmacist-prescribed hormonal contraception (HC) may offer additional avenues of access for patients; however, it is unknown whether pharmacists would support over-the-counter access to contraception over pharmacist-prescribed models. Objective: The objective of this study was to understand how North Carolina (NC) pharmacists believed HC should be classified and how pharmacist and pharmacy characteristics were associated with those beliefs. Methods: This study was a secondary analysis of a cross-sectional, anonymous, online survey completed by 587 licensed NC pharmacists. The primary outcome of interest was how pharmacists believed HC should be classified: prescription-only, pharmacist-prescribed, behind-the-counter, or over-the-counter. Multinomial bivariate and multivariable regression analyses were conducted to describe the association between pharmacist and pharmacy characteristics with the outcomes of interest through odds ratios and adjusted odds ratios, respectively. Chi-square tests were used to examine the association of geographic location with distribution of attitudes toward HC classification. Results: Fifty-one percent of NC pharmacists supported classification of HC as pharmacist-prescribed, while 23% supported non-prescription (behind- or over-the-counter) classification. Controlling for pharmacist demographics and pharmacy characteristics, completing residency training was significantly associated with supporting pharmacist-prescribed vs prescription-only classification (adjusted odds ratio (aOR) = 2.55, P = .02). Pharmacists had higher odds of supporting pharmacist-prescribed vs prescription-only HC if they agreed that they were well trained to do so (aOR = 3.14, P < .01). Distribution of attitudes about classification of HC did not significantly differ by geographic location (P = .14). Conclusions: Most NC pharmacists support deviating from the current prescription-only classification of HC, with more support for pharmacist-prescribed classification. Continuing education programs should focus on training pharmacists to feel more confident prescribing HC.

Point-of-care C-reactive protein testing service for respiratory tract infections in community pharmacy: a qualitativestudy of service uptake and experience of pharmacists.

Background Targeted interventions in community pharmacies, such as point-of-care C-reactive protein testing, could reduce inappropriate antimicrobial consumption in patients presenting with symptoms of respiratory tract infections, although data regarding Australian pharmacists’ perspectives on its provision are limited. Aim To explore pharmacists’ experiences and perspectives of point-of-care C-reactive protein testing, including barriers and facilitators, influencing service provision and uptake. Method A point-of-care C-reactive protein testing service for patients presenting with respiratory tract infection symptoms was trialled in five purposively selected community pharmacies in metropolitan Western Australia. Two pharmacists from each pharmacy participated in one-to-one semi-structured telephone interviews, regarding pharmacist demographics, pharmacy characteristics, experience with the point-of-care C-reactive protein service and training/resources. Interviews were audio-recorded and transcribed. Data were imported into NVivo for thematic analysis. Results Interview durations ranged from 28.2 to 60.2 min (mean: 50.7 ± 10.2 min). Of the five themes which emerged, participants reported the point-of-care C-reactive protein testing was simple, fast, reliable and accurate, assisted their clinical decision-making and contributed to antimicrobial stewardship. A major factor facilitating service provision and uptake by consumers was the accessibility and credibility of pharmacists. Barriers included time constraints and heavy documentation. Participants believed there was a public demand for the service. Conclusion Given the global antimicrobial resistance crisis, pharmacists have an important role in minimising the inappropriate use of antimicrobials. The point-of-care C-reactive protein service was readily accepted by the public when offered. However, ensuring efficient service delivery and adequate remuneration are essential for its successful implementation.

Rural community pharmacists’ ability and interest in administering COVID-19 vaccines in the Southern United States

BackgroundCommunity pharmacists are often the most accessible health professional in rural areas, which makes them well positioned to increase vaccine access in their communities. This study sought to document rural pharmacists’ ability to and interest in administering coronavirus disease 2019 (COVID-19) vaccinations. MethodsA sample of community pharmacists participating in a rural community pharmacy practice-based research network in the United States completed an online survey that assessed (1) demographic characteristics, (2) previous COVID-19 vaccine training, and (3) ability to administer COVID-19 vaccines. Data were collected between late December 2020 and mid-February 2021. Descriptive statistics and correlations were calculated. ResultsA total of 69 of 106 pharmacists completed the survey (response rate = 65%). Approximately half of pharmacists were ready (52%) or actively taking steps (39%) to provide COVID-19 vaccines in the next 6 months. Pharmacies had a median of 2 staff members who were authorized to administer COVID-19 vaccines. Almost half (46%) estimated they could administer more than 30 vaccinations per day. Most pharmacies could store vaccines at standard refrigeration (90%) and freezing (83%) levels needed for thawed and premixed vaccines, respectively. Most pharmacists planned to access COVID-19 vaccines through an agreement with a state or local public health entity (48%) or by ordering through group purchasing organizations (46%). Only 23% of pharmacists had received any COVID-19 vaccine training, and only 48% very much wanted to get the vaccine themselves. Several variables, including pharmacy type and pharmacists’ vaccine attitudes and previous COVID-19 training, were significantly associated (P < 0.05) with the anticipated number of COVID-19 vaccines pharmacies could administer daily. ConclusionEven early in the nation’s COVID-19 vaccine rollout, most rural pharmacies were interested in and preparing to administer COVID-19 vaccines. Few rural pharmacists had received COVID-19 training, and many expressed some hesitancy to receive the vaccine themselves. The number of vaccines pharmacists could administer varied with pharmacy and pharmacist characteristics.

Physician-pharmacy integration and oral cancer drug use and quality.

39 Background: Public reports suggest increasing integration of in-house specialty pharmacies by independent and system-based oncology practices. Understanding the impact of such integration has important implications for state-level regulations limiting physicians’ ability to launch pharmacies in certain states and policies governing pharmacy network design. In this analysis, I document the growth of in-house pharmacies and estimate the impact of this growth on oral cancer drug use and quality. Methods: I used 2006-2017 data from Medicare Fee-for-Service and Part D claims, pharmacy names and characteristics from health plan pharmacy network lists and the National Plan and Provider Enumeration System, and a unique Health System and Practice Dataset, developed by National Bureau of Economic Research and Harvard University researchers, that tracks practice ownership relationships. I first linked physician organizations and pharmacies that they operate using a novel claims-based algorithm combining information on pharmacy characteristics, similarities in names of practices and pharmacies, and the share of total pharmacy spending attributable to a single practice or system. I then used an event study approach to compare oral oncolytic use and quality at practices launching a pharmacy between 2009 to 2014 compared with matched controls. Outcomes included total spending on oral oncolytics, use of oral drugs when an intravenous equivalent exists (capecitabine and 5-fluoruracil), timeliness of new prescription fills (# days from first fill to last office visit), medication adherence, and early discontinuation of lenalidomide, tyrosine kinase inhibitors, aromatase inhibitors, tamoxifen, enzalutamide, and abiraterone. Results: The number of independent or system-based oncology practices with an in-house pharmacy filling any oncology prescriptions increased from 135 in 2006 to 442 in 2017. In that time, the share of Medicare Part D spending on oral oncolytics filled at in-house pharmacies increased from 4% in 2006 to 27% in 2017. The launch of an in-house pharmacy was not associated with an overall increase in spending on oral oncolytics, but was associated with a 4.5 percentage point (p =.01) increase in the use of capecitabine relative to 5-fluorouracil, within 2 years of launch. In-house pharmacies were associated with a modest decrease in the time to fill an initial prescription (2.4 days, p &lt;.001) within 2 years of launch, but no improvements in adherence or reductions in early discontinuation. Conclusions: There has been substantial growth in the use of in-house pharmacies in oncology in recent years. Having an in-house pharmacy only had modest effects on cost and quality. Policymakers should therefore approach claims that in-house pharmacies meaningfully impact cost and quality with caution.

Anti-doping knowledge and educational needs of Finnish pharmacists

ObjectivesPharmacists’ role in health care has evolved towards a more collaborative practice to combat current public health challenges and to support rational use of medicines. Previous literature also demonstrates pharmacists’ emerging role in sports and exercise medicine, including anti-doping and health counselling of athletes. The aim of this study was to assess: 1) What is the pharmacists’ self-assessed knowledge about doping and anti-doping activities? 2) How does the pharmacists’ and pharmacy characteristics effect on the self-assessed knowledge about doping and anti-doping activities? 3) What educational needs do the pharmacists report about doping and anti-doping activities? Material and MethodsA cross-sectional online survey was conducted among Finnish pharmacists in 2019. A convenience sampling method was used to reach the target group. The survey consisted of 26 questions considering pharmacists’ perceptions about doping, knowledge, and need for education about the pharmacology of doping agents, anti-doping counselling, and information sources. Descriptive statistics and cross-tabulation with Pearson's χ2 and the Kruskal-Wallis tests were used to analyse the data. ResultsA total of 246 pharmacy professionals completed a national online survey targeted at pharmacists in Finland. The average age of the respondents was 43 years (SD = 10), where 94% were females and 6% males. Pharmacists reported their self-assessed knowledge on anti-doping counselling to be poor or rather poor. Their highest needs for education were related to nutritional supplements’ doping risks, substances listed as doping agents, their mechanisms of action and purpose of use, and the adverse effects of doping agents and interactions with other medicines. More information was also needed about prohibited substances and methods in sports and doping in recreational sports. ConclusionPharmacists were willing to participate in anti-doping activities, including counselling athletes. However, many pharmacists perceived their knowledge as insufficient and reported educational needs that could be considered in undergraduate and continuing education of pharmacists. Universities, anti-doping organisations, and other related actors in the pharmacy and anti-doping field have an important role in providing more educational opportunities to pharmacists.

Pharmacists’ nonprescription syringe dispensing perceptions and behaviors: A three-state descriptive analysis

BackgroundOne approach to increasing the reach of syringe programs in rural areas could be through provision of syringes at community pharmacies. This study evaluated relationships between state-specific syringe policies, pharmacy, and pharmacist characteristics and pharmacists’ nonprescription syringe dispensing behaviors in a 3- state Appalachian region at high risk for HIV and HCV transmission. MethodsWe conducted a telephone census of community pharmacies in the Appalachian counties of North Carolina, Tennessee, and Virginia from April–June 2018. Behaviors studied included having ever sold syringes without a prescription, quantity of individuals to whom nonprescription syringes were dispensed in the past 30 days, having ever denied a request for nonprescription syringes, and past 30-day denial of nonprescription syringe requests. Behavioral intention and perceptions of legality were elicited. ResultsA response rate of 52.3 % was achieved (N = 391). North Carolina pharmacists reported increased past 30-day dispensing, less denial of nonprescription syringe requests, and decreased justification for syringe dispensing (proof of medical need) as compared to Tennessee and Virginia pharmacists. Behavioral intention to dispense did not vary by state but did vary by political affiliation. Perceptions of syringe dispensing legality in NC were significantly different from those in TN and VA. ConclusionsSignificant differences in pharmacists’ perceptions and behaviors were noted across state lines with North Carolina pharmacists reporting more engagement in syringe dispensing as compared to pharmacists in Tennessee and Virginia. Policy allowing pharmacists to dispense syringes to people who inject drugs appears to foster some but not all pharmacist engagement in this harm reduction intervention.

The Pharmacists’ and pharmacy technicians’ scopes of practice in the management of minor ailments at community pharmacies in Indonesia: a cross-sectional study

Background:Managing minor ailments in community pharmacy is an evolving pharmacy service in developing countries. Defined scopes of practice for pharmacy staff are essential for the safe management of minor ailments. Limited research exists regarding the perceptions of Indonesian pharmacists’ and pharmacy technicians’ scopes of practice in providing minor ailments management services.Objective:To evaluate pharmacists’ and pharmacy technicians’ understanding of their scopes of practice, perceived competency and factors influencing the delivery of minor ailments services in Indonesian community pharmacies.Methods:Cross-sectional surveys were conducted during January-February 2020 of pharmacists and pharmacy technicians attending seminars conducted by relevant Indonesian Associations in Central Java, Indonesia. Percentage of common responses (PCR) described similarity of perceived scopes of practice for pharmacists and pharmacy technicians. Univariate and multivariate analyses identified associations of scopes of practice with pharmacy characteristics.Results:A total of 185 pharmacists and 142 pharmacy technicians participated. Pharmacy technicians performed minor ailment consultations, however, if considered beyond their scope of practice, they referred the patient to the pharmacist (T=120/142, 84.5%). Vaginal thrush, bacterial conjunctivitis, gastro-oesophageal reflux disease, and acute pain were minor ailments perceived only within a pharmacist’s scope (PCR above 60%). Of 34 minor ailments, 11 showed PCR values between 40-60% overlapping pharmacists and pharmacy technicians perceived scopes of practice (allergy/rash, back pain, cold sores, dermatitis, diarrhoea, eczema, hayfever, haemorrhoids, rheumatism, sore throat, and superficial wounds). Back pain, cold sores, dermatitis, and sore throat associated pharmacists’ scope of practice with years of practice experience (p-value<0.05). Pharmacy technicians perceived their scopes of practice to be wider than perceived by pharmacists.Conclusions:Discordance between pharmacists’ and pharmacy technicians’ perceived scopes of minor ailments management highlights the need for clearly defined scopes of practice for each professional group. Each professional group must practise within their competence to ensure safe pharmacy practices.

Medication synchronization adoption and pharmacy performance.

While medication synchronization programs are becoming a staple in community pharmacies, a standard process needs to be identified to provide consistent positive outcomes. Many studies demonstrate how medication synchronization affects individual level patients but have not examined how medication synchronization affects the pharmacy's performance. Because community pharmacies are calibrated based on performance to adherence measures for all patients, it is important to understand whether resource-intensive interventions, such as medication synchronization, lead to improved performance. The aims of this study were to 1) examine pharmacy characteristics associated with medication synchronization adoption and 2) examine whether medication synchronization is associated with pharmacy-level performance on select medication adherence and utilization measures. This study used a cross-sectional design. Community pharmacies participating in the North Carolina Community Pharmacy Enhanced Services Network (NC CPESN℠) program were included in this study. Pharmacy performance was measured as summary score of pharmacy's performance on seven risk-adjusted measures which were used to measure pharmacy's performance in the program. Adoption of medication synchronization was measured as a binary variable capturing whether the pharmacy offered med sync at the time the survey was administered. Surveys were received from 160 out of 268 participating pharmacies (59.7% response rate) with a total of 155 pharmacies being included in the analytic sample. Pharmacies that adopted medication synchronization were more likely to have a clinical pharmacist on staff (c=5.4, p=0.019). Holding all else constant, medication synchronization adoption was not significantly associated with total medication adherence performance (p=0.371). Medication synchronization has proven successful in improving individual patient level adherence but may not change a pharmacy's overall performance in adherence for all patients. Further research is needed to examine how effective implementation might contribute to whether a medication synchronization program leads to meaningful gains in adherence for all patients.

Socio-ecological and pharmacy-level factors associated with naloxone stocking at standing-order naloxone pharmacies in New York City

BackgroundResearch on socio-ecological factors that may impede or facilitate access to naloxone in pharmacies remains limited. This study investigated associations between socio-ecological factors, pharmacy participation in the naloxone cost assistance program (NCAP), pharmacy characteristics and having naloxone in stock among pharmacies in New York City. MethodsPhone interviews were conducted with 662 pharmacies selected from the New York City Naloxone Standing Order List. Multi-level generalized linear modeling estimated associations between neighborhood racial and ethnic composition, poverty rates, overdose fatality rates, pharmacy participation in N-CAP, having private physical spaces within the pharmacy, knowledge of where to refer people to obtain naloxone and adjusted relative risk (aRR) that the pharmacy would have naloxone in stock. ResultsFindings from this study supported several of the hypotheses. Greater neighborhood poverty was associated with a lower likelihood of carrying naloxone compared to neighborhoods with less poverty (aRR = .79, CI95 % = .69, .90, p < .001). Pharmacies that provided a private window for consultations (aRR = 1.34, CI95 % = 1.19, 1.51, p < .001), a private room (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001), and a private area (aRR = 1.42, CI95 % = 1.30, 1.56, p < .001) were associated with a higher likelihood of carrying naloxone compared than those that did not. ConclusionsFindings from this study suggest that community-level socioeconomic marginalization is a contributor to disparities in naloxone availability among pharmacies in New York City. Findings support harm reduction interventions tailored to the built environment of pharmacies that respect privacy to those seeking naloxone.

The Use of Prothrombin Complex Concentrates: Results of a Nationwide Survey of Critical Care Pharmacists

Background Prothrombin complex concentrates (PCCs) are frequently used. Objective To elucidate practices and perceptions of proprietary and nonproprietary PCCs use. Methods An electronic pretested cross-sectional survey e-mailed thrice to 1 critical care pharmacist at 1170 US institutions. Questions addressed hospital and pharmacy characteristics, use of PCCs, and perceptions of effectiveness and safety. Results 429 (39.5%) of 1086 eligible institutions completed the questionnaire. PCCs were used several times per month to several times per week (62.6%). An order set was routinely or always used to direct PCCs usage at 66.4% of institutions. Four-factor PCCs were preferred by 93% of institutions. The most common perceived indications for 4-factor PCCs were hemorrhage related to warfarin (92.1%) or oral Xa inhibitors (81.8%), intracranial hemorrhage (78.4%), trauma hemorrhage (66.2%), surgical hemorrhage (61.1%), and refractory hemorrhage (57.3%). The most common perceived contraindications were heparin-induced thrombocytopenia (42%), disseminated intravascular coagulopathy (39.2%), and active thromboembolism (38.9%). Most institutions considered patient weight (78.8%), indication (77.6%), and International Normalized Ratio (76.9%) when dosing PCCs. Only 43.8% of institutions used fixed dose, only 19.6% compounded PCCs at the bedside, and only 11.9% administered PCCs by rapid infusion. Compared to standard blood products, respondents believed PCCs acted more rapidly, were less likely to cause volume issues, and were more expensive. Respondents were neutral about PCCs acting longer, being more effective at preventing or treating hemorrhage, or causing thromboembolism. Conclusions Off-label use of PCCs is common. Differing perceptions surrounding indications, contraindications, and comparisons to blood products/procoagulants likely contribute to variable practices.

Characteristics of online pharmacies selling Adderall

ObjectivesAdderall (amphetamine-dextroamphetamine) is a controlled substance with harmful adverse effects if abused or misused. We assessed the availability of Adderall from common search engines, and evaluated the safety and marketing characteristics of online pharmacies selling Adderall. DesignCross-sectional study. Setting and participantsFrom December 2019 to February 2020, the phrase “buy Adderall online” was queried in four search engines: Google (N = 100), Bing (N = 100), Yahoo (N = 50) and DuckDuckGo (N = 50). Online pharmacies that claimed to sell Adderall and had unique Uniform Resource Locators, were active, free-access, and in English language were included. Outcome measuresOnline pharmacies were categorized as rogue, unclassified, or legitimate on the basis of LegitScript classifications. Safety and marketing characteristics, and costs were collected. ResultsOf the 62 online pharmacies found to sell Adderall, 61 were rogue or unclassified. Across all rogue and unclassified online pharmacies, prescriptions were not required (100%), pharmacist services were not offered (100%), and quantity limits were not placed on the number of Adderall purchases (100%). Rogue and unclassified online pharmacies appealed to cost, offering price discounts (61%), bulk discounts (67%), and coupon codes (70%). Contrary to their claims, cheaper prices were available for all formulations and dosages of Adderall from GoodRx than from these online pharmacies. Rogue and unclassified online pharmacies promoted and enabled the illicit purchase of Adderall, appealing to privacy (74%), offering purchase through cryptocurrency (74%), and claiming registration or accreditation of their sites (33%). ConclusionRogue online pharmacies are pervasive in search engine results, enabling the illicit purchase of Adderall without a prescription. Consumers are at risk of purchasing Adderall, a medication with high abuse potential, from unsafe sources. Law enforcement, regulatory agencies, and search engines should work to further protect consumers from unregistered and illegitimate online pharmacies selling Adderall.

The Inverse Care Law might not apply to preventative health services in community pharmacy.

The Inverse Care Law states that healthcare availability is inversely related to the needs of the population served. Increasing the provision of community pharmacy (CP) services for cardiovascular disease has been suggested to improve equity of healthcare access, particularly for screening, but few studies examine this. The aim of this study was to determine how the availability and uptake of cardiovascular disease (CVD) prevention services in CPs varies according to practice and local population characteristics. Pharmacists at all Victorian CPs were invited by phone to participate in a survey. The survey examined pharmacy characteristics, CVD-relevant service characteristics, and resources for service provision. Pharmacists who declined were asked if they would instead briefly provide key information. Area-level socioeconomic (SES) data for each pharmacy was included in the analyses. Binary logistic regression was used to determine the association of pharmacy attributes with service delivery. Of 1238 CPs identified, 519 (42%) pharmacists completed the full questionnaire and 414 (33%) provided brief information. In general, services were more frequently available from pharmacies in lower SES and rural communities, with quality accreditation and with private counselling facilities. Factors predicting the likelihood of pharmacies receiving reimbursement for services that were not government-funded included having a private room or counselling area, and more than one pharmacist on duty. Factors predicting service delivery volume in the top quartile included script volume and private counselling facilities, and lower SES community profile. Only script volume predicted volume of government-funded medication reviews (MedsChecks). Our finding that the Inverse Care Law may not apply to preventative service provision in CPs is highly notable and contrary to multiple findings in other settings. An understanding of the context and drivers of increased CP service provision in more vulnerable communities may inform the delivery of more equitable health services generally.

Community pharmacies embedded within student health centers on college and university campuses: A cross-sectional survey

BackgroundPharmacies embedded within student health centers on college and university campuses provide a unique opportunity for pharmacists to improve the health, safety, and well-being of young adults. However, little is known about these pharmacies. ObjectivesTo describe the demographic and operational characteristics of on-campus pharmacies in the United States, and then describe medication dispensing and clinical services provided by pharmacists at these pharmacies. MethodsCross-sectional survey of pharmacy directors or equivalent representatives of on-campus pharmacies identified through the American College Health Association directory. Data were summarized using descriptive statistics. ResultsA representative at 103 on-campus pharmacies was contacted. Of these, 53 representatives completed the online survey (response rate of 51.5%). On-campus pharmacies are generally small in terms of both size and pharmacy staff. They most commonly serve students, faculty, and staff and are not usually open to the general public. Pharmacies are largely focused on dispensing prescriptions, with few reporting disease-state management services. Many receive income through sources other than dispensing prescriptions. Less than half were located at an institution with a school or college of pharmacy. ConclusionsOn-campus pharmacies are largely focused on dispensing prescriptions, but they have unique operational characteristics, and these characteristics frequently contribute to financial vulnerability. On-campus pharmacies are well positioned to develop services that are independent of dispensing roles, and engagement in these activities will become increasingly important as drug reimbursement declines. Future research is needed on the challenges facing on-campus pharmacies and on how pharmacists can help meet the needs of student populations.

Influence of Pharmacy Characteristics and Customer Quality of Life on Satisfaction of Community Pharmacy Customers.

The study objectives were to evaluate customer satisfaction with community pharmacy services and measure the relationships between customer satisfaction and pharmacy/pharmacist characteristics and customer quality of life. This was a cross-sectional survey of a convenience sample of customers at 20 community pharmacies in 10 different geographical areas in Baghdad city between May and September 2018. We used the satisfaction items which were developed by Paterson and colleagues in 2013. The survey also assessed customer quality of life (QoL) with 12 QoL items. The study recruited 400 pharmacy customers. Overall, customers reported good satisfaction with community pharmacy services. The most three satisfying aspects were the professional appearance of the pharmacy, the professionalism of pharmacy staff and explanations of possible adverse medication effects. Three customer characteristics were associated with high satisfaction rates including male gender, buying medications without a prescription, and seeking services for themselves. Three pharmacy characteristics increased the customer satisfaction rate including the availability of female pharmacists, having more than one pharmacist, and whether the pharmacy is open full time. For quality of life, patients who had a limitation in their activities and those who accomplished less than they would like were less satisfied with pharmacy services. To improve pharmacy services, pharmacists need to enhance their professional appearance, allocate more time for patient counselling, help patients to manage their medications and extend their working hours to meet customer needs.

Naloxone Availability in Retail Pharmacies and Neighborhood Inequities in Access

This study examines the implementation of North Carolina's statewide naloxone standing order and identifies community characteristics associated with pharmacy stocking and willingness to sell naloxone under the standing order. In April-June 2019, a mystery caller protocol was completed to assess if (1) North Carolina pharmacies had naloxone available and were willing to dispense it without a prescription, (2) pharmacy characteristics associated with availability, and (3) there were neighborhood differences (e.g., Census tract population size, density, racial composition, SES, rates of opioid overdoses, and rates of opioid prescriptions dispensed) in availability. Using random sampling stratified by inclusion on North Carolina's public list of pharmacies participating in the standing order, chain, independent, and health department pharmacies in North Carolina were sampled (n=161 of 2,044). In June 2019, the data were analyzed. Survey weights were utilized to calculate the prevalence of availability, and regression models were conducted to examine associations. An estimated 61.7% (95% CI=54.3, 68.5) of North Carolina retail pharmacies have naloxone available without a prescription. The odds of naloxone availability were lower for independent pharmacies than chains (OR=0.12, 95% CI=0.06, 0.25). Inclusion on North Carolina's public list of pharmacies had greater odds of naloxone availability (OR=2.32, 95% CI=1.22, 4.43). Naloxone availability was lower in communities with higher percentages of residents with public health insurance (OR=0.97, 95% CI=0.95, 0.999). Though more than half of the pharmacies in North Carolina participate in the standing order for naloxone, efforts to identify the best practices for ensuring widespread implementation of statewide standing orders for naloxone are warranted.

Widespread illegal sales of antibiotics in Chinese pharmacies \u2013 a nationwide cross-sectional study

BackgroundAccess to antibiotics without a prescription from retail pharmacies has been described as a major contributor to anti-microbial resistance (AMR) globally. In the context of high rates of AMR, the Chinese government has recently introduced strict policies regarding hospital antibiotic use, but the existing ban on antibiotic sales without prescription in retail pharmacies has not been strongly enforced. In 2016, a goal of prescription-only antibiotics by 2020 was announced. The objective of the study was to determine progress towards the 2020 goal, through estimating the proportion of retail pharmacies selling antibiotics without prescription across the three regions of mainland China.MethodsUsing the Simulated Patient method, we conducted a cross-sectional survey across purposively-sampled retail pharmacies in urban and rural areas of 13 provinces in eastern, central and western China. Medical students presented a scenario of a mild upper respiratory tract infection, following a strict three-step protocol. They recorded the pharmacy characteristics, and details of their experience, including at which step antibiotics were offered.ResultsComplete data were obtained from 1106 pharmacies. Antibiotics were obtained in 925 (83.6, 95% CI: 81.5, 85.8%) pharmacies without a prescription, 279 (25.2%) at Stage 1 (symptoms only described), 576 (52.1%) at stage 2 (asked for antibiotics), and 70 (6.3%) at Stage 3 (asked for penicillin or cephalosporins). There were significant differences between provinces, with antibiotic access (at any stage) ranging from 57.0% (57/100) in Zhejiang (81/82) to 98.8% in Guizhou. However, there were no significant differences in access to antibiotics by level of city, county, township or village (P = 0.25), whether the pharmacy was part of a chain or independent (P = 0.23), whether a licensed pharmacist was attending (P = 0.82) or whether there was a sign saying that prescriptions were required for antibiotics (P = 0.19).ConclusionsIt is easy to obtain antibiotics without a prescription in retail pharmacies in China, despite the fact it is against the law. This must be addressed as part of the wider anti-microbial stewardship effort which could include intense enforcement of the existing law, supported by a public education campaign.

Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy

BackgroundPharmacies are the most accessible healthcare settings across urban, suburban, and rural areas of the United States and, thus a key venue in the overdose risk environment. Pharmacy dispensing of naloxone is part of the public health response to the opioid overdose crisis, yet little is known about the pharmacy- and community-level characteristics with which naloxone provision is associated. MethodsWe conducted a longitudinal analysis of pharmacy-level quarterly naloxone dispensed from one large US community pharmacy chain from the 1st quarter of 2013 to the 2nd quarter of 2017, examining associations between naloxone provision and pharmacy-level characteristics and community factors in two US states, Rhode Island and Massachusetts. Rurality was defined using the rural urban commuting area (RUCA) scale scores, calculated based on US 2010 Census variables. Pharmacy-level characteristics (e.g., 24 h store, average daily volumes of total prescriptions, nonprescription syringe sales, buprenorphine prescriptions) derived from the pharmacy chain; community factors (e.g., RUCA score, ZIP-code level age, race distributions, and median household income) were obtained from the decennial census files. The linear mixed effects methods modeled dispensing history and the number of naloxone doses dispensed through binomial and negative binomial distributions respectively, accounting for trend and covariates. ResultsAdjusted analyses of dispensing data from 449 pharmacies in two states indicated that more rural pharmacies (i.e., stores in areas with higher RUCA scores), pharmacies with higher volumes of all prescriptions and of buprenorphine, that sell more nonprescription syringes, that have drive-throughs and longer weekend hours, and that are located in communities with younger age distributions were associated with increased likelihood of ever dispensing naloxone and a greater number of naloxone doses dispensed (all p<.05). ConclusionPharmacies are a key evolving element in the overdose risk environment, striving to develop reputations as sources of wellness, prevention, and harm reduction supplies, like naloxone. Pharmacy naloxone dispensing may be an especially effective strategy to alter the overdose risk environment in rural communities.

Organisational factors associated with safety climate, patient satisfaction and self-reported medicines adherence in community pharmacies.

Evidence suggests that community pharmacy service quality varies, and that this may relate to pharmacy ownership. However little is known about wider organisational factors associated with quality. To investigate organisational factors associated with variation in safety climate, patient satisfaction and self-reported medicines adherence in English community pharmacies. Multivariable regressions were conducted using data from two cross-sectional surveys, of 817 pharmacies and 2124 patients visiting 39 responding pharmacies, across 9 diverse geographical areas. Outcomes measured were safety climate, patient satisfaction and self-reported medicines adherence. Independent variables included service volume (e.g. dispensing volume), pharmacy characteristics (e.g. pharmacy ownership), patient characteristics (e.g. age) and areal-specific demographic, socio-economic and health-needs variables. Valid response rates were 277/800 (34.6%) and 971/2097 (46.5%) for pharmacy and patient surveys respectively. Safety climate was associated with pharmacy ownership (F8,225 = 4.36, P < 0.001), organisational culture (F4, 225 = 12.44, P < 0.001), pharmacists' working hours (F4, 225 = 2.68, P = 0.032) and employment of accuracy checkers (F4, 225 = 4.55, P = 0.002). Patients' satisfaction with visit was associated with employment of pharmacy technicians (β = 0.0998, 95%CI = [0.0070,0.1926]), continuity of advice-giver (β = 0.2593, 95%CI = [0.1251,0.3935]) and having more reasons for choosing that pharmacy (β = 0.3943, 95%CI = [0.2644, 0.5242]). Satisfaction with information received was associated with continuity of advice-giver (OR = 1.96, 95%CI = [1.36, 2.82]), weaker belief in medicines overuse (OR = 0.92, 95%CI = [0.88, 0.96]) and age (OR = 1.02, 95%CI = [1.01, 1.03]). Regular deployment of locums by pharmacies was associated with poorer medicines adherence (OR = 0.50, 95%CI = [0.30, 0.84]), as was stronger patient belief in medicines overuse (OR = 0.88, 95%CI=[0.81, 0.95]) and younger age (OR = 1.04, 95%CI = [1.01, 1.07]). No patient outcomes were associated with pharmacy ownership or service volume. This study characterised variation in the quality of English community pharmacy services identifying the importance of skill-mix, continuity of care, pharmacy ownership, organisational culture, and patient characteristics. Further research is needed into what constitutes and influences quality, including the development of validated quality measures.

Clinical pharmacy services in Germany: a national survey

ObjectivesClinical pharmacy services in German hospitals appear to be underdeveloped compared with other European countries. However, recent developments have increased the interest in expanding these services. Detailed data about the...