Independent Community Pharmacy Research Articles

Evaluation of a hybrid medication synchronization training module for pharmacy technicians

BackgroundMedication synchronization involves coordinating a patient’s medications to a single date each month. Medication synchronization programs close gaps in care and improve adherence compared with automatic refill-processing programs. Patients are 2-6 times more adherent to medications when enrolled in a medication synchronization program. Medication synchronization has historically been driven by pharmacists; however, pharmacy technicians are in a unique position to logistically run this service. ObjectiveThis study aimed to develop a training program for pharmacy technicians regarding medication synchronization and assess changes in knowledge and confidence before and after implementing a training program. Practice descriptionAn independent community pharmacy in North Carolina. Pharmacists provide medication therapy management, reimbursed clinical services, medication synchronization, and immunizations. Practice innovationThe training program included medication synchronization basics, patient enrollment process, processing a synced patient, and a hands-on practice session. Evaluation methodsTechnicians took a pretraining questionnaire assessing knowledge and confidence before immediately completing a one-on-one pharmacist-led training session with a hands-on component on medication synchronization. Technicians took the same post-training questionnaire 2 weeks after completing the training session and using medication synchronization in daily workflow. Pre- and post-training scores were assessed using a paired samples t test. ResultsTen technicians completed the training program; 40% of the technicians were certified and 30% were enrolled in a PharmD program. The mean pretraining knowledge score was 78% (7.1 of 9 points), the mean post-training knowledge score was 92% (8.3 of 9 points), and the mean difference between the pre- and post-training knowledge scores was 13.4% (1.2 points), with a statistically significant difference (P = 0.0026). Confidence with conducting a medication synchronization call increased from 7.2 to 9.6 on a 10-point Likert scale, and confidence scores increased regarding incorporating medication synchronization into workflow from 6.9 to 8.7. ConclusionThe standardized technician training program increased knowledge and confidence in technicians regarding managing a medication synchronization program.

Implementation Documentation and Process Assessment of the PharmNet Intervention: Observational Report.

The number of overdose deaths in the United States involving opioids continues to exceed 100,000 per year. This has precipitated ongoing declarations of a public health emergency. Harm reduction approaches, such as promoting awareness of, ensuring access to, and fostering willingness to use naloxone to reverse opioid overdose, are a key component of a larger national strategy to address the crisis. In addition, overdose reversal with naloxone directly and immediately saves lives. Because of pharmacies' ubiquity and pharmacists' extensive clinical training, community pharmacies are well-positioned, in principle, to facilitate naloxone access and education. In 2022, a single-site pilot study of PharmNet, a community pharmacy intervention incorporating naloxone distribution, awareness building, and referral, showed promising outcomes for both naloxone and resource distribution in the community. As a next step, this study was intended to be a pilot randomized controlled trial of PharmNet in 7 pharmacies. However, due to circumstances outside of the study team's control, data collection was unable to be fully completed as planned. In keeping with open research standards, we transparently report all available data from the study and discuss trial barriers and processes. We do so both to provide insights that may inform similar studies and to avoid the "file-drawer" (publication bias) problem, which can skew the aggregated scholarly literature through nonpublication of registered trial results or selective publication of findings affirming authors' hypotheses. This paper reports an in-depth implementation study assessment, provides the available observational data, and discusses implementation considerations for similar studies in independent (eg, nonchain) community pharmacies. Retrospective assessment of study outcomes and fidelity data provided for robust discussion around how resource differences in independent community pharmacies (vs well-resourced chain pharmacies), as well as high demands on staff, can affect intervention implementation, even when leadership is highly supportive. Community pharmacies, particularly independent community pharmacies, may require more support than anticipated to be successful when implementing a new intervention into practice, even if it might affect estimates of real-world effectiveness. Further implementation science research is needed specific to independent community pharmacies. All study elements are outlined in the International Registered Report Identifier (IRRID) PRR1-10.2196/42373. Although this paper reports results associated with that registration, results and conclusions should not be given the weight assigned to findings from a preregistered study. RR2-10.2196/42373.

Impact of the COVID-19 pandemic on pharmacists practicing in community pharmacies in the state of Nebraska

BackgroundThe rapid increase in COVID-19 combined with uncertainty surrounding transmission and treatment protocols resulted in unprecedented burnout amongst health care workers. As other health care workers scrambled to support patients, community pharmacists quickly responded to the pandemic by extending their services. This constantly changing environment amongst other factors created a high degree of psychological burden associated with COVID-19 for pharmacists. Although studies have examined the psychological impact of the pandemic on frontline health care workers, pharmacists are rarely included in these studies. ObjectiveTo examine the impact of COVID-19 on work and personal well-being from the perspective of pharmacists practicing in community pharmacies in Nebraska. MethodsA cross-sectional online survey collected data from pharmacists with an active Nebraska Pharmacist license (N=2763) from November 2022 to January 2023. The survey was a hybrid of researcher-developed items and the validated abbreviated Maslach Burnout Inventory (aMBI). The aMBI is a 9-item Likert-scale scored instrument, which captures three domains of burnout: Personal Accomplishment; Emotional Exhaustion; and Depersonalization. Data was analyzed using IBM SPSS Statistics version 27. ResultsThe response rate to the survey was 12.3% (n=339). Mean age of the respondents was 44.8 years with an average of 18.7 years in practice. Most respondents (n = 113, 50.7%) practiced in a community pharmacy followed by hospital (n = 72, 32.3%). 55.8% of community pharmacists reported that they considered leaving their current employer. Chi-square analysis confirmed that community pharmacists are more burned out than noncommunity pharmacists. ConclusionsPharmacists realized they had not been recognized for their contributions as frontline health care workers, which motivated them to consider leaving their employer and even the profession of pharmacy. This study found community pharmacists are burned out more than non-community pharmacists. Within community pharmacies, it was found that pharmacists practicing at corporate-owned community pharmacies had increased burnout compared to those practicing in independent community pharmacies.

Pilot Study to Evaluate the Feasibility of a Patient Questionnaire for the Purpose of Investigating the Extent of Purchasing Antibiotics without a Prescription in a Rural Province in South Africa: Rationale and Implications

Abstract Introduction: There are concerns with rising rates of antimicrobial resistance (AMR) across countries with appreciable impact on morbidity, mortality and costs. Amongst low- and middle-income countries, a key driver of AMR is the excessive use of antibiotics in ambulatory care, with a critical area being the appreciable selling of antibiotics without a prescription often driven by patient demand and limited knowledge. There is currently conflicting evidence in South Africa regarding this practice. Consequently, there is a need to explore these critical issues amongst patients, especially in more rural areas of South Africa. A pilot study was undertaken to address this. Methods: A two-step descriptive approach was undertaken. This involved two questionnaires amongst patients exiting chain and independent community pharmacies followed by cognitive interviews. Results: Overall, 21 patients were approached for an interview, including 11 for Part 1 of the questionnaire with 3 declining, and 10 for Part 2, with 2 declining. Subsequently 8 patients completed each part of the questionnaire. On average, it took 2 min 13 s to complete both parts. 3 of the 5 patients being dispensed an antibiotic were dispensed one without a prescription, with all 3 patients exiting from independent pharmacies. Key reasons for self-purchasing included money and convenience. There was mixed knowledge regarding antibiotics and AMR amongst the 8 patients interviewed with Part 2. Overall, there was a satisfactory understanding of the Part 1 questions, although some modifications were suggested. Some participants had difficulty with fully understanding the questions in Part 2, with a number of suggestions made to improve this for the main study. Conclusion: There were concerns with the extent of purchasing antibiotics without a prescription in this pilot study as well as the knowledge of patients regarding antibiotics and AMR. Both areas need addressing and will be explored further in the main study.

Role of Community Pharmacist in Asthma Management: Knowledge, Attitudes and Practice.

To investigate knowledge, attitude, and practice of asthma management counseling and the perceived barriers by community pharmacists. This cross-sectional study was conducted on 416 community pharmacists using an online-based questionnaire. The questionnaire included five parts that assessed socio-demographics and medical references used to seek drug-related information, pharmacists' knowledge (7 items), attitudes (5 items), practice (22 items) and the barriers for the provision of asthma management counseling (10 items). Binary logistic regression was conducted to find the variables that were significantly and independently associated with knowledge, attitude and asthma management counseling practice. Increased years of experience was associated with decreased knowledge (OR = 0.918, 95% Cl (0.869:0.970), P = 0.002) and less positive attitude toward asthma management (OR = 0.876, 95% Cl. (0.821:0.935), P < 0.001), while working in independent community pharmacy (OR = 2.097, 95% Cl. (1.273:3.454), P = 0.004) and increased awareness of asthma management guidelines (OR = 1.60, 95% CI. (1.044:2.453), P = 0.031) increased the odds of being in the high knowledge group. In contrast, increasing the daily number of pharmacy visitors OR = 1.009, 95% Cl. (1.001:1.016), P = 0.024) and having a pharmacy degree (OR = 2.330, 95% Cl. (1.256:4.326), P = 0.007) increased the odds of having a positive attitude. Male pharmacists (OR = 0.553, 95% Cl. (0.350:0.873), P = 0.011) and having bachelor in pharmacy (OR = 0.354, 95% Cl. (0.179:0.700), P = 0.003) decreased the odds of being in the high practice group. On the other hand, increased awareness of asthma management guidelines tripled the odds of being in the high practice group (OR = 3.067, 95% Cl. (1.964:4.787), P < 0.001). The current study findings offer valuable insights into the gaps in knowledge, attitude, and practice of asthma management counseling among community pharmacists, as well as the barriers and factors that impede the provision of these services. These insights serve as a guide for developing future strategies aimed at enhancing the role of pharmacists in asthma care.

Assessment of student pharmacist‐led academic detailing on independent community pharmacy naloxone orders

AbstractIntroductionAcademic detailing has been used as a preferential method to increase pharmacists' awareness of naloxone; however, its impact on actual dispensing rates is not well established.ObjectiveThe aim of this pilot study is to determine if a student‐led academic detailing on naloxone use and communication increased the amount of naloxone ordered from independent pharmacies in various geographic settings throughout Northeast Pennsylvania.MethodsThirty‐nine independent pharmacies which utilized a single wholesaler were randomized to receive an in‐person, student‐led training about naloxone use and communication. Students attended a train‐the‐trainer presentation to ensure a universal training was provided to all pharmacies. Students were provided with intranasal naloxone demonstration devices, handouts on effective communication, and talking points for each pharmacy visit. All academic detailing sessions were held live at each pharmacy during that pharmacy's regular business hours. Topics covered included appropriate naloxone use, what to expect after giving naloxone, and evidence‐based communication methods for engaging with patients about purchasing naloxone. Devices and handouts were left behind for pharmacists to use in daily practice. Naloxone and opioid shipping data for 3 months prior to and 3 months post‐intervention were compared.ResultsNaloxone ordered in the pre‐intervention period was 21 vs. 26 (intervention vs. control) (p = 0.59) and 31 vs. 29 post‐intervention (p = 0.25). There was no statistically significant difference in the number of pharmacies which ordered more naloxone pre vs. post‐intervention or in the total amount of opioids ordered pre vs. post‐intervention.ConclusionWhile pharmacies which received academic detailing did order more naloxone than pharmacies which did not, the difference did not rise to a level of statistical significance. As the population of this pilot study was small, expanding this approach to academic detailing to a larger population is warranted to possibly see more robust results.

Community Champions: The Crucial Contribution of an Independent Pharmacy in COVID-19 Vaccination Efforts in an Underserved Community.

Historically, pharmacists in independent community pharmacies have been pivotal in promoting community health. During the COVID-19 pandemic, they demonstrated their commitment by advocating for vaccination and providing accessible care, particularly in underserved communities. By addressing disparities, implementing strategies like mobile clinics and community outreach, and fostering trust and engagement, independent community pharmacists played a crucial role in bridging gaps in healthcare access for vulnerable populations and mitigating the impact of the COVID-19 pandemic.

Pharmacy technicians trained as community health workers: A prospective multicenter cohort study

BackgroundCommunity health workers (CHWs) are health professionals who are experts in linking patients to health resources. Although CHWs are employed in a variety of health institutions, access to their services may be challenging for patients in underserved locations. Community pharmacies are uniquely positioned to mitigate this barrier as they provide readily accessible care for patients residing in these areas. ObjectivesTo 1) quantify and report the CHW services provided by certified pharmacy technicians (CPhTs) in an underserved population and 2) provide an initial framework for the implementation of CHW services in community pharmacies or similar health care settings. MethodsThis prospective cohort study reports the findings of training CPhTs as CHWs in 3 independent community pharmacies from January 1, 2021 to July 1, 2021. CPhT-CHWs conducted monthly visits by phone, patient home, or pharmacy and documented services using a standardized assessment form. Descriptive statistics were used to summarize the baseline characteristics of the patient population, service codes, types of services and referrals made, and time spent per visit by CPhT-CHWs. ResultsA total of 198 patient visits by phone, patient home, or at the pharmacy were completed in a 6-month timespan. During these visits, the CPhT-CHW provided 351 services (203 primary services and 149 secondary services) and completed 51 referrals. The average time spent per visit (standard deviation) was 15.5 (11.5) 68.9 (35.4), and 30.6 (16.8) minutes for phone, home, and pharmacy visits, respectively. Patient home visits resulted in the highest average primary services per visit, longest time spent with the patient, and accounted for a majority of social services. ConclusionCPhT-CHWs were able to use various methods to contact these patients to further develop patient-to-provider and patient-to-pharmacy relationships. Training CPhTs as CHWs can be an effective way to increase patient contact and provide additional health services.

Objective Assessment of Adherence and Inhaler Technique among Asthma and COPD Patients in London: A Study in Community Pharmacies Using an Electronic Monitoring Device.

The INhaler Compliance Assessment (INCATM) device is an electronic monitoring device (EMD) that assesses both patient's adherence and inhaler technique (IT). This study aimed, first, to assess the value of using the INCATM device as an objective measure during medicine use review (MUR) consultations provided by community pharmacists (CPs) on patients' adherence and IT. Second, we aimed to explore patients' perceptions about the INCATM device. A mixed methods approach was used, involving two phases. Phase one was a service evaluation in independent community pharmacies in London with a before-and-after study design. The service included provision of an MUR consultation to asthma and COPD patients using objective feedback about adherence and IT generated with the INCATM device. Descriptive and inferential statistics were performed using SPSS. Phase two involved semi-structured interviews with respiratory patients. Thematic analysis was performed to generate key findings. Eighteen patients participated in the study (12 COPD and 6 asthma). The results showed significant improvement in the INCATM actual adherence from 30% to 68% (p = 0.001) and significant reduction in IT error rate from 51% to 12% (p = 0.002) after conducting the service. Analysis of the interviews revealed patients' positive attitudes in terms of the perceived benefits of the technology and a desire for future use and recommendation for others. Patients had also positive attitudes towards the consultations provided. Embedding an objective measure about adherence and IT during CPs' consultations showed a significant improvement in patients' adherence and IT and was accepted by patients as well.

Implementation of the appointment-based model in community pharmacies: An analysis of refills and adherence

BackgroundTraditionally, much of community pharmacy practice relies on patients to request their own medication refills. These refills are often not aligned, which has been shown to decrease adherence and workflow efficiencies. The appointment-based model (ABM) is designed to proactively synchronize refills and schedule patient-pharmacist appointments. ObjectivesTo describe the characteristics of patients enrolled in the ABM; and to compare the number of distinct refill dates, number of refills, and adherence for antihypertensives, oral antihyperglycemics, and statins 6-months and 12-months pre-post ABM implementation. MethodsIn September 2017, the ABM was implemented across independent community pharmacies within a pharmacy banner in Ontario, Canada. In December 2018, a convenience sample of three pharmacies was extracted. Demographic and clinical characteristics were collected on program enrollment (index) date for individual patients and their medication fill histories were used to investigate adherence measures including distinct number of refill dates, number of refills, and proportion of days covered. Descriptive statistics were analyzed using StataCorp. ResultsAnalysis of 131 patients (48.9% male; mean age 70.8 years ± 10.5 SD) filled on average 5.1 ± 2.7 medications with 73 (55.7%) experiencing polypharmacy. Patients had a significant reduction in mean number of refill dates (6.8 ± 3.8 SD six-months pre-enrollment, 4.9 ± 3.1 SD six-months post-enrollment, p < 0.0001). Adherence to chronic medications remained high (PDC ≥95%). ConclusionThe ABM was implemented for a cohort of established users, already highly adherent to their chronic medications. Results demonstrate reduced filling complexity and fewer refill dates while also sustaining the high baseline adherence across all chronic medications studied. Future studies should investigate patient perspectives and potential clinical benefits of the ABM.

Medication-Related Problems Identified and Addressed by Pharmacists Dispensing COVID-19 Antivirals at a Community Pharmacy.

Safe dispensing of coronavirus disease 2019 (COVID-19) oral antivirals requires comprehensive patient assessment to identify and address significant medication-related problems (MRPs). Given the fast-paced environment of community pharmacies and limited access to outside patient records, there are challenges with pharmacists ensuring the safe and appropriate dispensing of these medications. An independent community pharmacy in Pennsylvania developed and implemented a COVID-19 oral antiviral assessment protocol to systematically review all prescriptions dispensed for nirmatrelvir/ritonavir (Paxlovid™) and molnupiravir (Lagevrio™) to identify and address MRPs. A retrospective review was conducted to assess documented MRPs, including significant drug-drug interactions and inappropriate dosing requiring intervention, for prescriptions dispensed from 9 February 2022 to 29 April 2022. Pharmacists identified one or more significant MRPs requiring intervention on 42 of the 54 nirmatrelvir/ritonavir prescriptions (78%) and 0 of the 7 molnupiravir prescriptions. Most pharmacist interventions involved drug-drug interactions between nirmatrelvir/ritonavir and HMG-CoA reductase inhibitors and calcium channel blockers, along with four renal dose adjustments for nirmatrelvir/ritonavir. This study highlights the ability of community pharmacists to identify and address MRPs and promotes the use of a protocol to encourage safe dispensing practices for medications prone to MRPs.

Suspected inappropriate use of prescription and non-prescription drugs among requesting customers: A Saudi community pharmacists’ perspective

BackgroundInappropriate use of medications is a global health concern, and this is attributed to the increased accessibility to prescription and non-prescription (over-the-counter) drugs at community pharmacies. We investigated the inappropriate use of prescription and non-prescription drugs in community pharmacies based on the perspectives of the community pharmacists in Saudi Arabia. MethodsThis was a questionnaire-based, cross-sectional survey which employed convenient sampling (snowball technique) to recruit participants. Being a licensed practicing pharmacist in a retail chain or an independent community pharmacy was the inclusion criteria. Participants were asked to report the drugs they suspected of being inappropriately used along with the frequency, age and gender of the suspected customers. Pharmacists were also asked to mention the action taken to limit inappropriate use at their pharmacy. ResultsA total of 397 community pharmacists completed the questionnaire (86.9 % response rate). 86.4% of the pharmacists suspected some level of abuse or misuse to have occurred. After receiving the questionnaire, the pharmacists reported suspected inappropriate use as encountered during the past three months. Cumulative inappropriate use was reported 1069 times (prescription drugs – 530; non-prescription drugs – 539). The top three inappropriately used prescription-drug categories were gabapentinoids (22.5%), antipsychotics (17.5%) and topical corticosteroids (12.1%). Among non-prescription drugs, cough products (33.2%) ranked first, followed by cold and flu products (29.5%) and first-generation antihistamines (10.8%). The cross tabulations revealed that being in the age range of 26–50 years and being a male was significantly associated (p < 0.001) with abuse/misuse of antipsychotics, antidepressants, gabapentinoids, cough products and first-generation antihistamines. Eye products (Bimatoprost) and skin products abuse/misuse had significant association with female gender (p < 0.001) ConclusionThe results of our study provide crucial information to the healthcare authorities regarding the medications that can be inappropriately used at the community pharmacies in Saudi Arabia which necessitates implementation of stringent dispensing regulations. Educational programs can be implemented to increase the awareness among public regarding the harmful effects of inappropriate use of drugs.

Innovating the Model for Student Pharmacists to Increase Access to Hepatitis C Testing (Project IMPACT)

BackgroundPrevious initiatives have described the feasibility of conducting point-of-care testing (POCT) for hepatitis C virus (HCV) within community pharmacies. Limited research has been conducted to evaluate the role of student pharmacists and technicians in providing these services. ObjectiveDescribe the implementation of a student pharmacist–run HCV POCT initiative within an independent community pharmacy and evaluate the linkage to care process. Practice descriptionOne specialty and 3 community pharmacies managed by one independent pharmacy chain. Practice innovationPharmacy students screened participants for HCV and referred those with a reactive result or reporting untreated HCV to a partnering medical facility for confirmatory testing. Individuals with confirmed HCV had the option to receive their prescriptions, along with monthly telephonic monitoring services from the independent pharmacy’s specialty pharmacy. Evaluation methodsResearchers evaluated the number of participants who screened reactive or reported current HCV infection, successful referrals to medical care, and prescriptions dispensed by the specialty pharmacy for HCV treatment. ResultsFrom September 2020 to September 2022, 236 individuals were screened for HCV at the pharmacy, of whom 11 screened reactive (4.7%) and 4 participants reported untreated HCV infection. In total, 15 participants were referred to care and 4 of these participants (26.7%) were successfully linked. One participant received prescriptions and telephonic monitoring for HCV treatment from the specialty pharmacy as a direct result of Project IMPACT (Innovating the Model for Student Pharmacists to Increase Access to Hepatitis C Testing). Practice implications and conclusionsProject IMPACT demonstrated that community pharmacies can increase access to HCV screenings by using student pharmacists and technicians. Potential strategies to improve the linkage to care process include enhancing the quality of patient education and implementing telehealth services.

Preparedness for a pandemic: Independent community pharmacists’ experiences delivering COVID-19 vaccines

ObjectiveTo identify the experiences and preparedness for independent community pharmacies to deliver COVID-19 vaccines. DesignA mixed-methods study collected quantitative and qualitative data. Setting and participants: Every independent community pharmacy providing COVID-19 vaccines in North Dakota. Outcome measuresDuring state-required site visits, quantitative data determined by a Centers for Disease Control and Prevention (CDC)–developed reviewer guide were collected on each pharmacy’s preparedness on vaccine provision and quality assurance to provide COVID-19 vaccines. Qualitative data to describe the lived experiences of pharmacists were collected through site visit documentation and semistructured interviews with participating pharmacists. ResultsFifty-two pharmacies received site visits. All visited pharmacies met full compliance with CDC’s reviewer guide for billing and documentation of vaccine, vaccine procedures, recipient communication, and handling of ancillary supplies. Pharmacies varied in their compliance of vaccine storage and handling requirements. Forty-three interviews yielded 4 main themes about pharmacies’ role in vaccination during the pandemic: (1) professional role, (2) accessibility, (3) patient relations, and (4) community role. ConclusionSite visits demonstrated that independent community pharmacies were prepared to provide COVID-19 vaccines in response to public need, despite varying degrees of experience with and provision of routine immunizations. Interviews revealed that pharmacists recognized their important contribution to COVID-19 vaccine provision efforts.

Exploring the Membership Pharmacy Model: Initial impact and feasibility.

There is a need to shift pharmacy payment models, given the expanding role of the community pharmacist in improving patient outcomes, misaligned incentives of the existing reimbursement model, and deleterious effects of a lack of transparency on prescription costs. The primary objective of this paper was to develop a payment strategy for a Membership Pharmacy Model within an independent community pharmacy setting. A secondary objective of this paper is to explore the early impact of a novel value-based pharmacy payment model on patients, pharmacies, and self-insured employers. Good Shepherd Pharmacy, a nonprofit Membership Pharmacy founded in Memphis, TN, in2015. We discuss a novel, value-based payment model for community pharmacy, which involves a partnership between pharmacy and employer, without the use of a pharmacy benefit manager, using a recurring (i.e., membership pharmacy) business revenue model. The pilot program was assessed using the RE-AIM framework. The pilot enrolled 34 patients for whom 1399 prescriptions were filled spanning 13 quarterly refill cycles from January 2019-March 2022. After the intervention, proportion of days covered for diabetes and cholesterol medications both increased: 96.7% and 100% (P < 0.05); 90.3% and 98.1% (P > 0.05). Financial savings for the employer group were realized across both fee charges and prescription medication costs. The net savings provided to the employer was $67,843, a 35% reduction in topline pharmacy spending. Revenue for the pharmacy was realized exclusively through synchronization fees of $30 per fill. Synchronization fees for the entire study totaled $41,970, and the average revenue per quarterly batch refill was $3228. The Membership Pharmacy Model represents a potentially viable alternative to traditional fee-for-service, buy-and-bill pharmacy payment models through its use of medication pricing based on actual acquisition costs, lean pharmacy operations, and value-based reimbursement methods.

Hepatitis C screening in a community pharmacy setting: Patient perspective

BackgroundHepatitis C virus (HCV) is an infection of the liver, which contributes to over 15,000 deaths in the United States annually. When treated, HCV has a 90% or greater cure rate, however testing for HCV remains low. ObjectivesTo assess patient perspectives on HCV screenings in the community pharmacy setting including awareness of screening, willingness to be screened, barriers to screening, and willingness to pay for HCV screening. MethodsThis study used a cross-sectional survey design. The surveys were distributed by staff at an independent community pharmacy participating in an HCV screening initiative through the state department of public health. Eligible patients were born between 1945 and 1965. Descriptive statistics were calculated for survey variables. Open-ended responses were analyzed for additional context. ResultsFifty-seven surveys were returned and analyzed. The majority of the respondents were White (94%), female (56%), and had some college education (26%). Only 7% were aware that a finger-stick point-of-care test was available and 67% were unaware of the Centers for Disease Control and Prevention (CDC) recommendation for testing. The most frequently reported barrier or hesitation to screening was the patient not thinking they were at risk (29%) followed by uncertainty about cost (14%). Over half of respondents (63%) were either somewhat interested or very interested in testing in a community pharmacy, however, the majority (71%) were not willing to pay or only willing to pay less than $20. ConclusionsSurvey respondents were largely unaware of the recommendations and availability of finger-stick HCV screenings at community pharmacies but many were willing to be tested if low-cost. Providing patient education on the importance of HCV screenings and CDC recommendations may bolster interest in screening.

The role of community pharmacies in the HIV and HCV care continuum

IntroductionIn 2019, there were over 1.1 million people living with human immunodeficiency virus (HIV) and 2.4 million people living with hepatitis C virus (HCV) in the United States. One in seven (14%) are unaware of their HIV infection and almost half of all HCV infections are undiagnosed. People with unstable housing are disproportionately affected by HIV and HCV. The present study will evaluate interventions by community pharmacists that may reduce HIV and HCV transmission and promote linkage to care. MethodsThis study was conducted in an independent community pharmacy in Spokane, Washington. Eligible study participants were walk-in patients of the pharmacy, over the age of 18, and experiencing homelessness. Pharmacy patients were excluded if they had a history of HIV or HCV diagnosis, received a screening for HIV or HCV in the last six months or were unable to give informed consent. The intervention included administration of HIV and HCV point-of-care testing (POCT) using a blood sample, risk determination interview, comprehensive HIV and HCV education, and personalized post-test and risk mitigation counseling followed by referral to partnering health clinics. ResultsFifty participants were included in the final data analysis. Twenty-two participants (44%) had a reactive HCV POCT, and one participant had a reactive HIV POCT. Of the 94% of participants who reported illicit drug use, 74% reported injection drug use. Seventy-six percent (n = 38) qualified for PrEP. Pharmacist referrals were made for 28 participants and 71% were confirmed to have established care. ConclusionIndividuals experiencing homelessness are at an increased risk for acquiring HIV and HCV due to risky sexual behaviors and substance misuse. PrEP is underutilized in the U.S. and pharmacist involvement in the HIV and HCV care continuum may have a significant impact in improving linkage and retention in care of difficult to treat populations.

Impact of patient-centered prescription medication labels on adherence in community pharmacy

BackgroundPrescription medication labels are often constructed in a manner which hinders safe and appropriate use of medicines. The United States Pharmacopeia released voluntary standards to revise medication labels in an effort to support patients’ understanding and improve medication use. ObjectiveTo examine the impact of label changes on medication adherence before and after pharmacy implementation of the United States Pharmacopeia patient-centered prescription medication label standards. MethodsThis study used a retrospective pre-post cohort design. Prescription fill claims data were obtained from a community health plan serving Medicaid patients for 1 independent community pharmacy organization across 8 retail pharmacy sites. We calculated medication possession ratios (MPR) and proportion of days covered (PDC) for medications used for contraception, asthma, hypertension, and depression from 15 months before to 13 months after implementation of the label changes. ResultsFindings showed significant increases in mean MPR for asthma controller (increased by 0.111 [t = 0.290, P<0.0001]), antihypertensives (increased by 0.062 [t = 0.146, P < 0.0002]), and contraceptives medications (increased 0.133 [t = 0.209, P < 0.0001]) from preintervention to postintervention periods. Results also revealed increases in mean PDC for asthma controllers (increased by 0.193 [t = 0.267, P < 0.0001]), antihypertensives (increased by 0.067 [t = 0.175, P = 0.049]), and contraceptives (increased by 0.111 [t = 0.208, P < 0.0119]) from preintervention to postintervention periods. ConclusionWe report an association between a change to more patient-centered prescription medication labels and increased medication adherence based on MPR and PDC among Medicaid recipients.

Determinants to immunization information system implementation in independent community pharmacies.

Immunization information systems (IISs) facilitate consolidated vaccination data within each state. Many have limited pharmacy participation, especially Alabama. As pharmacists increasingly engage in delivery of vaccines recommended across the life span, it is critical to understand the barriers to IIS implementation, particularly in rural community pharmacies where access to primary care may be limited. The purpose of this study was to identify barriers and facilitators to IIS implementation in rural, independent community pharmacies in Alabama. Qualitative interviews with rural, independent community pharmacy personnel and IIS experts in both states with high IIS participation and Alabama (state with low IIS participation) were conducted. States with high participation were identified as those with ≥75% of adults recorded in their respective state IIS. Less than 25% of Alabama adults were recorded in the state IIS at the time of this study. Deductive coding using CFIR constructs was conducted with a second coder to ensure inter-rater reliability. CFIR Rating Rules were applied to the coded data to allow for identification of constructs that have the greatest impact on implementation. A total of twenty-five participants (16 pharmacy personnel; 9 IIS experts) were interviewed. During interviews, 32 of 39 CFIR constructs were mentioned and 11 constructs with a strong influence (+2 or -2) were identified. These included, "adaptability", "complexity", "compatibility", "available resources", "access to knowledge and information", "needs and resources of those served by the organization", "peer pressure", "external policy and initiatives", "knowledge and beliefs about the innovation", "engaging key stakeholders", and "engaging innovation participants". This qualitative study explored perceived barriers and facilitators to IIS implementation in the rural, independent community pharmacy setting from the perspectives of pharmacy personnel and IIS experts. Factors identified can be used to inform the development of resources and implementation strategies to improve IIS uptake and participation.

New Medicine Service by Community Pharmacists: An Opportunity to Enhance Universal Health Coverage at a Primary Health Level in South Africa.

The implementation of universal health coverage (UHC) in South Africa has focused on promoting equitable health care services to all citizens. In this regard, pharmacists are expected to expand their professional capabilities to promote primary healthcare system functionality. The new medicine service (NMS) has proven to be beneficial in medicine optimization and adherence. The aim of the NMS is to assist and advise patients on their newly diagnosed conditions and to promote the safe and rational use of medicines. This study explores the provision of NMS within the UHC primary healthcare service package and the opportunity for enhancing pharmacist practice. This pilot reports on the implementation of NMS in a low-middle income country. Data was obtained using convenience sampling and an interview-based approach. Findings were evaluated, analyzed, and reported using qualitative techniques. This study was conducted at an independent community pharmacy in Durban, South Africa. Fifty-four patients were successfully enrolled into the program based on the eligibility criteria; 19 patients exited the program before completion. From those that completed the program, 65.71% had no problems detected; rather the program served as a platform to provide information and ensure proper adherence practices, 34.29% of patients experienced problems and were referred back to the prescriber, or pharmacist. After the completion of the program, 54.29% where found to be adherent to their medication, however, 45.71% were found to be non-adherent and were counseled accordingly or referred back to the medical practitioner. This paper highlighted that the implementation of a pharmacist's full scope of practice and services such as the NMS is essential in improving therapeutic outcomes, recognize medicine related problems, and avert unnecessary use of medicines.