Independent Pharmacists Research Articles

Chain community pharmacists’ requests for patient information during routine care

BackgroundTo optimize service provision, community pharmacists need information (e.g., laboratory values and updated medication lists), which can be difficult to obtain. Contacting prescriber offices is a common approach to obtain information but is often ineffective. Health information exchange (HIE) is one potential solution to this problem, and recent survey research has identified the information needs of independent pharmacists that could be addressed through HIE. However, the information needs of chain community pharmacists are unknown. ObjectivesThe objective of this study was to characterize the patient information requests made by chain community pharmacists during routine practice. MethodsThis electronic card study captured cross-sectional observational data on patient information requests made by chain pharmacists in central Indiana during routine practice. Only one pharmacist meeting eligibility criteria per pharmacy could submit data. Pharmacists were randomized to a two-week data collection period. In real-time, pharmacists recorded the following: type of information requested, reason for request, information source, whether initial or follow up request, modality of communication, and the time required to make the request. Data analysis occurred via descriptive statistics. The Indiana University Institutional Review Board approved all study procedures. ResultsNineteen of the 33 eligible pharmacists (57.6%) consented to the study. Most participants held a PharmD degree (78.9%) and were the pharmacy manager (89.5%) at their location. Updated medication orders/lists (41.3%) and insurance (33.3%) were the most common type of requested information and was primarily used for prescription clarification/filling (93.4%). The prescriber office (53.6%), as well as the patient/caregiver (39.8%), were the most frequent source of this information. Requests were largely completed by telephone (61.2%) and averaged 6.0 minutes (SD: 4.8). ConclusionCommunity pharmacists require key patient data during routine practice. There is a need to develop mechanisms, like HIE, to address gaps in needed information in the community pharmacy setting, regardless of the offered services.

Drug-Related Problems Among Peritoneal Dialysis Patients: A 12-Year Retrospective Cohort Study.

Introduction Studies regarding drug-related problems (DRPs) can be found in other diseases, but data are lacking among peritoneal dialysis (PD) populations. Despite advancements in PD care, there remains a significant gap in understanding and addressing DRPs in the PD population. DRPs can lead to serious consequences, including medication errors, adverse reactions, and nonadherence, affecting patient outcomes and healthcare costs. Aim The aim of this study was to identify the prevalence of DRPs, types, causes, interventions performed, acceptance of interventions, and outcomes of DRPs among patients undergoing PD. In addition to this, the study sought to identify factors associated with DRPs in the PD population. Methods This single-center retrospective study recruited adult PD patients with at least one medication from January 2009 until November 2021. Pharmacy medication therapy adherence clinic (MTAC) clinical activity sheets were reviewed, and DRPs were classified based on the Pharmaceutical Care Network Europe Classification (PCNE) v9.1. The PCNE system consists of five essential domains: Problems (P), Causes (C), Interventions (I), Acceptance of the Intervention (A), and Outcomes (O). As part of the pharmacists' MTAC activities, DRPs were meticulously documented. Three pharmacists initially gathered and examined these recorded DRPs. Each identified DRP was then classified according to the type of problem, the underlying cause, any intervention performed to address the DRP, the level of acceptance, and the resulting outcome. Subsequently, these classifications were reviewed by two independent pharmacists to ensure accuracy and consistency. Results Out of 562 patients, 70.6% (n = 397) were on more than 10 drugs. Most patients (n = 520, 92.5%) had at least one DRP. From the 3,333 DRPs identified, the most common were effects of drug treatment not optimal (n = 1,595, 47.8%), followed by untreated symptoms (n = 843, 25.3%) and adverse drug events (n = 730, 21.9%). The main cause of the suboptimal treatment effect was patients' noncompliance (n = 891, 55.9%). For untreated symptoms, the main cause was no drug prescribed despite existing indications (n = 789, 93.6%). Interventions for DRPs were at either prescriber level (n = 2,064, 61.9%), patient-level (n = 1,244, 37.3%), or at other levels, such as with nurses (n = 25, 0.8%). Prescribers accepted 83% (n = 1713) of interventions suggested by pharmacists. Overall, 73.2% (n = 2,439) of DRPs were resolved. Number of medications (b = 0.223, 0.102-0.345) and number of MTAC visits (b = 0.381, 0.344-0.419) were predictive factors of the number of DRPs (p < 0.001). Conclusion There is a high prevalence of DRPs in PD patients. Pharmacists play an important role in detecting, intervening, and resolving DRPs to improve patients' outcomes.

Residents Preferences for Pharmacist-Managed Clinic in China: A Discrete Choice Experiment.

This study aimed to survey and analyze the preferences for pharmacist-managed clinic among urban residents in China. A discrete choice experiment was conducted in Nanjing, China. A D-efficient fractional factorial design was used to generate the questionnaire. Three models were used to investigate each patient's strength of preference and preference heterogeneity. The relative importance for each treatment attribute was also determined. 156 usable questionnaires (of 228 questionnaires sent out) were received. Respondents preferred pharmacist-managed clinics with the following characteristics: good pharmacists' knowledge and clinical medication practice competency, lower consultation fees, a dedicated consultation room, physician-pharmacist joint clinic, with pharmacists' knowledge competency receiving the highest priority. Latent class analysis revealed three classes (Experiential Type, Content Type and Economic Type) were identified based on respondents' preferences for pharmacist-managed clinics. The respondents were willing to choose a PMC relative to the current situation. When deciding on a pharmacist-managed clinic, residents are driven by pharmacists' competency, consultation fee, availability of consultation rooms and collaborative care or independent pharmacist service. Differences in patients' preferences identified in the study provide information on pharmacist-managed clinics that meet residents' expectations.

Developing paediatric skills and knowledge in pharmacy education: an exploration of a novel work-based learning experience

Abstract Introduction Pharmacy education in the United Kingdom must adapt to produce independent prescribing pharmacists ready to join an evolving healthcare system. Current placement practices exclude approximately 21% of the population due to a lack of specific recommendations surrounding paediatric experience and knowledge within the MPharm programme.[1] In turn, students’ current experiences may be limited by lack of interaction with unique learning outcomes offered by some healthcare settings, such as paediatric hospitals.[2] To promote student exposure in an overlooked speciality, novel approaches to work-based learning can be utilised. Aim This study aimed to explore pharmacy students’ experiences of work-based learning in a paediatric hospital setting. Methods In October 2022, fourth-year MPharm students at one school of pharmacy were invited to undertake work-based learning sessions across one academic year. The sessions aimed to develop students’ paediatric consultations skills and knowledge. Sessions consisted of a briefing, ward activities, scaffolded consultations with children and carers, and debriefs with a clinical supervisor. Debriefs included students reporting clinical information, required action and learning outcomes. All debriefs provided by students were transcribed by a clinical supervisor using a spreadsheet which recorded the date, ward visited, patient details, student handover, follow-up (if required) and learning outcomes. Data was initially cleaned, quality checked, and underwent content analysis to identify patterns and key themes to describe student experiences. Results Seventy-four students took part in sessions and delivered 233 consultations covering the medical history of the patient (76%, n=177), with varied levels of completeness. Students were exposed to acute conditions (41%, n=96) and chronic conditions (33%, n=76), with 13% (n=30) still awaiting diagnosis. Forty-eight percent (n=81) of learning points related to the pathology, diagnosis and symptoms of conditions, 24% (n=41) to medicines, 15% (n=25) to patient care, 11% (n=18) to non-clinical experiences and 2% (n=4) to other outcomes. In addition to carrying out ward activities, students underwent the processing of experiences during post-session debriefs: “It’s uncomfortable seeing a child struggle to breathe” [P131]. The process of active reflection was also evidenced in debriefs: “I felt very anxious, like a tightness in the chest, to hear that a child had a short life expectancy” [P145]; “I realised they had zero cultural competence after seeing a patient from the Middle East with jaundice” [P233]. Conclusion The study demonstrates a proof of concept that students can be exposed to complex care needs and challenging consultations under indirect supervision, demonstrating the paediatric setting to be a suitable work-based learning host. However, findings are limited to a single cohort of students at a single site, meaning transferability may be limited. Future studies could focus on longitudinal educational and emotional outcomes of students by measuring clinical knowledge, competence and confidence. Utilising post-session debriefs with peers and supervisors created a space to share both pharmaceutical and emotional learning points, aiding in managing the cognitive load of students. This experience not only highlights the requirement of paediatric exposure in pharmacy education programmes to aid the students’ future practice, but the importance of supervised reflective activities following work-based learning experiences.

Performance of ChatGPT on Factual Knowledge Questions Regarding Clinical Pharmacy.

ChatGPT is a language model that was trained on a large dataset including medical literature. Several studies have described the performance of ChatGPT on medical exams. In this study, we examine its performance in answering factual knowledge questions regarding clinical pharmacy. Questions were obtained from a Dutch application that features multiple-choice questions to maintain a basic knowledge level for clinical pharmacists. In total, 264 clinical pharmacy-related questions were presented to ChatGPT and responses were evaluated for accuracy, concordance, quality of the substantiation, and reproducibility. Accuracy was defined as the correctness of the answer, and results were compared to the overall score by pharmacists over 2022. Responses were marked concordant if no contradictions were present. The quality of the substantiation was graded by two independent pharmacists using a 4-point scale. Reproducibility was established by presenting questions multiple times and on various days. ChatGPT yielded accurate responses for 79% of the questions, surpassing pharmacists' accuracy of 66%. Concordance was 95%, and the quality of the substantiation was deemed good or excellent for 73% of the questions. Reproducibility was consistently high, both within day and between days (>92%), as well as across different users. ChatGPT demonstrated a higher accuracy and reproducibility to factual knowledge questions related to clinical pharmacy practice than pharmacists. Consequently, we posit that ChatGPT could serve as a valuable resource to pharmacists. We hope the technology will further improve, which may lead to enhanced future performance.

Testing the feasibility of the QuitAid smoking cessation intervention in a randomized factorial design in an independent, rural community pharmacy

BackgroundAdult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need.MethodsTwenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity.ResultsParticipants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%).ConclusionsThis demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed.Trial registrationThe trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241.

Economic evaluation of clinical pharmacy service using integrated health system in tertiary care hospital

ABSTRACT Background Clinical pharmacy services are the specialized practices of pharmacists to provide pharmaceutical care. All these activities are documented as pharmacist interventions to avoid medication errors which occur during prescribing, dispensing, and administration. The purpose of this study is to conduct an economic analysis of the pharmacist interventions using integrated health system. Research design and methods A retrospective study was conducted in a tertiary care hospital. Pharmacist interventions were analyzed by an independent pharmacist. Cost-saving and cost avoidance analyses were carried out for drug-related interventions. Economic analysis was performed and tabulated both in PKR and USD. Results Out of 1330 interventions, 1250 (95%) interventions were accepted and changed the prescription upon the physician-pharmacist consultation while 71 (5%) were not accepted. Interventions related to prescribing and duplication errors were the highest of all (30 and 29% respectively). Pharmacist interventions were recorded with a 95% acceptance rate. Cost analysis showed that pharmacist interventions saved around 105,115.88 US dollars. Conclusion Clinical pharmacy services provided by integrated health system are a cost saving program. The cost saved per intervention for our study is around USD 37 which is more than another similar study which quoted USD 30.35 per intervention.

Safety and quality of AI chatbots for drug-related inquiries: A real-world comparison with licensed pharmacists.

Pharmacists play a pivotal role in ensuring patients are administered safe and effective medications; however, they encounter obstacles such as elevated workloads and a scarcity of qualified professionals. Despite the prospective utility of large language models (LLMs), such as Generative Pre-trained Transformers (GPTs), in addressing pharmaceutical inquiries, their applicability in real-world cases remains unexplored. To evaluate GPT-based chatbots' accuracy in real-world drug-related inquiries, comparing their performance to licensed pharmacists. In this cross-sectional study, authors analyzed real-world drug inquiries from a Drug Information Inquiry Database. Two independent pharmacists evaluated the performance of GPT-based chatbots (GPT-3, GPT-3.5, GPT-4) against human pharmacists using accuracy, detail, and risk of harm criteria. Descriptive statistics described inquiry characteristics. Absolute proportion comparative analyses assessed accuracy, detail, and risk of harm. Stratified analyses were performed for different inquiry types. Seventy inquiries were included. Most inquiries were received from physicians (41%) and pharmacists (44%). Inquiries type included dosage/administration (34.2%), drug interaction (12.8%) and pregnancy/lactation (15.7%). Majority of inquires included adults (83%) and female patients (54.3%). GPT-4 had 64.3% completely accurate responses, comparable to human pharmacists. GPT-4 and human pharmacists provided sufficiently detailed responses, with GPT-4 offering additional relevant details. Both GPT-4 and human pharmacists delivered 95% safe responses; however, GPT-4 provided proactive risk mitigation information in 70% of the instances, whereas similar information was included in 25.7% of human pharmacists' responses. Our study showcased GPT-4's potential in addressing drug-related inquiries accurately and safely, comparable to human pharmacists. Current GPT-4-based chatbots could support healthcare professionals and foster global health improvements.

Survey of Georgia community pharmacists’ needs to engage in advanced community pharmacy services

BackgroundCommunity pharmacists improve health, reduce fragmentation in care, lower health costs, and improve health outcomes. In Georgia, pharmacists are able to enter collaborative drug therapy management protocols, such as hypertension management, with a collaborating physician, which may allow pharmacists to provide advanced community pharmacy services (ACPS), however few Georgia pharmacists have this licensure. No program(s) exist that empower pharmacists to successfully engage in ACPS across the state of Georgia nor trains pharmacists to successfully engage in collaborative practice. ObjectiveThe goal of this project was to explore community pharmacists’ perception, confidence, and engagement in ACPS and how this can improve access to care in Georgia. MethodsSix hundred one independent community pharmacists were sent an electronic survey May 13, 2022, with weekly email reminders through June 17, 2022. Results were analyzed with the independent sample t test. Thematic analysis was completed on open response survey questions. ResultsNinety responses were received (15% response rate). In the majority of survey outcomes, no differences were found in needs for success between rural versus urban pharmacists. Pharmacies with a smaller technician-to-pharmacists ≤2 (staffing) ratios identified billing for services as a higher priority need for success for them to confidently engage in ACPS (P = 0.012) while pharmacies with a higher technician-to-pharmacists >2 (staffing) ratio agreed a larger need was in optimization of current workflow to allow for advanced community pharmacy service incorporation (P = 0.034). All community pharmacists agreed they would require expansion in staffing and the qualities desired for additional hires to support ACPS include ambition, proficiency, and communication skills. ConclusionNumerous needs for success exist for community pharmacists to feel comfortable and confident to engage in ACPS. Addressing these needs may increase community pharmacist impact through increasing utilization of these services.

The Care Home Independent Pharmacist Prescriber Study (CHIPPS): development and implementation of an RCT to estimate safety, effectiveness and cost-effectiveness

Background Medicine prescribing, monitoring and administration in care homes can be significantly enhanced. Effective interventions to improve pharmaceutical care and resident outcomes are required. The enablement of pharmacists to prescribe provides an opportunity for pharmacist independent prescribers to assume responsibility for improving pharmaceutical care, medication-related outcomes and resident safety whilst reducing general practitioner workload. Objective(s) To determine the effectiveness and cost-effectiveness of pharmacist independent prescribing in care homes. Design Development work was undertaken through five work packages before the delivery of the definitive trial. Triads of pharmacist independent prescribers, care home and general practice with responsibility over 20 care home residents were recruited and cluster randomised to intervention or usual care for 6 months. Researchers were blinded at recruitment stage only. Recruitment of 880 residents was required to provide 80% statistical power, to show a 21% reduction in falls over 6 months, assuming 20% attrition. Randomisation was undertaken electronically at triad level, stratified by geographical area. Intention-to-treat analysis undertaken using a negative binomial model. Parameters were estimated using a generalised estimating equation approach. Costs were captured from an NHS perspective. Quality of life (EuroQol; five domain; five level) was collected by proxy to enable cost/quality-adjusted life-year estimation. A concurrent process evaluation was performed. Safety was monitored through a review of pharmacist independent prescriber activities, independent concerns reporting and review of adverse events. Participants Forty-nine triads of general practitioners, pharmacist independent prescribers and care homes were recruited with 454 residents allocated to the intervention arm and 428 to the control arm. Intervention Medication review and care planning, medication reconciliation, staff training, support with care home medication-related procedures, deprescribing and authorisation of monthly prescriptions. Main outcome measure Fall rate per person over 6 months. Results Data for 449 intervention and 427 control residents available for final analysis. The 6-month fall rate ratio in favour of intervention was 0.91 (95% confidence interval 0.66 to 1.26; p=0.58). No significant difference in secondary outcomes was identified except Drug Burden Index (rate ratio 0.83, 95% confidence interval 0.75 to 0.92; p&lt;0.001). No harms were identified. One quarter of medication-related interventions were associated with a reduced risk of falls. The intervention was positively received. Limitations Participant self-selection bias may have affected the generalisability of findings. Open-label cluster randomised controlled trial limited by 6-month follow-up. Potential ceiling effect due to concurrent pharmacist-led interventions. Falls potentially insufficiently proximal to the intervention. Conclusions To enhance effectiveness and acceptance of the proposed model, effective integration into care home and general practitioner teams was identified as a central requirement. A core outcome set and a training package were developed. The final model of care, whilst being safe and well received and resulting in a reduction in drug burden, demonstrated no improvement in the primary outcome of falls. With no improvement in quality-adjusted life-years identified, the pharmacist independent prescriber intervention was not estimated to be cost-effective. Future work To develop and evaluate better models of care for enhancing medication outcomes and safety in care homes or re-test with a longer intervention and follow-up period and a stronger primary outcome. Trial registration This trial is registered as ISRCTN10663852, definitive trial: ISRCTN17847169. Study registration This study is registered as PROSPERO CRD20150907. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme (NIHR award ref: RP-PG-0613-20007) and is published in full in Programme Grants for Applied Research; Vol. 11, No. 10. See the NIHR Funding and Awards website for further award information.

Are pharmacists on the front lines of the opioid epidemic? A cross-sectional study of the practices and competencies of community and hospital pharmacists in Punjab, Pakistan

IntroductionCountries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of...

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.

Perceived Role, Identity and Experiences of Pharmacists and the Potential Impact on COVID-19 Vaccine Uptake per Louisiana Region: A Prospective Cohort Study.

Some of the lowest COVID-19 community vaccination rates in America are found in Louisiana. This study investigated: (1) barriers that Louisiana pharmacists encountered during the pandemic; and (2) the effect of pharmacists' role and identity confidence on willingness to enforce vaccine mandates, and COVID-19 vaccine uptake. Fifty-four community pharmacists from nine regions of Louisiana participated in the study. Pharmacists completed questionnaires about: personal demographics, patient population, vaccination encouragement, COVID-19 concerns, and vaccination administration rates. The importance of feeling like a trusted voice in the community, as well as professional perception and self-assurance, were measured using Likert scale questions. During focus groups, participants discussed experiences with the COVID-19 vaccination rollout and vaccination-related obstacles. As the pandemic progressed, pharmacists reported being overworked, understaffed, and overburdened with new responsibilities. In regions with lower vaccination rates, pharmacists were less likely to feel at ease enforcing vaccine mandates. Independent pharmacists were less comfortable enforcing vaccine mandates than chain pharmacists but had more positive perceptions of their role and identity. This study contributes to further understanding of pharmacy workflow obstacles and pharmacists' perceptions of their professional roles and identities in the community.

Community pharmacists’ readiness to take action to improve working conditions

ObjectiveThe objective of this study was to assess pharmacists’ readiness to take actions resulting in change at the individual level or systemic level. Design/Setting and Participants/Outcome measuresAn online survey was distributed via pharmacy-related social media pages and several state pharmacy association newsletters and e-mail listservs. Fifteen items assessed participants’ readiness to pursue change using a 5-point scale based on the transtheoretical model of behavior change (1 = Do not plan on doing, 2 = Plan to take in the next 6 months, 3 = Plan to take in the next month, 4 = Took in the past 6 months, 5 = Took more than 6 months ago). Categorical principal components analysis (CATPCA) was used as a data reduction technique to identify underlying components of the 15 items assessing readiness to improve working conditions. Component scores for each component were calculated and used as dependent variables in multivariable linear regression models to test associations between the components and sociodemographic and work-related predictors. ResultsCATPCA revealed a 12-item scale with 2 components accounting for 39.97% of the total variance. Pharmacists working in independent pharmacies had a significantly higher willingness than chain pharmacists to pursue actions with potential to result in systemic-level changes, such as contacting or joining an organization to attempt to improve their current working conditions (regression coefficient = 0.623, P < 0.001). Pharmacists working in independent pharmacies had a significantly lower willingness than chain pharmacists to pursue actions resulting in individual-level changes, such as changing their current job or quitting (regression coefficient = −0.485, P < 0.001). ConclusionPharmacists working in national chains may be less willing than independent pharmacists to pursue systemic-level changes owing to fear of discipline from employers. Future research should examine the effect of interventions intended to increase pharmacists’ motivation and readiness to pursue changes to improve working conditions.

Independent community pharmacists’ attitudes and intentions toward dispensing buprenorphine/naloxone for opioid use disorder

BackgroundBuprenorphine/naloxone (BUP/NX) for opioid use disorder (OUD) is associated with positive health outcomes; however, challenges accessing prescribed BUP/NX at community pharmacies have been identified. ObjectiveThe theory of planned behavior was applied to determine whether independent community pharmacists’ attitudes toward dispensing BUP/NX for OUD predict intentions to dispense. MethodsA 40-item survey was administered to 185 Texas Community Pharmacy Enhanced Services Network pharmacists. The survey assessed intentions to dispense BUP/NX (3 items), attitudes toward BUP/NX (24 items), current barriers to dispensing BUP/NX (2 items), and demographics (10 items). Inferential statistics determined associations among pharmacists’ attitudes, practice setting characteristics, and intentions to dispense BUP/NX. Regression analysis determined whether attitude predicted intention to dispense BUP/NX, controlling for practice setting and demographic characteristics. ResultsResponses were obtained from 82 community independent pharmacists (response rate = 44%). Respondents were predominantly non-Hispanic white (45.8%) and women (56.6%) and practiced in pharmacies with an average 1129.1 (± 1034.5) dispensed prescriptions/week. Pharmacists had positive intentions (6.2 ± 3.5) and attitudes (14.4 ± 24.9) toward dispensing BUP/NX and attitudes did not predict intentions to dispense (P = 0.330). Positive drivers of attitude were related to improving patient outcomes, fulfilling a community need, and absence of conflicts with pharmacists’ personal and religious beliefs. A negative driver of attitude was financial reimbursement/loss. Pharmacists dispensing 2000 or more prescriptions/week had higher intentions (b = 3.22, P = 0.014) to dispense than those dispensing less than 500 prescriptions/week. The most common barrier to dispense BUP/NX was “refill was too soon” (54.8%). ConclusionCommunity independent pharmacists had positive attitudes toward and intentions of dispensing BUP/NX for OUD. However, attitudes did not predict intentions to dispense. Negative drivers of attitudes were related to factors not within pharmacists’ control, such as time to refill or financial reimbursement.Future studies focused on community pharmacy-based access to BUP/NX are warranted to elucidate issues that are impactful in improving pharmacists’ dispensing intentions and behavior.

Minimising Prescribing Errors: A Phenomenological Exploration of the Views and Experiences of Independent Prescribing Pharmacists.

This study aims to explore the views and experiences of pharmacist independent prescribing (IPs) regarding prescribing errors and strategies to mitigate errors in practice. One-to-one online semi-structured interviews were conducted with IP pharmacists across the UK. Verbatim transcripts of the interview were generated and coded using NVivo® 12 software for thematic analysis. A mixed inductive and deductive approach was used to generate themes and sub-themes which were then mapped onto the framework of factors that influence clinical practice proposed by Vincent et. al. A total of 14 interviews were conducted. Participants linked the risk-averse nature of a pharmacist, self-perception of their roles as medicines experts, and previous experience of keeping checks on doctor's prescriptions as a dispenser often made them feel confident in prescribing. However, lacking adequate diagnostic skills, inadequate prescribing training programmes, and dealing with complex patients often made them feel vulnerable to committing errors. Organisational and system-related factors such as work interruptions and increased workload were identified as other factors linked to prescribing errors. Independent prescribing pharmacists use a variety of strategies to reduce the risk of prescribing errors. Promoting diagnostic competency in their area of practice, strengthening undergraduate and prescribing curricula, and addressing known organisational and system-related factors linked to prescribing errors can minimise errors and promote patient safety.

Barriers and enablers to deprescribing for older people in care homes: The theory-based perspectives of pharmacist independent prescribers.

Over 70% of care home residents are prescribed potentially inappropriate medications (PIMs) associated with morbidity and mortality. Deprescribing is a common recommendation by pharmacists performing medication reviews in care homes, however requiring prescriber authorisation is a barrier. Care home Independent Pharmacist Prescribing Study (CHIPPS), a cluster randomised control trial integrated pharmacist independent prescriber (PIPs) into care homes to improve medication management, providing a unique opportunity to identify their barriers and enablers to deprescribing. To identify barriers and enablers to PIPs deprescribing medications in care homes. Secondary qualitative framework analysis was performed on interviews with CHIPPS' PIPs. A maximum variation sampling approach was used to select from the 14 PIPs included in the process evaluation to achieve diversity of PIPs' contextual factors e.g., previous experience in care homes. Transcripts were coded inductively for barriers and enablers to deprescribing and then mapped to Theoretical Domains Framework (TDF). Eleven PIP's interviews were sampled. Factors acted as enablers and barriers were PIP relationship with General Practitioner (GP), care home staff and residents/families, awareness of the PIP role and family trust in PIPs' deprescribing activities (social influences); PIPs' independent prescribing confidence, previous experience and ability dealing with residents' medications (beliefs about capabilities); understanding of PIP role and PIP confidence in their role as an independent prescriber (Social/professional role and identity); access to residents' records, deprescribing decision support, regular follow-up from care home staff, resident difficulties with medications, teamwork, and time restraints (Environmental context and resources). One factor acted as a barrier: believing negatives of deprescribing outweigh benefits regarding certain medications (Beliefs about consequences). PIPs' involvement in deprescribing within care homes is influenced by multiple barriers and enablers. Data mapped to TDF domains represent barriers that need addressing and enablers that should be highlighted to enhance PIPs' effectiveness in future interventions.

Fake drugs: Using Baseline Spectral Fingerprinting and a sorting algorithm to infer quality of medications.

An estimated 30-70% of available medications in low-income countries and conflict states are of low quality or counterfeit. Reasons for this vary but most are rooted in regulatory agencies being poorly equipped to oversee quality of pharmaceutical stocks. This paper presents the development and validation of a method for point-of-care drug stock quality testing in these environs. The method is termed Baseline Spectral Fingerprinting and Sorting (BSF-S). BSF-S leverages the phenomena that all compounds in solution have nearly unique spectral profiles in the UV spectrum. Further, BSF-S recognizes that variations in sample concentrations are introduced when preparing samples in the field. BSF-S compensates for this variability by incorporating the ELECTRE-TRI-B sorting algorithm, which contains parameters that are trained in the laboratory using authentic, proxy low quality and counterfeit samples. The method was validated in a case study using fifty samples that include factually authentic Praziquantel and inauthentic samples prepared in solution by an independent pharmacist. Study researchers were blinded to which solution contained the authentic samples. Each sample was tested by the BSF-S method described in this paper and sorted to authentic or low quality/counterfeit categories with high levels of specificity and sensitivity. In combination with a companion device under development using ultraviolet light emitting diodes, the BSF-S method is intended to be a portable and low-cost method for testing medications for authenticity at or near the point-of-care in low income countries and conflict states.

Baseline characteristics of people experiencing homelessness with a recent drug overdose in the PHOENIx pilot randomised controlled trial

BackgroundDrug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis.MethodsPeople experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants.ResultsOne hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide.ConclusionsPeople at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness.Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019.

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.