Independent Pharmacies Research Articles

Adherence towards good pharmacy practice of community pharmacists in central Visayas, Philippines

Abstract Introduction Community pharmacists play a pivotal role in bridging gaps in the delivery of health care services and for taking the roles of ensuring the rational use of medicines. With the advent of Good Pharmacy Practice, it is essential that there be an established national framework of quality standards and guidelines; however, there is dearth in the evaluation of GPP implementation in the country. Philippine community pharmacist's practices are expected to exhibit expertise in medications nonetheless, their practices often diverge significantly from these expectations. In this literature study, community pharmacists grapple with consultation roles due to lack of clinical guidelines, training, skills, and patient self-selection behavior. Aim The aim of the study was to assess the adherence towards Good Pharmacy Practice among community pharmacists in Central Visayas, Philippines and proposed a policy brief formulated based on the findings to gain a better understanding of the country's existing approach to community pharmacy practice. Methods The study used a quantitative descriptive cross-sectional research design to scrutinize community pharmacist practices in the Philippines, specifically in FDA-registered independent and chain pharmacies in Bohol, Cebu, Negros Oriental, and Siquijor provinces. Ethics approval was obtained from the Institutional Ethics Review Committee and four experts validated the instrument, resulting in a high and acceptable S-CVI and a reliability index of .893, indicating good reliability. The selection process involved stratified random sampling and a modified closed ended questionnaire from Badro et al. (2020) tallying 321 respondents. Data was recorded as 1 for Yes responses and 0 for No. The GPP adherence levels were categorized as poor adherence for <50% or good adherence for >75%. Results The demographic profile of the respondents indicates that the majority belongs to the Millennial generation aged 27- 45 years old. These respondents are predominantly female community pharmacists, mostly in Cebu. They hold a BS Pharmacy degree, having 3 years to less than 6 years of practice. Their work schedule typically exceeds 40 hours per week, and they operate within independent pharmacy. Findings revealed that the majority of community pharmacists in Central Visayas, Philippines have a poor adherence to the GPP indicators on data management and data recording with 69.8% (224), services and facilities with 94.7% (304), dispensing, preparation, administration and distribution of medicines with 96.2% (309) but good adherence to storage with 75.4% (242). The most significant challenges identified were time restrictions, a lack of understanding, a lack of training and resources. Additionally, time constraints, excessive workload, workforce shortage, lack of support from employers and other colleagues were recognized. But the majority shows compliance to FDA storage regulations and standards as a minimum requirement to continue the establishment and pharmacists operate in the community setting. Therefore, a three-pronged strategy is likely necessary: increasing the number of trained pharmacy staff, engaging in professional development and regulatory advocacy. Conclusion The majority of respondents demonstrated good adherence to storage indicators and poor adherence to data management, services and facilities and dispensing indicators. These findings highlight the need for targeted interventions and tailored strategies to elevate standards.

Respiratory Syncytial Virus (RSV): Independent Community Pharmacy Impact in Promoting Prevention Through Immunization

Background: Respiratory syncytial virus (RSV) typically results in mild cold-like symptoms; however, it can lead to severe complications and hospitalization in patients who are 60 years of age and older with long-term health conditions. Objective: The aim of this study was to assess patient knowledge about RSV and to provide patients with information about the virus and the vaccination. Methods: A multisite cross-sectional pilot study was conducted from September 12, 2023, to March 11, 2024, in the independent community pharmacy setting. Included were all patients aged 60 years and older who consented to filling out the 14-question survey. Excluded were patients who declined to take the survey. Patients completed the survey either on paper or electronically, and the survey included initial consent, demographic information, past medical history, knowledge of RSV, consent to vaccine administration, and reasons for refusal, if applicable. At the end of the survey, patients could consent to vaccine administration onsite and were provided with an educational handout. Results: The primary outcome revealed that 78% of participants had not received any education from their healthcare provider about RSV. Additionally, 70% correctly identified ways RSV might spread, 60% reported knowing how to protect themselves, and 58% correctly indicated that a previous RSV infection does not provide immunity. As for the secondary outcomes, 63% of participants consented to receive the vaccine on the day of the survey. Conclusion: The study underscores the critical role of community pharmacies in healthcare delivery and the need for enhanced educational efforts to support vaccination programs.

Pilot Study to Evaluate Patients’ Understanding of Key Terms and Aspects of Antimicrobial Use in a Rural Province in South Africa Findings and Implications

Abstract Introduction: Antimicrobial resistance (AMR) is a global concern, necessitating the understanding of utilisation patterns and their rationale. Pilot studies have been conducted in a rural province in South Africa to determine the extent of self-purchasing of antibiotics by patients from independent and chain pharmacies. It is imperative to understand the extent of knowledge and concerns of patients regarding the key aspects of antibiotic use and AMR, and potential language barriers, when pharmacists and their assistants are discussing the key aspects with patients. Consequently, the aim was to pre-test a patient questionnaire translated in three native languages building on the findings from the English language pilot. Materials and Methods: The English patient questionnaire (Parts 1 and 2) was translated to Sepedi, Tshivenda and Xitsonga. In total 30 patients were interviewed (5/language for Part 1 and Part 2 respectively) when leaving 10 chain and independent pharmacies. This was followed by interviews with patients to evaluate their understanding of questions and key concepts. Results: Eleven of 15 patients interviewed for Part 1 received antibiotics, including 8 without a prescription. Only independent pharmacies (8/10) dispensed antibiotics without prescriptions. Interviews revealed concerns about antibiotic knowledge and AMR and that certain terms including ‘antibiotic’ and ‘AMR’ posed challenges with patient understanding of the purpose of antibiotics. For instance, one patient self-purchased antibiotics for ‘cleansing’ of sexually transmitted infections. The questionnaires in the native languages were subsequently revised so that explanations for terms, including ‘antibiotic’ and ‘AMR’ will be provided in the main study. Conclusion: Similar to the previous pilot studies, self-purchasing of antibiotics was observed among independent pharmacies, although at varying rates, with similar indications. Continued health literacy education for pharmacists and patients, especially with native language communication, are needed to address current challenges and will be explored in the main study.

Retail Availability of Over-the-Counter Birth Control Pills at Texas Pharmacies: Results from a Mystery Caller Study

ObjectivesTo estimate the availability of the recently released over-the-counter (OTC) birth control pill (Opill®) in retail pharmacies and compare availability across pharmacies based on their chain status and setting. Study DesignIn April and May 2024, we conducted a mystery caller study of a sample of 500 Texas retail pharmacies. Sampled pharmacies were contacted by female project staff posing as potential customers and asked whether they had OTC birth control pills in stock and, if not, whether they could be ordered. We characterized pharmacies by chain status (independent pharmacy, chain pharmacy inside retail outlet, chain pharmacy with standalone location) and, using geolocation, as located in either rural or urban areas. ResultsOverall, 62% of pharmacies (N=477) reported having Opill® available for sale. This stock varied by pharmacy type, with independent pharmacies the least likely to stock it (25%) and standalone chain pharmacies the most likely (82%). Similar patterns were found in terms of pharmacies that had Opill® in stock or were willing to order it. We found no significant differences between urban and rural pharmacies. ConclusionsDespite its recent (March 2024) launch, Opill® was widely available in retail pharmacies in Texas, though independent pharmacies were less likely to stock it. While removing the need for prescriptions may make birth control pills more accessible, this access may vary by pharmacy type.

Designing state-level policies to support independent pharmacies in providing specialty care services in rural regions

This review paper explores the critical role of independent pharmacies in rural regions, emphasizing their potential to deliver specialty care services despite facing significant challenges. These challenges include financial constraints, regulatory barriers, and limited specialized training and resource access. The paper argues that comprehensive state-level policies are necessary to support these pharmacies, enabling them to overcome these obstacles and enhance healthcare access in rural areas. Key policy recommendations include providing financial incentives such as grants and subsidies, regulatory reforms to streamline licensing processes and expand the scope of practice for pharmacists, and promoting partnerships between pharmacies, healthcare providers, and telehealth services. The paper also highlights the importance of integrating independent pharmacies into state health programs and adopting advanced technologies like telepharmacy and electronic health records. Future research directions are suggested, focusing on the impact of digital health technologies and evolving healthcare payment models on independent pharmacies in rural regions. The paper concludes by underscoring the need for targeted policy interventions to strengthen the role of independent pharmacies in rural healthcare, thereby improving health outcomes and quality of life for rural populations.

The Role of Empathy and Relationship Quality in Building Customer Loyalty in Community Pharmacies: Evidence from Jordan

Aim: This study explores how pharmacist empathy influences customer loyalty through the mediating role of relationship quality in community pharmacies. Methodology: A cross-sectional study utilizing a web-based questionnaire and convenience sampling was conducted in Jordan. Data were analyzed using Structural Equation Modeling (SEM). Results: A total of 536 responses were gathered and analyzed from all Jordanian regions. The gender distribution was balanced, with 261 males (48.7%) and 275 females (51.3%). The age distribution was concentrated in the 35-44 age group (29.3%), followed by 25-34 (25.6%). The majority had a high level of education, with 323 (60.3%) holding a Bachelor's degree or higher academic qualification (19.0%). Most participants visited pharmacies at least once every six months (50.6%), primarily using independent community pharmacies (52.1%). The study findings highlight a significant positive impact of pharmacist empathy on the three key dimensions of pharmacist-patient relationship quality (trust, satisfaction, and commitment). Furthermore, a significant positive relationship was found between the relationship quality dimensions and both customer loyalty dimensions (attitudinal and behavioral loyalty). Conclusion: The study findings highlight the central role of pharmacist empathy in establishing a strong and enduring pharmacist-patient relationship quality, which in turn, enhance consumers loyalty, which is essential for thriving and surviving in today's competitive market.

Empowering precision medicine: Insights from a national survey on pharmacogenomics knowledge, attitudes, and perceptions among community pharmacists in the UAE

BackgroundCommunity pharmacists are essential to pharmacogenomics implementation because they can help trainers, clinical advisors, and other medical professionals understand the importance of pharmacogenomics and encourage them to use it in their practice. This study is to evaluate the community pharmacists' understanding, attitudes, and perceptions of pharmacogenomics in the United Arab Emirates (UAE). MethodsProfessionals employed at community pharmacies in Abu Dhabi, Dubai, and the Northern Emirates participated in a cross-sectional study design. From July 2023 to February 2024, five pharmacy students in their last year conducted the survey. The study team employed a structured questionnaire to collect data in addition to conducting in-person interviews. The study questionnaire comprised three distinct sections namely, demographic information, knowledge of pharmacogenomics concepts, and perceptions regarding pharmacogenomics. ResultsA total of 586 pharmacists enrolled in the study. The average knowledge score regarding pharmacogenomics was 75.1 % with a 95 % confidence interval (CI) of [72.4 %, 77.7 %]. The average attitude score toward pharmacogenomics was 67.5 % with a 95 % CI of [66.3 %, 68.7 %]. Better pharmacogenomics knowledge among several groups: independent pharmacies (OR 1.7; 95 % CI 1.2–2.4), Pharmacists in Charge (OR 1.4; 95 % CI 1.3–2.02), pharmacists with 11–15 years of experience (OR 2.1; 95 % CI 1.4–4.2), graduates from international universities (OR 4.6; 95 % CI 1.6–12.9), and those who received training on pharmacogenomics (OR 11.9; 95 % CI 3.3–14.5). Similarly, better attitude scores were observed among independent pharmacies (OR 1.5; 95 % CI 1.1–2.1), Pharmacists in Charge (OR 1.5; 95 % CI 1.07–2.1), pharmacists with 16–20 years of experience (OR 2.1; 95 % CI 1.16–3.7), graduates regional universities (OR 1.47; 95 % CI 1.05–2.1), and those who received training on pharmacogenomics (OR 4.8; 95 % CI 3.2–7.3). ConclusionThe positive attitudes toward pharmacogenomics that we found in our research indicate that community pharmacists in the United Arab Emirates are beginning to realize the potential advantages of pharmacogenomics in terms of improving patient care. Policies ensuring the privacy and confidentiality of genetic information are also necessary in considering concerns about the availability of genetic test results to insurance companies and potential employers.

Empowering pharmacy technicians as vaccine champions: A pilot study in independent community pharmacies

BackgroundIncreasing vaccine uptake in communities has been essential, even before coronavirus disease 2019. The use of "vaccine champions" or "VaxChamps" has shown promise. VaxChamps, who are often community members with specialized training but no special credentials, advocate for vaccination by sharing their experiences and knowledge. Pharmacy technicians’ scope of practice, coupled with their frequent interactions with pharmacy patients, make them ideal vaccine champions and a natural fit for the VaxChamp program. This study assessed the implementation and impact of the VaxChamp program in North Dakota community pharmacies. ObjectivesTo describe the development and implementation of the VaxChamp program in community pharmacies and evaluate its effect on vaccination rates and vaccine-related tasks within each pharmacy’s organizational context. MethodsThe VaxChamp program involved training one technician per participating pharmacy to spend 5 hours per week on vaccine-related tasks. Data collection included pre-post surveys, monthly reports, and semi-structured interviews with VaxChamps and pharmacists-in-charge from 6 pharmacies. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using inductive methods to identify key themes. ResultsThe 6 participating pharmacies varied in location and staffing. Most had prior vaccine administration experience. VaxChamps’ roles ranged from administrative tasks to direct vaccine administration, depending on the pharmacy’s staffing and workflow. Vaccination rates for pneumococcal and hepatitis B vaccines increased in several pharmacies, while shingles vaccination rates declined. The presence of advanced pharmacy practice experience students often influenced VaxChamps’ responsibilities, underscoring the need for clear role delineation. ConclusionIntegrating pharmacy technicians as VaxChamps in community pharmacies is a promising strategy to increase vaccination rates and enhance public health. Future research should explore ways to better integrate technicians into comprehensive immunization strategies and address the contextual factors that influence program implementation.

Community pharmacy chlamydia and gonorrhea test-to-treat program: Development of an implementation toolkit

BackgroundSexually transmitted infection (STI) surveillance showed more than 2.5 million cases of chlamydia, gonorrhea, and syphilis nationally in the United States in 2022. Individuals often seek out nonemergency medical care at pharmacies. This makes community pharmacies well-positioned to address rising STI rates by offering services to screen and treat common STIs. A local health department, an independent pharmacy, and a school of pharmacy in Pennsylvania partnered to implement a test-to-treat service for chlamydia and gonorrhea within a pharmacy. This pilot program utilized the following: (1) patient self-collected test kits for chlamydia and gonorrhea screening and; (2) standing orders for treatment at the pharmacy. One goal of this pilot was to develop resources others can use to implement similar pharmacy-based chlamydia and gonorrhea testing and treatment services. ObjectiveDevelop an expert-informed implementation toolkit for a chlamydia and gonorrhea test-to-treat program at a community pharmacy. MethodsThe “How to Build an Implementation Toolkit from Start to Finish” framework from the University of California at Berkeley was used to design the initial toolkit outline. Toolkit content was triangulated from 3 sources: (1) comprehensive literature review; (2) pilot program implementation team meetings; and (3) feedback from public health and other experts. Pilot program partners met regularly to review and edit the toolkit. The draft toolkit was then reviewed by outside experts and potential end-users. ResultsAn 11-item toolkit was developed. Toolkit contents were reviewed by 11 outside experts and potential end-users. Toolkit resources included STI training resources for pharmacy teams, testing and treatment standing orders, pharmacy treatment screening form, marketing strategies, patient education materials, sample workflow, essential supply list, and other key resources. ConclusionPharmacies may need additional resources for STI testing and treatment program implementation. Toolkit resources developed from this pilot program may help pharmacies overcome implementation barriers for similar programs.

Assessment of PrEP and PEP furnishing in San Francisco Bay Area pharmacies: An observational cross-sectional study

BackgroundOver 1 million people in the United States are infected with human immunodeficiency virus (HIV). As of 2021, pharmacists in California can prescribe PrEP and PEP without establishing a collaborative practice agreement in an effort to reduce HIV transmission. However, in 2021 less than 3% of independent pharmacies in the San Francisco Bay Area did so. To our knowledge, there has been no follow-up research assessing potential changes in pre-exposure prophylaxis/postexposure prophylaxis (PrEP/PEP) furnishing rates in the region. ObjectiveAssess the extent of PrEP/PEP furnishing in San Francisco Bay Area pharmacies 3 years after policy implementation. MethodsWe conducted an observational, cross-sectional study to identify independent community and mail-order pharmacies furnishing PrEP/PEP in the nine-county San Francisco Bay Area in 2024. Furnishing pharmacies were identified via phone calls and the findings were validated with in-person visits. We also identified the number of retail chain pharmacies furnishing PrEP/PEP in San Francisco County. ResultsWe contacted 202 independent community and mail order pharmacies in the nine-county San Francisco Bay Area by telephone; of these, 16 reported furnishing PEP/PrEP and all confirmed their ability to furnish when visited in person. We contacted 67 retail chain pharmacies in San Francisco County; of these, 11 pharmacies reported furnishing PrEP/PEP (10 Safeway; 1 Walgreens). ConclusionsMore pharmacies furnished PrEP/PEP in the 9-county San Francisco Bay Area in 2024 (8%) than in 2021 (3%); in addition, one retail chain pharmacy had instituted a furnishing protocol. However, furnishing rates remained low. Past research suggests that advertising and the development of furnishing protocols may help increase furnishing and increase medication access.

Pharmacy Naloxone Standing Order and Community Opioid Fatality Rates Over Time

Despite the proliferation of pharmacy standing-order naloxone dispensing across many US states before the change to over-the-counter status, few policy analyses have evaluated the implementation of pharmacy naloxone standing orders in addressing opioid overdose fatality among communities. To determine whether the implementation of pharmacy standing-order naloxone was associated with lower opioid fatality rates compared with communities without pharmacies with standing-order naloxone. This retrospective multisite study was conducted with an interrupted time series analysis across 351 municipalities in Massachusetts over 24 quarters (from January 1, 2013, through December 31, 2018). Standing-order naloxone dispensing data were collected from 2 sources for all major chain pharmacies and many independent pharmacies, covering 70% of retail pharmacies in Massachusetts. Municipalities had various standing-order naloxone implementation inceptions during the study period. Data were analyzed from December 2021 to November 2023. The main exposure was measured by the first quarter with standing-order naloxone dispensation as the actual implementation inception. The primary study outcome was municipal opioid fatality rate per 100 000 population obtained from the Massachusetts Registry of Vital Records and Statistics. The median (IQR) population size across 351 municipalities was 10 314 (3635 to 21 781) people, with mean (SD) proportion of female individuals was 51.1% (2.8 percentage points). Pharmacies from 214 municipalities (60.9%) reported dispensing standing-order naloxone over the study period. At the baseline of the first quarter of 2013, municipalities that eventually had standing-order naloxone had greater quarterly opioid fatality rates compared with those that never implemented standing-order naloxone (3.51 vs 1.03 deaths per 100 000 population; P < .001). After adjusting for municipal-level sociodemographic and opioid prevention factors, there was significant slope decrease of opioid fatality rates (annualized rate ratio, 0.84; 95% CI, 0.78-0.91; P < .001) following standing-order naloxone dispensing, compared with the municipalities that did not implement standing-order naloxone. There were no significant level changes of opioid fatality rates in the adjusted models. Sensitivity analyses yielded similar and significant findings. These findings suggest that community pharmacy dispensing of naloxone with standing orders was associated with a relative, gradual, and significant decrease in opioid fatality rates compared with communities that did not implement the standing-order naloxone program. These findings support the expansion of naloxone access, including over-the-counter naloxone as part of a multifaceted approach to address opioid overdose.

Does the type of pharmacy used influence medication adherence? A retrospective observational study in Aotearoa, New Zealand.

Community pharmacies in New Zealand have varying ownership and operational structures. Unlike independent pharmacies, corporate and hybrid pharmacies do not charge prescription copayments. This research aimed to determine whether people receiving free prescriptions from corporate and hybrid pharmacies (via copayment waiver) have greater medication adherence than the users of independent pharmacies. A nationwide, retrospective, observational study linked 1 year of dispensing data (1/05/2022 to 30/04/2023) from the Pharmaceutical Collection to patient enrollment data using a National Health Index number to identify demographics of different pharmacy-type users. People were assigned to a particular type of pharmacy if they collected at least 70% of their prescriptions from there; if they did not meet this threshold, they were defined as mixed users. People were classified as adherent if dispensing data showed they collected their supply of medication to cover at least 80% of the study period. The sample captured 218,080 people taking at least 1 diabetes medication, with a total of 360,079 unique medications being included in the analysis. The majority, 156,893, used independent pharmacies. The type of pharmacy used was shown to be a significant predictor of adherence. Corporate and hybrid pharmacy users were 0.90 (95% CI 0.88 to 0.93) and 0.93 (95% CI 0.90 to 0.96) times as likely be adherent than the users of independent pharmacies. Mail order pharmacy users were the most likely to be adherent, whereas mixed pharmacy users were the least likely to be adherent. Our findings suggest that prescription copayments provided by corporate and hybrid pharmacies are not the most significant barrier to medication adherence. Further research may identify more efficient ways of improving medication adherence than removing prescription copayments for all.

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

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

Community Pharmacists Identification of Gaps in Care - Statin Utilization for Primary Prevention.

Background: Statins are a highly effective lipid-lowering therapy associated with significant reductions in atherosclerotic cardiovascular disease (ASCVD) events and death. Despite these benefits, statins are underutilized. Pharmacist-led interventions to increase statin prescribing are effective. To our knowledge, no prior studies implemented a comprehensive cardiovascular risk assessment utilizing point-of-care (POC) testing in community pharmacies. Objectives: The primary objective was to determine if community pharmacists can be utilized to identify gaps in care regarding appropriate use of statin therapy for prevention of ASCVD events in HPSAs. Secondary objectives were to assess public interest in ASCVD risk assessment and statin prescribing by the pharmacist, and to identify factors associated with statin gaps in care. Methods: A cross-sectional study was conducted at three independent community pharmacies. Participants were identified based on age and medication history and were scheduled at their pharmacy to receive a comprehensive ASCVD risk screening consisting of POC measurement of a complete lipid panel, blood glucose or A1C, and blood pressure. Participants were informed of their statin candidacy at the screening. Participants completed a survey regarding perceptions of the services provided and opinions of statin prescribing by pharmacists. Results: Of the 57 participants, 43 (75.4%) were possible statin candidates. Most indicated trusting their pharmacist to prescribe a cholesterol-lowering medication and felt insurance should pay for these screenings. Conclusion: ASCVD risk assessment conducted within the community pharmacy setting for can be utilized to identify treatment gaps in status use. Participants indicated trusting pharmacists to provide this service and found the service valuable.

Community pharmacists’ experience of gabapentin misuse and abuse: A quantitative study from Jordan

Gabapentin is an anticonvulsant that has an abuse potential. The aim of this study was to investigate the misuse and abuse of gabapentin in Jordan from the perspective of community pharmacists. A cross-sectional survey using a self-reported structured questionnaire was used with a convenience sample of pharmacists employed by various independent and chain community pharmacies. An online technique was used in this study using Google forms. A total of 215 questionnaires were completed, with 200 respondents (93%) reporting awareness of cases of gabapentin abuse in their pharmacies. Less than half of the respondents (n = 94; 43.7%) indicated that gabapentin requests were not accompanied by prescriptions. Almost two-thirds of respondents (63.6%) noticed an increased pattern of gabapentin abuse/misuse during the last 6 months. The study underscores the need for regulatory efforts and pharmacovigilance to manage potential gabapentin abuse, along with pharmacist and patient education at the community pharmacy, regarding potential abuse of gabapentin.

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

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

Evaluating community pharmacists awareness, perception and roles in providing emergency contraceptives in Jordan

ObjectiveThis cross-sectional study aimed to assess Jordanian community pharmacists' awareness, perception, and roles concerning emergency contraceptives provision. Study designWe administered a structured questionnaire to community pharmacists in Jordan using convenience sampling. The questionnaire included sections on demographic information, knowledge about emergency contraceptives, perception towards emergency contraceptive, and prior experience in emergency contraceptives provision. ResultsA total of 299 community pharmacists responded to the study. Most pharmacists had a Pharm D/BPharm degree (94.6%) and worked in independent community pharmacies (75.6%). While pharmacists demonstrated relatively high knowledge scores regarding emergency contraception, with a median score of 10 out of 14, misconceptions persisted, particularly regarding the mechanism of action and side effects of emergency contraception. Pharmacists expressed mixed perceptions regarding emergency contraception, with a significant proportion advocating for prescription-only access (76.6%) and expressing ethical reservations (48.2%). Only 38.1% reported prior experience in emergency contraceptives provision. Regression analyses revealed that attendance at emergency contraceptives-focused workshops significantly increased the likelihood of pharmacists providing emergency contraceptives (Adjusted Odds Ratio=2.569, p = 0.001). ConclusionsJordanian community pharmacists exhibit readiness to provide emergency contraceptives, but persistent misconceptions and regulatory barriers hinder optimal provision. Targeted educational interventions, particularly through workshops, are crucial in enhancing pharmacists' knowledge and promoting emergency contraceptives provision. ImplicationsResponding pharmacists often reported the misconception that emergency contraceptives can cause abortion. Also, some pharmacists expressed religious or moral objections to prescribing oral emergency contraceptives. Thus, this study underscores the importance of receiving comprehensive training on ethical and religious considerations in healthcare practice.

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

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

A qualitative study of stakeholder perspectives of the current system of assessing pharmacists’ readiness for independent practice in Ireland

Abstract Introduction Pharmacy students in Ireland are supervised by an approved tutor pharmacist (preceptor) during placement in the final year of the MPharm programme. Since 2020, students must pass two assessments of their readiness to practise – a Competency Assessment completed by their preceptor and an Objective Structured Clinical Examination (OSCE) referred to as the Professional Registration Examination (PRE), prior to registration and independent practice. The Schools of Pharmacy in Ireland are collectively responsible for the PRE, including design and delivery of the national registration examination. A recent scoping review of the methods and processes used to determine pharmacists’ readiness for independent practice identified that Ireland is the only country globally where the Schools of Pharmacy are responsible for the national registration examination.[1] Aim This study aimed to explore pharmacy graduates’ and pharmacy preceptors’ perspectives of the current system of assessing pharmacist’s readiness for independent practice in Ireland. Methods Online, semi-structured interviews were undertaken with preceptors and recent pharmacy graduates. Purposive sampling was used to invite potential participants for interview. Preceptor participants were invited to take part via newsletter invitation and graduates were recruited via social media (Twitter advertisement). Interviews were recorded and transcribed verbatim. The topic guides were developed based on findings from a linked scoping review and the research team’s experience of the assessments.[1] The topic guides were piloted and refined. Key topics included participants’ awareness and perceptions of current assessments to determine readiness for independent practice and participants’ views regarding the readiness of newly registered pharmacists for independent pharmacy practice. Recruitment continued until thematic saturation was reached. Data were analysed using thematic analysis. Results Fifteen interviews were conducted with preceptors (n=7, female=5, male=2) and recent graduates (n=8, female=5, male=3). The key themes identified were: The Competency Assessment Process, The Professional Registration Examination, Pharmacy Curriculum, Placement Training, Alternative Assessment Methods and Challenges Post-Registration. The most frequently noted issues relating to pharmacy curriculum and training were lack of training and practise in development of soft skills, people management and conflict resolution. Participants expressed concern regarding the fact that legal constraints were preventing students from developing skills required of pharmacists, especially in relation to decision making and prescription checking, and this is considered an impediment to fully preparing students for independent practice. Readiness to practise of graduates is considered context-specific with concerns expressed in relation to locuming practices of newly registered pharmacists. Conclusion This study has highlighted a number of stakeholder concerns regarding the current system of assessment of readiness to practise of pharmacists in Ireland, in particular in relation to the Competency Assessment process. While the interview technique facilitated collection of detailed information, the sample size would prevent generalisation to the target population. The possibility of interviewer bias and/or social desirability bias in participants should be acknowledged. Further research is required to explore the feasibility of the improvements proposed by participants.

A qualitative study exploring the opportunities and challenges of providing digital community pharmacy services for older people in England

Abstract Introduction Digital healthcare can be an innovative, cost-effective solution for the growing healthcare needs of an ageing population, enhancing service accessibility.[1] Older individuals tend to rely more on community pharmacy services, supported by research indicating positive health outcomes.[2] However, scant evidence exists regarding the impact of digital community pharmacy services on this demographic, emphasising the need for crucial investigations into their effectiveness. Aim Identify challenges and opportunities in delivering digital pharmacy services for older population in community pharmacies in England, from perspectives of policymakers and pharmacy service providers. Methods Between November 2022 and May 2023, online/telephone interviews were conducted with stakeholders including policymakers/commissioners and pharmacy service providers. Recruitment involved purposive and convenience sampling, with commissioners sourced through networks and pharmacy providers via gatekeepers in industry associations. Topics covered the current state of digital pharmacy services in England, implementation opportunities and challenges, and suggestions for enhancement. Audio-recorded interviews were transcribed verbatim and analysed using both inductive and deductive thematic approaches, assisted by NVivo 12 Plus. Themes comprised challenges and solutions in digital pharmacy service delivery and factors influencing user acceptance. Deductive analysis shaped the coding framework based on Davis’s Technology Acceptance Model (TAM). Results Twelve interviews (three policy makers/commissioners [PM], four senior managers of community pharmacy [SM], five front-line community pharmacists [CP]) were completed. One of the interviewees was a female and all others were male. Their length of relevant employment in the field of community pharmacy ranged from three to seventeen years. The key findings indicated challenges in implementing digital pharmacy services to older populations may be due to unclear health policies and limited financial support for digital reforms to community pharmacy: “as a pharmacy we’ll take care of that, but we need to know that there will be funding for that before we go and do it all. I think there’s amazing things that can be done, but at local, small level, like a little community pharmacy, they just can’t afford to do the development” [SM1], and “so the majority of independent pharmacies, … they have paper prescriptions, so they’re not as technology based. I believe one, that’s because it’s money, so it’s funding. They get less funding” [CP4]. Interviewees highlighted that community pharmacists facing high workloads and time constraints, often prioritise other responsibilities over adopting new technologies: “unfortunately, there are a fair few demands on pharmacy team’s time at the moment, so where does promoting a digital priority fit on that long list of priorities and probably quite low down” [PM3]. They also expressed a need for additional technical training to effectively navigate digital pharmacy services. Conclusion This study provides insights into challenges in implementing digital pharmacy services for older people through diverse stakeholder perspectives, offering practical considerations for policy decisions, service design, and implementation strategies. Nevertheless, this study observes a deficient emphasis on deploying digital pharmacy services for older people. It is orientated towards a broader demographic, while those with specific medical conditions may receive pharmacy services more precisely. The applicability of this study may be limited, requiring region-specific research. Further research would be focusing on those over 50 in Greater Manchester aligns with the local community’s emphasis on ageing-related research, technology, and innovative ideas supported by academic institutions.