Independent Pharmacies Research Articles

Current uses and knowledge of medicinal plants in the Autonomous Community of Madrid (Spain): a descriptive cross-sectional study

BackgroundThe usage of medicinal plants as a key component of complementary and alternative medicine, has acquired renewed interest in developed countries. The current situation of medicinal plants in Spain is very limited. This paper provides new insights and greater knowledge about current trends and consumption patterns of medicinal plants in the Autonomous Community of Madrid (Spain) for health benefits.MethodsA descriptive cross-sectional study was designed for a population-based survey on medicinal plants. The data were collected (May 2018 to May 2019) using semi-structured face-to-face interviews in independent pharmacies, hospital centers and primary care health centers in the Autonomous Community of Madrid. The survey had 18 multiple choice and open-ended questions. Quantitative indices were calculated: Fidelity Level (FL), Use Value (UV) and Informants Consensus Factor (ICF). Chi-square test was used for data analysis.ResultsFive hundred forty-three people were interviewed. The majority of the participants (89.6%) have used medicinal plants to treat health disorders in the past 12 months, mainly for digestive problems, sleep disorders and central nervous system diseases. A total of 78 plants were recorded, being Matricaria recutita, Valeriana officinalis, Tilia spp. and Aloe vera the most used. The highest UV was found for Mentha pulegium (UV 0.130) followed by Aloe vera (UV 0.097) and Vaccinium macrocarpon. (UV 0.080). The highest FL values were for Eucalyptus spp. (FL 90.47%) for respiratory conditions and, Matricaria recutita (85.55%) and Mentha pulegium (84.09%) for digestive problems. The highest ICF corresponded to metabolism and depression (ICF = 1), pain (ICF = 0.97), insomnia (ICF = 0.96) and anxiety (ICF = 0.95). Participants mostly acquired herbal medicines from pharmacies, herbal shops and supermarkets. Some side effects (tachycardia, dizziness and gastrointestinal symptoms) and potential interactions medicinal plants-drugs (V. officinalis and benzodiazepines) were reported.ConclusionMany inhabitants of the Autonomous Community of Madrid currently use herbal products to treat minor health problems. The most common consumer pattern are young women between 18 and 44 years of age with higher education. In order to confirm the pattern, further research should be focused to investigate current uses of medicinal plants in other Spanish regions.

Patient Screenings for Preconception Health Interventions at a Community Pharmacy.

Preconception health refers to health before pregnancy and involves addressing risk factors that can negatively impact either a patient or future pregnancy. Pharmacists can play an essential role in screening for and managing patients’ risk factors to optimize pregnancy outcomes. The primary objective of this study is to determine whether preconception health screenings in community pharmacy settings identify opportunities for preconception health services, particularly pharmacy-based interventions. The secondary objectives are to describe the preconception health status of community pharmacy patients and their interest in receiving preconception care services by a clinical pharmacist in a community pharmacy setting. Two independent pharmacies conducted a pilot project where people were invited to complete a health screening form that evaluated their preconception health. Participants received a personalized health report with an invitation to meet with the clinical pharmacist for services related to identified opportunities, such as contraception and immunizations. Retrospective analysis was conducted for data collected from 43 women during the patient screening effort in three community pharmacy settings (two independent community pharmacy locations and one neighborhood pharmacy outreach event). Nearly all participants (n = 42, 98%) had at least one opportunity identified to receive preconception care services, with the majority related to their alcohol use (60%). A majority of participants (56%) indicated an interest in learning more about preconception services offered at the pharmacy, but only 19% wanted to schedule an appointment with a pharmacist. Thus, there is an apparent need and opportunity for utilization of preconception health services at the pharmacy.

“Over-the-counter” cannabidiol (CBD) sold in the community pharmacy setting in Colorado

The use of cannabidiol is becoming so popular that even pharmacies now carry over-the-counter (OTC) cannabidiol products in Colorado, USA. The primary goal of this study was to evaluate cannabidiol products sold in the community pharmacy setting to determine the content of cannabidiol and other active ingredients and the safety information that may be provided to individuals considering the use of these products. Documentation of cannabidiol products available for purchase in pharmacies was compiled by visiting chain and independent pharmacies within the state of Colorado. Cannabidiol products were documented for claims of use, dose, route, administration, additional ingredients, and cost. In total, 60 cannabidiol products (15 oral, 44 topical, and one transdermal) were found in 35 pharmacies. The concentrations of oral cannabidiol varied from 10 to 60 mg/mL. In total, 13 (87%) of the oral products were labeled as “full spectrum.” Six (40%) of the oral cannabidiol products listed medium-chain triglycerides, a compound with evidence of increasing oral bioavailability. The amount of cannabidiol labeled on topical products varied from 30 mg cannabidiol/15 mL to 1000 mg cannabidiol. Some products did not indicate any quantity of cannabidiol or did provide the amount of hemp extract/oil but did not specify how much cannabidiol was present. In total, 29 (66%) of the topical products contained additional active ingredients: arnica, camphor, capsaicin, menthol, peppermint oil, white willow bark (salicylic acid), tea tree oil, and trolamine salicylate. Only one type of transdermal product for cannabidiol delivery was found, which provided a dose of 20 mg cannabidiol/24 h. The findings of this study illustrate the extensive variability of cannabidiol products and the importance of communication with people considering their use. Counseling those utilizing these products may help to avoid drug–drug or drug–supplement interactions and adverse events.

Statewide Price Variation for Generic Benign Prostatic Hyperplasia Medications

To examine the geographic and pharmacy-type variation in costs for generic benign prostatic hyperplasia (BPH) medications in order to improve drug price transparency and reduce health disparities. Medical therapy for BPH can be expensive, having significant implications for uninsured and underinsured patients. We generated a 20% random sample of all pharmacies in Pennsylvania and queried each for the uninsured cash price of a 30-day prescription of tamsulosin 0.4mg daily, finasteride 5mg daily, oxybutynin immediate release 5mg TID and oxybutynin XL 10mg daily. Our primary objectives were to identify price variation based on pharmacy type (i.e., big chain and independent) and between geographic regions (predetermined by the Pennsylvania Health Care Cost Containment Council Database). We fit multivariable quantile regression models to test for an association between drug price and region after controlling for pharmacy type. Among 575 retail pharmacies contacted, 473 responded (82% response rate). The median cash price was significantly higher for big chain pharmacies than for independent pharmacies for tamsulosin ($66 vs. $15), finasteride ($68 vs. $15), oxybutynin immediate release ($49 vs. $35), and oxybutynin XL ($79 vs. $31) (all p < 0.05). When controlling for region, the median and 75th percentile price of all drugs was significantly higher for big chain pharmacies. When controlling for pharmacy type, regional variation was noted in all four drugs at the 75th percentile price and was greater for independent pharmacies. Compared to independent pharmacies, big chain pharmacies charged significantly more for generic BPH medications to uninsured patients. However, independent pharmacies demonstrated more regional variation in their pricing.

The 2017 deregulation of pharmacies in Italy: Introducing non-pharmacist ownership

Italy is the last European country to adopt policies on the liberalization of pharmacy ownership. In August 2017, the Italian government approved the law n. 124 (annual market and competition law), despite the opposition of some stakeholders. This law extended the ownership of pharmacies to non-pharmacist business partners. Law n. 124 is an important turning point for pharmacists in Italy and could lead to a general reorganization of the Italian pharmaceutical system. As has already happened in several European countries, the removal of barriers to pharmacy ownership incentivizes finance companies and pharmaceutical wholesalers to make significant investments in this sector, leading to the emergence of commercial pharmacy chains. The future of community pharmacies is uncertain and is closely linked to the fate of the current government. However, progressive polarization between independent pharmacies and pharmacies that are part of chains can already be observed.

Effects of Advanced Pharmacy Practice Experience Characteristics on Postgraduate Year 1 Residency Match Rates

Background: Mentors often provide advice to students regarding selection of Advanced Pharmacy Practice Experience (APPE) rotations to strengthen their candidacy for a residency position. However, the impact of APPE characteristics on the chances of matching is unknown. Objective: To determine the impact of APPE characteristics on Post Graduate Year-1 (PGY1) residency match rates at a Midwest US college of pharmacy. Methods: Graduates from a single college of pharmacy who participated in the PGY1 match in 2015 or 2016 were included. Match data were obtained from National Matching Services. APPE characteristics (e.g., rotation timing relative to the Midyear Clinical Meeting [MCM], rotation type, and setting) were stratified by matched status. Independent predictors were identified using multivariate logistic regression and tree-based models. Results: Ninety-nine students were included with 57 matching (57.6%). Students completing an infectious diseases rotation (75 vs. 51%; p = 0.028), a hospital rotation before the MCM (67 vs. 47%; p = 0.039), or a rotation in an ambulatory care clinic (67 vs. 47%; p = 0.045) were more likely to match. Students completing an independent community pharmacy rotation were less likely to match (8.3 vs. 64%; p < 0.001). After multivariate adjustment, all of these factors were associated with the likelihood of matching except completion of an infectious diseases (p = 0.077) or ambulatory care rotation (p = 0.073). Conclusion: A hospital rotation prior to the MCM was positively associated with matching while completion of an independent community pharmacy rotation was associated with non-matched status. The utility of these findings in guiding APPE selections for students pursing residency should be explored.

Medicaid managed care plans start paying Ohio pharmacists as providers

Medicaid managed care companies are working with the Ohio Department of Medicaid to act on a 2019 law that recognizes pharmacists as providers in Ohio. Since getting wind of what pharmacists are capable of doing for patients, three Medicaid managed care plans in Ohio have launched programs of their own to pay pharmacists as medical providers. Additional plans are expected to make announcements in the coming months. In April 2020, UnitedHealthcare began working with two independent community pharmacies in Ohio to launch a program that uses the expertise of pharmacists to expand access to care for patients and drive better health outcomes for Medicaid beneficiaries. Pharmacists in the program are able to bill and receive reimbursement for providing patient care services using existing CPT codes for evaluation and management, virtual check-ins, and transitional care management. “We feel community pharmacies can do more if we create the right incentives,” said Mike Roaldi, CEO of UnitedHealthcare Community Plan of Ohio. So far, two community pharmacies are participating in the program. UnitedHealthcare selected them based on the high concentration of plan members who frequent the pharmacies. These members also have multiple prescriptions and chronic conditions. Results are being measured both qualitatively and quantitatively. “The first thing we want to do right now is prove the concept works and get outcomes—we want the data,” said Roaldi. They are keeping track of three specific quality metrics: hospital readmissions, unnecessary prescriptions, and the management of chronic conditions. “We also want stories in this early stage about how pharmacists provide better care and [prevent errors for] patients,” said Roaldi. Ohio’s Centene managed care organization, through Buckeye Health Plan, launched its program in June 2020 and during the initial phase, participating pharmacists at a health system and two federally qualified health centers are expected to work with physicians to provide care for patients who have chronic conditions. As this article went to press, another Ohio Medicaid plan, CareSource, announced a provider status program focused on two independent community pharmacies. All programs will reimburse pharmacists for clinical services. When former Ohio governor John Kasich signed SB 265 at the beginning of 2019—a law that formally recognizes pharmacists as providers in Ohio law—the work had only begun for any real change to happen for Ohio pharmacists. “Ohio’s momentum has been based on three factors,” said Stuart Beatty, PharmD, director of strategy and practice transformation at the Ohio Pharmacists Association (OPA) and associate professor of clinical pharmacy at Ohio State University College of Pharmacy. Passing legislation and the overarching changes due to health care transformation have been critical, said Beatty. But so was Ohio’s investigation of the PBM industry. Once the public became aware of the issues for pharmacies, legislators started putting pressure on payers, specifically managed care organizations (MCOs). Beatty said the timing is important to consider. During the spring of 2019, as the provider status law was still waiting to go into effect officially, legislators questioned the MCOs during an April 2019 Ohio Joint Medicaid Oversight Committee meeting that was focused on PBMs. With Ohio legislators aware of the provider status law, they also began asking how the plans were going to implement the new law. According to Beatty, the public questioning opened the door for OPA to have meaningful conversations with payers about how pharmacists are an underutilized resource. “As a result, the plans started to realize what pharmacists can do and a shift happened,” said Beatty. “This combined with a focus toward value-based care got the discussion quickly turned in Ohio about how pharmacists can help patients achieve better health outcomes with an incentive structure in place,” he continued. The Ohio Department of Medicaid announced they will create provider identification numbers for pharmacists in January 2021. Antonio Ciaccia, director of government and public affairs at OPA, said this will put “rocket fuel” in the existing Medicaid managed care plans that are already working collaboratively with pharmacists. The Ohio Department of Medicaid has begun compensating pharmacists to conduct COVID-19 testing as well. After the U.S. Department of Health and Human Services made it clear earlier this year that allowing pharmacists to order and administer FDA-authorized COVID-19 tests supersede state limits on scope of practice, Ohio governor Mike DeWine had to take action, instructing Ohio’s Medicaid program to create codes that allow pharmacies to bill for tests on program beneficiaries.

Primary health care pharmacists and vision for community pharmacy and pharmacists in Chile.

The Chilean healthcare system is composed of public and private sectors, with most of the higher-income population being covered privately. Primary healthcare in the public system is provided in more than 2,500 public primary care centers of different sizes with assigned populations within territories. Private insurance companies have their own healthcare networks or buy services from individual health providers. Patients from the public system receive most medications free of charge in primary care pharmacies embedded in each care center. Private patients must purchase their medicines from community pharmacies. Some government policies subsidize part of the cost of medications, but original medicines remain as the most expensive of Latin America. Three chain pharmacies have more than 90% of the market share, and these pharmacies have negative public perception because of price collusion court sentences. A non-profit, municipal pharmacy model was developed but has limited implementation. Most privately owned independent and chain community pharmacies do not provide pharmaceutical services as there is no remuneration or cover by insurers. The limited number of publicly owned Municipal pharmacies could implement pharmaceutical services in community settings as they are non-profit establishments and have full-time pharmacists but are not resourced for these services. A limited number of pharmaceutical services are almost exclusively provided in public primary care, including medication reviews, pharmaceutical education, home visits and pharmacovigilance services, but several barriers to their implementation remain. A risk-based multimorbidity care model was implemented in 2020 for public primary care with additional employment of part-time pharmacists to provide services. We believe that this model will help pharmacists to optimize their time by prioritizing the much-needed clinical tasks. We propose within this multimorbidity care model that the more time-consuming services are provided to higher risk patients. Pharmacy prescribing i.e. amending or approving changes in medications in primary care for chronic conditions could also be useful for the health system, but pharmacists would require additional training. The landscape for pharmaceutical services for primary care in Chile is promising, but the integration with community pharmacies will not be possible until they are funded by public and private insurance, and the public perception of these establishments is improved.

Primary health care pharmacists and vision for community pharmacy and pharmacists in Chile

The Chilean healthcare system is composed of public and private sectors, with most of the higher-income population being covered privately. Primary healthcare in the public system is provided in more than 2,500 public primary care centers of different sizes with assigned populations within territories. Private insurance companies have their own healthcare networks or buy services from individual health providers. Patients from the public system receive most medications free of charge in primary care pharmacies embedded in each care center. Private patients must purchase their medicines from community pharmacies. Some government policies subsidize part of the cost of medications, but original medicines remain as the most expensive of Latin America. Three chain pharmacies have more than 90% of the market share, and these pharmacies have negative public perception because of price collusion court sentences. A non-profit, municipal pharmacy model was developed but has limited implementation. Most privately owned independent and chain community pharmacies do not provide pharmaceutical services as there is no remuneration or cover by insurers. The limited number of publicly owned Municipal pharmacies could implement pharmaceutical services in community settings as they are non-profit establishments and have full-time pharmacists but are not resourced for these services. A limited number of pharmaceutical services are almost exclusively provided in public primary care, including medication reviews, pharmaceutical education, home visits and pharmacovigilance services, but several barriers to their implementation remain. A risk-based multimorbidity care model was implemented in 2020 for public primary care with additional employment of part-time pharmacists to provide services. We believe that this model will help pharmacists to optimize their time by prioritizing the much-needed clinical tasks. We propose within this multimorbidity care model that the more time-consuming services are provided to higher risk patients. Pharmacy prescribing i.e. amending or approving changes in medications in primary care for chronic conditions could also be useful for the health system, but pharmacists would require additional training. The landscape for pharmaceutical services for primary care in Chile is promising, but the integration with community pharmacies will not be possible until they are funded by public and private insurance, and the public perception of these establishments is improved.

Point-of-sale Naloxone: Novel Community-based Research to Identify Naloxone Availability

IntroductionExpanding naloxone availability is important to reduce opioid-related deaths. Recent data suggest low, variable urban naloxone availability. No reports describe naloxone availability at the point of sale (POSN). We characterize POSN without prescription across a Midwestern metropolitan area, via a unique poison center-based study.MethodsPharmacies were randomly sampled within a seven-county metropolitan area, geospatially mapped, and distributed among seven investigators, who visited pharmacies and asked, “May I purchase naloxone here without a prescription from my doctor?” Following “No,” investigators asked, “Are you aware of the state statute that allows you to dispense naloxone to the public under a standing order?” Materials describing statutory support for POSN were provided. Responses were uploaded to REDCap in real time. We excluded specialty (veterinary, mail order, or infusion) pharmacies a priori. POSN availability is presented as descriptive statistics; characteristics of individual sites associated with POSN availability are reported.ResultsIn total, 150 pharmacies were prospectively randomized, with 52 subsequently excluded or unavailable for survey. Thus, 98 were included in the final analysis. POSN was available at 71 (72.5%) of 98 pharmacies. POSN availability was more likely at chain than independent pharmacies (84.7% vs 38.5%, p<0.001); rural areas were more commonly served by independent than chain pharmacies (47.4% vs 21.5%, p = 0.022). Five chain and five independent pharmacies (18.5% each) were unaware of state statutory support for collaborative POSN agreements. Statutory awareness was similar between independent and chain pharmacies (68.8% vs 54.6%, p = 0.453). Rationale for no POSN varied.ConclusionPOSN is widely available in this metropolitan area. Variability exists between chain and independent pharmacies, and among pharmacies of the same chain; awareness of statutory guidance does not. Poison centers can act to define local POSN availability via direct inquiry in their communities.

Harder to get than you think: Levonorgestrel emergency contraception access in West Virginia community pharmacies

ObjectivesEmergency contraception (EC) is the only noninvasive form of contraception available after risk exposure and is an important tool for preventing unintended pregnancy resulting from unprotected sex, sexual assault, or contraceptive failure. The U.S. Food and Drug Administration (FDA) removed age restrictions on levonorgestrel EC and made it available over-the-counter to everyone in 2013. Despite improved availability and accessibility since the change in FDA regulations, community pharmacies have not uniformly embraced the policy. West Virginia is a rural state with high rates of poverty and teen pregnancy. DesignThe investigators called community pharmacies in West Virginia to assess the availability and accessibility of levonorgestrel EC in addition to the pharmacy staff’s knowledge of effectiveness for this cross-sectional study. Setting and participantsThe study sample consisted of 509 community pharmacies throughout the state. Outcome measuresA structured script was employed to conduct phone calls to community pharmacies with items assessing availability, accessibility, and knowledge of effectiveness. ResultsAt the time of the phone calls, levonorgestrel EC was reported to be available in 48.9% of the community pharmacies in West Virginia. Chain pharmacies were more likely to report EC as being in stock (0.76) than independent pharmacies (0.15.). Other measures of accessibility also favored chain pharmacies versus independent pharmacies. The overall accessibility of EC at West Virginia community pharmacies was derived from a binary composite variable of “completely accessible” or “not completely accessible” by combining 5 predetermined items. Overall, EC was completely accessible to callers in 0.27 of all pharmacies with significant differences by pharmacy type (0.47 of chain pharmacies as compared with 0.03 of independent pharmacies). ConclusionAccessible EC could reduce unintended pregnancy and help break the state’s generational cycle of poverty and poor educational, social, and health outcomes. Pharmacists will be instrumental in expanding access to EC.

Community Pharmacy Engagement in Diabetes Prevention: Key Informant Interviews with Pharmacy Executives.

IntroductionEven though evidence-based diabetes prevention interventions exist, more than 1 in 3 Americans have prediabetes; the use of pharmacies has been explored as a way to reach and care for this population. The objective of this study was to analyze factors that influence adoption of type 2 diabetes prevention programs by community pharmacies.MethodsWe conducted 21 semistructured interviews in 2018 with decision makers from 11 independent pharmacies in 6 US states and the District of Columbia and from 10 chain pharmacies operating in 1 state, multiple states, and nationwide. We identified participants by using purposive sampling. We used qualitative methods to analyze data and conducted interviews until we reached saturation.ResultsMultiple themes emerged: 1) initiation of services is more likely if initial financial support is received; 2) patient demand for services, actual or perceived, is paramount; 3) diabetes prevention services often fit within the existing operations of a pharmacy and allow maximum use of resources; 4) customer loyalty is a clearly articulated advantage against competition; and 5) engagement in diabetes prevention affirms an expanded role and the value of pharmacies to serve communities.ConclusionPharmacies are well situated to deliver diabetes prevention programs to communities. Although considerable opportunity exists for pharmacies to address diabetes prevention, more could be done to reduce barriers to their use.

Cross-sectional Study on the Impact of Discount Pricing and Price Competition on Community Pharmacy Practice.

BackgroundWithout stipulated legislation, a free pricing policy can lead to a disparity in prices among private healthcare setups. Competition is especially rampant among community pharmacies, especially in the Sabah state of Malaysia, where the recent years have witnessed the steady growth of pharmacy players from Peninsular Malaysia. Thus, this study aimed to examine the impact of price competition and discount pricing on the practice of community pharmacy in Sabah, Malaysia.MethodsThis was a cross-sectional study using an online questionnaire. Survey participants included community pharmacists practicing in Sabah. The validated and pilot-tested questionnaire consisted of three parts: background information of the pharmacy, attitudes and perception toward medicine prices, and practice of discount pricing. All required data were collected from community pharmacists practicing only in Sabah. Data were then analyzed by using descriptive, Chi-Square, and Kendall's tau-b tests.ResultsOf the 150 community pharmacists contacted, only 70 responded, providing a response rate of 47%. In terms of pharmacy type, 71% of the respondents were pharmacist-owned independent pharmacies, while 19% were pharmacy chains owned by community pharmacists. The remaining were pharmacies owned by non-pharmacists (10%). Sixty percent of the community pharmacies had been in existence for more than 10 years, with 12% in existence for less than two years, and 28% in existence for three to 10 years. More than 80% of the respondents stated that the business aspect of community pharmacy had overwhelmed the professional practice aspects and that community pharmacists have become providers of products instead of providers of care. In terms of professionalism, 87% also noted that they are being perceived as profiteering in the medicine business at the expense of patients.ConclusionsThe free market situation in Malaysia for medicine pricing has brought a detrimental consequence for community pharmacists with each one trying to undercut prices. Differing pricing mechanisms of medicines based on the quantity ordered contribute to the problem of discount pricing and price competition. Most community pharmacists, as indicated by this study, want the problem to be addressed.

Strategies to Reduce Out-of-Pocket Medication Costs for Canadians Living with Heart Failure.

Daily medication is the cornerstone of evidence-based therapy to reduce mortality and morbidity in patients with heart failure (HF). Up to 20% of Canadian patients pay for medications out of pocket. We sought to identify strategies that patients and prescribers can employ to reduce these costs. We collected data from outpatient pharmacies in Hamilton, Ontario. We determined prices for different medications in each of the drug classes recommended for HF with reduced ejection fraction in the Canadian Cardiovascular Society's guidelines. We examined differences in dispensing and delivery fees and inquired about other cost-saving strategies. We collected data from 24 different pharmacies, including a selection of hospital-based, independent, and larger chain pharmacies. In the most extreme scenario (i.e., 90-day prescription instead of a 30-day prescription and the least expensive generic drug instead of the most expensive brand name drug), total medication costs can differ by up to $495.56 per month. Costs were affected by choice of agent within a drug class, generic versus brand-name drug, quantity dispensed, dispensing fee, and delivery cost. Prescription content, dispensing practice, and pharmacy choice can remarkably impact out-of-pocket costs for HF medications. Prescribers can reduce costs by writing 90-day prescriptions and choosing the lowest-cost generic drugs in each therapeutic class. Patients should consider the services received for their pharmacy dispensing fees, use free delivery services where needed, and request inexpensive generic drugs. Pharmacists can facilitate cost minimization without compromising therapeutic efficacy.

Impact of naloxone education for patients receiving buprenorphine-containing prescriptions indicated for opioid use disorder at an independent community pharmacy

ObjectivesA pilot study was conducted to identify whether an opioid education and naloxone distribution (OEND) service affected (1) willingness to accept naloxone; (2) naloxone dispensation; and (3) patient knowledge about opioids, overdose symptoms, and naloxone in patients receiving buprenorphine prescriptions for opioid use disorder (OUD). MethodsParticipants were enrolled from January 2, 2019, to February 15, 2019, in this prospective noncontrolled study when receiving a buprenorphine prescription at the study site. The exclusion criteria included prescriptions being picked up by someone other than the patient and those who were below 18 years of age. The participants completed a written pre- and postsurvey containing “Yes” or “No,” “Select all that apply,” and open-ended questions assessing (1) willingness to accept naloxone and (2) change in opioid and naloxone knowledge. ResultsFifty-two participants were enrolled, and all completed the pre- and postsurveys. After the education, there was a not statistically significant change in the proportion of participants willing to accept naloxone from the pharmacy (28.8% vs. 36.5%; P = 0.31). In addition, there was an improvement in the proportion of participants believing that they need to carry naloxone with them (15.4% vs. 40.4%; P < 0.001). Naloxone dispensing increased 400% after the intervention implementation. Improvements in opioid knowledge also occurred. More participants correctly identified buprenorphine as an opioid (48.1% vs. 86.5%; P < 0.001), and correctly identified that methamphetamine (19.2% vs. 3.8%; P = 0.02) and cocaine (17.3% vs. 3.8%; P = 0.03) are not opioids. Of the 52 participants enrolled, 11.5% correctly identified all opioids on the presurvey, whereas 50% correctly identified all opioids on the postsurvey. ConclusionPatients diagnosed with OUD who are prescribed buprenorphine may be at high risk of an overdose if they return to use; yet, few OEND programs specifically target this population. This study suggests that OEND based in community pharmacies may be a strategy to increase naloxone access among these patients.

Prescription drug monitoring programs in community pharmacy: An exploration of pharmacist time requirements and labor cost

ObjectiveTo (1) measure the average time community pharmacists require to query prescription drug monitoring program (PDMP) reports, and (2) estimate pharmacist labor costs associated with PDMP use. DesignThis exploratory project consisted of an observational time study followed by analysis of existing PDMP data sets. Data collected included time spent by pharmacists in Final Verification of controlled substance prescriptions (CSPs), and whether or not they queried the PDMP. Zip code level PDMP query rates and prescription volume of opioid and benzodiazepines (O&BZD) were linked to time-study results to calculate cost estimates of pharmacist labor. Setting and participantsCommunity pharmacists in Connecticut were observed and timed in their usual pharmacy setting as they verified CSPs. Deidentified PDMP data were obtained from the Connecticut Prescription Monitoring and Reporting System. Outcome measures(1) The time required by community pharmacists to query their PDMP in prescription filling workflow, and (2) the estimated labor costs associated with variable PDMP utilization rates. ResultsBetween November 2018 and January 2019, 9 pharmacists in 4 independent community pharmacies were observed verifying 53 CSPs. Pharmacists spent more time verifying CSPs when they queried the PDMP versus when they did not query the PDMP (106 ± 66 seconds vs. 28 ± 27 seconds; p < 0.01). Between June 2016 and May 2017, community pharmacists in 24 community pharmacies in 4 represented zip codes queried the PDMP for 11% (n = 19,074) of CSPs dispensed, costing an estimated $24,769 in pharmacist labor. To meet a 100% PDMP query rate for O&BZDs alone, an additional 3735 hours of pharmacist labor ($224,100) would be required. ConclusionPharmacists require considerably more time to verify CSPs when they query PDMPs. This extra time requirement may challenge community pharmacy operating costs, and also impose time pressures on community pharmacists.

A Student Pharmacist Quality Engagement Team to Support Initial Implementation of Comprehensive Medication Management within Independent Community Pharmacies.

In 2017, the Pennsylvania Pharmacists Care Network (PPCN), an enhanced pharmacy services network, and STRAND Clinical Technologies partnered to launch a payor contract with a Pennsylvania Medicaid Managed Care Organization for the provision of comprehensive medication management (CMM) at PPCN pharmacies. PPCN and the Community Leadership and Innovation in Practice Center at the University of Pittsburgh School of Pharmacy partnered to create the Quality Engagement Team (QET), a group of student pharmacists formed with the intent to support the initial implementation of this contract. The QET supported the pharmacies through biweekly phone calls, which led to increased pharmacist engagement and produced impactful patient encounter stories that were then reported back to the payor. We utilized Active Implementation Frameworks and select implementation strategies from the Expert Recommendations for Implementing Change project throughout the implementation period. The QET supported the successful implementation of this payor contract, which saw an increase in CMM encounters completed by the pharmacists during each month of the four-month contract period. Students, pharmacists and the payor each derived meaningful benefits from this initiative. Student pharmacists can be a powerful asset in the implementation of payor programs within an enhanced pharmacy services network, resulting in the mutually beneficial and sustainable support of the network.

To evaluate the impact of opening up ownership of pharmacies in South Africa

BackgroundFollowing the democratic elections in 1994 the South African private pharmaceutical services were mostly in metropolitan centred with a scattering of pharmacies in less densely populated areas. The Government introduced regulations relating to the ownership and licensing of pharmacies on the 25th of April 2003 to improve access to pharmaceutical services by removing ownership restriction to only pharmacists.ObjectiveTo assess the outcomes of the policy implementation in improving access to pharmacies.MethodThe register of pharmacies at the South African Pharmacy Council was analysed from 1994 to 2014. Each registration was assigned GPS coordinates using Q-GIS(V3.6) and mapped per province at a district level, following clean-up and verification of the register. New registrations were also categorised as either corporate or independent pharmacy. Population census was obtained from Statistics South Africa and used to determine the number of pharmacies per 100,000 population.Main outcome measure(s)Number of active pharmacies; Number of independent pharmacies; number of pharmacies in each district.ResultsThe number of active pharmacies increased from 1624 at the end of 2003 to 3021 by 2014. The closure rate decreased from 137 to 86 pharmacies per year post regulations, a 37.23% reduction with a net gain of approximately 127 pharmacies per year. About 38.30% of all pre-2003 pharmacies (622 of 1624) closed by 2014. The population increase in the study period was approximately 20.66% but the overall growth of pharmacies was only 1.88 pharmacies per 100,000 population (3.55 to 5.43). Following the regulations in 2004, 23.9% of pharmacies active within the system closed between 2004 and 2014, of which, 91.7% of them were independent pharmacies.ConclusionOpening up of pharmacy ownership in South Africa increased the number of pharmacies in the country but did not result in increased access in previously less populated areas. There was still clustering of pharmacies in a well resourced areas, with a steady growth in corporate pharmacy (35%) ownership.

Preferences for and Experiences With Pill Appearance Changes: National Surveys of Patients and Pharmacists

To better understand patients' and pharmacists' preferences for and experiences with changes in pill appearance (size, shape, color, and markings). Cross-sectional. We conducted independent national surveys of patients 50 years and older taking generic drugs for depression, diabetes, epilepsy, HIV, hyperlipidemia, or hypertension and of licensed pharmacists practicing in chain, franchise, or independent pharmacies. Responses were collected between January and April 2016. Of 1000 patient respondents (30% response rate), most reported experiencing changes in pill appearance (51%) and preferred to be notified about them (82%), but less than half recalled being notified (verbally: 36%; via sticker: 45%). Among patients who reported experiencing a change, 12% reported stopping their medication or using it less frequently. Of 710 pharmacist respondents (33% response rate), many reported changes in pill appearance occurring frequently in their pharmacies (47% reported that changes occurred 6 or more times per month) and more than three-fourths reported notifying patients about them often (verbally: 88%; via sticker: 77%). Our findings reveal opportunities to improve patients' experiences with pill appearance changes through better notification practices and patient education.

Pharmacy Stories from the COVID-19 Pandemic

Pharmacy Stories from the COVID-19 Pandemic