Independent Pharmacies Research Articles

Community pharmacists' experiences of working during lockdown

BackgroundTransmission of the novel coronavirus strain, SARS-CoV-2, caused many health services to reach crisis points worldwide. As infection rates rose, many countries implemented ‘lockdown’ periods where only essential services could remain open; this included community pharmacies in the UK. This study retrospectively explores the experiences of community pharmacists during the first lockdown period of the pandemic in the UK, helping us to learn for the future if another pandemic were to arise. ObjectiveThe objectives of this study were to explore the main professional and personal worries and concerns that pharmacists experienced during the first UK lockdown. Key practical issues specific to COVID-19 were investigated: staffing levels, precautionary measures undertaken, workload issues, medicines shortages, support, and guidance. In addition, the perceived effectiveness of support available to community pharmacists was examined. MethodsCommunity pharmacists in the Stoke-on-Trent and Staffordshire regions of the UK were invited to participate in a semi-structured telephone interview. Participants were recruited until no new themes emerged. Interviews were transcribed verbatim, and thematic analysis was undertaken using the Framework Approach. ResultsIn total, 29 community pharmacists were interviewed across Stoke-On-Trent and Staffordshire, with interviews lasting on average for 20 min. Fifteen interviewees were from independent pharmacies and 14 from large-chain pharmacies. Five themes emerged from the data: difficulty maintaining staffing levels; precautionary measures undertaken for staff and patients; increase in dispensing volume; dealing with medicines shortages; and perceptions of support varied, with guidance reported to be initially slow and conflicting. ConclusionOverall, this study highlights the crucial role that community pharmacists in the UK played in ensuring patients still received their medication and health advice, despite the challenging circumstances in which they found themselves. Community pharmacies need appropriate support, recognition, and funding to enable them to remain sustainable and continue to provide a critical service in the face of possible future pandemics.

Fundamental issues and pandemic pushes pharmacists past their limits

Fundamental issues and pandemic pushes pharmacists past their limits

Assessing the Availability of Foreign and American Sign Language Interpreting Services in Community Pharmacies.

Objective To determine community pharmacists' experience with foreign language and American Sign Language (ASL) interpretation services. Design A survey was drafted to gather information about pharmacists' familiarity with ASL and foreign language interpreting services as well as the frequency with which pharmacists encountered patients who needed these services. Setting Independent and chain community pharmacies in Spokane County, Washington, USA. Participants Fifty-two community pharmacies were identified using a provider-credential search. Fifty-one pharmacists (98%) agreed to participate and completed the survey. Interventions Surveys were initially conducted in person, but after the COVID-19 pandemic began data collection was halted and restarted via phone in accordance with the Washington State University Office of Research Support and Operations. Results Four out of 51 pharmacists surveyed (7.84%) indicated that they were fluent in a language besides English. Pharmacists reported encountering patients who spoke Spanish (31%), Russian (31%), ASL (8%), Arabic (5%), Mandarin Chinese (5%), Vietnamese (5%), Marshallese (5%), and Ukrainian (2%). Some pharmacists (8%) reported not encountering patients who spoke other languages besides English. Most pharmacists (72.5%) indicated their company offered interpreting services for foreign languages, but less than half of pharmacists surveyed (43.1%) had experience using these services. Forty-five percent of pharmacists surveyed did not know whether their company offered an interpreting service for ASL, and only 23.5% indicated that they had experience using ASL interpreting services. Conclusion Pharmacists are less familiar with services for patients who speak ASL and are less likely to have experience with ASL interpretation services than they are to have assisted foreign-language-speaking patients.

Targeted Medication Review of Falls-Risk Medications in Older Patients: A Community Pharmacy-Based Approach.

Objective To assess a community pharmacist-provided targeted medication review (TMR) intervention to reduce the number of falls risk-increasing drugs (FRIDs) prescribed to older patients in a community pharmacy setting. Design A single-site, prospective, interventional pilot study with a historical control group. Setting A single independent community pharmacy in rural Western New York. Participants A convenience sample of subjects was recruited for the intervention group based on the following inclusion criteria: 65 years of age or older, at least one prescription filled at the pharmacy within the past 90 days from date of enrollment in study, enrolled in a local Medicare plan, and prescription for at least one prespecified FRID filled at the pharmacy within 90 days before date of enrollment in study. A control group was collected that had different Medicare Part D plans than the intervention group but otherwise met inclusion criteria and ensured that between all of the control-group patients we included at least one patient prescribed each of the FRID classes that were found in the intervention group. Thirty-six subjects completed the study intervention, and 63 controls were collected. This offset in numbers between groups resulted from intervention subjects taking multiple FRIDs and the control needing to take the same class of FRID, thus one intervention subject may have required multiple control subjects to parallel each FRID class. Intervention The intervention involved the community pharmacist assessing the patient's fall risk, then educating the patient on the risks of the FRID he or she was prescribed, and recommending to either replace or discontinue the FRID. The outcomes assessment occurred three months later, with the pharmacist repeating the falls-risk assessment and following up regarding the patient's agreed-upon action plan. Results The intervention group had 52 FRIDs identified while the control group had 89. The discontinuation rate of FRIDs at three months was significantly higher in the intervention group (7.7% versus 0%; P = 0.0172). Conclusion This study demonstrated that a community pharmacist TMR intervention can reduce the use of FRIDs.

Factors related to technical management and adverse drug event reporting in independent retail pharmacies in Cali, Colombia

Independent retail pharmacies are required to have a technical manager responsible for the operation and adverse drug event reporting. In this context the following investigation is developed based on one objective: To establish factors related to the technical management and adverse drug event reporting in independent retail pharmacies in Cali. This is a cross-sectional observational study. Data was randomly collected from an estimated sample of 244 independent retail pharmacies. The results show that storage was the area of greatest implementation, 94% of the assessed pharmacies had a technical manager and 50% of them reported adverse drug events. A technical manager, being a chemist, pharmacist, or pharmacy manager, was associated with having computer equipment and dispensing homeopathic products. Adverse drug event reporting was directly associated with having bibliographic resources and inversely associated with the technical manager being a drug retailer. These data show the factors related to technical management of independent retail pharmacies and adverse drug event reporting were identified.

Barriers for Implementation of E-pharmacy Policy: Views of Pharmacy Authorities, Public Institutions and Societal Groups

Malaysian government has established National Digital Economy Policy to promote e-commerce adoption among small to medium enterprises (SMEs). Although this national policy has expanded to community pharmacists for providing e-pharmacy services, only a few independent pharmacies have adopted e-pharmacy practices. As such, it is important to critically investigate the implementation of e-pharmacy policies in promoting online pharmaceutical services in Malaysia. This study explores the barriers in implementing e-pharmacy policies from the perspective of pharmaceutical authorities, public agencies and societal groups. The Consolidated Criteria for Reporting Qualitative Research (COREQ) was employed in this study. Interview data were collected from key pharmaceutical authorities, agencies governing e-commerce and consumer affairs, health professionals and consumer societal groups. Thirty-three key actors participated in this study. Themes focusing on factors that impede the implementation of e-pharmacy policies were identified using an open-axial coding approach. Eight emerging themes were identified to be influencing policy inaction and policy barriers towards e-pharmacy implementation for empowering community pharmacists: (1) policymakers’ inattention to private business interests; (2) authoritarian administrative action unsuitable for e-pharmacy businesses; (3) deficit of trust towards community pharmacies practising e-pharmacy services; (4) conflicting policy requirements between safeguarding patients and business applications; (5) limited organisational resources and budget constraints; (6) policy incompatibility and different jurisdiction requirements; (7) unfriendly e-pharmacy requirements; and (8) dominant interest groups opposing e-pharmacy policies. Clear and consistent policies will benefit both patients and consumers as they acquire improved access to professional consultation and various options for quality medicine at competitive prices.

Increasing use of immunization information systems for routine vaccinations in independent community pharmacies: A randomized controlled trial

BackgroundOnly 60% of adults nationwide and just 36.8% of adults in Alabama have immunization data recorded in an Immunization Information System (IIS). The objective of this study, which took place before the coronavirus disease 2019 (COVID-19) pandemic, was to evaluate the impact of an IIS training program on pharmacists’ IIS enrollment, participation, awareness, knowledge, intention, and attitudes. MethodsA randomized controlled trial was conducted in 2019 among Alabama pharmacists (N = 41) practicing in independently owned pharmacies and providing vaccination services but whose pharmacy was not enrolled in Alabama’s IIS (Immunization Patient Registry with Integrated Technology [ImmPRINT]). Intervention pharmacists were offered a 2-hour IIS training program, including an online continuing pharmacy education article, demonstration videos, implementation guide, and informational flyer. Control pharmacies received the informational flyer only. Pharmacy-level outcomes, including enrollment and participation, were obtained from ImmPRINT administrative records. Pharmacist-level outcomes, including awareness, knowledge, intention, and attitudes, were self-reported using baseline, 1-month, and 3-month surveys. Two-way mixed analysis of variance, chi-square, and independent t tests were used to analyze differences in outcomes between and within groups. ResultsEnrollment in ImmPRINT was significantly greater among intervention pharmacists’ pharmacies (P = 0.035). In particular, 59.1% of intervention pharmacies compared with 26.3% of control pharmacies were enrolled in ImmPRINT at 3 months. No statistically significant differences were found between groups in terms of participation in ImmPRINT. Intervention pharmacists’ awareness of IIS was significantly greater than control pharmacists (P = 0.028) at 1 month (postintervention). Furthermore, the IIS training program significantly improved intervention pharmacists’ knowledge (P = 0.030) and attitudes (P = 0.016) toward IIS over 3 months compared with the control group. ConclusionsThis pharmacist-centered training program focused on practical strategies to integrate IIS into pharmacy workflow. Results show that pharmacists’ enrollment, awareness, knowledge, and attitudes significantly improved as a result of this training. As pharmacists become more involved in immunization efforts, particularly in response to COVID-19, awareness of and participation in responsible immunization documentation are critical.

Assessing content and factors influencing responses to information requests in community pharmacies in Jordan: A simulated patients study.

ObjectivesTo assess the management of requests for information about a prescription only medicine (simvastatin for treatment of dyslipidemia) by pharmacy staff in community settings and explore the factors influencing the information content.MethodsA cross sectional study conducted using the stimulated patient (SP) method between November 2018 and May 2019. The SP conveyed the request at the beginning of the encounter in a standardized way based on predetermined plots and was instructed to ask the pharmacy staff directly if information was not discussed spontaneously. After the visit, the SP provided written feedback including information about the scenario and a copy of individualized feedback. The study was reported according to the checklist for reporting research using simulated patient methodology (CRiSP). Factors influencing information content with or without information demand were investigated.ResultsA total of 55 visits were analyzed. The average content score for the information discussed spontaneously was 16.2% with the standard deviation (SD) equal to15.6. The score improved significantly after information was demanded by the SP; the average total information content score became 34.4% (SD = 16) with p < 0.001. The score of information discussed spontaneously was higher for male pharmacy staff, older age, more experience, and a Pharm D degree. When the SP prompted or demanded for information, older pharmacy staff with more experience and with a college degree scored higher. Independent pharmacies, longer visit durations, and less distraction were associated significantly with higher information scores Pharmacy staff aged 35–39 and those with 6–10 years of experience were significant contributors to spontaneous discussion of information with p values = 0.003 and 0.013, respectively. After the SP demanded information, pharmacy staff with less than 5 years of experience and greater confidence as well as longer visits were positively predicting higher information scores with p values of 0.049, 0.04, and 0.04, respectively.ConclusionsInformation provided by community pharmacists responding to information requests about prescription only medications was found to be suboptimal. Patient requests for information were found to be a positive driver for better information content. Further research of mixed methodologies is required to clarify the factors and motivators enabling information exchange in community settings and to outline true training needs.

Assessing Willingness of Patients with Diabetes to Attend Pharmacist-Led Structured and Patient Specific Diabetes Self-Management Education.

Background: The American Diabetes Association recommends that people with diabetes should participate in diabetes self-management education, however data shows that many patients do not attend educational classes. Objectives: To examine the views of patients with diabetes who utilize services at an independent pharmacy in Richmond, Virginia regarding their (1) interest in attending diabetes self-management education and support (DSMES) services, (2) perceptions of a pharmacist leading DSMES services, (3) willingness to pay for DSMES services, and (4) relationship between self-reported diabetes management status with their willingness to attend DSMES services. Methods: A qualitative survey was administered over five months to patients with diabetes at an independent community pharmacy in Richmond, VA. The survey included 35 questions in a mixed format of Likert scale, dichotomous, and fill in the blank. Survey data was analyzed using univariate, bivariate, and/or multivariate analysis using SAS 9.4. Results: Twenty seven surveys were completed, 15% response rate. Patients were female (56.7%) with an average age of 69 ± 10.8 years. Caucasian race accounted for 90% of patients, 6.7% reported Black or African American, the remainder responded "other". Patients agreed they were interested in attending individual virtual and in person DSMES sessions with a rate of 52% and 87%, respectively. When asked about the full service of 9 group sessions, 33% responded disagree and 30% reported agree. 52% of patients reported belief that pharmacists had the knowledge to lead sessions. When asked about willingness to pay, patients mostly selected the lowest cost option ($25 - $35). Conclusion: Patients with diabetes are willing to participate in DSMES services and believe pharmacists can lead the sessions. It is important to continue to advocate for DSMES services so patients can understand the full benefits of the program and receive the best possible care.

Extracting low-cost signals of perceived quality control in community pharmacies: a simulated client study of contraceptive dispensing in Bogotá

We determine whether community pharmacies in Bogotá produce differential quality signals, and if they are related to an objective quality measure: the compliance with prescription rules. In this quantitative descriptive study, we use the simulated client methodology (N=298) to assess whether Bogota’s community pharmacies comply with prescription rules related to contraceptive medications. We find that one per cent of the staff at the pharmacy asked for a prescription when the pills were requested. Five per cent of the staff asked additional questions that signal knowledge or interest in the correct delivery of pills. We do not find differences by socio-economic level or type of pharmacy ownership (i.e., large firm versus independent) regarding the request of prescriptions or further questions about the pills. Concerning the aesthetic signals of quality, independent pharmacies were less likely to display a diploma of their chemist, and the likelihood that their staff wore white coats was also lower. We conclude that Bogota’s community pharmacies differentiation is based on simple signals associated with a professional image, but not with actual procedures that guarantee the safety of consumers.

COVID-19 pandemic vaccination preparedness strategies for independent community pharmacies

ObjectiveThis study aimed to determine independent community pharmacist preparedness for coronavirus disease 2019 (COVID-19) vaccination and to identify strategies for COVID-19 pandemic vaccination implementation in Pennsylvania. MethodsThis study used a complementary mixed-methods approach to recruit independent community pharmacists to participate in an electronic survey and 2 virtually conducted focus groups before the availability of the first COVID-19 vaccine. Information was gathered and compiled into 5 topic areas: (1) workflow, (2) resources, (3) staff and patient safety, (4) communication, and (5) documentation and training. Data collection occurred between October and December 2020. Survey data were analyzed using descriptive statistics. Focus group discussions were audiorecorded and transcribed. A directed, content analysis was conducted to identify strategies for each topic area, and supporting quotes were selected. ResultsA total of 88 and 11 independent community pharmacists participated in the survey and focus groups, respectively. Because of the small size of most independent pharmacies, participants recommended working with community partners to support off-site mass vaccination clinics. Leveraging partnerships with community organizations and universities could be used to support staffing for vaccination efforts. Using an appointment-based immunization model was identified as one tool to optimize patient and staff safety during the pandemic. Pharmacists suggested using existing scheduling tools and text messaging and automated phone calls for second-dose reminders. Finally, independent pharmacists recommended further training and process improvements to support vaccine documentation and transmission to the Pennsylvania Statewide Immunization Information System. ConclusionRecommendations from this study were used to support planning and preparation for COVID-19 vaccinations across Pennsylvania. Incorporation of pharmacists’ ideas and recommendations on pandemic vaccination implementation is an important strategy to efficiently expand vaccination administration during pandemics.

Capacidad tecnológica en la farmacia independiente mexicana para la incorporación de un sistema de ventas en línea

The current demands generated by the Covid-19 pandemic have forced many establishments to migrate theirbusinesses to an online platform, so it is important to know if independent pharmacies have the possibilityof making use of this tool, therefore that the objective of the present study was to diagnose the technologicalcapabilities of the independent pharmacy. The aim is to know if this type of business has the capabilitiesto incorporate an online sales system (e-commerce) as a sales strategy. The pilot study was carried out inthe metropolitan area that borders the northern area of Mexico City. A quantitative methodology with anexploratory and descriptive approach was used, through the survey method that was taken and modifiedfrom a study by Méndez (2020), which showed that independent pharmacies in the area lack technologicalinfrastructure despite that the staff has the ability to handle technology to incorporate e-commerce as a salesstrategy. This pilot study is effective for the diagnosis of technological capabilities in independent pharmacytypebusinesses and works as a model to apply it in a larger sample that allows to conclude a global realityof these businesses in Mexico.

NHS could introduce performers list for independent prescribing pharmacists

NHS England is considering setting up a performers list for pharmacist prescribers, in line with similar lists held for doctors and dentists, the deputy chief pharmaceutical officer for England has said. Speaking at an event for members of the Association of Independent Multiple Pharmacies (AIMp) on 29 September 2022, Bruce Warner said the consideration was […]

Big four pharmacy chains call on health secretary to introduce Pharmacy First in England

The chief executives of the four biggest UK pharmacy chains, the Pharmaceutical Services Negotiating Committee (PSNC), the National Pharmacy Association, the Company Chemists’ Association and the Association of Independent Multiple Pharmacies have written to the health secretary calling on him to introduce a ‘Pharmacy First’ service in England. The letter, written to Steve Barclay, also […]

Fragile medicines supply chain causing worst stock issues 'in four years', says wholesaler

The UK is facing a serious problem in its supply of medicines, which is driving up prices for the NHS, according to the head of sales at a major wholesaler. Speaking at an event for members of the Association of Independent Multiple Pharmacies (AIMp) held near Birmingham on 29 September 2022, David McNicol, head of […]

Waheedat Owodeyi

As a black, female, independent pharmacy owner, Waheedat Owodeyi is fairly unique and, perhaps not surprisingly, “is not afraid to challenge the status quo”, according to her nominator. Owodeyi first graduated as a pharmacist in Nigeria, before moving to the UK in 2004, doing her preregistration placement and carefully building experience working in Boots, Asda […]

Limited access to pharmacy-based naloxone in West Virginia: Results from a statewide purchase trial

BackgroundWest Virginia (WV) has the highest overdose mortality rate in the United States and expanding naloxone access is crucial for reducing opioid overdose deaths. We conducted a purchase trial to establish an objective measure of naloxone access under WV’s naloxone standing order (NSO) program. MethodsA stratified random sample of 200 chain and independent retail pharmacies across WV were included. Each pharmacy underwent two purchase attempts—one by a person who used illicit opioids (PWUIO) and one by a potential bystander who did not use illicit opioids but had a relationship with a PWUIO. We used matched-pairs analysis to identify differences in outcomes by purchaser type (PWUIO vs bystander). Chi-square and independent-samples t-tests were used to compare outcomes by pharmacy type (chain vs independent). ResultsOverall, 29% of purchase attempts were successful, with no significant difference between PWUIO and bystanders (p = 0.798). Fewer than half (44%) of successful purchases included verbal counseling, and bystanders were more likely to receive counseling than PWUIO (33% vs 4%, p = 0.018). Common reasons for failed purchases were naloxone not being in stock (41%), requiring a naloxone prescription (35%), and/or requiring formal identification (23%). Chain pharmacies were more likely to sell naloxone than independents (35% vs 19%, p = 0.001). ConclusionsWe documented limited naloxone access under the WV NSO. These findings indicate that simply establishing an NSO program is insufficient to expand access. Implementation efforts should ensure adequate naloxone stocks, pro-active delivery of NSO-related information and pharmacist training, and avoidance of recordkeeping requirements that may impede access.

The Journey to Advanced Clinical Pharmacy Practice: Global Collaboration Will Accelerate the Pace

The Journey to Advanced Clinical Pharmacy Practice: Global Collaboration Will Accelerate the Pace

CONSIDER New Mexico: Effects of naloxone training among pharmacists and pharmacy technicians

BackgroundPharmacists serve a critical role in providing health care, especially in medically underserved areas. Despite the opioid crisis and legislation in most states allowing pharmacists to dispense naloxone without a prescription from another provider, pharmacists face multiple barriers to dispensing naloxone. ObjectiveThis study tested the effectiveness of CONSIDER New Mexico, an innovative educational initiative designed to increase naloxone dispensing by pharmacies. MethodsA quasi-experimental study was conducted in New Mexico in 2019-2020. Community pharmacists and pharmacy technicians were recruited from a purposive sample of pharmacies. Data were collected through pre- and postintervention surveys with 65 pharmacists and 44 technicians from 49 pharmacies. Data analysis included hybrid fixed-effects regression models of variables associated with pre-post intervention change in intent to dispense naloxone and generalized least squares with maximum likelihood estimation for pre-post intervention change in naloxone dispensing. ResultsPositive intervention effects were observed for measures of normative beliefs, self-efficacy, and intent to dispense naloxone (P < 0.05). Changes in normative beliefs and self-efficacy were associated with greater intent to offer naloxone to patients (P < 0.05). In addition, the median number of naloxone prescriptions dispensed per month increased 3.5 times after intervention. A statistically significant positive association was observed between the intervention and naloxone dispensing after adjusting for other factors (P < 0.001). Pharmacies providing more than 4 additional health services were more likely to increase naloxone dispensing postintervention than pharmacies offering not more than 2 services (P < 0.01). This difference averaged 19 naloxone prescriptions per month. Estimated change in dispensing postintervention was statistically significantly lower at independent, clinic-based, and other pharmacies where an average of 36 fewer naloxone prescriptions were dispensed per month compared with chain drug stores (P = 0.03). ConclusionThe CONSIDER New Mexico intervention effectively increased self-efficacy, intent to dispense, and naloxone dispensing. Findings will inform future research examining widespread dissemination and implementation of the intervention and the sustainability of intervention effects.

Use of value stream mapping to improve the medication synchronization process

BackgroundLean methodology, specifically value stream mapping, can be used to identify and reduce inefficiencies in the medication synchronization process. ObjectivesThe objectives of this study were to (1) evaluate potential medication synchronization process improvements to reduce nonvalue-added actions, (2) assess fidelity to the medication synchronization core components, and (3) identify the best process for medication synchronization for an independent community pharmacy with multiple locations. MethodsThis study used an observational, cross-sectional design. A value stream map was created to provide a detailed illustration of each step in the medication synchronization process. Time for each step of the medication synchronization process was observed on site on different days and times as well as the time required to process, package, and verify prescription medications. These steps were conducted before interventions were made to the process and after to compare the difference. The organizational readiness for change tool was administered to employees of the independent pharmacy before interventions to determine their perspective of the medication synchronization process and assess their readiness for change. ResultsOwing to various interventions made to the medication synchronization process, 2 steps in the process were eliminated. This resulted in a decrease in adherence packaging time workflow by 69.4%. Staff (n = 9) rated the medication synchronization process on 4 components: acceptability of the current process (13.8 ± 3.6), intervention appropriateness (13.7 ± 3.7), feasibility of a new medication synchronization process (17.1 ± 2.3), and organizational level of support (21.8 ± 4.1). ConclusionValue stream mapping proved to be a valuable tool in identifying inefficiencies in the medication synchronization process and reducing nonvalue-added waste. The result was a decrease in time required for adherence packaging workflow and a more standardized medication synchronization process across multiple independent pharmacy locations. This more standardized process can play a key role in improving the continuity of patient care, increasing medication adherence, and in turn decreasing the number of hospital admissions.