Local Pharmacists Research Articles

Unmet Health Care Need and Income-Related Horizontal Equity in Access During the COVID-19 Pandemic

Using monthly data from the Understanding Society (UKHLS) COVID-19 Survey we analyse the evolution of unmet need and assess how the UK health care system performed against the norm of horizontal equity in health care access during the first wave of COVID-19 wave. Unmet need was most evident for hospital care, and less pronounced for primary health services (medical helplines, GP consultations, local pharmacist advice, over the counter medications and prescriptions). Despite this, there is no evidence that horizontal equity, with respect to income, was violated for NHS hospital outpatient and inpatient care during the first wave of the pandemic. There is evidence of pro-rich inequities in access to GP consultations, prescriptions and medical helplines at the peak of the first wave, but these were eliminated as the pandemic progressed. There are persistent pro-rich inequities for services that relate to individuals’ ability to pay (over the counter medications and advice from the local pharmacist).

Supplements for stress and anxiety

Stress and anxiety affect millions of people in the United States and have only worsened during the COVID-19 pandemic. While therapy, prescription medications, or a combination of both remain the standard treatment for anxiety and stress, some supplements are available to manage mild to moderate symptoms. As more and more patients turn to their local pharmacists for advice on managing mental health symptoms, what should they know about the supplements out there?

A Cross Sectional Survey of Knowledge, Attitude and Practice of Antibiotic Use for Children in Chennai among Mothers

Background and Aim: Mothers play a vital role in providing antibiotics to their children since they are too often affected with infections. Hence, the purpose of this study to assess the knowledge, attitude and practice towards antibiotic use of children in Chennai among mothers. 
 Materials and Methods: A cross sectional survey was conducted among mothers of 250 participants. A questionnaire based online survey was conducted and distributed through the survey planet. The data were collected and tabulated in Microsoft Excel sheets which were transferred to SPSS Version 20 for statistical analysis. Chi square test was performed to check for association between variables. 
 Results: About 71.3% of the mothers are not aware that antibiotic resistance is a worldwide problem and 53.3% are paying attention to the expiry date of antibiotics and also 59.3% of the respondents give higher doses of antibiotics to their child than what doctor’s prescribed. 44% of them are providing antibiotics prescribed by local pharmacists without any doctor's prescription. A highly significant association was seen in mothers with monthly income of <30000 rupees do not prefer expensive antibiotics compared to monthly income of >30000 rupees (Chi square test; p<0.001, statistically significant). 
 Conclusion: The study concluded that the mother’s limited knowledge about antibiotics. Hence it is important to facilitate multilevel parent’s education programs regarding antibiotic usage and create awareness about the complications of misconceptions of antibiotics.

Role of pharmacists during the COVID-19 pandemic in China-Shanghai experiences.

The roles and contributions of pharmacists in Shanghai during the coronavirus disease 2019 (COVID‐19) pandemic are described in this report. Five pharmacists have been appointed as members of an expert interdisciplinary health care team tasked with taking care of all adult patients with COVID‐19 in Shanghai in a designated hospital, the Shanghai Public Health Clinical Center (SPHCC). They work with pharmacists at SPHCC, having responsibilities that include drug supplies, dispensing, pharmacy intravenous admixture services (PIVAS), prescription audits, medication reconciliations, pharmacotherapy, therapeutic drug monitoring, and patient education. Due to the pandemic, pharmacy operations in all hospitals are modified to adhere to guidelines for infection risk mitigation and personnel protection. Community pharmacies serve as the public access point to health care and medical supplies, providing services beyond dispensing and medication counselling. The establishment of internet hospitals (telehealth facilities) provide new opportunities for delivering pharmaceutical care and working with health care professionals. Pharmacists also participate in evaluating new treatments and keeping health care teams informed of new findings for potential treatment considerations. In response to the critical need for health care professionals in Wuhan, 68 pharmacists from different parts of the country went there to work with the local pharmacists. Through assuming new roles and adapting existing practice, pharmacists have acquired invaluable experiences for future practice advancement. In order to assume these responsibilities effectively, pharmacists need to be equipped with the necessary skills for meeting the evolving health care challenges.

Treatment options and results of adjuvant treatment in nonmuscle-invasive bladder cancer (NMIBC) during the Bacillus Calmette-Guérin shortage.

Given the worldwide shortage of Bacillus Calmette-Guérin (BCG), we review the efficacy of alternative BCG application schedules, doses or strains and intravesical chemotherapy in patients with nonmuscle-invasive bladder cancer (NMIBC). Modifying BCG schedules by reducing the dose is preferable to reducing the frequency of BCG that increases recurrence rates and should be avoided if possible. Changing the BCG substrain represents a reasonable option, as current evidence does not suggest different oncological outcomes with specific BCG substrains. Mitomycin C (MMC) alone is inferior to BCG with maintenance, but promising results have been demonstrated when used with chemohyperthermia and electromotive drug administration. Several other intravesical chemotherapies including Gemcitabine and Epirubicin should be used when both BCG and MMC are in short supply. In case of BCG shortage, much will depend on the severity and length of the BCG shortage, but our review supports several solutions: First, we recommend contacting the local pharmacist or BCG supplier to consider alternative BCG strains or sterile splitting of BCG doses. In the complete absence of BCG, consideration should be given to MMC with chemohyperthermia or electromotive drug administration where available or other intravesical chemotherapy. High-risk patients should be considered for cystectomy.

Independent pharmacist prescribing of statins for patients with type 2 diabetes: An analysis of enhanced pharmacist prescriptive authority in Idaho

ObjectivesThis study describes the development and patients’ perceptions of a community pharmacist–led, statin-prescribing service for patients with diabetes and aims to identify why patients indicated for statin therapy were not prescribed therapy at the time of pharmacist consultation. SettingThis pilot service began in 4 community-based Albertsons Companies pharmacies located in western Idaho. Patients eligible for the statin-prescribing service had a current diagnosis of type 2 diabetes, were aged between 40 and 75 years, were currently taking medications to manage their diabetes and had no contraindications to statin therapy. Practice descriptionDue to recent law changes in Idaho, pharmacists can now prescribe statins and certain other medications without oversight from a medical provider or the need for a collaborative practice agreement. Practive innovationPatients were identified and contacted by their local community pharmacist to discuss the statin-prescribing service. Once statin therapy was initiated, patients completed a brief, 7-question survey regarding their perceptions of the service. EvaluationThis study evaluated the following: number of patients eligible for the prescribing service, number of patients who received a pharmacist-written statin prescription, and patients’ perceptions regarding the service. MethodsOf the 64 patients screened, 18 (28%) were eligible for statin therapy. Of those eligible, 6 (33%) accepted pharmacist services and 4 patients started statin treatment. Two patients were prescribed a statin by the community pharmacist, whereas the other 2 patients contacted their primary care provider and requested a statin prescription at the pharmacist’s recommendation. ResultsOverall, participating patients (n = 4) reported feeling comfortable and satisfied with all aspects of the protocol and their pharmacist’s role as a prescriber. ConclusionThis pilot was the first example of community pharmacists independently prescribing statins outside of the clinic setting. The service could target an important health initiative.

Community pharmacists' perceptions, attitudes and barriers towards pharmacist-led minor ailment services in Malaysia.

Background Community pharmacists are increasingly recognized to have an important role in providing a convenient and accessible alternative support for patients with minor ailments. In view of the abilities of community pharmacists in managing minor ailments, some countries have started the pharmacy-based minor ailment schemes that offers public access to treatment and advice of minor ailments from their local pharmacist. Nevertheless, there is limited study in Malaysia that explore the current practice of community pharmacists in managing minor ailment. Objective This study aims to evaluate community pharmacists' perceptions, attitudes and barriers of pharmacist-led minor ailment services. Setting Community pharmacists inMalaysia. Methods A cross-sectional survey among community pharmacists practicing in Malaysia was conducted between December 2017 until March 2018. The self-administered survey was distributed online via email, Facebook and WhatsApp's group. Main outcome measure Community pharmacists' perceptions, attitude and barriers towards minor-ailment service in community pharmacy settings. Results A total of 305 community pharmacists had completed the survey. The majority of community pharmacists in Malaysia had positive perceptions and attitudes towards pharmacist-led minor ailment services. The most common perceived barriers were lack of patient's medical information, absence of dispensing separation and lack of support from other healthcare professionals. Ethnicity, position and years of working experience were found to have significant associations with community pharmacists' score of attitudes and barriers related to minor ailment treatment in community pharmacy settings. Conclusion Community pharmacists in Malaysia have positive perceptions and attitudes over benefits of minor ailment services to public, however the barriers towards the service must be overcome to ensure service is sustainable for public's benefits.

Exploring the common prescribing errors that occur in the emergency department.

Prescribing errors are a subset of medication errors that occur on the forms used to prescribe medicines for patients. On their discharge from the emergency department (ED), many patients are given a prescription form to obtain medicines from their local community pharmacist. On the identification of a prescribing error, the patient is sent back to the ED because the medicine cannot be dispensed. To identify the most common prescribing errors on prescriptions returned to one large inner-city ED in South Wales from community pharmacies. Prescriptions that were returned to the ED over a six-week period from September and October 2016 were analysed to determine the types of prescribing errors that occurred and their frequency. A total of 10,218 patients attended the ED over the six-week period, of which 7,731 patients were seen by a clinician and discharged home. Of these, 322 patients were discharged with a prescription, and 20 (6%) of these patients returned to the ED with a prescribing error that prevented the pharmacist from dispensing the medicines. The most common prescribing error was incorrect or missing prescriber information. This study identified that there was a low rate of prescribing errors in the ED, and this was comparable with the rate of prescribing errors identified in the literature. Common prescribing errors could be mitigated through the introduction of electronic prescribing in the ED.

Unmet Health Care Need and Income-Related Horizontal Equity in Access During the Covid-19 Pandemic

Using monthly data from the Understanding Society (UKHLS) COVID-19 Survey we analyse the evolution of unmet need and assess how the UK health care system performed against the norm of horizontal equity in health care access during the first wave of COVID-19 wave. Unmet need was most evident for hospital care, and less pronounced for primary health services (medical helplines, GP consultations, local pharmacist advice, over the counter medications and prescriptions). Despite this, there is no evidence that horizontal equity, with respect to income, was violated for NHS hospital outpatient and inpatient care during the first wave of the pandemic. There is evidence of pro-rich inequities in access to GP consultations, prescriptions and medical helplines at the peak of the first wave, but these were eliminated as the pandemic progressed. There are persistent pro-rich inequities for services that relate to individuals' ability to pay (over the counter medications and advice from the local pharmacist).

Courts Strike Down Trump’s ‘Refusal of Care’ Conscience Rule

Courts Strike Down Trump’s ‘Refusal of Care’ Conscience Rule

Llegada de las ampolletas inyectables a México y Estados Unidos. Diferencias y similitudes en la práctica farmacéutica (1896-1939).

<p>A finales del siglo XIX y principios del XX, las ampolletas inyectables llegaron a México y Estados Unidos con recibimientos distintos por parte de los farmacéuticos locales. Mientras que en México la recepción de las ampolletas fue favorable, en Estados Unidos fueron acogidas con desconfianza, lo que dio lugar a diferencias importantes en su desarrollo y manufactura en ambos países. El objetivo de este trabajo es analizar las divergencias y similitudes que tuvieron los procesos de introducción de las ampolletas inyectables en México y Estados Unidos. Se busca mostrar que la adopción de las ampolletas fue influenciada por los modelos terapéuticos y de industrialización del medicamento que prevalecían durante la época, los cuales determinaron las características principales de la profesión y la práctica farmacéutica en cada nación.</p>

The contemporary role and potential of pharmacist contribution for community health using social media.

Background Social media (SM) is everywhere, and it affects all aspects of life, including health care. This study aimed to identify pharmacist activity in SM and explore the potential for pharmacist contributions using SM. Methods Focus group discussions (FGDs) were conducted in four cities in Indonesia. The investigators collaborated with a local pharmacist association to select a wide range of pharmacists as participants. The discussions were audiotaped, transcribed, and thematically analyzed. Results Forty-one pharmacists participated in the FGDs. Four broad themes were identified: pharmacist use of SM, current initiatives using SM, public acceptance, and opportunities for role expansion. WhatsApp was the most used SM and had meaningful contribution to spread information and change a patient's behavior. Participants used SM mainly for personal purposes, but when it came to pharmacy and health issues, they were among the first to be contacted by patients or to counter misleading information in SM. A number of participants actively used SM for health promotion in form of sharing health information, promoting use of medicines, providing drug reminders, and encouraging compliance to medication. The public had a high trust to information provided by pharmacists in SM. Although participants believed pharmacists can play a role in educating patients and influencing the health of the communities, they considered being active in SM as burdensome, time consuming, and potential for lawsuit. Conclusions SM has become a venue for pharmacists to improve the health of the people. Several unique features in SM may facilitate pharmacist contributions; however, whether pharmacists continue to undertake such initiative cannot be guaranteed.

Feedback on the transition to routine use of Connexin, a tool to improve city-hospital cooperation

Abstract Issue The French national health strategy “Ma Santé 2022” underlines the need to decompartmentalize the organization of care through city-hospital cooperation. The Connexin® platform aims, as part of treatments prescribed in hospitals and delivered in community, to identify all health professionals around the patient, and ensure they communicate and coordinate with each other to improve the coherence and relevance of care within the pathway. Description of the problem A pilot phase of deployment of the tool was conducted in two regions to measure the organizational and clinical impact of its use. This evaluation was based on qualitative interviews with the various stakeholders (local pharmacists, hospital teams, institutional partners, etc.). The objective was to assess the adoption and transition phases while identifying its effects and added value for health professionals using it. Results Adherence was important: many pharmacists registered, reflection on the service organization in hospital teams. Despite some access problems (codes lost, dual authentication), professionals believe Connexin® facilitates communication between primary care and hospital actors. However, transition was difficult in several hospitals (lack of support from management mainly), insufficient use by pharmacists (hampered by the new missions entrusted to them by law). Support closest to professionals in the tool implementation thus seems crucial to ensure transition to routine use. Lessons Connexin® is a secure, intuitive platform adapted to health professionals’ needs for cooperation. Mobilization of the various actors around the platform proves the interest for and the relevance of such a tool to optimize the efficiency of care. However, the organizational impact, no matter how small, is a barrier to the transition to routine use, a finding shared for many tools. Key messages While the platform was designed by primary, hospital and institutional health professionals, the study points out the need to set up a project governance and appropriate support during implementation. Any organization impact is an obstacle to the evolution of practices.

2083. A Targeted Remote Audit and Feedback Intervention Utilizing a Local Non-ID Trained Pharmacist

BackgroundTele Stewardship (tASP) is a developing model for hospitals without local ID expertise. We report results of a tASP initiative using a hospital’s local non-ID trained pharmacist to conduct ertapenem (erta) audit and feedback (A&F).MethodsEvaluation of erta use before and after implementation of a collaborative A&F process from October 2018 to March 2019. A central ID physician and ID pharmacist with EMR access reviewed charts of patients receiving erta Mon-Fri by phone with a local Critical Care trained pharmacist. Advice was given to the local pharmacist on when and how to intervene. The local pharmacist made all interventions. Acceptance rates and time involved were recorded. Usage was tracked as DOT/1,000 PD of inpatient usage. No other new local ASP interventions were undertaken during this time.Results120 erta orders were reviewed. Figure 1 reveals usage before and after implementation. Median usage dropped 55%. Median purchasing cost decreased by 73%. 51 unique patients received erta in the month prior to intervention, and 35 patients per month on average received erta afterwards. 30 providers ordered erta in the month prior to intervention, and 17 providers per month on average ordered erta afterwards. The overall intervention acceptance rate was 88%, and Figure 2 shows the breakdown of accepted interventions. Figure 3 describes the indications for use of erta orders after intervention started. Figure 4 shows changes in other antibiotics during this time. During this time, no patients were identified that later needed a carbapenem restarted or suffered harm due to this intervention. The average daily time required was 15 minutes for the central team and 22 minutes for the local pharmacist.ConclusionUsing a remote collaboration with a local pharmacist, we showed a marked decrease in the use of one targeted antimicrobial. The time commitment was minimal, and no patient harm was identified. Tele-stewardship utilizing local non-ID trained pharmacists can be a significant tool for improving antimicrobial use in community hospitals. tASP’s should monitor for compensatory increase in other broad-spectrum antibiotics. Further local education regarding proper management of UTI’s and other common conditions may provide additional improvements in use of erta. Disclosures All authors: No reported disclosures.

Obliv[i]on C: Sedatives, Schedules, and the Stresses of ‘Modern Times’: South African Pharmaceutical Politics, 1930s to 1960s

ABSTRACTThis article focuses on histories of one category of the many new synthetic drugs of the mid-twentieth century, which were variously termed hypnotics, sedatives and tranquillisers. I invoke Obliv(i)on as a metonym for pharmaceutical products now largely forgotten, for the general absence in our historiography of their significance, and for amnesia about the politics of pharmaceutical regulation in South Africa in the 1930s to 1960s. Along with antibiotics and hormones, by 1962, synthetic sedatives and tranquillisers were amongst the most frequently prescribed medical drugs in this country. As in many other countries they came to be amongst the fastest-selling, most desired, and on occasion, most dangerous new drugs of the post-war era. The article identifies a number of registers in which and moments when these sedatives became of pharmacological, professional or public interest, and sketches a chronology of their regulatory politics in South Africa in the mid-twentieth century. While South African markets remained limited, many local pharmacists, manufacturers, importers, and consumers were quick to embrace the therapeutic aspirations and chemical technologies of the time. In turn, they helped to accelerate multiple changes in a fulcrum period of the uneven emergence of ‘pharmaceutical modernity’ in South Africa.

The pharmacist and pharmacy have evolved to become more than the corner drugstore: a win for vaccinations and public health

ABSTRACT Perhaps under acknowledged in the adult immunization delivery system are pharmacists. Depending on the state, pharmacists can assess and administer vaccines to patients under vaccination protocols, standing orders or with a physician’s prescription for vaccination. As most individuals live within miles of a community pharmacy that offer accessibility, broad operating hours, and lack of visit fees or few requirements for appointments, the role of the local community pharmacy and pharmacists has evolved. Many pharmacies have embraced immunizations as a service offering seasonal influenza and often a range of Advisory Committee on Immunization Practices-recommended vaccines across the lifespan. Pharmacists are moving away from strictly product distribution to supporting public health and prevention, experiencing tremendous growth and expansion of services across the public health and primary care spectrum. Pharmacies are using vaccination services as a strategy to transform and advance community pharmacy, shaping a model that provides greater convenience and access to vaccines and other preventive services benefiting population and public health while seeking to optimize health outcomes and control health-care costs.

Rural Caregivers' Willingness for Community Pharmacists to Administer the HPV Vaccine to Their Age-Eligible Children.

Human papillomavirus (HPV) vaccination uptake varies by geographic regions with rural, often medically underserved areas, lagging behind more urban regions in terms of vaccine initiation and completion. In these regions, pharmacies may serve as an additional location for HPV vaccine administration. Little is known about rural caregivers' willingness to have their HPV vaccine age-eligible children obtain this vaccine from their local pharmacist. First and second authors conducted 26 in-depth interviews with caregivers of HPV vaccine age-eligible children living in rural regions of a southwestern state to explore their perceptions of the HPV vaccine and their willingness for pharmacist-administered HPV vaccination. They analyzed interview data using an inductive qualitative content analyses approach. The majority of caregivers were unaware that pharmacists could offer adolescent vaccines. However, most were willing to allow their children to receive the vaccine from this non-traditional source. Comments related to obtaining vaccinations from pharmacists related mostly to concerns about proper training and their certification to vaccinate against HPV. Caregivers believed that having a pharmacist administer the HPV vaccine would not affect their relationship with their primary care provider. Caregivers preferred print health education resources and were interested in also receiving health information via social media to learn more about the HPV vaccine and pharmacists' role in HPV vaccine administration. Pharmacies may serve as an additional site to increase HPV vaccine initiation and completion. Rural regions need additional health information about the HPV vaccine and pharmacists' abilities to administer this cancer prevention resource.

Impact of a Telehealth-Based Antimicrobial Stewardship Program in a Community Hospital Health System.

Data on antimicrobial stewardship programs (ASPs) facilitated via telehealth in the community hospital setting are limited. A telehealth-based ASP was implemented in 2 community hospitals (285 and 176 beds). Local pharmacists without residency or prior antimicrobial stewardship training were trained to conduct prospective audit and feedback. For approximately 60 minutes 3 times weekly at the 285-bed hospital and 2 times weekly at the 176-bed hospital, infectious diseases (ID) physicians remotely reviewed patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft tissue infections with local pharmacists. Recommendations for ASP interventions made by ID physicians were relayed to primary teams and tracked by local pharmacists. Antimicrobial utilization was collected in days of therapy (DOT) per 1000 patient-days (PD) for a 12-month baseline and 6-month intervention period, and analyzed with segmented linear regression analysis. Local ID consultations were tracked and antimicrobial cost savings were estimated. During the 6-month intervention period, 1419 recommendations were made, of which 1262 (88.9%) were accepted. Compared to the baseline period, broad-spectrum antibiotic utilization decreased by 24.4% (342.1 vs 258.7 DOT/1000 PD; P < .001) during the intervention period. ID consultations increased by 40.2% (15.4 consultations per 1000 PD vs 21.5 consultations per 1000 PD; P = .001). Estimated annualized savings on antimicrobial expenditures were $142 629.83. An intense ASP model, facilitated in the community hospital setting via telehealth, led to reduced broad-spectrum antimicrobial utilization, increased ID consultations, and reduced antimicrobial expenditures.

A Job Analysis to Define the Role of the Pharmacy Preceptor

Objective. To use a comprehensive job analysis to identify and describe the roles and responsibilities of pharmacist preceptors. Methods. After gathering input from local pharmacist preceptors, a task inventory questionnaire was created that included 92 tasks divided among nine domains related to the job of preceptors. The task inventory questionnaire was distributed to expert pharmacist preceptors in the United States, which were those who had been recognized for excellence in precepting by a national organization. Participants evaluated each task and determined whether they were responsible for the task, as well as the importance, difficulty, and frequency of each task. A composite score for each task was calculated based on a unique combination of these ratings. Descriptive statistics summarized the findings for each task and across the domains. Results. Nineteen pharmacist preceptors completed the task inventory questionnaire. The three most salient domains were professionalism (M=41.9, SD=12.9), communication (M=37.0, SD=11.7), and interpersonal skills (M=37.0, SD=10.3). The three most critical tasks related to professionalism were maintaining professional composure in stressful situations, demonstrating a commitment to service and the profession, and engaging in sound ethical and moral decision-making. Conclusion. This study represents the first attempt of using a job analysis to define pharmacist preceptor roles and responsibilities. More research is needed to fully understand the implications of these results, to understand how the relative significance of tasks may vary based on the population assessed (eg, learners and less experienced pharmacists), and to improve and validate the findings of the task inventory questionnaire developed in this study.

Assessment of the degree of awareness among post-graduate medical physicians and Pharmacists about look-alike, sound-alike drug and potential medication errors

Background: With thousands of drugs currently in the market, the potential for medication errors due to confusing drug names amongst practising physicians, pharmacists and patients is significant. The existence of confusing drug names is one of the most common causes of medication error. There are many look-alikes, sound-alike (LASA) combinations that could potentially result in medication errors. There is insufficient data about medication errors due to LASA. Hence, we conducted the present study to determine the degree of awareness regarding LASA drugs among post graduate medical physicians and Pharmacists.Methods: This study was a cross-sectional, questionnaire-based survey, conducted among 137 year post graduate medical residents of a tertiary care teaching hospital and 121 local pharmacists in an urban metropolitan Indian city.Results: There were 34% resident doctors and 17% pharmacists were aware of concept of LASA drugs. Only 46% resident doctors and 22% pharmacists had knowledge about the full form of LASA. Among resident doctors, 39% came across prescription errors due to LASA drugs. Only 69% of the pharmacists agreed that they consulted their doctors when they faced problems due to prescription errors due to similar looking and similar sounding drugs.Conclusions: Look-Alike, Sound-Alike (LASA) drugs are common source of medication errors. Our study suggests that there is lack of awareness about LASA drugs amongst resident doctors and pharmacists, which may contribute to occurrence of medication errors. Therefore, combined efforts by prescribers, pharmacists, organizations, manufacturers and patients is required to overcome medication errors due to LASA drugs.