Pharmacy Access Research Articles

Public health detailing to increase naloxone access in NYC pharmacies

BackgroundDrug overdose is a public health crisis in the United States. Opioid overdose deaths are preventable using naloxone, an opioid antagonist that reverses the effect of an opioid and prevents fatal overdose. ObjectivesThis study aimed to evaluate changes in naloxone standing order status, attitudes, and practice behavior after an 8-week public health detailing campaign on increasing naloxone access conducted among pharmacists in independent pharmacies in New York City (NYC). MethodsCampaign recommendations were to (1) enroll in the NYC pharmacy naloxone standing order program, (2) offer naloxone to at-risk patients, and (3) educate patients on how to use naloxone. Evaluation was performed using initial and follow-up surveys administered to pharmacists during detailing visits and Department of Health and Mental Hygiene data on pharmacies in the standing order program. ResultsDetailing visits were completed with 1153 pharmacists; follow-up visits were completed with 457 (40%). Self-reported attitudes and practice behavior related to the 3 campaign recommendations improved (P < 0.01). After the campaign, 519 new pharmacies enrolled in the standing order program. ConclusionsThe detailing campaign substantially increased the number of pharmacies enrolled in the standing order program and was associated with improved attitudes and practice behavior related to naloxone provision to varying degrees. Other jurisdictions could consider detailing pharmacists as a strategy to increase naloxone access.

ANALYSIS OF SPATIAL DISPARITY OF PHARMACIES IN VIRGINIA, U.S.A.

Many scholars have studied spatial equity issues of urban service delivery facilities in the past, including the pharmacy accessibility and pharmacy deserts. However, the analysis of spatial disparity of pharmacies in Virginia is lacking. To fill this research gap, we employed both statistical and geospatial methods to examine the pharmacy disparity and desert issues in Virginia. These methods include correlation, stepwise regression, average nearest neighbor analysis, network analysis, and geographically weighted regression (GWR). We examined five vulnerable populations and their accessibility to pharmacies. These subpopulations include racial minorities (defined as non-white population in this study), persons with income below poverty level, older adults (age 65+), persons with disability, and households without vehicles. We found that spatial inequity of pharmacies exists in Virginia. At the statewide macro level, the spatial distribution of older adults is, largely, correlated with that of pharmacies. However, as revealed by GWR at local levels, the spatial pattern of pharmacy distribution is much more complicated, exhibiting both spatial inequity and social inequity (especially racial inequity, which is ubiquitous in Virginia). Pharmacies may be adequate for certain groups of people, but simultaneously inadequate for others.

Pharmacy Deserts and Pharmacies' Roles Post-Extreme Weather and Climate Events in the United States: A Scoping Review.

The effects of climate change are seen with a rise of extreme weather and climate events (EWCEs) which lead to the closures of many healthcare facilities, such as community pharmacies. Pharmacists in community pharmacies are seen as the most accessible healthcare professional to the public and are responsible for the continued delivery of care to patients. However, amid closures due to EWCEs and the emergence of pharmacy deserts, there is decreased access to pharmacies and a disruption of care. It is important to address the preparedness and accessibility of pharmacies post-EWCEs to guide future research and policy. Additionally, to tackle health disparities that arise due to pharmacy deserts, the populations most affected by a decreased access to pharmacies should be identified. We conducted a scoping review to assess the preparedness and accessibility of pharmacies post-EWCEs and to identify populations most affected by pharmacy deserts. We searched PubMed, Embase, and Web of Science from January 1, 2012 to September 30, 2022 and included all English-language, peer-reviewed primary literature that examined the preparedness and accessibility of community pharmacies in the United States post-EWCEs and addressed disparities within pharmacy deserts. Studies meeting these criteria were screened of their titles and abstracts by the first author and discrepancies were resolved with co-authors. We used Covidence for data extraction. A total of 472 studies were identified (196 duplicates removed) and after screening, 53 studies were assessed for eligibility. The results of included publications (N = 26) showed that pharmacists and pharmacies are not equipped with the necessary emergency protocols which could lead to decreased access of pharmacies in the wake of EWCEs. Pharmacy deserts disproportionately affect residents living in rural, lower income, and Black/African American and Hispanic/Latino neighborhoods. The lack of preparedness of pharmacies post-EWCEs could worsen medication access. This scoping review addresses challenges impacting pharmacies and patients post-EWCEs and within pharmacy deserts. In times of increased need, these challenges implicate the well-being of communities affected by EWCEs by breaking the continuum of care and access to medications. Here we offer suggestions for future research and directions for policy change.

Demographic and socioeconomic correlates to buprenorphine access in pharmacies

BackgroundResearch has focused on buprenorphine prescribing with limited attention to the role of pharmacy access to buprenorphine for opioid use disorder. ObjectiveThis study examines demographic and socioeconomic correlates to buprenorphine access in Georgia pharmacies. MethodsA 5-question (12 potential subqueries) telephone administered survey was used to investigate access and stocking patterns of specific dosages and formulations of buprenorphine in Georgia pharmacies (n = 119). Descriptive statistics characterized physician and pharmacy demographics and buprenorphine stocking practices. Correlations between various factors including buprenorphine stocking practices, geographic, and sociodemographic characteristics were identified using nonlinear regression models. ResultsThe majority of pharmacies stocked the most commonly prescribed 8/2 mg dosage strength of buprenorphine/naloxone films and tablets (69.0% and 63.0%, respectively). Other strengths were less likely to be readily available. Pharmacies in Suburban Census tracts were 77.0% more likely to stock any type of buprenorphine monotherapy [odds ratio (OR) = 1.77, t = 2.37, P < 0.05] and 58.1% more likely to stock the 8 mg buprenorphine monotherapy formulation [OR = 1.58, t = 2.15, P < 0.05] than Urban tracts. Pharmacies in areas with above-average non-White populations were 29.6% more likely to stock a monotherapy product [OR = 1.30, t = 2.16, P < 0.05], and those in areas with above-average poverty rates were more likely to stock the 8 mg/2 mg buprenorphine/naloxone tablets [OR = 1.04, t = 2.02, P < 0.05]. There were no additional differences across the sample in formulation or dosage strengths. Pharmacists who endorsed challenges dispensing buprenorphine (23.3%) cited issues around insurance coverage, payment difficulty, prior authorization issues, and low stock of specific formulations. ConclusionsResults suggest that low availability of certain dosages or formulations of buprenorphine in local pharmacies could obstruct access for patients. Future research should address barriers to supplying buprenorphine and collaborative measures between pharmacists and prescribers to improve access.

Associations between pharmacy choice and influenza vaccination: Mail order vs community pharmacy users.

BACKGROUND: Despite the effectiveness of vaccines, US adult vaccination rates remain low. This is especially true for the influenza vaccine, which is recommended annually and widely available. The accessibility of community pharmacies as convenient places to receive influenza vaccines has been shown to increase uptake. However, use of mail order pharmacies may reduce in-person pharmacist encounters and reduce the likelihood that users receive annual influenza vaccines. OBJECTIVE: To determine the association between the type of pharmacy a patient uses and their likelihood of receiving an influenza vaccine. METHODS: This cross-sectional cohort study used the 2018 Medical Expenditure Panel Survey to observe noninstitutionalized US adult pharmacy users. Pharmacy type was dichotomized into community use only vs any mail order pharmacy use. Multivariable weighted logistic regression was used to identify associations between the type of pharmacy used and influenza vaccination, adjusting for sociodemographic, health status, and health care access and utilization confounders. All analyses were stratified by age (< 65 and ≥ 65 years). RESULTS: The aged younger than 65 years and aged 65 years and older samples had 8,074 and 4,037 respondents who represented 95,930,349 and 40,163,276 weighted observations, respectively. Compared with community pharmacy users, mail order users were more likely to be aged 65 and older, be White, have high income, and have a usual source of care (P < 0.0001). Adjusted odds ratios (AORs) for influenza vaccination were significantly lower among community pharmacy users than mail order users among individuals aged younger than 65 years (AOR=0.71; 95% CI = 0.580.87) but was not significant among those aged 65 years and older (AOR = 0.87; 95% CI = 0.69-1.09). CONCLUSIONS: Community pharmacy users aged younger than 65 years are less likely to receive the influenza vaccine than their mail order pharmacy user counterparts. These counterintuitive results could be caused by residual confounding due to differences in factors that influence pharmacy use type and vaccination likelihood. Further exploration is needed to account for differences between these populations that independently drive vaccination choice. DISCLOSURES: Dr Burbage was a fellow in the Real World Evidence, Population Health and Quality Research Postdoctoral Fellowship Program in collaboration with University of North Carolina Eshelman School of Pharmacy and Pharmacy Quality Alliance, and supported by Janssen Scientific Affairs at the time of this study. She is now employed by Janssen Scientific Affairs. Dr Parikh is an employee of Pharmacy Quality Alliance. Dr Campbell was employed by Pharmacy Quality Alliance at the time of the study. He is now employed by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA. Dr Ramachandran has received an unrelated research contract with Pharmacy Quality Alliance. Dr Gatwood has received vaccine-related research grants from Merck & Co. and GlaxoSmithKline unrelated to this project and consulting fees for a vaccine-related expert panel with Merck & Co. unrelated to this manuscript and is an advisory board member with Janssen Scientific Affairs. Dr. Urick was employed by the UNC Eshelman School of Pharmacy at the time of this writing and is currently employed by Prime Therapeutics. He has received community pharmacy-related consulting fees from Cardinal Health and Pharmacy Quality Solutions unrelated to this work. Dr Ozawa has a research grant from Merck & Co. unrelated to this project. This project did not receive funding from any agency in the public, commercial, or not-for-profit sectors.

A wastewater-based evaluation of the effectiveness of codeine control measures in Australia.

From 1 February 2018, codeine was rescheduled from an over-the-counter (OTC) to a prescription-only medicine in Australia. We used wastewater-based epidemiology to measure changes in population codeine consumption before and after rescheduling. We analysed 3703 wastewater samples from 48 wastewater treatment plants, taken between August 2016 and August 2019. Our samples represented 10.6 million people, 45% of the Australian population in state capitals and regional areas in each state or territory. Codeine concentrations were determined by liquid chromatography-tandem mass spectrometry and converted to per-capita consumption estimates using the site daily wastewater volume, catchment populations and codeine excretion kinetics. Average per-capita consumption of codeine decreased by 37% nationally immediately after the rescheduling in February 2018 [95% confidence interval (CI) = 35.3-39.4%] and substantially in all states between 24 and 51% (95% CI = 22.4-27.0% and 41.8-59.4%). The decrease was sustained at the lower level to August 2019. Locations with least pharmacy access decreased by 51% (95% CI = 41.7-61.7%), a greater decrease than 37% observed for those with greater pharmacy access (95% CI = 35.1-39.4%). Regional areas decreased by a smaller margin to cities (32 versus 38%, 95% CI = 30.2-34.1% versus 34.9-40.4%, respectively) from a base per-capita usage approximately 40% higher than cities. Wastewater analysis shows that codeine consumption in Australia decreased by approximately 37% following its rescheduling as a prescription-only medicine in 2018. Wastewater-based epidemiology can be used to evaluate changes in population pharmaceutical consumption in responses to changes in drug scheduling.

P009Nurse practitioner prescribing of mifepristone in canada

<h3>Objectives</h3> In 2017, mifepristone became available for medication abortion in Canada and nurse practitioners became eligible prescribers. Barriers to abortion — such as rural and remote location, patient knowledge and stigma — could potentially be addressed through nurse practitioner provision. This study aimed to examine barriers and enablers to implementation of mifepristone prescribing in nurse practitioners' practice. <h3>Methods</h3> We conducted a sequential exploratory mixed methods study from August 2020 to May 2021 including a cross-sectional survey of nurse practitioners in Canada followed by semi-structured interviews with these providers and with stakeholders in health administration, government, advocacy, and regulation. We used feminist and interpretive theoretical lenses for analysis and organized data thematically. Descriptive analyses were used to interpret quantitative survey data. <h3>Results</h3> 181 nurse practitioners completed the survey, of whom 36% (n=65) self-identified as medication abortion providers and 64% (n=116) as non-providers. Mentorship was a key enabler of nurse practitioners' provision of medication abortion. Barriers included limited pharmacy access, lack of surgical back-up, and employer restrictions. Twenty-two nurse practitioners and 20 stakeholders participated in interviews. Enablers included clinical leadership roles, engagement in community education and communication, and interprofessional outreach. Barriers included low priority of abortion in nurse practitioners' practices, lack of support from colleagues or employers, and infrastructural barriers to ultrasound and emergency services. <h3>Conclusions</h3> Regulatory change is insufficient to change practice. Findings support the critical role of mentorship to improve uptake of nurse practitioners' prescription of mifepristone and address employer restrictions and resource barriers, and point to the need to augment abortion education to foster understanding among colleagues. Findings can be integrated into policy, support practice changes, and direct future research to advance equitable access to abortion.

Readiness and willingness of Malaysian community pharmacists in providing vaccination services

BackgroundVaccination is an effective public health intervention in reducing morbidity and mortality of infectious diseases. Compared to other countries where community pharmacists (CPs) administer vaccines, CPs in Malaysia are not authorised. This study aimed to assess CPs' readiness and willingness to provide vaccination in Malaysia, identify potential barriers to and factors supporting the provision of this service.MethodsA cross-sectional study was conducted among Malaysian CPs from April to June 2021. A validated online questionnaire was distributed through social media, instant messaging, email, and pharmacy societies.ResultsOf 492 CPs recruited throughout Malaysia, 439 (89.2%) expressed willingness to provide vaccination services to the public, 403 (81.9%) agreed with the accessibility of community pharmacies to the public, and 73.4% agreed that their role in vaccination could help to improve the overall vaccination coverage rate. The lack of pharmacist training in vaccination and concerns on maintaining patient safety were identified as barriers to CPs' implementation of vaccination services, with 52.8% and 47.8% of them agreeing, respectively. Training sessions and operational guidelines on providing vaccination services are required to overcome the barriers.ConclusionCPs in Malaysia were ready and willing to provide vaccination services to the public. However, the implementation demands training workshops and re-evaluation of CPs in public vaccination programmes by Malaysian healthcare policymakers.

Changes in pharmaceutical retail market and regional inequality of community pharmacists accessibility in mainland China: a retrospective cross-sectional study

ObjectivesTo describe the development of pharmaceutical retail market and community pharmacists in mainland China and identify challenges from both government and business perspectives.DesignA retrospective cross-sectional study.SettingCommunity pharmacies providing primary care...

Pharmacy deserts and COVID-19 risk at the census tract level in the State of Washington

Community pharmacies are a crucial component of healthcare infrastructure, including for COVID-19 pandemic prevention services like testing and vaccination. Communities that are “pharmacy deserts,” experience healthcare inequities. However, little research has characterized where these communities are, making it difficult for local leaders to prioritize resources for them. This study identifies pharmacy deserts at the census tract level in Washington state for the first time and explores their association with COVID-19 risk. Out of 1,441 tracts, 127 were pharmacy deserts, comprising approximately 454,000 adults, or 8% of the state’s adult population. Among those tracts identified as pharmacy deserts, 67% were considered high risk for COVID-19. Solutions are needed to expand equitable access to pharmacy services in these communities. The methods and data presented herein provide healthcare leaders with information to address this pharmacy access gap in Washington and could be similarly applied to other settings. Three categories of policy changes could address health inequities found in our study: 1) improve financial incentives for pharmacists to practice in underserved areas, 2) prevent pharmacy closures, and 3) deploy innovative care delivery methods such as telehealth services.

A national analysis of the pharmacy workforce in Indonesia

BackgroundPharmacists play a fundamental role in healthcare systems and achieving Universal Health Coverage (UHC) through quality primary healthcare service provision. While the World Health Organization (WHO) forecasts a global shortage of health workforce by 2030, mainly affecting low- and middle-income nations (LMICs), limited published literature is found regarding pharmacy workforce capacity in LMICs, including Indonesia. This paper aims to analyse pharmacists’ capacity in Indonesia to identify emerging workforce planning gaps for future workforce planning and policies in Indonesia.MethodSeveral data sources were accessed, including a database from the National Pharmacy Committee and the professional leadership body in Indonesia. Descriptive (frequencies, percentages, and mean), correlational and time-series analysis using curve estimation were conducted. Secondary data on the number of programmes, pharmacy students, pharmacy workforce (pharmacists and pharmacy technicians) per province were obtained from the Ministry websites and reports.ResultThere were a total of 77 191 registered pharmacists in Indonesia in 2019. The pharmacists’ pyramid showed a youth bulge as a general indication of market expansion in the education sector correlating to the pharmacy programme’s number and size. There was a variation in pharmacy workforce density and access to pharmacy programmes across islands, which also were strongly correlated. Forecasting estimates that by 2030, women will represent around 86% of pharmacists in Indonesia. More female pharmacists were found working in the hospital and primary healthcare (providing direct services to patients) than male pharmacists. Younger pharmacists worked in the industrial sector, while older pharmacists worked in governmental and educational institutions.ConclusionThis study signposted workforce planning gaps for policy development in Indonesia, including a need to develop structured training to support early career pharmacists in their practice. There is also a need for better access to professional development programmes designed to support female pharmacists return to the regulated workforce following career breaks. National policy to promote equitable distribution and retention of pharmacists is recommended.

Health-Related Disparities in the Metropolitan Region Ruhr: Large-Scale Spatial Model of Local Asthma Prevalence, Accessibility of Health Facilities, and Socioeconomic and Environmental Factors

This paper investigates the area of the Metropole Ruhr in terms of spatial distributions of environmental factors that can prevent or cause a significantly lower or higher rate of respiratory diseases such as asthma. Environmental factors can have negative impact, like air pollution, and positive, like the access to urban green areas. In the second part of the analysis, the accessibility of pharmacies, hospitals, and medical facilities that offer a special treatment for people with respiratory diseases will be spatially analysed and associated to those detected urban areas of higher and lower prevalence. The results of both approaches are spatially blended with socioeconomic and socio-demographic values of the respective residents. With this it is possible to point out whether accessibility of health facilities is a suitable and equitable for all people diagnosed with asthma regardless of their educational or migration background, their employment rate, salary or age. Consequently, all values will be disaggregated from large spatial units, such as city districts municipalities or neighbourhoods, to small city blocks, to assess large-scale spatial variability. This provides the opportunity of a point-by-point investigation and statistical analysis with a high level of detail that significantly exceeds previous study results. In the sociological context of environmental justice this highly interdisciplinary study contributes to the assessment of fair health conditions for people in densely populated conurbations.

The impact of caller characteristics on levonorgestrel emergency contraception access in West Virginia community pharmacies

ObjectiveAccess to levonorgestrel (LNG) emergency contraception (EC) has increased since the FDA removed age restrictions on over-the-counter (OTC) LNG EC in 2013, but availability is highly variable and numerous barriers to access remain. The purpose of this study was to assess availability and accessibility of LNG EC at community pharmacies in West Virginia (WV). MethodsA mystery caller cross-sectional study was conducted to assess availability and accessibility of LNG EC. Inquiries were made by identified ‘research’ staff and by staff presenting as a 16 y/o. ResultsNearly half of community pharmacies reported having LNG EC in stock. Pharmacy staff were significantly more likely to tell research callers LNG EC was in stock (53%) and more likely to report willingness to order it (50%) than ‘teen’ callers (45% and 34%, respectively). There was no significant difference between caller types on the five barriers assessed. ConclusionLack of availability may contribute to teen and unintended pregnancies.

Application and utility of geographic information systems in pharmacy specific health research: A scoping review.

Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data. The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research. During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies. After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n=36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n=6). Population density (58.3%; n=28), income indicators (43.8%; n=21) and minority community composition rates (41.7%; n=20) were the most used population variables. GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.

Use of Cysteamine and Glutaraldehyde Chemicals for Robust Functionalization of Substrates with Protein Biomarkers-An Overview on the Construction of Biosensors with Different Transductions.

Currently, several biosensors are reported to confirm the absence/presence of an abnormal level of specific human biomarkers in research laboratories. Unfortunately, public marketing and/or pharmacy accessibility are not yet possible for many bodily fluid biomarkers. The questions are numerous, starting from the preparation of the substrates, the wet/dry form of recognizing the (bio)ligands, the exposure time, and the choice of the running buffers. In this context, for the first time, the present overview summarizes the pre-functionalization of standard and nanostructured solid/flexible supports with cysteamine (Cys) and glutaraldehyde (GA) chemicals for robust protein immobilization and detection of biomarkers in body fluids (serum, saliva, and urine) using three transductions: piezoelectrical, electrochemical, and optical, respectively. Thus, the reader can easily access and compare step-by-step conjugate protocols published over the past 10 years. In conclusion, Cys/GA chemistry seems widely used for electrochemical sensing applications with different types of recorded signals, either current, potential, or impedance. On the other hand, piezoelectric detection via quartz crystal microbalance (QCM) and optical detection by surface plasmon resonance (LSPR)/surface-enhanced Raman spectroscopy (SERS) are ultrasensitive platforms and very good candidates for the miniaturization of medical devices in the near future.

Pharmacy deserts: More than where pharmacies are

BackgroundIn the United States, geographic access is a major driver of health care disparities. Studies have shown that pharmacy deserts are prevalent in the United States, even in major metropolitan areas. However, one limitation often cited by these studies is the use of distance rather than travel time to define pharmacy deserts. ObjectiveThe aim of this study was to assess pharmacy deserts using travel time and to provide a more holistic approach by incorporating analysis of private vehicles and public transportation. MethodsPharmacy details were collected from the National Provider Identifier database and neighborhood characteristics from collected census data for the four largest U.S. cities. Pharmacy access was evaluated using open-source routing engines. We determined neighborhoods in pharmacy deserts using both distance and travel time analyses. Sensitivity analysis was performed to determine changes to pharmacy deserts based on small changes in travel time. ResultsOf 4654 neighborhoods identified in the four cities of interest, 670 (14.4%) neighborhoods were in pharmacy deserts based on distance. Despite accounting for 28.9% of all neighborhoods, predominantly white neighborhoods only accounted for 4.3% of pharmacy deserts. When evaluating pharmacy deserts by car and public transportation, predominantly white neighborhoods accounted for 2.3% and 1.7% of total pharmacy deserts, respectively. Finally, by reducing travel time from 15 minutes to 10 minutes, pharmacy deserts by car and public transportation increased by 105% and 199%, respectively. All but 3 of the new pharmacy deserts found in the sensitivity analysis were found in nonpredominantly white neighborhoods. ConclusionUsing travel time and incorporating modes of transportation, we found that disparities in pharmacy access are more than just where pharmacies are located geographically. There are additional layers of disparities, such as access to public transportation, that need to be addressed to reduce the number of pharmacy deserts.

Buprenorphine and naloxone access in pharmacies within high overdose areas of Los Angeles during the COVID-19 pandemic

BackgroundBuprenorphine and naloxone are first-line medications for people who use opioids (PWUO). Buprenorphine can reduce opioid use and cravings, help withdrawal symptoms, and reduce risk of opioid overdose. Naloxone is a life-saving medication that can be administered to reverse an opioid overdose. Despite the utility of these medications, PWUO face barriers to access these medications. Downtown Los Angeles has high rates, and number, of opioid overdoses which could potentially be reduced by increasing distribution of naloxone and buprenorphine. This study aimed to determine the accessibility of these medications in a major urban city by surveying community pharmacies regarding availability of buprenorphine and naloxone, and ability to dispense naloxone without a prescription.MethodsPharmacies were identified in the Los Angeles downtown area by internet search and consultation with clinicians. Phone calls were made to pharmacies at two separate time points–September 2020 and March 2021 to ask about availability of buprenorphine and naloxone. Results were collected and analyzed to determine percentage of pharmacies that had buprenorphine and/or naloxone in stock, and were able to dispense naloxone without a prescription.ResultsOut of the 14 pharmacies identified in the downtown LA zip codes, 13 (92.9%) were able to be reached at either time point. The zip code with one of the highest rates of opioid-related overdose deaths did not have any pharmacies in the area. Most of the pharmacies were chain stores (69.2%). Eight of the 13 (61.5%) pharmacies were stocked and prepared to dispense buprenorphine upon receiving a prescription, and an equivalent number was prepared to dispense naloxone upon patient request, even without a naloxone prescription. All of the independent pharmacies did not have either buprenorphine or naloxone available.ConclusionsThere is a large gap in care for pharmacies in high overdose urban zip codes to provide access to medications for PWUO. Unavailability of medication at the pharmacy-level may impede PWUO ability to start or maintain pharmacotherapy treatment. Pharmacies should be incentivized to stock buprenorphine and naloxone and encourage training of pharmacists in harm reduction practices for people who use opioids.

Pre-Exposure Prophylaxis Barriers, Facilitators and Unmet Need Among Rural People Who Inject Drugs: A Qualitative Examination of Syringe Service Program Client Perspectives.

BackgroundPeople who inject drugs (PWID) are at high risk for HIV infection, yet in rural areas PWID are understudied with respect to prevention strategies. Kentucky is notable for heavy rural HIV burden and increasing rates of new HIV diagnoses attributable to injection drug use. Despite high need and the strong evidence for Pre-Exposure Prophylaxis (PrEP) as a gold-standard biomedical HIV prevention tool, scale up has been limited among PWID in Kentucky and elsewhere. This paper explores individual, environmental, and structural barriers and facilitators of PrEP care from the perspective of PWID in rural Kentucky.MethodsData are drawn from an ongoing NIH-funded study designed to adapt and integrate a PrEP initiation intervention for high-risk PWID at point of care in two rural syringe service programs (SSPs) in southeastern Kentucky. As part of this initiative, a qualitative study guided by PRISM (Practical, Robust, Implementation, and Sustainability Model) was undertaken to gather SSP client perspectives on intervention needs related to PrEP, competing needs related to substance use disorder, as well as tangible supports for and barriers to PrEP uptake. Recruitment and interviews were conducted during September-November 2021 with 26 SSP clients, 13 from each of the two SSP sites. A semi-structured guide explored injection behaviors, SSP use, knowledge of PrEP, perceived barriers to PrEP, as well as aspects of the risk environment (e.g., housing instability, community stigma) that may impact PrEP uptake. Interviews were digitally recorded, transcribed verbatim and verified by project staff. A detailed coding scheme was developed and applied by independent coders using NVivo. Coded transcripts were synthesized to identify salient themes in the data using the principles of thematic analysis All study procedures were approved by the University IRB.ResultsParticipants were 96% white, 42% female, with a median age of 41 years (range 21–62); all reported injection use within the past month. Overall, we found low PrEP awareness among this sample, yet interest in PrEP was high, with several indicating PrEP is urgently needed. Clients reported overwhelmingly positive experiences at the SSPs, considering them trusted and safe locations to receive health services, and were enthusiastic about the integration of co-located PrEP services. Lack of basic HIV and PrEP knowledge and health literacy were in evidence, which contributed to common misperceptions about personal risk for HIV. Situational risks related to substance use disorder, particularly in the context of withdrawal symptoms and craving, often lead to heightened HIV injection and sexual risk behaviors. Stigma related to substance use and HIV arose as a concern for PrEP uptake, with several participants reflecting that privacy issues would impact their preferences for education, prescribing and monitoring of PrEP. Noted tangible barriers included inconsistent access to phone service and transportation. Primary supports included high levels of insurance coverage, consistent pharmacy access, and histories with successful medication management for other health conditions.ConclusionsDrawing on the critical perspectives of people with substance use disorder, our findings provide important and actionable information on individual and environmental barriers and facilitators of PrEP uptake among rural PWID at high risk for HIV infection. These data will drive the adaptation and implementation of a client-centered approach to integrated PrEP care within rurally located SSP settings to address unmet needs for PrEP care.

Pharmacy access to contraception expands to more states

Since 2016, California pharmacists have had the authority to prescribe hormonal contraception. In 2017, the state of Colorado followed suit. Today, community pharmacists in 20 U.S. jurisdictions can prescribe birth control. In several other states, similar legislation is in progress, which would bring the tally to half of U.S. states where pharmacists can provide birth control directly to patients.

Appalachian Parent and Provider Views on the Use of Pharmacies for Human Papillomavirus Vaccination in Adolescents

The uptake of the human papilloma virus (HPV) vaccine in West Virginia is lagging despite it being highly protective against HPV related diseases. The purpose of this study was to determine parent and provider perception on usingpharmacies for HPV vaccination in adolescents. This was done by surveying both parents and providers in a rural academic institution. Providers were surveyed before and six months after an educational intervention that instructed providers on local legislation and the logistics of prescribing the HPV vaccine through pharmacies. The provider survey assessed awareness of pharmacy vaccine access and prescribing practices. Parents of adolescents were surveyed to assess what patients might benefit most from pharmacy access for vaccination. A total of 71 providers completed the initial survey, and 45 completed the six-month assessment. Only 22.5% were aware of the pharmacy legislation at the initial survey, and 64.4% at six months (p=