Pharmacy Public Health Research Articles

Development of a Questionnaire to Measure Public Perceptions of the Role of Community Pharmacy in Public Health (PubPharmQ).

Community pharmacies are well placed to provide public-health interventions within primary care settings. This study aimed to establish the general public's perceptions of community pharmacy-based public-health services in the UK by designing a structured questionnaire to assess the barriers and facilitators to optimizing this role. A standardized questionnaire was developed informed by the literature, additional semi-structured interviews, and synthesis of key findings with the authors' previous research based on data generated from eight focus groups. The original 42-item questionnaire was distributed online from May to June 2021 via social media platforms to capture the views of non-regular pharmacy users. Following exploratory factor analysis, and Cronbach's alpha analysis, total Likert scale response scores were calculated. Of the 306 responders, 76.8% were female with a mean age of 34.5 years (SD = 15.09). The most prevalent pharmacy use reported was 1-2 times a year (28.1%). Exploratory factor analysis revealed four scales: Expertise, Role in Public Health, Privacy, and Relationship (18 items) with acceptable internal consistency and good face and content validity. Awareness of well-established pharmacy services was high; however, responders demonstrated poor awareness of public-health-related services and low recognition of pharmacy expertise for this role. A lack of an established relationship with community pharmacies and privacy concerns were also perceived barriers. Based on these findings, considerable effort is needed to increase public awareness and address these concerns if strategic plans to utilize community pharmacy in the delivery of public-health policy are to be successful. The PubPharmQ provides a novel, structured questionnaire to measure the public's perceptions of community pharmacy's role in public health.

“So let me give you money, you give me what I want”: decision-making priorities around contraceptive method and source choice among young women in Kenya

BackgroundMany factors influence young women’s choice of contraceptive methods and where to source them, yet less is known about whether one of these choices (method or source) is prioritized and the relationship between these choices. This study qualitatively explored decision-making around contraceptive method and source choice among young women in Kenya.MethodsIn August–September 2019, 30 in-depth interviews were conducted with women ages 18–24 who had used two or more contraceptive methods and resided in three counties: Nairobi, Mombasa or Migori. Participants were recruited from public and private health facilities and pharmacies. Interview guides captured information about decision-making processes for each contraceptive method the respondent had ever used. Responses were audio-recorded, transcribed, translated into English, coded, and analyzed thematically.ResultsThe majority of respondents knew which method they wanted to use prior to seeking it from a source. This was true for all types of methods that women ever used. Of the small number of respondents who selected their source first, most were in the post-partum period or experiencing side effects and sought counseling at a source before choosing a method.ConclusionsThis study highlights the importance of providing young women with high quality counseling that provides full information about contraceptive options and addresses that young women’s needs vary along the reproductive health continuum of care. This will ensure that young women have information to inform future contraceptive decision-making prior to seeking care.

Pharmacist honoured for COVID-19 vaccination work

A pharmacist has received a British Citizen Award for services to healthcare in recognition of his work in public health pharmacy, in particular during the COVID-19 pandemic. Viral Doshi, who splits his time between community pharmacy and working in public health for Hillingdon Council, was presented with his award on 31 January 2023 in London […]

Abstract A130: Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings

Abstract Introduction: Hospitals and private healthcare facilities are the primary setting for administering the human papillomavirus (HPV) vaccine. A goal of the President's Cancer Panel on HPV vaccination is to maximize access to vaccination services through expansion of alternative settings for receiving the HPV vaccine, such as in public health settings, schools and pharmacies. It is unclear whether utilization of these alternative settings for HPV vaccination is increasing, and which factors are associated with accessing these alternative avenues. Methods: In a cross-sectional analysis, we utilized the National Immunization Survey-Teen data from 2014 to 2020 (n = 59,140) to describe trends and factors associated with HPV vaccine uptake in private, public, and alternative settings. We calculated average annual percent change (AAPC) between 2014 and 2020, estimating the proportion of HPV vaccine across settings. Using multinomial logistic regression, we estimated the odds of receipt of HPV vaccine in public health settings and other alternative settings compared to private healthcare settings, adjusting for sociodemographic covariates. Results: We found a non-significant decrease in proportion of individuals receiving vaccines at public health settings (17.7% in 2014 vs. 13.5% in 2020; AAPC = -3.2), and a non-significant increase in private healthcare settings (79.2% in 2014 vs. 83.9% in 2020; AAPC = 0.6). We also found a non-significant decrease in the proportion of individuals receiving vaccines in alternative settings such as schools and pharmacies (3.1% in 2014 and 2.6% in 2020; AAPC = -0.9). Adjusted multinomial logistic regression analyses found several sociodemographic/socioeconomic factors associated with receiving HPV vaccine at public health facilities versus private/hospital settings. The log odds of receiving vaccinations at a public facility vs. a private facility increases almost four times moving from above poverty (earning≥ $75,000) to below poverty (aOR = 3.74; 95% CI 3.06, 4.57). The log odds of receiving HPV vaccines at a public facility compared to a private facility decreased by 26% for White teenagers vs. Black teenagers (aOR = 0.74; 95% CI 0.64, 0.86), and by 24% (aOR = 0.76; 95% CI 0.58, 0.98) for log odds of receiving vaccine at alternative settings for White teenagers vs. Black teenagers. There was also an association between educational level and log odds of receiving vaccines at a public facility (high school or less vs. college graduate aOR = 0.38; 95% CI 0.31, 0.46), and people without physician recommendations were significantly more likely to receive vaccines at public versus private settings (aOR = 1.71, 95% CI 1.41, 2.08). Conclusions: Sociodemographic and socioeconomic factors such as race, poverty, education, and access to physician HPV recommendations are all associated with receiving the HPV vaccine at public health facilities versus private settings. This information is important in targeting increased vaccine uptake among individuals with less access to care due to these factors. Citation Format: Melissa Christina White, Oyomoare L. Osazuwa-Peters, Dina K. Abouelella, Justin M. Barnes, Eric Adjei Boakye, Trinitia Y. Cannon, Tammara L. Watts, Nosayaba Osazuwa-Peters. Trends and factors associated with receipt of human papillomavirus (HPV) vaccine in private, public and alternative settings [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A130.

Location, location, location: does providing public health services from community pharmacies contribute to tackling health inequalities?

Community pharmacies have long been advocated as an accessible source of advice on health improvement in communities. This cross-sectional study explored the association between provision of pharmacy public health services and factors that might influence the extent to which pharmacies contribute to tackling inequalities. Publically available data were used to explore the association between pharmacy public health service provision and pharmacy characteristics (socioeconomic deprivation, urbanity, opening hours and workload). Regression models were fitted to the number of service consultations. The association between the number of services provided and the mean number of consultations across each service was investigated using regression models. Pharmacies showed a propensity for being situated in areas of higher socioeconomic deprivation. There was no association between socioeconomic deprivation and number of service consultations a pharmacy provided. Clustering of pharmacies in less affluent areas led to over half of all public health service consultations being in the two most deprived quintiles. Providing healthcare services from pharmacies in more deprived areas does not mean the public use them or that pharmacies will prioritize their delivery. The higher prevalence of pharmacies in disadvantaged communities is an important factor in ensuring pharmacy services support reducing inequalities.

Public perceptions of the role of community pharmacy in public health

Abstract Introduction Community pharmacies are well-placed to provide public health interventions, yet they are underutilised for services of this nature (1), which are needed to achieve public health policy goals. Previous qualitative studies have explored public perceptions of the role of community pharmacy in delivering public health services (2). However, to date, these views have not been captured quantitatively, which means it is not clear if the general public shares these views. Aim The aim was to design a questionnaire to obtain public perceptions of the role of community pharmacy in public health interventions and to establish any barriers and facilitators that exist regarding community pharmacy utilisation. Methods A questionnaire was developed based on published literature and semi-structured interviews. Following initial piloting of a paper-based then online format (by ten individuals) a 42-item questionnaire was completed digitally via Qualtrics by a self-selecting sample of the general public recruited through social media (i.e., Twitter, Instagram and Facebook) in May and June 2021. Principal component analysis with Varimax rotation was used to identify the underlying factors (scales) of the questionnaire. Cronbach’s alpha analysis was undertaken to ensure good internal consistency. Information on frequency of community pharmacy use and for what reason was collected. Content and thematic analysis were conducted on the free text qualitative comments. Content analysis was conducted first to observe which aspects of the questionnaire were mentioned the most. Further to this, thematic analysis was conducted as there were responses which did not fit into the content analysis. Results There were 306 valid questionnaire responses, where 235 (76.8%) were females. The mean age was 34.5 years (SD=15.09). Factor analysis identified four scales with a total of 18-items, all demonstrating good internal consistency. Scales were labelled as (n=number of items; ἀ =Cronbach’s alpha value): Expertise (n=3, ἀ =0.815); Role (n=4, ἀ =0.745); Privacy (n=3, ἀ =0.770) and Relationship (n=8, ἀ =0.862). Scale scores indicated that a lack of awareness of their role and expertise was a barrier and adequate privacy was an important facilitator in delivering public health services. In support of the quantitative findings, content analysis identified lack of privacy as a dominant theme, and further thematic analysis uncovered lack of knowledge of community pharmacy’s role in public health as an important barrier to uptake of services. Thematic analysis uncovered the themes ‘lack of knowledge of services’ and ‘accessibility’. Conclusion The outcome of this study was the development of a four scale, 18-item questionnaire to capture public perceptions of the community pharmacy’s role in public health. This can, therefore, be used in future studies aiming to explore public perceptions of community pharmacy. Strengths include being the first questionnaire to explore perceptions of community pharmacy. Weaknesses include the possibility of bias using social media in recruitment. This could be tackled using paper versions of the questionnaire in different settings. Further research is needed to continue testing the psychometric properties of the questionnaire with consideration given to the addition of a fifth scale to measure perceptions of Accessibility. References (1) Kember, J., Hodson, K., & James, D. H. (2018). The public’s perception of the role of community pharmacists in Wales. International Journal of Pharmacy Practice (26), 120-128. (2) Gidman, W., & Cowley, J. (2013). A qualitative exploration of opinions on the community pharmacists’ role amongst the general public in Scotland, International Journal of Pharmacy Practice, (21), 288-296.

Investigating the relationship between community pharmacy and GP Emergency Hormonal Contraception (EHC) provision: a linear regression analysis

Abstract Introduction Emergency Hormonal Contraception (EHC) is contracted by Local Authorities to be provided free-of-charge from 46% of community pharmacies in England. (1) There is no difference in EHC consultation outcomes between community pharmacy and GP surgeries. A study in a rural area demonstrated that introduction of a community pharmacy EHC service can reduce GP EHC prescribing rates by approximately 41%, without influencing Family Planning Clinics or Accident and Emergency departments. (2) However, it is not known whether this relationship is universally present, and this relationship has not previously been quantified. Aim To describe the relationship between rates of GP EHC prescribing and commissioned community pharmacy EHC provision. Methods Freedom of Information (FOI) requests were submitted to all Local Authorities in England for numbers of EHC provisions through commissioned services between March 2019 and April 2020. The data were matched to Clinical Commissioning Group (CCG) GP prescribing data, obtained from openprescribing.net. Using population estimates from the Office of National Statistics, rates of supply per 10,000 female population (aged 12-55) were determined. The data indicated small numbers of outliers, which can distort linear regression; boxplots allowed the removal of data points outside 1.5 times the Inter Quartile Range from the 1st or 3rd quarter. Using SPSS v24, linear regressions were calculated between GP prescribing rates and community pharmacy EHC provision rates. This was repeated for community pharmacy EHC provision rates and the proportion of commissioned pharmacies. Results There were 147 Local Authority commissioners identified across England, 113 (76.9%) responded to the FOI request. Of these, 5 did not commission EHC services from community pharmacy. Local Authority and CCG boundaries were compared, 86 areas were identified as ‘co-terminus’ (i.e., greater than 95% overlap). These 86 areas included 82,822 GP prescriptions and 207,731 community pharmacy provisions. The data reflected an estimated female population aged 12-55 of 9,380,153 (Local Authority mean 109,072, SD 83,899), 60% of the total English female (12-55) population. Removing outliers left 92.5% of the data for analysis. The mean GP prescribing rate was 79.3/10,000 (SD 26.3) and the mean community pharmacy provision rate was 200.2/10,000 (SD 154.9). Linear regression indicated a negative correlation between GP prescribing rates and community pharmacy provision rates (R2=0.21) and a positive correlation between community pharmacy provision rates and the proportion of commissioned pharmacies (R2=0.21). Conclusion This study shows that increasing the community pharmacy provision rate by 100/10,000 decreases the GP prescribing rate by 8/10,000. Increasing the proportion of commissioned pharmacies to 100%, through a national service may change GP prescribing rates. This regression analysis predicts this would decrease the GP EHC prescribing rate by 15% to 66.3/10,000. Whilst this data is not fully representative of commissioning in England, this single commissioning change could move 20,706 GP consultations to community pharmacy annually across England. Comparisons with Wales and Scotland (who have national services) suggest this impact could potentially even be doubled. The strength of this study is it’s use of routine data facilitating replication, however local commissioning arrangements mean the conclusions are not necessarily applicable beyond England. References (1) Mackridge AJ, Gray NJ, Krska J. A cross-sectional study using freedom of information requests to evaluate variation in local authority commissioning of community pharmacy public health services in England. BMJ Open. 2017;7(7):e015511 (2) Lloyd K, Gale E. Provision of emergency hormonal contraception through community pharmacies in a rural area. J Fam Plann Reprod Health Care. 2005;31(4):297-300.

Utilizing social and behavioral change methods in clinical pharmacy initiatives

AbstractPharmacists are often involved in creating, implementing, and evaluating initiatives that aim to improve medication use. Pharmacy initiatives can occur in various settings, can involve interactions with patients or prescribers to optimize medication use, and incorporate information from multiple sources. Similar to pharmacy initiatives, public health initiatives are heterogeneous, complex, and work with the public to improve health behaviors in a variety of settings. Various program planning and health behavior change techniques are utilized in the planning of public health programs. Community‐based public health programs designed using social and behavioral theories have shown improved outcomes when compared with programs not based on theory. Given the overlapping objectives for planning community‐based public health programs and pharmacy initiatives, the use of social and behavioral theories may provide pharmacists with an additional tool to assist in creation of multi‐layered, effective pharmacy initiatives. Data supporting two health behavior theories focused on individuals (Transtheoretical Model and Health Belief Model), and one ecological model (Social Ecological Model) are reviewed and applied to three different pharmacy initiative scenarios. Greater incorporation of behavioral change theories and models may be helpful in creating effective, comprehensive pharmacy initiatives.

Evaluation of Drug Pricing in Nigeria: A Focus on Affordability and Availability of Essential Medicines in Federal Capital Territory Abuja

Critical to the success of a country’s healthcare delivery services is the affordability, availability, and accessibility of essential medicines to the populace irrespective of their income status. The price of medicines is an important determinant of medicines affordability and accessibility. Due to seeming inefficient health insurance programs, medicine financing in Nigeria is generally out-of-pocket. In Nigeria, drug prices are set mostly by market forces, with government tariffs, taxes, and distribution mark-ups accounting for a significant proportion of the final price.The following thematic areas of interest to were the focus in evaluating the current situation of drug pricing: National Drug Policy and Drug Pricing; National Drug Distribution Guideline and Drug Pricing; National Policy Framework on Drug Revolving Fund and Drug Pricing; Nigerian Pharmaceutical Market and Drug Pricing.The study evaluated drug pricing in Nigeria by comparing the availability and prices of various brands of a chosen set of essential medicines in different parts of the health sector and different types of health facilities in the Federal Capital Territory Abuja to assess the availability and affordability of these medicines.The study design used a questionnaire format data collection tool based on the 2nd edition of the World Health Organization (WHO) and Health Action International manual for measuring medicine prices, availability, affordability, and price components. The survey was carried out within the Federal Capital Territory Abuja at both public and private health facilities, including community pharmacies. A total of 145 facilities were enumerated and 20% were successfully surveyed. Key data collected included; percentage availability, price of originator brand and generics, price ratio to the international reference price, and the economic effect of current drug prices on the populace.The results showed varied and fantastic outcome, on inferential statistics in comparative analysis; Firstly, for the Public hospital vs Private hospital Medicines’ Prices, there was a significant difference (P<0.05) between the price of medicines in private hospital and the median price of medicines in public hospitals. Also, price of medicines in private hospital was 2.9 times higher than the median price of medicine in public hospital ( p=0.013, t=2.9); Secondly, for the Innovator brand vs Most sold generic brand in community pharmacy, there was a significant difference between the median price of innovator brands of medicines and the median price of the most sold generics. The median price of the innovator brands was approximately 5 times the median price of the most sold generics (p=0.000291, t=4.689); Thirdly, for the Price of medicines across community pharmacies (innovator brand), there was no significant difference (p>0.05) in the prices of innovator brands across the community pharmacies assessed. (p=0.459); Fourthly, for the Price of medicines across community pharmacies (Most sold generic), there was no significant difference (p>0.05) in the prices of the most sold generic brands of medicines across community pharmacies assessed (P=0.915); Fifthly, for the Price of medicine across public hospitals, there was no significant difference (p>0.05) between the prices of medicines across the public hospitals assessed. (p=0.877).There exists a huge price disparity between public and private health facilities, hence there is an overarching need to regulate drug prices in the health sector so as to ensure affordability and availability of essential medicines and other healthcare commodities. There is poor availability of some essential medicines particularly in the public health pharmacies, it is imperative that appropriate measures be put in place to ensure medicine availability. Improving access to medicines is key to attainment of Universal Health Coverage and Patients’ satisfaction of the healthcare delivery system. Keywords: Drug Pricing, Essential Medicines, Affordability, Availability, Nigeria, FCT Abuja DOI: 10.7176/JHMN/97-01 Publication date: January 31 st 2022

Determinants of Knowledge and Behaviours of Indonesian Health Care Providers toward the Prevention of COVID-19

Background: Due to the high risk of exposure of health care providers (HCPs) at the forefront of the COVID-19 responses, their knowledge and prevention behaviors towards COVID-19 have become crucial parts of their job performances.Purpose: This study aims to identify the level of knowledge and prevention behaviors of HCPs toward COVID-19 and factors associates.Methods: This study utilized a cross-sectional research design. The samples consisted of 182 HCPs in Malang, East Java Province, Indonesia. The data were collected through structured self-developed online questionnaires, consists of socio-demographic characteristics, knowledge, and prevention behaviors. The data were treated as categorical data types and then analyzed using frequency distribution, chi-squares, and logistic regression performing by SPSS 22 software.Results: The HCPs working at hospitals have about 1once times better knowledge than those who work at public health centers, clinics, and pharmacies (COR = 1.03; 95% CI: 0.72-14.76). Nurses have 3.4 times better knowledge than other HCPs (COR = 3.43; 95% CI: 0.27-43.84). HCPs with 5 to 10-year experience have 6.4 times better prevention behavior than those with less than five years or over 10-year experience (COR = 6.42; 95% CI: 0.57-72.76).Conclusion: The knowledge and prevention behaviors of HCPs toward COVID-19 prevention were influenced by age, residence area, occupation, and the length of working experience. Therefore, HCPs need to understand the new healthy habits and actively contribute to COVID-19 intervention programs.

Empowering Public Health Pharmacy Practice-Moving from Collaborative Practice Agreements to Provider Status in the U.S.

This article describes the history and evolution of pharmacist-physician collaborative practice agreements (CPAs) in the United States with future directions to support pharmacists’ provider status as the profession continues to evolve from product-oriented to patient-centered care and population health. The pharmacy profession has a long history of dispensing and compounding, with the addition of clinical roles in the late 20th century. These clinical roles have continued to expand into diverse arenas such as communicable and non-communicable diseases, antimicrobial stewardship, emergency preparedness and response, public health education and health promotion, and critical and emergency care. Pharmacists continue to serve as integral members of interprofessional and interdisciplinary healthcare teams. In this context, CPAs allow pharmacists to expand their roles in patient care and may be considered as a step towards securing provider status. Moving beyond CPAs to a provider status would enable pharmacists to be reimbursed for cognitive services and promote integrated public health delivery models.

Strengthening pandemic preparedness through pharmacy and public health collaborations: Findings from a facilitated discussion exercise

BackgroundCommunity pharmacists are key partners to public health agencies during pandemics and other emergencies. Community pharmacy and public health agencies can establish memoranda of understanding (MOUs) for dispensing and administering medical countermeasures and providing related services to affected population(s) during a public health incident. ObjectiveThe objective of this facilitated discussion exercise was to identify the strengths and opportunities associated with the activation of a statewide pharmacy–public health agencies MOU with community pharmacists on the basis of a simulated pandemic influenza event. MethodsA facilitated discussion exercise was held in the Puget Sound region of the State of Washington in May 2017. The participants included pharmacists from 2 community pharmacy organizations, emergency preparedness officials from 2 local health departments and the state health department, staff of the state pharmacy association, and faculty from a school of pharmacy. The evaluators recorded the discussions and observations, augmented by a postexercise telephone call with participants from each of the participating community pharmacy organizations. Key themes from the exercise are reported. ResultsFive themes were identified during the facilitated discussion exercise. Two themes described the strengths of the MOU and its operational plan: (1) collaboration strengthens preparedness and response planning, and (2) an MOU provides a framework for effective collaboration. Three themes acknowledged the opportunities to optimize activation of the existing MOU: (1) early and active engagement between health department personnel and community pharmacists, (2) establishing pharmacy policies and procedures to support readiness and response, and (3) addressing the training or other educational needs of community pharmacists. ConclusionThis exercise provided community pharmacists and public health agency personnel an opportunity to better plan for responding to a pandemic. The open dialogue in this facilitated discussion allowed the exercise participants to identify the strengths, priorities, and perspectives as well as the gaps in the MOU operational plan. The lessons learned in this exercise can inform the community pharmacy and public health response to the coronavirus disease pandemic.

Public Health and Pharmacy Partnerships in Opioid Harm Reduction: Responding to Community Needs.

Minnesota pharmacists were encouraged to utilize legislation allowing them to dispense naloxone, an opioid overdose reversal drug, without prescription. Unfortunately, this legislation has not been utilized widely resulting in preventable death. This study sought to determine how a partnership between public health and academic pharmacy could facilitate community pharmacists' naloxone dispensing. Pharmacy and public health professionals collaborated in two counties to identify ways to support naloxone dispensing. Community pharmacies in these areas were provided with multidisciplinary support in naloxone and naloxone protocol education; dispensing measures were tracked before and throughout the study. Through partnerships between public health and pharmacy, naloxone dispensing measures increased. In-person visits with a public health or pharmacy advocate were associated with increased protocol uptake, dispensing, and naloxone stocking. Support from public health professionals and pharmacists in partnership shows great promise in increasing naloxone protocols and dispensing in a community pharmacy setting.

Status and effects of health workforce related factors on implementation of universal health care in Nakuru West Sub County, Nakuru, Kenya

Background: Globally, due to low health care coverage, there have been continued efforts to ensure that there is increased accessibility to quality, affordable and equitable universal health care (UHC) services in most parts of developing countries, such as within Nakuru county in Kenya.Methods: The study focused on determining health workforce gaps in health care facilities that affect the implementation of UHC in Nakuru West Sub County. Cross-sectional study design was applied, data was collected using structured questionnaires, analyzed using statistical package for social sciences 23rd version and presented in charts for ease comparison.Results: The findings of this study indicated that there was shortage of HWCs. This implies that the staffing in the facilities located in Nakuru West Sub-County is inadequate for the implementation of the Kenyan government UHC and it was evident that the mostly affected sections were the nursing, public health officer (PHO), pharmacy, clinical officers and laboratory in that order. Most alarmingly, majority of the HCWs (58.2%) were not being appreciated for good work, despite the fact that they play a key role in the implementation of UHC.Conclusions: It is therefore imperative for the county government which is the arm of the Kenyan government to ensure that they recruit adequate health care workers in all cadres to serve the continuously rising population and HCWs should have adequate level of education, acceptable training skills and be well- motivated.

Role of community pharmacy in public health

Currently, in every country, community pharmacists play an essential role as they take responsibility for access to healthcare for the medicine-related needs of patients. In India, however, only the provision of medicines remains the central movement of the group pharmacist. In the country, patient-oriented treatment is still rarely given by most community pharmacists. As domestic medicine development and national healthcare expenditure rise rapidly, the role of pharmacists in society and, with it, their management of medicines will change. The aim of this editorial is to examine the genesis of the private-owned Indian community pharmacy and to outline its education, training and prospects.

Pharmacy Emergency Preparedness and Response (PEPR): a proposed framework for expanding pharmacy professionals' roles and contributions to emergency preparedness and response during the COVID-19 pandemic and beyond.

BackgroundPharmacists have long been involved in public health and emergency preparedness and response (EP&R), including through preventive measures such as screening, vaccinations, testing, medical and pharmaceutical countermeasures, as well as ensuring medication safety and access during natural disasters and pandemics. Pharmacy professionals are considered essential partners in response to the ongoing COVID-19 pandemic. Community and hospital pharmacies are expanding services and hours to provide essential services, putting pharmacists and their co-workers at the frontlines for patient care and safety to improve public health. In addition, pharmacy professionals are increasingly integrating into global, national, state and local EP&R efforts, including into interprofessional teams, such as Medical Reserve Corps (MRCs). However, lacunae exist for further integration of pharmacists into public health and safety initiatives. There are increasing opportunities and recommendations that should be expanded upon to provide improved patient care and population health interventions, and to ensure healthcare worker and public health safety.ObjectiveDevelop a Pharmacy Emergency Preparedness and Response (PEPR) Framework and recommendations for pharmacy professional pathways towards full integration within public health EP&R efforts (such as the COVID-19 pandemic), and enhanced recognition of pharmacists’ skills, roles and contributions as integral members of the interprofessional healthcare team.MethodsThis paper draws on the American Society of Health-System Pharmacists (ASHP) 2003 Statement on the Role of Health-System Pharmacists in Emergency Preparedness and lessons learned from previous and current public health emergencies, such as the 2009 H1N1 pandemic and the current COVID-19 pandemic, to provide expanded guidance for pharmacists and pharmacy professionals across all practice settings in EP&R. The proposed PEPR framework also incorporates information and recommendations from The Pharmacy Organizations’ Joint Policy Recommendations to Combat the COVID-19 Pandemic (March 2020), CDC-NIOSH, International Pharmaceutical Federation (FIP) Guidance, health departments and emergency preparedness guidance and resources, Boards of Pharmacy, and other pharmacy professional organizations and educational institutions.ResultsBased on methods and resources utilized in developing this proposed PEPR Framework, five key focus areas were identified, as follows:1)Emergency preparedness and response2)Operations management3)Patient care and population health interventions4)Public health pharmacy education and continuing professional education5)Evaluation, research, and dissemination for impact and outcomesConclusionPharmacists and pharmacy professionals have been at the frontlines in responding to the COVID-19 pandemic. Yet, challenges remain, such as limited availability of personal protection equipment, high risk of infectious exposures inherent in healthcare professions, and legislative hurdles resulting in lack of provider status and related reimbursements. Recommendations to enhance pharmacy's scope as public health professionals involved in EP&R include targeted training and education on key framework areas and policymaking. Pharmacy professionals should further integrate with interdisciplinary public health teams. Additional research and dissemination on impacts and outcomes of EP&R can enhance recognition of pharmacy professionals' contribution and value during public health emergencies. The proposed PEPR Framework can be utilized to develop, implement, evaluate, and disseminate results in order to strengthen existing efforts and to establish new initiatives in EP&R.

Exploring the factors influencing the quality of "Health Support Pharmacy" services in Japan: Perspectives of community pharmacists.

Internationally, community pharmacists play a key role in public health services. In Japan, a new system called Health Support Pharmacy (HSP) was introduced in 2016, to promote responsible self-medication with non-prescription medicines and increase awareness of public health activities provided through community pharmacies. The number of HSP services provided has been increasing; however, the service quality varies depending on pharmacies and/or pharmacists. Thus, it is important to identify factors that influence HSP service quality. To identify factors that can impact on the quality of HSP services provided by community pharmacists in Japan. In-depth semi-structured online interviews were conducted with twenty-four community pharmacists from across Japan. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. All themes identified were deductively categorised into 3 domains using Donabedian's framework of structure, process and outcome. Participants identified 8 key themes and 23 sub-themes pertaining to the quality of pharmacy public health services. For the structure domain these were: adequate resources, professional expertise, and policy and procedures. For the process domain these were: provision of individual services, provision of community health education and other events, and collaboration with other professionals. For the outcome domain these were: impact on individuals and the general public, and impact on other professionals. This study identified factors which can impact HSP service quality by community pharmacists in Japan. Whilst the major themes identified align with those reported in other studies pertaining to expanded roles for community pharmacists, this study also identified findings which appear to be unique to the Japanese context. These findings, based on Donabedian's framework, may be used to better understand the scope and quality of HSP services delivered in Japan.

Design of a disaster preparedness escape room for first and second-year pharmacy students

Background and purposeEducational escape rooms assist students with the development of teamwork, augmentation of problem-solving skills, and reinforcement of key course concepts. In this report, we examined the feasibility of creating a bioterror preparedness escape room in a small enrollment pharmacy public health elective course. Educational activity and settingA bioterror preparedness escape room was developed for pharmacy students in a health elective course. The instructional objectives of training students in disaster preparedness were assessed via group readiness assessment tests in the scenario and individual readiness assessment tests after the completion of the activity. FindingsTwenty-eight students participated in the escape room activity in groups of 6 to 8 students (n = 4 observations) and all groups escaped. Student performance was higher on the initial attempts of three group readiness assessment tests (88 ± 16.0%, 82 ± 7.1%, 78 ± 12.0%) than in the final individual readiness assessment test (73.4 ± 20.4%). Students indicated that they found the educational escape room to be enjoyable (95.7%) and felt that all members of the team were involved in solving the problems (86.9%). SummaryA disaster preparedness educational escape room was designed and implemented in a public health elective for pharmacy students. Findings indicate that the educational escape room format is an effective method for reinforcing course content, however additional improvements could be made to the instructional design to enhance individual student knowledge retention.

The Socio-cultural Dynamics of Antibiotic Misuse in Hyderabad City, India: a Qualitative Study of Dentist and Pharmacist

Background: Antibiotic resistance and antibiotic-associated adverse events are rapidly escalating and considered as a global health threat and public health problem. There is poor evidence base on the contextual specificities and everyday use of antibiotic in public health dentistry and pharmacy dispensing practices. The study explores the socio-cultural dynamics emergent around antimicrobials in the Indian Public dentistry and pharmacy practice in India.
 Methods: Using purposive sampling, dentists and pharmacists were recruited for the study in Hyderabad City, Telangana State, India. Using semi-structured interviews, dentists and pharmacists were asked about how antibiotics were prescribed and dispensed, perceptions of antibiotic use in community and socio-cultural norms prevailing in the use of the antimicrobial practice.
 Results: The dominant themes, emerged by both dentists and pharmacists, was the avoidance of dentist visit on encountering dental infection, reliance on self-medication, use of over-the-counter antibiotics and easy accessibility of antibiotics without prescription as a primary driver of antibiotic misuse and development of antimicrobial resistance, which is associated with socio-cultural practices and economic problems. 
 Conclusions: The speculations of qualitative responses to antimicrobial resistance are profoundly entangled in the specificities of dental infection management across cultures and locales in daily life. This study emphasizes the need for enforcement of regulatory mechanism on antibiotic dispensing over the counters, educating dental patients in avoiding self medications, educational and training initiatives are necessary to sensitize and rationalize dentist and pharmacist in the use of antibiotics.

The effects of community pharmacy public health interventions on health and health inequalities

The effects of community pharmacy public health interventions on health and health inequalities