Pharmacy Team Research Articles

Expanding public health initiatives through community pharmacies and student pharmacists: A programmatic case study

BackgroundCommunity pharmacies are critical to the public health infrastructure in the United States and provide reliable information for public health concerns. Public health agencies curate educational materials that community pharmacy teams can disseminate. Student pharmacists participate in experiential learning at community pharmacies which could be utilized for dissemination of these resources. ObjectivesThe objectives of this project were to (1) design a model for dissemination of public health information at community pharmacies; and (2) evaluate both the dissemination model’s reach within communities and student pharmacist learnings from engagement in the model. MethodsWe engaged student pharmacists in a model to disseminate information at community pharmacies for 2 Centers for Disease Control and Prevention initiatives about Opioid Use Disorder Anti-Stigma and Antibiotic Stewardship Education. The number of pharmacies and student pharmacists who participated from 2021 from 2023 was retrospectively reviewed to demonstrate programmatic reach. A retrospective text mining of student assignments was conducted to evaluate student experiences. Descriptive statistics were used to report quantitative data. An inductive, rapid content analysis was completed for qualitative data. ResultsAcross 3 years, 333 student pharmacists participated. Students reached 121 community pharmacies, 139 practicing pharmacist preceptors, and over 2000 patients with education and resources. Eleven student learning points emerged from the qualitative analysis. These included learnings around opioid use disorder and antibiotic stewardship. Students also acknowledged that there are public health needs present in communities and that community pharmacy teams are well-positioned to address these needs. ConclusionEngaging student pharmacists to distribute curated information from public health authorities, both to pharmacist preceptors and patients at community pharmacies, is one way to educate future pharmacists, pharmacy teams, and communities on public health priorities. Pharmacies can serve as key venues in communities for dissemination of reliable public health information.

Reducing the time to chemotherapy start for planned admissions.

e23201 Background: Planned hospital admissions for chemotherapy should be initiated shortly after arrival. Between January 2022 and May 2023, 25.7% of sarcoma patients at Medstar Washington Hospital Center admitted for chemotherapy experienced initiation of chemotherapy delays of more than 6 hours. Delays in chemotherapy initiation can lead to prolonged hospitalization with associated higher costs, increased risk of hospital acquired conditions, and decreased patient satisfaction. Methods: Discussions with team members involved in the initiation of inpatient chemotherapy process identified the following issues contributing to delay: absence of recent lab results, challenges with IV access, missing chemotherapy consent forms, absence of chemotherapy orders, failure to notify team members of patient arrival, lack of dose adjustments based on lab work, and insufficient pharmacy staffing. As our chemotherapy floor policy is to start pre-medications once the chemotherapy is on the unit, we defined the time to chemotherapy start as the time of the first pre-medication minus the time the patient checked in to the hospital’s admissions office. Patients with unforeseen issues such as a new fever on arrival were excluded. We obtained baseline data for sarcoma admissions between January 2022 to May 2023. Two Plan-Do-Study-Act (PDSA) cycles were implemented. The first cycle involved the introduction of a chemotherapy calendar. The second cycle implemented a group email system to finalize all arrangements for the admission. We collected about 3 months of data for each PDSA cycle. Results: Pre-intervention, there were 101 sarcoma admissions with 14.9% of patients starting chemotherapy in < 3 hours while 25.7% took > 6 hours. In the post-intervention data combining both PDSA cycles, 6.8% of patients started chemotherapy in < 3 hours while 43.2% took > 6 hours. As such, the average time to chemotherapy start was increased in post-intervention groups (table 1) despite improvements in many of the common issues. The median time to chemotherapy start based on the number of agents the patient was receiving was 4.98, 6.4, and 7.18 hours respectively for 1, 2, and 3 agents in the post-intervention group. Conclusions: Despite multiple attempts, the median time to chemotherapy start increased in the post-intervention groups. Our interventions targeted many of the barriers except insufficient pharmacy staff. With the median start time increasing based on the number of agents the patient was receiving, it appears that pharmacy mixing and delivery chemotherapy is likely one of the main causes of the delays. Subsequent discussions with the pharmacy team revealed plans to increase staffing as a proactive measure to address this issue. [Table: see text]

Impact of pharmacists’ training on the knowledge of pain and associated risks: results of the OPTYMED 2 study

The use of OTC analgesics is common worldwide, and the importance of the pharmacy teams is growing. Pharmacist-led medication implies that the pharmacy staff should have the necessary knowledge to deliver appropriate drugs, prevent an inappropriate drug consumption, and identify the patients in need of a medical advice. A randomized controlled study to assess the impact of training on pain knowledge and associated situations at risk among the French pharmacists and dispensers was performed. Participants were randomized into two groups receiving (n = 97) or not (n = 93) a training in the e-learning format. The training consisted of the 4 modules including the general knowledge of pain, headaches, acute musculoskeletal and chronic pain. The training modules were accompanied by the summary leaflets. The success rates were significantly higher in the trained group, with 35 % of participants reaching at least 70 % (primary endpoint) versus 2.3 % in the non-trained group. The results were not influenced by the size of the pharmacy. The knowledge improvement was more pronounced for the modules on the general knowledge of pain and headache management. For the questions associated to the risk situations, the success rates of at least 70 % were also significantly higher in the trained group The highest difference in success rates after the training was observed for the use of nonsteroidal antiinflammatory drugs during pregnancy and breastfeeding. Very low rates were obtained in both groups for the secondary headaches and the analgesic treatment adjustment in particular cases, such as chronic alcoholism or low weight. Results of this pilot study show that a training focused on pain could improve the overall knowledge of pain and suggest that it may contribute to a better pain identification, management and referral to physicians of patients at risk by the pharmacy staff in routine practice. The benefits of such a training should be assessed in a long-term prospective study, and the impact of a similar training in real-life practice remains to be evaluated.

"You don't get side effects from social prescribing"-A qualitative study exploring community pharmacists' attitudes to social prescribing.

Social prescribing is an approach that enables the referral of patients to non-clinical support and places a focus on holistic care. This study explored views of community pharmacists regarding social prescribing in pharmacies. A qualitative phenomenological approach was used. A convenience sample of eleven community pharmacists from Northern England were recruited via social media (Twitter, Facebook) and took part in a semi-structured, one-to-one qualitative interviews that asked about their knowledge of social prescribing, the advantages of community pharmacist involvement and any barriers they predicted to its implementation. Interviews were transcribed verbatim and thematically analysed. The sample included largely male pharmacists (63.3%) with less than five years' experience (45.5%) and included pharmacists working as employees (63.6%), locums (27.3%) and owners (9%) in both chain (36%) and independent stores (54.5%). The main findings indicate an enthusiasm for but limited understanding of social prescribing. Factors which appeared to influence involvement were training requirements and time available to complete an additional service in busy pharmacies. Opportunities centred on the broader pharmacy team's role to optimise health outcomes. The findings indicate pharmacists may be an underused resource due to a poor understanding of the full scale and scope of social prescribing beyond health promotion, lifestyle interventions. Further work is needed to explore the transferability of the findings to the broader pharmacy workforce to understand how social prescribing can be positioned within pharmacy practice.

A qualitative study exploring the opportunities and challenges of providing digital community pharmacy services for older people in England

Abstract Introduction Digital healthcare can be an innovative, cost-effective solution for the growing healthcare needs of an ageing population, enhancing service accessibility.[1] Older individuals tend to rely more on community pharmacy services, supported by research indicating positive health outcomes.[2] However, scant evidence exists regarding the impact of digital community pharmacy services on this demographic, emphasising the need for crucial investigations into their effectiveness. Aim Identify challenges and opportunities in delivering digital pharmacy services for older population in community pharmacies in England, from perspectives of policymakers and pharmacy service providers. Methods Between November 2022 and May 2023, online/telephone interviews were conducted with stakeholders including policymakers/commissioners and pharmacy service providers. Recruitment involved purposive and convenience sampling, with commissioners sourced through networks and pharmacy providers via gatekeepers in industry associations. Topics covered the current state of digital pharmacy services in England, implementation opportunities and challenges, and suggestions for enhancement. Audio-recorded interviews were transcribed verbatim and analysed using both inductive and deductive thematic approaches, assisted by NVivo 12 Plus. Themes comprised challenges and solutions in digital pharmacy service delivery and factors influencing user acceptance. Deductive analysis shaped the coding framework based on Davis’s Technology Acceptance Model (TAM). Results Twelve interviews (three policy makers/commissioners [PM], four senior managers of community pharmacy [SM], five front-line community pharmacists [CP]) were completed. One of the interviewees was a female and all others were male. Their length of relevant employment in the field of community pharmacy ranged from three to seventeen years. The key findings indicated challenges in implementing digital pharmacy services to older populations may be due to unclear health policies and limited financial support for digital reforms to community pharmacy: “as a pharmacy we’ll take care of that, but we need to know that there will be funding for that before we go and do it all. I think there’s amazing things that can be done, but at local, small level, like a little community pharmacy, they just can’t afford to do the development” [SM1], and “so the majority of independent pharmacies, … they have paper prescriptions, so they’re not as technology based. I believe one, that’s because it’s money, so it’s funding. They get less funding” [CP4]. Interviewees highlighted that community pharmacists facing high workloads and time constraints, often prioritise other responsibilities over adopting new technologies: “unfortunately, there are a fair few demands on pharmacy team’s time at the moment, so where does promoting a digital priority fit on that long list of priorities and probably quite low down” [PM3]. They also expressed a need for additional technical training to effectively navigate digital pharmacy services. Conclusion This study provides insights into challenges in implementing digital pharmacy services for older people through diverse stakeholder perspectives, offering practical considerations for policy decisions, service design, and implementation strategies. Nevertheless, this study observes a deficient emphasis on deploying digital pharmacy services for older people. It is orientated towards a broader demographic, while those with specific medical conditions may receive pharmacy services more precisely. The applicability of this study may be limited, requiring region-specific research. Further research would be focusing on those over 50 in Greater Manchester aligns with the local community’s emphasis on ageing-related research, technology, and innovative ideas supported by academic institutions.

Nebulised pentamidine prophylaxis of pneumocystis pneumonia in adults accessing HIV services at royal free hospital, London.

Receipt of nebulised pentamidine in people with HIV was audited to identify if individuals were appropriately receiving nebulised pentamidine, and whether national guidelines were being followed when prophylaxis was commenced and discontinued. Of 76 people with who received nebulised pentamidine, the main indication for starting nebulised pentamidine was a co-trimoxazole adverse drug reaction. Co-trimoxazole desensitization was not attempted before starting nebulised pentamidine. The main indication for stopping nebulised pentamidine prophylaxis was when immune reconstitution occurred. This single centre audit revealed that national guidelines were being followed in most cases. The lack of information regarding the reason for starting or stopping nebulised pentamidine prophylaxis, or detail of the clinician's concerns about potential poor adherence with oral regimens of prophylaxis as a reason for choosing nebulised pentamidine prophylaxis, identifies a need for improved documentation of clinicians' decision-making. Introduction of pharmacist-led interventions/alerts using patients' electronic records, similar to those used in primary care, would enable the specialist pharmacy team to identify when and if co-trimoxazole desensitization has been offered and discussed/declined before a clinician prescribes nebulised pentamidine as well as enabling identification of those in who pentamidine prophylaxis has been continued, despite "immune reconstitution".

Integration of electronic project management software in an investigational drug service pharmacy within an academic medical center.

An investigational drug services (IDS) pharmacy plays a vital role in supporting clinical trial research by ensuring the safe and efficient management of investigational products. This article describes the implementation of an electronic project management software to improve an IDS pharmacy's study protocol work. The article describes the implementation of the software and how this approach addressed specific challenges, including project oversight, process standardization, documentation, reporting, accountability, and intrateam communication. We describe an electronic project management software system used to streamline and standardize the work associated with study protocols. This software provides an organized and customizable workspace to manage tasks associated with each study protocol. The software automates task creation, tracks progress, and ensures comprehensive record keeping. Additionally, the software fosters effective communication within the team and offers real-time reporting to assess team productivity and progress. We have observed improved consistency, enhanced revenue, including approximately $18,000 in additional fee capture, and increased collaboration among pharmacy team members. Implementing an electronic project management software has proven highly beneficial in the IDS pharmacy. The software has significantly improved workflow efficiency by addressing challenges in study protocol management. While initial setup and training required time and resources, the long-term benefits in project oversight, collaboration, and revenue capture justify the investment. An electronic project management software is a valuable tool in managing the complexity of study protocol activities and supports the pharmacy's crucial role in advancing clinical research.

Critical care pharmacy service provision and workforce in adult extracorporeal membrane oxygenation centres: a multicentre cross-sectional survey.

There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres. To describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs. We conducted a multicentre, cross-sectional electronic survey inviting one pharmacy professional response per UK ECMO centre. We collated information on workforce, service provision, and pharmaceutical care activities provided by pharmacy teams in adult CCUs with an ECMO service. The survey response rate was 90.9%: representatives of 10/11 tertiary hospitals providing ECMO services responded. Median critical care pharmacist to critical care bed was 1:12.1 (IQR: 1:9.4-1:14.9). Most centres (90.0%) did not meet national standards for pharmacy professionals to critical care bed staffing ratios for weekday services. Total critical care beds covered by the critical care pharmacy team varied across the UK: median (IQR) - 45 (37-80) beds. Two centres funded pharmacist time for ECMO activity, and one centre funded a pharmacy technician post. Median peak ECMO activity was 4 ECMO patients in a single day (IQR: 3-5). Most respondents reported reduced pharmacy service at weekends compared to weekday, with limited on-site support. Most responding ECMO centres in the UK reported pharmacy staffing ratios below nationally agreed critical care standards. There was high variability in clinical pharmacy services to ECMO patients over 7days.

Barriers to medication error reporting in a federally qualified health center

ObjectiveTo explore the National Coordinating Council for Medication Error Reporting and Prevention Categories of Errors health professionals are most likely to report and characterize what barriers to medication error reporting influence decisions to report and the extent they do so at a large federally qualified health center (FQHC). DesignProspective, cross-sectional, survey. Setting and participantsA total of 161 medical professionals at a large FQHC clinic with a small pharmacy team. Outcome measuresSurvey responses to explore respondent understanding of medication error categories and the influence of barriers to medication error reporting on their decision to report. ResultsThirty-six (22.4%) respondents completed the survey. Nearly 40% of respondents would not report a near-miss error and were influenced by workplace/environmental barriers significantly more than those who would report. Regardless of reporting experience or patient-care role, assessed barrier categories influence the decision to report similarly. ConclusionNear-miss medication errors are inconsistently reported. Efforts to improve reporting should emphasize addressing workplace/environmental barriers.

Patient-perceived understanding of home-going medication with transitions of care services at a pediatric institution

BackgroundTransitions of care (TOC) is the coordination and continuity of health care as a patient transfers between different settings. This can include a wide range of services, such as medication reconciliation, patient counseling, bedside delivery of medications, and others that meet individual patient needs. In the pediatric population, patients are at increased risk of potential medication errors and subsequent harm owing to reduced patient and caregiver health literacy, limited dosage form availability, and errors in medication administration. The use of TOC services at the time of hospital discharge in this population has the potential to make a positive impact on patient safety and the treatment of medical conditions. ObjectivesThe primary objective of this study was to determine whether patient-perceived understanding of home-going medications was greater in patients and/or caregivers who received medication bedside delivery and education from a pharmacy-led TOC service at a large pediatric academic medical center. The secondary objective was to determine whether the primary practice area of the pharmacist providing medication education led to changes in understanding of home-going medication(s). MethodsUsing institution-wide, patient satisfaction surveys from January 1, 2021, to December 31, 2021, patient and caregiver responses were queried for 2 questions about home-going medications, relating to the understanding of administration and the potential adverse effects. Patients were divided into 2 groups depending on TOC services received, as documented in the electronic medical record (EMR). Survey responses for each of the 2 questions were categorized as top-box percentage by study group. Hypothesis testing between study groups for the primary and secondary outcomes were conducted using chi-squared tests at an alpha of 0.05. Statistical analyses were conducted using SAS version 9.4. ResultsOf the 1159 patients included in the study, 441 received TOC services, deemed the intervention group, and 718 did not receive TOC services, deemed the control group. When the intervention and control group were asked about understanding of medication administration, 96.37% versus 93.18% of patients (P = 0.007) gave the most favorable response of “yes, definitely,” respectively. Furthermore, 78.51% versus 77.44% of patients (P = 0.053) gave the most favorable response when asked about understanding potential medication adverse effects, respectively. ConclusionPatients receiving TOC services by a member of the pharmacy team had a greater score for understanding of both medication administration and adverse effects. Furthermore, this greater score was consistent among the education provided by the inpatient and outpatient pharmacist.

The study of the professional activity of pharmacy specialists in modern conditions

Aim. To study the peculiarities of the professional activity of pharmacists in dispensing medicines and other pharmacy products in modern conditions, characterized by a high level of risks and uncertainties. Materials and methods. Materials and methods are based on the use of statistical, scientific and monographic materials and the results of our personal research. Scientific methods of analysis, abstract and logical, comparison, surveys, and sociological (questionnaires) methods using Google forms were applied. A total of 194 рharmacy specialists (PhS) took part in the survey. The results were processed using modern Microsoft Excel software products. Results and discussion. The general requirements for the organization of the pharmacist’s workplace for dispensing medicines have been determined. Important professional and business qualities of the personality of PhS (14 in total) have been identified, among which the first place is occupied by the presence of pharmaceutical education, the conditions for successful professional activity (20 directions), a list of individual practical actions that PhS perform most often (13 actions). The necessary practical skills that PhS should possess in today’s conditions (10 skills) have been identified. The features of pharmacy visitors and their requests during communication with PhS have been studied. Possible options for communication between them and professional response of PhS from the point of view of professional ethics and deontology, respectful attitude to visitors under any conditions have been clarified. The peculiarities of communication between PhS and other healthcare specialists, including doctors, and colleagues in the pharmacy team have been determined. Conclusions. The results of the survey made it possible to determine the peculiarities of the professional activity of PhS in modern conditions. The correct assessment and rational use of human resources can have a positive impact on the economic performance of the pharmacy, pharmaceutical supply of the population, medical military and civilian institutions in today’s conditions under the influence of crisis phenomena.

Enhancing Drug Management, Cost Savings, and Staff Satisfaction in Anesthesiology: A Quality Improvement Project in a Chinese Tertiary Hospital.

In alignment with China's national directive for improved drug management in anesthesiology, the Affiliated Hospital of Qingdao University initiated a quality improvement project, aiming to tackle the prevailing challenges of inefficiencies in drug administration, escalating drug costs, and the notable communication gap between pharmacists and anesthesiologists. We employed a Plan-Do-Study-Act methodology to establish a pharmacy team and execute a multidimensional pharmaceutical intervention. The interventions included the formulation of standard procedures, guidelines and regulations, assistance from an information system (including automatic dispensing cabinets and prospective prescription review system), communication feedback (via WeChat groups), and education for anesthesiology staff. The intervention spanned from April to September 2023, focusing on optimizing medication management, achieving cost savings, and enhancing the satisfaction of anesthesia team members, with an additional observation from October to December 2023. Following the interventions, improvements were observed in drug management practices. These enhancements included increased compliance with accounting procedures, more rigorous registration of controlled substances, and more effective disposal of liquid residues. There was no adverse events related to high-alert medications or look-alike drug usage errors. The introduction of automatic dispensing cabinets and a prospective prescription review system markedly improved work efficiency. The utilization of a WeChat group facilitated effective communication about unreasonable prescriptions and drug-related issues. Among the 29,061 patients who underwent surgery both before and after the interventions, significant reductions were observed both in the drug proportion and the per capita drug costs (P = 0.03, P = 0.014, respectively). The per capita drug cost decreased by 20.82%, from ¥723.43 to ¥572.78, consistently remaining below ¥600 throughout the 9-month observation period. The per capita cost of monitoring drugs including dezocine, butorphanol, haemocoagulase agkistrodon, penehyclidine, and ulinastatin experienced a significant reduction (P < 0.05). Additionally, in the satisfaction questionnaires returned, a remarkable 94.44% of anesthesiology staff expressed high satisfaction with the comprehensive pharmaceutical interventions. The quality improvement project has yielded remarkable positive outcomes, serving as a model worthy of reference and replication in similar healthcare settings.

Facilitators and barriers to community pharmacy PrEP delivery: a scoping review.

Pre-exposure prophylaxis (PrEP) is an effective medication to reduce the risk of acquiring HIV. PrEP is available free of charge in the UK from sexual health clinics. Expanding PrEP delivery to community pharmacies holds promise and aligns with UK government goals to eliminate new cases of HIV by 2030. The aim of this scoping review was to describe the existing evidence about the barriers to and facilitators of community pharmacy oral PrEP delivery, for pharmacists and pharmacy clients, as aligned with the Capacity Opportunity, Motivation Behaviour (COM-B) Model. Five bibliographic and five review databases were searched from inception to August 2023. Literature of any study design was included if it discussed barriers and facilitators of community pharmacy PrEP delivery. Trial registrations, protocols and news articles were excluded. A total of 649 records were identified, 73 full texts were reviewed and 56 met the inclusion criteria, predominantly from high-income/westernized settings. Most of the included literature was original research (55%), from the United States (77%) conducted during or after the year 2020 (63%). Barriers to PrEP delivery for pharmacists included lack of knowledge, training and skills (capability), not having the necessary facilities (opportunity), concern about the costs of PrEP and believing that PrEP use could lead to risk behaviours and sexually transmitted infections (motivation). Facilitators included staff training (capability), time, the right facilities (opportunity), believing PrEP could be a source of profit and could reduce new HIV acquisitions (motivation). For clients, barriers included a lack of PrEP awareness (capability), pharmacy facilities (opportunity) and not considering pharmacists as healthcare providers (motivation). Facilitators included awareness of PrEP and pharmacist's training to deliver it (capability), the accessibility of pharmacies (opportunity) and having an interest in PrEP (motivation). To effectively enhance oral PrEP delivery in UK community pharmacies, the identified barriers and facilitators should be explored for UK relevance, addressed and leveraged at the pharmacy team, client and care pathway level. By comprehensively considering all aspects of the COM-B framework, community pharmacies could become crucial providers in expanding PrEP accessibility, contributing significantly to HIV prevention efforts.

Exploring the potential extended role of community pharmacy in the management of osteoarthritis: A multi-methods study with pharmacy staff and other healthcare professionals.

Osteoarthritis is the commonest form of chronic joint pain, which patients often self-manage before seeking healthcare advice. Patients frequently seek advice from community pharmacies, and a recent policy has recommended integrating community pharmacies into long-term condition pathways. This study explored community pharmacy teams' (CPs) and other healthcare professionals' (HCPs) views on community pharmacies providing an extended role for osteoarthritis management, identifying potential barriers and facilitators to this. A multi-methods study comprising surveys of CPs and other HCPs, followed by qualitative interviews. Descriptive statistics were used in an exploratory analysis of the survey data. Qualitative data were analysed using reflexive thematic analysis and the identified barriers and facilitators were mapped to the Theoretical Domains Framework. CPs and other HCPs in the surveys and interviews reported that an extended role for osteoarthritis management could include: a subjective assessment, explaining the joint problem and its treatment, medication management and support for self-care. There was less consensus on diagnosing the problem as OA and completing an objective assessment. A key facilitator was training to deliver the role, whilst barriers were high workload and lack of access to General Practitioner medical records. Acceptable elements of an extended community pharmacy role for osteoarthritis centre around the provision of information, advice on medication and supported self-management. CPs are well placed to contribute towards evidenced-based osteoarthritis management. Feasibility testing of delivering the extended role is needed and future implementation requires training for CPs and raising public awareness of the extended role.

Outcomes and Barriers Associated with Telehealth-Based Hepatitis C Treatment During Early Phases of the COVID-19 Pandemic.

The COVID-19 pandemic has presented challenges for hepatitis C virus (HCV) treatment given the need for thorough evaluation by specialists, treatment coordination, follow-up visits, laboratory monitoring, and potential health behavior impacts on patients. The objective of this study was to evaluate HCV treatment during the beginning of the COVID-19 pandemic, when care was conducted virtually, by examining patient demographics associated with treatment initiation and discontinuation rates. This retrospective study included 73 patients with quantifiable HCV RNA evaluated by gastroenterologists and infectious disease clinicians and referred to an HCV clinical pharmacy team for treatment coordination from March 1, 2020, to September 30, 2020. Data collection included baseline demographics, clinical characteristics, and treatment characteristics. Patients were followed until June 15, 2021. Forty-three patients (59%) initiated HCV treatment while 30 patients (41%) did not. Patient demographics were not associated with HCV treatment initiation rates except for presence of alcohol use disorder within the past 6 months (P = .003). Of the 43 patients that initiated HCV treatment, 9 patients (21%) discontinued their treatment. Twenty-two of 25 patients (88%) with laboratory analysis achieved sustained virologic response. There were no demographic or geographic disparities between patients that initiated HCV treatment and those that did not during the study period. Results of this study suggest that active alcohol use disorder diagnosis may be associated with HCV treatment noninitiation. This study emphasizes the need for further research to define the standards of care in assessing active alcohol use disorder during HCV treatment evaluation.

Development of a Pharmacy Point-of-Dispensing Toolkit for Anthrax Post-Exposure Prophylaxis for Allegheny County Postal Workers.

The Centers for Disease Control and Prevention (CDC) and the US Postal Service (USPS) consider anthrax to be a potential threat to USPS workers. A county health department-owned pharmacy supports local USPS response in the event of an exposure. The pharmacy team identified the need to review and update the local anthrax response plan. A Pharmacy Point-of-Dispensing Toolkit and response plan for initial 10-day post-exposure antibiotic prophylaxis was developed for use by a local health department in the event of a mass anthrax exposure at a US Post Office sorting facility. The pharmacist's role in medical countermeasures planning for anthrax exposure is also discussed to illustrate how pharmacists' medication expertise can be utilized. The CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning framework and inputs from an interprofessional stakeholder team were used to develop a Medical Countermeasures Response Plan and Implementation Toolkit for mass point-of-dispensing (POD) in the event of an anthrax exposure. Stakeholders attended a USPS Community Partner Training event where additional revisions to the toolkit were made. The toolkit and standing order are now implemented at the local health department to be reviewed and updated on a yearly basis by health department leadership. Pharmacists can use their medication expertise and experience with patient education to design emergency response plans focused on increasing patient safety and medication adherence. Pharmacists should be involved in emergency response and medical countermeasures planning that involve medications.

Study of factors influencing the occurrence of conflicts in pharmacies

The aim of the study was to investigate the factors influencing the occurrence of conflicts in pharmacies during the provision of pharmaceutical care, with the subsequent goal of optimizing the social and psychological climate within the team and improving the quality of service to the population. Materials and methods. Systematic-analytical, mathematical statistical, comparative, and sociological research methods were employed in the study. Descriptive statistics were utilized to present the obtained data. To assess the significance of individual factors, the questionnaire results were converted into corresponding component weights (Wij). Results. The study of conflicts between visitors and pharmacy employees, from the point of view of visitors, revealed several key findings. Most customers expressed dissatisfaction with the prices of medicines and medical devices (Wij = 1.00). Additionally, there were concerns about the perceived quality of the products (Wi j= 0.67), and some customers reported feeling distressed due to the unavailability of necessary medicines (Wij = 0.57). The study, conducted from the point of view of employees, focused on conflicts between employees and visitors. The findings revealed that conflicts most often arise due to dissatisfaction with the prices of medicines and medical devices (Wij = 1.00). Additionally, issues such as requests to dispense over-the-counter medicines from the list of prescription drugs (Wij = 0.70) and returning medicines to the pharmacy after purchase (Wij = 0.67) were identified as contributing factors. The analysis of factors that provoke conflicts in the pharmacy team revealed several key contributors. The most significant include the inadequate behavior of employees (Wij = 1.00), inconsistency in words, assessments, and actions of some team members with the expectations and requirements of others (Wij = 0.89), and psychological incompatibility between employees (Wij = 0.88). The study of conflicts between the administration and subordinates in the pharmacy revealed frequent occurrences linked to several factors. Most notably, conflicts were associated with an imperfect bonus system (Wij = 1.00), high workload (Wij = 0.92), and a perceived lack of career development opportunities (Wij = 0.76). Conclusions. The factors that contribute to the emergence of conflict situations in pharmacies have been identified and studied. Approaches to preventing and resolving conflicts by pharmacy employees are proposed.

Development of a Discharge Counseling and Medication Reconciliation Process for Pediatric Patients Within a Large, Academic Health System

OBJECTIVE This study aims to characterize the impact of a pharmacist-driven discharge medication reconciliation and counseling program targeting high-risk pediatric patients to mitigate barriers in transitions of care. METHODS This was a single-center quality improvement initiative including high-risk pediatric patients within a large academic medical center. Pharmacy, medical, and information technology team members developed a scoring system to identify patients at high risk of hospital readmission that resulted in a trigger tool built within the electronic medical record (EMR). Pharmacy workflow, the EMR documentation, and staff training were implemented. The primary end point was the number of high-risk patients with complete medication reconciliation and/or discharge counseling performed during the first 2 months after implementation. The secondary end points included quantification and qualification of the interventions conducted by a pharmacist. RESULTS Pediatric clinical pharmacists conducted discharge medication reconciliation and/or counseling for 60 patients during the first 2 months after implementation. There were 65 interventions performed, including 60 discharge medication reconciliations and 5 discharge counseling sessions. Of these interventions, 22 were recommendations on appropriate medication dosing and frequency (37%), 12 on duration of therapy (20%), and 8 were medication additions (13%). There were 6 interventions on adherence assistance (10%), 6 involved selection of medication formulation (10%), 3 involved medication discontinuation (5%), 2 involved appropriate therapy selection (3%), and 1 involved medication stability (1%). All interventions were accepted and implemented by the prescribing providers. CONCLUSIONS Pharmacist-driven discharge medication reconciliation and counseling programs targeting pediatric high-risk population might be an effective tool to mitigate gaps in transitions of care.

Abstract NS6: Connecting the Dots; a Pharmacist-Led Care Transition Model for Stroke Patients Post-Discharge

Background/Purpose: Stroke is a leading cause of adult disability worldwide, and one in four is due to recurrence, with the highest risk within the first 30 days post-discharge. Post-discharge follow-up is key to preventing hospital readmission and recurrent stroke. At our hospital, adult ischemic stroke (IS) patients are auto-enrolled in a pharmacist-led transitions of care program. Initially, our pharmacy team completes a medication history and reconciliation. Prior authorization and financial assistance services are offered. Patients who choose to remain enrolled are discharged with a 28-day supply of their medications, followed by all subsequent medications sent in adherence pill packs. Patients then receive a call 5-to-7 days post-discharge from a pharmacist to provide counseling on secondary stroke prevention and the importance of medication adherence. The pharmacist also ensures that the patient has scheduled follow-up appointments with both their primary care provider and the stroke clinic. Methods: In this retrospective cohort study, we included adult IS patients discharged from our center between October 2021 and July 2022. We compared those who chose to continue with our services beyond discharge with patients who opted out of our program. The primary outcome is medication adherence. The secondary outcome is the readmission rate. Results: Participation in our program resulted in an adherence rate of 98.5% compared with an adherence rate of 70.2% in those who declined to participate. Readmission was lower for participation, although not significantly so. Conclusions: Our program resulted in an improvement in medication adherence and a trend towards lower readmission rates amongst participating IS patients post-discharge. Further studies should be completed to examine the additional impacts of a pharmacist-led post-discharge program on secondary stroke prevention related to surrogate markers (Blood pressure, lipids, A1C, etc.) over time.

Enhancing Annual Wellness Visits: A Pharmacy-Driven Quality Improvement Approach With Multidisciplinary Collaboration.

Annual wellness visits (AWVs) guide appropriate patient care through lifestyle modifications, medication intervention, or social assistance. We launched a quality improvement program to target Medicare beneficiaries as part of an Accountable Care Organization (ACO). Key stakeholders collectively implemented a process consisting of two cohorts: AWVs completed with the support of the pharmacy team or directly by providers. A standardized workflow for the pharmacy cohort involved the clinical pharmacists and pharmacy extenders, allowing a layered learning experience. The AWV completion rate was optimized with the interventions of the pharmacy team.