Pharmacy Users Research Articles

Characteristics of online pharmacy users in a nationally representative sample

ObjectiveTo identify health care–related factors associated with online pharmacy use by considering patients’ prescription drug insurance coverage, number of prescriptions, health care expenditures, types of medications purchased, and health status. MethodsData were obtained from the Agency for Healthcare Research and Quality's 2002–2010 Medical Expenditure Panel Survey. Online pharmacy users were compared with nonusers across study variables in unadjusted and adjusted comparisons using logistic regression. Survey weights were applied to generate nationally representative estimates. ResultsA total of 443 online pharmacy users were identified, representing an average of 1.5 million individuals per year. Online users were found to be older and to have more prescriptions compared with nonusers, as well as to have higher health care expenditures and higher Charlson comorbidity index scores. Online users were also more likely to be privately insured, white, and married, and to be more educated. In logistic regression models, higher prescription expenditures (odds ratio [OR] 1.17 [1.05–1.32]), higher number of prescriptions (OR 5.13 [1.4–19]), medium to high income (OR 1.82 (1.3–2.5)], and use of erectile dysfunction drugs (OR 2.09 [1.06–4.10]) were associated with greater odds of online pharmacy use. Black race (OR 0.47 [0.3–0.72]), Medicaid insurance coverage (OR 0.23 [0.1–0.5]), and use of narcotic medications (OR 0.72 [0.53–0.97]) were associated with decreased odds of online pharmacy use. ConclusionThis study showed that age, race, income level, insurance coverage, high health care expenditures, and higher number of prescriptions are predictors for online pharmacy use.

Prevalence of medication management by community pharmacists in patients of a Newfoundland family medicine clinic.

Although the degree to which pharmacists may renew or adapt prescriptions varies widely by province, the overarching trend of expanded services is clearly growing.1-3 With the addition of reimbursement programs in some provinces1 and the introduction of prescriptive authority in others,2,4 there is clear growth in pharmacists’ scope of practice. As a result, pharmacists have more responsibility for and input into patient care. Medication management is an umbrella term that encompasses a variety of professional activities undertaken by a registered pharmacist to optimize safe and effective drug therapy outcomes for patients.5,6 Currently in Newfoundland and Labrador (NL), medication management includes providing an interim supply of medications, extending a prescription and adapting a prescription.6 The majority of Canadian pharmacists have the authority to provide these services; however, there are differences between provinces in what is permitted and how this authority is attained.7 In NL, both providing an interim supply and extending a prescription entail dispensing additional medication for a previously prescribed chronic therapy. When an interim supply is provided, the original prescription may have been filled at another pharmacy. An interim supply allows for a small quantity to be given that is usually less than one refill, to bridge the time needed for the patient to see his or her prescriber or to return to his or her usual pharmacy. When a prescription is extended, an additional refill of a 90-day supply or less is given for a medication previously filled at that pharmacy. Adapting a prescription includes changing the dosage form, regimen or quantity, filling in missing information and making a nonformulary generic substitution. These medication management services cannot be applied to a narcotic, controlled drug or targeted substance, including benzodiazepines.6 In 2010, changes to the NL Pharmacy Regulations permitted the use of medication management under the procedure outlined in the NL Pharmacy Board (NLPB) Standards of Pharmacy Practice.6,8 To provide this service, NL pharmacists must provide NLPB with a signed declaration indicating they have thoroughly read and understand the medication management standard of practice. As part of the fundamental requirements for performing medication management, NLPB states that in most instances the original prescriber or the patient’s primary health provider must be notified, preferably via faxing a standard form.6 In June 2012, the NL Prescription Drug Program (NLPDP) agreed to pay pharmacists for medication management services provided to NLPDP beneficiaries.9 The Ross Family Medicine Centre (RFMC) is an academic clinic in St. John’s, NL. Prescribers in this clinic include 5 family physicians, 1 nurse practitioner and family medicine residents. Although the RFMC provides care to patients of all ages, this clinic specializes in geriatric care. Medication management documentation received by the RFMC is scanned into patients’ electronic medical records. On January 28, 2013, the RFMC implemented a policy of referring patients to their community pharmacist for an interim supply or prescription extension if they ran out of medications prior to being able to see their prescriber. The change in policy was driven by the belief that this service would help to more effectively use prescribers’ time by reducing time addressing calls or faxes for medication refills, while maintaining continuity of treatment for patients. Currently, there are limited Canadian data on the use of interim supply and extending and/or adapting a prescription, and there is no information on these practices in NL. In the first year (2009) that this scope was in effect in British Columbia (BC), only 0.17% of prescriptions were renewed or adapted. Of those, 80% were prescription renewals.10 In contrast, when medication management labour costs among 10 BC pharmacists who were known high users of medication management were studied, adaptation or renewal was applied to 8.2% prescriptions over a 40-hour work period. Of those, only 47% involved renewing a prescription.11 Given the potential for optimization of patient care, a better understanding of the local prevalence of medication management use, including the frequency of specific medication management services, may lead to improvements in the process for pharmacists, prescribers and patients. The objectives of this study were to determine the prevalence of medication management use by NL community pharmacists in patients of the RFMC and to determine the frequency of the subcategories of medication management in this same population.

Estudio epidemiológico de la dermatitis atópica desde la farmacia comunitaria: Estudio DAFAC

Objectives: To design and evaluate the usefulness of a community pharmaceutical intervention in reference to atopic dermatitis consultations in the community pharmacy office, establishing consensus with dermatologists regarding the criteria for patient referral. To identify the most common reasons for consultation and determine which cases require referral to the physician. Methods: An epidemiological study was carried out in Spanish community pharmacies between February 2011 and January 2012, including all pharmacy users consulting due to skin problems. After receiving specific online training, the participating pharmacists applied the consensus-based intervention protocol. The reasons for consultation were registered, along with the cases of referral to the physician, the existence of overinfections, and the use of adequate products for skin care. Results/Discussion: A total of 259 pharmacies from 15 Spanish autonomous communities participated in the study, with the registry of 688 valid interventions. A total of 354 patients (51.5 %) were males and 334 (48.5 %) females, and disease conditions were found to be more frequent in patients under 14 years of age. In 70 % of the cases referral to the dermatologist was not necessary. Reasons for consultation: itching, irritation, sleep disturbances, anxiety and stress, and overinfection (35 %) as the main cause of referral. Development and diffusion of the protocol and referral criteria, as well as of the results of the study among the associates of SEFAC and the rest of community pharmacists will allow the resolution of many cases of atopic dermatitis – thereby contributing to improve patient quality of life.

Proactive pharmaceutical care interventions decrease patients’ nonadherence to osteoporosis medication

Using a protocolled intervention program, pharmacists can decrease nonadherence to osteoporosis medication, by continuous monitoring and tailored counseling sessions, starting at treatment initiation. In the usual care group, 32.8% of patients initiating osteoporosis medication discontinued or were nonadherent, compared to 19.0% of patients in the intervention group. While community pharmacies have been shown to offer a promising platform for osteoporosis management in patients with osteoporosis, more research is needed to determine pharmacists' effects on improving adherence. The aim of this study was to determine the effects of a community pharmacists' intervention program on the 1-year discontinuation and nonadherence rates of patients initiating osteoporosis medication. This intervention study included 937 patients, recruited from 13 Dutch community pharmacies, initiating osteoporosis medication. The intervention group (N = 495), received the Medication Monitoring and Optimization (MeMO) intervention, comprising of continuous monitoring of patients' adherence to their osteoporosis medication and tailored counseling sessions with nonadherent patients. Results were compared to an internal (n = 442) reference group, receiving usual pharmacy care. Primary study outcomes were therapy discontinuation and nonadherence; results were adjusted for potential confounders using Cox proportional hazard analysis. Secondary outcome was patients' satisfaction. In the usual care group, 32.8% of patients initiating osteoporosis medication discontinued or were nonadherent, compared to 19.0% of patients in the intervention group (P < 0.001). Ninety-three percent of the respondents were satisfied with the pharmacies' services provided. Notably, 31% mentioned that the pharmacy was the only place where they received information on various aspects of administration and acting of their medication. Pharmacists can decrease nonadherence and discontinuation with osteoporosis medication by providing tailored counseling sessions and continuous monitoring of drug use. Pharmaceutical care programs, such as MeMO, contribute to more optimal use of osteoporosis medication.

Gap Analysis between Patients’ Expectations and Services Provided by Pharmacy Store of a Tertiary Care Hospital

ABSTRACT Pharmacy store of hospital is among one the major revenue generating area of hospital. Its performance can be a vital element in the success of any upcoming hospital. Nowadays, not only the availability of prescribed drugs matters but explanation of dose, frequency and duration of drugs to be taken, behavior of pharmacist and waiting time to get drugs play an important role in satisfaction of patients. The pharmacy store of the hospital provides more specialized and more time-saving services for patients. It also eases the financial burden on pharmacy users via drug discounts. A cross-sectional comparative study was conducted on 90 respondents. A self administered predesigned, pretested, structured questionnaire was given to selected respondents on first contact to the pharmacy store of the hospital with the aim to study the perception of patients and hospital on various parameters. Seventy-one percent respondents appreciated the accessibility to pharmacy. When segregated by sociodemographic characteristics females showed greater level of satisfaction than males, respondents above 50 years of age, respondents who were unmarried, those who had came for a follow-up were most satisfied with services. Eighty-six percent respondents appreciated the politeness in communication by pharmacists. There was some discordance between the perception of patients and the perception of hospital in accessibility to pharmacy. A large number of respondents were satisfied with clarity and brevity of information given by pharmacy staff, the presence of pharmacist, and availability of prescribed drugs. How to cite this article Bajpai J, Gurbani NK. Gap Analysis between Patients’ Expectations and Services Provided by Pharmacy Store of a Tertiary Care Hospital. Int J Res Foundation Hosp Healthc Adm 2014;2(2):73-78.

Multiple pharmacy use and types of pharmacies used to obtain prescriptions

ObjectivesTo evaluate trends and patterns in the prevalence of multiple pharmacy use (MPU) and to describe the number and types of pharmacies used by multiple pharmacy users from 2003 to 2009. DesignRetrospective, cross-sectional, descriptive study. SettingUnited States from 2003 to 2009. Participants89,941 responses to the Medical Expenditure Panel Survey over 7 years. InterventionAnalysis of respondent pharmacy use behaviors. Main outcome measuresAnnual use of more than one pharmacy and number and types of pharmacies used. ResultsMPU among patients using medications increased significantly during the study period (from 36.4% [95% CI 35.2–37.6] in 2003 to 43.2% [41.9–44.4] in 2009)—a relative increase of 18.7% (P = 0.01). Multiple pharmacy users used between 2 and 17 different pharmacies per year to obtain prescription medications. Although approximately 70% of multiple pharmacy users used only two pharmacies, the proportion using three or more pharmacies increased from 24.1% (22.5–25.7) in 2003 to 29.1% (27.4–30.8) in 2009. Mail service pharmacy use had the largest relative increase among multiple pharmacy users during the study period (27.2%), and MPU was nearly twice as high (75%) among mail service users compared with non–mail service users. ConclusionMPU is common on a national level and has increased greatly in recent years. Patient use of pharmacies that have the potential to share medication information electronically is low among multiple pharmacy users, suggesting increased workload for pharmacists and potential medication safety concerns. This has important implications for pharmacists, as it potentially impedes their ability to maintain accurate medication profiles for patients.

How to attract them and keep them: the pharmacy attributes that matter to Australian residents with chronic conditions

To explore the attributes of pharmacy choice for people with chronic conditions. Semi-structured interviews were conducted between May and October 2012, across four regions in three Australian states. Purposive sampling was used to recruit participants with chronic conditions and unpaid carers. Interviews were analysed via the constant comparison method. Ninety-seven interviews were conducted. The majority of participants were regular patrons of one pharmacy and five attributes influenced this choice: patient-centred care, convenience, price, personal trait or preference and service/medication need. Patient-centred care, such as providing individualised medication counselling, continuity of care, development of relationships and respectful advice, emerged as an important attribute. There was minimal discussion as to choosing a pharmacy based on the provision of professional services, underscoring the limited consumer knowledge of such services and related standards of care. Patient-centred care is an important attribute of quality care as perceived by people who are regular community pharmacy users. These findings highlight the need for pharmacy staff to implement a patient-centred approach to care, thus meeting the perceived needs of their customers. A greater effort is also necessary to raise the profile of pharmacy as a healthcare destination.

Contested space in the pharmacy: Public attitudes to pharmacy harm reduction services in the West of Scotland

Internationally, community pharmacies have become increasingly involved in providing harm reduction services and health advice to people who use illicit drugs. This paper considers public opinion of community pharmacy services. It discusses attitudes to harm reduction services in the context of stigmatization of addiction and people who use drugs. This exploratory study involved twenty-six purposively sampled members of the public, from the West of Scotland, participating in one of 5 focus groups. The groups were composed to represent known groups of users and non-users of community pharmacy, none of whom were problem drug users. Three thematic categories were identified: methadone service users in community pharmacies; attitudes to harm reduction policies; contested space. Harm reduction service expansion has resulted in a high volume of drug users in and around some Scottish pharmacies. Even if harm reduction services are provided discretely users' behavior can differentiate them from other pharmacy users. Drug users' behavior in this setting is commonly perceived to be unacceptable and can deter other consumers from using pharmacy services. The results of this study infer that negative public opinion is highly suggestive of stereotyping and stigmatization of people who use drugs. Participants considered that (1) community pharmacies were unsuitable environments for harm reduction service provision, as they are used by older people and those with children; (2) current drug policy is perceived as ineffective, as abstinence is seldom achieved and methadone was reported to be re-sold; (3) people who use drugs were avoided where possible in community pharmacies. Community pharmacy harm reduction services increasingly bring together the public and drug users. Study participants were reluctant to share pharmacy facilities with drug users. This paper concludes by suggesting mechanisms to minimize stigmatization.

Factors affecting Medicare Part D beneficiaries’ decision to receive comprehensive medication reviews

To identify factors influencing Medicare Part D beneficiaries' decision to receive pharmacist-provided comprehensive medication reviews (CMRs) and to evaluate their experiences with pharmacist-provided CMRs. Cross-sectional descriptive study. Beneficiaries living in Maryland or Minnesota, from November 2011 to January 2012. Medicare beneficiaries of two Medicare Part D plans who had completed a previous telephone interview for a larger project of medication therapy management quality improvement. Self-reported mail survey. Responses to survey items assessing beneficiaries' perceived importance of proposed factors affecting their decision to receive CMRs and items evaluating patients' experiences with pharmacist-provided CMRs if they had one in the previous year. The valid response rate was 33.4% (238 of 713). Among the proposed factors, "knowing the out-of-pocket cost" (4.12 ± 1.28 [mean ± SD]) and "conducting in the usual pharmacy" (4.01 ± 1.37) were most important in making a decision to get a CMR. Factors rated significantly more important by those who had versus had not received a CMR included "usual pharmacy," "receiving medication list," "physician's support," and "pharmacists discuss changes with physicians." About one-third (30.6%) of respondents reported having pharmacist-provided CMRs within the previous year. Most respondents believed that having CMRs was important for their health (90.6%) and were satisfied with the results of CMRs (94.7%). Patients preferred their usual pharmacy or convenient places to have a CMR. Also, a collaborative pharmacist-physician working relationship would be helpful in providing CMRs. Patients who received CMRs expressed a positive attitude toward and satisfaction with pharmacist-provided services.

PIN99 - Disparities In Influenza Vaccinations Among Community Pharmacy Users And Non-Users

PIN99 - Disparities In Influenza Vaccinations Among Community Pharmacy Users And Non-Users

Assessment of Pharmacy Information System Performance in Selected Hospitals in Isfahan City During 2011

In supporting a therapeutic approach and medication therapy management, pharmacy information system acts as one of the central pillars of information system. This ensures that medication therapy is being supported and evaluated with an optimal level of safety and quality similar to other treatments and services. This research aims to evaluate the performance of pharmacy information system in three types of teaching, private and social affiliated hospitals. The present study is an applied, descriptive and analytical study which was conducted on the pharmacy information system in use in the selected hospitals. The research population included all the users of pharmacy information systems in the selected hospitals. The research sample is the same as the research population. Researchers collected data using a self-designed checklist developed following the guidelines of the American Society of Health-System Pharmacists, Australia pharmaceutical Society and Therapeutic guidelines of the Drug Commission of the German Medical Association. The checklist validity was assessed by research supervisors and pharmacy information system pharmacists and users. To collect data besides observation, the questionnaires were distributed among pharmacy information system pharmacists and users. Finally, the analysis of the data was performed using the SPSS software. Pharmacy information system was found to be semi-automated in 16 hospitals and automated in 3 ones. Regarding the standards in the guidelines issued by the Society of Pharmacists, the highest rank in observing the input standards belonged to the Social Services associated hospitals with a mean score of 32.75. While teaching hospitals gained the highest score both in processing standards with a mean score of 29.15 and output standards with a mean score of 43.95, and the private hospitals had the lowest mean scores of 23.32, 17.78, 24.25 in input, process and output standards respectively. Based on the findings, the studied hospitals had minimal compliance with the input, output and processing standards related to the pharmacy information system. It is suggested that the establishment of a team composed of operational managers, computer fields experts, health information managers, pharmacists as well as physicians may contribute to the promotion of the capabilities of pharmacy information system to be able to focus on health care practitioners' and users' requirements.

Impact of a community pharmacists' hypertension-care service on medication adherence. The AFenPA study

One of the main factors associated with the inadequacy of blood pressure control is patients' non-adherence to antihypertensive drug therapy. To determine the effect of an intervention program on antihypertensive medication adherence in the community pharmacy setting. Treated hypertensive patients were enrolled in a 6-month controlled study involving thirteen Spanish community pharmacies. A pharmacist intervention program which consisted of specific education on issues related to medication adherence and hypertension was provided. Additionally, patients were provided with a home blood pressure monitoring device and instructed to measure their blood pressure. The control group received usual pharmacy care. Antihypertensive medication adherence was evaluated by pill counts at baseline and at the end of the study. Data from 176 patients were included in and analyzed in the study: 89 in the control group and 87 in the intervention group. The percentage of adherence for intervention group patients increased between baseline and the end of the study (86.0% vs. 96.5%), while it didn't change in the control group (86.5% vs. 85.4%). The proportion of patient adherence at the end of the study was higher in the intervention group compared to the control group (96.5% vs. 85.4%; P = .011). The odds of adherence to antihypertensive drug therapy in the intervention group was 4.07 (95% CI: 1.04-15.95; P = .044) times higher than the control group. In this sample of treated hypertensive patients, the pharmacist intervention was associated with significant improvement in antihypertensive medications adherence, compared to usual care.

Pharmacy surveillance and low-literacy pharmacist intervention

McCoy et al. 1. McCoy A.B. Cox Z.L. Neal E.B. et al. Real-time pharmacy surveillance and clinical decision support to reduce adverse drug events in acute kidney injury: a randomized, controlled trial. Appl Clin Inform. 2012; 3: 221-238 Crossref PubMed Scopus (29) Google Scholar concluded that real-time “pharmacy surveillance had no incremental benefit” compared with preexisting clinical decision support (CDS) systems (e.g., computer alerts) in detecting and preventing medication errors. Nearly 400 acute kidney injury patients were studied in a 3-month randomized clinical trial. Adult patients were enrolled who experienced a ±0.5 mg/dL change in serum creatinine over 48 hours. They had an active order for one or more nephrotoxic or renally cleared medications. In addition to CDS alerts and usual care pharmacy services (e.g., rounding with medical and surgical teams), the intervention included real-time monitoring of drug prescribing and kidney function trends by pharmacists using a Web-based surveillance tool. Blinded judges determined that potential or actual adverse drug events (ADEs) occurred for 104 (8.0%) usual care and 99 (7.1%) intervention group patients (P = 0.4). Time until providers modified or discontinued targeted nephrotoxic or renally cleared medications did not differ between usual care and intervention patients (33.4 vs. 30.3 hours, P = 0.3).

Factors associated with adherence to phosphodiesterase type 5 inhibitors for the treatment of pulmonary arterial hypertension

Objectives:To assess factors associated with adherence to phosphodiesterase type 5 inhibitors (PDE5Is) in the management of pulmonary arterial hypertension (PAH).Methods:This study analyzed pharmacy benefit claims of naïve Adcirca and Revatio users between January 1, 2008 and December 31, 2010. Patients were considered adherent if their proportion of days covered (PDC) was ≥ 80% over a 6-month period. Logistic regressions were estimated to assess the factors associated with adherence. Analyses were stratified by use of a specialty pharmacy or retail pharmacy. A sensitivity analysis was performed by excluding individuals with 90-day supply.Results:Of the total of 2143 patients included, 46.8% were adherent. Adherence was higher among 930 specialty pharmacy users (65.6%) than 1213 retail pharmacy users (32.3%, p < 0.001). Adherence was higher among Adcirca users (60.7%; approved dose 40 mg once-daily) than Revatio users (44.3%, p < 0.001; approved dose 20 mg thrice-daily). Among retail pharmacy users, adherence was higher in patients using Adcirca (OR = 2.59; 95% CI = 1.60–4.22) and patients with an index prescription given by pulmonologists (OR = 1.70; 95% CI = 1.15–2.50), while lower in patients with higher copayment ($51–$250: OR = 0.61, 95% CI = 0.42–0.90; $251+: OR = 0.57, 95% CI = 0.39–0.83). Among specialty pharmacy users, only high copayment ($251+: OR = 0.56, 95% CI = 0.35–0.90) was found to be a significant factor for non-adherence. After excluding individuals with 90-day supply, adherence rate was 29.6% in retail pharmacy and 57.9% in specialty pharmacy (p < 0.001), and regression results were similar.Limitations:Diagnosis of PAH was not confirmed without access to medical claims. Pharmacy refill records might not reflect actual consumption. Adherence evaluated for 6 months might not be generalizable to longer periods.Conclusion:Adherence to PDE5Is for PAH is sub-optimal. The findings suggest that adherence to PDE5Is in patients with PAH is associated with the use of specialty pharmacy, simpler dosing frequency, a lower financial barrier, and a prescription given by pulmonologists.

Abstracts and Index of Authors

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution’s outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy. Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test. Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; χ 2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; χ 2 = 929.04, p < 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; χ 2 = 52.5; p < 0.001). Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.

Improved antiretroviral refill adherence in HIV-focused community pharmacies

To determine differences in patient characteristics, antiretroviral therapy (ART) regimen characteristics, and regimen refill adherence for human immunodeficiency virus (HIV)-focused pharmacy (HIV-P) versus traditional pharmacy (TP) users. Retrospective cohort study. California Walgreens pharmacies from May 2007 to August 2009. HIV-positive patients with greater than 30 days of antiretroviral prescription claims. Deidentified prescription records for patients filling any ART prescription at any California Walgreens pharmacy during the study period were assessed. ART regimen refill adherence (calculated by modified medication possession ratio [mMPR]) and dichotomous measure of optimal adherence of 95% or greater. 4,254 HIV-P and 11,679 TP users were included. Compared with TP users, HIV-P users traveled farther to pharmacies (5.03 vs. 1.26 miles, P < 0.01). A greater proportion of HIV-P users filled prescriptions for chronic diseases (35% vs. 30%) and received fixed-dose combination antiretroviral tablets (92% vs. 83%) (all P < 0.01). Median mMPR was higher for HIV-P users (90% vs. 77%, P < 0.0001). After adjusting for age, gender, insurance, medication use, and distance from pharmacy, use of HIV-P (odds ratio 1.90 [95% CI 1.72-2.08]) and fixed-dose combination antiretroviral tablets (3.34 [2.84-3.96]) were most strongly associated with having 95% or greater ART regimen refill adherence. For HIV-positive patients struggling with antiretroviral adherence, clinicians may consider minimizing pill burden with combination tablets and referral to an HIV-focused pharmacy.

Impact of HIV-Specialized Pharmacies on Adherence and Persistence with Antiretroviral Therapy

Patient adherence (the degree to which patients follow their therapeutic regimen as prescribed within a set period of time) and persistence (the time to treatment discontinuation, with a permissible gap) with drug therapy are essential components of HIV/AIDS treatment. Select community pharmacies offer specialized services for HIV/AIDS patients to help combat some of the barriers to adherence and persistence. We assessed adherence and persistence with antiretroviral therapy (ART) for patients using HIV-specialized pharmacies in nine cities from seven states compared to traditional community pharmacy users over a 1-year period. Data were limited to one pharmacy chain. Propensity scoring was used to obtain 1:1 matches for "Specialized" and "Traditional" pharmacy users based on age, gender, number of prescription-inferred chronic conditions (obtained by mapping a patient's prescriptions to the Medi-Span Drug Indications Database), and presence of prescription anxiety and/or depression medication, resulting in 7064 patients in each group. Proportion of days covered (PDC) was used to measure adherence. Specialized pharmacy users had a significantly greater mean (74.1% versus 69.2%, p<0.0001) and median (90.3% versus 86.3%, p<0.0001) PDC. A greater percentage of patients in the Specialized group were able to obtain a PDC of 95% or better (39.3% versus 35.5%). Patients in the Specialized group were significantly more persistent (p=0.0117). Community pharmacies specialized in HIV services may be effective avenues for helping patients achieve greater adherence and persistence with ART. Given the value of specialized community pharmacies, payers should consider implementing policies to encourage the use of such pharmacies for filling ART.

The Study on Service Design Development for Pharmacy Users: Using Smart Phone Application

Objective: This study is to review the current state of services offered to pharmacy users, and develop a service design converging a prescription service and a smart phone application service in order to enhance patients’ experience at pharmacies and home. Background: Under the new medical system; separation of prescribing and dispensing drugs, a doctor writes a prescription to their patients and patients have their prescription filled at the pharmacy. As the number of flue, allergy and atopy patients has increased, waiting lines have been longer at pharmacies. Besides, the current medical service system lacks of providing proper information on prescribed pills to patients. There are already services offered during waiting times such as offering free drinks, magazines or suggesting general drugs which you can buy without prescription, however they neither cover the current medical service’s shorts nor shorten the waiting time. Method: I researched objective and perceived waiting times reduction methods, the current service status at pharmacies, and the government’s policy direction in a medical service. Also, I observed a patient’s journey from the hospital to pharmacy and then horne. I examined the circumstance at pharmacies, patients’ behaviors and their thoughts during their journey, and extracted three main goals to design a service in order to help patients have positive perception during the waiting time; (1) to reduce the perceived time by the way of visualizing time and offering readings about what patients consider necessary, (2) to educate patients what they are into and how to get through, (3) to establish trust among patients, doctors and pharmacists. Based on three goals, I designed a structure and a wireframe for a new service application of smart phones. Results: With a new service design for pharmacy users, users can track their medical record and visit the information about their current medical treatments anytime. Also the service helps patients build reliable relationships with doctors and pharmacists. Conclusion: Experience is not just an activity but series of multiple activities. The serving range of a medical service should not be determined by stakeholders but user’s holistic experience. By approaching a service design with a holistic vision, it can enrich not only a temporary experience but also a whole life well being. Application: Since there are already many service applications advising patients about their illness and finding right doctors, this service design is focused on the experience from getting a prescription till feeling better. The next move is to combine those two parts medical services and design an integrated service application. As a prescription is going to be coded in numbers, we might consider to design an un-attended pharmacy which can shorten huge amount of time for filling prescriptions.

Don't Leave Without Them: Dispensing asthma medications to pediatric patients upon discharge is associated with decreased hospital readmissions

Purpose: Asthma exacerbations are a leading cause of hospital and emergency department admissions at pediatric institutions. The objective of this study was to determine if patients who obtain discharge medications from a pediatric institution's outpatient pharmacy after an admission for asthma have a lower thirty-day readmission rate than those who do not obtain discharge medications from the outpatient pharmacy.&#x0D; Methods: This multi-phase retrospective study included an initial chart review, an intervention period, and a second chart review of the intervention period. The chart reviews included patients ages two years and older with a discharge diagnosis of asthma or wheezing. During the intervention phase, pharmacists promoted use of the outpatient pharmacy by patients admitted for these conditions using multiple methods. In each chart review, the patients readmitted for asthma or wheezing within thirty days were classified as either outpatient pharmacy users (OPP users) or non-OPP users. Differences in readmission rates between OPP users and non-OPP users, as well as differences in overall OPP utilization, were analyzed before and during the intervention phase using a Chi-square test.&#x0D; Results: The initial chart review found no significant difference in thirty day readmission rates between OPP users and non-OPP users (6.2% and 7.5%, respectively; x2 = 1.15; p = 0.274). The number of OPP users increased significantly from the first chart review to the second (11.8% and 45.9%, respectively; x2 = 929.04, p &lt; 0.001). The second chart review revealed that OPP users had a significantly lower readmission rate than non-OPP users during the intervention phase (2.3% and 10.9%, respectively; x2 = 52.5; p &lt; 0.001).&#x0D; Conclusion: Obtaining discharge medications from the OPP was associated with a lower thirty-day readmission rate in children with asthma. Promoting use of the OPP for transitional care should continue to be part of future efforts to decrease hospital readmissions.&#x0D; &#x0D; Type: Original Research

Slovenian pharmacy performance: a patient-centred approach to patient satisfaction survey content development

To identify content of pharmacy performance relevant to patient satisfaction. Interviews with pharmacy users were conducted at their homes. The Delphi meeting was run at the Faculty of Pharmacy, Ljubljana, Slovenia. A two-phase process was employed. In Phase I, interviews with 43 pharmacy users were conducted to identify patients' experiences and expectations relating to pharmacies. The content analysis of their responses resulted in a list of themes from which items were generated. In Phase II, a 10 member expert panel was employed in a two round Delphi technique to rate the importance of each item for the patient satisfaction. Themes derived from the interviews and their importance for patient satisfaction as assessed by the expert panel. Seventy-nine themes were generated from the survey responses which were grouped into four main categories: 'Relations', 'Counseling', 'Physical facilities and location' and 'Process'. In total, 69 items were generated. The expert panel rated 84% of generated items as very or somewhat important. The qualitative study provides insights on the content of pharmacy performance relevant to patients. Identified categories encompass a wide range of issues that contribute to patient satisfaction with pharmacy performance.