Points Of Dispensing Research Articles

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.

Hospital-Based Preparedness Measures for CBRNE Disasters: A Systematic Review.

Chemical, Biological, Radiological or Nuclear and Explosive (CBRNe) disasters have historically caused significant fatalities and posed global threats. The inadequate preparedness of hospital equipment for CBRNe incidents underscores the urgent need for hospitals to modernize and standardize their equipment to effectively manage these high-risk situations. The purpose of this systematic review was to examine hospital-based preparedness measures for CBRNe incidents. The PRISMA guidelines were followed for this review. A comprehensive search of English-language peer-reviewed literature from January 2010 to 2023 was conducted, identifying 2191 items from PubMed, ScienceDirect, EBSCO, and Google Scholar. The modified ROBINS-I instrument was used to assess bias, ensuring the reliability and validity of the studies. Data synthesis was conducted jointly by both authors. After eliminating duplicates and reviewing abstracts, 124 studies remained. Upon full-text examination, only 20 studies met the criteria for inclusion in this review. The review identified three key interrelated domains of preparedness: personal, technological, and structural measures. Most studies emphasized decontamination, Personal Protective Equipment (PPE), and detection, while the management of deceased bodies, transportation, and Points of Dispensing (PODs) were largely overlooked. These findings may assist hospital administrators and policymakers in enhancing their facilities' readiness for CBRNe emergencies.

Assessing the impact of an electronic chemotherapy order verification checklist on pharmacist reported errors in oncology infusion centers of a health-system.

Chemotherapies are medications with narrow therapeutic indices and potential for severe adverse events that account for at least 1 to 3% of medication errors in all adult and pediatric oncology patients. The use of an electronic chemotherapy order verification (ECOV) checklist can standardize the steps of chemotherapy verification by pharmacists, which can potentially increase medication error detection at the point of dispensing. This study evaluated the implementation of a standardized chemotherapy order verification checklist on pharmacist error reporting, particularly good-catches or near-misses type errors. This retrospective, quasi-experimental, pre-/post-analysis of internal voluntary medication errors reported from 12 University Hospitals Seidman oncology infusion centers from June 2022 through December 2022. Error reports, categorized based on severity, were compared pre/post-implementation of the ECOV checklist. A total of 62 and 71 cases of medication errors were reported in the pre-intervention and post-intervention periods, respectively. The rate of pharmacy reported medication errors was 2.4 times greater in the post-intervention period of the ECOV checklist (p < 0.006). Pharmacy reported errors increased among all error severities reported. However, the finding did not deduce a statistically significant difference (p < 0.244). This study demonstrates the effectiveness of implementing the ECOV checklist in increasing the rate of pharmacy reported medication errors. The checklist was designed to complement existing pharmacist workflow and provide a source of documentation for steps of sequential pharmacist evaluation.

Community pharmacists’ views about prescription medicine co-payments and potential implications for equitable access to medicines: a critical realist interpretation

BackgroundIn many countries the community pharmacist’s role includes collecting prescription medicine co-payments at the point of dispensing. This is a context which can provide unique insights into individuals’ access to prescription medicines, as interactions with service users about out-of-pocket (OOP) expenses that may negatively affect a pharmacist’s patient counselling role. Prior research has identified that OOP expenses for prescription medicines led to decreased treatment adherence. This study aims to understand the role of community pharmacists in the collection of co-payments for prescription medicines in one region of Aotearoa New Zealand, and the possible implications for equitable access to medicines.MethodsThis is a qualitative study using a case study research design. Data were collected through focus groups, individual interviews, and an electronic survey. Using a critical realist approach in thematic analysis, findings were categorised as Causal tendencies (the things that cause the events); Events (the things that community pharmacists experience); and Experiences (the perceptions and feelings of individual participants).ResultsOur analysis finds that the current profession of community pharmacy in Aotearoa New Zealand, is under strain. The results suggest that broader government policies, such as the pharmacist’s role in delivering essential health services, the fairness of standard prescription co-payments, and the role of community pharmacists as gatekeepers, have a significant influence on the profession. In addition, the study found that individual community pharmacists have a unique position in the co-payment process, face power imbalances within their role, and the study indicates evidence of value judgements towards service users.ConclusionsThis study is exploratory; however, its examination of the policy of prescription medicine co-payments from the perspective of community pharmacists, who play a vital role in both dispensing medicines and collecting prescription medicine co-payments, is novel. Despite prescription medicine co-payments being a routine part of pharmacists’ role in many countries, it is a topic where there is limited published peer-reviewed literature. The study adds to existing evidence that funding models influence community pharmacists’ role. In addition, this study identified value judgements about service users in relation to prescription medicine co-payments which may influence service users’ health-seeking behaviour. In this setting, limited representation of at-risk populations in the community pharmacy profession may be a factor that negatively influence interactions between pharmacists and service users.

Improving disaster relief plans for hurricanes with social media

Decisions on humanitarian responses to natural disasters are subject to considerable epistemic uncertainty. This paper advocates for postponing the decision point of pre-positioning relief supplies as close to landfall as possible and searching social media right post-landfall so that the demands can be estimated more accurately. We use a realistic hurricane preparedness case to demonstrate the effectiveness of our models and parametric estimation using social media data. The optimal timing to deploy relief supplies before hurricane landfall is noted to be 12 h in advance, which reduces the total cost by 13% more than if relief supplies are deployed 18+ hours in advance. Meanwhile, utilizing social media information can reduce the total cost as well as all kinds of specific costs being considered, excluding the point of dispensing (POD) sites setup cost, by approximately 15%. As the attitude toward risk goes from optimistic, to neutral, and to pessimistic, the number of PODs increases from 3 to 7, and to 8. A similar pattern can be noted in the total costs incurred by these decision-makers. Further, as the aversion to risk increases, locations tend to be chosen farther from landfall with these farther locations serving the less severe patients.

Points-of-Dispensing (PODs) 위치를 고려한 긴급물류창고 위치 선정

The significance of choosing optimal locations for emergency facilities is emphasized both in natural disasters and public health emergencies like pandemics. To ensure effective management of emergency logistics, procurement, and distribution, it is crucial to consider the establishment of facilities such as Points-of-Dispensing (PODs) that facilitate fast and efficient distribution. Consequently, when deciding on the location of logistics warehouses as part of emergency logistics management, it is essential to take into account the positioning of temporary facilities like PODs. We propose an integer programming model that integrates the Maximal Covering Location Problem (MCLP) and includes capacity constraints. Additionally, we conducted a case study in Incheon Metropolitan City to compare the outcomes. Through this case analysis, we present the optimal subset of temporary logistics warehouses, enabling the development of an optimal location-distribution plan. The study holds three main implications: (1) it provides an optimized selection of locations that aids in the decision-making process for policies; (2) the empirical analysis using real data allows for its application in similar disaster management situations; (3) the proposed model can be utilized to determine the positioning of various public facilities

Challenges in managing, sustaining, and assessing closed point of dispensing sites: Findings from a qualitative study.

Most U.S. public health agencies rely upon closed points of dispensing (PODs) to aid in medical countermeasure (MCM) distribution. However, few studies have focused on how to assess closed POD preparedness and none have examined best practices for managing sites once they have been recruited. This study involved qualitative interviews with U.S. disaster planners to elucidate their approaches and challenges to managing, sustaining, and assessing existing closed POD sites. In all, 16 disaster planners participated. Common management practices included frequent communication with sites, providing formal and informal training, and assisting with POD exercises. Very few jurisdictions reported doing formal assessments of closed POD sites. The largest challenges identified were staff turnover and keeping sites engaged, sometimes leading to sites voluntarily withdrawing or needing to be removed from being a closed POD. Frequent communication and building partnerships with closed POD site personnel were recommended to maintain and sustain existing sites. Formal and informal assessments will provide assurance of deployment readiness. Closed POD management is a challenging, but essential process to ensure readiness to deploy. Practices outlined by this study can be implemented to enhance closed POD network management at other jurisdictions. This should increase the ability to distribute MCMs rapidly during a future event, contributing to stronger community resilience. Public health officials should continue expanding and improving closed POD networks to enable MCM delivery and minimize morbidity and mortality related to mass casualty events.

Academic Center Partnership with Health Department and Church to Rapidly Deploy COVID-19 Vaccine POD Reaching Underserved Populations

The COVID-19 pandemic has disproportionately impacted people of color, underscoring the importance of equity in the public health response. The Duquesne University Center for Integrative Health (DUCIH) is a university-wide center focused on training future practitioners and improving health equity in the Pittsburgh region. DUCIH’s initial pandemic response included a virtual adaptation of community health programs and supporting partners’ testing and vaccination efforts. In March 2021, the Allegheny County Health Department (ACHD) asked DUCIH to establish a vaccine Point of Dispensing (POD) at Central Baptist Church in Pittsburgh’s Hill District, to reach underrepresented populations. DUCIH engaged the Schools of Health Sciences, Nursing, and Pharmacy and multiple university offices to recruit an interprofessional team of 263 volunteers. From March to June 2021, the POD administered 5,652 vaccines in an underserved neighborhood, with a majority of doses administered to people of color, meeting the POD’s aim. This university-church partnership has continued with vaccine clinics and health screenings. This case study shares lessons for rapid response to public health emergencies through university-wide collaboration with community partners. Universities with health science schools should cultivate relationships with local health departments to promote awareness of these capabilities.

A Survey of Location-Allocation of Points of Dispensing During Public Health Emergencies.

Public health emergencies such as disease outbreaks and bioterrorism attacks require immediate response to ensure the safety and well-being of the affected community and prevent the further spread of infection. The standard method to increase the efficiency of mass dispensing during health emergencies is to create emergency points called points of dispensing (PODs). PODs are sites for distributing medical services such as vaccines or drugs to the affected population within a specific time constraint. These PODs need to be sited in optimal locations and have people (demand points) assigned to them simultaneously; this is known as the location-allocation problem. PODs may need to be selected to serve the entire population (full allocation) or different priority or needs groups (partial allocation). Several previous studies have focused on location problems in different application domains, including healthcare. However, some of these studies focused on healthcare facility location problems without specifying location-allocation problems or the exact domain. This study presents a survey of the PODs location-allocation problem during public health emergencies. This survey aims to review and analyse the existing models for PODs location-allocation during public health emergencies based on full and partial demand points allocation. Moreover, it compares existing models based on their key features, strengths, and limitations. The challenges and future research directions for PODs location-allocation models are also discussed. The results of this survey demonstrated a necessity to develop a variety of techniques to analyse, define and meet the demand of particular groups. It also proved essential that models be developed for different countries, including accounting for variations in population size and density. Moreover, the model constraints, such as those relating to time or prioritizing certain groups, need to be considered in the solution. Finally, additional comparative studies are required to clarify which methods or models are adequate based on predefined criteria.

Walking distance for vulnerable populations to public health emergency response points of dispensing in New York City.

During certain public health emergencies, points of dispensing (PODs) may be used to rapidly distribute medical countermeasures such as antibiotics to the general public to prevent disease. Jurisdictions across the country have identified sites for PODs in preparation for such an emergency; in New York City (NYC), the sites are identified based largely on population density. Vulnerable populations, defined for this analysis as persons with income below the federal poverty level, persons with less than a high school diploma, foreign-born persons, persons of color, persons aged ≥65 years, physically disabled persons, and unemployed persons, often experience a wide range of health inequities. In NYC, these populations are often concentrated in certain geographic areas and rely heavily on public transportation. Because public transportation will almost certainly be affected during large-scale public health emergencies that would require the rapid mass dispensing of medical countermeasures, we evaluated walking distances to PODs. We used an ordinary least squares (OLS) model and a geographically weighted regression (GWR) model to determine if certain characteristics that increase health inequities in the population are associated with longer distances to the nearest POD relative to the general NYC population. Our OLS model identified shorter walking distances to PODs in neighborhoods with a higher percentage of persons with income below the federal poverty level, higher percentage of foreign-born persons, or higher percentage of persons of color, and identified longer walking distances to PODs in neighborhoods with a higher percentage of persons with less than a high school diploma. Our GWR model confirmed the findings from the OLS model and further illustrated these patterns by certain neighborhoods. Our analysis shows that currently identified locations for PODs in NYC are generally serving vulnerable populations equitably-particularly those defined by race or income status-at least in terms of walking distance.

Extreme heat at outdoor COVID-19 vaccination sites

Extreme heat is an increasing climate risk due to climate change and the urban heat island (UHI) effect and can jeopardize points of dispensing (PODs) for COVID-19 vaccination distribution and broader public health emergency preparedness (PHEP) response operations. These PODs were often located on large parking lot sites with high heat severity and did not take heat mitigation or management strategies into account for unacclimated workers and volunteers. To investigate the personal heat exposure of workers, volunteers, and clients at three PODs in Tucson, Arizona, we collected ambient air temperatures, wet bulb globe temperatures (WBGT), surface temperatures, and thermal images. We also made qualitative observations and compared data against daily meteorological records. Ambient air temperatures at all three PODs exceeded the meteorological recorded high. WBGT on average were 8°F (4.4 °C) higher in full sun locations than shaded locations such as tents. Evaporative cooling decreased ambient air temperatures by 2°F (1.2 °C) when placed one per tent, but decreased ambient air temperatures by 7°F (3.9 °C) when placed en masse in a larger tent. Vehicle surface temperatures exceeded recommended safe limits of 140°F (60 °C) at all three sites, with a maximum temperature recorded at 170.9°F (77.2 °C). Public health professionals should consider heat resilience, including heat mitigation and management measures, in POD and PHEP response operations to reduce exposure. This includes considering the UHI effect in the siting of PODs, applying heat mitigation strategies in the design of PODs such as the adaptive use of solar panels for shading, and improving heat safety guidance for workers and volunteers.

COVID-19 Vaccination of HCWs in the First Phase of a Large-Scale Mass Vaccination Program within a Healthcare System

Background: The approval of the first SARS-COV-2 vaccines for COVID-19 were accompanied by unprecedented efforts to provide vaccination to healthcare workers and first responders. More information about vaccine uptake in this group is needed to better refine and target educational messaging. Methods: HCA Healthcare used federal guidance and internal experience to create a systemwide mass vaccination strategy. A closed point-of-dispensing (POD) model was developed and implemented. The previously developed enterprise-wide emergency operations strategy was adapted and implemented, which allowed for rapid development of communications and operational processes. A tiering strategy based on recommendations from the National Academies was used in conjunction with human resources data to determine vaccine eligibility for the first phase of vaccination. A comprehensive data and reporting strategy was built to connect human resources and vaccine consent data for tracking vaccination rates across the system. Results: Vaccination of employed and affiliated colleagues began December 15, 2020, and was made available based on state-level release of tiers. Within the first 6 weeks, in total, 203,544 individuals were eligible for vaccine based on these criteria. Of these, 181,282 (89.1%) consented to and received vaccine, 19,788 (9.7%) declined, and 2,474 (1.2%) indicated that they had already been vaccinated. Of those eligible, the highest acceptance of vaccine was among the job codes of specialists and professionals (n = 7,914 total, 100% consent), providers (n = 23,335, 99.6%,), and physicians (n = 3,218, 98.4%). Vaccine was most likely to be declined among job codes of clerical and other administrative (n = 12,889 total, 80.1% consent), clinical specialists and professionals (n = 22,853, 81.0%,) and aides, orderlies and technicians (n = 17,803, 82.6%,). Registered nurses made up the largest eligible population (n = 56,793), and 89.5% of those eligible consented to receive vaccination. Average age among those who consented was slightly older (48.3 years) than those that declined (44.7 years), as was length of employment tenure (6.9 vs 5.0 years). Conclusion: A large-scale, closed POD, mass vaccination program was able to vaccinate nearly 200,000 healthcare workers for SARS-CoV-2 in 6 weeks. This program was implemented in acute-care sites across 20 different US states, and it was able to meet the various state-level requirements for management of processes, product, and required reporting. The development of a standardized strategy and custom, centralized monitoring and reporting facilitated insight into the characteristics of early vaccine adopters versus those who decline vaccination. These data can aid in the refining and targeting of educational materials and messaging about the SARS-CoV-2 vaccine.Funding: NoDisclosures: None

Leveraging Local and Regional Partners to Implement Hospital Closed Point of Dispensing Sites

Background: Point of dispensing (POD) sites are critical to local public health agencies (LPHA) when an emergen-cy occurs requiring medications or vaccinations. Delivering medical countermeasures (MCM) ensures community support mechanisms and the general public are provided with a pharmaceutical intervention to limit untoward outcomes caused by the emergency. While LPHAs are required to have an MCM response plan, these plans vary based on jurisdictional size and geographical location in Ohio. This study evaluated the implementation potential of an MCM toolkit developed for LPHAs and hospitals across Ohio. Methods: An MCM toolkit was created consisting of planning resources, training modules, sample exercises, and custom graphics. The toolkit was evaluated using Consolidated Framework for Implementation Research constructs by public health, hospital, hospital association, and emergency management professionals across Ohio by an electronic sur-vey and phone interview. Qualitative and quantitative data were collected to determine overall implementation potential. Results: Thirty-eight (n=38) respondents with jurisdictional influence over 44 Ohio counties participated. Electronic survey results demonstrated high implementation potential for the MCM toolkit (weighted average 4.71/5.00). Phone interviews highlighted: (1) jurisdictional and regionalized planning approaches were necessary for MCM delivery, and (2) hospitals should function as closed POD sites for jurisdictional LPHAs. Conclusion: This work demonstrates the importance of MCM response planning for LPHAs and hospitals. Imple-mentation and planning materials for this work could be adopted into practice by LPHAs and hospitals across the United States to further assist in emergency preparedness planning.

Approaches, Successes, and Challenges in Recruiting Closed Points of Dispensing Sites: A Qualitative Study.

Closed points of dispensing (PODs) are an essential component of local public health preparedness programs because most local public health agencies lack the infrastructure to distribute medical countermeasures to all community members in a short period of time through open PODs alone. However, no study has examined closed POD recruitment strategies or approaches to determine best practices, such as how to select or recruit an agency, group, or business to become a closed POD site once a potential partner has been identified. We conducted qualitative interviews with US disaster planners to identify their approaches and challenges to recruiting closed POD sites. In total, 16 disaster planners participated. Recruitment considerations related to selecting sites, paperwork needed, and challenges faced in recruiting closed POD sites. Important selection criteria for sites included size, agencies or businesses with vulnerable or confined populations who lack access or ability to get to or through open POD sites, and critical infrastructure organizations. Major challenges to recruitment included difficulty convincing sites of closed POD importance, obstacles with recruiting sites that can administer mass vaccination, and fear of legal repercussions related to medical countermeasure dispensing or administration. Closed POD recruitment is a frequently challenging but highly necessary process both before and during the current pandemic. These recommendations can be used by other disaster planners intending to start or expand their closed POD network. Public health agencies should continue working toward improved distribution plans for medical countermeasures, both oral and vaccine, to minimize morbidity and mortality during mass casualty events.

How community pharmacists envision using pharmacogenomic data: A qualitative analysis

BackgroundNearly 300 medications contain pharmacogenomic information in their labeling approved by the U.S. Food and Drug Administration. As this number continues to grow, community pharmacists will be called on to use available pharmacogenomic data at the point of dispensing. ObjectiveThis qualitative study aimed to describe how pharmacists envision the integration of pharmacogenomic data into the current workflows of community pharmacy practice. MethodsCommunity pharmacists from a regional supermarket chain pharmacy in the greater Pittsburgh area were interviewed using a semistructured interview guide. Participating pharmacists were presented with 3 clinical scenarios, followed by questions, to gain insight into how they envisioned the integration of pharmacogenomic data into community pharmacy workflow. The interview transcriptions were transcribed and coded. The content was analyzed to deduce the final themes. Supporting quotes were selected to illustrate each theme. ResultsTen community pharmacists from 3 different pharmacy locations participated in the study. A thematic analysis produced 6 themes: (1) integrating pharmacogenomic data into the dispensing software, (2) receiving an alert for pharmacogenomic information within the dispensing software, (3) accessing pharmacogenomic clinical guidelines to guide drug–decision-making, (4) contacting the prescriber by adding a task to the call queue, (5) placing a mandatory counseling alert on medications that were adjusted using pharmacogenomic data, and (6) counseling the patient on the first refill of a medication that was adjusted using pharmacogenomic data. ConclusionThis study describes how pharmacists envisioned the integration of pharmacogenomic data into community pharmacy workflow. The participants sought the integration of pharmacogenomic data into existing dispensing software, alerts for actionable prescribing changes using patient-specific pharmacogenomic data when available, and access to clinical decision support. In addition, the participants preferred to engage prescribers and receive alerts to counsel patients at prescription pick-up. These findings are key to integrating pharmacogenomic data into community pharmacy practice.

POD variant comparisons.

Points of distribution, also known as points of dispensing (POD), are a means for public and private organizations to assist their communities in times of crisis. There are two principal categories of PODs, open and closed, but all PODs differ in design, properties, and application. This study investigates two POD variations: drive-through and supervisor, which have their own unique requirements for being stood up, run, and shut down, as well as differing requirements for planning, staffing, and logistics. There are also similarities in the requirements that each POD category share which lead to certain efficiencies in planning for POD standup, execution, and shutdown. The primary findings of this paper are that planners cannot rely on one POD design and its properties to accommodate every situation, and each POD design has its own strengths and weaknesses. These are related to staffing, security, space requirements, and material logistics needs. Flexibility should be exercised when choosing the correct design, and implementing the proper strategy is key to standing up and executing a POD that will best serve a community. Every situation is different and factors such as population, available infrastructure, resource requirements, and individual skill of the POD staff all influence the design of a POD. Planners should consider resources such as available volunteers, trained personnel (medical and security), and buildings or outdoor space available to run a POD. With proper planning, a POD is an excellent tool to effectively and efficiently serve the public.

I Spy with My Little Eye: A Paediatric Visual Preferences Survey of 3D Printed Tablets.

3D printing (3DP) in the pharmaceutical field is a disruptive technology that allows the preparation of personalised medicines at the point of dispensing. The paediatric population presents a variety of pharmaceutical formulation challenges such as dose flexibility, patient compliance, taste masking and the fear or difficulty to swallow tablets, all factors that could be overcome using the adaptable nature of 3DP. User acceptability studies of 3D printed formulations have been previously carried out in adults; however, feedback from children themselves is essential in establishing the quality target product profile towards the development of age-appropriate medicines. The aim of this study was to investigate the preference of children for different 3D printed tablets (Printlets™) as an important precursor to patient acceptability studies. Four different 3DP technologies; digital light processing (DLP), selective laser sintering (SLS), semi-solid extrusion (SSE) and fused deposition modeling (FDM) were used to prepare placebo printlets with similar physical attributes including size and shape. A single-site, two-part survey was completed with participants aged 4–11 years to determine their preference and opinions based on visual inspection of the printlets. A total of 368 participants completed an individual open questionnaire to visually select the best and worst printlet, and 310 participants completed further non-compulsory open questions to elaborate on their choices. Overall, the DLP printlets were the most visually appealing to the children (61.7%) followed by the SLS printlets (21.2%), and with both the FDM (5.4%) and SSE (11.7%) printlets receiving the lowest scores. However, after being informed that the SSE printlets were chewable, the majority of participants changed their selection and favoured this printlet, despite their original choice, in line with children’s preference towards chewable dosage forms. Participant age and sex displayed no significant differences in printlet selection. Printlet descriptions were grouped into four distinct categories; appearance, perceived taste, texture and familiarity, and were found to be equally important when creating a quality target product profile for paediatric 3D printed formulations. This study is the first to investigate children’s perceptions of printlets, and the findings aim to provide guidance for further development of paediatric-appropriate medicines using different 3DP technologies.

Non-destructive dose verification of two drugs within 3D printed polyprintlets.

Three-dimensional printing (3DP) is a revolutionary technology in pharmaceuticals, enabling the personalisation of flexible-dose drug products and 3D printed polypills (polyprintlets). A major barrier to entry of this technology is the lack of non-destructive quality control methods capable of verifying the dosage of multiple drugs in polyprintlets at the point of dispensing. In the present study, 3D printed films and cylindrical polyprintlets were loaded with flexible, therapeutic dosages of two distinct drugs (amlodipine and lisinopril) across concentration ranges of 1-5% w/w and 2-10% w/w, respectively. The polyprintlets were non-destructively analysed for dose content using a portable near infrared (NIR) spectrometer and validated calibration models were developed using partial least squares (PLS) regression, which showed excellent linearity (R2 Pred=0.997, 0.991), accuracy (RMSEP= 0.24%, 0.24%) and specificity (LV1 = 82.77%, 79.55%) for amlodipine and lisinopril, respectively. X-ray powder diffraction (XRPD) and thermogravimetric analysis (TGA) showed that sintering partially transformed the phase of both drugs from the crystalline to amorphous forms. For the first time, we report a non-destructive method for quality control of two separate active ingredients in a single 3D printed drug product using NIR spectroscopy, overcoming a major barrier to the integration of 3D printing into clinical practice.

The content of patient counseling about interchangeable medicines and generic substitution in Finnish community pharmacies\xa0- a survey of dispensers

BackgroundGeneric substitution aims to increase the use of more affordable generic preparations and restrain the growth of medicine expenditures. Pharmaceutical staff plays an important role in generic substitution by implementing substitution and counseling customers. The aim of this study was to explore how Finnish dispensers inform pharmacy customers about interchangeable medicines and generic substitution and what customers ask dispensers about generic substitution and the reference price system.MethodsA questionnaire was sent to a random sample of dispensers (n = 1054) working in community pharmacies in spring 2018. The data was analyzed using frequencies, percentages and the Chi-square test and Fisher’s exact test. The open-ended questions were analyzed first using inductive content analysis and later with the quantitative methods mentioned above.ResultsThe final study material consisted of 498 questionnaires (response rate 51%). The main topics dispensers always informed customers about were the physician’s record in the prescription not to substitute the medicine (69%) and that the prescribed or purchased interchangeable medicine did not belong in the reference price band (59%). Topics mentioned often by dispensers dealt with customer’s chance to choose their medicine from among several alternative products (68%) and the manufacturer of the interchangeable medicines (66%). Differences in appearance (33%) or in composition (28%) of interchangeable products were the most common topics mentioned only when the customer asked about them. Of the respondents 17.6% always and 51.4% often informed the customer about the least expensive interchangeable product at the point of dispensing. Customers’ questions about the generic substitution and reference price system most commonly (82.4%) concerned the similarity of interchangeable medicines.ConclusionsFinnish dispensers provide customers with a wide range of information about different subjects when dispensing interchangeable medicines. Patient counseling generally meets the legislative requirements, except for price counseling. In future, information about generic substitution and interchangeable medicines should continuously be provided to customers both at pharmacies and elsewhere, e.g. through educational campaigns.

In-Home Strategic National Stockpile Dispensing by Means of Home Health Agencies: An Alternative Means of Dispensing to Vulnerable Populations.

The Federal Emergency Management Agency prescribes a 48-h timeline between the declaration of an emergency and the treatment of the last person with Strategic National Stockpile (SNS) medical countermeasures (MCM). Many states struggle to meet the 48-h window. Issues surrounding adequate staffing, critical to maintaining necessary Points Of Dispensing (POD) throughput, are noted in the literature. The use of public and private partnerships in the health-care sector may improve POD throughput. This study describes a novel strategy for partnering with home health agencies (HHAs) to augment MCM distribution. The HHA In-Home Dispensing Model we propose authorizes HHAs to act as Closed PODs following a head of household model. Here, we evaluate the effectiveness of the model using a case study. First, we provide an overview of the methods used to estimate the duration of in-home nurse dispensing shifts. We then present the results for our case study area. Next, we discuss how the model can be used and its limitations. We conclude that the HHA In-Home SNS Dispensing Model shows promise and should receive further consideration, as it can decrease demand at open PODs and increase the reach of MCMs to vulnerable populations who might otherwise have difficulty receiving them.