Access To Health Care Providers Research Articles

Impact of the COVID-19 pandemic on type 2 diabetes care and factors associated with care disruption in Kenya and Tanzania

ABSTRACT Background The COVID-19 pandemic affected healthcare delivery globally, impacting care access and delivery of essential services. Objectives We investigated the pandemic’s impact on care for patients with type 2 diabetes and factors associated with care disruption in Kenya and Tanzania. Methods A cross-sectional study was conducted among adults diagnosed with diabetes pre-COVID-19. Data were collected in February–April 2022 reflecting experiences at two time-points, three months before and the three months most affected by the COVID-19 pandemic. A questionnaire captured data on blood glucose testing, changes in medication prescription and access, and healthcare provider access. Results We recruited 1000 participants (500/country). Diabetes care was disrupted in both countries, with 34.8% and 32.8% of the participants reporting change in place and frequency of testing in Kenya, respectively. In Tanzania, 12.4% and 17.8% reported changes in location and frequency of glucose testing, respectively. The number of health facility visits declined, 14.4% (p < 0.001) in Kenya and 5.6% (p = 0.001) in Tanzania. In Kenya, there was a higher likelihood of severe care disruption among insured patients (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI][1.05–2.34]; p = 0.029) and a lower likelihood among patients residing in rural areas (aOR, 0.35[95%CI, 0.22–0.58]; p < 0.001). Tanzania had a lower likelihood of severe disruption among insured patients (aOR, 0.51[95%CI, 0.33–0.79]; p = 0.003) but higher likelihood among patients with low economic status (aOR, 1.81[95%CI, 1.14–2.88]; p = 0.011). Conclusions COVID-19 disrupted diabetes care more in Kenya than Tanzania. Health systems and emergency preparedness should be strengthened to ensure continuity of service provision for patients with diabetes.

The Role of Pharmacists in Opioid Addiction Management

Opioid addiction claims thousands of lives every year in the United States. The prevalence of misuse, abuse, and overdose continues to rise despite the measures and initiatives taken by the federal government and other government agencies to manage the problem. These efforts have led to a re-evaluation of the role different healthcare providers can play to ensure the problem is adequately addressed. Being one of the most accessible healthcare providers to patients under opioid therapy, pharmacists are better positioned to deal with opioid addiction. They dispense millions of opioids every year making them better positioned to screen for patients who are likely to develop an addiction problem and refer them to treatment resources before the abuse escalates to opioid use disorder (OUD). The aim of this review is to explore the role of pharmacists in opioid addiction management including prevention, screening, education, naloxone prescribing, counselling, and referral to treatment resources. The review also provides pertinent information regarding the current state of the opioid crisis in the US, including recent data on prevalence and opioid-related deaths. Exploring the role of pharmacists is instrumental in coming up with effective measures that can help in opioid addiction management. Keywords: opioids, opioid addiction management, pharmacists, opioid misuse, opioid abuse, opioid use disorder

“Not just rebellious, it's revolutionary”: Do-it-yourself hormone replacement therapy as Liberatory Harm Reduction

For some transgender people, hormone replacement therapy (HRT) is “an ontological necessity for a livable life” (Fondén, 2020, p. 29). Some trans people engage in do-it-yourself (DIY) HRT (aka “DIYers”) because of care barriers, including medication costs, difficulty accessing healthcare providers, and mistrust in professionalized medical systems. Although DIY HRT is often framed as highly risky, we analyzed in-depth interviews with 36 U.S. DIYers to understand how they themselves perceived their goals, challenges, and risk mitigation using the Liberatory Harm Reduction and lay expertise frameworks. Participants emphasized experiences of transphobia within medical spaces. In contrast, participants characterized DIY HRT as a community-driven, accessible, and empowering practice. Through self-organized online forums and mutual aid, DIYers constructed adaptive health-promoting practices that challenge biomedical conceptualizations of risk and affirm trans agency.

Effective strategies for Fecal Immunochemical Tests (FIT) programs to improve colorectal cancer screening uptake among populations with limited access to the healthcare system: a rapid review

BackgroundColorectal cancer (CRC) is one of the leading causes of cancer death globally. CRC screening can reduce the incidence and mortality of CRC. However, socially disadvantaged groups may disproportionately benefit less from screening programs due to their limited access to healthcare. This poor access to healthcare services is further aggravated by intersecting, cumulative social factors associated with their sociocultural background and living conditions. This rapid review systematically reviewed and synthesized evidence on the effectiveness of Fecal Immunochemical Test (FIT) programs in increasing CRC screening in populations who do not have a regular healthcare provider or who have limited healthcare system access.MethodsWe used three databases: Ovid MEDLINE, Embase, and EBSCOhost CINAHL. We searched for systematic reviews, meta-analysis, and quantitative and mixed-methods studies focusing on effectiveness of FIT programs (request or receipt of FIT kit, completion rates of FIT screening, and participation rates in follow-up colonoscopy after FIT positive results). For evidence synthesis, deductive and inductive thematic analysis was conducted. The findings were also classified using the Cochrane Methods Equity PROGRESS-PLUS framework. The quality of the included studies was assessed.ResultsFindings from the 25 included primary studies were organized into three intervention design-focused themes. Delivery of culturally-tailored programs (e.g., use of language and interpretive services) were effective in increasing CRC screening. Regarding the method of delivery for FIT, specific strategies combined with mail-out programs (e.g., motivational screening letter) or in-person delivery (e.g., demonstration of FIT specimen collection procedure) enhanced the success of FIT programs. The follow-up reminder theme (e.g., spaced out and live reminders) were generally effective. Additionally, we found evidence of the social determinants of health affecting FIT uptake (e.g., place of residence, race/ethnicity/culture/language, gender and/or sex).ConclusionsFindings from this rapid review suggest multicomponent interventions combined with tailored strategies addressing the diverse, unique needs and priorities of the population with no regular healthcare provider or limited access to the healthcare system may be more effective in increasing FIT screening. Decision-makers and practitioners should consider equity and social factors when developing resources and coordinating efforts in the delivery and implementation of FIT screening strategies.

Co-development and testing of an extended community pharmacy model of service delivery for managing osteoarthritis: protocol for a sequential, multi-methods study (PharmOA)

BackgroundOsteoarthritis is a common, painful and disabling long-term condition. Delivery of high-quality guideline-informed osteoarthritis care that successfully promotes and maintains supported self-management is imperative. However, osteoarthritis care remains inconsistent, including under use of core non-pharmacological approaches of education, exercise and weight loss.Community pharmacies are an accessible healthcare provider. United Kingdom government initiatives are promoting their involvement in a range of long-term conditions, including musculoskeletal conditions. It is not known what an enhanced community pharmacy role for osteoarthritis care should include, what support is needed to deliver such a role, and whether it would be feasible and acceptable to community pharmacy teams. In this (PharmOA) study, we aim to address these gaps, and co-design and test an evidence-based extended community pharmacy model of service delivery for managing osteoarthritis.MethodsInformed by the Theoretical Domains Framework, Normalisation Process Theory, and the Medical Research Council (MRC) framework for developing complex interventions, we will undertake a multi-methods study involving five phases:1. Systematic review to summarise currently available evidence on community pharmacy roles in supporting adults with osteoarthritis and other chronic (non-cancer) pain.2. Cross-sectional surveys and one-to-one qualitative interviews with patients, healthcare professionals and pharmacy staff to explore experiences of current, and potential extended community pharmacy roles, in delivering osteoarthritis care.3. Stakeholder co-design to: a) agree on the extended role of community pharmacies in osteoarthritis care; b) develop a model of osteoarthritis care within which the extended roles could be delivered (PharmOA model of service delivery); and c) refine existing tools to support community pharmacies to deliver extended osteoarthritis care roles (PharmOA tools).4. Feasibility study to explore the acceptability and feasibility of the PharmOA model of service delivery and PharmOA tools to community pharmacy teams.5. Final stakeholder workshop to: a) finalise the PharmOA model of service delivery and PharmOA tools, and b) if applicable, prioritise recommendations for its wider future implementation.DiscussionThis novel study paves the way to improving access to and availability of high-quality guideline-informed, consistent care for people with osteoarthritis from within community pharmacies.

Multi-criteria decision making to validate performance of RBC-based formulae to screen beta-thalassemia trait in heterogeneous haemoglobinopathies

BackgroundIndia has the most significant number of children with thalassemia major worldwide, and about 10,000-15,000 children with the disease are born yearly. Scaling up e-health initiatives in rural areas using a cost-effective digital tool to provide healthcare access for all sections of people remains a challenge for government or semi-governmental institutions and agencies.MethodsWe compared the performance of a recently developed formula SCS_{BTT} and its web application SUSOKA with 42 discrimination formulae presently available in the literature. 6,388 samples were collected from the Postgraduate Institute of Medical Education and Research, Chandigarh, in North-Western India. Performances of the formulae were evaluated by eight different measures: sensitivity, specificity, Youden’s Index, AUC-ROC, accuracy, positive predictive value, negative predictive value, and false omission rate. Three multi-criteria decision-making (MCDM) methods, TOPSIS, COPRAS, and SECA, were implemented to rank formulae by ensuring a trade-off among the eight measures.ResultsMCDM methods revealed that the Shine & Lal and SCS_{BTT} were the best-performing formulae. Further, a modification of the SCS_{BTT} formula was proposed, and validation was conducted with a data set containing 939 samples collected from Nil Ratan Sircar (NRS) Medical College and Hospital, Kolkata, in Eastern India. Our two-step approach emphasized the necessity of a molecular diagnosis for a lower number of the population. SCS_{BTT} along with the condition MCVle 80 fl was recommended for a higher heterogeneous population set. It was found that SCS_{BTT} can classify all BTT samples with 100% sensitivity when MCVle 80 fl.ConclusionsWe addressed the issue of how to integrate the higher-ranked formulae in mass screening to ensure higher performance through the MCDM approach. In real-life practice, it is sufficient for a screening algorithm to flag a particular sample as requiring or not requiring further specific confirmatory testing. Implementing discriminate functions in routine screening programs allows early identification; consequently, the cost will decrease, and the turnaround time in everyday workflows will also increase. Our proposed two-step procedure expedites such a process. It is concluded that for mass screening of BTT in a heterogeneous set of data, SCS_{BTT} and its web application SUSOKA can provide 100% sensitivity when MCVle 80 fl.

Pharmacist dispensing of mifepristone: An opinion of the Women's Health Practice and Research Network of the American College of Clinical Pharmacy

AbstractA rising percentage of patients are electing medication abortion over procedural abortion for increased safety and privacy. Access to medication abortion is essential healthcare, but many Americans face unsurmountable barriers when pursuing this option. This has been in large part due to unnecessary restrictions imposed by the United States Food and Drug Administration (FDA) Risk Evaluation and Mitigation Strategy (REMS) for mifepristone, used in combination with misoprostol for medication abortion. Moreover, many states have imposed additional restrictions on abortion, further impeding access to care. Since its original approval in 2000, mifepristone can only be prescribed by certified prescribers. Until recently, mifepristone could only be dispensed by certified prescribers, whereby more accessible community and mail‐order pharmacies were prohibited from dispensing mifepristone. During the Coronavirus disease 2019 public health emergency, there was a temporary allowance for certified prescribers to utilize mail or mail‐order pharmacies to deliver medications to patients. In January 2023, the FDA approved modifications to the mifepristone REMS to allow certified pharmacies to dispense the medication. Given the established safety and effectiveness of mifepristone, the evidence supports its distribution via pharmacies and leveraging pharmacists to expand medication abortion access. Pharmacists are one of the most widely accessible healthcare providers and their responsibility centers on patient and medication safety and improving health outcomes. This article, an opinion of the American College of Clinical Pharmacy Women's Health Practice and Research Network, adds the voice of members of the pharmacy profession to the collective efforts to ensure access to medication abortion, including pharmacist dispensing of mifepristone. We encourage pharmacists to embrace this fresh opportunity to provide medication abortion care in their communities.

The Development and Implementation of a Forensic Education Module for Nebraska Critical Access Providers: A Pilot Study.

Sexual assault, intimate partner violence, and human trafficking are traumatic events for individuals and communities. As healthcare shortages increase, critical access hospitals must manage resources to ensure comprehensive forensic care effectively. Current literature indicates a lack of forensic healthcare education for providers within critical access hospitals. This forensic education module for critical access healthcare providers aimed to (a) increase forensic examination competencies, (b) improve forensic interviewing skills, (c) increase provider self-efficacy, and (d) show knowledge retention. This mixed-methods pilot study utilized a convenience sample of 45 healthcare providers in Nebraska critical access hospitals who presented for the forensic education module training. Repeated measures analysis of variance and paired t tests assessed the aims of this study. Structured surveys gathered qualitative data on three themes. Implementation of the forensic education module showed a statistically significant increase in forensic interviewing skills, nonstatistically significant changes in general self-efficacy, and sustainability of knowledge and self-efficacy over 6 weeks. Analysis also showed a clinically significant increase in provider self-efficacy over 6 weeks. Structured questionnaire responses showed participants valued the content to address their perceived barriers to providing care. This study validates the need for increased education in Nebraska's rural and medically underserved areas to ensure access to forensic care and provision of services. This pilot study shows the potential for forensic education interventions to increase provider competencies and improve provider self-efficacy, with evidence of retention of knowledge and skills.

Gender-affirming hormone therapy in Portugal: knowledge, safety and adherence

Background: More research is needed to understand the knowledge, experiences, safety, and adherence of individuals on gender-affirming hormone therapy (GAHT) for gender dysphoria treatment. Aim: To assess the knowledge of the Portuguese transgender population on GAHT about the therapy, examine the experiences of those who initiated it through the Portuguese National Health System, and evaluate the safety, monitoring and adherence to hormonal therapy. Methods: Cross-sectional study with Portuguese transgender adults who had hormonal therapy. Participants completed an original questionnaire that utilized an ordinal Likert-style scale that ranged from 0 (worst result) to 6 (best result) for most items. Descriptive statistics and non-parametric tests were used to analyze both categorical and continuous variables. The level of statistical significance was set at 0.05. Results: Participants’ knowledge on GAHT was rated with a median of 5 points, relying mostly on the internet for information. 14.1% felt insufficiently informed. 71.2% faced obstacles obtaining GAHT, with long waiting times being the most common. Feminizing therapy was significantly more expensive. Initial consultation was often with psychologists/sexologists, with endocrinologists commonly being the first providers of GAHT. 43.3% didn’t undergo informed consent and 11.3% had no pretreatment blood tests. Only 53.2% discussed fertility with medical professionals, and of those, only 8.0% opted for it. 79.6% regularly underwent routine analyses and 87.3% were followed up in medical appointments, mainly with an endocrinologist. 6.3% of participants discontinued therapy, mostly due to adverse effects and difficulty obtaining prescriptions. Discussion: Internet sources dominated as the main information channel for GAHT, emphasizing the importance of healthcare professionals guiding patients to reliable sources. Limited healthcare provider knowledge and access barriers were identified. Primary care physicians had limited involvement, raising safety concerns. Inadequate fertility counseling and follow-up in family medicine were found. Discontinuation of therapy and nonadherence highlighted the need for comprehensive care and monitoring.

Assessing pharmacist and clinician perspectives on pharmacist-prescribed hormonal contraceptives

BackgroundAfter the Dobbs et al. ruling in June 2022 by the U.S. Supreme Court eliminated the federal right to abortion care, concerns about access to reproductive health have been elevated. Barriers to contraception use consist of knowledge deficits, unfavorable legal rulings, cost and insurance coverage, unnecessary medical practices, and health care inequities. Pharmacists are the most accessible health care providers who are positioned to mitigate these barriers and expand reproductive health access through scope of practice expansion. The American College of Obstetricians and Gynecologists has expressed their support for pharmacists prescribing hormonal contraceptives. As of October 2022, 22 states and jurisdictions have a protocol in place to allow for autonomous prescribing of hormonal contraceptives by pharmacists. ObjectiveThe objective of this study was to simultaneously assess pharmacist and clinician perspectives of all ages and sexual identities, on pharmacist-prescribed hormonal contraceptives and barriers faced in accessing contraception. MethodsThe researchers conducted an institutional review board–approved observational study via a cross-sectional survey distributed to licensed pharmacists and clinicians from October 2022 to February 2023. The survey population included those who were 18 years or older, English speaking, and recruited both in person and through e-mail listservs. The survey assessed barriers to contraception access, perspectives toward pharmacist-prescribed hormonal contraception, likelihood of receiving pharmacist-prescribed hormonal contraception, and pharmacist comfort with prescribing hormonal contraceptives. ResultsNearly 38% of respondents reported having ever experienced ≥ 1 barrier in accessing contraception, which were having a time barrier or delay in appointment, a cost or copay barrier, and/or lacking an obstetrician/gynecologist. Eighty-one percent of all respondents agreed or strongly agreed with pharmacist-prescribed hormonal contraception. Sixty-one percent of pharmacists said they are either very or somewhat comfortable prescribing hormonal contraception. Pharmacists’ most commonly reported concerns were payment for services, lack of access to patient medical records, and patient safety. ConclusionsAfter Dobbs et al., most pharmacists and clinicians in Rhode Island support pharmacist-prescribed hormonal contraceptives and the most frequently reported barriers faced in accessing contraception may be overcome through pharmacist prescribing. The information and data gathered from this study supported legislation for pharmacist prescriptive authority for hormonal contraception in Rhode Island.

THU212 Exploring The Experiences Of Adult Patients With Turner Syndrome At A Multidisciplinary Clinic

Abstract Disclosure: S. Shin: Grant Recipient; Self; Canadian Menopause Society Pfizer Research Award. L. Liang: None. C. Korenvain: None. L. McCarthy: None. I.C. Lega: None. Context: Turner syndrome (TS), a genetic condition affecting 1 in 2500 live female births, is associated with short stature, infertility, and premature menopause. Patients with TS are often followed by multidisciplinary clinics as children, but such care is often lacking in adulthood. A multidisciplinary clinic in Canada fills this gap, providing dual visits with an endocrinologist and gynecologist. There is a paucity of research exploring the experiences of adults with TS with respect to menopause and fertility, and the perceived impact of a multidisciplinary team. Objective: To explore the experiences of adults with TS regarding 1) reproductive health and menopause, and 2) interacting with a multidisciplinary team for the management of TS. Methods: Qualitative semi-structured interviews were conducted with 21 adult TS patients who attend a multidisciplinary TS clinic. Interviews were transcribed verbatim and coded by two independent researchers. A codebook was developed using an iterative process with input from the entire research team. Themes were generated using thematic analysis. Results: Twenty-one participants aged 20 to 65 were interviewed and five themes emerged from the data. 1) Participants’ differing feelings toward fertility status. Experience with fertility differed widely and was affected by the timing of diagnosis, how the diagnosis was communicated, and feelings toward having children. 2) Resiliency. Participants sought ways to adapt to living with TS, striving towards resilience by leaning on support from family and others with TS. 3) Involvement in one’s own care. Many participants were actively engaged in their care and sought support in learning more about their condition. 4) Desire for comprehensive health care. Many participants felt the multidisciplinary TS clinic was knowledgeable, convenient, and effective in managing their comorbidities. 5) Barriers to accessing health care. Participants identified challenges in accessing health care providers with TS expertise, in navigating the financial burden involved in comprehensive TS care, and in accessing inclusive care. Conclusion: Infertility appeared to have a variable impact on participants, ranging from those who felt it was an important aspect in developing their self-identity to those who felt it had little impact. Our research highlights the importance of using a tailored approach to providing fertility care. Participants desired to be actively involved in their own healthcare and for further access to educational resources. The participants greatly appreciated the care provided in the multidisciplinary care model and called for further capacity building in TS expertise among all healthcare providers. To improve the care of our TS patients, our findings support the demand/need for additional TS-specific clinics across the world. Presentation: Thursday, June 15, 2023

Racial Disparity in Anthracycline-induced Cardiotoxicity in Breast Cancer Patients.

Breast cancer has become the most common cancer in the US and worldwide. While advances in early detection and treatment have resulted in a 40% reduction in breast cancer mortality, this reduction has not been achieved uniformly among racial groups. A large percentage of non-metastatic breast cancer mortality is related to the cardiovascular effects of breast cancer therapies. These effects appear to be more prevalent among patients from historically marginalized racial/ethnic backgrounds, such as African American and Hispanic individuals. Anthracyclines, particularly doxorubicin and daunorubicin, are the first-line treatments for breast cancer patients. However, their use is limited by their dose-dependent and cumulative cardiotoxicity, manifested by cardiomyopathy, ischemic heart disease, arrhythmias, hypertension, thromboembolic disorders, and heart failure. Cardiotoxicity risk factors, such as genetic predisposition and preexisting obesity, diabetes, hypertension, and heart diseases, are more prevalent in racial/ethnic minorities and undoubtedly contribute to the risk. Yet, beyond these risk factors, racial/ethnic minorities also face unique challenges that contribute to disparities in the emerging field of cardio-oncology, including socioeconomic factors, food insecurity, and the inability to access healthcare providers, among others. The current review will address genetic, clinical, and social determinants that potentially contribute to this disparity.

Piloting an opioid callback program in community pharmacies

BackgroundAlthough opioid prescribing has recently trended downward, opioid-related overdoses and deaths have drastically increased. Community pharmacists are accessible health care providers who are well positioned to disseminate information on opioid safety and to educate and counsel on medication use, managing adverse events, and proper medication disposal. Patient callbacks facilitate appropriate medication usage. We developed an opioid callback program that provides a framework for pharmacists to follow up with patients with an opioid prescription. ObjectivesThis study aimed to (1) describe the development of the opioid callback initiative and (2) report results from a pilot test in 2 community pharmacies. MethodsThe opioid callback process and data collection forms were collaboratively developed with community pharmacists at each site. Data recorded on the opioid callback forms were descriptively analyzed and chi-square test of independence explored differences by pain durations related to opioid disposal, security, and safety. Participating pharmacy staff were interviewed to identify facilitators and barriers to implementation, as well as opportunities for improvement. ResultsForty-one opioid callbacks were attempted and 36 were completed (87.8%). Pharmacists were statistically significantly more likely to discuss naloxone with patients with chronic pain (89.5%) than those with acute pain (46.2%). Pharmacists reported that the program successfully raised awareness of opioid disposal opportunities and safe opioid practices, including storage and naloxone ownership. They expressed patients’ willingness to answer questions and appreciation for the extra attention and care. ConclusionCommunity pharmacists are well positioned to address the opioid crisis as access points for medication questions, opioid safety education, opioid disposal, naloxone, and medications for people with an opioid use disorder. This study presents a proof of concept for a pharmacist-led opioid callback program. Expansion could help inform patients about how to use opioids safely, how to treat an opioid overdose, and where to dispose of unused medications.

Evaluating student pharmacist knowledge, attitudes, and confidence in caring for paediatric patients with HIV

Background: Despite advances in the management of human immunodeficiency virus (HIV), people living with HIV (PLWH) experience stigma that impacts the healthcare they receive. Numerous studies demonstrate that provider education regarding HIV helps alleviate bias. Pharmacy schools significantly vary in their curriculum surrounding HIV education, with a limited focus on HIV in the paediatric population. Being one of the most accessible healthcare providers, improving pharmacist education and attitudes could positively impact treatment outcomes for children living with HIV. Method: An Advanced HIV Elective course that included content in the management of children living with HIV (CLWH) was developed and implemented by faculty at a Doctor of Pharmacy program in the United States. Student pharmacist knowledge, confidence, and perceptions of providing care for this population were assessed before and after the didactic module. Results: The incorporation of a paediatric HIV module increased the knowledge and confidence of student pharmacists in the management of PLWH and CLWH. Areas of improvement include the selection of antiretroviral therapy (ART), ART medication counselling, and paediatric immunisations. However, a significant difference in attitudes and perceptions towards PLWH and CLWH was not observed. Conclusion: Although improvement in student pharmacist knowledge and confidence was seen after the implementation of a paediatric HIV module, innovative ways to address bias, stigma, and misinformation are needed to promote positive health outcomes for marginalised communities, including those living with HIV.

The Pharmacist's role in dermatology: Patient medication adherence.

Medication non-adherence is currently estimated to have caused at least 100 000 preventable deaths and over $100 billion in preventable medical costs. Adherence is particularly poor in dermatological conditions, with more than 50% of patients discontinuing topical treatments within the first year. Pharmacists are among the most accessible health-care professionals with the potential to greatly impact medication non-adherence through patient education, medication therapy management, and improved access to care. This review aimed to determine how pharmacists have improved medication adherence in dermatology and discuss strategies for further involvement. An extensive medical literature search using the PubMed database was conducted to evaluate clinical studies, published in the last 20 years, that have evaluated the pharmacist's role and impact on adherence of to dermatological products. PubMed search terms include: "pharmacists' role in dermatologic medication adherence", "pharmacist-led interventions in dermatology", "pharmacist medication adherence dermatology" and "pharmacist intervention dermatology". A total of 18 relevant studies were identified. Pharmacists improved dermatological medication adherence by increasing access to medications, providing medication counseling programs, and performing treatment monitoring services. However, corticophobia may contribute to pharmacists' hesitancy in making corticosteroid over-the-counter recommendations. Pharmacists are accessible health-care providers with the potential to improve dermatological medication adherence. Future advanced training in dermatology medications may refine pharmacists' knowledge of dermatological products.

Correlations with Congenital Syphilis in the United States: A Cross-Sectional Study

Syphilis is caused by the bacterium Treponema pallidum and is transmitted from human to human through sexual contact. Congenital syphilis (CS) occurs when the mother transmits the infection to the fetus. Clinical manifestations of CS include anemia, hepatosplenomegaly, blindness, deafness, meningitis, and deformities in bone structure. The number of cases of CS have increased over the past decade in the United States according to the CDC. A study was conducted correlating the number of Medicaid enrollees in 2020, the number of uninsured persons in 2020, and the number of cases of COVID-19 in 2020 to cases of CS in the United States in 2021. A Spearman rank correlation analysis was done using SPSS. Results were statistically significant for all three pairs of variables with positive correlations; Medicaid enrollment and CS cases (r = 0.735, P&lt;.05), uninsured persons with CS cases (r = 0.713, P&lt;.05), COVID-19 cases and CS cases (r = 0.689, P&lt;.05). Reasons for the increase in CS cases are multifactorial, including variations in state laws regarding syphilis screening in the prenatal period, differences in provider processes for persons on Medicaid, persons uninsured, and restrictions to accessing healthcare providers during the COVID-19 pandemic. Future studies should include questionnaires and interviews with women on their experiences during prenatal visits in regards to syphilis screening, particularly women covered by Medicaid, and surveys completed by healthcare providers to gain insight and to identify factors that affect a woman not being tested for syphilis during her pregnancy.

How consequences of colorectal cancer treatment are managed: a qualitative study of stakeholder experiences about supportive care and current practices

PurposeColorectal cancer (CRC) survivors experience treatment-effects such as symptoms and functional impairments. There is limited evidence about how these are managed and what services or supports are available in the community. We aimed to identify current practice and available supports for managing consequences of treatment from clinician and CRC survivor perspectives.MethodsThis qualitative study, informed by an interpretivist constructionist paradigm, included semi-structured interviews. Clinicians with experience of treating CRC patients and adult CRC survivors were recruited across Australia. Interviews explored experiences about problems experienced after CRC treatment and how these were managed. Data collection and analysis, using thematic analysis, was iterative whereby emergent themes during analysis were incorporated into subsequent interviews.ResultsWe interviewed 16 clinicians and 18 survivors. Survivors experienced a range of consequences of treatment amendable to support including allied health, information, and self-management. Barriers to support access included clinicians’ worry about patient out-of-pocket expenses, long waitlists, lack of awareness about existing supports, and perception no therapeutic options were available. Healthcare professionals with expertise in CRC were often difficult to identify outside of cancer settings. Survivorship care could be improved with individualised timely information and identification of pathways to access healthcare providers with expertise in managing consequences of CRC treatment within primary care.ConclusionsTo improve CRC survivor lives posttreatment, routine assessment of consequences of treatment, individualised care planning involving relevant healthcare professionals, access to supportive care when needed, and improved information provision and engagement of a range of health professionals in follow-up care are needed.

Addressing the Opioid Crisis—The Need for a Pain Management Intervention in Community Pharmacies in Canada: A Narrative Review

Background: The opioid crisis is a public health concern in Canada with a continued rise in deaths and presents a significant economic impact on the healthcare system. There is a need to develop and implement strategies for decreasing the risk of opioid overdoses and other opioid-related harms resulting from the use of prescription opioids. Pharmacists, as medication experts and educators, and as one of the most accessible frontline healthcare providers, are well positioned to provide effective opioid stewardship through a pain management program focused on improving pain management for patients, supporting appropriate prescribing and dispensing of opioids, and supporting safe and appropriate use of opioids to minimize potential opioid misuse, abuse, and harm. Methods: A literature search was conducted in PubMed, Embase and grey literature to determine the characteristics of an effective community pharmacy-based pain management program, including the facilitators and barriers to be considered. Discussion: An effective pain management program should be multicomponent, address other co-morbid conditions in addition to pain, and contain a continuing education component for pharmacists. Solutions to implementation barriers, including pharmacy workflow; addressing attitudes beliefs, and stigma; and pharmacy remuneration, as well as leveraging the expansion of scope from the Controlled Drugs and Substances Act exemption to facilitate implementation, should be considered. Conclusions: Future work should include the development, implementation, and evaluation of a multicomponent, evidence-based intervention strategy in Canadian community pharmacies to demonstrate the impact pharmacists can have on the management of chronic pain and as one potential solution to helping curb the opioid crisis. Future studies should measure associated costs for such a program and any resulting cost-savings to the healthcare system.

Affirmation of LGBTQ+ healthcare providers: A dynamic process, requiring ongoing education and training

Introduction LGBTQ+ patients continue to face high levels of discrimination and disparities in healthcare environments partly due to a lack of accessible affirming healthcare providers. Providers in LGBTQ+ healthcare may have unrecognized gaps in their affirmation due to a lack of continual education and training after achieving a self-determined high standard. It is unclear how an LGBTQ+ training would affect self-reported clinical attributes of LGBTQ+ healthcare providers. Method Self-identified LGBTQ+ affirming providers (N = 131) received an online LGBTQ+ training. Participants completed a survey consisting of demographic questions and the seven-point Likert LGBT Development of Clinical Skills Scale (LGBT-DOCSS) immediately before, right after, and three months following the training. Result Providers had very high baseline LGBT-DOCSS scores prior to training. Clinical Preparedness and Basic Knowledge significantly increased immediately following training and improvements were sustained at three months. Conclusion Despite achieving high baselines of LGBTQ+ preparedness and knowledge, LGBTQ+ affirming providers can continue to learn and improve and likely need regular ongoing education and training to maintain high levels of affirmation in the rapidly evolving field of LGBTQ+ healthcare.

Out of Sight, Out of Mind? Electoral Responses to the Proximity of Health Care

Do voters reward incumbents for the provision of public services? In this article, we study the political economy of catchment areas of public services to answer this question. Rather than examining the binary relationship between health care provision and electoral returns within politically defined borders, we study whether increases in geographic accessibility of health care providers and decreases in congestion in services attract votes for the incumbent. Leveraging a health care reform in Turkey, which substantially impacted the geospatial distribution of public health clinics in Istanbul, we find that decreases in walking time and improvements in congestion levels in the closest clinic from a polling station significantly increase vote share of the AKP, the incumbent party, at that polling station. We also show that poorer communities were more responsive to improvements in spatial accessibility to the local clinics.