Urban Pharmacies Research Articles

Retail Availability of Over-the-Counter Birth Control Pills at Texas Pharmacies: Results from a Mystery Caller Study

ObjectivesTo estimate the availability of the recently released over-the-counter (OTC) birth control pill (Opill®) in retail pharmacies and compare availability across pharmacies based on their chain status and setting. Study DesignIn April and May 2024, we conducted a mystery caller study of a sample of 500 Texas retail pharmacies. Sampled pharmacies were contacted by female project staff posing as potential customers and asked whether they had OTC birth control pills in stock and, if not, whether they could be ordered. We characterized pharmacies by chain status (independent pharmacy, chain pharmacy inside retail outlet, chain pharmacy with standalone location) and, using geolocation, as located in either rural or urban areas. ResultsOverall, 62% of pharmacies (N=477) reported having Opill® available for sale. This stock varied by pharmacy type, with independent pharmacies the least likely to stock it (25%) and standalone chain pharmacies the most likely (82%). Similar patterns were found in terms of pharmacies that had Opill® in stock or were willing to order it. We found no significant differences between urban and rural pharmacies. ConclusionsDespite its recent (March 2024) launch, Opill® was widely available in retail pharmacies in Texas, though independent pharmacies were less likely to stock it. While removing the need for prescriptions may make birth control pills more accessible, this access may vary by pharmacy type.

A cross-sectional survey exploring organizational readiness to implement community pharmacy-based opioid counseling and naloxone services in rural versus urban settings in Alabama

BackgroundRural US regions experience lower naloxone dispensing rates compared to urban counterparts, particularly in Alabama. In light of this, strategies to enhance opioid counseling and naloxone services (OCN) in rural community pharmacies are critical. However, organizational readiness to implement OCN in rural versus urban contexts where resource networks may differ is not well understood. ObjectivesThe purpose of this study was to explore organizational readiness and identify factors associated with implementation of OCN in rural versus urban Alabama community pharmacies. MethodsAlabama community pharmacists and technicians were recruited to participate in an anonymous online cross-sectional survey via email. The survey instrument was adapted from the Organizational Readiness to Change Assessment (ORCA). Primary outcome measures included 3 overarching ORCA domains (Evidence, Context, and Facilitation) with 19 subscales regarding OCN implementation readiness, measured via 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Secondarily, pharmacy OCN implementation status (implementer, non-implementer, or in-development) was measured via multiple-choice (1-item). Differences in mean domain and subscale scores between rural and urban pharmacies were evaluated using Mann-Whitney U tests and influential factors affecting OCN implementation status were assessed via logistic regression (alpha = 0.05). ResultsOf 171 respondents, the majority were pharmacists (78.6 %) in urban locations (57.1 %). Mean[SD] clinical experience evidence (Evidence) (3.98[0.69] vs 3.74[0.71]; p = 0.029), staff culture (Context) (4.04[0.66] vs 3.85[0.76]; p = 0.047), service measurement goals (Context) (3.92[0.77] vs 3.66[0.79]; p = 0.034), and senior management characteristics (Facilitation) (3.87[0.72] vs 3.71[0.66]; p = 0.045) subscales were higher in urban versus rural pharmacies. Notably, 66.7 % of pharmacies were current OCN implementers, and pharmacies with higher ORCA context domain scores had 3.230 greater odds of implementing or being in the process of developing OCN (95 % CI = 1.116–9.350; p = 0.031). ConclusionOrganizational readiness to implement OCN was higher among urban versus rural pharmacies in terms of perceived strength of clinical evidence, staff culture, service measurement goals, and senior management characteristics. Future research may leverage key contextual factors to enhance OCN implementation.

Community Point of Care Testing in Diagnosing and Managing Chronic Kidney Disease.

Chronic kidney disease (CKD) poses a significant global health challenge with increasing prevalence and associated morbidity. Point-of-care testing (POCT) provides an opportunity to improve CKD management and outcomes through early detection and targeted interventions, particularly in underserved communities. This review evaluates the roles of POCT in CKD, focusing on utility (through screening programs, monitoring of kidney function, and assessing participants on renally excreted medications), accuracy, and acceptability. Screening programs employing POCT have demonstrated promising outcomes, with improved rates of CKD diagnosis in groups with disparate health outcomes, offering a vital avenue for early intervention in high-risk populations. These have been conducted in rural and urban community or pharmacy settings, highlighting convenience and accessibility as important facilitators for participants. In addition, POCT holds significant promise in the monitoring of CKD, particularly in groups requiring frequent testing, such as kidney transplant recipients and patients on renin-angiotensin-aldosterone inhibitors. The consideration of the variable analytical performance of different devices remains crucial in assessing the utility of a POCT intervention for CKD. While the convenience and improved accessibility of home self-testing versus healthcare professional management is important, it must be balanced with acceptable levels of accuracy and precision to maintain patient and clinical confidence. Despite challenges including variability in accuracy and the user-friendliness of devices, patient feedback has generally remained positive, with studies reporting increased patient satisfaction and engagement. However, challenges regarding wider uptake are limited by healthcare professional confidence (in test reliability), the potential for increased workload, and early prohibitive costs. In conclusion, POCT represents a growing and valuable tool in enhancing CKD care, particularly in resource-limited settings, but careful consideration of device selection and implementation strategies is essential to achieve desired outcomes.

Naloxone Availability and Cost After Transition to an Over-the-Counter Product

The US Food and Drug Administration approved Narcan, a nasal spray formulation of naloxone, for sale as an over-the-counter (OTC) medication in March 2023. The purpose of OTC approval was to improve naloxone accessibility to reduce opioid overdoses; however, research has not yet evaluated whether naloxone's availability and cost changed since this policy was implemented. To evaluate whether the accessibility and cost of naloxone at North Carolina community pharmacies changed after OTC naloxone became available and whether cost and availability varied by pharmacy type and urbanicity. This longitudinal telephone-based secret shopper survey study included a stratified sample of 202 North Carolina community pharmacies, including health department, independent, and chain pharmacies. There were 2 separate data collection efforts from March to April 2023 (before OTC naloxone could be sold at pharmacies) and November 2023 to January 2024 (after OTC naloxone was sold at pharmacies). OTC naloxone first became available for sale at community pharmacies in September 2023. The main outcomes were same-day availability of naloxone without a clinician-issued prescription and the quoted out-of-pocket cost for cash-paying patients. Data were collected from 192 pharmacies. Same-day naloxone availability increased from 42.2% (81 of 192) before OTC naloxone availability to 57.8% (111 of 192) after (P < .001). The mean (SD) quoted out-of-pocket cost decreased from $90.93 ($42.6) pre-OTC availability to $62.67 ($41.0) post-OTC availability (P < .001). Independent pharmacies had higher mean (SD) costs than chain pharmacies in both the pre-OTC phase ($109.47 [$37.90] vs $86.40 [$35.70]; P < .001) and post-OTC phase ($77.59 [$38.90] vs $57.74 [$35.90]; P = .004). Out-of-pocket costs did not differ by urbanicity in the pre-OTC phase; however, mean (SD) costs were higher at suburban ($88.67 [$66.80]) and rural ($65.43 [$35.00]) pharmacies compared with urban pharmacies ($53.58 [$29.00]) in the post-OTC phase (P = .003). The Food and Drug Administration's approval of OTC naloxone nasal spray contributed to an increase in pharmacy-based availability of naloxone and a reduction of its cost for cash-paying patients. Cost was higher at independent pharmacies compared with chain pharmacies and lower in urban pharmacies compared with suburban and rural pharmacies.

Feasibility of pharmacy-based research opportunity to enhance community testing and surveillance

BackgroundApproximately 89% of the US population lives within five miles of a community pharmacy, which provides a network of geographically distributed recruitment nodes for testing and surveillance of infection and disease. ObjectivesEstablish feasibility of Pharmacy-based Research Opportunities To Enhance Community Testing and Surveillance in the context of SARS-CoV-2 infection in a community pharmacy setting with University of Kentucky serving as the coordinating center and research hub for sample analysis. MethodsTwo community pharmacies in Kentucky served as community-based recruitment sites to assess SARS-CoV-2 exposure through longitudinal (5 visits over 56 days) collection of nasal swabs and blood samples from subjects. ResultsFifty subjects were recruited between May 2022 and December 2023 for longitudinal sample collection. Three phases of recruitment were investigated by first establishing standard operating procedures in an urban pharmacy, then expanding recruitment at a second pharmacy in a rural setting, and finally increasing recruitment at the urban pharmacy. During the first phase of recruitment, 12 participants were recruited. Of these participants, two never scheduled a visit after the initial screening. The median time for study completion from first to last visit within this phase was 59 days (interquartile range: 56-68 days). During the second phase of recruitment, eight of nine participants completed all five visits. The median time to complete all visits was 105 days (interquartile range: 98-112 days). During the ongoing third phase, 29 subjects were recruited, and 19 participants completed all required visits and the remainder continue to schedule follow-up appointments. ConclusionCommunity pharmacies have a significant role in promoting public health. The geographic distribution of community pharmacies makes them appealing locations for recruitment of outpatient cohorts for local surveillance of infections and chronic inflammatory conditions with opportunities for broad implementation of this project for clinical trials in underserved communities.

Composition of factors for local heat adaptation measures at the local level in cities of the mid-latitude – An approach for the south-west of Germany

Traditional heat health warning systems focus on severe and extreme heat events at the district or regional level, often overlooking localized risk and protective factors such as healthcare access and urban green spaces. This approach considers less the varying impacts of heat within cities, including the phenomenon of Urban Heat Islands (UHIs) and the diverse needs of different populations. To address these shortcomings, a need for the development of an Urban Heat Health Warning and Information System (UHHWIS) that operates within the framework of Heat Health Action Plans is needed. Such a system integrates national acute heat health warnings with city-specific assessments of UHI effects and other relevant factors. The technical implementation of the UHHWIS involves the calculation and preprocessing of basic factors such as the Normalised Difference Vegetation Index (NDVI), imperviousness, and UHI intensity. Additionally, further factors are assessed, spatially processed, and provided in accordance with Open Geospatial Consortium (OGC) standards. An iso-area analysis is conducted to evaluate the accessibility of protective factors, such as urban green spaces, drinking wells, hospitals, physicians, and pharmacies, based on the city’s road topology. One crucial factor considered in the system is the casting of shadows, which is influenced by both time and location and facilitated through deck.gl. The developed template encompasses all these components into a unified system aimed at protecting vulnerable and risk groups, such as the elderly, through resilient, climate-adapted urban planning. The system provides warnings and information tailored to the urban morphology and prevailing conditions, complemented by a catalogue of potential short- to long-term measures focused on behavioral changes and climate-resilient urban planning strategies. The template can be adapted for use in various European cities, offering valuable insights to decision-makers in city administration for mitigating thermal stress and enhancing resilience against urban heat nowadays and in future.

Pre-exposure and postexposure prophylaxis access in rural versus urban pharmacies in Georgia and Pennsylvania

BackgroundPre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) prevent HIV among individuals at high risk for acquisition. Pre-existing structural barriers to PrEP/PEP access among rural patients may be exacerbated further if pharmacies do not keep PrEP/PEP in stock, constituting a significant barrier to mitigating the HIV epidemic. ObjectivesTo compare PrEP/PEP availability for same-day pickup in rural vs urban Georgia and Pennsylvania pharmacies. MethodsWe conducted a cross-sectional simulated patient caller study, calling pharmacists in Georgia and Pennsylvania to see whether PrEP/PEP was available for same-day pickup. We identified retail pharmacies through state pharmacy boards and categorized rurality using state-based definitions. We used multivariable logistic regression to assess PrEP availability by rurality and Ending the HIV Epidemic (EHE) designation, accounting for chain pharmacy status and county-level racial composition. ResultsAmong 481 pharmacies contacted (304 in Pennsylvania and 177 in Georgia), only 30.77% had PrEP for same-day pickup and only 10.55% had PEP for same-day pickup. PrEP availability did not differ significantly by state. Urban pharmacies had 2.02 (95% CI: 1.32–3.09) greater odds of PrEP same-day availability compared to rural pharmacies. Pharmacies in EHE counties had 3.45 (95% CI: 1.9–6.23) times higher odds of carrying PrEP compared to non-EHE counties. ConclusionsPharmacies were unlikely to carry PrEP or PEP. Pharmacies in rural compared to urban, and non-EHE compared to EHE locations were less likely to carry PrEP. Addressing pharmacy barriers to PrEP/PEP may enhance access to HIV prevention for those living at high risk of HIV.

Knowledge of community pharmacists on infantile haemangioma: Gaps and lack confidence to deliver propranolol still need to be filled.

To evaluate the knowledge, practices and self-confidence of community pharmacists, pharmacy technicians and pharmacy students about infantile haemangioma (IH) and propranolol treatment. A national survey was conducted in France from May 2022 to October 2022. A 42-item online questionnaire was used to assess pharmacists' knowledge of the epidemiology, clinical features and management of IH and propranolol treatment. The survey included 255 participants. The mean age was 34.9 years (±9.0); 225 (88%) were women. In all, 193 (76%) practised in urban pharmacies. Altogether, 83 participants (33%) had delivered oral propranolol solution for IH in the last 6 months. Participants' median score for self-confidence regarding propranolol dispensing was five (interquartile range, 2.5-6) on a scale of 1 to 10. Overall, 96 (38%) had more than 50% correct answers on the questionnaire. Multinomial regression models showed high scores on the questionnaire associated with high self-confidence when delivering oral propranolol solution, low number of years since graduation and having already delivered propranolol treatment. This study highlights a lack of knowledge of IH and modalities of propranolol treatment by community pharmacists and slight self-confidence when delivering propranolol. Greater cooperation between healthcare professionals could improve the proper use of medicine.

A multi-site repeated prevalence study of medicine shortages in community pharmacies.

Medicine shortages are a global problem. Prior studies have focused on hospitals, and staff views, with less information on community practice. This study aimed to estimate the prevalence of medicine shortages in community pharmacies and potential impact on patients. Four community pharmacies (two urban, two rural) in Ireland recorded details of prescription request shortages per items dispensed. Data were gathered one study day per month from February to April 2023. A prevalence across sites was estimated and trends examined using a Poisson regression. There were 76 medicine requests defined as shortages out of 3734 prescription item requests, giving a mean shortage prevalence of 2% (95% CI 1.6-2.5%). There was a non-significant, 17%, increase in shortage rate across the study period (p = 0.256). Higher rates were observed in the two urban pharmacies. In total, 61/76 (80%) of shortages were associated with a delay in patient treatment. Shortages are prevalent in community pharmacy and cause delays in patient treatment and increase in workload of pharmacy staff. Regulatory initiatives to address the issue at a manufacturer level have been proposed, although workforce planning, resourcing and professional role expansion are also required to protect pharmacy staff and patient outcomes.

Development and validation of a patient satisfaction survey for pharmaceutical service at primary care settings.

Patient satisfaction is a key quality indicator of pharmacy service. However, there are few studies that develop and validate patient satisfaction surveys applied to pharmaceutical services in primary care settings. It is imperative to establish a well-validated multidimensional instrument for evaluating the viability and sustainability of pharmacy service across geographically diverse regions in low- and middle-income countries. To develop and validate patient satisfaction instrument for community pharmaceutical services, we carried out a cross-sectional survey in seven provinces across China. The study was conducted in four phases: 1) literature review-based item generation, 2) expert panel endorsed questionnaire refinement, 3) pilot questionnaire development, and 4) psychometric validation. Survey respondents were standard patients recruited locally and trained to conduct unannounced visits to pre-selected primary care centers. Between December 2020 and November 2021, the pilot survey comprised a total of 166 unannounced standard patient visits from 125 healthcare facilities. The final 24-item Likert-type instrument encompassed five domains: relationship, medication counselling, empathy, accessibility, and overall satisfaction. The satisfactory survey revealed excellent internal consistency. Factor analyses resulted in a four-factor solution that accounted for 70.7% variance. The results suggest that the questionnaire is a valid and reliable instrument, which has been taken an important step to evaluate patient satisfaction with pharmaceutical services in Chinese primary care settings. Further research on its cross-culture adaptation and applicability in urban retail pharmacy settings is warranted.

Medicines and Medication Literacy: Social Practices and Use of Information

This article discusses results from a sociological study on (i) the sources and use of information on medicines and/or supplements and (ii) the self-assessment of how informed participants were about the last medicine or supplement they purchased. It seeks to demonstrate the plurality of information sources (expert and lay) that individuals call upon—with which they build up their medication literacy—and their perception of the information they have. While these social components of literacy are scarcely visible in available studies, the need to produce knowledge on them is a requisite for a more laypeople-centred approach in public policies seeking to promote medication literacy. A questionnaire was applied in-person (n = 1107) in urban pharmacies in Lisbon and Porto (Portugal). Results show expert information (medical and pharmaceutical) as the dominant reference, followed by lay sources (family/friends/colleagues), while digital sources were less valued than interpersonal ones. This interpersonal dimension was a relevant factor in the building of trust in information. The self-assessment of the information on medication was higher in functional literacy and lower in comprehensive literacy. Studies on medication literacy are particularly relevant in the current context of the expansion and diversification of medicines’ use and of individuals’ growing autonomy in their consumption habits.

Dealing with sexually transmitted infections in private pharmacies in Morocco

Context: Sexually transmitted infections continue to be a health problem in many countries. The management of these infections requires the mobilization of all health actors. Aims: To evaluate the management of sexually transmitted infections at private pharmacies in a Moroccan city. Methods: The simulated patient technique was used. Thirty-six pharmacies were visited to determine how cases of vaginal discharge syndrome and genital ulceration were managed in practice. Results: Rural (18) and urban (18) pharmacies were surveyed. The pharmacies visited were often of moderate (58.3%) to low (27.8%) activity and the activity of the pharmacy was significantly different (p=0.045) during the visit for vaginal discharge or genital ulceration. The duration of visits was less than five minutes in the majority of cases (91.7%). The nature of the syndrome vary significantly affected encounter duration (p=0.000). The proposition of medication to the simulated patient was carried out by 75% of the pharmacists/vendors (X = 3.36; σ = 0.860) and the type of syndrome very significantly affected the proposed management (p=0.009). The average prescription price was 298.32 dirhams per visit (σ = 39.353). None of the cases of genital ulceration or vaginal discharge were offered treatment that perfectly matched the protocol used by the Moroccan Ministry of Health. Conclusions: In the face of microbial resistance to antibiotics, sexually transmitted infections must be managed in the best conditions. In the future, studying the knowledge of these actors and proposing training on treatment protocols for sexually transmitted infections could contribute to the fight against these infections in this city.

Project on exceptional dispensation in the Principality of Asturias

Community pharmacy (CF) is daily confronted with situations that prevent the proper dispensing of medication, putting at risk the continuity of treatment by patients, which causes medication-related problems (DRPs). In this pilot study, carried out in the Principality of Asturias, the aim was to quantify the number of incidents of this type related to those aspects of the prescription that could be easily corrected by the community pharmacist through simple interventions at the time of dispensing. It was carried out in ten pharmacies in this autonomous community during normal opening hours over fifteen working days. The sample included a total of 32,331 containers dispensed. A total of 406 incidences of exceptional dispensing were recorded. The total incidence rate reached 1.26% of the dispensations, which extrapolating to the total number of dispensations made in Asturias during the month of October 2020 would give us a figure of 27,030 total dispensations susceptible to exceptional dispensing.The total incidence rate was lower in urban pharmacies (1.03%) compared to semi-urban and rural pharmacies (1.37% and 1.39%). Most of the cases (59.4 %) involved patients with an individual contribution to the Health System corresponding to 10 % (TSI2) and the mean age of the patient was 60.8 years. Regarding the level of care, 79% of the cases corresponded to Primary Care (PC) prescriptions. The most common type of incidence is "potential interruption due to prescription not active at the time of dispensing (exceeding the 10-day margin)" with an incidence rate of 0.61 % of the dispensations, which would mean a total of 13,181 prescriptions susceptible to exceptional dispensing due to this type of incidence.In terms of economic savings, it was found that 63 of the 406 cases would have necessarily required a medical consultation and 30% of them would have been for active patients. Therefore, the remaining 343 cases, which could be resolved through exceptional dispensing by the community pharmacist, would mean a saving of more than 4,000 consultations and nearly 200,000 euros in direct and indirect costs if the pharmacist were allowed to intervene.

MEASURING SPATIAL ACCESSIBILITY TO HEALTHCARE FACILITIES IN ISFAHAN METROPOLITAN AREA IN IRAN

Abstract. Appropriate spatial accessibility to healthcare facilities is an important component of the efficient delivery of healthcare. This study aims to measure spatial accessibility to healthcare facilities in Isfahan Metropolitan Area, a rapidly growing megacity in Iran. We used two methods of population-weighted fuzzy analytic hierarchy process and the two-step floating catchment area (2SFCA) to measure spatial accessibility to urban healthcare facilities, including hospitals, pharmacies, clinics, and laboratories. The results of these two methods were compared. Not surprisingly, the center of Isfahan has the highest accessibility scores for healthcare facilities, and the peripheral areas of the city have the lowest levels. Despite the existence of higher numbers of healthcare facilities in northern parts of Isfahan, accessibility to healthcare facilities is low because of the large population. Both methods show that healthcare services are not evenly distributed in Isfahan. Some areas with a high population have low accessibility to health facilities. Ideally, these areas would be prioritized for future health infrastructure investment. The methods used here can help urban healthcare policymakers identify spatial inequalities in access to care and thus target the areas in need.

Creation and Implementation of a New Sentinel Surveillance Model in Pharmacy Offices in Southern Europe.

Traditionally, health sentinel networks have focused on the reporting of data by primary care physicians and hospitals, ignoring the role of the community pharmacist as an expert in drugs. The objective of this study was to describe a method for creating a network of sentinel pharmacies in a region of Southern Europe in order to have a pharmaceutical surveillance system that is representative of the territory to be monitored and that can respond to any events or incidents that can be followed up by the community pharmacy. The creation process was carried out in three phases: a first phase of selection through a cluster and population analysis and a final adjustment, a second phase of voluntariness and random selection, and a third phase of training and implementation of the network. A sentinel network of 75 community pharmacies has been established in Catalonia. The network monitors 2.47% of the total population with a homogeneous proportion of urban (42), rural (30), and mountain-area (3) pharmacies based on the particular characteristics of the territory. This model allows increased surveillance in the territory, objectively and representatively detects problems arising from the use of medicines, and establishes improvement strategies of public health.

Effect of neighborhood-level income on access to emergency contraception

ObjectiveWe aim to investigate whether the availability of over-the-counter EC varies by neighborhood income level, independent vs chain pharmacies, or urban vs rural pharmacies. Study DesignWe conducted a cross-sectional “mystery shopper” telephone survey in July 2019 to ascertain whether sampled pharmacies stocked EC. Pharmacies located in 12 Pennsylvania counties were randomly sampled after stratification by neighborhood income level. ResultsOf 200 pharmacies sampled, 195 responded. Only 76% had EC available for same day purchase, which did not differ by neighborhood-level income. The odds that chain pharmacies stocked EC were nearly 10 times the odds that independent pharmacies stocked EC, with 96/105 chain pharmacies versus 52/90 independent pharmacies having EC available for same day purchase (91% vs 58%; OR 9.50, 95% CI 4.03−22.42). The mean number of barriers (stocking over-the-counter EC behind-the-counter, cost >$40, and requiring identification for purchase) was lower among chain vs. independent pharmacies. Pharmacies in low/moderate-income areas (64% vs 44%, p = 0.02) and independent pharmacies (94% vs 32%, p < 0.01) were more likely to keep over-the-counter EC behind-the-counter. Independent pharmacies were more likely to require identification for purchase (29% vs 59%, p < 0.01). ConclusionMore than a decade after over-the-counter approval, EC is still not uniformly available at pharmacies in Pennsylvania. Barriers including behind-the-counter stocking and identification requirements disproportionally limit access in low-income neighborhoods and independent pharmacies, threatening equitable access to this contraceptive method. ImplicationPharmacies in lower-income neighborhoods and independent pharmacies were more likely to impose undue barriers to EC access and purchasing, disproportionally affecting residents in lower-income areas. A multidisciplinary approach in advocacy and policy reform is necessary to ensure equitable access to EC.

VARIETY OF DRUGS SOLD WITHOUT PRESCRIPTION FOR COMMONLY PRESENTING COMPLAINTS IN RURAL AND URBAN PHARMACIES OF FAISALABAD DISTRICT

BACKGROUND &amp; OBJECTIVE: Pharmacies play an important role in provision of health care to the community.The objective of the study was to explore the reasons for a variety of drugs sold without prescription for commonly presenting complaints in Rural and Urban Pharmacies of Faisalabad District.&#x0D; METHODOLOGY: This explanatory sequential mixed method design involved workers from twenty-five pharmacies from urban and rural areas of Faisalabad from February to July 2020. After obtaining informed consent, fifty pharmacy workers filled a pre-designed questionnaire (followed by twenty-five semi-structured, individual, face-to-face interviews. Quantitative data was analyzed via SPSS software and transcribed interviews were organized manually for data analysis.&#x0D; RESULTS: Response rate was 76.2%. As reported by the pharmacists,40% and 90% of urban and rural population respectively came to pharmacies for over-the-counter drugs. Fifty percent belonged to middle class among urban and 70% belonged to rural population. Data analysis led to formation of 36 codes, 6 subthemes and 3 themes. Out of the four reasons quoted by the pharmacists (time constraints, lack of basic facility locally, financial constraints, and myths/fear of going to doctor), there was a statistically significant difference for rural population going directly to pharmacies because of financial constraints.&#x0D; CONCLUSION:&#x0D; Lack of education and financial constraints are the leading influential factors for people taking over-the-counter drugs in both rural and urban population, with time constraints being at the top list among urban population. Robust policies and public health care programs can lead to public awareness at large and can help in creating an environment of health care provision with MINIMAL RISKS.

Evaluation of Medicine Abuse Trends in Community Pharmacies: The Medicine Abuse Observatory (MAO) in a Region of Southern Europe.

The misuse of medicines is a global public health concern that needs to be taken into consideration and requires actions across all government sectors and society. The aim of this study is to identify trends of drug abuse in Catalonia, a region of Spain located in the South of Europe. For this purpose, a questionnaire-based detection tool was created and implemented in 60 community pharmacies. Out of 548 questionnaires (98.4%), 64.2% of participants were men and the highest age proportion was 25–35 years (31.4%). Potential drug abuse was the highest in urban pharmacies (84.9%). The main drug class involved were benzodiazepines (31.8%), codeine (19.3%), tramadol (7.5%), methylphenidate (5.8%), gabapentinoids (5.8%), cycloplegic drops (4.4%), z-drugs (2.6%), piracetam (2.2%), dextromethorphan (1.6%) and clomethiazole (1.1%). The majority of drugs were requested without prescription (58.6%) and through probably forged prescriptions (23.7%). Slightly less than half (49.8%) of the patients request frequently to the pharmacist, especially in rural and mountain pharmacies (73.3% and 88.5%, respectively). A small proportion (10.8%) were requested with intimidation. Pharmacists only supplied in 21.7% of the cases. This study has demonstrated the suitability of the new detection system, being a useful approach to replicate in other locations with similar needs.

The High Necessity of Rapid Antigen Detection Test (RADT) use to Guide Antibiotic Prescribing Pattern for Acute Pharyngotonsillitis in Syria

The objectives of this study were to assess the percentage of the inappropriate antibiotics prescribing for clinically diagnosed Group A β-hemolytic streptococcus (GABHS) caused acute pharyngotonsillitis (APT), and to investigate factors influencing this prescribing and the possibility and necessity of routine usage of RADT for rational treatment of APT in different primary care facilities in Latakia, Syria. Throat swabs were collected from 80 patients, ≥ 5 years old, seen in urban or rural pharmacies, otolaryngology clinic or emergency unit of University Tishreen hospital over a period of 6 months, who were diagnosed and treated for APT depending on clinical findings. RADT was applied and McIsaac score (MIS) was recorded for all patients. Throat cultures were done only for negative RADT cases seen in the hospital. The chi square (χ2) statistical test was used for comparing categorical variables. A P value of &lt;0.05 was considered significant. Antibiotics were prescribed for 59 patients (74%) among them RADT results were positive for only 9 patients (15.25%) with a percentage of inappropriate antibiotic prescribing of (84.75%). Cultures were GABHS negative for all negative RADT cases. The most frequently prescribed antibiotic was azithromycin (50.8%). Antibiotics prescribing was significantly influenced by the presence of fever (P=0.041), anterior cervical adenitis (P=0.0003), and MIS≤0 (P=0.0001). We found a significance association of the presence of tonsillar exudate (P=0.013) and MIS≥4 (P=0.002) with positive RADT results. There was no significant difference in antibiotic prescribing according to age, sex or place of consultation. Our findings highlight the great need to use RADT in clinical practice as important adjuvant tool in APT diagnosis to reduce the percentage of antibiotic prescribing and so limiting of bacterial resistance.

SCAN! A pharmacy-based, sun safety feasibility study

ObjectivesSkin cancer is the most common form of cancer, and individuals from the medically underserved Appalachian region are at elevated risks for cancer morbidity and mortality. Skin cancer can be prevented by decreasing ultraviolet light exposure (sunscreen sun protection factor 30, shade, clothing, sunglasses, hats) and can be caught at an early treatable stage through a routine skin examination. The Skin Cancer Awareness Now! (SCAN!) pilot project promoted skin cancer prevention and screening in community pharmacies, using a dynamic communication model. The objectives of the study were to understand (1) the feasibility of the SCAN! and (2) the preliminary impact of the SCAN! MethodsWe conducted pre- and postintervention surveys of the SCAN!, a student pharmacist–led or pharmacy resident–led intervention in community pharmacies (n = 3). ResultsParticipants (n = 90) had a mean age of 43.8 (SD= 18.4) years, were predominantly white (92.1%), without a college degree (65.6%), and had an average family income in the range of $25,000-$49,999, with approximately 16% falling below the poverty level. To begin, the SCAN! scored highly in attention (mean = 5.8), liking (mean = 6.1), comprehension (mean = 6.7), and intentions to be sun safe (mean = 6.0). Most improved in their knowledge of the amount of sunscreen needed per application for sun safety (66%, P < 0.01) and of melanoma features from pre- and postintervention (39%, P < 0.01). A multivariate analysis of variance indicated that knowledge and intentions improved (all P’s < 0.01). Interaction effects indicated that improvements in knowledge were greater for those in the rural pharmacy (P = 0.03), and improvements in perceived importance were greater for those in urban pharmacies (P = 0.01). ConclusionThe SCAN! intervention was well received by the population. Our study provides evidence that community pharmacy is a novel venue for skin cancer prevention interventions, particularly for rural, medically underserved populations.