Journal of the American Pharmacists Association最新文献

Background: Over 2.3 million reproductive-age women in the United States live in a maternity care desert, a county without obstetric services or providers; over 3 million more reside in a county with low access to maternity care. The National Alliance of State Pharmacy Associations (NASPA) issued a toolkit outlining maternal health services community pharmacists are positioned to provide within their scope of practice.

Objectives: The primary objective of this study was to determine whether community pharmacists practicing in maternity care deserts/low access areas in Ohio provide NASPA-recommended maternal health services. Secondary objectives were to assess knowledge and attitudes related to maternal health; interest and barriers for developing new services; and screening and referrals for key social determinants of health.

Methods: An anonymous cross-sectional survey was electronically distributed to Ohio community pharmacists working in maternity care deserts/low access areas (n = 216) in fall/winter 2023 to evaluate their awareness, practices, and attitudes.

Results: Thirty-one pharmacists responded (14%). Almost half knew that maternal mortality had increased in recent years. Although 61% reported familiarity with the term "maternity care desert," only 35% recognized they are currently practicing in one. Provision of NASPA-recommended services to reproductive-age women ranged from 90% (immunizations) to 11% (alcohol use screening/counseling). About 96% believed that community pharmacists can help optimize women's health before and during pregnancy. The majority of respondents reported "never" screening for social determinants of health, but 48% were interested in learning more. While 67% of respondents are interested in providing more services for women at their pharmacy, they also reported obstacles like lack of time and staff.

Conclusion: There is a need to raise awareness about maternal mortality and maternity care deserts among Ohio community pharmacists. Given the interest expressed in providing additional services, pharmacists should receive more support to provide needed care for medically-underserved populations.

Background: Despite evidence-based guidelines and available therapies, many patients with type 2 diabetes (T2D) have suboptimal glycemic control. The current standard of care suggests initial monotherapy followed by add-on therapy to achieve and maintain target HbA1c. However, clinical trials revealed that intensive glycemic control, especially at the early stages of the disease, could result in earlier and better long-term glycemic control in addition to reducing diabetes-related complications and mortality risk.

Objective: This population-based study aimed to investigate treatment initiation patterns among newly diagnosed drug-naïve patients with T2D in real-world clinical settings, focusing on two recommended approaches: initial combination therapy and step-therapy.

Methods: A retrospective study was conducted using claims data from the Merative MarketScan Research Databases between 2017 and 2019. The study included drug-naïve patients with T2D with continuous enrollment in medical and pharmacy plans. Patients were categorized into the initial combination therapy or step-therapy cohorts based on their initial treatment regimen. Baseline characteristics of the cohorts were recorded, and logistic regression analysis was performed to identify factors associated with receiving each approach.

Results: The study included a total of 117,419 patients in the Commercial/Medicare population and 18,574 patients in the Medicaid population. About 10% to 12% of patients received initial combination therapy as their initial pharmacotherapy regimen. Several patient demographic and clinical characteristics were significantly associated with the use of initial combination therapy vs. step-therapy. Results also showed a greater usage of loose-dose combination pills over fixed-dose combinations.

Conclusion: Given the lack of real-world studies on combination vs. step-therapy, the study findings provide insights into the current treatment initiation patterns and associated factors among drug-naïve patients with T2D. These findings contribute to understanding the real-world clinical practices in diabetes management and may help guide clinicians in making informed decisions regarding pharmacotherapy approaches.

Background: Community pharmacists are well placed to identify and vaccinate unimmunized or under-immunized individuals who can put themselves and communities at risk of preventable disease. We designed and tested VaxCheck, a novel life-course vaccine review service that can be used to raise awareness and guide personal vaccination action plans, in community pharmacies in Ontario, Canada.

Objective: To understand the experiences of community pharmacists and staff directly involved with providing the VaxCheck service as part of initial testing.

Methods: Semi-structured interviews were performed with pharmacy staff from 9 pharmacies who participated in the study. Interviews were conducted at baseline and following each of 3 Plan-Do-Study-Act quality improvement cycles. Activities undertaken to perform VaxCheck were assessed. An inductive thematic analysis was performed to identify dominant themes and subthemes. Activities and descriptive codes were then correlated to the Consolidated Framework for Implementation Research (CFIR).

Results: Twenty-six interviews were conducted. Pharmacy staff described VaxCheck activities as spanning 3 stages: (1) Promotion/offering of VaxCheck, (2) Completing the VaxCheck, and (3) Enacting recommendations and follow-up. VaxCheck activities were compatible with workflow related to delivery of other vaccines and medication reviews. Thematic analysis found 3 considerations guided VaxCheck adoption: (1) Aligning VaxCheck with workflow through flexible integration, (2) Enabling patient-oriented vaccination services, and (3) Contributing to community healthcare provision. Data aligned with all CFIR domains with strengths noted in constructs from the "Innovation characteristics" and "Individuals" domains. Barriers to implementation were identified in "Inner setting," "Outer setting," and "Process" domains, such as pharmacy workflow capacity, patient knowledge about vaccination, availability of vaccine records, and interactions with other healthcare providers.

Conclusion: Community pharmacists found VaxCheck to be a valuable, accessible service that was well-received by patients and supported adult vaccination reviews and individualized recommendations. VaxCheck was compatible with pharmacy workflow but needed additional resources for sustainability and promotion with stakeholders.

Background: Pharmacovigilance is essential for patient safety, but underreporting adverse drug reactions (ADRs) is a global challenge.

Objectives: This review evaluated the effectiveness of strategies for enhancing ADR reporting by healthcare professionals (HCPs).

Methods: This systematic review was conducted following the Cochrane and the PRISMA guidelines. Five international databases were searched from inception to December 2023 and updated search to September 2024. Randomized clinical controlled trials (RCTs) and non-RCTs on enhancing ADR reporting were included. The primary outcomes were the number of overall ADR and high-quality ADR reports. Study quality was assessed using the Effective Practice and Organization of Care risk of bias (ROB), and ROBIN-I for RCT, and non-RCT. All data were evaluated using a random-effects model, and heterogeneity was assessed using I² statistic and chi-squared tests.

Results: From 1672 studies, 13 studies (10 RCTs, and 3 non-RCTs) with 28,116 participants were included. Two of 10 RCTs had low ROB while the remaining were judged as unclear and moderate ROB. Most studies were in high-income countries, and the main strategy was educating HCPs through workshops. Meta-analysis showed significant increases in overall ADR reporting through educating HCPs with a rate ratio (RR) of 5.09 (95% CI: 3.36-7.71, I² = 84.5%, low certainty), and in high-quality reporting with 1.31 (95% CI: 1.09-1.58, I² = 0.0%, moderate certainty). Subgroup analysis indicated that educating HCPs through face-to-face workshops combined with the Tawai app (RR:10.5, 95% CI: 8.74-12.61), a face-to-face workshop alone (RR:6.69, 95% CI: 5.43-8.25, I² = 0.0%), and repeated telephone (RR:2.59, 95% CI: 1.75-3.84, I² = 8.8%) significantly increased the overall number of ADR reports with moderate certainty. Email or letter communications showed no significant effect.

Conclusion: Educating HCPs via interactive strategies like face-to-face workshops with or without a mobile app and repeated phone calls improved ADR reporting. However, long-term, high-quality studies are needed to confirm these findings before recommending widespread implementation in clinical practice, especially in low-and middle-income countries.

From 2000 to 2025, the profession of pharmacy expanded into vaccinations, point-of-care testing, and chronic disease prevention and management. In the next 25 years, pharmacy will continue to advance in new ways. This paper focuses on expanded roles of community and ambulatory care pharmacy to more directly improve public health. Built around the ten essential services of public health, this paper calls upon the profession of pharmacy to stretch beyond traditional roles to assume roles that would strengthen the public health workforce and make seminal contributions to improved population health. Barriers to be overcome in pursuit of that future are also addressed. The paper will conclude with a public health-focused call to pharmacy.

Background: The 2024 Standards of Care in Diabetes recommend initiation of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) prior to starting basal insulin and to reconsider initiating a GLP-1 RA before starting bolus insulin if not already initiated. GLP-1 RA addition leads to improved glycemic benefits as well as risk reduction of cardiovascular and renal outcomes in patients with a history of these events. While there is evidence demonstrating the trends of insulin reduction or discontinuation following GLP-1 RA initiation, data regarding longer-term durability of GLP-1 RA use to sustain patients off bolus insulin are lacking.

Objective: This retrospective study aimed to assess the percentage of patients remaining off bolus insulin after transitioning from a basal-bolus regimen to GLP-1 RA therapy with basal insulin over a period of 3 years.

Methods: We conducted a single centered, retrospective study analyzing patient data from July 2018 through July 2023. Patients were included if they had a diagnosis of type 2 diabetes, were on a basal-bolus insulin regimen, had a GLP-1 RA initiated followed by bolus insulin discontinuation within 90 days, and remained on a GLP-1 RA for at least 6 months. The primary outcome was the percentage of patients who were sustained off bolus insulin after 3 years following GLP-1 RA initiation.

Results: There were 252 patients included. At 3 years, 82.6% of patients were sustained off bolus insulin. The mean change in weight at 3 years was -8.5 kg. The mean A1c initially decreased from 8.6% to 7.8%, but then increased slightly to 8.1% at the end of the study timeframe.

Conclusion: This trial demonstrated the majority of patients on basal-bolus regimens where bolus insulin was replaced with a GLP-1 RA were sustained off bolus insulin for a 3 year period of time. These results highlight the promising durability of converting bolus insulin to GLP-1 RAs.

The pharmacy profession stands at a pivotal juncture as it faces unprecedented technological advancements that will rapidly reshape the healthcare landscape by 2050. This commentary explores the implications of technological advancements for pharmacy practice and how it may impact the workforce in the coming decades. The advent of digital health technologies (DHTs), artificial intelligence (AI), and automation is poised to transform patient engagement and care delivery. The Covid-19 pandemic has accelerated this shift, and traditional pharmacy roles have evolved to meet these expectations. As AI and DHT adoption increase, it will push the profession beyond its historical focus on logistics and medication dispensing. Several potential scenarios may unfold by 2050, ranging from a diminished workforce overshadowed by technology to an evolved profession that leverages novel technologies to enhance clinical services and patient care. To prepare for these changes, the profession must address key challenges, including advancing education and training to incorporate new competencies, establishing sustainable financial models for emerging roles, embracing advocacy and navigating regulatory constraints to expand scopes of practice, and overcoming societal resistance to change. By embracing continuous learning and adaptability, pharmacists can seize the opportunity to redefine their roles, ensuring they remain indispensable in an evolving healthcare environment.