Pub Date : 2025-10-09DOI: 10.1016/j.japh.2025.102933
Monica F. Roberts, Patricia R. Freeman, Laura K. Stinson, Adrienne Matson, Sharon L. Walsh
Community pharmacists are well-positioned to contribute to public health initiatives related to prescription opioid safety and naloxone access, but many barriers, including gaps in knowledge and confidence, prevent them from fully engaging with their patients and communities on these topics. The Kentucky site of the HEALing (Helping to End Addiction Long-term Initiative) Communities Study sought to involve community pharmacists in the effort to prevent opioid-related overdose deaths. Throughout the study, strategies to provide in-person educational outreach to community pharmacists were developed, implemented, and redesigned, resulting in a new format: the minivisit method. Minivisits are based on the principles of academic detailing but aim to more efficiently meet the needs of busy community pharmacists. Implemented by pharmacists for pharmacists, minivisits deliver key messages in brief, unscheduled visits to all community pharmacies in an identified geographic area. Paired with on-going support, high-quality printed materials, and in-depth continuing education activities, minivisits offer a promising alternative to traditional education formats. The minivisit method can be adapted to the goals, budget, and educational needs of a given program. This commentary details the trial-and-error process by which minivisits were developed and implemented and the key components of the minivisit method. The aim of this commentary is to inspire and inform future efforts to educate community pharmacists and expand practice to improve public health.
{"title":"The minivisit method: Adapting opioid-related educational outreach for community pharmacies","authors":"Monica F. Roberts, Patricia R. Freeman, Laura K. Stinson, Adrienne Matson, Sharon L. Walsh","doi":"10.1016/j.japh.2025.102933","DOIUrl":"10.1016/j.japh.2025.102933","url":null,"abstract":"<div><div>Community pharmacists are well-positioned to contribute to public health initiatives related to prescription opioid safety and naloxone access, but many barriers, including gaps in knowledge and confidence, prevent them from fully engaging with their patients and communities on these topics. The Kentucky site of the HEALing (Helping to End Addiction Long-term Initiative) Communities Study sought to involve community pharmacists in the effort to prevent opioid-related overdose deaths. Throughout the study, strategies to provide in-person educational outreach to community pharmacists were developed, implemented, and redesigned, resulting in a new format: the minivisit method. Minivisits are based on the principles of academic detailing but aim to more efficiently meet the needs of busy community pharmacists. Implemented by pharmacists for pharmacists, minivisits deliver key messages in brief, unscheduled visits to all community pharmacies in an identified geographic area. Paired with on-going support, high-quality printed materials, and in-depth continuing education activities, minivisits offer a promising alternative to traditional education formats. The minivisit method can be adapted to the goals, budget, and educational needs of a given program. This commentary details the trial-and-error process by which minivisits were developed and implemented and the key components of the minivisit method. The aim of this commentary is to inspire and inform future efforts to educate community pharmacists and expand practice to improve public health.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102933"},"PeriodicalIF":2.5,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-08DOI: 10.1016/j.japh.2025.102940
Michael J. DiStefano, Nai-Chia Chen, Carl V. Asche, Kelly E. Anderson, T. Joseph Mattingly II
Background
Community pharmacies are critical access points for health care in the United States, especially for underserved populations. However, a substantial number of recent pharmacy closures have been widely documented. Pharmacies at greater risk of closure are typically found in urban areas, are independently-owned businesses, and disproportionately serve low-income populations. While prior research has quantitatively assessed the impact of pharmacy closures on medication adherence and geographic access, less is known about the broader impacts of pharmacy closures on communities, pharmacy operations, pharmacy staff, and patients.
Objective
To qualitatively describe the impacts of community pharmacy closures in Colorado and Utah on communities, pharmacy operations, pharmacy staff, and patients from the perspective of pharmacists and technicians.
Methods
We conducted three semistructured focus groups in September and October 2024 with 13 participants who had experienced a community pharmacy closure in Colorado or Utah within the previous 6 years. Focus group transcripts were analyzed using a mixed deductive-inductive approach to identify major themes.
Results
Closures negatively impacted communities by creating pharmacy deserts, harming local economies, and complicating workforce recruitment beyond the pharmacy industry. Increased prescription volume, staffing challenges, and operational stress at remaining pharmacies disrupted pharmacy operations. Staff described emotional and psychological tolls, including stress, burnout, and regret over career choices, as well as job loss and increased competition for available positions. Closures also impacted patients by increasing wait times, disrupting continuity of care, and disproportionately affecting vulnerable populations such as those without transportation, older adults, and individuals requiring controlled substances.
Conclusion
Pharmacy closures have far-reaching consequences that extend beyond access to medications, affecting the social and economic fabric of communities and the overall well-being of both pharmacy staff and patients. These findings can inform future research and policy efforts aimed at mitigating the negative impacts of closures and promoting equitable access to pharmacy services.
{"title":"“The crux of the community”: A qualitative focus group study of the impact of community pharmacy closures in Colorado and Utah","authors":"Michael J. DiStefano, Nai-Chia Chen, Carl V. Asche, Kelly E. Anderson, T. Joseph Mattingly II","doi":"10.1016/j.japh.2025.102940","DOIUrl":"10.1016/j.japh.2025.102940","url":null,"abstract":"<div><h3>Background</h3><div>Community pharmacies are critical access points for health care in the United States, especially for underserved populations. However, a substantial number of recent pharmacy closures have been widely documented. Pharmacies at greater risk of closure are typically found in urban areas, are independently-owned businesses, and disproportionately serve low-income populations. While prior research has quantitatively assessed the impact of pharmacy closures on medication adherence and geographic access, less is known about the broader impacts of pharmacy closures on communities, pharmacy operations, pharmacy staff, and patients.</div></div><div><h3>Objective</h3><div>To qualitatively describe the impacts of community pharmacy closures in Colorado and Utah on communities, pharmacy operations, pharmacy staff, and patients from the perspective of pharmacists and technicians.</div></div><div><h3>Methods</h3><div>We conducted three semistructured focus groups in September and October 2024 with 13 participants who had experienced a community pharmacy closure in Colorado or Utah within the previous 6 years. Focus group transcripts were analyzed using a mixed deductive-inductive approach to identify major themes.</div></div><div><h3>Results</h3><div>Closures negatively impacted communities by creating pharmacy deserts, harming local economies, and complicating workforce recruitment beyond the pharmacy industry. Increased prescription volume, staffing challenges, and operational stress at remaining pharmacies disrupted pharmacy operations. Staff described emotional and psychological tolls, including stress, burnout, and regret over career choices, as well as job loss and increased competition for available positions. Closures also impacted patients by increasing wait times, disrupting continuity of care, and disproportionately affecting vulnerable populations such as those without transportation, older adults, and individuals requiring controlled substances.</div></div><div><h3>Conclusion</h3><div>Pharmacy closures have far-reaching consequences that extend beyond access to medications, affecting the social and economic fabric of communities and the overall well-being of both pharmacy staff and patients. These findings can inform future research and policy efforts aimed at mitigating the negative impacts of closures and promoting equitable access to pharmacy services.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102940"},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145276929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-08DOI: 10.1016/j.japh.2025.102937
Gi Eun Han, Andrew Y. Hwang
Background
Opioids can cause adverse cardiovascular effects (e.g., hypotension, arrhythmias), which can be concerning in individuals with pre-existing cardiovascular disease (CVD). Currently, little is known regarding the trends in opioid use among individuals with CVD.
Objective
To evaluate the long-term trends of prescription opioids among adults with CVD in the United States.
Methods
Using National Health and Nutrition Examination Survey data from 2001 to March 2020, adults ≥20 year old with ≥1 of the following CVDs – heart failure, coronary heart disease, angina, myocardial infarction, and stroke – were identified. Trends in the use of any, short-term (≤90 days), and long-term (>90 days) prescription opioids were evaluated. Subgroup analyses were conducted to test trends in any prescription opioid use by CVD types, pain-related comorbidities, and demographic/socioeconomic characteristics. Multivariable logistic regression, adjusted for age, was used to test the trends in 4-year examination periods.
Results
Among 6250 participants with CVD, no significant trends in the use of any prescription opioids were observed throughout the study period (9.4% in 2001–2004% to 11.8% in 2017-March 2020; P = 0.25). The prevalence of long-term prescription opioid use increased from 6.6% in 2001-2004% to 10.4% in 2017-March 2020, with a peak prevalence of 12.6% in 2013–2016 (P = 0.04). During the study period, an increase in the prevalence of any prescription opioid use was seen among individuals aged ≥65 years, from 7.5% in 2001-2004% to 11.3% in 2017-March 2020 (P = 0.006).
Conclusion
Although overall prescription opioid use among participants with CVD remained relatively consistent between 2001 and March 2020, the use of long-term opioid prescriptions increased, possibly reflecting a growing burden of chronic pain in this population. Prescription opioid use also appeared to have increased among individuals aged ≥65 years, raising concerns due to their heightened risk of cardiovascular adverse effects from opioids.
{"title":"Trends in opioid use among adults with cardiovascular disease, 2001 – March 2020","authors":"Gi Eun Han, Andrew Y. Hwang","doi":"10.1016/j.japh.2025.102937","DOIUrl":"10.1016/j.japh.2025.102937","url":null,"abstract":"<div><h3>Background</h3><div>Opioids can cause adverse cardiovascular effects (e.g., hypotension, arrhythmias), which can be concerning in individuals with pre-existing cardiovascular disease (CVD). Currently, little is known regarding the trends in opioid use among individuals with CVD.</div></div><div><h3>Objective</h3><div>To evaluate the long-term trends of prescription opioids among adults with CVD in the United States.</div></div><div><h3>Methods</h3><div>Using National Health and Nutrition Examination Survey data from 2001 to March 2020, adults ≥20 year old with ≥1 of the following CVDs – heart failure, coronary heart disease, angina, myocardial infarction, and stroke – were identified. Trends in the use of any, short-term (≤90 days), and long-term (>90 days) prescription opioids were evaluated. Subgroup analyses were conducted to test trends in any prescription opioid use by CVD types, pain-related comorbidities, and demographic/socioeconomic characteristics. Multivariable logistic regression, adjusted for age, was used to test the trends in 4-year examination periods.</div></div><div><h3>Results</h3><div>Among 6250 participants with CVD, no significant trends in the use of any prescription opioids were observed throughout the study period (9.4% in 2001–2004% to 11.8% in 2017-March 2020; <em>P</em> = 0.25). The prevalence of long-term prescription opioid use increased from 6.6% in 2001-2004% to 10.4% in 2017-March 2020, with a peak prevalence of 12.6% in 2013–2016 (<em>P</em> = 0.04). During the study period, an increase in the prevalence of any prescription opioid use was seen among individuals aged ≥65 years, from 7.5% in 2001-2004% to 11.3% in 2017-March 2020 (<em>P</em> = 0.006).</div></div><div><h3>Conclusion</h3><div>Although overall prescription opioid use among participants with CVD remained relatively consistent between 2001 and March 2020, the use of long-term opioid prescriptions increased, possibly reflecting a growing burden of chronic pain in this population. Prescription opioid use also appeared to have increased among individuals aged ≥65 years, raising concerns due to their heightened risk of cardiovascular adverse effects from opioids.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102937"},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-08DOI: 10.1016/j.japh.2025.102936
Jade Denninger, Kathryn McNeil, Michael Herman, Alexander Bos, Katharine Wilson, Alexandra Herman
Background
Cesarean-section surgical site infections (SSIs) are the leading cause of postcesarean complications. Few studies have examined postcesarean antibiotic prophylaxis in patients with obesity (Body mass index >30 kg/m2 or greater) in a real-world setting.
Objectives
The aim of this study was to evaluate the implementation of a postcesarean oral cephalexin and metronidazole antibiotic prophylaxis protocol for patients with obesity, describe clinical outcomes in these patients, and describe the pharmacist's role in protocol implementation.
Methods
An interdisciplinary team, including a pharmacist, developed this protocol for post-cesarean antibiotic prophylaxis. The pharmacist later implemented the order sets and screened patients to recommend prophylaxis. We conducted a single center, retrospective cohort study comparing SSI outcomes of patients with obesity at 60-days who received 48-hours of antibiotic prophylaxis with oral cephalexin and metronidazole to patients who received standard of care.
Results
Of 397 patients, 202 received 48-hour antibiotic prophylaxis, 41 received partial antibiotic prophylaxis, and 154 did not receive postcesarean antibiotic prophylaxis in addition to standard of care. At 60 days postcesarean, SSIs were significantly lower in the 48-hour prophylaxis group compared to standard of care (7.9% vs. 11%, P = 0.004). There was not a significant reduction in SSIs (9.4% vs. 11%, P = 0.114) when including patients who received partial antibiotic prophylaxis. Higher BMI was associated with an increased risk of infection. When controlling for BMI, patients not receiving prophylactic antibiotics had an increased incidence of SSI (adjusted OR = 2.62, 95% CI; 1.122-6.132). There were no hospital readmissions for patients who received prophylaxis compared to 3.2% (n = 5) patients who did not.
Conclusion
Postcesarean antibiotic prophylaxis with oral cephalexin and metronidazole for 48 h in patients with obesity was associated with reduced incidence of SSI within 60 day follow up. Pharmacists play a key role in the implementation of protocols which can improve patient outcomes.
背景：剖宫产手术部位感染（SSI）是剖宫产术后并发症的主要原因。在现实环境中，很少有研究对肥胖患者（BMI为30 kg/m2）剖宫产后抗生素预防进行检查。目的：本研究的目的是评估肥胖患者剖宫产后口服头孢氨苄和甲硝唑抗生素预防方案的实施情况，描述这些患者的临床结果，并描述药剂师在方案实施中的作用。方法：一个跨学科的团队，包括一名药剂师，制定了剖宫产后抗生素预防方案。药剂师后来实施的命令集和筛选患者建议预防。我们进行了一项单中心、回顾性队列研究，比较了60天内接受48小时口服头孢氨苄和甲硝唑抗生素预防的肥胖患者与接受标准治疗的患者的SSI结果。结果：397例患者中，202例接受48小时抗生素预防，41例接受部分抗生素预防，154例在标准护理之外未接受剖宫产后抗生素预防。在剖宫产后60天，48小时预防组的ssi明显低于标准护理组（7.9% vs 11%, p=0.004）。当包括接受部分抗生素预防的患者时，ssi没有显著降低（9.4% vs 11%， P=0.114）。BMI越高，感染风险越高。在控制BMI时，未接受预防性抗生素治疗的患者SSI发生率增加（校正OR=2.62, 95% CI; 1.122-6.132）。接受预防治疗的患者无再入院，而未接受预防治疗的患者为3.2% （n=5）。结论：肥胖患者剖宫产术后48小时口服头孢氨苄和甲硝唑预防抗生素与60天随访期间SSI发生率降低相关。药剂师在方案的实施中发挥着关键作用，可以改善患者的预后。
{"title":"Implementation of a protocol for postcesarean delivery oral cephalexin and metronidazole to prevent surgical site infection in patients with BMI≥30 kg/m2","authors":"Jade Denninger, Kathryn McNeil, Michael Herman, Alexander Bos, Katharine Wilson, Alexandra Herman","doi":"10.1016/j.japh.2025.102936","DOIUrl":"10.1016/j.japh.2025.102936","url":null,"abstract":"<div><h3>Background</h3><div>Cesarean-section surgical site infections (SSIs) are the leading cause of postcesarean complications. Few studies have examined postcesarean antibiotic prophylaxis in patients with obesity (Body mass index >30 kg/m<sup>2</sup> or greater) in a real-world setting.</div></div><div><h3>Objectives</h3><div>The aim of this study was to evaluate the implementation of a postcesarean oral cephalexin and metronidazole antibiotic prophylaxis protocol for patients with obesity, describe clinical outcomes in these patients, and describe the pharmacist's role in protocol implementation.</div></div><div><h3>Methods</h3><div>An interdisciplinary team, including a pharmacist, developed this protocol for post-cesarean antibiotic prophylaxis. The pharmacist later implemented the order sets and screened patients to recommend prophylaxis. We conducted a single center, retrospective cohort study comparing SSI outcomes of patients with obesity at 60-days who received 48-hours of antibiotic prophylaxis with oral cephalexin and metronidazole to patients who received standard of care.</div></div><div><h3>Results</h3><div>Of 397 patients, 202 received 48-hour antibiotic prophylaxis, 41 received partial antibiotic prophylaxis, and 154 did not receive postcesarean antibiotic prophylaxis in addition to standard of care. At 60 days postcesarean, SSIs were significantly lower in the 48-hour prophylaxis group compared to standard of care (7.9% vs. 11%, <em>P</em> = 0.004). There was not a significant reduction in SSIs (9.4% vs. 11%, <em>P</em> = 0.114) when including patients who received partial antibiotic prophylaxis. Higher BMI was associated with an increased risk of infection. When controlling for BMI, patients not receiving prophylactic antibiotics had an increased incidence of SSI (adjusted OR = 2.62, 95% CI; 1.122-6.132). There were no hospital readmissions for patients who received prophylaxis compared to 3.2% (n = 5) patients who did not.</div></div><div><h3>Conclusion</h3><div>Postcesarean antibiotic prophylaxis with oral cephalexin and metronidazole for 48 h in patients with obesity was associated with reduced incidence of SSI within 60 day follow up. Pharmacists play a key role in the implementation of protocols which can improve patient outcomes.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102936"},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-08DOI: 10.1016/j.japh.2025.102938
Nga-Weng (Ivy) Leong MS, Shishir Maharjan PhD, Saara Z. Nasruddin PhD, Chandler Gandy, Donna W. Strum PhD, Yi Yang MD, PhD
Background
Primary medication nonadherence is a multifaceted problem that leads to poor health outcomes. Various interventions have been studied to improve primary nonadherence across different populations and/or disease areas. However, there is no comprehensive review to understand the scope and depth of available evidence on intervention effectiveness.
Objective
This study aims to examine recent literature on interventions designed to improve primary medication nonadherence.
Methods
An electronic search of CINAHL, Cochrane Central, Embase, ProQuest, PsycINFO, PubMed, and Scopus was conducted for relevant literature up to July 2025. Articles published in English since 2000 and focused on interventions to improve primary medication nonadherence were included. The Health Pyramid Framework and the Template for Intervention Description and Replication were used for data extraction.
Results
Forty articles published after 2000 were included in this review. Thirty-two studies were conducted in the US. Study settings included ambulatory care clinic, inpatient, outpatient, emergency department, and pharmacy. Eighteen studies focused on cardiovascular diseases/medications. Interventions were classified as clinical intervention (n = 6, 15%), patient counseling and education-related (n = 23, 57.5%), and socioeconomics-related (n = 11, 27.5%). Intervention types included national statutory amendments (n = 2, 5%), face-to-face education (n = 4, 10%), hybrid education (n = 3, 7.5%), e-prescribing (n = 6, 15%), patient assistance provided by manufacturers (n = 9, 22.5%), and virtual reminders or education (n = 16, 40%). Most counseling and education-related interventions (n = 13, 32.5%) were conducted by pharmacists. Primary nonadherence was measured using prescription abandonment, failure to initiate medications or reversed claims. Interventions (n = 9, 22.5%) involving face-to-face or hybrid counseling by pharmacists and interventions (n = 10, 25%) that lowered out-of-pocket costs were found to be effective in improving primary nonadherence.
Conclusion
Various strategies have been employed across different health care settings and patient populations to improve primary medication nonadherence; their effectiveness varied significantly. Face-to-face or hybrid counseling by pharmacists or nurses has been shown to be effective in improving primary nonadherence.
{"title":"Interventions to improve primary medication nonadherence: A scoping review","authors":"Nga-Weng (Ivy) Leong MS, Shishir Maharjan PhD, Saara Z. Nasruddin PhD, Chandler Gandy, Donna W. Strum PhD, Yi Yang MD, PhD","doi":"10.1016/j.japh.2025.102938","DOIUrl":"10.1016/j.japh.2025.102938","url":null,"abstract":"<div><h3>Background</h3><div>Primary medication nonadherence is a multifaceted problem that leads to poor health outcomes. Various interventions have been studied to improve primary nonadherence across different populations and/or disease areas. However, there is no comprehensive review to understand the scope and depth of available evidence on intervention effectiveness.</div></div><div><h3>Objective</h3><div>This study aims to examine recent literature on interventions designed to improve primary medication nonadherence.</div></div><div><h3>Methods</h3><div>An electronic search of CINAHL, Cochrane Central, Embase, ProQuest, PsycINFO, PubMed, and Scopus was conducted for relevant literature up to July 2025. Articles published in English since 2000 and focused on interventions to improve primary medication nonadherence were included. The Health Pyramid Framework and the Template for Intervention Description and Replication were used for data extraction.</div></div><div><h3>Results</h3><div>Forty articles published after 2000 were included in this review. Thirty-two studies were conducted in the US. Study settings included ambulatory care clinic, inpatient, outpatient, emergency department, and pharmacy. Eighteen studies focused on cardiovascular diseases/medications. Interventions were classified as clinical intervention (n = 6, 15%), patient counseling and education-related (n = 23, 57.5%), and socioeconomics-related (n = 11, 27.5%). Intervention types included national statutory amendments (n = 2, 5%), face-to-face education (n = 4, 10%), hybrid education (n = 3, 7.5%), e-prescribing (n = 6, 15%), patient assistance provided by manufacturers (n = 9, 22.5%), and virtual reminders or education (n = 16, 40%). Most counseling and education-related interventions (n = 13, 32.5%) were conducted by pharmacists. Primary nonadherence was measured using prescription abandonment, failure to initiate medications or reversed claims. Interventions (n = 9, 22.5%) involving face-to-face or hybrid counseling by pharmacists and interventions (n = 10, 25%) that lowered out-of-pocket costs were found to be effective in improving primary nonadherence.</div></div><div><h3>Conclusion</h3><div>Various strategies have been employed across different health care settings and patient populations to improve primary medication nonadherence; their effectiveness varied significantly. Face-to-face or hybrid counseling by pharmacists or nurses has been shown to be effective in improving primary nonadherence.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102938"},"PeriodicalIF":2.5,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-26DOI: 10.1016/j.japh.2025.102932
Alex J. Adams
Despite expanded clinical authority, pharmacists often face barriers to full provider status in Medicaid owing to outdated reimbursement policies and administrative restrictions. This paper describes Idaho’s comprehensive approach to pharmacist integration into its Medicaid program through a profession-neutral “what, not who” reimbursement framework coupled with its “standard of care” regulatory framework. Rather than defining eligibility by provider type, Idaho allows any licensed health professional to bill for Medicaid-covered services within their legal scope of practice. Key reforms included statutory changes, regulatory updates, provider enrollment optimization, and alignment of pharmacist reimbursement with midlevel providers. Pharmacists can now enroll as rendering providers and bill directly for services using their National Provider Identifier. Idaho’s model demonstrates that full pharmacist integration into Medicaid can be achieved in a framework that is scalable, bipartisan, and adaptable, offering a policy roadmap for other states seeking to enhance access to health care especially in rural settings.
{"title":"Pharmacist provider status in Medicaid: A state health director’s perspective on policy and practice","authors":"Alex J. Adams","doi":"10.1016/j.japh.2025.102932","DOIUrl":"10.1016/j.japh.2025.102932","url":null,"abstract":"<div><div>Despite expanded clinical authority, pharmacists often face barriers to full provider status in Medicaid owing to outdated reimbursement policies and administrative restrictions. This paper describes Idaho’s comprehensive approach to pharmacist integration into its Medicaid program through a profession-neutral “what, not who” reimbursement framework coupled with its “standard of care” regulatory framework. Rather than defining eligibility by provider type, Idaho allows any licensed health professional to bill for Medicaid-covered services within their legal scope of practice. Key reforms included statutory changes, regulatory updates, provider enrollment optimization, and alignment of pharmacist reimbursement with midlevel providers. Pharmacists can now enroll as rendering providers and bill directly for services using their National Provider Identifier. Idaho’s model demonstrates that full pharmacist integration into Medicaid can be achieved in a framework that is scalable, bipartisan, and adaptable, offering a policy roadmap for other states seeking to enhance access to health care especially in rural settings.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102932"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-26DOI: 10.1016/j.japh.2025.102931
Emily Parry, Allison Hursman, Ellen Rubinstein, Taylor Thooft, Rylie Johnson, Jada Ford, Kimaria Stevenson, Lauren Lowe
Background
Ambulatory care pharmacists (ACPs) support patients and the health care team through clinical services such as patient education and comprehensive disease state management. Although multiple studies show the impact of ACPs on others, little research has been done on their own experiences.
Objectives
This study aimed to learn from ACPs about their workplace experiences and identify systemic factors that affect their role as members of interprofessional health care teams.
Methods
This exploratory, qualitative study consisted of digitally recorded, semistructured interviews with ACPs. Interviews were transcribed and analyzed inductively and iteratively by a multidisciplinary research team to determine salient themes.
Results
Twenty-one pharmacists (10 in private health systems, 11 in public health systems) participated, 15 of whom described the effects of leadership, metrics, and reimbursement on their roles. Although many pharmacists felt supported by leadership, others noted consistent pressure to meet arbitrary quality metrics and frustration with limited reimbursement options. Public health system pharmacists seemed to be more affected by these systemic factors than their private health system counterparts.
Conclusion
Leadership, metrics, and reimbursement are all systemic factors that affect ACPs’ workplace experiences, as evinced by participant interviews. More research is necessary to determine how best to support ACPs across health systems to ensure that they can continue providing high-quality, accessible patient care.
{"title":"A descriptive study of systemic factors that affect ambulatory care pharmacists","authors":"Emily Parry, Allison Hursman, Ellen Rubinstein, Taylor Thooft, Rylie Johnson, Jada Ford, Kimaria Stevenson, Lauren Lowe","doi":"10.1016/j.japh.2025.102931","DOIUrl":"10.1016/j.japh.2025.102931","url":null,"abstract":"<div><h3>Background</h3><div>Ambulatory care pharmacists (ACPs) support patients and the health care team through clinical services such as patient education and comprehensive disease state management. Although multiple studies show the impact of ACPs on others, little research has been done on their own experiences.</div></div><div><h3>Objectives</h3><div>This study aimed to learn from ACPs about their workplace experiences and identify systemic factors that affect their role as members of interprofessional health care teams.</div></div><div><h3>Methods</h3><div>This exploratory, qualitative study consisted of digitally recorded, semistructured interviews with ACPs. Interviews were transcribed and analyzed inductively and iteratively by a multidisciplinary research team to determine salient themes.</div></div><div><h3>Results</h3><div>Twenty-one pharmacists (10 in private health systems, 11 in public health systems) participated, 15 of whom described the effects of leadership, metrics, and reimbursement on their roles. Although many pharmacists felt supported by leadership, others noted consistent pressure to meet arbitrary quality metrics and frustration with limited reimbursement options. Public health system pharmacists seemed to be more affected by these systemic factors than their private health system counterparts.</div></div><div><h3>Conclusion</h3><div>Leadership, metrics, and reimbursement are all systemic factors that affect ACPs’ workplace experiences, as evinced by participant interviews. More research is necessary to determine how best to support ACPs across health systems to ensure that they can continue providing high-quality, accessible patient care.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102931"},"PeriodicalIF":2.5,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.japh.2025.102930
Shaquib Al Hasan, Tsung-Hua Shen, Felix Cheuk Wun Ting, Joel F. Farley
Background
The Medicare Part D medication therapy management (MTM) program provides comprehensive medication reviews (CMRs) to eligible patients. Despite its introduction in 2006, benefits of the MTM program are still not well understood, lacking research in large generalizable Medicare populations.
Objectives
To examine the effectiveness of receiving a CMR on health care utilizations and associated spending.
Methods
A new user retrospective cohort study was used to compare changes in healthcare utilization and spending in CMR recipients to a matched cohort of Medicare beneficiaries who were eligible, but did not receive a CMR. Linking MTM files to inpatient, outpatient, and prescription claims for a 20% random sample of Medicare beneficiaries aged 65 and older, we obtained 533,550 CMR recipients and 1,413,860 non-recipients, and a propensity score matched sample of 531,314 CMR recipients and 531,314 nonrecipients. Difference-in-difference models were used to compare the 1-year probability and number of emergency department (ED) and hospital visits, and inpatient, outpatient, and prescription and total health spending between CMR recipients and nonrecipients.
Results
Relative to CMR nonrecipients and the year prior to CMR delivery, CMR recipients experienced a 0.49% (95% confidence interval [CI], 0.33% to 0.64%%) and 1.72% (95% CI, 1.57% to 1.88%) lower probability of an ED visit and hospitalization 1 year after CMR delivery, respectively. Similarly, CMR receipt resulted in a reduction of 80 hospital stays (95% CI, 45 to 115) and 337 ED visits (95% CI, 305 to 370) per 10,000 recipients, respectively. Per beneficiary, non-prescription medical spending declined by $378 (95% CI = 314 to $442) while prescription spending increased by $470 (95% CI = $436 to $503) resulting in an additional $91 in total spending (95% CI = $20 to $164) among recipients.
Conclusion
Health care utilization reduction associated with CMR, found in this study, suggests that CMR in older adults may help reduce nonprescription health care expenditure in the year following CMR.
{"title":"Health care utilization and spending following comprehensive medication review in Medicare part D","authors":"Shaquib Al Hasan, Tsung-Hua Shen, Felix Cheuk Wun Ting, Joel F. Farley","doi":"10.1016/j.japh.2025.102930","DOIUrl":"10.1016/j.japh.2025.102930","url":null,"abstract":"<div><h3>Background</h3><div>The Medicare Part D medication therapy management (MTM) program provides comprehensive medication reviews (CMRs) to eligible patients. Despite its introduction in 2006, benefits of the MTM program are still not well understood, lacking research in large generalizable Medicare populations.</div></div><div><h3>Objectives</h3><div>To examine the effectiveness of receiving a CMR on health care utilizations and associated spending.</div></div><div><h3>Methods</h3><div>A new user retrospective cohort study was used to compare changes in healthcare utilization and spending in CMR recipients to a matched cohort of Medicare beneficiaries who were eligible, but did not receive a CMR. Linking MTM files to inpatient, outpatient, and prescription claims for a 20% random sample of Medicare beneficiaries aged 65 and older, we obtained 533,550 CMR recipients and 1,413,860 non-recipients, and a propensity score matched sample of 531,314 CMR recipients and 531,314 nonrecipients. Difference-in-difference models were used to compare the 1-year probability and number of emergency department (ED) and hospital visits, and inpatient, outpatient, and prescription and total health spending between CMR recipients and nonrecipients.</div></div><div><h3>Results</h3><div>Relative to CMR nonrecipients and the year prior to CMR delivery, CMR recipients experienced a 0.49% (95% confidence interval [CI], 0.33% to 0.64%%) and 1.72% (95% CI, 1.57% to 1.88%) lower probability of an ED visit and hospitalization 1 year after CMR delivery, respectively. Similarly, CMR receipt resulted in a reduction of 80 hospital stays (95% CI, 45 to 115) and 337 ED visits (95% CI, 305 to 370) per 10,000 recipients, respectively. Per beneficiary, non-prescription medical spending declined by $378 (95% CI = 314 to $442) while prescription spending increased by $470 (95% CI = $436 to $503) resulting in an additional $91 in total spending (95% CI = $20 to $164) among recipients.</div></div><div><h3>Conclusion</h3><div>Health care utilization reduction associated with CMR, found in this study, suggests that CMR in older adults may help reduce nonprescription health care expenditure in the year following CMR.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102930"},"PeriodicalIF":2.5,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.japh.2025.102929
Suzanne Whitten, Sharmon P. Osae, Russ Palmer, Rebecca H. Stone, Beth Bryles Phillips, Chelsea A. Keedy, Blake R. Johnson, Henry N. Young, Devin L. Lavender
Background
Collaborative drug therapy modification (CDTM) authorizes adjustment of dosages, dosage schedules, and/or medications within a defined protocol under physician supervision within Georgia. Pharmacist-led collaborative drug therapy management positively impacts health outcomes leading to reduced health care expenditures. Less than 1% of Georgia pharmacists have a CDTM license.
Objective
The objective was to obtain feedback from rural primary health care system administrators to assist in increasing CDTM services and expand access to patient care services in Georgia.
Methods
An exploratory qualitative interview research design was utilized. Complete target population sampling was used to increase likelihood of data saturation. In January 2023, 7 health system administrators were interviewed regarding knowledge of pharmacists and pharmacist-led CDTM, as well as perceived benefits of and barriers to implementation of pharmacist-led CDTM. Interview responses were transcribed. A two-cycle inductive coding process utilizing constant comparison was employed to identify themes verified by analyst triangulation.
Results
Inconsistent understanding of pharmacist knowledge, skills, and abilities under CDTM by administrators was identified. Perceived benefits of pharmacist-led CDTM included (1) improved patient care, (2) increased value-based metrics, and (3) enhanced physician-pharmacist collaborations. Perceived barriers to the expansion of pharmacist services included concerns regarding (1) physician acceptance, (2) pharmacist knowledge and comfort, and (3) loss of revenue. Improving administrator and provider awareness of pharmacist abilities and providing evidence of benefit from similar services were identified by administrators as potential ways to encourage CDTM participation.
Conclusion
Health-system administrators are one of the key stakeholders in successful pharmacist-led CDTM implementation, but may have limited understanding of pharmacist knowledge, skills, and abilities under pharmacist-led CDTM. Improving their knowledge and understanding, as well as identifying and addressing their perceived benefits and barriers to implementing CDTM, may facilitate the expansion of pharmacist-led CDTM services, particularly in Georgia.
{"title":"Rural health system administrator perspectives on pharmacists' role in collaborative drug therapy management","authors":"Suzanne Whitten, Sharmon P. Osae, Russ Palmer, Rebecca H. Stone, Beth Bryles Phillips, Chelsea A. Keedy, Blake R. Johnson, Henry N. Young, Devin L. Lavender","doi":"10.1016/j.japh.2025.102929","DOIUrl":"10.1016/j.japh.2025.102929","url":null,"abstract":"<div><h3>Background</h3><div>Collaborative drug therapy modification (CDTM) authorizes adjustment of dosages, dosage schedules, and/or medications within a defined protocol under physician supervision within Georgia. Pharmacist-led collaborative drug therapy management positively impacts health outcomes leading to reduced health care expenditures. Less than 1% of Georgia pharmacists have a CDTM license.</div></div><div><h3>Objective</h3><div>The objective was to obtain feedback from rural primary health care system administrators to assist in increasing CDTM services and expand access to patient care services in Georgia.</div></div><div><h3>Methods</h3><div>An exploratory qualitative interview research design was utilized. Complete target population sampling was used to increase likelihood of data saturation. In January 2023, 7 health system administrators were interviewed regarding knowledge of pharmacists and pharmacist-led CDTM, as well as perceived benefits of and barriers to implementation of pharmacist-led CDTM. Interview responses were transcribed. A two-cycle inductive coding process utilizing constant comparison was employed to identify themes verified by analyst triangulation.</div></div><div><h3>Results</h3><div>Inconsistent understanding of pharmacist knowledge, skills, and abilities under CDTM by administrators was identified. Perceived benefits of pharmacist-led CDTM included (1) improved patient care, (2) increased value-based metrics, and (3) enhanced physician-pharmacist collaborations. Perceived barriers to the expansion of pharmacist services included concerns regarding (1) physician acceptance, (2) pharmacist knowledge and comfort, and (3) loss of revenue. Improving administrator and provider awareness of pharmacist abilities and providing evidence of benefit from similar services were identified by administrators as potential ways to encourage CDTM participation.</div></div><div><h3>Conclusion</h3><div>Health-system administrators are one of the key stakeholders in successful pharmacist-led CDTM implementation, but may have limited understanding of pharmacist knowledge, skills, and abilities under pharmacist-led CDTM. Improving their knowledge and understanding, as well as identifying and addressing their perceived benefits and barriers to implementing CDTM, may facilitate the expansion of pharmacist-led CDTM services, particularly in Georgia.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102929"},"PeriodicalIF":2.5,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145153282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.japh.2025.102928
Laura Hellemans, Julie Hias, Leen Haegemans, Karolien Walgraeve, Astrid Liesenborghs, Astrid Lammens, Lorenz Van der Linden, Mieke Deschodt, Jos Tournoy
Background
Geriatric patients with multimorbidity and polypharmacy are at high risk for medication-related harm. Complex interventions including medication reconciliation and medication review can improve outcomes, though their effectiveness in older patients remains unclear due to implementation failure in recent trials. The ASPIRE (The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE) project evaluates a complex intervention aimed at reducing unplanned hospital revisits in geriatric patients while simultaneously maximizing intervention implementation.
Objectives
To perform an implementation evaluation by describing the implementation strategies, evaluating fidelity, feasibility, and acceptability and documenting process outcomes of the ASPIRE intervention.
Methods
A convergent parallel mixed-methods design was used with quantitative data from all intervention patients and qualitative data from semi-structured interviews and one focus group. The implementation strategies were designed based on the Expert Recommendations for Implementing Change guidelines. Fidelity to each intervention component was quantitatively measured for all intervention patients, using an 80% threshold to define successful implementation. Feasibility and acceptability were qualitatively assessed using Flottorp's contextual analysis framework. Intervention duration and process outcomes were reported descriptively.
Results
The ASPIRE trial enrolled 415 intervention participants aged 85.9 (±5.78) years. The complex intervention was successfully implemented with 87% of patients receiving all intervention components and considered feasible and acceptable by the majority of stakeholders. Key factors for successful implementation with the greatest impact on fidelity, feasibility, and acceptability included adequate time and workforce allocation, additional training, established working relationships, a shared information system and a detailed intervention guide. Median intervention duration was 77.3 (interquartile range (IQR) 65.8-93.5) minutes and 64.5 (IQR 54.2-78.8) minutes for patients discharged home or to a nursing home, respectively.
Conclusion
The ASPIRE intervention was successfully implemented and considered feasible and acceptable by the stakeholders, highlighting its potential to improve care for geriatric patients. The high level of implementation provide a strong basis for the further evaluation of its effectiveness.
{"title":"Implementation evaluation of a pharmacist-led complex intervention: A mixed-methods analysis embedded within the ASPIRE randomized controlled trial","authors":"Laura Hellemans, Julie Hias, Leen Haegemans, Karolien Walgraeve, Astrid Liesenborghs, Astrid Lammens, Lorenz Van der Linden, Mieke Deschodt, Jos Tournoy","doi":"10.1016/j.japh.2025.102928","DOIUrl":"10.1016/j.japh.2025.102928","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients with multimorbidity and polypharmacy are at high risk for medication-related harm. Complex interventions including medication reconciliation and medication review can improve outcomes, though their effectiveness in older patients remains unclear due to implementation failure in recent trials. The ASPIRE (The effect of a trAnSitional Pharmacist Intervention in geRiatric inpatients on hospital visits after dischargE) project evaluates a complex intervention aimed at reducing unplanned hospital revisits in geriatric patients while simultaneously maximizing intervention implementation.</div></div><div><h3>Objectives</h3><div>To perform an implementation evaluation by describing the implementation strategies, evaluating fidelity, feasibility, and acceptability and documenting process outcomes of the ASPIRE intervention.</div></div><div><h3>Methods</h3><div>A convergent parallel mixed-methods design was used with quantitative data from all intervention patients and qualitative data from semi-structured interviews and one focus group. The implementation strategies were designed based on the Expert Recommendations for Implementing Change guidelines. Fidelity to each intervention component was quantitatively measured for all intervention patients, using an 80% threshold to define successful implementation. Feasibility and acceptability were qualitatively assessed using Flottorp's contextual analysis framework. Intervention duration and process outcomes were reported descriptively.</div></div><div><h3>Results</h3><div>The ASPIRE trial enrolled 415 intervention participants aged 85.9 (±5.78) years. The complex intervention was successfully implemented with 87% of patients receiving all intervention components and considered feasible and acceptable by the majority of stakeholders. Key factors for successful implementation with the greatest impact on fidelity, feasibility, and acceptability included adequate time and workforce allocation, additional training, established working relationships, a shared information system and a detailed intervention guide. Median intervention duration was 77.3 (interquartile range (IQR) 65.8-93.5) minutes and 64.5 (IQR 54.2-78.8) minutes for patients discharged home or to a nursing home, respectively.</div></div><div><h3>Conclusion</h3><div>The ASPIRE intervention was successfully implemented and considered feasible and acceptable by the stakeholders, highlighting its potential to improve care for geriatric patients. The high level of implementation provide a strong basis for the further evaluation of its effectiveness.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"66 1","pages":"Article 102928"},"PeriodicalIF":2.5,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145139993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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