Journal of the American Pharmacists Association最新文献_第5页

Because I see you: Pharmacist social determinants of health as predictor of structural awareness 因为我看见了你：药剂师的健康社会决定因素是结构意识的预测因素。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-31 DOI: 10.1016/j.japh.2024.102225

Background

The contribution of Social Determinants of Health (SDOH) to health disparities and patient outcomes is widely acknowledged. Much less has been done to characterize provider SDOH, and in particular, their effect on delivery of structurally competent care. Differing lived experiences create blind spots to the critical upstream factors contributing to health.

Objectives

The primary objective of this study was to examine the association between Structural Awareness (SA) and SDOH when controlling for year of first licensure, primary setting of pharmacy practice, race, and gender. The secondary objective was to examine the difference in mean SA scores with 4 stand-alone predictor variables: reliance on public transportation, insurance coverage gaps, food insecurity, and housing insecurity.

Methods

This study is a cross-sectional web-based survey of 606 Minnesota pharmacists. SDOH risk and SA scores were assessed using modified versions of the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences and Cultural Competence Self-Assessment Questionnaire tools, respectively. The association of these scores was assessed using a multiple linear regression model, and the association with stand-alone variables was done using t-tests.

Results

SDOH risk was significantly associated with SA at the 95% confidence level with a P-value of 0.0016. Food and housing insecurity were also significantly associated with SA score while reliance on public transportation and insurance coverage gaps were not.

Conclusion

Pharmacy and other healthcare professional training programs should create opportunities for exposure to the SDOH experienced by their patients through immersive learning and/or experiential education.

背景：健康的社会决定因素对健康差异和患者预后的影响已得到广泛认可。但在描述医疗服务提供者的社会决定健康因素，特别是其对提供结构合格的医疗服务的影响方面，所做的工作要少得多。不同的生活经历造成了对影响健康的关键上游因素的盲点：本研究的主要目的是在控制首次获得执照的年份、药房执业的主要环境、种族和性别的情况下，研究结构意识（SA）与健康的社会决定因素（SDOH）之间的关联。次要目标是研究 SA 平均得分与四个独立预测变量的差异：对公共交通的依赖、保险覆盖缺口、食品不安全和住房不安全：本研究是对明尼苏达州 606 名药剂师进行的横断面网络调查。分别使用 PRAPARE 和 CCSAQ 工具的修订版对 SDOH 风险和 SA 分数进行评估。采用多元线性回归模型评估这些分数之间的关联，并采用 t 检验法评估与独立变量之间的关联：结果：在 95% 的置信水平上，SDOH 风险与 SA 有明显的相关性，P 值为 0.0016。食物和住房不安全也与SA得分显著相关，而对公共交通的依赖和保险覆盖缺口则不相关：结论：药剂学和其他医疗保健专业培训项目应通过沉浸式学习和/或体验式教育，创造机会让学生接触患者所经历的 SDOH。

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引用次数: 0

Qualitative evaluation to Understand barriers and facilitators to prescribing angiotensin receptor-neprilysin inhibitors (ARNi) and sodium-glucose cotransporter inhibitors (SGLT2i) in patients with heart failure with reduced ejection fraction (HFrEF) 通过定性评估了解射血分数降低型心力衰竭 (HFrEF) 患者处方血管紧张素受体-奈普利酶抑制剂 (ARNi) 和钠-葡萄糖转运体抑制剂 (SGLT2i) 的障碍和促进因素。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-28 DOI: 10.1016/j.japh.2024.102224

Background

Despite sodium-glucose cotransporter-2 inhibitors (SGLT2i) and angiotensin receptor/neprilysin inhibitors (ARNi) being cost-effective evidenced-based therapies for the management of Heart Failure with Reduced Ejection Fraction (HFrEF), research shows that less than 30% of patients with HFrEF are prescribed these agents.

Objective

This study aimed to understand clinician-perceived barriers and facilitators to prescribing ARNi and SGLT2i in patients with HFrEF.

Methods

We conducted virtual and in-person semi-structured interviews in a large integrated healthcare delivery system in the United States. Twenty cardiology clinicians managing patients with HFrEF were recruited using purposeful sampling to target providers across professions and practice sites. The interview guide was developed based on a literature review and insights from a practicing cardiologist. It inquired about perceived prescribing behaviors, focusing on factors affecting the use of ARNi and SGLT2i. We identified key themes using rapid qualitative analysis.

Results

Twenty clinicians were interviewed: 13 physicians, 5 advanced practitioners, and 2 clinic-based pharmacists. Eighteen interviews were analyzed; we excluded 2 as the clinicians interviewed did not meet the inclusion criteria. Three major themes were identified: 1) clinician-reported prescribing patterns don't always align with the American College of Cardiology/American Heart Association guidelines for the use of SGLT2i and ARNi due to clinical inertia, lack of familiarity, knowledge, and comfort with use, and concerns over polypharmacy or adverse events, 2) clinician-perceived and actual out-of-pocket cost reduced prescribing of ARNi or SGLT2i to patients, exacerbated by a lack of visibility into patients' prescription coverage, denials of coverage by insurance, and navigating prior authorization related workflows, and 3) incorporation of a clinic-based pharmacist increased the prescribing of these medications.

Conclusion

Increasing cost transparency, implementing interventions to overcome clinical inertia and cost hurdles, and increasing clinic-based pharmacist support may improve evidenced-based prescribing in patients with HFrEF, especially for comparatively novel classes such as ARNi and SGLT2i.

背景：尽管钠-葡萄糖共转运体-2抑制剂（SGLT2i）和血管紧张素受体/肾素抑制剂（ARNi）是治疗射血分数减低型心力衰竭（HFrEF）的经济有效的循证疗法，但研究表明，只有不到30%的HFrEF患者处方了这些药物：本研究旨在了解临床医生在为 HFrEF 患者开具 ARNi 和 SGLT2i 处方时遇到的障碍和促进因素：我们在美国的一个大型综合医疗保健服务系统中进行了虚拟和面对面的半结构化访谈。通过有目的的抽样调查，我们招募了 20 名管理 HFrEF 患者的心脏病学临床医生，他们均为不同专业和执业地点的医疗服务提供者。访谈指南是根据文献综述和一名执业心脏病专家的见解制定的。它询问了患者的处方行为，重点是影响 ARNi 和 SGLT2i 使用的因素。我们通过快速定性分析确定了关键主题：我们对 20 名临床医生进行了访谈：结果：我们对 20 名临床医生进行了访谈：13 名医生、5 名高级执业医师和 2 名诊所药剂师。我们对 18 个访谈进行了分析；由于受访临床医生不符合纳入标准，我们排除了两个访谈。我们确定了三大主题1）临床医生报告的处方模式并不总是符合美国心脏病学会/美国心脏协会关于使用 SGLT2i 和 ARNi 的指南，原因包括临床惰性、缺乏熟悉、知识和使用舒适度，以及对多重用药或不良事件的担忧、2）临床医生认为和实际的自付费用减少了患者对 ARNi 或 SGLT2i 的处方，而缺乏对患者处方承保范围的了解、保险拒绝承保以及与事先授权相关的工作流程又加剧了这种情况；以及 3）诊所药剂师的加入增加了这些药物的处方量。结论提高成本透明度、实施干预措施以克服临床惰性和成本障碍，以及增加诊所药剂师的支持，可改善心衰患者的循证处方，尤其是 ARNi 和 SGLT2i 等相对新型的药物。

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引用次数: 0

Examination of differences between actual and potential revenue generation in a pharmacist-run ambulatory clinic 研究药剂师经营的非住院诊所实际创收与潜在创收之间的差异。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-26 DOI: 10.1016/j.japh.2024.102223

Background

Pharmacists are not billable health care providers under Medicare Part B or most insurance plans. Because of this, pharmacist services are relegated to incident-to-provider billing, despite pharmacists routinely providing services high in complexity. This discrepancy may negatively skew perceptions of pharmacists’ contributions to outpatient clinic care.

Objective

The objective of this study was to identify the potential revenue generation for pharmacist-delivered services at a single, rural South Dakota clinic if pharmacists were considered billable health care providers.

Methods

This retrospective, single center study utilized a chart review of first-quarter data from a single ambulatory clinic served by a 0.5 full time equivalent pharmacist serving Chronic Disease Management (CDM) and COVID-19 patients. For each appointment, the chart note was reviewed for elements that would satisfy requirements for Current Procedural Terminology billing codes. Medicare and Medicaid reimbursement was determined using official 2022 Physician Fee Schedules and private insurance reimbursement was set at a single rate of 60% of the fee schedule of the most common private payer.

Results

During the 3-month study period, 118 patients (206 appointments) were seen by the pharmacist. The amount paid to the clinic was estimated at $2174.91. The hypothetical amount paid to the clinic if pharmacists were considered billable health care providers is $10,415.31 for CDM clinic and $7953.48 for COVID-19 clinic, totaling $18,368.79. Excluding uninsured patients, the hypothetical total is $17,102.03, with total unrealized revenue of $16,193.88.

Conclusion

If pharmacists were considered billable health care providers and their services were billed accordingly, the potential revenue generation is significantly higher than actually generated revenue. This estimated data can be used to better quantify and qualify appointment-related data for nonpharmacist clinic managers.

背景：在医疗保险 B 部分或大多数保险计划中，药剂师都不属于计费医疗服务提供者。正因如此，尽管药剂师经常提供复杂性较高的服务，但药剂师的服务却被归类为 "事件到提供者"（incident-to-provider billing）。这种差异可能会对药剂师对门诊护理的贡献产生负面影响：本研究旨在确定，如果药剂师被视为可计费的医疗服务提供者，那么药剂师在南达科他州一家农村诊所提供的服务可能产生的收入：这项回顾性的单中心研究利用了对一家门诊诊所第一季度数据的病历审查，该诊所有一名相当于 0.5 个全职药剂师的药剂师为慢性病管理 (CDM) 和 COVID-19 患者提供服务。对每次预约的病历记录都进行了审查，以确定是否符合当前程序术语 (CPT®) 账单代码的要求。医疗保险和医疗补助的报销额度是根据 2022 年的官方医生收费表确定的，私人保险的报销额度则设定为最常见私人付款人收费表的 60% 的单一费率：在为期三个月的研究期间，药剂师共为 118 名患者（206 次预约）提供了服务。支付给诊所的金额估计为 2,174.91 美元。如果将药剂师视为收费医疗服务提供者，则 CDM 诊所支付的假设金额为 10,415.31 美元，COVID-19 诊所支付的假设金额为 7,953.48 美元，共计 18,368.79 美元。如果不包括未参保患者，假设总额为 17 102.03 美元，未实现收入总额为 16 193.88 美元：如果将药剂师视为应收费的医疗服务提供者，并对其服务进行相应收费，那么潜在的创收将大大高于实际创收。这一估算数据可用于更好地量化和限定非药剂师诊所管理人员的预约相关数据。

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引用次数: 0

Career advancement insights from certified pharmacy technicians: Enhanced opportunities for the pharmacy technician workforce 注册药房技师的职业发展见解：为药房技师队伍提供更多机会。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-26 DOI: 10.1016/j.japh.2024.102214

Background

Sustainable career advancement opportunities for pharmacy technicians will be a critical part of patient-centered community pharmacy environments as the role of the pharmacist provider expands.

Objective

(1) To determine the impact of a Pharmacy Technician Certification Board (PTCB) pharmacy certification on career advancement and professional growth metrics; (2) To assess technicians’ role in advanced pharmacy services before and after certification; and (3) To identify changes in pharmacist services when a certified pharmacy technician (CPhT) was added to the provider team.

Methods

A 73-question web-based survey was distributed to all PTCB CPhT in the United States, Washing DC, Puerto Rico, Guam, and the US Virgin Islands. The survey was distributed by PTCB in April 2021 with a 28-day collection period. The survey included multiple choice, rating scale, and free text questions centered on 5 domains: practice experience, career aspirations, compensation, pharmacy practice motivations, and impact of COVID-19 pandemic.

Results

A total of 23,007 CPhTs completed the survey. Respondents were primarily females (85.5%), age 30-39 (32.8%), and ≥10 years CPhT experience (42.8%). The majority of respondents cited improvement of patient health (77.4%), career advancement opportunities (53.5%), the ability to expand their role during emergencies (e.g., COVID-19) (52.6%), and future career advancement opportunities (51.7%) as benefits of CPhT certification. Increases in job responsibility after certification included changes occurring in roles related to clinical pharmacy services, patient education, preventive health services, provider communication, and staff training. Respondents agreed that PTCB-certification allowed for the expansion of pharmacists’ services where they practiced, including clinical services (18.5%), patient education (18.3%), and preventive health services (18.1%).

Conclusion

CPhT’s value certification for its benefits on career advancement, personal growth, and salary enhancement. Affirmation of skill and training through certification is also recognized to positively influence patient care and the pharmacy's ability to provide advanced patient care and services.

背景：目标：(1) 确定药学技术人员认证委员会药学 (PTCB) 认证对职业发展和专业成长指标的影响；(2) 评估技术人员在认证前后在高级药学服务中的作用；(3) 确定在提供团队中加入认证药学技术人员 (CPhT) 后药剂师服务的变化：向美国、华盛顿特区、波多黎各、关岛和美属维尔京群岛的所有 PTCB 认证药学技师 (CPhT) 发放了一份包含 73 个问题的网络调查问卷。该调查由 PTCB 于 2021 年 4 月发布，收集期为 28 天。调查包括围绕五个领域的多项选择、评分表和自由文本问题：结果：23007 名 CPhT 完成了调查。受访者主要为女性（85.5%），年龄在 30-39 岁之间（32.8%），有超过 10 年的 CPhT 工作经验（42.8%）。大多数受访者认为，获得 CPhT 证书的好处包括改善患者健康（77.4%）、获得职业晋升机会（53.5%）、能够在紧急情况下（如 COVID-19）扩大自己的角色（52.6%）以及未来的职业晋升机会（51.7%）。认证后工作职责的增加包括与临床药学服务、患者教育、预防保健服务、医疗服务提供者沟通和员工培训相关的角色变化。受访者一致认为，通过 PTCB 认证后，药剂师的服务范围得以扩大，包括临床服务（18.5%）、患者教育（18.3%）和预防保健服务（18.1%）：结论：CphT 认证对职业发展、个人成长和薪酬提高都有好处，因此药剂师非常重视认证。通过认证对技能和培训的肯定也被认为会对病人护理和药房提供先进的病人护理和服务的能力产生积极影响。

{"title":"Career advancement insights from certified pharmacy technicians: Enhanced opportunities for the pharmacy technician workforce","authors":"","doi":"10.1016/j.japh.2024.102214","DOIUrl":"10.1016/j.japh.2024.102214","url":null,"abstract":"<div><h3>Background</h3><div>Sustainable career advancement opportunities for pharmacy technicians will be a critical part of patient-centered community pharmacy environments as the role of the pharmacist provider expands.</div></div><div><h3>Objective</h3><div>(1) To determine the impact of a Pharmacy Technician Certification Board (PTCB) pharmacy certification on career advancement and professional growth metrics; (2) To assess technicians’ role in advanced pharmacy services before and after certification; and (3) To identify changes in pharmacist services when a certified pharmacy technician (CPhT) was added to the provider team.</div></div><div><h3>Methods</h3><div>A 73-question web-based survey was distributed to all PTCB CPhT in the United States, Washing DC, Puerto Rico, Guam, and the US Virgin Islands. The survey was distributed by PTCB in April 2021 with a 28-day collection period. The survey included multiple choice, rating scale, and free text questions centered on 5 domains: practice experience, career aspirations, compensation, pharmacy practice motivations, and impact of COVID-19 pandemic.</div></div><div><h3>Results</h3><div>A total of 23,007 CPhTs completed the survey. Respondents were primarily females (85.5%), age 30-39 (32.8%), and ≥10 years CPhT experience (42.8%). The majority of respondents cited improvement of patient health (77.4%), career advancement opportunities (53.5%), the ability to expand their role during emergencies (e.g., COVID-19) (52.6%), and future career advancement opportunities (51.7%) as benefits of CPhT certification. Increases in job responsibility after certification included changes occurring in roles related to clinical pharmacy services, patient education, preventive health services, provider communication, and staff training. Respondents agreed that PTCB-certification allowed for the expansion of pharmacists’ services where they practiced, including clinical services (18.5%), patient education (18.3%), and preventive health services (18.1%).</div></div><div><h3>Conclusion</h3><div>CPhT’s value certification for its benefits on career advancement, personal growth, and salary enhancement. Affirmation of skill and training through certification is also recognized to positively influence patient care and the pharmacy's ability to provide advanced patient care and services.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094112","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}

引用次数: 0

Community pharmacy chlamydia and gonorrhea test-to-treat program: Development of an implementation toolkit 社区药房衣原体和淋病检测治疗计划：开发实施工具包。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-24 DOI: 10.1016/j.japh.2024.102222

Background

Sexually transmitted infection (STI) surveillance showed more than 2.5 million cases of chlamydia, gonorrhea, and syphilis nationally in the United States in 2022. Individuals often seek out nonemergency medical care at pharmacies. This makes community pharmacies well-positioned to address rising STI rates by offering services to screen and treat common STIs. A local health department, an independent pharmacy, and a school of pharmacy in Pennsylvania partnered to implement a test-to-treat service for chlamydia and gonorrhea within a pharmacy. This pilot program utilized the following: (1) patient self-collected test kits for chlamydia and gonorrhea screening and; (2) standing orders for treatment at the pharmacy. One goal of this pilot was to develop resources others can use to implement similar pharmacy-based chlamydia and gonorrhea testing and treatment services.

Objective

Develop an expert-informed implementation toolkit for a chlamydia and gonorrhea test-to-treat program at a community pharmacy.

Methods

The “How to Build an Implementation Toolkit from Start to Finish” framework from the University of California at Berkeley was used to design the initial toolkit outline. Toolkit content was triangulated from 3 sources: (1) comprehensive literature review; (2) pilot program implementation team meetings; and (3) feedback from public health and other experts. Pilot program partners met regularly to review and edit the toolkit. The draft toolkit was then reviewed by outside experts and potential end-users.

Results

An 11-item toolkit was developed. Toolkit contents were reviewed by 11 outside experts and potential end-users. Toolkit resources included STI training resources for pharmacy teams, testing and treatment standing orders, pharmacy treatment screening form, marketing strategies, patient education materials, sample workflow, essential supply list, and other key resources.

Conclusion

Pharmacies may need additional resources for STI testing and treatment program implementation. Toolkit resources developed from this pilot program may help pharmacies overcome implementation barriers for similar programs.

背景：性传播感染（STI）监测显示，2022 年美国全国衣原体、淋病和梅毒病例超过 250 万例。人们经常在药店寻求非急诊医疗服务。因此，社区药房完全有能力通过提供筛查和治疗常见性传播疾病的服务来应对不断上升的性传播疾病发病率。宾夕法尼亚州的一个地方卫生部门、一家独立药店和一所药学院合作，在药店内开展了衣原体和淋病的检测治疗服务。该试点项目利用：（1）患者自取的衣原体和淋病筛查试剂盒；（2）药房的长期治疗订单。该试点项目的目标之一是开发资源，供其他机构用于实施类似的药房衣原体和淋病检测与治疗服务：目标：为社区药房的衣原体和淋病检测治疗项目开发一套由专家提供信息的实施工具包：方法：采用加州大学伯克利分校的 "如何从头到尾构建实施工具包 "框架来设计工具包的初始大纲。工具包的内容从三个来源进行了三角测量：(1) 综合文献回顾；(2) 试点计划实施团队会议；(3) 来自公共卫生和其他专家的反馈。试点计划合作伙伴定期举行会议，审查和编辑工具包。随后，外部专家和潜在最终用户对工具包草案进行了审查：开发了一个包含 11 个项目的工具包。11 位外部专家和潜在最终用户审查了工具包的内容。工具包资源包括为药房团队提供的性传播感染培训资源、检测和治疗常备单、药房治疗筛查表、营销策略、患者教育材料、工作流程样本、基本供应清单以及其他关键资源：结论：药房在实施性传播感染检测和治疗项目时可能需要额外的资源。本试点项目开发的工具包资源可帮助药房克服类似项目的实施障碍。

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引用次数: 0

The potential feasibility of tobacco-focused medication therapy management in pharmacies affiliated with Federally Qualified Health Centers: Perspectives of pharmacists 联邦合格医疗中心下属药房开展以烟草为重点的药物治疗管理的潜在可行性：药剂师的观点。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-23 DOI: 10.1016/j.japh.2024.102210

Background

Tobacco-focused medication therapy management (MTM) interventions executed in pharmacies located in Federally Qualified Health Centers (FQHC) may provide an innovative means to reach smokers with low incomes and reduce health disparities. However, greater understanding of the intervention’s potential feasibility in this setting is needed.

Objective

To inform the feasibility of implementing an MTM program to address tobacco and nicotine dependence in the FQHC setting by assessing the experience and perceptions of pharmacists working in pharmacies associated with FQHCs.

Methods

A convergent mixed methods approach was used to assess indicators associated with the domains of the Consolidated Framework for Implementation Research (CFIR). Pharmacists from FQHC-based pharmacies in the Southeast United States completed surveys (n = 24) and interviews (n = 15). Quantitative data were summarized descriptively. Qualitative data were content coded.

Results

Quantitative and qualitative data were mapped across all 5 CFIR domains. Pharmacists report high rates of tobacco and nicotine use among their patients and that addressing their use is important. A total of 62.5% of pharmacists had some or a great deal of experience with tobacco and nicotine dependence. Quantitative and qualitative data demonstrate that the pharmacists and their FQHCs would support MTM efforts focused on tobacco and nicotine dependence. Qualitative findings highlight that pharmacists view an MTM intervention as aligning with their current workflow. Quantitative and qualitative data highlight how factors related to pharmacists’ engagement in introducing tobacco and nicotine dependence treatment programs to patients, the electronic medical record, time, staffing, and patient-level barriers could impact the feasibility of an MTM intervention focused on tobacco and nicotine dependence.

Conclusion

Findings suggest an MTM intervention focused on tobacco and nicotine dependence has the potential to be feasible within FQHC-based pharmacies. Considerations related to training, staffing, time, identifying participants, and supporting participant engagement must be taken into account to support its implementation.

背景：在联邦合格医疗中心（FQHC）的药房实施以烟草为重点的药物治疗管理（MTM）干预措施，可为低收入吸烟者提供一种创新手段，并减少健康差异。然而，还需要进一步了解该干预措施在这种环境下的潜在可行性：通过评估在联邦定点医疗机构相关药房工作的药剂师的经验和看法，了解在联邦定点医疗机构实施MTM项目以解决烟草和尼古丁依赖问题的可行性：采用聚合混合方法评估与实施研究综合框架（CFIR）领域相关的指标。来自美国东南部以 FQHC 为基础的药房的药剂师完成了调查（24 人）和访谈（15 人）。对定量数据进行了描述性总结。对定性数据进行了内容编码：结果：定量和定性数据在所有五个 CFIR 领域中均有体现。药剂师报告称，患者中使用烟草和尼古丁的比例很高，因此解决患者使用烟草和尼古丁的问题非常重要。62.5%的药剂师在烟草和尼古丁依赖方面有一些或很多经验。定量和定性数据表明，药剂师和他们所在的 FQHC 将支持以烟草和尼古丁依赖为重点的 MTM 工作。定性研究结果表明，药剂师认为 MTM 干预与其当前的工作流程相一致。定量和定性数据强调了药剂师参与向患者介绍烟草和尼古丁依赖治疗项目、电子病历、时间、人员配备以及患者层面的障碍等相关因素如何影响以烟草和尼古丁依赖为重点的MTM干预的可行性：研究结果表明，以烟草和尼古丁依赖为重点的MTM干预措施有可能在以FQHC为基础的药房中可行。必须考虑到与培训、人员配备、时间、确定参与者以及支持参与者参与有关的因素，以支持其实施。

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引用次数: 0

Over-the-counter analgesic-related exposure and toxicity in pediatrics 儿科非处方止痛药相关的接触和毒性。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-19 DOI: 10.1016/j.japh.2024.102218

Background

Analgesics are one of the most commonly purchased and used over-the-counter (OTC) medication classes from pharmacies in the United States. Drug toxicity is a leading cause of injury death in the United States. Limited studies, if any, have examined the impact of specific OTC medication toxicities in the pediatric population.

Objective

To examine the toxicity arising from the use of OTC analgesic medications in pediatric patients in Ohio.

Methods

Data from National Poison Data System for Ohio were obtained for the past 5 years. This data were processed to focus on target populations; pediatrics defined as ages 0–17 years experiencing toxicities related to OTC analgesic medications. The data were categorized into 3 groups: 0–6 year old, 7–12 year old, and 13–17 year old, and reported toxicity was studied based on medications used/given, reasoning for toxicity, and medical outcomes.

Results

Patients aged 0–6 years mainly experienced toxicities from acetaminophen (35%) and ibuprofen (52.7%), due to unintentional exposure (general misuse and therapeutic error; 74.2% and 25.4%, respectively), causing primarily minimal clinical effect (48.4%). Ages 7–12 experienced toxicities from acetaminophen (38.5%) and ibuprofen (44.9%) due to unintentional exposure therapeutic error (44.8%) and intentional suspected suicides (30.1%), causing mainly minimal clinical effects (35.5%) and no effect (23.4%). Pediatric ages 13–17 experienced toxicities due to ibuprofen (36.3%) and acetaminophen (38.9%), with primary reasoning of intentional suspected suicide (81.3%), causing medical outcomes of minor effect and no effect (38.2% and 31.2%, respectively). A chi-square test was performed to analyze correlation between case intention (unintentional or intentional) and age group. Proportion of intentional exposures differed by age [X² (2, N = 18,766) = 14,672, P < 0.0001].

Conclusion

Observations from this study underscore the importance of raising awareness about OTC analgesic toxicities which remain prominent in Ohio.

背景：镇痛药是美国药房最常购买和使用的非处方药之一。药物中毒是美国伤害致死的主要原因之一。对特定非处方药物毒性对儿科人群影响的研究有限：目的：研究俄亥俄州儿科患者因使用非处方药（OTC）镇痛药而产生的毒性：方法：从俄亥俄州国家毒物数据系统获取过去 5 年的数据。对这些数据进行了处理，重点关注目标人群；儿科定义为 0-17 岁经历非处方镇痛药物中毒的儿童。数据被分为三组：0-6 岁、7-12 岁和 13-17 岁，根据使用/给予的药物、中毒原因和医疗结果对报告的毒性进行研究：结果：0-6 岁患者主要因对乙酰氨基酚（35%）和布洛芬（52.7%）中毒，原因是无意接触（一般误用和治疗失误，分别占 74.2% 和 25.4%），主要造成的临床影响很小（48.4%）。7-12岁儿童因无意接触治疗失误（44.8%）和故意疑似自杀（30.1%）导致对乙酰氨基酚（38.5%）和布洛芬（44.9%）中毒，主要造成轻微临床影响（35.5%）和无影响（23.4%）。13-17岁的儿童因布洛芬（36.3%）和对乙酰氨基酚（38.9%）中毒，主要原因是故意疑似自杀（81.3%），造成的医疗结果是轻微影响和无影响（分别为38.2%和31.2%）。对病例意图（无意或有意）与年龄组之间的相关性进行了卡方检验。故意暴露的比例因年龄而异[X2 (2, N = 18,766) = 14672, p < .0001]：本研究的观察结果表明，提高人们对俄亥俄州仍很突出的非处方药镇痛药毒性的认识非常重要。

{"title":"Over-the-counter analgesic-related exposure and toxicity in pediatrics","authors":"","doi":"10.1016/j.japh.2024.102218","DOIUrl":"10.1016/j.japh.2024.102218","url":null,"abstract":"<div><h3>Background</h3><p>Analgesics are one of the most commonly purchased and used over-the-counter (OTC) medication classes from pharmacies in the United States. Drug toxicity is a leading cause of injury death in the United States. Limited studies, if any, have examined the impact of specific OTC medication toxicities in the pediatric population.</p></div><div><h3>Objective</h3><p>To examine the toxicity arising from the use of OTC analgesic medications in pediatric patients in Ohio.</p></div><div><h3>Methods</h3><p>Data from National Poison Data System for Ohio were obtained for the past 5 years. This data were processed to focus on target populations; pediatrics defined as ages 0–17 years experiencing toxicities related to OTC analgesic medications. The data were categorized into 3 groups: 0–6 year old, 7–12 year old, and 13–17 year old, and reported toxicity was studied based on medications used/given, reasoning for toxicity, and medical outcomes.</p></div><div><h3>Results</h3><p>Patients aged 0–6 years mainly experienced toxicities from acetaminophen (35%) and ibuprofen (52.7%), due to unintentional exposure (general misuse and therapeutic error; 74.2% and 25.4%, respectively), causing primarily minimal clinical effect (48.4%). Ages 7–12 experienced toxicities from acetaminophen (38.5%) and ibuprofen (44.9%) due to unintentional exposure therapeutic error (44.8%) and intentional suspected suicides (30.1%), causing mainly minimal clinical effects (35.5%) and no effect (23.4%). Pediatric ages 13–17 experienced toxicities due to ibuprofen (36.3%) and acetaminophen (38.9%), with primary reasoning of intentional suspected suicide (81.3%), causing medical outcomes of minor effect and no effect (38.2% and 31.2%, respectively). A chi-square test was performed to analyze correlation between case intention (unintentional or intentional) and age group. Proportion of intentional exposures differed by age [<em>X</em><sup>2</sup> (2, <em>N</em> = 18,766) = 14,672, <em>P</em> < 0.0001].</p></div><div><h3>Conclusion</h3><p>Observations from this study underscore the importance of raising awareness about OTC analgesic toxicities which remain prominent in Ohio.</p></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1544319124002449/pdfft?md5=7dfc052e694a071b06cf572ed20f55aa&pid=1-s2.0-S1544319124002449-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mapping pharmacy deserts in North Carolina: a geospatial analysis and its implications for University of North Carolina Health’s catchment population 绘制北卡罗来纳州的药房荒漠图：地理空间分析及其对北卡罗来纳大学健康中心覆盖人群的影响。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-19 DOI: 10.1016/j.japh.2024.102215

Background

Pharmacy deserts represent areas where residents face notable challenges to accessing pharmacies. North Carolina (NC) presents an intriguing case study due to its diverse geographic landscape yet lacks extensive research regarding its pharmacy deserts.

Objectives

This study aims to map pharmacy deserts in NC using pharmacy location and social determinants of health (SDOH) data measured using the social vulnerability index (SVI) and descriptively characterize health care utilization statistics for University of North Carolina (UNC) Health’s catchment population.

Methods

Pharmacy location data was compiled from the NC Board of Pharmacy. Pharmacy deserts were defined based on SVI > 0.75 and distance thresholds aligned to United States Department of Agriculture standards. Residential characteristics were retrieved from PolicyMap and Social Explorer databases. UNC Health patient utilization data were collected by UNC Pharmacy Data Analytics group for 3 NC counties.

Results

Two thousand and two NC pharmacies met inclusion criteria. 17.2% urban tracts (1.3M residents) and 4.25% rural tracts (0.14M residents) were identified as pharmacy deserts (adj. P < 0.001). Those residing in deserts had significantly less internet access, annual medical cost per capita, and access to homeless relief services as well as significantly higher food insecurity rates and Medicare cost per capita (adj. P < 0.001). UNC-specific health care utilization statistics for the 3 assessed counties were all poorer in deserts compared to nondeserts within the same counties (P > 0.05).

Conclusion

A geospatial map with the location of pharmacy deserts in NC was created to highlight differences in patient health care utilization, affecting rural and urban areas. By incorporating SDOH predictors, this study provides a more nuanced map of NC pharmacy deserts compared to reviewing distance to pharmacies alone. Higher rates of emergency department and inpatient visits in counties with more residents in pharmacy deserts suggests potential health outcomes associated with limited pharmacy access.

背景：药房荒漠是指居民在获得药房服务方面面临重大挑战的地区。北卡罗来纳州（NC）因其多样的地理景观而成为一个引人入胜的案例研究，但却缺乏对其药房荒漠的广泛研究：本研究旨在利用药房位置和使用社会脆弱性指数（SVI）测量的健康社会决定因素（SDOH）数据绘制北卡罗来纳州的药房荒漠图，并描述北卡罗来纳大学（UNC）健康中心覆盖人群的医疗保健利用统计数据：方法：药房位置数据由北卡罗来纳州药房委员会提供。根据 SVI >0.75 和与美国农业部 (USDA) 标准一致的距离阈值定义药房荒漠。住宅特征来自 PolicyMap 和 Social Explorer 数据库。UNC Health 的患者使用数据由 UNC 药房数据分析小组收集，涉及北卡罗来纳州的三个县。17.2%的城市地区（130 万居民）和 4.25%的农村地区（14 万居民）被认定为药房荒漠（adj. p0.05）：我们绘制了北卡罗来纳州药房荒漠位置的地理空间地图，以突显影响城乡地区患者医疗保健利用率的差异。通过纳入可持续发展的健康和卫生状况的预测因素，这项研究提供了一张更细致的北卡罗来纳州药房荒漠地图，而不是仅仅审查药房的距离。在药房荒漠居民较多的县，急诊室和住院病人就诊率较高，这表明有限的药房使用可能会带来潜在的健康后果。

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引用次数: 0

Borne of necessity: pharmacy-based harm reduction and express sexually transmitted infection services 出于需要：以药房为基础的减低伤害和特快性传播感染服务。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-19 DOI: 10.1016/j.japh.2024.102213

Background

HIV, hepatitis C virus (HCV), Sexually Transmitted Infections (STIs), and substance use disorder are interrelated epidemics. Augmented services to respond to this “syndemic” are hampered by shortages of health care workers, especially in rural areas. In an Indian Health Service hospital in rural Minnesota, the pharmacy sought to integrate harm reduction and express STI services into its scope of practice.

Objectives

Provide pharmacy-based harm reduction and express STI services to increase access to care for community members, especially those without a primary care provider.

Methods

The program was designed with input from tribal counterparts and internal medical staff. The pharmacy window was made the intake point for services for patient education, harm reduction materials, and STI testing and treatment. Collaborative practice agreements and standing orders greatly expanded the pharmacy’s ability to deliver care. Later in the program, the pharmacy was able to introduce patient incentives.

Results

From October 2022 to November 2023, the program had 500 visits from 101 unique patients with a median age of 36. Among users of the service, 71% did not have a primary care provider. Once patient incentives were introduced, express STI testing increased over 10-fold. The laboratory panels had a 44% positivity rate for either an STI or HCV.

Conclusions

Pharmacy can be an accessible and effective means of delivering harm reduction, STI, and HCV services. Patient incentives may greatly increase testing and detection of infectious diseases among patients who may otherwise not seek care.

背景：艾滋病毒（HIV）、丙型肝炎病毒（HCV）、性传播感染（STI）和药物使用障碍是相互关联的流行病。由于医护人员短缺，尤其是在农村地区，应对这种 "综合症 "的强化服务受到阻碍。在明尼苏达州农村地区的一家印第安人健康服务医院中，药房试图将减低伤害和明确的性传播感染服务纳入其业务范围：提供以药房为基础的减低伤害和快速性传播感染服务，以增加社区成员，尤其是那些没有初级医疗服务提供者的社区成员获得医疗服务的机会：方法：该计划的设计参考了部落同行和内部医务人员的意见。药房窗口成为患者教育、减低伤害材料、性传播感染检测和治疗服务的接收点。合作实践协议和长期医嘱极大地扩展了药房提供医疗服务的能力。在项目后期，药房还推出了患者激励措施：从 2022 年 10 月到 2023 年 11 月，该计划共接待了 101 名患者的 500 次就诊，患者年龄中位数为 36 岁。在这项服务的使用者中，71%的人没有初级保健提供者。一旦引入对患者的激励措施，性传播感染快速检测的数量增加了十倍以上。性传播感染或丙型肝炎病毒实验室检测的阳性率为 44%：结论：药房可以成为提供减低伤害、性传播感染和丙型肝炎病毒服务的一种方便有效的手段。对患者的激励措施可能会大大提高传染病的检测率，否则这些患者可能不会寻求治疗。

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引用次数: 0

Culturally competent approaches in addressing hypertension control disparities in African Americans: The pharmacist's perspective 解决非裔美国人高血压控制差异的文化适应方法：药剂师的视角。

IF 2.5 4区医学 Q3 PHARMACOLOGY & PHARMACY

Journal of the American Pharmacists Association

Pub Date : 2024-08-17 DOI: 10.1016/j.japh.2024.102217

In the United States, cardiovascular disease (CVD) is the leading cause of death. Despite advancements in the identification of risk factors and management of CVD leading to improved mortality over the years, disparities in outcomes persist among racial/ethnic groups. In this commentary, we discuss the multifaceted nature of this issue, including structural barriers and historical injustices that lead to healthcare mistrust. Emphasizing culturally appropriate approaches, we explore the pharmacist's role in providing culturally competent care and propose policy recommendations to improve disparities in blood pressure outcomes. The paper underscores the importance of collaborative efforts among healthcare providers, policymakers, and communities to address this critical public health challenge.

在美国，心血管疾病（CVD）是导致死亡的主要原因。尽管多年来在心血管疾病的风险因素识别和管理方面取得了进步，从而改善了死亡率，但种族/族裔群体之间在治疗结果上的差距依然存在。在这篇评论中，我们讨论了这一问题的多面性，包括导致医疗不信任的结构性障碍和历史性不公正。在强调文化适宜性方法的同时，我们探讨了药剂师在提供文化适宜性护理中的作用，并提出了改善血压结果差异的政策建议。本文强调了医疗服务提供者、政策制定者和社区通力合作以应对这一重大公共卫生挑战的重要性。

引用次数: 0