Journal of the American Pharmacists Association最新文献

Background: Buprenorphine is an effective medication for treating opioid use disorder (OUD) and reducing opioid-related overdose deaths. Community pharmacies are key access points for buprenorphine, with pharmacists well-positioned to dispense and counsel patients on appropriate use. Recent evidence has identified pharmacists' growing engagement in buprenorphine services; yet, access to buprenorphine and related services in community pharmacies remains limited.

Objectives: This systematic review aimed to investigate and synthesize evidence from existing literature on pharmacy-based buprenorphine programs for OUD, including stocking/dispensing patterns, and pharmacists' knowledge, attitudes, and barriers (KAB) to providing buprenorphine services.

Methods: Searches were performed across 4 databases: PubMed, Web of Science, CINAHL, and Google Scholar. Eligible articles included U.S.-based, peer-reviewed original research conducted between 2002 and 2024, focusing on pharmacy-based buprenorphine programs for OUD and community pharmacists' KAB related to buprenorphine. PRISMA guidelines were followed.

Results: Search retrieved a total of 488 articles with 38 meeting the criteria for inclusion. Community pharmacy-based buprenorphine programs for OUD included physician-pharmacist collaborative care models, established dispensing agreements, and reinforced counseling. Buprenorphine stocking/availability varied across pharmacy types, with independent pharmacies less likely to stock and dispense the medication than chain pharmacies. Pharmacists appeared to exhibit limited knowledge and a cautious willingness to dispense buprenorphine. Barriers included concerns about perceived Drug Enforcement Administration (DEA) "caps"/investigations, wholesaler flags, diversion risks, inadequate knowledge, and insufficient communication with clinicians.

Conclusion: This study found that community pharmacist involvement in buprenorphine programs has the potential to improve access to OUD treatment. However, wider adoption of these initiatives requires rigorous evaluation through randomized controlled trials and longitudinal studies to demonstrate their effectiveness. Barriers, including perceived DEA investigations and wholesaler restrictions, may limit pharmacist engagement in providing buprenorphine. Policy reforms addressing these concerns are needed, alongside efforts to increase pharmacists' knowledge and foster better communication/collaboration between clinicians and pharmacists to enhance buprenorphine access and utilization.

Background: Osteoporosis, marked by reduced bone density, significantly impacts quality of life. Recent estimates on its economic and humanistic burden in the United States are scarce.

Objective: To evaluate the marginal burden of osteoporosis on total all-cause health care costs and health-related quality of life (HRQoL) in the United States.

Methods: This retrospective cross-sectional study utilized 2019-2021 Medical Expenditure Panel Survey data, including adults aged ≥50 years with or without osteoporosis. HRQoL was assessed using physical component summary (PCS) and mental component summary (MCS) scores. Descriptive analyses reported sociodemographic/clinical characteristics, healthcare expenditures, and PCS/MCS scores. A two-part model assessed the marginal effect of osteoporosis on total healthcare expenditures. Multivariable generalized linear model (GLM) estimated the marginal differences in MCS and PCS scores between the osteoporosis and nonosteoporosis groups, while multivariable linear regression assessed factors associated with HRQoL among patients with osteoporosis.

Results: There were approximately 2.89 million patients with osteoporosis and 25 million without osteoporosis. The marginal total health care expenditures were $8572.15 (95% CI: $6546.39-$14,597.92) higher for the osteoporosis Vs. nonosteoporosis group. Age, sex, marital status, year, and certain comorbidities were significant predictors of HRQoL among osteoporosis patients. Multivariable GLM indicated PCS scores were 6.29 units lower (95% CI: -7.08 to -4.15) and MCS scores were 4.22 units lower (95% CI: -8.34 to -3.31) among osteoporosis Vs. nonosteoporosis patients.

Conclusion: Patients with osteoporosis showed higher economic burden and lower HRQoL than those without, highlighting the need for policy changes and innovative approaches to improve HRQoL and reduce healthcare expenses for osteoporosis management.

Background: Prescription drug monitoring programs (PDMPs) track patients' prescription records for high-risk medications and prompt real-time alerts to pharmacists when specific criteria are met. PDMPs are increasingly implemented by health care systems to attempt to mitigate harms associated with prescription opioids.

Objective: This study aims to explore and compare PDMP experiences among Australian community pharmacists from states where PDMP use is mandated and nonmandated.

Methods: A representative sample of community pharmacists from New South Wales, Queensland, Victoria, and Western Australia were invited to complete an anonymous online survey. The survey collected pharmacy and pharmacist-related information and asked pharmacists to rank PDMP's usefulness and barriers on a 5-point scale. Mann-Whitney U tests were conducted to determine if there were statistically significant differences in scores between mandated and nonmandated states.

Results: In total, 690 pharmacists were included. Pharmacists in mandated states had statistically higher mean 'usefulness' scores for 5 out of 17 items, such as informing clinical decision-making (P < 0.001) and increasing confidence to refuse medication supply (P = 0.002). PDMP-related barriers were rarely reported by pharmacists, although there were statistically significant differences for specific barriers between mandated and nonmandated states. Nonmandated states had significantly higher mean scores for 5 barriers, including 'unsure what to do with the PDMP information' (P < 0.001) and 'PDMP is not integrated into dispensing software' (P = 0.005). Mandated states had statistically higher mean scores for 9 barriers, including 'not all scripts appear in PDMP' (P < 0.001) and 'inaccurate information in the PDMP' (P < 0.001).

Conclusion: There were significant differences in pharmacists' PDMP experiences between mandated and nonmandated states, which may have policy implications given Australia's recent investment into national prescription monitoring.

Background: The clinical benefits of long-term opioid therapy (LTOT) are not clearly known; however, LTOT is associated with various adverse outcomes.

Objective: This study aimed to estimate the incidence and risk factors associated with LTOT in adults aged ≥ 65 years.

Methods: This was a retrospective cohort study using Medicare claims data. Opioid-naïve older adults filling an opioid prescription between 2014 and 2016 were included. The outcome variable was LTOT, defined as an opioid use episode longer than 90 days and having > 60 cumulative days of supply. Predictor variables included patient characteristics, characteristics of initial opioid dispensed, and pain conditions. Multivariable logistic regression was performed to assess the association between predictors and LTOT.

Results: Among 162,287 participants, 10,296 (6.3%) met the definition of LTOT. Key patient characteristics associated with LTOT were age > 85 years (adjusted odds ratio 1.13 [95% confidence interval 1.05-1.21]); > 5 comorbidities (1.55 [1.45-1.65]); and history of drug use disorder (1.53 [1.35-1.74]), alcohol use disorder (1.38 [1.23-1.54]), tobacco use disorder (1.31 [1.23-1.40]), and opioid use disorder (2.00 [1.69-2.37]). Characteristics of initial opioid associated with LTOT were dispensing long-acting opioids (1.72 [1.21-2.44]) and concomitant use of benzodiazepines (1.16 [1.08-1.25]), gabapentinoids (1.57 [1.47-1.67]), and prescription nonsteroidal anti-inflammatory drugs (1.24 [1.17-1.31]). Anxiety disorders were associated with 1.4-1.5 times increased odds of LTOT. Moreover, initial opioid supply of ≥ 30 days led to 11-16 times higher odds of LTOT than days' supply of 1-3 days.

Conclusions: Factors related to patient characteristics (age, number of comorbidities, substance use disorders, anxiety disorders) and initial opioid dispensation (duration of action, certain concomitant medications, days' supply) are associated with LTOT in older adults. Prescribers should consider these factors when prescribing opioids to senior patients.

Background: As efforts to increase buprenorphine prescribing continue to intensify, pharmacy dispensing plays an important role in access to essential medications for opioid use disorder. Existing survey research suggests stigma and regulatory concerns are barriers to pharmacists dispensing buprenorphine, but facilitators are less clear, as are in-depth perceptions of pharmacists regarding buprenorphine.

Objective: To assess barriers and facilitators to buprenorphine dispensing in Appalachian Kentucky using a series of focus groups with pharmacy employees.

Methods: Between September and October 2023, five structured focus groups were conducted with a total of 19 pharmacists and pharmacy technicians across a mixture of high- and low-buprenorphine-dispensing counties. Investigators independently coded focus group transcriptions using a grounded theory approach to describe current dispensing practices as well as barriers to and facilitators of buprenorphine dispensing.

Results: Most participants described dispensing buprenorphine, but there was substantial variation in dispensing practices. Participants identified patient-, provider-, pharmacy-, regulatory-and medication-related barriers to and patient-, provider-, pharmacy-, and regulatory-related facilitators of pharmacy dispensing. Patient- and provider-related barriers accounted for over half of barriers identified. The most common facilitators were also patient- and provider-related.

Conclusion: In a series of 5 focus groups with pharmacy staff in Appalachian Kentucky, the most common barriers to buprenorphine dispensing were patient and provider behaviors. Patient stories were the most common facilitators. Interventions to increase pharmacy buprenorphine dispensing should focus on addressing misperceptions regarding behavior, preferably driven by positive patient testimony.

Background: Health systems have implemented pharmacy consolidated service centers (PCSCs) to address increased patient volume, elevated drug costs, and decreased reimbursements. Assessing pharmacy productivity remains a challenge given that metrics have historically been determined by calculations of variables that do not capture the actual work. Several investigators have demonstrated improved labor outcomes in health-system pharmacy with the use of novel productivity models. However, the utility of a novel productivity model at a PCSC has not been assessed.

Objective: This study aimed to develop a productivity model with validation by comparison to past time periods to represent work at a PCSC.

Methods: The amount of time needed to complete work was determined by performing time studies. A modified Delphi process was used to ensure an appropriate perception of workload. Time standards for each category were averaged to determine the specific relative value units, which were then multiplied by total biweekly orders and combined with fixed activities to determine the unit of service. Actual hours worked were obtained for 6 prior pay periods to compare tool productivity with actual productivity.

Results: Time studies were performed over a 3-month period. The total average hours per pay period calculated by the tool for repackaging was 167.4 or 2.1 full-time equivalents (FTEs) and for warehousing was 176.8 or 2.2 FTEs. Although tool productivity followed the same trends as historical calendar day productivity, it was consistently higher per pay period over the 12-week comparison.

Conclusion: By performing time studies, a productivity model was developed for a PCSC that generated productivity data that correlated with 12 weeks of data using a historical model. This study provides the ability to assess trends over time with a more precise evaluation of work leading to the discussion that this tool is superior to historical productivity models.

Background: While research has identified characteristics that improve students' chances of matching into a postgraduate year 1 (PGY1) residency, it is unclear how graduating from an online pharmacy program affects these chances.

Objectives: Our qualitative descriptive study aimed to explore perceptions of residency program directors (RPDs) toward online pharmacy students and how these perceptions may affect match rankings.

Methods: PGY1 RPDs were identified using the American Society of Health-System Pharmacists Residency Directory, recruited via email, and interviewed with a set of prespecified open-ended questions. Interviews were digitally recorded and transcribed, with transcripts being used to develop consensus codes and consequent themes and subthemes.

Results: Fourteen RPDs from a variety of residency program types were interviewed. Most RPDs had positive or neutral perceptions towards online pharmacy programs. Their perceptions of the students in these programs were mixed, with some extolling drive and motivation, while others assuming laziness as motivation for pursuing an online program. RPDs mentioned that being in an online pharmacy program could negatively affect students' skills, such as patient care and communication skills, while others felt it could positively affect self-advocacy and time management skills. Despite these concerns, RPDs reiterated they use the same criteria and advice as they would for traditional students and that it would not affect their ranking.

Conclusion: RPDs' perceptions toward online pharmacy programs and the students in them were mixed, with some being concerned the nature of these programs would negatively impact skills needed for residency. Despite these concerns, RPDs reiterated these students will be assessed no differently from traditional students.

Background: There's limited information available about the range of harm reduction (HR) services provided by rural pharmacies.

Objective: This study's objectives are to describe the types of HR services offered by rural pharmacies and examine pharmacists' attitudes and willingness to offer those services.

Methods: A cross-sectional online survey was sent to pharmacists who are members of a practice-based research network for rural community pharmacies. Pharmacists reported the frequency to which their pharmacy engage in as well as their willingness to offer the following HR services: naloxone dispensing; buprenorphine dispensing; point of care testing for human immunodeficiency virus (HIV) and Hepatitis C (HCV); and nonprescription syringe (NPS) sales. Also, pharmacists' knowledge and willingness to sell drug test strips and attitudes toward people who inject drugs (PWIDs) were assessed. Descriptive statistics were calculated.

Results: A total of 61 pharmacists completed the survey (completion rate = 45.2%). Most reported dispensing naloxone 2-3 times per month (90.2%), and a third dispensed buprenorphine daily (32.8%). Only one pharmacy offered HIV testing, and none offered HCV testing. Most pharmacies (65.6%) had a policy regarding the sale of NPS, with 21.3% reporting they never dispense nonprescription syringes. Many pharmacists were willing to sell fentanyl test strips (67.2%) and xylazine test strips (50.8%). Pharmacists' most negative attitudes related to believing PWID customers make other customers feel uncomfortable and that providers keep patients on buprenorphine for too long.

Conclusion: Many rural community pharmacists engage in HR services and are willing to offer more. However, stigmatizing attitudes highlight the need for pharmacy-focused HR training to reduce stigma and increase knowledge.