Journal of the American Pharmacists Association最新文献

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.

Background

Smoking is the leading cause of preventable disease, disability, and death. Pharmacists can aid in smoking cessation through pharmacotherapy recommendations, patient counseling, and follow-up.

Objective

Describe a standardized transitions of care (TOC) pharmacist workflow for patients' tobacco cessation efforts at hospital discharge and to secondarily evaluate patient participation, impact on cessation outcomes, and pharmacist effort to provide the service.

Practice description

TOC pharmacists provide medication optimization and education to patients admitted to and discharged from Norton Healthcare hospitals. Medication optimization for tobacco cessation occurs through a provider recommendation or by utilizing the Kentucky Board of Pharmacy–authorized protocol.

Practice innovation

A standardized workflow was created for TOC pharmacists to identify patients who use tobacco, assess patients’ current tobacco use and willingness to quit, select appropriate pharmacotherapy, document, and follow up after discharge.

Evaluation methods

A retrospective descriptive study was performed for adult patients assessed by TOC pharmacists for tobacco cessation between November 2021 and April 2022, with follow-up visits completed through December 2022.

Results

The pharmacists assessed 357 patients and 252 (70.6%) stated they were interested in tobacco cessation. Of those interested, 117 patients (46.4%) indicated they were interested in receiving follow-up from TOC pharmacists and refills from a Norton pharmacy. Of the 117 patients interested in follow-up, 73 patients (62.4%) completed at least 1 follow-up visit with the TOC pharmacist. At the last completed follow-up visit, 26 patients (35.6%) reported complete tobacco cessation. Of the 47 patients who did not have complete cessation, they reported using 39% less tobacco on average compared with their initial assessment at hospital discharge. The mean time spent by TOC pharmacists using this workflow was 13.5 minutes per follow-up visit.

Conclusions

This project formalized a standardized and sustainable TOC pharmacist workflow that demonstrated a positive impact on tobacco cessation efforts for participating patients.

Background

Although pneumococcal vaccine is recommended for everyone 65 years of age and older, only 58% of Canadians in this age group have been vaccinated, well below the Public Health Agency of Canada’s target of 80%. To improve uptake, a stepped-wedge cluster randomized trial testing the effectiveness of a community pharmacist intervention was developed.

Objective

This prespecified sub-study aimed to uncover and quantify factors contributing to vaccine hesitancy by exploring the nature of patient-pharmacist conversations about pneumococcal vaccine.

Methods

Beginning each month (April– August 2023), participating pharmacies were randomly selected to receive an education package designed to enhance pharmacists’ knowledge, skills, and abilities in promoting pneumococcal vaccination. Pharmacists provided usual care (control stage) until they received the educational package and transitioned to the intervention stage. Weekly scorecards tracked patient-pharmacist conversations about pneumococcal vaccination. Chi-squared tests compared time taken for each conversation and patient-reported reason(s) for refusal between control and intervention stages.

Results

Thirteen pharmacies from across Alberta were included in the analysis, reporting 656 patient-pharmacist conversations (control stage n = 271, intervention stage n = 385). Time taken for pneumococcal vaccine conversations decreased after pharmacies received the education package (65% of conversations resulting in vaccination took <20 minutes in the control stage, compared to 88% in the intervention stage (P = 0.004)). The most common patient-reported reason for refusal, needing more time to think about the vaccine, remained similar between stages (P = 0.23). However, during the intervention stage, fewer patients refused vaccination due to lack of time to receive it today (P = 0.016) and perceived lack of benefit (P = 0.035), but more patients refused vaccination due to cost barriers (P = 0.026).

Conclusion

The education provided in this study changed the reasons for refusing vaccines, suggesting the nature of patient-pharmacist conversations became more efficient and informed. Similar interventions could be adopted across Canada and the United States to help combat vaccine hesitancy.

Background

Late-life depression (LLD) often goes underdiagnosed and undertreated. Community pharmacists are one of the most accessible and trusted healthcare professionals (HCPs) and may play a significant role in LLD screening.

Objective

This study aimed to develop and pilot a pharmacist-delivered depression screening and referral service for older adults (≥65 years) at risk of depression, within community pharmacy.

Methods

Community pharmacists across New South Wales, Australia, were recruited to participate in a prospective pilot study. Pharmacists/pharmacy staff received specialized training before recruiting and screening patients aged ≥65 years using the Geriatric Depression Scale-15 (GDS-15). Patients scoring ≥6 were referred to another HCP, e.g., general practitioner, and followed-up by the pharmacist 1-week postscreening. Patients were also followed-up by a research team member 6-weeks postscreening to explore outcomes of the screening. Semi-structured interviews with pharmacists and patients were undertaken following completion of the pilot study to explore their experiences delivering/receiving the screening service. A thematic inductive analysis approach was used to analyze interview data.

Results

A total of 39 community pharmacies participated in this study. In total, 113 participants attended the training sessions. Pharmacists screened 15 patients from 8 pharmacies, of which 67% were female. Two thirds of patients (67%) received a GDS-15 score of ≥6, indicating possible depression and requiring referral. Pharmacists referred 80% of patients to another HCP. One patient was diagnosed with depression and commenced antidepressant therapy. Five patients and 6 pharmacists participated in semi-structured interviews. Barriers to screening included lack of time and mental illness stigma. Facilitators included pharmacist-patient relationships and training.

Conclusion

Pharmacist-delivered LLD screening was found to be acceptable by both pharmacists and patients, with pharmacists reporting training improved their comfort and confidence with depression screening. These pilot study findings may inform future work into service delivery models to support early identification and treatment of LLD.

Background

Over 1 million people in the United States are infected with human immunodeficiency virus (HIV). As of 2021, pharmacists in California can prescribe PrEP and PEP without establishing a collaborative practice agreement in an effort to reduce HIV transmission. However, in 2021 less than 3% of independent pharmacies in the San Francisco Bay Area did so. To our knowledge, there has been no follow-up research assessing potential changes in pre-exposure prophylaxis/postexposure prophylaxis (PrEP/PEP) furnishing rates in the region.

Objective

Assess the extent of PrEP/PEP furnishing in San Francisco Bay Area pharmacies 3 years after policy implementation.

Methods

We conducted an observational, cross-sectional study to identify independent community and mail-order pharmacies furnishing PrEP/PEP in the nine-county San Francisco Bay Area in 2024. Furnishing pharmacies were identified via phone calls and the findings were validated with in-person visits. We also identified the number of retail chain pharmacies furnishing PrEP/PEP in San Francisco County.

Results

We contacted 202 independent community and mail order pharmacies in the nine-county San Francisco Bay Area by telephone; of these, 16 reported furnishing PEP/PrEP and all confirmed their ability to furnish when visited in person. We contacted 67 retail chain pharmacies in San Francisco County; of these, 11 pharmacies reported furnishing PrEP/PEP (10 Safeway; 1 Walgreens).

Conclusions

More pharmacies furnished PrEP/PEP in the 9-county San Francisco Bay Area in 2024 (8%) than in 2021 (3%); in addition, one retail chain pharmacy had instituted a furnishing protocol. However, furnishing rates remained low. Past research suggests that advertising and the development of furnishing protocols may help increase furnishing and increase medication access.

Background

Objective

Methods

Results

Conclusion

Background

Although vaccines are an effective solution for preventing infectious disease, some vaccination rates remain below national targets, creating a need to increase vaccination access and uptake. A potential solution to improve vaccination rates is the implementation of policies that allow for more convenient vaccination access, such as the expansion of vaccination delivery by nonphysician healthcare providers (NPHPs) outside of traditional clinical settings.

Objective

To understand perspectives on vaccine administration at complementary sites (such as pharmacies, mobile clinics, and pop-up clinics) by NPHPs, and the barriers surrounding administration.

Methods

We performed interviews with healthcare providers and vaccination policy experts to elicit perspectives on including vaccination program scope, facilitators and barriers to NPHPs administering vaccines, and recommendations for improvement of vaccine administration. Eligible participants were required to either work directly in vaccination administration or work in vaccination policy.

Results

Thirty-eight participants completed interviews. Participants reported that U.S. individuals have a positive view of vaccination at complementary sites and by NPHPs, especially since the COVID-19 pandemic, where vaccination was often performed by NPHPs at complementary sites. Concerns expressed by participants included language barriers, out-of-pocket costs, and mistrust among marginalized communities. Participants described the complexity of state and local regulations, particularly scope of practice laws, as a barrier to implementation of NPHP vaccination programs at complementary sites.

Conclusion

NPHPs and vaccination advocates report that complementary sites represent a potentially important step to ensuring broader, more equitable vaccination service in the United States.

Background

Community pharmacies are critical to the public health infrastructure in the United States and provide reliable information for public health concerns. Public health agencies curate educational materials that community pharmacy teams can disseminate. Student pharmacists participate in experiential learning at community pharmacies which could be utilized for dissemination of these resources.

Objectives

The objectives of this project were to (1) design a model for dissemination of public health information at community pharmacies; and (2) evaluate both the dissemination model’s reach within communities and student pharmacist learnings from engagement in the model.

Methods

We engaged student pharmacists in a model to disseminate information at community pharmacies for 2 Centers for Disease Control and Prevention initiatives about Opioid Use Disorder Anti-Stigma and Antibiotic Stewardship Education. The number of pharmacies and student pharmacists who participated from 2021 from 2023 was retrospectively reviewed to demonstrate programmatic reach. A retrospective text mining of student assignments was conducted to evaluate student experiences. Descriptive statistics were used to report quantitative data. An inductive, rapid content analysis was completed for qualitative data.

Results

Across 3 years, 333 student pharmacists participated. Students reached 121 community pharmacies, 139 practicing pharmacist preceptors, and over 2000 patients with education and resources. Eleven student learning points emerged from the qualitative analysis. These included learnings around opioid use disorder and antibiotic stewardship. Students also acknowledged that there are public health needs present in communities and that community pharmacy teams are well-positioned to address these needs.

Conclusion

Engaging student pharmacists to distribute curated information from public health authorities, both to pharmacist preceptors and patients at community pharmacies, is one way to educate future pharmacists, pharmacy teams, and communities on public health priorities. Pharmacies can serve as key venues in communities for dissemination of reliable public health information.

Background

Due to the shortage of professionals and the ever-increasing need for and demand for appointments, consultation with physicians is becoming increasingly difficult, and delays are increasing. To limit this issue, several countries have experimented with different models of independent prescribing through pharmacies.

Aim

This study aimed to analyze the contribution of independent prescribing by community pharmacists in primary care using a micro, meso, and macrolevel framework.

Method

This was a scoping review of 3 different databases: Medline, Scopus, and Embase. The search (all databases) was executed on May 14, 2024. To be selected for the review, articles needed to be published after 2000, written in English or French, and focused on independent prescribing by community pharmacists. The articles had to investigate the pharmacist-independent prescribing (PIP) efficacy, effectiveness, or efficiency. Only original research was included. The bibliographies of the included papers were reviewed for additional studies. The articles were imported into Covidence to perform the review.

Results

The search yielded 2802 articles, and 1062 remained after removing duplicates. Finally, 13 studies were included in the scoping review. As an independent prescriber, the community pharmacist can improve patient access to primary care, reducing treatment delays (microlevel). In addition, patient safety is maintained, and patients’ quality of life is increased. Giving the community pharmacist an extra role helps reduce the workload on physicians, and thus facilitates access to care (mesolevel). The PIP model seems to be cost-effective for society and avoid medical consultations (macrolevel).

Conclusion

This review highlights the potential value and relevance of pharmacist-independent prescribers. Minor ailment services were frequently described, but PIP has also been implemented for chronic conditions. The benefits to society are felt at all levels: micro, meso, and macro. Its effectiveness and efficacy have been established, but additional studies are needed, particularly on its efficiency.