Contraception for transgender and gender diverse individuals in pharmacy education: A cross-sectional survey and select resources.

INTRODUCTION: Pharmacists must be knowledgeable to care for all patients, including transgender and gender diverse individuals. Some institutions may have gaps in their pharmacy school curriculum specific to transgender contraceptive care. The current study evaluated and offered recommendations regarding the current state of transgender contraceptive care education within pharmacy curricula. METHODS: An 18-question anonymous survey was developed and sent to members of the American Association of Colleges of Pharmacy - Pharmacy Practice section contact list. The survey collected baseline demographic characteristics and curricular information, including whether contraception for transgender individuals was taught and the modalities utilized. The institutional review board at Butler University reviewed and approved this survey project. RESULTS: A response rate of 68% was obtained (99 of 144 institutions). Of those institutions responding, 39% reported that contraception for transgender individuals is taught as part of the curriculum at their respective institutions. In addition, a diverse set of teaching modalities were reported, such as didactic and team-based learning. Only six (4.3%) of the 138 individual faculty respondents indicated they obtained training focused on transgender care. CONCLUSIONS: Approximately 40% of the responding institutions reported teaching about contraception care for transgender individuals. Based on this survey, the authors encourage institutions to assess their current curriculum and incorporate this topic accordingly. In addition, the authors recommend offering development opportunities for faculty and student pharmacists so that current and future health care professionals are best equipped to provide care for all patients in any practice.

Update and recommendations: Pharmacists' prescriptive authority for tobacco cessation medications in the United States.

To characterize state laws in the United States regarding the expansion of pharmacists' prescriptive authority for tobacco cessation medications, compare key components across different models, and discuss important considerations for states that are considering similar legislation or policies. Legislative language was reviewed and summarized for all states with pharmacist prescriptive authority for tobacco cessation medications, and state boards of pharmacy were contacted to determine the number of registered complaints or safety concerns received as a result of pharmacists' prescribing under these authorities. As of June 2022, 17 states have enacted laws for pharmacists' prescriptive authority for tobacco cessation medications; most (N = 16) have implemented procedures, and 1 is in the process of adopting a similar prescribing model. Of 16 states with fully delineated protocols, 8 (Colorado, Idaho, Indiana, New Mexico, North Dakota, Oregon, Utah, Vermont) include all medications approved by the U.S. Food and Drug Administration for smoking cessation, and 8 (Arizona, Arkansas, California, Iowa, Maine, Minnesota, Missouri, North Carolina) include nicotine replacement therapy medications only. Most protocols specify minimum cessation education requirements for pharmacists and define required intervention elements (e.g., screening, cessation intervention components, follow-up, and documentation requirements). Personal communications with state boards of pharmacy revealed no complaints or safety concerns regarding pharmacists' prescribing for cessation medications since these authorities were first implemented, in New Mexico, in 2004. The number of states with pharmacists' prescriptive authority for tobacco cessation medications has increased substantially in recent years. There have been no registered complaints or safety concerns since the inception of this expanded scope of practice. Although the profession has made meaningful progress, there are inconsistencies across states with respect to medications that are included and requirements for implementing tobacco cessation services, which may impede broader adoption.

A report on pharmacists with the NCMP credential.

OBJECTIVE: To characterize the demographics and practices of pharmacists with The North American Menopause Society Certified Menopause Practitioner (NCMP) credential. METHODS: A cross-sectional electronic survey was disseminated to pharmacists with the NCMP credential in June 2018. Twenty-four items were posed to respondents regarding demographics, educational background, and employment, in addition to perspectives regarding the utility of the credential in practice. The questions consisted of multiple choice, as well as open-ended responses. RESULTS: Of the 40 pharmacists who were invited to participate, 26 (65%) responded. The majority of respondents were women (84%), practicing for at least 10 years (range 5-47 y), based in Canada (70%), and practicing in the community (43%) or compounding (39%) pharmacies. Most pharmacists reported pursuing the credential for credibility with patients (81%), to increase their knowledge about menopause (77%), and for credibility with other healthcare providers (73%). Almost all (88%) plan to renew their credential. Among these pharmacists, many are presently counseling about treatment options (78%) and educating about selected treatment (78%). Pharmacists are most interested in initiating systemic hormonal therapy (61%) and modifying or continuing systemic hormonal therapy (57%). CONCLUSIONS: Pharmacists find the NCMP credential to be valuable. Although pharmacists are engaged in counseling and recommendations, they desire prescriptive authority related to menopause care. Future studies should explore the various pharmacist care models and evaluate the impact of pharmacist care on organizational operations and patient outcomes.

Assessment of Glucagon-like Peptide-1 Receptor Agonists in Veterans Taking Basal/Bolus Insulin Regimens.

Background: Clinical use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is well established as add-on therapy to oral medications and basal insulin. However, there is little published data regarding the use of GLP-1 RAs for longer than 12 months in patients taking basal/bolus insulin regimens. The primary goal of our study was to assess the long-term efficacy of GLP-1 RAs as add-on therapy to basal/bolus insulin regimens. Methods: This study was a retrospective record review of all patients on basal/bolus insulin regimens who received additional therapy with a GLP-1 RA. The primary outcome was the change in glycosylated hemoglobin A1c (HbA1c) at 3, 6, 12, 18, and 24 months after initiation of the GLP-1 RA. Secondary outcomes included change in weight and total daily dose (TDD) of insulin and incidence of hypoglycemia and other adverse effects (AEs). Results: Ninety-two patient records were reviewed. Mean glycemic control changed from baseline -1.1% (95% CI, -1.3 to -0.8; P < .001) at 3 months; -1.0% (95% CI, -1.3 to -0.7; P < .001) at 6 months; -0.9% (95% CI, 1.3 to -0.6; P < .001) at 12 months; -0.9% (95% CI, -1.4 to -0.3; P = .002) at 18 months; and -0.7 (95% CI, -1.4 to 0.1; P = .07) at 24 months. A significant decrease in weight was also observed from baseline through 18 months, and a significant decrease in TDD of insulin was identified from baseline through 12 months. Hypoglycemia was documented in 29.8% of patients at any point during GLP-1 RA therapy, and gastrointestinal AEs were documented in 18.3% of patients. Conclusions: Adding GLP-1 RAs to complex insulin regimens may help achieve glycemic control while decreasing insulin requirements and mitigating undesirable AEs, such as weight gain.

Evaluation of appropriate use of bisphosphonates and denosumab in patients with cancer.

BACKGROUND: National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS: A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS: A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS: Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.

Opinions and experiences of Indiana pharmacists and student pharmacists: the need for addiction and substance abuse education in the United States.

BACKGROUND: Substance abuse and addiction are growing public health problems. Pharmacists are potentially in a position to be of great assistance in ameliorating these threats yet might not be receiving the education and training to do so effectively. OBJECTIVE: To assess the relative perceived importance of substance abuse topics in pharmacy education among student pharmacists and pharmacy practitioners in the state of Indiana. METHODS: Questionnaires were administered in class to students at Purdue University College of Pharmacy and via direct mail to the home addresses of randomly selected licensed Indiana pharmacists in 2009 to elicit information on the relevance and interest for particular topics within addiction education, prior education received regarding addiction, and the frequency of professional interactions that involved addiction. RESULTS: Three hundred fifty students (74%) and 625 pharmacists (26%) responded to the survey. The average interest across all surveyed topics was 3.18/4.00 for students and 3.47/4.00 for practitioners. Areas rated highly by both groups included withdrawal, pain management, and recognition of signs and symptoms of addiction in patients. Qualitative responses from practitioners suggest strong interest in further education in this area and a perceived need for increased educational exposure during the student pharmacist experience. The average pharmacist respondent spent 6.94% of the time dealing with people who were addicted, and 22.2% had independent addiction education. CONCLUSIONS: Pharmacists and pharmacy student respondents overwhelmingly felt that educational preparation in this area is important. A significant portion of time in practice is spent managing addiction-related issues, and further educational opportunities are being pursued beyond graduation to fulfill the educational needs of the practitioner respondents.