Electronic health records and e-prescribing in Australia: An exploration of technological utilisation in Australian community pharmacies.

OBJECTIVE: This study aimed to assess the utilisation, benefits, and challenges associated with Electronic Health Records (EHR) and e-prescribing systems in Australian Community Pharmacies, focusing on their integration into daily practice and the impacts on operational efficiency, while also gathering qualitative insights from community pharmacists. METHODS: A mixed-methods online survey was carried out among community pharmacists throughout Australia to assess the utilisation of EHR and e-prescribing systems, including the benefits and challenges associated with their use. Data was analysed based on pharmacists' age, gender, and practice location (metropolitan vs. regional). The chi-square test was applied to examine the relationship between these demographic factors and the utilisation and operational challenges of EHR and e-prescribing systems. RESULTS: The survey engaged 120 Australian community pharmacists. Of the participants, 67 % reported usability and efficiency issues with EHR systems. Regarding e-prescribing, 58 % of pharmacists faced delays due to slow software performance, while 42 % encountered errors in data transmission. Despite these challenges, the benefits of e-prescribing were evident, with 79 % of respondents noting the elimination of illegible prescriptions and 40 % observing a reduction in their workload. Issues with prescription quantity discrepancies and the reprinting process were highlighted, indicating areas for improvement in workflow and system usability. The analysis revealed no significant statistical relationship between the utilisation and challenges of EHR and e-prescribing systems with the demographic variables of age, gender and location (p > 0.05), emphasising the necessity for healthcare solutions that address the needs of all pharmacists regardless of specific demographic segments. CONCLUSION: In Australian community pharmacies, EHR and e-prescribing may enhance patient care but come with challenges such as data completeness, technical issues, and usability concerns. Implementing successful integration relies on user-centric design, standardised practices, and robust infrastructure. While demanding for pharmacists, the digital transition improves efficiency and quality of care. Ensuring user-friendly tools is crucial for the smooth utilisation of digital health.

Barriers to Buprenorphine Dispensing by Medicaid-Participating Community Retail Pharmacies.

Importance: Controlled substances have regulatory requirements under the US Federal Controlled Substance Act that must be met before pharmacies can stock and dispense them. However, emerging evidence suggests there are pharmacy-level barriers in access to buprenorphine for treatment for opioid use disorder even among pharmacies that dispense other opioids. Objective: To estimate the proportion of Medicaid-participating community retail pharmacies that dispense buprenorphine, out of Medicaid-participating community retail pharmacies that dispense other opioids and assess if the proportion dispensing buprenorphine varies by Medicaid patient volume or rural-urban location. Design, Setting, and Participants: This serial cross-sectional study included Medicaid pharmacy claims (2016-2019) data from 6 states (Kentucky, Maine, North Carolina, Pennsylvania, Virginia, West Virginia) participating in the Medicaid Outcomes Distributed Research Network (MODRN). Community retail pharmacies serving Medicaid-enrolled patients were included, mail-order pharmacies were excluded. Analyses were conducted from September 2022 to August 2023. Main Outcomes and Measures: The proportion of pharmacies dispensing buprenorphine approved for opioid use disorder among pharmacies dispensing an opioid analgesic or buprenorphine prescription to at least 1 Medicaid enrollee in each state. Pharmacies were categorized by median Medicaid patient volume (by state and year) and rurality (urban vs rural location according to zip code). Results: In 2016, 72.0% (95% CI, 70.9%-73.0%) of the 7038 pharmacies that dispensed opioids also dispensed buprenorphine to Medicaid enrollees, increasing to 80.4% (95% CI, 79.5%-81.3%) of 7437 pharmacies in 2019. States varied in the percent of pharmacies dispensing buprenorphine in Medicaid (range, 73.8%-96.4%), with significant differences between several states found in 2019 (χ2 P < .05), when states were most similar in the percent of pharmacies dispensing buprenorphine. A lower percent of pharmacies with Medicaid patient volume below the median dispensed buprenorphine (69.1% vs 91.7% in 2019), compared with pharmacies with above-median patient volume (χ2 P < .001). Conclusions and Relevance: In this serial cross-sectional study of Medicaid-participating pharmacies, buprenorphine was not accessible in up to 20% of community retail pharmacies, presenting pharmacy-level barriers to patients with Medicaid seeking buprenorphine treatment. That some pharmacies dispensed opioid analgesics but not buprenorphine suggests that factors other than compliance with the Controlled Substance Act influence pharmacy dispensing decisions.

Pharmacist assessments and care to improve adult vaccination rates: A report from project IMPACT vaccine confidence.

BACKGROUND: Neglect of vaccination needs among adults results in a needless burden of hospitalization, suffering, and death. America's community pharmacists deliver a substantial portion of adult vaccinations, yet many Americans still have unmet vaccination needs. OBJECTIVES: This study evaluated rates of vaccine contraindications, acceptance, and willingness to be vaccinated among ambulatory adults. PRACTICE DESCRIPTION: This was a prospective, multisite, multistate, observational study conducted in three waves between October 2021 and August 2023. PRACTICE INNOVATION: Pharmacists conducted comprehensive vaccination need assessments. EVALUATION METHODS: The primary outcomes were numbers of vaccination needs per participant and vaccinations administered, scheduled, or declined. RESULTS: Pharmacists identified a mean of 1.8-2.2 unmet vaccination needs per adult assessed, more than in pilot studies. Participants had already received 61%-74% of vaccinations recommended for them hence 26%-39% of needs were unmet at baseline. The leading vaccination needs were COVID-19, influenza, zoster, tetanus-containing, and pneumococcal vaccines. From a baseline mean of 59.1% for these five vaccinations, pharmacists increased the mean percentage vaccinated to 73.2%. When an option for scheduling future vaccination was added to the process, declinations dropped from 46%-18%. CONCLUSION: This study provides insight into adult vaccine acceptance, willingness, and declination behaviors not described elsewhere. Offering options for future vaccination reduced declination rates. Pharmacists resolved substantial proportions of adult vaccination needs. The signal that apportioning adult vaccines needed, but not received on day of assessment, across several months could help resolve unmet vaccination needs warrants additional research, especially with the rising number of vaccines recommended for adults.

Determining the association between grocery nutrition scores and number of medications taken for metabolic syndrome: A pilot study.

BACKGROUND: Metabolic syndrome is a cluster of disease states that increases an individual's risk of developing diabetes or cardiovascular disease. When treating metabolic syndrome, lifestyle and diet are primary areas for interventions. A dietician-led grocery nutrition system scoring patients' purchases may correlate to better control of metabolic health. OBJECTIVE: To compare the number of medications taken for metabolic syndrome for patients with grocery nutrition scores at goal versus those below goal as pre-defined by the dietician team. PRACTICE DESCRIPTION: This exploratory, retrospective cohort pilot study took place in a single pharmacy within a large community pharmacy chain in Northwest Ohio. PRACTICE INNOVATION: This retrospective cohort study compared the number of medications taken for metabolic syndrome between two groups: patients with a grocery nutrition score at a dietician-set goal and patients not at goal. EVALUATION METHODS: Data were collected from May 2022 to March 2023, with patients completing a questionnaire collecting information on demographics. In addition, the questionnaire, grocery nutrition scores, and patient medication records were collected. Descriptive statistics were calculated for demographic items. A number of medications taken for metabolic syndrome by patients at dietician-set grocery nutrition score goal and not at goal were compared using a Mann-Whitney U test. RESULTS: A total of 40 patients were enrolled in this study. There was not a significant difference in a number of medications taken for metabolic syndrome between groups, with patients who had a grocery nutrition score at goal taking an average of 1.20 medications compared to 1.96 for those with grocery nutrition scores below goal. CONCLUSIONS: While no statistical difference in mean medication use was identified, grocery nutrition scores may help understand patients' dietary habits. Larger studies are required to test the relationship between grocery nutrition scores, patient-specific factors, and medications taken for metabolic syndrome.

Despair and hope: Is the retail community pharmacy workforce in danger of becoming a monopsony labor market?

OBJECTIVE: Mergers of big chain retail community pharmacies can affect the competitiveness of the pharmacy workforce to negotiate better wages and work conditions. However, it is unclear whether these types of mergers are generalizable to the U.S. pharmacy workforce. We should observe this effect when comparing annual wage trends between retail community pharmacy workers and nonretail community pharmacy workers. In the absence of this effect, annual wage trends would be similar. To examine this theory, annual wage trends for community pharmacy workers were compared with hospital pharmacy workers between 2012 and 2022. DESIGN, SETTING AND PARTICIPANTS: A serial cross-sectional study was performed to compare the annual wages between retail community pharmacy workers and hospital pharmacy workers between 2012 and 2022 using data from the U.S. Bureau of Labor and Statistics (BLS). Pharmacy workforce was categorized as pharmacists, pharmacy technicians, and pharmacy aides (clerks) and grouped into retail or hospital pharmacy settings based on the North American Industry Classification System. Pharmacy workers' annual wages were based on the U.S. BLS Quarterly Census of Employment and Wages data. OUTCOME MEASURES: Annual wages. RESULTS: Between 2012 and 2022, statistically significant annual wage reduction was greater among pharmacists in the retail than pharmacists in the hospital setting by -$1974 (95% CI -$2921 to -$1026) per year. However, these trends were not statistically significant among pharmacy technicians and pharmacy aides. Pharmacy technicians in the retail and hospital settings had a 3.4% and 7.0% increase in average annual wages, respectively. Pharmacy aides in the retail and hospital settings had a 16.8% and 21.6% increase in average annual wages, respectively. CONCLUSION: Although pharmacists' annual wages decreased, it is unclear whether this was caused by the monopsony labor market. These findings suggest that there may be inefficiencies in the retail community pharmacy labor market, which may stimulate policies to improve pharmacy workforce conditions and patient safety.

Spatial accessibility and travel to pharmacy by type in the Detroit region.

BACKGROUND: Community pharmacies are a critical part of the health care provision system. Yet less is understood about the spatial accessibility to pharmacies and how people travel to reach these services. OBJECTIVES: This study compared spatial accessibility and actual travel to different types of pharmacies among selected neighborhoods in the Detroit region. METHODS: Three types of neighborhoods were selected and compared, including two lower income Black urban neighborhoods of high-density and four upper income White suburbs (two of low density and two of high density). Spatial accessibility was computed by pharmacy type and compared among neighborhoods using ANOVA. Pharmacy trips reported in a travel survey were geocoded and linked with community pharmacies in a list generated from ReferenceUSA business data. Destination choices were mapped and the relationship between spatial accessibility and actual distance traveled was examined using ordinary least squares regressions. RESULTS: On average, urban residents in Detroit had higher access to local independent pharmacies (0.74 miles to the nearest one) but relatively lower access to national chains (1.35 miles to the nearest one), which most residents relied on. Urban residents also tended to shop around more for services even among national chains. In fact, they bypassed nearby local independent pharmacies and traveled long distances to use farther pharmacies, primarily national chains. The average trip distance to pharmacy was 2.1 miles for urban residents, but only 1.1 miles and 1.5 miles for residents in high-density suburbs and low-density suburbs, respectively. CONCLUSION: Supposedly good spatial access considering all pharmacies together may mask excessive burden in reaching the pharmacy services needed in low-income minority urban communities, as shown in the case of Detroit. Thus, when mapping pharmacy deserts, it is important to distinguish spatial accessibility among different pharmacy types.

Assessment of without prescription antibiotic dispensing at community pharmacies in Hazara Division, Pakistan: A simulated client's study.

Antibiotics dispensing without a prescription is an irrational practice and can increase the risk of antibiotic resistance, which is a significant public health concern around the globe. This study was aimed to determine the extent to which antibiotics are supplied without prescription in the community pharmacies (CPs) at Hazara Division from November 2020 to February 2021. The simulated client method (SCM) was used, and the data were gathered, recorded, and analyzed through different statistical methods with descriptive and inferential techniques. The antibiotic dispensing was observed in CPs (90.5%), the most dispensed antibiotics were azithromycin (29.4%) and ciprofloxacin (46.5%) respectively. Furthermore, visited medical stores/ drug outlets, 9.5% of the visited stores denied dispensing of antibiotics because they preferred a referral to visit physicians (23. 9%) and (12.8%) did not had the antibiotics at the time of visits. Antibiotics were more obtainable in retail medical stores (AOR = 8.6, 95 percent Cl: 3.0-24.7; p = 0.001) than in pharmacies. In rural areas antibiotics dispensing was more (p = 0.004) as compared to urban areas. Staff members also had asked about patient's (17.7%) symptoms and drug allergies (12.3% and 3.9%), and (1.5%) they consoled them about their medications. The findings of this study indicate that nonprescription antibiotic sales are very common, despite national rules prohibiting this activity. When the simulated Client requested for any medication to relieve his or her discomfort, many antibiotics were given out without a prescription. Pharmacies/medical stores in Hazara Division selling antibiotics without a prescription are worrying and need immediate action by regulators.

Perceptions of Pharmacy students about their competences for professional practice in community pharmacy

Abstract Pharmaceutical education should enable the development of competences for community pharmacy practice, which is an important field for the pharmacist workforce. The aim of this study was to evaluate the competences perceived by pharmacy interns from a Brazilian pharmacy school for community pharmacy practice. This study adopted a combined quantitative and qualitative approach. The study cohort included undergraduate students who undertook internships in community pharmacy in the final year of the pharmacy course. Students responded to an 11-item structured questionnaire according to a five-point Likert scale that included perceptions of their competences for community pharmacy practice. Among the 693 possible answers, 605 (87.3%) agreed that the course promoted the development of competences for professional practice in community pharmacy. Less than 70% of students perceived themselves as prepared to respond to symptoms and provide non-prescription medicines. Qualitative analysis of the comments revealed three themes: the need to improve patient information skills, improve practice as a member of a health care team, and improve dispensing according to legal requirements. These findings may support improvements in undergraduate pharmacy programs, such as the inclusion of experiential learning, active learning methods, interprofessional education, and development of clinical skills.

Mapping community pharmacy services in Brazil: a scoping review

Abstract The delivery of clinical pharmacy services has been growing in Brazilian community pharmacies, and it is necessary to have a comprehensive understanding of the topic. This scoping review aimed to provide an overview of Brazilian studies about clinical pharmacy services in community pharmacies. Original research articles, with no restriction of time, study design, or patient's health condition, were included. Searches were conducted in PubMed, Scopus, Web of Science, Scielo, and Lilacs. Two reviewers conducted the screening, full-text reading, and data extraction independently. ROB and ROBINS-I were used for the assessment of quality. Charts and tables were built to summarise the data. Seventy-two articles were included. A diversity of study designs, number of participants, terms used, and outcomes was found. São Paulo and Sergipe States had the highest number of studies (n=10). Pharmacists' interventions were not fully reported in 65% of studies, and most studies presented an unclear risk of bias. Studies were very diverse, impairing the comparisons between the results and hindering their reproducibility. This review suggests using guidelines and checklists for better structuration of pharmacists' interventions as well as reporting results and measuring fidelity in future research.

Challenges for Polish Community Pharmacists in Provision of Services to Immigrants and Non-Polish-Speakers in 2018.

BACKGROUND International patient services in community pharmacies are becoming increasingly common. The growing number of immigrants, as well as the developing trend of medical tourism, make it necessary to provide these people with access to healthcare services, including pharmaceutical services in generally accessible pharmacies. Serving non-Polish-speaking patients, however, requires both fluent specialist knowledge of a foreign language and interpersonal skills. These skills can greatly influence the proper use of medications by patients. This study aimed to investigate the reported challenges for Polish community pharmacists in the provision of services to immigrants and non-Polish-speakers in 2018. MATERIAL AND METHODS The study included 98 pharmacists and pharmaceutical technicians from community pharmacies in Poland. The research tool was a questionnaire sent to pharmacy staff in cooperation with pharmacy councils in 2018. RESULTS Analysis of the data gathered using a 5-point Likert scale showed that the participants rated the preparedness for international patient services in pharmacies as medium (mean 2.76±1.33). The mean foreign language knowledge score was 2.99±1.29. The participants indicated a low possibility of acquiring these language skills (mean 2.53±0.91), and emphasized that patients from abroad rarely asked about the use of the medications (mean=2.20±1.06). CONCLUSIONS This study showed that in 2018, pharmacy staff in Poland did not feel adequately prepared to provide comprehensive pharmacy services for immigrants and non-Polish-speakers, with concerns of non-compliance with medications due to poor communication.

Roles and reimbursement of pharmacists as South Africa transitions towards Universal Health Coverage (UHC): An online survey-based study.

BACKGROUND: The implementation of Universal Health Coverage in SA has sought to focus on promoting affordable health care services that are accessible to all citizens. In this regard, pharmacists are expected to play a pivotal function in the revitalization of primary health care (PHC) during this transition by the expansion of their practice roles. OBJECTIVES: To assess the readiness and perceptions of pharmacists to expand their roles in an integrated health care system. To determine the availability and pricing of primary health care services currently provided within a community pharmacy environment and to evaluate suitable reimbursement for the provision of such services by a community pharmacist. METHODS: Community pharmacists' across SA were invited to participate in an online survey-based study. The survey consisted of both open- and closed-ended questions. Descriptive statistics for closed-ended questions were generated and analysed using Microsoft Excel® and Survey Monkey®. Responses for the open-ended questions were transcribed, analysed, and reported as emerging themes. RESULTS: Six hundred and sixty-four pharmacists' responded to the online survey. Seventy-five percent of pharmacists' reported that with appropriate training, a transition into a more patient-centered role might be beneficial in the re-engineering of the PHC system. However, in order to adopt these new roles, appropriate reimbursement structures are required. The current fee levied by pharmacists in community pharmacies that offered these PHC services was found to be lower to that recommended by the South African Pharmacy Council; this disparity is primarily due to a lack of information and policy standardisation. Therefore, in order to ensure that fees levied are fair, comprehensive service package guidelines are required. CONCLUSIONS: This study provides baseline data for policy makers on pharmacists' readiness to transition into expanded roles. Furthermore, it can be used as a foundation to establish appropriate reimbursement frameworks for pharmacists providing PHC services.

Management of common minor ailments in Qatar: Community pharmacists' self-perceived competency and its predictors.

Studies focused on comprehensive assessment of self-perceived competency of community pharmacists to manage minor ailments are scanty despite that self-perceived competency is a valid determinant of task performance. The objectives of the study were to assess community pharmacists' self-perceived competency to manage fourteen common minor ailments in Qatar, and identify its significant predictors. A cross-sectional assessment of 307 community pharmacists was conducted with a pre-tested 20-item questionnaire. Self-perceived competency was assessed with nine elements on a scale of 1-10 (Maximum obtainable score: Each minor ailment = 90; each element = 140). Mann-Whitney U and bivariate logistic regression were used for data analyses. The response rate was 91.9% (282/307). The majority of the respondents were males (68.1%; 192/282), within the age range of 31-40 years (55.3%; 156/282). The minor ailments with the highest median competency score were constipation (76), and cold/catarrh (75) while travel sickness (69), and ringworm (69) had the lowest. The two condition-specific competency elements with the highest median score were recommendation of over-the-counter (OTC) medicines (115), and provision of instructions to guide its use (115). Ability to differentiate minor ailments from other medical conditions had the lowest median competency score (109). The significant predictors self-perceived competency were female gender (OR = 2.39, 95%CI: 1.34-4.25, p = 0.003), and working for chain pharmacies (OR = 2.54, 95%CI: 1.30-4.96, p = 0.006). Overall, Community pharmacists' self-perceived competency was adequate for majority of the common minor ailments, and it was highest for constipation and cold/catarrh, and specifically for the recommendation of OTC medicines and provision of instructions to guide its use. However, diagnostic ability to differentiate minor ailments from other medical conditions with similar features had the lowest median competency score. Female gender and working in chain pharmacies were the significant predictors of self-perceived competency to manage minor ailments.

Pharmacists' perceptions of the use of internet-based medication information by patients: A cross-sectional survey.

PURPOSE: The credibility and the reliability of Internet webpages to seek medication-related information is questionable. The main objective of the current study was to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients. METHODS: This is a cross-sectional descriptive study that was conducted to evaluate perception and experience of pharmacists with the use of Internet-based medication information by their patients. During the study period, 200 pharmacists were approached to participate in the study using a paper-based survey to assess their perceptions and current experience with the use of Internet-based medication information by their patients. Data were analyzed using descriptive statistics (mean/standard deviation for continuous variables, and frequency/percentages for qualitative variables). Also, simple linear regression was utilized to screen factors affecting pharmacists' perception scores of the use of Internet-based medication information. RESULTS: Among 161 recruited pharmacists, the majority (n = 129, 80.1%) reported receiving inquiries from patients about Internet-based medication information within the last year. Among them, only 22.6% (n = 29) of pharmacists believed that Internet-based medication information is somewhat or very accurate. Unfortunately, only 24.2% (n = 31) of them stated that they always had enough time for their patient to discuss their Internet-based medication information. Regarding pharmacists' perception of the use of Internet-based medication information by their patients, more than half of the pharmacists (>50%) believe that Internet-based medication information could increase the patient's role in taking responsibility. On the other hand, 54.7% (n = 88) of the pharmacists believed that Internet-based medication information would contribute to rising the healthcare cost by obtaining unnecessary medications by patients. Finally, pharmacists' educational level was found to significantly affect their perception scores toward patient use of Internet-based medication information where those with higher educational level showed lower perception score (r = -0.200, P-value = 0.011). CONCLUSION: Although pharmacists felt that usage of Internet-based data by patients is beneficial, they also have believed that it has a negative impact in terms of rising the healthcare cost, and it promotes unnecessary fear or concern about medications. We suggest that pharmacists be trained on principles of critical appraisal to become professional in retrieval information on the Internet that might improve their delivery of healthcare information and their recommendations to patients.

E-prescribing and access to prescription medicines during lockdown: experience of patients in Aotearoa/New Zealand.

BACKGROUND: Health services internationally have been compelled to change their methods of service delivery in response to the global COVID-19 pandemic, to mitigate the spread of infection amongst health professionals and patients. In Aotearoa/New Zealand, widespread electronic delivery of prescriptions (e-prescribing) was enabled. The aim of the research was to explore patients' experiences of how lockdown, changes to prescribing and the interface between general practices and community pharmacy affected access to prescription medications. METHOD: The research employed a mixed-method approach. This included an online survey (n = 1,010) and in-depth interviews with a subset of survey respondents (n = 38) during the first COVID-19 lockdown (March-May 2020). Respondents were recruited through a snowballing approach, starting with social media and email list contacts of the research team. In keeping with the approach, descriptive statistics of survey data and thematic analysis of qualitative interview and open-ended questions in survey data were combined. RESULTS: For most respondents who received a prescription during lockdown, this was sent directly to the pharmacy. Most people picked up their medication from the pharmacy; home delivery of medication was rare (4%). Survey and interview respondents wanted e-prescribing to continue post-lockdown and described where things worked well and where they encountered delays in the process of acquiring prescription medication. CONCLUSIONS: E-prescribing has the potential to improve access to prescription medication and is convenient for patients. The increase in e-prescribing during lockdown highlighted how the system could be improved, through better feedback about errors, more consistency across practices and pharmacies, more proactive communication with patients, and equitable prescribing costs.

Knowledge, attitude and practices of community pharmacists regarding COVID-19: A paper-based survey in Vietnam.

OBJECTIVE: To survey the knowledge, attitude, and practices of Vietnamese pharmacists regarding the COVID-19 pandemic. METHOD: This cross-sectional, paper-based study was conducted from June to August 2020. A validated questionnaire (Cronbach's alpha = 0.84) was used to interview 1,023 pharmacists in nine provinces of Vietnam. Analysis of covariance was employed to identify factors associated with the knowledge of pharmacists. The best model was chosen by using the Bayesian Model Averaging method in R software version 4.0.4. RESULTS: The mean knowledge score was 12.02 ± 1.64 (range: 6-15), which indicated that 93.4% of pharmacists had good knowledge of COVID-19. There was no difference in the average score between males and females (p > 0.05). The multivariate linear regression model revealed that the knowledge was significantly associated with pharmacists' age, education level, and residence (p < 0.001). About attitude and practices, pharmacists daily sought and updated information on the COVID-19 pandemic through mass media and the internet (social network and online newspapers). Nearly 48% of them conceded that they communicated with customers when at least one person did not wear a face mask at the time of the COVID-19 outbreak. At medicine outlets, many measures were applied to protect pharmacists and customers, such as equipping pharmacists with face masks and hand sanitizers (95.0%), using glass shields (83.0%), and maintaining at least one-meter distance between two people (85.2%). CONCLUSION: The pharmacists' knowledge of COVID-19 transmission, symptoms, and prevention was good. Many useful measures against the spread of this perilous virus were applied in medicine outlets. However, pharmacists should restrict forgetting to wear face masks in communication with medicine purchasers. The government and health agencies should have practical remedies to reduce the significant differences in the COVID-19 knowledge of pharmacists among provinces and education-level groups.

Hydroxychloroquine availability during COVID-19 crisis and its effect on patient anxiety.

OBJECTIVE: To report the results of a survey exploring the experience of patients with SLE facing hydroxychloroquine (HCQ) shortage that occurred during the early phases of the COVID-19 pandemic. METHODS: A survey was designed by Lupus Europe's patient advisory network and distributed through its social media, newsflash and members' network. People with lupus were asked about their last HCQ purchases and their level of anxiety (on a 0-10 scale) with regard to not being able to have access to HCQ, once in April 2020 (first wave) and after 11 August (second wave). The results were compared. RESULTS: 2075 patients responded during the first wave; 1001 (48.2%) could get HCQ from the first place they asked, 230 (11.1%) could get the drug by going to more than one pharmacy, 498 (24.0%) obtained HCQ later from their usual pharmacy and 126 (6.1%) from other sources. 188 (9.1%) could not get any; 32 (1.5%) did not respond to this question. All countries showed significant improvement in HCQ availability during the second wave. 562 (27.4%) patients reported an extremely high level of anxiety in wave 1 and 162 (10.3%) patients in wave 2; 589 (28.7%) and 268 (17.1%) patients reported a high level of anxiety in wave 1 and wave 2, respectively. CONCLUSIONS: The HCQ shortage had a significant impact on patients with SLE and has been responsible for psychological consequences including anxiety. Indeed, despite an objective improvement in drug availability, the event is leaving significant traces in patients' mind and behaviours.

Time-trend analysis of medicine sales and shortages during COVID-19 outbreak: Data from community pharmacies.

BACKGROUND: COVID-19 is a worldwide public health concern. Disruptions in the drug market are expected and shortages might worsen. Community pharmacies can contribute to early identification and report of medicines' supply and demand issues. OBJECTIVE: The aim of this study is to characterize the impact of the COVID-19 outbreak on outpatient medicines' sales and shortages. METHODS: A retrospective, time-trend analysis of medicine sales, shortages and laboratory-confirmed COVID-19 cases was performed from February 1st to April 30th, 2020, and its homologous period (regarding sales only). A detailed analysis of 6 pharmaceutical substances was performed. All data were subjected to rescaling using the min-max normalization method, in order to become comparable. Data analysis was performed using Microsoft® Excel. RESULTS: The pandemic resulted in an increase in medicines' demand and reported shortages during the early stage of the outbreak. The maximum proportion of medicine sales was registered on March 13th, 2020, 4 days after the WHO declared COVID-19 a pandemic. By the end of March, sales have already dropped to proportions similar to those of 2019. The maximum proportion of drug shortages was reached about one week after the sales peak and by the end of the study period were below those recorded in the pre-COVID-19 period. The analyzed drugs were paracetamol, ascorbic acid, dapagliflozin plus metformin, rosuvastatin plus ezetimibe, formoterol, and hydroxychloroquine, as these pharmaceutical substances registered the highest growth rate in sales and shortages when compared to the same period in the previous year. Hydroxychloroquine showed the most different pattern trends on sales and shortages of these medicines. CONCLUSIONS: Pharmacies can provide timely and real-world data regarding sales and shortages. The adopted measures to guarantee the continuous supply of the medicine market seem to have worked. The long-term impacts of this pandemic are unknown and should continue to be closely monitored.

Feasibility and outcomes of a hepatitis C screening programme in community pharmacies.

AIMS: To ascertain the feasibility and outcomes of point-of-care testing for hepatitis C virus (HCV) antibodies in people with risk factors screened in community pharmacies. METHODS: Ten pharmacies in the Waitemata District Health Board piloted point-of-care antibody HCV screening with consenting participants. Individuals with a positive HCV antibody result had a confirmatory HCV RNA test performed at a local laboratory, with pharmacist follow-up to discuss the result. RNA positive individuals were referred to their general practitioner for further follow-up including antiviral therapy. Number of tests, number of positives and number treated were collected. Pharmacists completed a survey about their experiences. RESULTS: Of 192 participants, seven (3.6%) had positive tests on screening, four of whom had a positive RNA assay and received HCV medication, and one of whom had a positive RNA assay but has not yet received treatment. Two had negative RNA results. Pharmacist feedback was very positive with most wishing to continue the point-of-care testing service. Most wanted to be able to treat HCV in order to improve linkage to care. CONCLUSIONS: Pharmacy point-of-care testing with immediate results and pharmacist follow-up of positive results can aid diagnosis of HCV in at-risk populations and help treatment uptake.

An interactive website to aid young women's choice of contraception: feasibility and efficacy RCT.

BACKGROUND: Effective use of contraception can reduce numbers of unintended pregnancies, but misunderstandings and concerns about contraception abound. Increasingly, women seek health-care information online. OBJECTIVES: To develop an interactive website to aid informed choice of contraceptive method, including long-acting reversible contraception (Phase I), and test its effectiveness in a parallel, single-blind randomised trial (Phase II). Approval came from London - Camden & King's Cross Research Ethics Committee (reference 17/LO/0112). SETTING AND PARTICIPANTS: For both phases, women aged 15-30 years were recruited from general practice, sexual health services, maternity services, community pharmacies and an abortion service. DESIGN: In Phase I, we conducted three systematic literature reviews, a review of YouTube (YouTube, LLC, San Bruno, CA, USA) videos about contraception, and focus groups and interviews with young women to explore barriers to and concerns and misperceptions about contraception. We then iteratively co-designed an interactive website, Contraception Choices [URL: www.contraceptionchoices.org (accessed June 2020)], with young women and a software company. In Phase II, we evaluated the website through a randomised trial that began as a feasibility trial. Early demand for Contraception Choices stimulated a design change from a feasibility to an efficacy trial, with follow-up for clinical outcomes at 3 and 6 months. A randomisation list was incorporated into the trial software program to allocate participants to the intervention (website) or control group (standard care). INTERVENTION: Contraception Choices is a co-designed, evidence-based, interactive website to aid informed choice of contraception. It provides information about different methods, addresses common concerns and offers tailored contraceptive options in response to individual preferences. MAIN OUTCOME MEASURES: Qualitative - participant views and experience of the intervention, assessed through qualitative interviews. Quantitative primary outcomes - follow-up rate at 6 months in the initial feasibility trial, using a long-acting reversible contraception method, and satisfaction with contraceptive method at 6 months in the efficacy trial. RESULTS: A total of 927 women were randomised online to the website (n = 464) or control group (n = 463), of whom 739 (80%) provided follow-up data at 6 months [786 women (85%) provided data at 3 and/or 6 months that were included in the analysis of primary outcomes]. There was little difference between groups in the proportion using long-acting reversible contraception at 6 months [30.4% intervention vs. 31.0% control, adjusted odds ratio after imputation 0.87 (95% confidence interval 0.60 to 1.27)] or in satisfaction with contraceptive method [proportion being 'satisfied' or 'very satisfied', 82.6% intervention vs. 82.1% control, adjusted odds ratio 0.93 (95% confidence interval 0.69 to 1.25)]. Qualitative evaluation indicated highly positive views about the website and increased knowledge of contraceptive methods that could dispel misperceptions. Women appreciated having information tailored to their specific needs and felt better prepared before consultations. LIMITATIONS: We did not include intermediate measures, such as knowledge of contraceptive methods, intention to change method or confidence in discussing contraception with a health-care professional, which may have indicated other benefits of using the website. In future, the website should be studied in different settings (e.g. schools and in routine practice) to see whether or not it improves the quality or efficiency of contraceptive consultations. CONCLUSIONS: Our systematic review indicated wide-ranging influences on women's use of contraception globally. The website, Contraception Choices, was very popular with young women and contraception service providers. It was not associated with statistically significant differences in use of long-acting reversible contraception or satisfaction with contraceptive method at 6 months. TRIAL REGISTRATION: Current Controlled Trials ISRCTN13247829. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 56. See the NIHR Journals Library website for further project information.

WHAT WAS THE QUESTION?: Choosing between types of contraception can be challenging, so can a website help women make the right choice for them? WHAT DID WE DO?: We asked women what they think about contraception. We looked at other studies and YouTube (YouTube, LLC, San Bruno, CA, USA) videos. We then designed the Contraception Choices website with young women [URL: www.contraceptionchoices.org (accessed January 2020)]. The website describes each type of contraception and compares them side by side. When users answer questions about what matters to them, the website suggests three types of contraception they might like. A total of 927 women helped us test the website in an online trial. We asked everyone what contraception they were using and how satisfied they were with it 6 months later. WHAT DID WE FIND?: Women really liked the website. Ninety-seven per cent of participants found it helpful or very helpful for 'getting useful information about contraception' and 87% responded that it was helpful or very helpful for 'finding a method of contraception that is right for you'. Comments included: However, seeing the website did not mean that women used a more reliable type of contraception. Women were just as satisfied with their contraception whether or not they had seen the website. We think that this is because many other factors are involved; for example, some women found it difficult to access long-acting contraception methods from health services. WHAT DOES THIS MEAN?: Young women liked the Contraception Choices website and found it useful. Women can be put off by contraception side effects and the views of partners, friends, family and others. On its own, the Contraception Choices website was not enough to help more women use the most reliable contraception methods.

What is the attitude towards and the current practice of information exchange during self-medication counselling in German community pharmacies? An assessment through self-report and non-participant observation.

BACKGROUND: Guidelines encourage relevant information exchange between pharmaceutical staff and patients during self-medication consultation. Thereby, assessing the patient's situation and providing information is crucial for patient safety. So far, limited studies have investigated this information exchange, particularly in Germany. We aimed to assess the attitude towards and the current practice of guideline-recommended information exchange in German community pharmacies. METHODS: In total, twelve guideline-recommended parameters were predefined for gathering patient-related information and for the provision of information. These information exchange parameters were evaluated in two parts: Firstly, in a self-report of pharmaceutical staff via an online questionnaire to assess the reported importance, difficulty and frequency of the parameters as well as barriers to their implementation; secondly, in a non-participant observation in five pharmacies to evaluate the actual consultation practice. RESULTS: In the self-report, all parameters were rated by more than 76% of 1068 participants as important. 'Concurrent medication' was determined to be the most difficult parameter to address (54%). All parameters of information gathering were rated to be addressed during routine counselling by at least 70% of the respondents. Parameters of information provision were all rated to be addressed by at least 45%. 'Lack of patient's interest' was identified as the most frequent barrier to appropriate counselling (84%). During the observation, the information gathering parameters were each addressed between 8 to 63% in the consultations, parameters of information provision between 3 to 34%. CONCLUSION: Despite broad acceptance, the guideline parameters of information exchange were comparatively little addressed during the actual routine care. This might be due to a perceived 'lack of patient's interest' in counselling. Our results suggest to scrutinize whether patients are in fact not interested in counselling and to further explore how the positive intention of pharmaceutical staff towards information exchange can be further translated into everyday practice.