Racial and Ethnic Inequities in Spatial Access to Pharmacies: A Geographic Information System Analysis.

BACKGROUND: Pharmacy accessibility is crucial for equity in healthcare access because community pharmacists may reach individuals who do not have access to other healthcare providers. OBJECTIVE: To determine whether spatial access to pharmacies differs among racial/ethnic groups across the rural-urban continuum. METHODS: We obtained a 30% random sample of the Research Triangle Institute (RTI) synthetic population, sampled at the census block level. For each individual, we defined optimal pharmacy access as having a driving distance ≤2 miles to the closest pharmacy in urban counties, ≤5 miles in suburban counties, and ≤10 miles in rural counties. We used a logistic regression model to measure the association between race/ethnicity and pharmacy access, while controlling for racial/ethnic composition of the census tract, Area Deprivation Index, income, age, gender, and US region. The model included an interaction between race/ethnicity and urbanicity to evaluate whether racial/ethnic inequities differed across the rural-urban continuum. RESULTS: The sample included 90,749,446 individuals of whom 80.6% had optimal pharmacy access. Racial/ethnic inequities in pharmacy access differed across the rural-urban continuum (p-value for interaction= <0.0001). In rural areas, Black (OR 0.87; 95%CI 0.86-0.87), Hispanic (OR 0.80; 95%CI 0.79-0.80), and Indigenous (OR 0.47; 95%CI 0.47-0.48) individuals had lower odds of optimal pharmacy access, compared to White individuals. Hispanic (OR 0.96; 95%CI 0.96-0.97) and Indigenous individuals (OR 0.75; 95%CI 0.75-0.76) had lower odds of optimal pharmacy access compared to White individuals in suburban areas. In Western states, Asian had lower odds of optimal pharmacy access in suburban (OR 0.88; 95%CI 0.86-0.90) and rural areas (OR 0.91; 95%CI 0.87-0.95) compared to White Individuals. CONCLUSIONS: Racial/ethnic inequities in spatial access to community pharmacies vary between urban and rural communities. Underrepresented racial/ethnic groups have significantly lower pharmacy access in rural and some suburban areas, but not in urban areas.

Impact of pharmacist motivational interviewing on hepatitis B vaccination in adults with diabetes.

BACKGROUND: In 2011, the Advisory Committee on Immunization Practices recommended hepatitis B (HepB) vaccination for previously unvaccinated adults (aged 19-59 years) with diabetes. Despite these recommendations, vaccination coverage for HepB vaccination for persons with diabetes remains low. OBJECTIVES: The primary objective was to determine the impact of a community pharmacist-led motivational interviewing (MI) intervention on HepB vaccination initiation among adults with diabetes who were previously unvaccinated against HepB. The secondary objective was to describe HepB vaccination series completion among adults with diabetes who initiated the first dose of a HepB vaccine. METHODS: A prospective, nonrandomized, controlled cluster trial was conducted across 58 regional grocery store chain pharmacies: a total of 29 pharmacies in the MI group and 29 pharmacies in the control group. Pharmacy location-level baseline data were collected during a 12-month pre-program period. The MI program was delivered over 10 months. Alerts were generated during prescription processing throughout the study period for eligible patients at each MI pharmacy location. The MI consisted of a face-to-face conversation between the pharmacist and the patient at the time of prescription pick-up. The difference in the primary outcome of HepB vaccination series initiation between patients receiving MI and control patients was assessed using a difference-in-differences analysis. For series completion, patients who initiated the HepB vaccination series were followed up for over 12 months after their first HepB vaccine dose. RESULTS: There was a statistically significant 3.711% increase in HepB vaccination when comparing eligible individuals who received the MI intervention (n = 1569) to eligible individuals in the control group (n = 3640). Of the patients in the MI group who initiated HepB vaccination, 40 of 65 patients (61.5%) completed the vaccination series. CONCLUSION: A pharmacist-led MI intervention increased HepB vaccination rates among adult patients with diabetes. Community pharmacists can effectively provide vaccinations that require multiple doses to complete the vaccination series.

Disparities in distribution of COVID-19 vaccines across US counties: A geographic information system-based cross-sectional study.

BACKGROUND: The US Centers for Disease Control and Prevention has repeatedly called for Coronavirus Disease 2019 (COVID-19) vaccine equity. The objective our study was to measure equity in the early distribution of COVID-19 vaccines to healthcare facilities across the US. Specifically, we tested whether the likelihood of a healthcare facility administering COVID-19 vaccines in May 2021 differed by county-level racial composition and degree of urbanicity. METHODS AND FINDINGS: The outcome was whether an eligible vaccination facility actually administered COVID-19 vaccines as of May 2021, and was defined by spatially matching locations of eligible and actual COVID-19 vaccine administration locations. The outcome was regressed against county-level measures for racial/ethnic composition, urbanicity, income, social vulnerability index, COVID-19 mortality, 2020 election results, and availability of nontraditional vaccination locations using generalized estimating equations. Across the US, 61.4% of eligible healthcare facilities and 76.0% of eligible pharmacies provided COVID-19 vaccinations as of May 2021. Facilities in counties with >42.2% non-Hispanic Black population (i.e., > 95th county percentile of Black race composition) were less likely to serve as COVID-19 vaccine administration locations compared to facilities in counties with <12.5% non-Hispanic Black population (i.e., lower than US average), with OR 0.83; 95% CI, 0.70 to 0.98, p = 0.030. Location of a facility in a rural county (OR 0.82; 95% CI, 0.75 to 0.90, p < 0.001, versus metropolitan county) or in a county in the top quintile of COVID-19 mortality (OR 0.83; 95% CI, 0.75 to 0.93, p = 0.001, versus bottom 4 quintiles) was associated with decreased odds of serving as a COVID-19 vaccine administration location. There was a significant interaction of urbanicity and racial/ethnic composition: In metropolitan counties, facilities in counties with >42.2% non-Hispanic Black population (i.e., >95th county percentile of Black race composition) had 32% (95% CI 14% to 47%, p = 0.001) lower odds of serving as COVID administration facility compared to facilities in counties with below US average Black population. This association between Black composition and odds of a facility serving as vaccine administration facility was not observed in rural or suburban counties. In rural counties, facilities in counties with above US average Hispanic population had 26% (95% CI 11% to 38%, p = 0.002) lower odds of serving as vaccine administration facility compared to facilities in counties with below US average Hispanic population. This association between Hispanic ethnicity and odds of a facility serving as vaccine administration facility was not observed in metropolitan or suburban counties. Our analyses did not include nontraditional vaccination sites and are based on data as of May 2021, thus they represent the early distribution of COVID-19 vaccines. Our results based on this cross-sectional analysis may not be generalizable to later phases of the COVID-19 vaccine distribution process. CONCLUSIONS: Healthcare facilities in counties with higher Black composition, in rural areas, and in hardest-hit communities were less likely to serve as COVID-19 vaccine administration locations in May 2021. The lower uptake of COVID-19 vaccinations among minority populations and rural areas has been attributed to vaccine hesitancy; however, decreased access to vaccination sites may be an additional overlooked barrier.

OTC hearing aids: An opportunity for collaborative working relationships between pharmacists and audiologists.

In 2017, the United States Food and Drug Administration Reauthorization Act created a new category of hearing aids to be sold over the counter (OTC), disrupting how nearly 30 million persons with hearing loss will seek and purchase hearing aids. Laws and regulations do not require a medical evaluation or an appointment with an audiologist prior to purchasing OTC hearing aids. However, it is likely that patients will approach pharmacists with questions about OTC hearing aids when considering these devices available at the community pharmacy. The objective of this commentary is to discuss the opportunity for collaborative working relationships between pharmacists and audiologists in the context of OTC hearing aids. The most relevant barriers to pharmacist/audiologist collaboration are turf concerns, lack of trust, and distance between practice sites. OTC hearing aids can positively impact hearing health care across the nation with successful collaboration between the professions of pharmacy and audiology.

Access to community pharmacies: A nationwide geographic information systems cross-sectional analysis.

BACKGROUND: Pharmacy accessibility is key for the emerging role of community pharmacists as providers of patient-centered, medication management services in addition to traditional dispensing roles. OBJECTIVE: To quantify population access to community pharmacies across the United States. METHODS: We obtained addresses for pharmacy locations in the United States from the National Council for Prescription Drug Programs and geocoded each. For a 1% sample of a U.S. synthetic population, we calculated the driving distance to the closest pharmacy using ArcGIS. We estimated the proportion of population living within 1, 2, 5, and 10 miles of a community pharmacy. We quantified the role of chain vs regional franchises or independently owned pharmacies in providing access across degrees of urbanicity. RESULTS: We identified 61,715 pharmacies, including 37,954 (61.5%) chains, 23,521 (38.1%) regional franchises or independently owned pharmacies, and 240 (0.4%) government pharmacies. In large metropolitan areas, 62.8% of the pharmacies were chains; however, in rural areas, 76.5% of pharmacies were franchises or independent pharmacies. Across the overall U.S. population, 48.1% lived within 1 mile of any pharmacy, 73.1% within 2 miles, 88.9% within 5 miles, and 96.5% within 10 miles. Across the United States, 8.3% of counties had at least 50% of residents with a distance greater than 10 miles. These low-access counties were concentrated in Alaska, South Dakota, North Dakota, and Montana. CONCLUSIONS: Community pharmacies may serve as accessible locations for patient-centered, medication management services that enhance the health and wellness of communities. Although chain pharmacies represent the majority of pharmacy locations across the country, access to community pharmacies in rural areas predominantly relies on regional franchises and independently owned pharmacies.

Pharmacist competencies for over-the-counter hearing aids: A Delphi study.

BACKGROUND: The 2017 Food and Drug Administration Reauthorization Act established a new category of hearing aids to be available over the counter to increase accessibility and affordability of hearing aid devices. To prepare for increased consumer demand, pharmacists must be ready to meet the needs of the millions of adults eligible to seek over-the-counter hearing aids at the community pharmacy. To date, no organization has proposed competency statements to describe a pharmacist with the knowledge, skills, and abilities aligning with safe and effective use of over-the-counter hearing aids to be sold at community pharmacies. OBJECTIVES: The objective of this study was to establish competencies needed for pharmacists to safely and effectively assist patients seeking over-the-counter hearing aids at the community pharmacy. METHODS: The Delphi technique was selected to achieve group consensus for competency statements. The project began with a kickoff meeting in July 2019 and continued with a brainstorming round followed by 3 rounds of surveys ending in March 2020. Each survey presented competency statements for panelists to review, rate their agreement, and offer revisions. Statements that reached consensus to accept (≥80% agreement) were advanced to the final list. Statements that did not reach consensus were advanced to subsequent survey rounds. RESULTS: A total of 14 individuals representing pharmacy, audiology, hearing aid manufacturers, and persons with hearing loss participated. In total, 26 competency statements were accepted by consensus, 2 statements were rejected by consensus, and 11 statements did not reach consensus. All 26 accepted statements were mapped to the Pharmacists' Patient Care Process before final approval by the stakeholder panel. CONCLUSION: Pharmacists will likely play new interprofessional roles in the delivery of hearing health care as over-the-counter hearing aids come to market. With professional competency statements, pharmacists will have a framework for the knowledge, skills, and abilities needed to safely assist patients seeking over-the-counter hearing aids at the community pharmacy.

How community pharmacists envision using pharmacogenomic data: A qualitative analysis.

BACKGROUND: Nearly 300 medications contain pharmacogenomic information in their labeling approved by the U.S. Food and Drug Administration. As this number continues to grow, community pharmacists will be called on to use available pharmacogenomic data at the point of dispensing. OBJECTIVE: This qualitative study aimed to describe how pharmacists envision the integration of pharmacogenomic data into the current workflows of community pharmacy practice. METHODS: Community pharmacists from a regional supermarket chain pharmacy in the greater Pittsburgh area were interviewed using a semistructured interview guide. Participating pharmacists were presented with 3 clinical scenarios, followed by questions, to gain insight into how they envisioned the integration of pharmacogenomic data into community pharmacy workflow. The interview transcriptions were transcribed and coded. The content was analyzed to deduce the final themes. Supporting quotes were selected to illustrate each theme. RESULTS: Ten community pharmacists from 3 different pharmacy locations participated in the study. A thematic analysis produced 6 themes: (1) integrating pharmacogenomic data into the dispensing software, (2) receiving an alert for pharmacogenomic information within the dispensing software, (3) accessing pharmacogenomic clinical guidelines to guide drug-decision-making, (4) contacting the prescriber by adding a task to the call queue, (5) placing a mandatory counseling alert on medications that were adjusted using pharmacogenomic data, and (6) counseling the patient on the first refill of a medication that was adjusted using pharmacogenomic data. CONCLUSION: This study describes how pharmacists envisioned the integration of pharmacogenomic data into community pharmacy workflow. The participants sought the integration of pharmacogenomic data into existing dispensing software, alerts for actionable prescribing changes using patient-specific pharmacogenomic data when available, and access to clinical decision support. In addition, the participants preferred to engage prescribers and receive alerts to counsel patients at prescription pick-up. These findings are key to integrating pharmacogenomic data into community pharmacy practice.

A conceptual value-based incentivization model of adult immunization for community pharmacists.

OBJECTIVE: To design a value-based payment model to incentivize pharmacists for increased administration of influenza, herpes zoster, pertussis-containing, and pneumococcal vaccines to adults at community pharmacies. DESIGN: A modified delphi technique was used to create a concept for a value-based payment model through consensus of expert opinion. SETTING: and participants: Experts were recruited from a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution to participate in 4 electronic surveys and 1 in-person meeting. OUTCOME MEASURES: Consensus on model design by means of a modified delphi technique. RESULTS: A panel of 11 experts participated in a series of electronic surveys and 1 in-person meeting. The final value-based payment model addressed how and when pharmacists would receive an incentive for meeting specific vaccination goals. The final value-based payment model also addressed the following concepts: estimated cost avoidance, vaccine effectiveness, and community protection. A 3-tiered incentive model was agreed on by the participants to tie increased vaccination rates with increased payment. Vaccination goals for each tier were defined as the percent increase in vaccination rates from the year immediately preceding. Incentives were defined as a percentage of estimated direct medical costs avoided to be shared between the payer and pharmacy. CONCLUSION: A conceptual value-based payment model to incentivize pharmacists for increased delivery of adult vaccinations at community pharmacies was designed and agreed on by experts representing a regional supermarket pharmacy, a self-insured employer, a managed care organization, and an academic institution. Consensus was achieved by aligning the interests of both payers and pharmacies. The final model included 3 tiers of bundled incentives to reward percent increases in adult vaccination from historical baselines. This model may be used as an example for community pharmacies and health care payers to design future value-based immunization programs.

Implementation strategies from deployment of the National Diabetes Prevention Program in Pennsylvania community pharmacies.

OBJECTIVE: To identify implementation strategies used by community pharmacists when initiating the National Diabetes Prevention Program (NDPP). DESIGN: This study was a qualitative, mid-implementation study using a semi-structured interview guide. SETTING AND PARTICIPANTS: Community pharmacies in Pennsylvania that received grant funding from the Pennsylvania Pharmacists Association to begin the NDPP. OUTCOME MEASURES: A final list of implementation strategies from the Expert Recommendations for Implementing Change and corresponding action items for pharmacists to begin the NDPP in their community pharmacies. RESULTS: Twenty strategies were used by community pharmacists when implementing the NDPP. These strategies were grouped into 3 implementation phases: (1) designing the program; (2) enrolling patients; and (3) keeping patients engaged. Strategies were further organized into 8 clusters based on strategy characteristics. Pharmacists commonly noted that making classes dynamic, keeping patients engaged through interactive activities, and encouraging patients to join classes with a companion were important when implementing the NDPP. CONCLUSION: Pharmacists used an array of strategies to implement the NDPP. This comprehensive list of strategies and accompanying action items can be used by community pharmacists nationwide to facilitate the implementation of the NDPP.

Community pharmacists' educational needs for implementing clinical pharmacogenomic services.

OBJECTIVES: Pharmacist leadership and knowledge of pharmacogenomics is critical to the acceleration and enhancement of clinical pharmacogenomic services. This study aims for a qualitative description of community pharmacists' pharmacogenomic educational needs when implementing clinical pharmacogenomic services at community pharmacies. METHODS: Pharmacists practicing at Rite Aid Pharmacy locations in the Greater Pittsburgh Area were recruited to participate in this qualitative analysis. Pharmacists from pharmacy locations offering pharmacogenomic testing and robust patient care services were eligible to participate in a semistructured, audio-recorded interview. The semistructured interview covered 4 domains crafted by the investigative team: (1) previous knowledge of pharmacogenomics; (2) implementation resources; (3) workflow adaptation; and (4) learning preferences. Interviews were transcribed verbatim and independently coded by 2 researchers. A thematic analysis by the investigative team followed. Supporting quotes were selected to illustrate each theme. RESULTS: Eleven pharmacists from 9 unique pharmacy locations participated in this study. The average length of practice as a community pharmacist was 12 years (range, 1.5-31 years). Pharmacist's pharmacogenomic educational needs were categorized into 5 key themes: (1) enriched pharmacogenomic education and training; (2) active learning to build confidence in using pharmacogenomic data in practice; (3) robust and reputable clinical resources to effectively implement pharmacogenomic services; (4) team-based approach throughout implementation; (5) readily accessible network of pharmacogenomic experts. CONCLUSION: This study describes the educational needs and preferences of community pharmacists for the successful provision of clinical pharmacogenomic services in community pharmacies. Pharmacists recognized their needs for enriched knowledge and instruction, practice applying pharmacogenomic principles with team-based approaches, robust clinical resources, and access to pharmacogenomic experts. This deeper understanding of pharmacist needs for pharmacogenomic education could help to accelerate and enhance the clinical implementation of pharmacogenomic services led by community pharmacists.

Implementation of comprehensive medication management at supermarket pharmacies in a pharmacy network.

OBJECTIVE: To garner experience with the early implementation of pharmacist-provided comprehensive medication management at a regional supermarket pharmacy during the initial launch of a statewide community pharmacy enhanced services network payer contract. METHODS: A series of key informant interviews were conducted with pharmacists at Giant Eagle Pharmacy locations in Pennsylvania. To be eligible to participate, pharmacists must have been trained by the Pennsylvania Pharmacists Care Network to deliver contracted comprehensive medication management services and willing to participate in audio recorded, telephonic interviews every 2 weeks. Interviews concluded when each pharmacist completed a total of 6 interviews or when the project period ended. A semistructured interview guide was developed by the investigators to elicit the pharmacists' experience providing contracted services. Interviews were transcribed and coded by 2 independent investigators. Coding discrepancies were resolved. The final coded transcripts were presented back to the project team to identify and finalize major themes. Illustrative quotes were selected to represent each theme. RESULTS: Interviews from 10 pharmacists were included in the analysis. Five themes emerged as keys of successful early implementation: (1) promote commitment of the pharmacy team, (2) use effective whole-team patient engagement strategies, (3) personalize patient encounters by providing patient-centered care and practicing interpersonal skills, (4) make workflow and staffing resources easily accessible, and (5) make clinical patient care tools readily available. CONCLUSION: These results highlight thematic trends for how pharmacists can successfully engage their patients in contracted comprehensive medication management services. Understanding the success of early implementation at a regional supermarket pharmacy can serve as a framework for other participants in community pharmacy enhanced services networks to replicate and scale contracted patient care services.

Facilitating pandemic influenza vaccination implementation in grocery store chain community pharmacies.

OBJECTIVE: The objective of this study was to determine strategies to implement influenza pandemic vaccinations effectively at grocery store chain community pharmacies. METHODS: Clinical pharmacy coordinators and pharmacy managers representing 3 grocery store chain community pharmacies across Pennsylvania were identified for participation in semistructured telephone interviews. Interviews were audio-recorded and transcribed. Transcripts were independently coded by 2 investigators and coding discrepancies were resolved. A thematic analysis was conducted, and supporting quotes were selected for each theme. RESULTS: Twelve pharmacists participated in the interviews, which were conducted from September 2016 to November 2017. Five key themes were identified: (1) mobilize pharmacy staff members to specific locations to prepare for a high volume of vaccinations; (2) implement vaccination clinics during high-volume scenarios; (3) utilize nonpharmacy spaces to increase vaccination capabilities; (4) determine vaccine distribution by highest risk populations that each pharmacy serves; and (5) conduct training customized to the pharmacy chain that supplements national pandemic influenza training. CONCLUSION: Grocery store chain community pharmacies are desirable sites for pandemic vaccination because of a variety of factors, such as space and staffing flexibility. Developing a pandemic vaccination plan will enable community pharmacists to contribute more effectively during influenza pandemics.

First Experiences with Over-the-Counter Hearing Aids for Mild-to-Moderate Hearing Loss: A Case Report.

This patient case report describes a first experience in late 2022 and early 2023 with over-the-counter (OTC) hearing aids for a 71-year-old male with self-perceived, age-related hearing loss. The patient reported no "red flag" medical conditions that would preclude him from safely using an OTC hearing aid device. After also meeting inclusionary criteria required to be printed on the device label, the patient was offered FDA registered OTC hearing aids. The first device pair was returned due to malfunction. The second device pair was an in-the-canal style, black in color, and powered by disposable batteries. He required help setting up the device from his spouse, an audiologist, and a pharmacist. Improved scores on the Self-Assessment of Communication and Significant Other Assessment of Communication were noted from the patient and his spouse. The patient continued to use the second device pair for 6 months after first use with no additional help. Our experience supports the pharmacist's role in identifying appropriate candidates for OTC hearing aids, helping patients select a device, and supporting device setup and self-fitting processes at community pharmacies. Further experiences are needed to demonstrate how pharmacists can support OTC hearing aid purchases at community pharmacies.

Racial disparities in access to health care infrastructure across US counties: A geographic information systems analysis.

Infrastructure system in the U.S. have been shown to be linked to social and health inequities. We calculated driving distance to the closest health care facility for a representative sample of the U.S. population using ArcGIS Network Analyst and a national transportation dataset, and identified areas where Black residents have a longer driving distance to the closest facility than White residents. Our data demonstrated that racial disparities in access to health care facilities presented large geographic variation. Counties with significant racial disparities were concentrated in the Southeast and did not correspond to counties with a greater proportion of the overall population >5 miles to the closest facility, which were concentrated in the Midwest. This geographic variation demonstrates the need to adopt a spatially explicit data driven approach in the design of equitable health care facility establishment that address the specific limitations of the local infrastructure.