Preconception health status and associated disparities among rural, Midwestern women in the United States.

BACKGROUND: Little is known about the preconception/interconception health and behaviors of reproductive-age women in the rural Midwest of the United States. The purpose of this study was to quantify preconception/interconception health status and to identify disparities compared with statewide estimates. METHODS: In this cross-sectional study, we collected data on 12 health conditions and behaviors that are risk factors for adverse maternal and infant health outcomes from nonpregnant women ages 18-45 years in rural northwestern Ohio. Statistical tests were used to identify associations between selected demographic characteristics and a subset of eight high-priority health measures (smoking, diabetes, heavy alcohol use, folic acid intake, normal weight, sufficient physical activity, and effective contraception use); all but physical activity could be compared with Ohio estimates derived from the Behavioral Risk Factor Surveillance System and Ohio Pregnancy Assessment Survey. RESULTS: Three hundred-fifteen women participated, with 98.4% reporting at least one high-priority risk factor. Statistically significant differences were identified among subpopulations related to smoking, folic acid, normal weight, sufficient physical activity, and effective contraception use. In addition, the proportion of participants reporting hypertension (P < 0.001), smoking (P < 0.001), abnormal weight (P = 0.002), and lack of daily folic acid intake (P = 0.006) were statistically significantly higher than expected based on statewide estimates. CONCLUSIONS: Women in the rural Midwest of the United States are at risk for poor health and pregnancy outcomes. Statewide estimates tracking preconception/interconception health status may obscure variation for at-risk groups, particularly in rural or underserved areas. These findings illustrate the need for interventions to advance preconception/interconception health and improve methods to capture and analyze data for rural women.

Pharmacists' perception of climate change and its impact on health.

OBJECTIVES: This study's primary objective was to assess pharmacists' knowledge and beliefs regarding climate change and health. Secondary objectives included assessing perceptions of its relevance to pharmacists and pharmacy practice as well as potential roles in mitigating climate change. METHODS: An 18-question, anonymous survey was developed using questions adapted from previously published surveys that evaluated the general public's views of international issues and health professionals' perceptions of climate change and health, with additions specific to the Midwestern United States and Ohio. It was sent electronically to a random sample of 500 registered pharmacists living and working in Ohio. Data were analyzed using descriptive and nonparametric statistics. RESULTS: Seventy pharmacists participated in the study. The majority of respondents (78.3%) believed climate change is happening. More respondents recognized climate change to be a great or moderate threat to human health worldwide (72.7%) than to patients in their community (45.4%; P < .001). A little more than half (54.5%) thought climate change was relevant to pharmacy practice. Perceived barriers that reduced willingness to communicate with the public about this topic included lack of time (73.4%) or knowledge (49.2%) and feeling that it would not make a difference (46.1%) or it is too controversial (35.4%). Respondents believed pharmacists could have the greatest impact through increasing sustainability in the health care system (48.5%). CONCLUSION: Most respondents recognized that climate change is happening, is a threat to human health worldwide, and is relevant to pharmacy. However, many did not recognize its potential impact on their own patients or their role in climate action, showing a need for more education on this topic. As these are the first data collected among pharmacists in the United States, additional studies should be performed in other parts of the country as opinions may vary based on personal experience with or exposure to impacts of climate change.

Food for thought: Can community pharmacists help patients living in food deserts?

BACKGROUND: Community pharmacists can play an important role in helping patients who live in food deserts through screening, adjusting therapeutic recommendations and counseling practices, and making referrals to community resources. However, literature regarding community pharmacists' knowledge, practices, and attitudes regarding food deserts is scant. OBJECTIVES: The primary objective of this study was to assess Ohio community pharmacists' knowledge regarding food deserts. Secondary objectives included determining their attitudes, practices, and perceived barriers related to this topic. METHODS: An anonymous 26-question survey was created and distributed to a random sample of 500 licensed community pharmacists in Ohio. Participants were granted 3 weeks to complete the survey and were offered a link to free Accreditation Council for Pharmacy Education-approved continuing pharmacy education as an incentive. The survey was deemed exempt by the Institutional Review Board. RESULTS: The survey was successfully delivered to 491 pharmacists; 72 participated (14.7% response rate). About 43% of respondents were familiar with the term "food desert," and less than one-third (31.9%) reported being aware of community resources. Of those who thought that some of their patients lived in food deserts, the majority indicated that they did not consider it in patient interactions (65.1%) and "never" adjusted their counseling practices (65.1%). Barriers that prevented them from referring patients included lack of knowledge and confidence as well as workflow constraints. About 68% of respondents somewhat or strongly agreed that pharmacists could help patients living in food deserts, and 65.3% were interested in learning more information about food deserts. CONCLUSION: Deficiencies in knowledge regarding food deserts and available resources were found among Ohio community pharmacists, but they showed interest in learning more information. Efforts should be made to educate community pharmacists about food deserts and to determine how to optimize their ability to assist patients as needed.

Routine Healthcare Utilization Among Reproductive-Age Women Residing in a Rural Maternity Care Desert.

It is important that women of reproductive age have access to and use routine health services to improve birth outcomes. While it is estimated that more than 5 million women in over 1000 counties across the United States live in maternity care deserts, to date there have been no published studies characterizing access and barriers to routine healthcare utilization in these areas. Therefore, a cross-sectional study was conducted in a rural county in northwest Ohio with 315 women ages 18-45 years. Health insurance coverage, usual source of care, length of time since routine check-up, and barriers to receipt of health services were assessed via a self-reported, anonymous survey. Over one-tenth (11.3%) of participants reported having no health insurance coverage. A total of 14.4% reported having no usual source of care and 22.8% reported not having a routine check-up in the past year. Just over one-half (53.0%) of participants reported having at least one barrier to accessing health care. In a logistic regression analysis, having a routine check-up in the past year was inversely associated with number of barriers (OR 0.73, 95% CI 0.56-0.95; p = 0.019); women who reported more barriers were less likely to report receipt of preventive care in the past year. The results of this study reveal that many reproductive-age women living in a maternity care desert face challenges in accessing health services. Policies and programs need to be developed and implemented to close these gaps and maximize opportunities for optimal health.

Retrospective evaluation of preconception care opportunities in a chain community pharmacy setting.

OBJECTIVES: Certain prescription medications should be avoided during pregnancy to reduce the risk of fetal harm. Identification of these medications to minimize exposure may be achieved through the integration of preconception care recommendations into medication therapy management (MTM) services. The primary objective of this study was to identify missed opportunities for pharmacists to provide preconception care support related to medications associated with adverse pregnancy outcomes for reproductive-aged women who received MTM consultations at a regional supermarket pharmacy chain. Secondary objectives examined the concurrent use of prenatal vitamins, folic acid, or hormonal contraception in patients receiving medications associated with adverse pregnancy outcomes. METHODS: The study examined all MTM and prescription drug claims submitted by a regional chain of supermarket pharmacies from January 1, 2018 to June 30, 2019, to identify female patients aged 15-45 years who received MTM services. Prescription claims were cross-referenced to determine which of these patients also received medications associated with adverse pregnancy outcomes. To identify patients with long-term use of opioids and nonsteroidal anti-inflammatory drugs, a restriction based on days supplied was then applied. RESULTS: Of the 2020 female patients who received MTM services and filled at least 1 prescription during the study period, 731 (36.2%) were found to have received at least 1 medication associated with adverse pregnancy outcomes for the minimal days' threshold. Of these, 509 (69.6%) lacked evidence of concurrent prescription contraception, and 74 (10.1%) had a concurrent prescription for folic acid or prenatal vitamins. CONCLUSION: The use of medications associated with adverse pregnancy outcomes was widespread in this sample of reproductive-aged women. The findings of this study indicate the need for additional research to investigate the implementation of targeted MTM interventions to build standard workflow processes and facilitate pharmacists' management of this critical clinical issue.

The critical need for clinical decision support systems for identification and management of teratogenic medications.

OBJECTIVES: To describe the critical need for clinical decision support systems to identify and manage use of potentially teratogenic medications in women of reproductive potential in the United States. DATA SOURCES: Medline, CINAHL Plus, Academic Search Complete, International Pharmaceutical Abstracts, and the Cochrane Library databases were searched on November 1, 2018, with the key words (teratogen* OR birth defect OR Category D OR Category X OR (pregnancy or pregnant)) AND (clinical decision support OR decision support OR electronic record) to identify primary literature published in peer-reviewed journals describing clinical decision support systems implemented in outpatient settings in the United States to promote safe prescribing and clinician counseling for teratogenic medications. A hand search of the reference lists of relevant articles, including review articles, found through this search strategy was also performed. SUMMARY: Despite the great potential for clinical decision support to assist clinicians in minimizing inadvertent fetal exposure to potentially teratogenic medications, there were only seven primary articles meeting the criteria. The results of these studies have shown some evidence of effectiveness yet had several notable limitations. No published clinical decision system showed great success. An eighth article, published in 2017, details the design of an intervention that had been implemented but not yet evaluated. CONCLUSION: There is a relative paucity of data regarding clinical decision support systems focused on teratogenic medications in the outpatient setting in the United States. Additional clinical decision support systems in this area need to be developed.

Pharmacists' attitudes regarding provision of sexual and reproductive health services.

OBJECTIVES: The primary objective was to assess attitudes from Ohio pharmacists about contraceptive authority. Secondary objectives included determining pharmacists' perceptions of benefits, barriers, and preparedness for offering such services and examining attitudes about and experiences with other reproductive health topics to inform future research. METHODS: An anonymous 26-question Institutional Review Board-approved electronic survey was developed and distributed via Qualtrics to a random sample of 500 licensed pharmacists in Ohio. Two months were allotted for survey completion. A link to free Accreditation Council for Pharmacy Education-approved continuing pharmacy education (CPE) through Ohio Northern University was offered as an incentive for completing the survey. RESULTS: One hundred thirty-eight pharmacists completed the survey (62% female). Fifty-eight percent worked in community pharmacy and 34% in health-system pharmacy. The majority indicated that oral and transdermal contraceptive methods should be pharmacist-initiated (57% and 54%, respectively) through a collaborative practice agreement or statewide protocol. More pharmacists supported provision of hormonal contraception through a collaborative practice agreement rather than a statewide protocol. Increased access to care and convenience for patients were identified most frequently as potential benefits. Time constraints, concerns of increased liability, and other barriers for initiating such services were identified by pharmacists. Pharmacists most frequently listed clinical guidelines, CPE, and patient education materials as tools needed to successfully initiate contraceptive therapy regimens. Pharmacists responding to the survey were also proponents of increasing involvement in other aspects of sexual and reproductive health, such as expedited partner therapy (64%) and human papilloma virus vaccination (67%). Respondents indicated a potential lack of experience or training in topics such as expedited partner therapy and intimate partner violence. CONCLUSION: Pharmacists surveyed showed interest in providing sexual and reproductive health services, including pharmacist-provided prescription contraceptive products and preventive health services. Further studies are needed to evaluate pharmacists' roles in other sexual and reproductive health services.

Use of targeted medication reviews to deliver preconception care: A demonstration project.

OBJECTIVES: To demonstrate the ability of a statewide network of community pharmacists to provide preconception care services with the use of targeted medication reviews (TMRs). Community pharmacists are well qualified and well positioned to assist in this public health priority; however, there are no documented case studies of pharmacists providing preconception care with the use of TMRs. METHODS: Through the demonstration project, pharmacists provided educational TMRs focused on 3 elements of preconception care to women aged 15 to 45 years enrolled in a nonprofit managed care plan: (1) medications that may cause fetal harm (category D/X); (2) folic acid use; and (3) immunizations. TMRs were generated and released to the individual pharmacy where that patient had prescriptions filled. Any practicing pharmacist in Ohio participating in the medication therapy management platform with a patient in the sample received a TMR notification. The pharmacists documented and billed for the service through this commercially available platform. RESULTS: Nineteen weeks after implementation of the TMRs, 1149 individual pharmacists from 818 different pharmacies had completed at least 1 TMR. Pharmacists completed 33% of all TMR opportunities with a 65% success rate. CONCLUSION: Establishing new services that were focused on preconception care resulted in rapid integration into existing medication therapy management processes in hundreds of pharmacies across Ohio. These results may help to provide justification for additional payers to reimburse for similar services. Through demonstrating the impact on preconception care, the role of the community pharmacist may continue to expand to include provision of additional preventive care services following the model developed in this initiative.

Provision of Clinical Preventive Services by Community Pharmacists.

Community pharmacists are highly accessible health care professionals, providing opportunities for partnerships with other health care and public health professionals to expand the population's access to clinical preventive services. To document examples of the community pharmacist's role in providing clinical preventive services to the general population, we conducted PubMed searches using the key word "community pharmacy" and key words from the US Preventive Services Task Force recommendations rated A or B. We present 4 descriptive summaries of clinical preventive services that can be offered by community pharmacists. Community pharmacists can provide clinical preventive services such as providing education, conducting screenings, and making referrals to improve population health.

Preventing infant mortality: Pharmacists' call to action.

OBJECTIVE: To highlight ways in which pharmacists can influence the infant mortality rate. SUMMARY: The infant mortality rate in the United States is higher than in many other industrialized nations. Because pharmacists are accessible and knowledgeable health care professionals, there are multiple opportunities for pharmacist intervention from the preconception to the postpartum periods that can affect the leading causes of infant death. Specifically, areas of focus for pharmacists' direct patient care activities can include family planning, substance use, folic acid, drug information, maternal disease management, maternal medication management, infant medication management, safe sleep, breastfeeding, and vaccines. In addition, there are opportunities for pharmacists to influence infant mortality through clinical-community linkages, research, and advocacy. CONCLUSIONS: Through clinical-community linkages and direct patient care, pharmacists can work toward reducing infant mortality in their communities.

Pharmacy Interns' Perception of Climate Change and Its Impact on Health.

Background: The effects of climate change are major threats to health and well-being. While the profession of pharmacy can make a difference through patient care activities, sustainability, and advocacy, literature detailing U.S. pharmacist and student pharmacist views on this topic is scant. Objectives: To assess Ohio pharmacy interns' knowledge and beliefs regarding climate change and human health as well as its relevance to pharmacy practice and education, and to compare and contrast their perceptions with those of Ohio pharmacists previously surveyed. Methods: An anonymous 31-item electronic survey was emailed to a random sample of 500 pharmacy interns registered in Ohio with questions regarding climate change and health, climate change policy, potential roles for pharmacists and pharmacy interns, pharmacy education, and demographics. Data were analyzed using descriptive and nonparametric statistics, and responses collected from this study were compared with those from the Ohio pharmacist study conducted the previous year. Results: Ninety-two interns completed the survey. The majority of respondents thought climate change is happening (87%), will harm human health in their community (68%), and is relevant to pharmacists or pharmacy practice (62%). Compared to registered pharmacists, pharmacy interns more often acknowledged these statements and more often identified roles in climate action. Sixty-two percent somewhat or strongly agreed that there should be more education about climate change and health in the pharmacy curriculum. Conclusion: The majority of Ohio pharmacy interns participating in this survey recognized the impact of climate change on health, believed they have roles in mitigating its effects, and wanted to learn more about it. As these are the first data assessing U.S. pharmacy interns' perceptions of this topic, additional studies should be performed in other parts of the country. Increased education among student pharmacists may help propel the pharmacy profession to take the lead in climate action and sustainability.

Healthy People and Interested Students: Medical and Pharmacy Students' Knowledge and Attitudes Regarding Public Health.

Little is known about health professions students' awareness and attitudes regarding public health in the United States. Therefore, the purpose of this study was to assess medical and pharmacy students' knowledge and interest in the Healthy People initiative as well as perceptions of public health content in their curricula. An electronic survey was distributed in March 2021 in seven schools across Ohio; participation was incentivized through a USD 5 donation to the Ohio Association of Foodbanks to aid in COVID-19 relief efforts (maximum USD 1000) for each completed survey. A total of 182 medical students and 233 pharmacy students participated (12% response rate). Less than one-third of respondents reported familiarity with Healthy People and correctly identified the latest edition. However, nearly all respondents agreed public health initiatives are valuable to the American healthcare system. Almost all students expressed a desire to practice interprofessionally to attain public health goals. Both medical and pharmacy students recognized core public health topics in their curricula, and nearly 90% wanted more information. These findings indicate that the majority of medical and pharmacy students in Ohio believe public health initiatives to be important, yet knowledge gaps exist regarding Healthy People. This information can guide curricular efforts and inform future studies of health professions students.

Using a mock board of pharmacy disciplinary hearing to teach concepts related to administrative law, addiction, empathy, and professionalism.

BACKGROUND AND PURPOSE: The purpose of this project was to impact pharmacy students' personal and professional development through simulation of a board of pharmacy disciplinary hearing regarding addiction. EDUCATIONAL ACTIVITY AND SETTING: The mock board hearing was conducted as part of the required curriculum. Faculty obtained materials from a prior board hearing. The actual respondent, lawyer, former executive director, and a board agent participated. Students served as board members and president, asked questions of the witnesses, and deliberated per board procedure. After the event, student learning and perceptions were assessed through knowledge-based, opinion-based questions, and open-ended questions. FINDINGS: Of the 141 students who attended the event, 97% completed the assessment. The average score on the knowledge-based questions was 95%. Ratings of perceptions and reflections of the experience were used in tandem to understand the experience. In general, students indicated the experience was positive and impactful towards their education. Students indicated they felt that the experience allowed them to better understand addiction and empathize with someone called before the board. In fact, there were fundamental differences in perceptions regarding the "addicted person," going from a penalizing and stigmatized perspective to one of caring and compassion. SUMMARY: Students were knowledgeable about the board and its regulatory process after the event. More than knowledge, students indicated fundamental changes in their views of addiction. Other institutions may consider implementing similar exercises to engender empathy and professionalism regarding drug addiction and regulatory compliance.

Partners in Public Health: Public Health Collaborations With Schools of Pharmacy, 2015.

To collect data on public health collaborations with schools of pharmacy, we sent a short electronic survey to accredited and preaccredited pharmacy programs in 2015. We categorized public health collaborations as working or partnering with local and/or state public health departments, local and/or state public health organizations, academic schools or programs of public health, and other public health collaborations. Of 134 schools, 65 responded (49% response rate). Forty-six (71%) responding institutions indicated collaborations with local and/or state public health departments, 34 (52%) with schools or programs of public health, and 24 (37%) with local and/or state public health organizations. Common themes of collaborations included educational programs, community outreach, research, and teaching in areas such as tobacco control, emergency preparedness, chronic disease, drug abuse, immunizations, and medication therapy management. Interdisciplinary public health collaborations with schools of pharmacy provide additional resources for ensuring the health of communities and expose student pharmacists to opportunities to use their training and abilities to affect public health. Examples of these partnerships may stimulate additional ideas for possible collaborations between public health organizations and schools of pharmacy.

Fulfilling an Unmet Need: Roles for Clinical Pharmacists in Preconception Care.

Preconception care refers to a set of interventions that identify and address biomedical, behavioral, and social risks to a woman's health that may negatively impact a future pregnancy. A great need for preconception care currently exists in the United States, and women's attitudes about discussions with health care providers about healthy and safe pregnancies are positive. Clinical pharmacists are well positioned to work with other health care and public health professionals to ensure that all women of childbearing potential have access to preconception care. As part of the collaborative health care team, clinical pharmacists can directly provide services or support and referrals to other members of the health care team or to community resources through clinical-community linkages. Specifically, clinical pharmacists can provide education, counseling, and/or services to women to address family planning, medication and disease state management, immunizations, screenings, health promotion, and substance use. Clinical pharmacists can also impact preconception care through drug information services, advocacy, and research. Preconception care services can be incorporated into daily pharmacy practice, and there are potential means for reimbursement. Multiple roles exist for clinical pharmacists to fulfill unmet needs in preconception care.

Global Health Education in Doctor of Pharmacy Programs.

The objective of this Review is to characterize content related to global health in didactic and experiential curricula of doctor of pharmacy (PharmD) programs in the United States. The review was completed through a systematic website search of 133 US PharmD programs accredited or currently in the process of obtaining accreditation to identify global health dual degrees, minors/concentrations, required and elective courses, and experiential opportunities. Programs' course catalogs were referenced as needed to find more specific course listings/descriptions. More than 50 programs offered an elective course related to global health; eight had a required course; eight offered a minor or certification for global health; three offered dual degrees in pharmacy and global health. Fourteen institutions had a center for global health studies on campus. More than 50 programs offered experiential education opportunities in global health including international advanced pharmacy practice experiences or medical mission trips. Inclusion of and focus on global health-related topics in US PharmD programs was widely varied.