We can do more than just sell the test: pharmacist perspectives about over-the-counter rapid HIV tests.

Pharmacist attitudes about the over-the-counter (OTC) sale of HIV rapid tests in pharmacies were explored through interviews conducted among 17 licensed community pharmacists in a Midwestern, moderate HIV incidence state between May and September 2012. Participants recognized that OTC rapid HIV tests would increase the number of people aware of their HIV status. Concerns included linkage to care and results consultation for those who test HIV-positive. Point of sale was identified as an opportunity for consultation about the test and to establish a relationship for future discussion about results and linkage to care. Pharmacists could provide initial test consultation or information, and consultation about the test results in order to provide post diagnosis support and facilitate linkage to care.

Pharmacists' perspectives on HIV testing in community pharmacies.

OBJECTIVE: To assess the feasibility, readiness, and acceptability of offering rapid human immunodeficiency virus (HIV) testing in community pharmacies. DESIGN: Qualitative study. SETTING: Community pharmacies in Indiana from May to September 2012. PARTICIPANTS: 17 licensed community pharmacists. INTERVENTION: Semistructured interviews among a convenience sample of community pharmacists. MAIN OUTCOME MEASURES: Community pharmacists' self-reported attitudes toward rapid HIV testing in community pharmacies, perceptions of peer acceptability, and opinions about readiness for implementation of the practice in community pharmacies. RESULTS: Participants accepted the idea of pharmacy-based HIV testing, describing it as accessible, convenient, and nonstigmatizing. Acceptability was closely linked to positive patient relationships and pharmacist comfort with consultation. Identified challenges to pharmacy-based HIV testing included staffing issues, uneasiness with delivering positive test results, lack of information needed to link patients to care, insufficient consulting space, and need for additional training. Participants indicated that peer beliefs about the acceptability of pharmacist-based HIV testing would vary but that more recently trained pharmacists likely would be more accepting of the practice. CONCLUSION: Most participants felt that offering HIV testing was a reasonable addition to the evolving role of the community pharmacist, pending resolution of personal and institutional barriers.

Association of antipsychotic use with hospital events and mortality among medicare beneficiaries residing in long-term care facilities.

OBJECTIVE: Antipsychotic (AP) utilization has grown significantly in long-term care (LTC) settings. Although a growing literature associates AP use with higher mortality in elderly with dementia, the association of APs with hospital events is unclear. The authors examine prevalence and trends in AP use by Medicare beneficiaries residing in LTC and the association of APs and other drug use variables with hospital events and mortality. DESIGN: Retrospective analysis using sequential multivariate Cox proportional hazards models. SETTING: Medicare Current Beneficiary Survey linked to Institutional Drug Administration and Minimum Data Set files. PARTICIPANTS: A total of 2,363 LTC Medicare beneficiaries, 1999-2002. MEASUREMENTS: Trends in LTC AP use overall and by type and duplicative use; association of AP utilization and two outcomes: hospital events and all-cause mortality. RESULTS: AP use rose markedly from 1999 to 2002 (26.4%-35.9%), predominantly due to increased use of atypical agents. After controlling for sociodemographic and clinical factors, AP use is not related to hospital events (hazard ratio [HR] = 0.98, 95% confidence interval [CI] = 0.82-1.63 p = 0.7951). AP use is associated with reduced mortality in unadjusted and intermediate models, but loss of significance in the final model (HR = 0.83, 95% CI = 0.69-1.00, p = 0.0537) suggests that disease and drug burden factors may confound the AP-mortality relationship. CONCLUSION: This study provides no evidence of increased hospital events or mortality in LTC residents who use AP medications. Findings contribute to a growing body of evidence that APs, particularly atypical agents, may be associated with reduced mortality in LTC residents.

Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries.

OBJECTIVES: Numerous studies have documented disparities in health care utilization between non-Hispanic White and minority elders. We investigated differences in anti-dementia medication use between non-Hispanic White and minority community-dwelling Medicare beneficiaries with dementia. METHODS: Using multivariate analysis with generalized estimating equations, we estimated prevalence ratios (PRs) for anti-dementia medication use by race/ethnicity for 1,120 beneficiaries with dementia from years 2001 through 2003 of the Medicare Current Beneficiary Survey. RESULTS: After adjusting for demographics, socioeconomics, health care access and utilization, comorbidities, and service year, we found that anti-dementia medication use was approximately 30% higher among non-Hispanic Whites compared to other racial/ethnic groups (PR=0.73, 95% confidence interval [CI]=0.59, 0.91). As for individual racial/ethnic groups, prevalence disparities remained significant for non-Hispanic Blacks (PR=0.75, 95% CI=0.57, 0.99) and non-Hispanic others (PR=0.50, 95% CI=0.26, 0.96) but were attenuated for Hispanics (PR=0.84, 95% CI=0.59, 1.20). DISCUSSION: Results provide evidence that racial/ethnic disparities in utilization of drugs used to treat dementia exist and are not accounted for by differences in demographic, economic, health status, or health utilization factors. Findings provide a foundation for further research that should use larger numbers of minority patients and consider dementia type and severity, access to specialty dementia care, and cultural factors.

Complementary and alternative medicine use among older urban African Americans: individual and neighborhood associations.

PURPOSE: Older African Americans may be vulnerable to risks due to impaired healthcare access and understudied complementary and alternative medicine (CAM) use and other traditions. We describe CAM use among older African Americans in Baltimore, MD, examining associations among CAM and sociodemographic, health status, healthcare utilization and neighborhood factors. METHODS: Cross-sectional telephone survey of 95 African Americans ages > or =60 on use of CAM modalities (herb/home remedies, prayer, group spiritual practices, meditation/visualization, massage, chiropractic, acupuncture, relaxation/biofeedback) in prior year. RESULTS: A large majority (88.4%) reported CAM use in the previous year: 50.5% reported CAM use excluding individual prayer. The most commonly reported modalities were individual prayer (96.8%), herbs/home remedies (29.5%) and group spiritual practices (17.0%). Most (77.3%) herbal/home remedy users disclosed use to providers. In multivariable logistic regression at the individual level, CAM was associated with higher number of comorbidities (OR = 1.24, 95% CI: 1.06-1.45), older age (OR = 1.09, 95% CI: 1.01-1.17) and more years of education (OR = 1.24, 95% CI: 1.03-1.49). Adding neighborhood variables attenuated effects of comorbidity (OR = 1.17, 95% CI: 0.99-1.39); residence in more racially integrated neighborhoods (OR = 1.03, 95% CI: 1.00-1.06; p = 0.047) was also important. CONCLUSIONS: CAM use was greater than expected. Although disclosure of herb use was high, providers should probe for CAM use.

Factors Associated With Adherence to Statin Medications of Patients Enrolled in a Self-insured University Health Plan.

PURPOSE: The purpose of this study was to examine the association of patient and prescription factors with statin adherence of patients enrolled a self-insured university health plan. METHODS: We conducted a retrospective, longitudinal analysis of pharmacy claims data from a self-insured university for those enrollees prescribed a statin during a 38-month period (2009-2012). Adherence was calculated as the portion of days covered and was defined as portion of days covered ≥80%. To be included in the study, patients had to have ≥2 statin claims and be continuously enrolled in the plan. A logistic regression model was constructed to identify longitudinal predictors of adherence. In addition, a Cox proportional hazards model was run to examine predictors of adherence during 1year of statin therapy. FINDINGS: There were 222 patients in the study. These 222 patients generated a total of 3,349 statin claims. With a mean (SD) observation period of 970 (346.5) days, those patients taking statin medications had a mean adherence rate of 54.5%. Adherent and nonadherent patients were similar regardless of statin switching and inferred household income. However, those patients with greater adherence levels were older, more likely to be male, had previous statin exposure, paid higher mean copayments, and were more likely to use mail order as their delivery channel. In logistic regression, older age (odds ratio [OR] = 1.07, P = 0.001), male sex (OR = 1.79, P = 0.047), and the use of mail order (OR = 3.07, P = 0.002) were significantly associated with adherence. Of the original 222 patients, 200 patients completed 1 full year of therapy. In a subsequent Cox proportional hazards analysis, the retail delivery channel (hazard ratio = 1.904, P = 0.025) was associated with higher risk for nonadherence during a 1-year period. IMPLICATIONS: Despite the benefits associated with statin medications, adherence remains a challenge for certain groups of patients, including patients who are female, younger patients, and patients who use retail pharmacies (vs mail order) when filling their prescriptions. Health care professionals and employers, especially those employers who are self-insured, would be well served in developing adherence interventions aimed at these specific populations.

Predicting pharmacy syringe sales to people who inject drugs: Policy, practice and perceptions.

BACKGROUND: Pharmacies have much to contribute to the health of people who inject drugs (PWID) and to community efforts in HIV and hepatitis C (HCV) prevention through syringe access. However, little is known about what predicts pharmacy syringe sales without a prescription. OBJECTIVE: To identify factors predicting pharmacy syringes sales to PWID. METHODS: A hybrid staggered online survey of 298 Indiana community pharmacists occurred from July-September 2016 measuring pharmacy policy, practice, and pharmacist perceptions about syringe sales to PWID. Separate bivariate logistical regressions were followed by multivariable logistic regression to predict pharmacy syringe sales and pharmacist comfort dispensing syringes to PWID. RESULTS: Half (50.5%) of Indiana pharmacies sold syringes without a prescription to PWID. Pharmacy syringe sales was strongly associated with pharmacist supportive beliefs about syringe access by PWID and their comfort level selling syringes to PWID. Notably, pharmacies located in communities with high rates of opioid overdose mortality were 56% less likely to sell syringes without a prescription than those in communities with lower rates. Pharmacist comfort dispensing syringes was associated with being male, working at a pharmacy that sold syringes to PWID and one that stocked naloxone, having been asked about syringe access by medical providers, and agreement that PWID should be able to buy syringes without a prescription. CONCLUSIONS: As communities with high rates of opioid overdose mortality were less likely to have pharmacies that dispensed syringes to PWID, a concerted effort with these communities and their pharmacies should be made to understand opportunities to increase syringe access. Future studies should explore nuances between theoretical support for syringe access by PWID without a prescription and actual dispensing behaviors. Addressing potential policy conflicts and offering continuing education on non-prescription syringe distribution for pharmacists may improve comfort distributing syringes to PWID, and therefore increase pharmacy syringe sales.

Preferences of Gay and Bisexual Men for Pharmacy-Based HIV Testing and Over-the-Counter HIV Tests.

A 2013 study among 169 Indiana men aged 18-45 who have sex with men assessed the acceptability of and preferences for pharmacy-based and over-the-counter (OTC) HIV testing. Rural men in general and men who did not know their HIV status were more likely to purchase an OTC HIV test. Men who did not know their HIV status also preferred an OTC HIV test to pharmacy-based testing. Pharmacies should enhance information around the sale of OTC HIV tests, particularly in rural areas. Information should include test results, opportunities for consultation, and linkage to care.