Battling professional self-sabotage: Embracing standard of care as the future of pharmacy regulation.

Laws and regulations are intended to protect the public; however, overregulation of the profession can block initiatives focused on patient safety and public health. This article discusses the 3 main regulatory approaches to pharmacy practice: standard of care (SOC), bright line, and right touch. An SOC regulatory model supports practitioners delivering patient care within their scope of practice and clinical training. Patient safety is maintained by measuring care against other practitioners within the same practice setting while supporting practitioners practicing at the top of their clinical ability. Compared with bright line and right touch approaches, the SOC regulatory model provides the adaptability needed to respond to different practice scenarios and settings, thus increasing access to health care and opportunities for innovation. To have a lasting impact on the profession and support patients, all pharmacy professionals must be fluent in regulatory approaches and advocate for states to transition to SOC regulatory models.

The impact of COVID-19 on select considerations in patients of reproductive age: Brief talking points for pharmacists.

The coronavirus disease 2019 (COVID-19) pandemic has elicited many health concerns, including the impact of the infection and vaccine on reproductive health. Although robust evidence demonstrates the safety of all available COVID-19 vaccines, misinformation and disinformation related to the vaccine continue to circulate. As accessible and essential health care workers, it is crucial that pharmacists are informed of the evidence related to effects of the COVID-19 infection and vaccinations on reproductive health care. Menstrual cycle changes have been noted owing to COVID-19 infection, pandemic stress, and COVID-19 vaccination. COVID-19 infection and vaccination have not been shown to influence female fertility, pregnancy rates, and lactation. The use of exogenous estrogen may further contribute to an increased risk of thromboembolism with COVID-19 infection, and differences in the risk of cerebral venous sinus thrombosis appear to exist between the types of vaccines. The benefits of COVID-19 vaccination outweigh any risks. Shared decision-making is necessary when discussing vaccination with patients. Pharmacists play a vital role in dispelling misinformation and disinformation related to the impact of COVID-19 illness and vaccination on reproductive health care.

Pharmacist contraception services: All about access.

As increasing numbers of U.S. states and jurisdictions grant pharmacists the authority to prescribe contraception, it is essential that pharmacists understand reproductive justice principles. Many structural barriers exist surrounding pharmacist contraception services that limit patient access to and ability to use these services. Pharmacists should offer comprehensive and all-inclusive reproductive health care services and referrals as part of their role as contraception providers.

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

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

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

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

Building Interprofessional Competencies Through a Collaborative Prescribing Activity With Osteopathic, Pharmacy, and Physician Assistant Students.

Introduction: Medication errors can lead to significant adverse events. Nearly 50% of medication errors occur during the prescription-writing stage of the medication use process, and effective interprofessional collaboration and communication are key to reducing error in this process. Methods: We developed a three-part, 60-minute, interprofessional education activity providing medical, physician assistant, and pharmacy students the opportunity to practice collegial interprofessional communication surrounding prescribing practices. Learners met virtually initially as a large group and divided into small groups facilitated by a health professional. Part 1 involved reviewing two prescriptions prepared by learners; part 2 was a discussion about the education, roles, and responsibilities of each profession; and part 3 focused on identifying prescription errors in examples provided by faculty. Students completed a post-pre survey measuring their perception of learning the Interprofessional Collaborative Competency Attainment Survey (ICCAS) areas. Results: Of 317 participants (151 doctor of osteopathy, 68 master of physician assistant studies, and 98 doctor of pharmacy students), 286 completed the post-pre survey, for a 90% response rate. Students reported statistically significant (p < .001) increases in all 20 questions spanning the six ICCAS areas. Discussion: The virtual format allowed multiple institutions to participate from various locations. It broadened the learners' experience by fostering interaction among those with varied perspectives and allowed collaboration between locations and programs that otherwise could not have participated. The activity introduced students to virtual collaboration and key telehealth skills, enhancing their confidence and familiarity with virtual interactions in a professional setting.

Perceptions of the benefits and challenges of the role of advanced practice nurses in nurse-led out-of-hours care in Hong Kong: a questionnaire study.

AIMS AND OBJECTIVES: The aim of the study was to identify the factors that nurses perceive may facilitate or hinder the development of advanced practice nurse roles in Hong Kong. BACKGROUND: Advanced practice nurses are increasingly prominent in nurse-led out-of-hours care in Hong Kong in response to changes to junior doctors' hours of work. SETTING: Three five-day workshops for Hong Kong-based advanced practice nurses were offered in partnership with UK clinicians. The aim of the workshops was to share UK experiences of implementation of the 'Hospital at Night' model of care delivery. The questionnaire study undertaken was not part of the workshop programme. However, the workshops gave the authors a unique opportunity to access relatively large numbers of Hong Kong-based advanced practice nurses. PARTICIPANTS: The workshops were attended by experienced nurses who had been or were about to be appointed as advanced practice nurses. All nurses who attended one of the three workshops (n=120) agreed to participate in the study. METHODS: Responses to two open questions posed in the questionnaire were the subject of a content analysis. RESULTS: A prominent finding of the study was that respondents viewed the benefits of introducing advanced practice nurse roles in Hong Kong as outweighing any challenges. One of the main features of the perceived benefits relates to improving the quality and safety of patient care. The greatest challenges associated with the role related to acceptance of the role by other healthcare professionals, and difficulties associated with the general public's traditional attitudes to healthcare provision in Hong Kong. CONCLUSIONS: Education of the public concerning the implementation of such roles is of crucial importance. RELEVANCE TO CLINICAL PRACTICE: Findings from this study enhance understanding of the factors that hinder or facilitate advanced practice roles in out-of-hours care in Hong Kong.

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

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

A report on pharmacists with the NCMP credential.

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

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

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

Curricular Considerations for Preparing Student Pharmacists to Prescribe Hormonal Contraception.

In 2014, the pharmacist's role in the United States expanded to include prescribing hormonal contraception, and this practice is currently addressed by policy in 14 states and the District of Columbia. Training and education requirements for this expanded scope of practice vary between states and are changing rapidly. The objective of this review is to examine how student pharmacists are taught to provide contraceptive care, specifically for prescribing ongoing hormonal contraception and emergency contraception, and to identify potential gaps in the United States pharmacy curricula related to contraception. Despite steady adoption into community pharmacy practice, there is sparse literature assessing educational methods used to teach contraceptive care. This review offers recommendations to promote consistent and comprehensive student pharmacist education in providing contraceptive care across institutions, regardless of state policy status.

Pharmacists' Perceptions, Barriers, and Potential Solutions to Implementing a Direct Pharmacy Access Policy in Indiana.

This study assessed pharmacists' perceptions, barriers, and potential solutions for implementing a policy allowing pharmacists to prescribe hormonal contraceptives in Indiana. A mixed-method survey (n = 131, 22.3% response rate), using Likert-type scales, dichotomous responses (yes/no), and open-ended questions, was distributed to pharmacy preceptors in Indiana. Pharmacists felt prescribing contraceptives would be beneficial (79.1%) and were interested in providing this service (76.0%), but only 35.6% reported having the necessary resources. Participants with a PharmD were significantly more likely to feel the service would be beneficial (odds ratio [OR] = 10.360, 95% confidence interval [CI: 1.679, 63.939]) and be interested in prescribing contraceptives (OR = 9.069, 95% CI [1.456, 56.485]). Reimbursement (86.4%), training courses (84.7%), private counseling rooms (69.5%), and increasing technician responsibilities (52.5%) were identified as ways to ease implementation. Women had significantly greater odds of being more comfortable than men prescribing injections (OR = 2.237, 95% CI [1.086, 4.605]), and intravaginal rings (OR = 2.215, 95% CI [1.066, 4.604]), when controlling for age, degree, and setting. Qualitative findings reinforced quantitative findings.

Evaluation of Student Pharmacists' Attitudes and Perceptions of Hormonal Contraception Prescribing in Indiana.

Community pharmacists' scope of practice is expanding to include hormonal contraceptive prescribing. Prior to introducing statewide legislation, it is important to assess the perceptions of future pharmacists. A cross-sectional survey was distributed to 651 third- and fourth-year professional students enrolled at three colleges of pharmacy in Indiana. Data were collected between September and October 2019 to assess students' attitudes about prescribing hormonal contraceptives, readiness to prescribe, perceived barriers, and desire for additional training. In total, 20.9% (n = 136) students responded. Most (89%, n = 121) believe that pharmacist-prescribed hormonal contraceptives would be beneficial to women in Indiana, and 91% (n = 124) reported interest in providing this service. Liability, personal beliefs, and religious beliefs were the most commonly cited perceived barriers. Most students felt they received adequate teaching on hormonal contraceptive methods (90%, n = 122) and hormonal contraceptive counseling (79%, n = 107); only 5% (n = 7) felt ready to provide the service at the time of survey completion. Student pharmacists in their final two years of pharmacy school are interested in prescribing hormonal contraceptives and believe that this service would be beneficial. This expansion of pharmacy practice would likely be supported by future pharmacists who feel the service could provide benefit to women seeking hormonal contraceptives in Indiana.

Infertility Management and Pharmacotherapy: What Every Pharmacist Should Know.

Infertility is a significant public health concern in the United States. As such, utilization of infertility services, including pharmacotherapeutic treatments, is prevalent, and the role of the pharmacist as part of the health care team is essential. Pharmacists can assist patients by providing education on infertility causes, risk factor mitigation, referrals, nonpharmacologic and pharmacologic management options, navigation of the prescription process, and resource availability for the significant financial burden accompanying infertility treatment. In-depth pharmacotherapeutic information may not be readily available to pharmacists dispensing and counseling on these medications, and infertility management regimens are often varied and complicated requiring more in-depth counseling on use and administration. Given the complexity of infertility management, pharmacists are a valuable patient support and education resource. This article provides an in-depth review of infertility management strategies, both nonpharmacologic and pharmacologic.

Opposition to Pharmacist Contraception Services: Evidence for Rebuttal.

Pharmacist contraception services are growing across the United States. Several states have authorized pharmacists to prescribe contraception, and the interest in other states continues to grow. Opposition to these practices exists and centers on discussions related to safety, training, cost, and fragmentation of care. We review these arguments and provide evidence refuting these concerns. Pharmacist-prescribed contraception increases access to care, and patients express interest in utilizing this service at the pharmacy. Pharmacists follow evidence-based recommendations. Counseling on preventative services and referral to other providers is part of contraception care by pharmacists. Training programs have been developed to equip both pharmacy students and pharmacists with the knowledge, skills, and tools needed to successfully provide these services. This article can serve as a guide for pharmacists and advocates when discussing pharmacist-prescribed contraception with policymakers, patients, and other healthcare professionals.

Emergency Contraception Algorithm and Guide for Clinicians.

There are currently three forms of emergency contraception: oral levonorgestrel, oral ulipristal acetate, and the copper intrauterine device. The copper intrauterine device is the most effective, followed by ulipristal acetate and levonorgestrel, respectively. Although levonorgestrel is the least effective method, studies show that more prescribers are familiar with it and that is the most frequently used method. Clinicians should consider several factors when helping women make informed medical decisions regarding emergency contraception, including access to the products, a woman's individual preference, timing since unprotected intercourse, body mass index or weight, and initiation or resumption of routine contraception. This article explains and summarizes these considerations and provides an algorithm to guide clinicians.

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

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