Impact of Geodemographic Factors on Antibiotic Prescribing for Acute, Uncomplicated Bronchitis or Upper Respiratory Tract Infection.

OBJECTIVE: To assess the impact of geodemographic factors on antibiotic prescribing for adult acute, uncomplicated bronchitis or upper respiratory tract infection. METHODS: A retrospective, observational study of 63,051 single health-system, outpatient discharges with a primary diagnosis of bronchitis or upper respiratory tract infection in 2019. Univariate analyses of prescribing predictors and multivariable stepwise logistic modeling were performed. RESULTS: Patients who were older (aOR 1.02; 95% CI 1.02, 1.02), male (1.10; 1.06, 1.14), black (1.29; 1.22, 1.38), smoked (1.18; 1.14, 1.23), seen in urgent care (1.26; 1.22, 1.31) and living in an area with more owner-occupied housing (1.41; 1.30, 1.53) were more likely to receive antibiotics. Patients who were Asian (0.88; 0.77, 0.99), had Medicare (0.83; 0.78, 0.87), Medicaid (0.84; 0.79, 0.87) or Exchange insurance (0.90; 0.82, 0.98), or seen in the emergency department (0.43; 0.40, 0.46) were less likely to receive antibiotics. Distance from a patient's address and their encounter location did not predict antibiotic prescribing. CONCLUSIONS: Antibiotic prescribing interventions for adult acute bronchitis and upper respiratory tract infections could target patients living in an area with higher socioeconomic status.

Clinical and Economic Effects of a Pharmacist-Administered Antiretroviral Therapy Adherence Clinic for Patients Living with HIV.

BACKGROUND: Pharmacists have demonstrated the ability to improve patient adherence to antiretroviral therapy (ART). OBJECTIVE: To determine the clinical and economic effects of a pharmacist-administered ART adherence clinic for patients living with human immunodeficiency virus (HIV). METHODS: This pilot study with a pretest-posttest design examined the effect of a pharmacy adherence clinic on patient HIV viral load and CD4 count over a 6-month period. Patients with documented adherence problems were referred to the clinic. The pharmacist counseled patients at baseline and met with patients 1-2 weeks, 6 weeks, 3 months, and 6 months after starting ART. A societal perspective net cost analysis of the pharmacy adherence clinic was conducted to assess the economic efficiency of the intervention. RESULTS: Twenty-eight patients were enrolled in the study, and 16 patients reached completion. Median HIV RNA significantly decreased from 48,000 copies/mL (interquartile range [IQR] = 16,750-139,000) to undetectable (< 20 copies/mL) at 6 months for all study participants who completed the full intervention (P = 0.001). In the 3 months following the intervention, we estimated that it prevented approximately 0.13 secondary HIV infections among the sexual partners of the 16 participants who completed the intervention. The total cost of the intervention was $16,811 ($1,051 per patient), which was less than the future savings in averted HIV-related medical care expenditures ($49,702). CONCLUSIONS: A pharmacy adherence clinic that focused on early and sustained ART adherence interventions helped patients with documented medication adherence problems achieve an undetectable HIV RNA. The intervention was highly cost saving, with a return of nearly $3 in future medical care savings per dollar spent on the intervention. DISCLOSURES: This work was supported in part by a research grant to Dilworth, Mercier, and Borrego from the American Society of Health-System Pharmacists Foundation. Klein and Pinkerton were supported in part by grants T32-MH19985 and P30-MH52776, respectively, from the National Institute of Mental Health. No funding bodies had any role in the study design, data collection, analysis, decision to publish, or preparation of the manuscript. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Health Resources and Services Administration. The authors have no conflicts of interest to disclose. Study concept and design were contributed primarily by Dilworth, Mercier, and Borrego, along with the other authors. Dilworth took the lead in data collection, along with Pinkerton, Klein, Mercier, and Jakeman. Data interpretation was performed by Dilworth and Pinkerton, along with the other authors. The manuscript was written by Dilworth, Klein, and Jakeman, with assistance from the other authors, and revised by Dilworth, Jakeman, and Klein, with assistance from the other authors. The results from this study were presented in part at the 2015 United States Conference on AIDS in Washington, DC, on September 10-13, 2015.

Disparities in pharmacists' patient education for Hispanics using antidepressants.

OBJECTIVES: To assess pharmacists' provision of antidepressant information and to examine the effect of patient ethnicity and language skills on pharmacists' provision of information and patient education. DESIGN: Cross-sectional, randomized, between-subjects study. SETTING: Wisconsin, from September to November 2008. PARTICIPANTS: 540 community pharmacists. INTERVENTION: Participants were exposed to one of three vignettes describing a patient coming into the pharmacy for an initial dispensation of an antidepressant. Vignettes varied according to patient ethnicity (white or Hispanic) and language spoken (English or Spanish). MAIN OUTCOME MEASURES: Respondents' information and education messages given to patients about antidepressants and whether Hispanic patient ethnicity and English language ability reduced pharmacists' communication about antidepressants. RESULTS: A majority of participants would provide information regarding the medication's name (93.3%) and dosage schedule (92.8%). Many pharmacists also reported that they would tell the patient to take the medication on a daily basis (92.6%) and that it takes 2 to 4 weeks for the medication to have a noticeable effect (87.8%). Multivariate models showed that pharmacists would provide significantly less information (ß = -0.24 [95% CI -0.31 to -0.17]) and education messages (-0.17 [-0.24 to -0.09]) to Spanish-speaking patients. CONCLUSION: These findings suggest that Spanish-speaking patients may face disparities in the level of care received from community pharmacists. Interventions should be available to enhance pharmacists' communication with Spanish-speaking patients in an effort to facilitate safe and effective medication use.

Pharmacists' communication with Spanish-speaking patients: a review of the literature to establish an agenda for future research.

BACKGROUND: Spanish-speaking people represent more than 12% of the total population in the United States and are poised to become the largest minority group in the United States by 2015. Although researchers have studied pharmacist-patient communication for approximately 30 years, little emphasis has been placed on the interactions between pharmacists and Spanish-speaking patients. OBJECTIVES: The objectives of this review are (1) to describe empirical studies on Spanish-speaking patient/pharmacist communication examined relative to patient factors, pharmacist factors, and environmental factors that may influence Spanish-speaking patient/pharmacist communication and (2) to integrate medical and nursing literature to generate a research agenda for future study in this area. METHODS: We compiled articles from a systematic review of (1) CINAHL, International Pharmacy Abstracts, PubMed, and Web of Knowledge databases using "Hispanic limited English proficiency," "Latino limited English proficiency," "language-assistance services," "Spanish-speaking patients," "Latino patients," "Spanish-speaking health literacy," "pharmacy health literacy," "patient-provider communication," "pharmacy language barriers," and (2) bibliographies of selected articles. RESULTS: This search generated 1174 articles, 7 of which met the inclusion criteria. We categorized the results into 4 topic areas: "Spanish-speaking patient literacy," "pharmacists knowledge of/proficiency in the Spanish language," "pharmacy resources to overcome language barriers," and "pharmacists' attitudes toward communicating with Spanish-speaking patients." CONCLUSIONS: These studies provide a macroscopic look at the linguistic services offered in pharmacies, gaps in services, and their subsequent impact on pharmacists and patients. Future research should investigate Spanish-speaking patients' literacy issues, pharmacy staff language skills, factors that influence pharmacists' counseling, and language-assistance programs for pharmacists and patients. Furthermore, these studies need to be conducted in large Hispanic/Latino populated areas where positive service models are likely to be present. Addressing these issues will provide pharmacists and pharmacies with information to overcome language barriers and provide Spanish-speaking patients with quality care.