Pharmacist counseling when dispensing naloxone by standing order: A secret shopper study of 4 chain pharmacies.

BACKGROUND: Texas has passed legislation to increase access to naloxone, the opioid overdose antidote, allowing pharmacists to dispense by standing order without an outside prescription. Given this added responsibility, there is a need to assess real-world counseling provided by pharmacists when dispensing naloxone. OBJECTIVES: Assess naloxone accessibility and counseling provided by community pharmacists when dispensing naloxone by standing order. METHODS: A total of 11 student pharmacists (mean age 25 years; 63.6% female; primarily Hispanic [36.4%], Asian [27.3%], and white [27.3%]) audited community pharmacies by presenting to purchase naloxone. Variables included naloxone availability and price, counseling duration, and whether 13 predetermined counseling points were provided unprompted. Shoppers were prepared with a background story if asked so that each answered questions consistently. All shoppers participated in two 1-hour training sessions, including verification of their ability to accurately assess naloxone counseling. Pharmacies in Bexar County, TX were selected randomly from 4 pharmacy chains, each of which have implemented statewide standing orders within their chain. Descriptive statistics were calculated. A Fisher exact test and linear mixed-effects regression model were used to assess variation across chains in whether naloxone was dispensed and the mean total number of counseling points provided, respectively. RESULTS: The shoppers audited 45 pharmacies. Naloxone was dispensed in 31 of 45 (68.9%) encounters (mean cost: $129.59). The mean counseling duration was 89 seconds. The most common counseling points included: administration technique (24 of 31), readministration of second dose (22 of 31), and calling 9-1-1 (20 of 31). All other points were included in less than one-third of pharmacists' counseling. Across the 4 chains, there was significant variation in naloxone dispensing and the number of counseling points provided. CONCLUSION: Secret shoppers were unable to access naloxone from nearly one-third of pharmacies. Counseling often excluded concepts pertinent to patient safety and effectiveness, suggesting opportunities remain to promote consistent, high-quality naloxone counseling in community pharmacies.

Characterizing Pharmacist Perspectives on Utilizing a Personalized Family Medication Safety Plan for Opioid Education with Adolescents and Parents.

BACKGROUND: Exposure to prescription opioids during adolescence is associated with an increased risk of future opioid misuse. The pervasive and growing impact of the opioid epidemic requires evidence-based, co-designed interventions targeted at adolescents. MedSMA℞T Families is an intervention tailored to educate adolescents and their families about opioid misuse prevention and consists of two parts: the MedSMA℞T: Adventures in PharmaCity videogame and the family medication safety plan (FMSP). OBJECTIVE: This study sought to explore pharmacists' perceptions of using the family medication safety plan to facilitate opioid education among parents and their adolescents. The purpose of this project was to also gather information for iterative adaptations to improve implementation and dissemination of the FMSP in pharmacy settings. METHODS: Pharmacists were recruited from Pharmacy Practice Enhancement and Action Research Link (PearlRx) and the Pharmacy Society of Wisconsin (PSW). Twenty-one pharmacist interviews were conducted between September 2021 and March 2022. Consenting pharmacists reviewed the FMSP. Then, semi-structured interviews were conducted, recorded, and transcribed. Inductive thematic analyses were performed using NVivo software. RESULTS: Four prevalent themes emerged: (1) the purpose of FMSP as a communication tool, (2) instructions to clarify how to use FMSP, (3) barriers to using FMSP, and (4) suggestions to improve FMSP format. Most pharmacists described the FMSP as a tool to encourage interactive opioid conversations between adolescents, families, and pharmacists. Pharmacists suggested creating multiple customizable formats and incorporating instructions on how to use the FMSP. CONCLUSIONS: Pharmacists noted that the FMSP was an interactive and engaging communication tool to tailor opioid consultations with adolescents and their families. Patients might use the FMSP as a visual cue to help think of what question(s) they should ask pharmacists. Pharmacists stated that the FMSP could facilitate tailored opioid safety communication and medication consultations. Insights will inform future medication misuse prevention interventions as well as adaptation.

Effect of heparin II domain of fibronectin on actin cytoskeleton and adherens junctions in human trabecular meshwork cells.

PURPOSE: To determine whether the heparin II (HepII) domain of fibronectin previously shown to increase outflow facility affects the formation and assembly of actin cytoskeleton and adherens junctions in human trabecular meshwork (HTM) cells. METHODS: Normal HTM cells and two transformed HTM cell lines were treated for 24 hours with increasing concentrations of the HepII domain. Disruptions in adherens junctions and the actin cytoskeleton were determined using immunofluorescence microscopy and Western blot analysis of immunoprecipitated cadherin/catenin complexes. Actin filaments were detected with phalloidin. Catenin (alpha and beta) and cadherin antibodies were used to detect adherens junctions. RESULTS: Treatments of cultures with the HepII domain caused cadherin/beta-catenin complexes in adherens junctions and actin filaments to disassemble. The disruption of adherens junctions and actin filaments occurred in a dose-dependent and temporal fashion. The disassembly of actin filaments occurred first, followed by the disassembly of adherens junctions. Dissociation of adherens junctions, but not actin filaments, was reversible if the HepII domain was removed. Reassembly of actin filaments required the addition of serum. Serum, however, could not trigger the reassembly of actin filaments if the HepII domain was present, suggesting that the HepII domain acted downstream of the serum stimulated RhoA activity. CONCLUSIONS: The exposure of HTM cells to the HepII domain triggers the disassembly of actin filaments and the subsequent destabilization of adherens junctions in HTM cells. This suggests that the HepII domain may increase outflow facility in cultured anterior segments by altering the organization of the TM cytoarchitecture.

The power of the patient question: A secret shopper study.

OBJECTIVES: To examine the effect of one standardized patient question on the length, number and type of new topics pharmacists addressed. To explore how community pharmacists counsel secret shoppers on two types of over-the-counter (OTC) medications-ibuprofen (IB) and emergency contraceptives (EC). METHODS: 25 pharmacists from 7 independent, midwestern community pharmacies consented to have secret shoppers purchase an OTC medication and to have their consultations audio-recorded. Following standardized scenarios, 5 secret shoppers audio-recorded 73 encounters. At the end of 36 encounters secret shoppers asked one standard question, "What else should I know before taking this product?" Role Theory informed the study design with apriori hypotheses that topics assessed, topics discussed, and consultation length would vary by the OTC medication (IB or EC) and whether secret shoppers asked a question. Audio-recording coding had high inter-rater reliability (kappa=0.94). RESULTS: Length of encounter was significantly associated with patients asking the question (p<0.05), but not type of OTC medication. On average 1.22 new topics were discussed with a patient question. New topics included information about safe and efficacious use of the OTC's. CONCLUSION: Results highlight the importance of encouraging patients to ask pharmacists their questions about OTC products for safe use and thorough consultations.