Exploring LGBTQ+ cultural competency and DEI in continuing education: A cross-sectional review of U.S. pharmacy legislation.

BACKGROUND: Lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, or other sexual orientations or gender identities (LGBTQ+) cultural competency training is offered in pharmacy curricula to variable extents. State legislation directly dictates pharmacist training through continuing pharmacy education (CPE) requirements. OBJECTIVES: This study aimed to identify the U.S. states and the District of Columbia (D.C.) that require CPE or training on topics related to LGBTQ+ cultural competency or topics related to diversity, equity, and inclusion (DEI) in general. In addition, this study quantified and compared each state's CPE hours required for each renewal period. METHODS: This cross-sectional study retrospectively examined pharmacy legislation on CPE requirements for each of the 50 U.S. states and D.C. Only state legislation that was signed into law and related to pharmacy practice was included. Official websites for each board of pharmacy were identified to locate lawbooks, laws, rules, regulations, and statutes specific to pharmacy practice. Search terms included "lgbt," "lgbtq," "cultural," "cultural competency," "equity," "health equity," "implicit," and "implicit bias." Two study investigators independently collected data from March 2023 to April 2023. Data were re-reviewed for accuracy in January 2024. Discrepancies were resolved through discussion until a consensus was reached. The total number of required CPE hours, years for each pharmacist license renewal, required LGBTQ+ cultural competency CPE hours, and required DEI-focused CPE hours were described using descriptive statistics. RESULTS: A total of 44 of 51 states and D.C. required 30 CPE hours for each 2-year renewal cycle or 15 CPE hours for each 1-year renewal cycle. California and D.C. had LGBTQ+ cultural competency CPE requirements of 1 CPE hour or 2 CPE hours per cycle, respectively. Five additional states, Illinois, Maryland, Michigan, Oregon, and Washington, required training or CPE on topics related to DEI as a whole. CONCLUSION: Few U.S. states require CPE on LGBTQ+ cultural competency. This study highlights the need for standardized pharmacist training in LGBTQ+ health care.

Evaluating the impact and equity of a tobacco-free pharmacy law on retailer density in New York City neighbourhoods.

BACKGROUND: In 2018, New York City (NYC) implemented a tobacco-free pharmacy law as part of a comprehensive policy approach to curb tobacco use. This study models the reduction in tobacco retailer density following the ban to examine differences in the policy's impact across neighbourhoods. METHODS: Tobacco retailer density per 1000 residents was calculated in July 2017 for each of NYC's Neighborhood Tabulation Areas (NTAs, n=188) before and after removing pharmacies as licensed tobacco retailers. Pearson correlations and linear regression (with predictors scaled to 10 unit increments) measured associations between the projected change in retailer density after the ban and NTA demographic characteristics. RESULTS: On average, retailer density decreased by 6.8% across neighbourhoods (SD: 6.3), with 17 NTAs experiencing reductions over 15%. Density reduction was greater in NTAs with higher median household income (r: 0.41, B: 1.00, p<0.0001) and a higher proportion of non-Hispanic white residents (r: 0.35, B: 0.79, p<0.0001). NTAs with a higher percentage of adults with less than a high school education (r: -0.44, B: -2.60, p<0.0001) and a higher proportion of Hispanic residents (r: -0.36, B: -1.07, p<0.0001) benefited less from the policy. These relationships held after assessing absolute changes in density (vs per cent change). CONCLUSIONS: NYC's tobacco-free pharmacy law substantially reduces tobacco retailer density overall, but the impact is not equal across neighbourhoods. In order to minimise disparities in the tobacco retail environment, local governments considering a similar ban should supplement this strategy with other retailer restrictions to achieve equitable outcomes.

[A new support given to patients in retail pharmacies: The "shared checkup of medication"]. / Un nouveau dispositif d'accompagnement du patient en officine : le « bilan partagé de médication ¼.

In accordance with the recommendations of the HPST law of 21st July 2009, the retail pharmacists heavily put a lot into new missions, concerning as well prevention and screening as therapeutic education of patient. In that context, two types of pharmaceutical conversations relative to patient's therapeutic training were primarily planned : the first one concerns patients with thrombosis' risk treated by oral anticoagulants (antivitamin K or direct oral anticoagulant), whereas the second one is intended to asthmatics cured by corticoids' inhalation. Then the publication in 2017 and 2018 respectively of amendments no 11 et 12 to the National convention of 4th April 2012 organizing relationships between titular pharmacists and health insurance planned a third type of support called « shared checkup of medication ¼. It is a matter of program of personalized pharmaceutical monitoring intended to patients at least 65 years old and suffering from one or several long-lasting affection(s), and also to patients at least 75 years old and chronically treated by at least five different active substances. Those new pharmaceutical conversations aim on the one hand to improve observance of chronic medications - current by elderly patients - and on the other hand to prevent drug iatrogenesis - favored by polymedication - while reasserting the major role of the retail pharmacist as health professional.

Pharmacist-Driven Strategies for Hypertension Management in Los Angeles: A Community and Stakeholder Needs Assessment, 2014-2015.

In 2014, the Los Angeles County Department of Public Health received federal funding to improve the prevention and control of hypertension in the population through team-based health care delivery models, such as pharmacist-led medication therapy management. To inform this work, the department conducted a 3-part needs assessment consisting of 1) a targeted context scan of regional policies and efforts, 2) a key stakeholder survey, and 3) a public opinion internet-panel survey of Los Angeles residents. Results suggest that political will and professional readiness exists for expansion of pharmacist-led medication management strategies in Los Angeles. However, several infrastructure and economic barriers, such as a lack of sufficient payment or reimbursement mechanisms for these services, impede progress. The department is using assessment results to address barriers and shape efforts in scaling up pharmacist-led programming in Los Angeles.

[Cooperation according to French Law "hospital, patients, health and territories": Pharmacists' involvement in Aquitaine region]. / Missions de coopération introduites par la loi « hôpital, patients, santé et territoires ¼ : participation des pharmaciens d'officine en Aquitaine.

BACKGROUND: In 2009, the French Act "Hospital, Patients, Health and Territories" (loi "Hôpital, Patients, Santé et Territoires") reorganized the outpatient care pathway and defined missions aimed at improving cooperation between pharmaceutical and medical professionals. Five years later, we conducted a survey among community pharmacists in order to assess the appropriation of these missions and the way cooperation was implemented. We also aimed to investigate factors that could hamper or ease the development of these activities in order to identify actions needed to improve pharmacists' involvement. METHODS: In partnership with the local health authorities "Agence régionale de santé", we conducted a survey via an online questionnaire sent to pharmacy holders in July 2014 in Aquitaine region. Information was collected about the pharmacies, involvement in collaborative activities, and barriers to cooperation. RESULTS: Overall, 20% (249) of pharmacists responded to the survey. They owned predominantly rural pharmacies (46%) or neighborhood pharmacies (41%), with two pharmacists per pharmacy (48%). Regarding collaborative activities, the majority of pharmacists (78%) had conducted interviews with their patients taking vitamin K antagonist therapy and they were willing to continue (87%). The implication was less common concerning other actions such as referent pharmacist for nursing homes (19%) or activities relating to therapeutic educational programs for patients with chronic conditions (34%). The vast majority of respondents (85%) were not aware of opportunities to become a correspondent pharmacist. The main obstacles for engaging in these activities were the lack of time, lack of knowledge about these missions and the lack of remuneration. We identified differences in pharmacists' involvement in collaborative activities depending on selected characteristics of the pharmacies. CONCLUSION: The findings of this survey underlined pharmacists' acceptance of these missions and suggest that better information and appropriate remuneration could enhance commitment. Recent changes in the legal framework (establishment of "pharmaceutical fees", extension of the scope of pharmaceutical interviews) enable funding for collaborative practices between medical practitioners and pharmacists, thus encouraging better coordination in the patient care pathway.

Contribution of Arabic Medicine and Pharmacy to the Development of Health Care Protection in Bosnia and Herzegovina - the First Part.

The time interval from the 9th to the 13th century remained known as the "Golden period of the Arab science", and a significant place among the taught sciences are occupied by Medicine and Pharmacy. In the history of medicine, Islamic medicine, also known as Arabic medicine, refers to the science of medicine developed in the Islamic Golden Age, and written in Arabic Arabs were able to use their cultural and natural resources and trade links to contribute to the strong development of pharmacy. After the collapse of the Arab rule, the Arab territorial expanses and cultural heritage were taken over by the Turks. Although scientific progress in the Turkish period slowed down due to numerous unfavorable political-economic and other circumstances, thanks to the Turks, Arab culture and useful Islamic principles expanded to the territory of our homeland of Bosnia and Herzegovina. Significant role in the transfer of Arabic medical and pharmaceutical knowledge was also attributed to the Sephardic Jews who, with their arrival, continued to perform their attar activities, which were largely based on Arab achievements. However, insufficiently elaborated, rich funds of oriental medical and pharmaceutical handwriting testify that Oriental science has nurtured in these areas as well, and that the Arab component in a specific way was intertwined with other cultures and traditions of Bosnia and Herzegovina.

Emerging Developments in Pharmacists' Scope of Practice to Address Unmet Health Care Needs.

Pharmacists' comprehensive training is being leveraged in emerging patient care service opportunities that include prescriptive authority under collaborative practice agreements (CPAs) with prescribers or through state-based protocols. CPAs and state-based protocols expand pharmacists' scope of practice to allow the pharmacist to perform designated functions under the terms of the agreement or protocol. For patient-specific CPAs, this often includes initiating, modifying, or discontinuing therapy and ordering laboratory tests. For population-based CPAs and state-based protocols, pharmacists are often authorized to initiate medications to address a public health need. CPAs and state-based protocols are mechanisms to optimally use pharmacists' education and training.

The Continuum of Pharmacist Prescriptive Authority.

Recently momentum has been building behind pharmacist prescriptive authority for certain products such as oral contraceptives or naloxone. To some, prescriptive authority by pharmacists represents a departure from the traditional role of pharmacists in dispensing medications. Nearly all states, however, currently enable pharmacist prescriptive authority in some form or fashion. The variety of different state approaches makes it difficult for pharmacists to ascertain the pros and cons of different models. We leverage data available from the National Alliance of State Pharmacy Associations (NASPA), a trade association that tracks pharmacy legislation and regulations across all states, to characterize models of pharmacist prescriptive authority along a continuum from most restrictive to least restrictive. We identify 2 primary categories of current pharmacist prescriptive authority: (1) collaborative prescribing and (2) autonomous prescribing. Collaborative prescribing models provide a broad framework for the treatment of acute or chronic disease. Current autonomous prescribing models have focused on a limited range of medications for which a specific diagnosis is not needed. Approaches to pharmacist prescriptive authority are not mutually exclusive. We anticipate that more states will pursue the less-restrictive approaches in the years ahead.

ASSESSMENT OF PRACTICE AT RETAIL PHARMACIES IN PAKISTAN: EXTENT OF COMPLIANCE WITH THE PREVAILING DRUG LAW OF PAKISTAN.

The main objective of this study was to assess the practice at retail pharmacies in Pakistan and to compare the same in rural and urban areas. The maintenance of pharmacy and drug inspectors' visit was also assessed. This cross sectional study was conducted in Abbottabad, Pakistan during October-November, 2012. A sample of 215 drug sellers or drug stores was selected by employing convenient sampling method. With a response rate of 91.6%, 197 drug sellers participated in this study. All the drug sellers were male. Overall, 35% (n = 197) of the drug sellers did not have any professional qualification. A majority of the drug sellers were involved in various malpractices like selling of medicines without prescription (80.7%), prescribing practice (60.9%), prescription intervention (62.4%) and selling of controlled substances (66%) without a license for selling it. These malpractices were significantly higher in rural area than that in urban area.

Impact of allowing pharmacists to independently renew prescriptions: A population-based study.

OBJECTIVES: To study the impact of a 2009 policy change in British Columbia (BC) that allowed pharmacists to independently renew certain prescriptions for chronic conditions. DESIGN: Population-based analysis. SETTING: BC, Canada. PARTICIPANTS: All residents of BC (more than 3.9 million). INTERVENTION: Prescription drug use data were collected from the PharmaNet database. This database contains a record of all ambulatory prescription drug dispensations in BC including a variable indicating whether a pharmacist renewed the prescription. MAIN OUTCOME MEASURES: We studied pharmaceutical and physician insurance claims datasets for all BC residents for 2 years following the 2009 policy change. We assessed the number and types of drugs renewed by pharmacists, and whether these complied with the policy. Further, we matched pharmacist-renewed prescriptions to equivalent potentially renewable prescriptions and assessed the impact on ambulatory physician visits. RESULTS: Over the first 2 years, pharmacists renewed 150,950 prescriptions in BC. Almost one-half of these renewals did not appear to match the conditions set out in the new regulatory policy (n = 69,970, 47%). Those that did match the conditions (n = 80,980, 53%) represented a very small proportion of the 47 million prescriptions that pharmacists could have renewed (0.17%). The most frequently renewed medications were treatments for dyslipidemias, hypertension, diabetes, and gastroesophageal reflux disease. Pharmacist-renewed prescriptions were preceded by a 30% relative decrease in ambulatory physician visits in the week before dispensing, but there was also a 17% relative increase in visits in the week following the pharmacist-renewed prescription. CONCLUSION: Overall, the use of pharmacist renewals was very low and one-half of the renewals were not policy-concordant. Pharmacist renewals were associated with the intended reductions in physician visits before dispensing, but there was also an unintended increase in visits after dispensing. These findings suggest that future policies such as this one need to be differently designed and closely monitored.

[Legislation on the pharmaceutical industry in Morocco during the French protectorate 1912 - 1956]. / La législation sur l'industrie pharmaceutique au Maroc durant le Protectorat français 1912-1956.

In Morocco, the pharmaceutical industry was born with the French protectorate. She knew a great evolution: from a limited production for local needs, it became an important activity, organized to export pharmaceutical patent medicines. This article revisits the birth and history of this industry during the protectorate. It refers to the situation at the time by listing some examples of active establishments and some specialities marketed. It also aims to increase knowledge about the industry and provides an overview of the situation of practitioners remembering the texts governing the profession. Based on the available literature, we examined and analyzed the arrangements related to the establishment, organization and evolution of the pharmaceutical industry.

Pharmacist authority to provide HPV vaccine: novel partners in cervical cancer prevention.

OBJECTIVES: While the provision of cervical cancer prevention services in the United States has expanded to new settings beyond clinics that give Pap smears, prevention efforts are being hampered by relatively low human papillomavirus (HPV) vaccine coverage. Pharmacies are an underused setting to deliver HPV vaccine. To better understand this opportunity, we sought to classify pharmacists' authority to administer HPV vaccine in each US state. METHODS: For each US state and the District of Columbia (for simplicity, we refer to these 51 regions as states), we interviewed a member of the state's pharmacy association, member of the state board of pharmacy, or a faculty member at a school or college of pharmacy. RESULTS: Most states (80%) allowed pharmacists to provide HPV vaccine to adult women ages 19 and older, and 61% of states allowed provision to girls age 12. The mechanism for pharmacists to immunize was highly variable across states. For example, a 12 year-old girl seeking HPV vaccine could receive it from a pharmacist in 31% of states under a protocol between a specific physician and pharmacist, in 24% with an HPV vaccine prescription, and in 6% without prior physician approval. Pharmacists' authority was broadest on the west coast and limited on the east coast. Pharmacist authority to provide HPV, Tdap, and meningitis vaccines was very similar, but it was highly dependent on patient age. CONCLUSIONS: US states' laws governing pharmacists' ability to offer HPV vaccine varied widely. One consequence is that newly expanded cervical prevention efforts underuse pharmacists.

How have pharmacists in different practice settings integrated prescribing privileges into practice in Alberta? A qualitative exploration.

WHAT IS KNOWN AND OBJECTIVE: Since 2007, pharmacists in Alberta have had authority to adapt existing prescriptions and independently prescribe medications after a peer review process. This study aimed to explore and characterize how pharmacists incorporated prescribing into practice 3 years after this legislation was approved. METHODS: We invited pharmacists to participate in semi-structured telephone interviews to discuss their prescribing practices. Pharmacists working in community, primary care network, hospital or other settings were selected using a mix of purposive and random sampling. Two investigators independently analysed each transcript using an Interpretive Description approach and thematically categorized prescribing practices according to the level of adoption. RESULTS AND DISCUSSION: Thirty-eight pharmacists (n = 13 independent prescribers) participated. Eighteen (47%) had a primary practice site from community practice, eight (21%) primary care, five (13%) hospital practice and seven (18%) from other settings including specialty clinics and long-term care. Twenty-eight participants were categorized as adopters and ten as non-adopters in their primary practice setting. Prescribing practices adopted were characterized as product focused, disease focused or patient focused. Sixteen (42%) described product-focused prescribing where they continued an existing therapy or substituted medications based on formulary guidelines. Seven (18%) described disease-focused prescribing where current therapies were adapted or initiated based on a protocol in a specific therapeutic area. Five (13%) described patient-focused prescribing where they initiated therapy based on patient needs and values, their assessment of the patient and best evidence. Non-adopters were not prescribing, but many described provision of disease or patient-focused care where they influenced prescribing by interacting with other members of the healthcare team. Most commonly, community pharmacists participated in product-focused prescribing, whereas hospital and primary care pharmacists practised disease-focused prescribing. WHAT IS NEW AND CONCLUSION: Our data suggest that there have been context-related differences in uptake across practice settings. Despite this, pharmacists in all studied settings engaged in prescribing activities using three approaches and many pharmacists who were not directly prescribing medications reported having involvement in drug therapy decision-making.

[Academic cell therapy facilities are challenged by European regulation on advanced therapy medicinal products]. / Les unités de thérapie cellulaire à l'épreuve de la réglementation sur les médicaments de thérapie innovante.

Regulation (EC) n° 1394/2007 from the European Parliament and the Council describes a new category of health products termed « Advanced Therapy Medicinal Products ¼ (ATMPs). ATMPs derive from cell engineering, tissue engineering or genetic manipulations, and can in some instances be combined with medical devices. ATMPs are distributed and administered to patients, after biotechnology or pharmaceutical companies have obtained a marketing authorization that is granted by the European Commission on the basis of the European Medicines Agency (EMA) assessment. Seven years after the publication of the regulation, few of these therapies have received a marketing authorization, and even fewer have met commercial success, suggesting that a number of medical and economic issues still need to be sorted out in order to achieve sustainability in this field. The coexistence of three sets of rules for three categories of health products that are biologically and medically related - ATMPs, ATMPs produced under the hospital exemption rule, and cell therapy products (CTPs) (a specific legal category in France) that have long been used in hematopoietic cell transplantation - constitutes a complex regulatory framework. This situation raises significant issues for historical as well as emerging operators in this moving field that are discussed thereafter.

Exploring the potential impact of hospital ward-based pharmacy interns on drug safety.

Clinical pharmacists play an important role in improving drug safety on hospital wards. However, little is known about the impact of pharmacy interns. The objective of our study was, therefore, to investigate the impact of hospital ward-based pharmacy interns on drug safety. This study was conducted as part of the project "P-STAT 2: Pharmacy interns on the ward" on 14 surgical wards in seven hospitals in Germany and a total of 27 pharmacy interns participated. All patients admitted to the participating wards from 1st June 2008 until 31st October 2008 and from 1st December 2008 till 30th April 2009 were included. The pharmacy interns were involved in medication reconciliation, and identifying, resolving, and preventing drug-related problems (DRPs) using the classification system APS-Doc. A total of 6,551 patients were included. Patients received on average (+/- SD) 4.4 +/- 3.9 drugs. The pharmacy interns detected a total of 4,085 DRPs and on average 0.6 +/- 1.2 DRPs per patient. Most frequently detected DRPs were potential drug-drug interactions (n = 591, 14%), missing drug strength, when different strengths were available (n = 373, 9%), and incomplete medication record (n = 296, 7%). The pharmacy interns conducted an intervention for 98% (n = 4,011) of all DRPs. According to their documentation, 74% of the DRPs (n = 3,038) were solved. Drugs which were most often related with DRPs were simvastatin, diclofenac, and ibuprofen. This is the very first study exploring the potential impact of pharmacy interns on drug safety on surgical wards in Europe. Pharmacy interns can play an important role to improve drug safety on hospital wards.

Pharmacy in Turkey: past, present, and future.

Pharmacy in Turkey underwent a radical change within the last decade. Introduction of the Health Transformation Program in 2003 has had a significant impact on Turkey's pharmacy system in accordance with objectives of the program to establish new pricing regulations for pharmaceuticals based on reference prices, and to develop better computer based health information/record systems. In this context, Pharmaceutical Tracking (Track-and-Trace) System using two dimensional matrix barcodes was initiated to prevent not only drug counterfeiting, but also fraud against the medical insurance system and off-record transactions within the pharmaceutical sector; and the process of recording prescriptions in an electronic format was launched. Some other improvements have also been made with respect to pharmacy education, law and practice. In contrast with all these positive outcomes, Turkish pharmacy sector is currently in a deep financial struggle. This paper aims to provide a brief overview of the recent developments in Turkish pharmacy system and to discuss future roles and challenges of the profession.

[Hospital pharmacy residency in France in 2014: to a recognition of the specialization?]. / L'internat en pharmacie hospitalière en France à l'horizon 2014 : vers une formation reconnue ?

The current format of French residency in hospital pharmacy was created in 1983 and is a 4-year specialized training. So far, training has not been recognized as a prerequisite for hospital pharmacy practice. Since 2011, pharmacy residents and hospital pharmacists representative structures have lobbied for that recognition and the government has worked in that direction. The ideology of the concept was validated after a period of probation and the regulatory procedure began late 2012. Two key elements were initially identified as obstacles: first the European legislation on recognition of professional qualifications and then the fear that there might not be enough hospital pharmacists trained in order to complete the care missions in hospital pharmacies in France. The European legislation has now been amended in order to recognize professional qualifications and a demographic analysis of hospital pharmacists leads to the conclusion that these items are no longer obstacles. In 2014, hospital pharmacy residency, through the Specialized Studies degree, should be recognized as a prerequisite for hospital pharmacy practice.