Informing inclusive and affirmative hospital pharmacy services for 2SLGBTQ+ patients.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: Two-spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) people disproportionally experience health disparities, and hospital pharmacists, given their accessibility and expertise in medication management, are ideally positioned to provide care to this vulnerable population. This study investigated the barriers and facilitators faced by hospital pharmacists when providing care to 2SLGBTQ+ patients, with the goal of informing enhancement of quality care provided to these patients. METHODS: A mixed-methods triangulation design was utilized, comprising an online survey and qualitative interviews with Canadian hospital pharmacists. The survey used the lens of systemic oppression as a framework and assessed pharmacists' perceptions and knowledge. Survey data were analyzed using descriptive statistics, and interviews were analyzed using thematic analysis. RESULTS: A total of 129 individuals participated in the survey, and 15 participants were interviewed. Eleven themes were identified, and findings revealed a complex web of individual, interpersonal, and systemic barriers and facilitators. Pharmacists expressed a lack of proficiency and confidence in discussing 2SLGBTQ+ health topics, further compounded by an apprehension to engage and a fear of causing harm. Pharmacists desired support from their leadership teams and organizations in the form of access to resources, time to engage in training, and workplace environments that encourage discussions about 2SLGBTQ+ health. CONCLUSION: Hospital pharmacists in Canada are willing to provide inclusive care to 2SLGBTQ+ patients but face significant barriers. These findings highlight the need for comprehensive education, supportive workplace cultures, and accessible resources to address health disparities and improve care for 2SLGBTQ+ individuals.

A Scoping Review of Interprofessional Education Training Aimed to Improve 2SLGBTQ+ Health.

OBJECTIVES: This scoping review aims to identify and summarize the available literature on 2-spirited, lesbian, gay, bisexual, transgender, queer, plus (2SLGBTQ+) interprofessional health education and to identify optimal methods of interprofessional training to improve health care professional competency for this patient population. METHODS: A search of PubMed and Embase was conducted and supplemented with a manual search of reference lists from identified articles. Articles were included if they reported an interprofessional education event on the topic of 2SLGBTQ+ health to at least 2 or more groups of health care professionals or students. Article screening was completed independently by 2 reviewers. Data from the included articles were extracted and mapped according to the type of participant (health care students or working health care professionals), type of event (workshop, case-based, course/curriculum, or forum), and type of assessment. RESULTS: One hundred articles were screened, of which 15 articles met the inclusion criteria. Twelve articles focused on interprofessional health education for entry-to-practice students, with the remaining 3 articles involving practicing health care professionals. When mapped by type of event, 1-time case-based and workshop style events were the most used to deliver training. All 15 studies used an immediate presurvey and postsurvey design to evaluate the knowledge and competence of the participants after training. CONCLUSIONS: Interprofessional education for improving 2SLGBTQ+ health is largely delivered within entry-to-practice degree programs via 1-time events with knowledge- and confidence-based assessments. Further research is needed to determine the impact of this training in practice, as well as the applicability for the training of practicing health care professionals.

Barriers and Facilitators Related to Delivery of Hospital Pharmacy Services to Women, Children, and Their Families during a Pandemic: A Qualitative Study.

Background: When the COVID-19 pandemic was declared in March 2020, health care professionals were challenged to adapt quickly and efficiently to change their work practices. However, an evidence-informed approach has not yet been used to systematically gather data on barriers and facilitators related to delivery of hospital pharmacy services in Canada. Objectives: The primary objective was to identify and describe barriers and facilitators related to the delivery of hospital pharmacy services to women, children, and their families during the COVID-19 pandemic. The secondary objective was to provide recommendations for improvement in delivery of pharmacy services to enhance patient care during pandemics. Methods: This qualitative study involved semistructured virtual interviews with pharmacists who worked in direct or nondirect patient care throughout the pandemic (since March 2020) at women's and/or children's hospitals in Canada. Individual interviews were completed virtually using conferencing software. An interview guide mapped to the Theoretical Domains Framework version 2 (TDFV2) was used to facilitate the interviews. Interviews were audio-recorded and transcribed verbatim by the principal investigator. Transcribed interviews were coded, mapped to the TDFV2, and analyzed using thematic analysis. Results: Interviews were completed with 21 pharmacists in 7 provinces across Canada. Barriers and facilitators coded to the TDFV2 were grouped into 4 main themes: communication and collaboration, adaptability, health and well-being, and preparedness. Conclusions: Participants highlighted a significant number of barriers that they experienced during the COVID-19 pandemic; overall, however, participants reported that they felt prepared for subsequent waves of the COVID-19 pandemic and future pandemics.

Contexte: Lors de la déclaration de la pandémie de COVID-19 en mars 2020, les professionnels de la santé ont été mis au défi de s'adapter rapidement et efficacement à la situation en changeant leurs pratiques professionnelles. Cependant, une approche fondée sur des données probantes pour recueillir systématiquement des données sur les obstacles à la prestation des services de pharmacie hospitalière au Canada et les éléments facilitant celle-ci n'a pas encore été utilisée de manière systématique. Objectifs: L'objectif principal consistait à identifier et à décrire les obstacles à la prestation de services de pharmacie hospitalière aux femmes, aux enfants et à leur famille et les éléments facilitant celle-ci pendant la pandémie de COVID-19. L'objectif secondaire consistait, quant à lui, à fournir des recommandations pour améliorer la prestation de services de pharmacie afin d'améliorer les soins aux patients pendant une pandémie. Méthodes: Cette étude qualitative comprenait des entrevues virtuelles semi-structurées avec des pharmaciens ayant travaillé dans le domaine des soins directs ou non directs aux patients tout au long de la pandémie (depuis mars 2020) dans des hôpitaux pour femmes et/ou enfants au Canada. Les entretiens individuels ont été réalisés virtuellement à l'aide d'un logiciel de conférence. Un guide d'entretien adapté de la 2e version du cadre des domaines théoriques (TDFV2) [Theoretical Domains Framework] a été utilisé pour faciliter les entretiens. Ceux-ci ont été enregistrés sur bande audio et retranscrits textuellement par le chercheur principal. Les entretiens ainsi retranscrits ont été codés, reportés sur le TDFV2 et analysés par thème. Résultats: Des entrevues ont été réalisées auprès de 21 pharmaciens dans 7 provinces du Canada. Les obstacles et les éléments facilitateurs codés selon le TDFV2 ont été regroupés en 4 grands thèmes: communication et collaboration; adaptabilité; santé et bien-être; et état de préparation. Conclusions: Les participants ont mentionné un nombre important d'obstacles qu'ils ont rencontrés pendant la pandémie de COVID-19; dans l'ensemble, cependant, les participants ont déclaré qu'ils se sentaient préparés aux vagues ultérieures de la pandémie de COVID-19 et aux futures pandémies.

Comparison of standard versus high-dose ibuprofen for the treatment of hemodynamically significant patent ductus arteriosus in preterm infants.

OBJECTIVE: To evaluate the effectiveness and safety of standard vs. high-dose ibuprofen for the treatment of hemodynamically significant patent ductus arteriosus(hs-PDA). STUDY DESIGN: A retrospective study of preterm infants who received either standard (10-5-5 mg/kg/day) or high (postnatal age 1-3 days: 10-5-5 mg/kg/day; 3-5 days: 15-7.5-7.5 mg/kg/day; >5 days: 20-10-10 mg/kg/day) dose ibuprofen for hs-PDA was conducted. RESULT: Sixty preterm infants with a mean birthweight of 898.2 (±262.6) g and mean gestational age of 26.3 (±0.6) weeks were included. High-dose ibuprofen was associated with a 21%(95% CI, -1.87 to 39.06%; p = 0.07) absolute reduction in PDA ligation compared to standard-dose ibuprofen. On adjusted analysis, receipt of standard-dose ibuprofen (OR 7.37, 95% CI, 1.2-45.27; p = 0.03) independently predicted increased PDA ligation risk. There were no differences in oliguria, NEC, or BPD between groups. CONCLUSION: High-dose ibuprofen may significantly reduce PDA ligations. No difference in the safety profile with high-dose ibuprofen as compared to the standard-dose regimen was demonstrated.