Promoting harm reduction in rural South Dakota using an interdisciplinary consortium.

BACKGROUND: Deaths from drug-related overdoses are increasing. Rural areas continue to have fewer accessible resources than urban areas. The START-SD (Stigma, Treatment, Avoidance, and Recover in Time - South Dakota) project is funded by the Health Resources and Services Administration and aims to address needs surrounding substance use disorder (SUD) in South Dakota. Pharmacists can play a key role in these efforts. OBJECTIVE: Describe harm reduction and prevention activities implemented through START-SD to reduce the impact of SUD in South Dakota. PRACTICE DESCRIPTION: The interdisciplinary team at South Dakota State University, including pharmacists and student pharmacist researchers, partnered with collaborating organizations to provide improved access to prevention, treatment, and recovery services for those impacted by SUD. PRACTICE INNOVATION: Given the rural and conservative nature of the state, the START-SD team used an innovative framework to implement harm reduction and prevention programs that other states could adopt. EVALUATION METHODS: Because the START-SD project uses evidence-based programs, evaluation focuses on the number of programs implemented and the number of people subsequently served. Data are collected and reported biannually by the team. RESULTS: The core team established and expanded an interdisciplinary consortium and advisory board. A variety of harm reduction and prevention strategies were implemented: establishing and developing partnerships with key organizations, working to increase access to harm reduction programs, facilitating educational activities and trainings, and working to reduce stigma related to SUD and harm reduction. DISCUSSION: Reducing the impact of SUD requires a broad, multifaceted approach, as well as overcoming many environmental barriers. Pharmacists and pharmacy staff are uniquely positioned to positively affect harm reduction for patients. CONCLUSION: More work to decrease the impact of SUD is needed, particularly in rural areas. Pharmacists can play a key role in projects to increase the reach and impact of prevention, treatment, and recovery efforts.

Does price disclosure in pharmaceutical advertising result in price transparency? Evidence from a randomized experiment.

Background: Policies that mandate list price disclosure in direct-to-consumer pharmaceutical advertising (DTCPA) cite price transparency among the benefits. The expectation is that price transparency will lead to changes in consumer behavior that will ultimately lower healthcare costs. Objective: The objective of this study was to assess the impact of price transparency on perceived level of information and consumer behaviors, specifically intentions to seek treatment and intentions to comparison shop. Methods: A nine-arm randomized experiment was conducted to expose respondents to television advertisements for prescription drugs that varied by price disclosure type (no price/control, list price only, or price plus, which disclosed the list price and typical out-of-pocket cost) and indicated condition (deep vein thrombosis/pulmonary embolism [DVT/PE], diabetes, or rheumatoid arthritis [RA]). The sample was recruited from US adult members of the nationally representative Amerispeak online panel. Results: The sample included 2138 respondents. For ads featuring prescription drugs for DVT/PE, findings provide no evidence of an impact from price disclosure on perception of sufficient information. For ads for prescription drugs for diabetes, there was no evidence of an impact from list price only, but the price plus group was more likely than the control group to report the ad provided sufficient information (OR = 2.475). For ads for RA prescription drugs, both the list price only group (OR = 3.380) and price plus group (OR = 2.720) were more likely to report sufficient information than the control. Findings provide no evidence of an impact from price disclosure on consumer behaviors (i.e., intention to seek treatment or intention to comparison shop). Conclusions: Mandatory DTCPA list price disclosure may not be the most effective tool for improving price transparency and affecting consumer behavior.

Attention to price disclosures in direct-to-consumer prescription drug advertising and the impact on drug perceptions.

BACKGROUND: Mandatory disclosure of the price of prescription drugs within direct-to-consumer pharmaceutical advertisements (DTCA) has been proposed as a potential means of curbing rising drug costs in the United States. While price transparency in DTCA has widespread public support, empirical evidence regarding the effects of such drug prices disclosures remains limited. OBJECTIVES: This study assessed the degree to which a price disclosure was noticed, the individual characteristics associated with price disclosure recognition, and the impact on perceived drug affordability, effectiveness, and safety. METHODS: A randomized experiment was conducted among 2,138 members of the Amerispeak online panel. Participants were shown a television commercial for a drug treating either type II diabetes, deep vein thrombosis/pulmonary embolism (DVT/PE), or rheumatoid arthritis (RA) that disclosed the list price, disclosed the list price plus the average out-of-pocket cost, or had no price disclosure. RESULTS: Roughly forty percent of participants noticed when a price was disclosed while 20-24% noticed information about individual costs varying (the higher of these percentages occurred when the average out-of-pocket cost was provided). Attention did not vary systematically with the cost amount. Recognition of the different elements of the price disclosure were most predicted by sociodemographic variables such as race, education, and income as well as health characteristics. Price disclosure altered perceived affordability of the advertised medication in a manner consistent with the costs provided, but such consistent significant effects were not found for perceived drug effectiveness and safety. CONCLUSIONS: Repeated exposure to price disclosure in television DTCA or supplementary sources of price information may be necessary to increase attention to drug price information, especially among those who are most vulnerable to the burden of drug costs. Price transparency appears useful for adjusting affordability perceptions, but additional research needs to examine how such perceptions factor into healthcare decision-making and drug pricing.

Insight into development of a mentorship program in a professional pharmacy organization.

INTRODUCTION: The American Association of Colleges of Pharmacy Pharmacy Practice Section appointed a task force charged with developing a formal, national mentorship program for association section members. This manuscript provides insight into the creation of a mentorship program in a professional organization. METHODS: Eighteen task force volunteers were divided into four sub-teams, along with a chair and vice chair. Sub-team responsibilities were segmented into the following: (1) mission and vision development, (2) structure and content, (3) assessment and impact, and (4) dissemination and scholarship. Task force members were surveyed to generate recommendations for creating a formal mentorship program within a professional organization and reflect on the process. RESULTS: Seven of 14 eligible task force members completed the questionnaire (50% response rate). Most participants were mid-career, involved in a range of development aspects, and represented both committee members and leadership within the task force. The average time commitment was 15-19 hours over the year. The most common resource utilized was published literature and guidance documents. Identified needs included validated assessment tools, a wider range of exemplary programs to review, and guidance on broader organizational support. Strengths included organization and sub-team structure. Areas for improvement included coordination between sub-teams and resources available. Participants noted the challenges of creating a program to meet the diverse needs of a large membership. CONCLUSIONS: This manuscript demonstrates the feasibility and evidence-based approach in creation of a mentorship program within a national organization.

Leveraging pharmacists to maintain and extend buprenorphine supply for opioid use disorder amid COVID-19 pandemic.

PURPOSE: Strategies for deploying clinical pharmacists to increase access to buprenorphine in inpatient, outpatient and transitional care, and community practice settings are described. SUMMARY: Access to medications for opioid use disorder (MOUD) is essential, but patients face many barriers when pursuing treatment and MOUD. The coronavirus disease 2019 (COVID-19) pandemic has compounded the opioid crisis and worsened outcomes by introducing new barriers to MOUD access. Many strategies to ensure continued access to MOUD have been described, but the role of leveraging pharmacists during the opioid/COVID-19 syndemic to improve medication access and outcomes remains underappreciated. Pharmacists, while both qualified and capable of liberalizing access to all forms of MOUD, may have the strongest impact by increasing access to buprenorphine. Herein, we present progressive strategies to maintain and extend buprenorphine access for patients with OUD through deployment of clinical pharmacists, particularly in the context of the COVID-19 pandemic, during which access may be further restricted. CONCLUSION: Leveraging pharmacists to extend access to MOUD, particularly buprenorphine, remains an underutilized strategy that should be implemented, particularly during the concurrent COVID-19 global pandemic.

Retinoic acid-responsive CD8 effector T cells are selectively increased in IL-23-rich tissue in gastrointestinal GVHD.

Gastrointestinal (GI) graft-versus-host disease (GVHD) is a major barrier in allogeneic hematopoietic stem cell transplantation (allo-HSCT). The metabolite retinoic acid (RA) potentiates GI-GVHD in mice via alloreactive T cells expressing the RA receptor-α (RARα), but the role of RA-responsive cells in human GI-GVHD remains undefined. Therefore, we used conventional and novel sequential immunostaining and flow cytometry to scrutinize RA-responsive T cells in tissues and blood of patients who had received allo-HSCT and to characterize the impact of RA on human T-cell alloresponses. Expression of RARα by human mononuclear cells was increased after exposure to RA. RARαhi mononuclear cells were increased in GI-GVHD tissue, contained more cellular RA-binding proteins, localized with tissue damage, and correlated with GVHD severity and mortality. By using a targeted candidate protein approach, we predicted the phenotype of RA-responsive T cells in the context of increased microenvironmental interleukin-23 (IL-23). Sequential immunostaining confirmed the presence of a population of RARαhi CD8 T cells with the predicted phenotype that coexpressed the effector T-cell transcription factor T-bet and the IL-23-specific receptor (IL-23R). These cells were increased in GI- but not skin-GVHD tissues and were also selectively expanded in the blood of patients with GI-GVHD. Finally, functional approaches demonstrated that RA predominantly increased alloreactive GI-tropic RARαhi CD8 effector T cells, including cells with the phenotype identified in vivo. IL-23-rich conditions potentiated this effect by selectively increasing ß7 integrin expression on CD8 effector T cells and reducing CD4 T cells with a regulatory cell phenotype. In summary, we have identified a population of RA-responsive effector T cells with a distinctive phenotype that is selectively expanded in human GI-GVHD and that represents a potential new therapeutic target.

Mental Health Literacy Affects Mental Health Attitude: Is There a Gender Difference?

Objectives: In the current study, we aimed to compare the levels of and factors associated with mental health attitude between males and females. Of particular interest was ascertaining the degree to which mental health literacy was related to mental health attitude and whether this relationship would vary by gender. Methods: A total of 732 participants aged 18 years or more were recruited from attendees at the 2016 Minnesota State Fair. We used the Mental Health Literacy Scale (MHLS) to measure attitude toward and literacy of mental health. Results: Our multivariate analysis reported that males' mental health attitude was significantly lower than females. Some factors associated with mental health attitude differed by gender as well. Among men, receiving more social support, experiencing higher levels of depression, and being married predicted greater mental health attitude. Among women, older age was associated with lower mental health attitude levels. However, mental health literacy was the strongest factor regardless of gender. Men and women with greater mental health literacy had a more positive mental health attitude. Conclusions: Provision of tailored mental health literacy education both for males and females could potentially improve the public's mental health attitude toward mental illness.

Report of the 2020 Special Committee on Substance Use and Pharmacy Education.

EXECUTIVE SUMMARYThe 2020 Special Committee on Substance Use and Pharmacy Education was charged to update the work of the 2010 Special Committee on Substance Abuse and Pharmacy Education Report (SAPER) specifically with recommendations on core curricular content and delivery processes on substance misuse and substance use disorder (SUD). This report provides information on the committee's process to address the charges, background information and resources pertaining to the charges, and rationale for SUD being a critical topic for curriculum at colleges and schools of pharmacy. This committee offers several recommendations to the Association of Colleges of Pharmacy (AACP) pertaining to the committee charges.

Is health literacy associated with mental health literacy? Findings from Mental Health Literacy Scale.

PURPOSE: This study aims to measure associated factors of Mental Health Literacy (MHL) among Minnesotans by using the Mental Health Literacy Scale and Andersen's Health Behavior Model. DESIGN AND METHODS: This study utilized cross-sectional survey data with 732 participants. FINDINGS: Participants in higher education groups showed higher MHL levels than those who have less education. Non-Latino Whites had higher MHL levels than any other racial group. Participants who engaged in social groups had higher MHL levels. Interestingly, the relationship between health literacy and MHL was the most substantial factor. PRACTICE IMPLICATIONS: Interventions aiming to improve health literacy seems beneficial to increase MHL. In addition, a variety of programs should be implemented, such as social programs that target those with less social group interaction.

The Use of Narratives to Deliver Information in Direct-To-Consumer Prescription Drug Commercials: A Content Analysis.

Information communicated through a narrative format is typically processed and evaluated differently compared to non-narrative formats. Therefore, differences in the use of narratives across various information categories within direct-to-consumer prescription drug advertisements (DTCA) could have significant implications for consumers' processing of that information. Such differences could have further implications regarding the "fair balance" rule put forth by the Food and Drug Administration (FDA). This study sought to document the presence and nature of narrative and non-narrative messages in a content analysis of 61 U.S.-based broadcast DTCA airing during 2016. Specific narrative styles (classic drama, vignette, first person, second person, third person) were distinguished from non-narrative styles (lecture, directive, endorsement, graphic/demonstration) according to key characteristics of each (chronology and character, showing versus telling). Results indicated widespread use of narrative styles in DTCA overall, but the styles used differed substantially between different types of information. Narrative styles were delivered prominently to present health condition and drug benefits information while non-narrative styles primarily reinforced drug benefits and presented drug risks. These differences offer a new frame through which to view an imbalanced presentation of drug risks and benefits and provide a foundation for future research to test the effects of various narrative and non-narrative forms on patient understanding and message recall.

Optimal Intensity of Warfarin Therapy in Patients With Mechanical Aortic Valves.

OBJECTIVE:: To review the current guidelines and published literature in order to identify the evidence-based international normalized ratio (INR) goal in patients with a mechanical aortic valve. DATA SOURCES:: Medline/PubMed, Cochrane and Google Scholar database searches for relevant articles from 1946 through March 2017 were executed using the key words "mechanical aortic valve" and "antithrombotic therapy or anticoagulation therapy or warfarin." STUDY SELECTION AND DATA EXTRACTION:: All English-language observational and interventional studies assessing INR goals in patients with a mechanical aortic valve were evaluated. RESULTS:: After low thrombogenic valves became standard in the practice, the INR goal decreased to 2 to 3 in low-risk recipients with most of bileaflet mechanical aortic valves. There is a paucity of data to justify the INR goal of 2 to 3 in high-risk patients. Until further higher evidence is available, it is reasonable to target an INR range of 2.5 to 3.5 in patients with risk factors for thromboembolism with low thrombogenic valves, except for On-X valve. The INR goal in high-risk On-X aortic valve recipients can be managed at 1.5 to 2.5 with low-dose aspirin 3 months after valve implantation. CONCLUSION:: The INR goals of 2 to 3 for low risk and 2.5 to 3.5 for high risk should be considered for bileaflet mechanical aortic valve recipients. Additionally, a lower INR goal of 2 to 3 for the first 3 months after valve replacement followed by an INR goal of 1.5 to 2.5 in both low- and high-risk aortic On-X valve recipients may be considered.

An Updated Analysis of Direct-to-Consumer Television Advertisements for Prescription Drugs.

PURPOSE: In 2015, the American Medical Association called for a ban of direct-to-consumer advertising (DTCA) for prescription drugs. Yet, the pharmaceutical industry spends more than ever on broadcast advertisements, with national health care costs largely driven by drug spending. An evaluation of these ads is critical, as these advertisements can impact the frequency which patients ask their doctors about medications. METHODS: A content analysis of prime-time direct-to-consumer ads was conducted across 4 major cable television networks. The ad content (n = 61) was coded for factual claims made regarding target conditions, appeals used, portrayal of medications, and lifestyle characteristics shown. RESULTS: We found a substantial decrease in the percentage of ads that conveyed information about the conditions being targeted, such as risk factors (16%) and prevalence (16%). Positive emotional appeals (94%) continued to be emphasized; yet there was decreased use of negative emotional appeals (51%), pointing to an overall more positive portrayal of a patient's experience with a medication. The lifestyles portrayed in the sample largely featured how products can enable more recreational activities (69%) and fewer ads (7%) presented alternatives to product use. CONCLUSIONS: Direct-to-consumer advertising continued to promote prescription drugs above educating the population. Improvement in the educational value of DTCA is likely to require regulatory action rather than reliance on self-regulation by the pharmaceutical industry.

Hydrogen Peroxide Triggers a Dual Signaling Axis To Selectively Suppress Activated Human T Lymphocyte Migration.

H2O2 is an early danger cue required for innate immune cell recruitment to wounds. To date, little is known about whether H2O2 is required for the migration of human adaptive immune cells to sites of inflammation. However, oxidative stress is known to impair T cell activity, induce actin stiffness, and inhibit cell polarization. In this study, we show that low oxidative concentrations of H2O2 also impede chemokinesis and chemotaxis of previously activated human T cells to CXCL11, but not CXCL10 or CXCL12. We show that this deficiency in migration is due to a reduction in inflammatory chemokine receptor CXCR3 surface expression and cellular activation of lipid phosphatase SHIP-1. We demonstrate that H2O2 acts through an Src kinase to activate a negative regulator of PI3K signaling, SHIP-1 via phosphorylation, providing a molecular mechanism for H2O2-induced chemotaxis deficiency. We hypothesize that although H2O2 serves as an early recruitment trigger for innate immune cells, it appears to operate as an inhibitor of T lymphocyte immune adaptive responses that are not required until later in the repair process.

The Moderating Role of Age in Responses to Direct-to-Consumer Prescription Drug Advertising.

Age is an important factor that can influence processing of and response to health messages. Many studies examining evaluations of and responses to direct-to-consumer prescription drug advertising (DTCA) have incorporated age as a predictor variable, moderating variable, or sample criterion. However, findings have been inconsistent. This study attempts to add clarity to this body of research by assessing age differences in the antecedent factors of various DTCA outcomes. A multigroup structural equation modeling analysis revealed several significant differences in variable relationships between older (50+) and younger (<50) adults. Overall, older adults exhibited greater complexity in their consideration of DTCA than younger adults in terms of the sheer number of significant relationships within the model. In particular, trust in mediated health information sources and trust in one's physician appeared to be more relevant predictors for older adults. Trust in DTCA was also distinguished as having an inverse relationship with behavioral intentions among older adults while showing a straightforward positive association with attention among younger adults. Further analysis indicated that health status accounted for some but not all of the age differences. It is suggested that younger adults are more open to seeking additional information following DTCA exposure, whereas older adults remain ambivalent.

Factors associated with the persuasiveness of direct-to-consumer advertising on HPV vaccination among young women.

This quantitative study explored young women's response to direct-to-consumer pharmaceutical advertising (DTCA) for a human papillomavirus (HPV) vaccine. In particular, the study examined (a) the association of factors stemming from consumer research with actual and intended behavioral responses to DTCA for HPV and (b) key elements drawn from commonly used health-related theories to determine the strongest associations with behavioral intentions regarding the HPV vaccine. Survey findings showed that vaccinated women indicated that DTCA played a role in their decision to get vaccinated against HPV more so than those who were not vaccinated. Trust in DTCA for an HPV vaccine brand was significantly related to intentions to seek more information about the vaccine. Also, perceived barriers had the only significant association with behavioral intentions when taking into account perceived threat and response efficacy. These results provide practical implications for key industry decision makers and health communication professionals on the design of effective theory-based health communication message content for an HPV vaccine brand with consequent social implications.