Do disasters predict international pharmacy legislation?

Objective The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007-17 and 2013-17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation . Conclusions It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic? The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add? This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners? Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies.

Authority of Pharmacists to Administer Human Papillomavirus Vaccine: Alignment of State Laws With Age-Level Recommendations.

OBJECTIVES: One strategy to increase the uptake of human papillomavirus (HPV) vaccine among adolescents is through the use of pharmacists. Our objectives were to (1) use a publicly available database to describe the statutory and regulatory authority of pharmacists to administer the HPV vaccine in the United States and (2) discuss how the current status of laws may influence achievement of the Healthy People 2020 goal of 80% HPV vaccination rate for teenagers aged 13-15. METHODS: Using information from the Centers for Disease Control and Prevention's (CDC's) Public Health Law Program database, we identified state laws in effect as of January 1, 2016, giving pharmacists authority to administer vaccines. We used a standardized analysis algorithm to determine whether states' laws (1) authorized pharmacists to administer HPV vaccine, (2) required third-party authorization for pharmacist administration, and (3) restricted HPV vaccine administration by pharmacists to certain patient age groups. RESULTS: Of 50 states and the District of Columbia, 40 had laws expressly granting pharmacists authority to administer HPV vaccine to patients, but only 22 had laws that authorized pharmacists to vaccinate preadolescents aged 11 or 12 (ie, the CDC-recommended age group). Pharmacists were granted prescriptive authority by 5 states, and they were given authority pursuant to general (non-patient-specific) third-party authorization (eg, a licensed health care provider) by 32 states or patient-specific third-party authorization by 3 states. CONCLUSIONS: Most states permitted pharmacists to administer HPV vaccines only to boys and girls older than 11 or 12, which may hinder achievement of the Healthy People 2020 goal for HPV vaccination. Efforts should be made to strengthen the role of pharmacists in addressing this public health issue.

Adherence: a review of education, research, practice, and policy in the United States / Cumplimiento: revisión de la educación, investigación, práctica y política en Estados Unidos

Objective: To describe the education, research, practice, and policy related to pharmacist interventions to improve medication adherence in community settings in the United States. Methods: Authors used MEDLINE and International Pharmaceutical Abstracts (since 1990) to identify community and ambulatory pharmacy intervention studies which aimed to improve medication adherence. The authors also searched the primary literature using Ovid to identify studies related to the pharmacy teaching of medication adherence. The bibliographies of relevant studies were reviewed in order to identify additional literature. We searched the tables of content of three US pharmacy education journals and reviewed the American Association of Colleges of Pharmacy website for materials on teaching adherence principles. Policies related to medication adherence were identified based on what was commonly known to the authors from professional experience, attendance at professional meetings, and pharmacy journals. Results: Research and Practice: 29 studies were identified: 18 randomized controlled trials; 3 prospective cohort studies; 2 retrospective cohort studies; 5 case-controlled studies; and one other study. There was considerable variability in types of interventions and use of adherence measures. Many of the interventions were completed by pharmacists with advanced clinical backgrounds and not typical of pharmacists in community settings. The positive intervention effects had either decreased or not been sustained after interventions were removed. Although not formally assessed, in general, the average community pharmacy did not routinely assess and/or intervene on medication adherence. Education: National pharmacy education groups support the need for pharmacists to learn and use adherence-related skills. Educational efforts involving adherence have focused on students' awareness of adherence barriers and communication skills needed to engage patients in behavioral change. Policy: Several changes in pharmacy practice and national legislation have provided pharmacists opportunities to intervene and monitor medication adherence. Some of these changes have involved the use of technologies and provision of specialized services to improve adherence. Conclusions: Researchers and practitioners need to evaluate feasible and sustainable models for pharmacists in community settings to consistently and efficiently help patients better use their medications and improve their health outcomes (AU)

Objetivo: Describir la educación, investigación, practica y política relacionadas con las intervenciones farmacéuticas para mejorar el cumplimiento de la medicación en establecimientos comunitarios en Estados Unidos. Métodos: Los autores utilizaron Medline e International Pharmaceutical Abstracts (desde 1990) para identificar los estudios de intervención de farmacia comunitaria y ambulatoria que trataban de mejorar el cumplimiento de la medicación. Los autores también buscaron en literatura primaria usando Ovid para identificar estudios relativos a la enseñanza de farmacia sobre cumplimiento de la medicación. Se revisaron las bibliografías de los estudios relevantes para identificar literatura adicional. Buscamos en los sumarios de tres revistas de educación de farmacia de Estados Unidos y se revisó la web de la Asociación Americana de Facultades de Farmacia a la busca de materiales sobre principios de educación sobre cumplimiento. Las políticas relacionadas con cumplimiento de medicación se identificaron mediante lo que era conocido por los autores desde su experiencia profesional, asistencia a congresos y revistas farmacéuticas. Resultados: Investigación y práctica: se identificaron 29 estudios: 18 ensayos controlados aleatorizados; 3 estudios de cohorte prospectivos; 2 estudios de cohorte retrospectivos; 5 estudios de caso control; y otro estudio. Hubo una considerable variabilidad en los tipos de intervenciones y en el uso de medidas del cumplimiento. Muchas de las intervenciones eran realizadas por farmacéuticos con formación clínica avanzada y no por típicos farmacéuticos comunitarios. Los efectos positivos de las intervenciones disminuyeron o no se mantuvieron después de que las intervenciones desaparecieron. Aunque no se evaluó formalmente, en general, las farmacias comunitarias normales no evaluaban rutinariamente y/o intervenían en el cumplimiento de la medicación. Educación: Los grupos nacionales de educación de farmacia apoyan la necesidad de que los farmacéuticos aprendan y usen habilidades relacionadas con el cumplimiento. Los esfuerzos educativos relacionados con el cumplimiento se han centrado en el conocimiento de los estudiantes de las barreras al cumplimiento y en las habilidades de comunicación necesarias para envolver a los pacientes en un cambio actitudinal. Política: Varios cambios en el ejercicio de la farmacia y en la legislación nacional han proporcionado a los farmacéuticos la oportunidad de intervenir y monitorizar el cumplimiento de la medicación. Algunos de estos cambios incluyeron el uso de tecnologías y la provisión de servicios especializados para mejorar el cumplimiento. Conclusiones: Los investigadores y facultativos necesitan evaluar modelos factibles y sostenibles para los farmacéuticos en la comunidad para ayudar consistente y eficientemente a pacientes en su mejor uso de las medicaciones y mejorar sus resultados en salud (AU)