Negative Consequences of the Widespread and Inappropriate Easy Access to Purchasing Prescription Medications on the Internet.

BACKGROUND: The purchase of prescription medications via the Internet is a global phenomenon with significant economic, social, and health-related impacts. The growth of online purchasing of prescription medicines is significant and has been amplified by social isolation related to the COVID-19 pandemic, with many patients unable to obtain medicines as they normally would. By contrast, there are licensed, certified, legitimate retail pharmacies that provide significant and vital services to patients. OBJECTIVE: To review the major public health threat from illegal entities that sell any type of prescription medicines to individuals without proper physician oversight. DISCUSSION: Rogue and inappropriate online vendors are providing counterfeit and substandard medications fraudulently with untold impacts on morbidity and mortality globally. This article presents the differentiation between the types of legal and illegal Internet pharmacies, as well as the actions that are currently in play to affect the illegal online purchase of prescription medicines. Much must be done in a collaborative, global effort to address the public health threat of obtaining prescription drugs via the Internet. CONCLUSION: Global, federal, state, health professional, societal, and patient-specific collaborations are necessary to affect the significant threat that is now present via the increasing ease of access to online medication purchases.

Cannabis for Chronic Pain: Challenges and Considerations.

The National Academies of Sciences, Engineering, and Medicine has found substantial evidence that cannabis (plant) is effective for the treatment of chronic pain in adults, and moderate evidence that oromucosal cannabinoids (extracts, especially nabiximols) improve short-term sleep disturbances in chronic pain. The paradoxical superiority of the cannabis plant over cannabinoid molecules represents a challenge for the medical community and the established processes that define modern pharmacy. The expanding and variable legalization of cannabis in multiple states nationwide represents an additional challenge for patients and the medical community because recreational and medicinal cannabis are irresponsibly overlapped. Cannabis designed for recreational use (containing high levels of active ingredients) is increasingly available to patients with chronic pain who do not find relief with current pharmacologic entities, which exposes patients to potential harm. This article analyzes the available scientific evidence to address controversial questions that the current state of cannabis poses for health care professionals and chronic pain patients and sets the basis for a more open discussion about the role of cannabis in modern medicine for pain management. A critical discussion on these points, the legal status of cannabis, and considerations for health care providers is presented.

Associations between communication climate and the frequency of medical error reporting among pharmacists within an inpatient setting.

OBJECTIVE: Although error-reporting systems enable hospitals to accurately track safety climate through the identification of adverse events, these systems may be underused within a work climate of poor communication. The objective of this analysis is to identify the extent to which perceived communication climate among hospital pharmacists impacts medical error reporting rates. METHODS: This cross-sectional study used survey responses from more than 5000 pharmacists responding to the 2010 Hospital Survey on Patient Safety Culture (HSOPSC). Two composite scores were constructed for "communication openness" and "feedback and about error," respectively. Error reporting frequency was defined from the survey question, "In the past 12 months, how many event reports have you filled out and submitted?" Multivariable logistic regressions were used to estimate the likelihood of medical error reporting conditional upon communication openness or feedback levels, controlling for pharmacist years of experience, hospital geographic region, and ownership status. RESULTS: Pharmacists with higher communication openness scores compared with lower scores were 40% more likely to have filed or submitted a medical error report in the past 12 months (OR, 1.4; 95% CI, 1.1-1.7; P = 0.004). In contrast, pharmacists with higher communication feedback scores were not any more likely than those with lower scores to have filed or submitted a medical report in the past 12 months (OR, 1.0; 95% CI, 0.8-1.3; P = 0.97). CONCLUSIONS: Hospital work climates that encourage pharmacists to freely communicate about problems related to patient safety is conducive to medical error reporting. The presence of feedback infrastructures about error may not be sufficient to induce error-reporting behavior.

The importance of survey research standards.

Every discipline within fields of research has instituted guidelines and templates for research endeavors and subsequent publications of findings, with the ultimate result being an increase in quality and acceptance by researchers within and across disciplines. These significant efforts are by nature ongoing, as well they should. These enhancements and guideline developments have been instituted in basic science disciplines, clinical pharmacy, and pharmacy administration relevant and related to subsequent scholarly publication of research findings. Specific research endeavors have included bench research, clinical trials and randomized clinical trials, meta analyses, outcomes research, and large scale database analyses. A similar need for quality and standardization also exists for survey research and scholarship. The purpose of this paper is to clarify why this is important and crucial for the Journal and our academy.

The expanding public health threat of obesity and overweight.

Obesity and overweight is a continuing public health crisis. This health threat respects no boundaries or economic strata, and is a pervasive universal threat with short- and long-term negative sequelae associated. Pharmacists and other health professionals need to structure interventions from individual patient and population-based standpoints. Documentation of effects of programmes needs to be disseminated and incorporated into educational, research and practice-based efforts.

Patients' view of retail clinics as a source of primary care: boon for nurse practitioners?

PURPOSE: To estimate consumer utilities associated with major attributes of retail clinics (RCs). DATA SOURCES: A discrete choice experiment (DCE) with 383 adult residents of the metropolitan statistical areas in Georgia conducted via Random Digit Dial survey of households. The DCE had two levels each of four attributes: price ($59; $75), appointment wait time (same day; 1 day or more), care setting-provider combination (nurse practitioner [NP]-RC; physician-private office), and acute illness (urinary tract infection; influenza), resulting in 16 choice scenarios. The respondents indicated whether they would seek care under each scenario. CONCLUSIONS: Cost savings and convenience offered by RCs are attractive to urban patients, and given sufficient cost savings they are likely to seek care there. All else equal, one would require cost savings of at least $30.21 to seek care from an NP at RC rather than a physician at private office, and $83.20 to wait one day or more. IMPLICATIONS FOR PRACTICE: Appointment wait time is a major determinant of care-seeking decisions for minor illnesses. The size of the consumer utility associated with the convenience feature of RCs indicates that there is likely to be further growth and employment opportunities for NPs in these clinics.