Retroactive application of the EPIS framework to promote future implementation success in community pharmacy clinical interventions.

BACKGROUND: The assessment of the implementation process of a clinical intervention in a community pharmacy setting can reveal useful insights for future implementation efforts. OBJECTIVE: We aimed to examine the implementation of a community pharmacist-led prospective registry and practice tool (RxING, Epidemiology Research Coordinating Center and the University of Alberta) designed to reduce cardiovascular risk among patients with diabetes and to assess how the participating pharmacists could be supported at each of these stages. METHODS: Semistructured interviews were conducted developed using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. The EPIS framework was used to evaluate the implementation of an online, guideline-driven tool (RxING tool) designed to help pharmacists implement and document the care of patients with diabetes by a group of community pharmacies located in Alberta, Canada. RESULTS: In relation to the preparation phase, responses focused more on suitability of the work environments and less on workflow adjustment. With regard to the implementation stage, participants mentioned that often the pharmacy manager or owner received the training to operate the RxING tool, complicating their ability to engage in regular patient recruitment and follow-up. Most pharmacies did not have specific goals relating to patient recruitment and retention. Concerns hindering sustainability of the evidence-based practice centered around the time-consuming online documentation process and patient retention. Finally, innovation factors identified from the pharmacists' responses were related to patient recruitment and streamlining the documentation process. CONCLUSIONS: This study identified 17 key recommendations that should be considered when designing and implementing future community pharmacy-led projects. In particular, providing assistance and training to pharmacies on-site, specific planning for program roll-out, identifying participating staff who have the time to engage with the program, and troubleshooting how to best integrate programs in normal workflow processes are some key recommendations.

Financial toxicity and its impact on health outcomes and caregiver burden among adult cancer survivors in the USA.

Aim: To examine the association between cancer-related financial toxicity on cancer survivors' physical and mental health outcomes and caregiver burden. Materials & methods: 2016-2017 Medical Expenditure Panel Survey data were used to identify adult cancer survivors with cancer-related financial toxicity. Multivariable regression analyses were employed to examine the association between cancer-related financial toxicity and cancer survivors' self-reported physical and mental health outcomes and caregiver burden. Results: A total of 53.7% of adult cancer survivors reported experiencing financial toxicity. Those who experienced financial toxicity reported 14% greater pain, and poorer physical and mental health outcomes as compared to those who did not experience financial toxicity, ranging from 38% greater odds for activity limitations to 427% greater odds for mental task limitation. Moreover, cancer survivors with financial toxicity reported 206% greater odds for caregiver burden. Conclusions: Intervention programs for reducing financial toxicity among adult cancer survivors and their caregivers should be developed.

The cost of cancer care has increased substantially over the past decade imposing significant financial burden on cancer survivors, with a growing number of cancer survivors experiencing financial toxicity. Using the Cancer Self-Administered Questionnaire of the Medical Expenditure Panel Survey, this study estimated the impact of cancer-related financial toxicity on cancer survivors' self-reported health outcomes and caregiver burden. The results highlight the impact of financial toxicity on cancer survivors' physical health and mental health outcomes and caregiver burden in a nationally representative sample of noninstitutionalized adults in the USA. The study findings document the critical need to develop interventions and implement structural policy changes aimed at identifying and reducing financial toxicity among adult cancer survivors and their caregivers.

The Long-Term Impact of Levodopa/Carbidopa Intestinal Gel on 'Off'-time in Patients with Advanced Parkinson's Disease: A Systematic Review.

INTRODUCTION: Levodopa/carbidopa intestinal gel (LCIG; carbidopa/levodopa enteral suspension) has been widely used and studied for the treatment of motor fluctuations in levodopa-responsive patients with advanced Parkinson's disease (PD) when other treatments have not given satisfactory results. Reduction in 'off'-time is a common primary endpoint in studies of LCIG, and it is important to assess the durability of this response. This systematic literature review was conducted to qualitatively summarise the data on the long-term effects of LCIG therapy on 'off'-time. METHODS: Studies were identified by searching PubMed, EMBASE and Ovid on 30 September 2019. Studies were included if they reported on patients with PD, had a sample size of ≥ 10, LCIG was an active intervention and 'off'-time was reported for ≥ 12 months after initiation of LCIG treatment. Randomised clinical trials, retrospective and prospective observational studies, and other interventional studies were included for selection. Data were collected on: 'off'-time (at pre-specified time periods and the end of follow-up), study characteristics, Unified Parkinson's Disease Rating Scale (UPDRS) II, III and IV total scores, dyskinesia duration, quality of life scores, non-motor symptoms and safety outcomes. RESULTS: Twenty-seven studies were included in this review. The improvement in 'off'-time observed shortly after initiating LCIG was maintained and was statistically significant at the end of follow-up in 24 of 27 studies. 'Off'-time was reduced from baseline to end of follow-up by 38-84% and was accompanied by a clinically meaningful improvement in quality of life. Stratified analysis of 'off'-time demonstrated mean relative reductions of 47-82% at 3-6 months and up to 83% reduction at 3-5 years of follow-up. Most studies reported significant improvements in activities of daily living and motor complications. Most frequent adverse events were related to the procedure or the device. CONCLUSION: In one of the largest qualitative syntheses of published LCIG studies, LCIG treatment was observed to provide a durable effect in reducing 'off'-time. INFOGRAPHIC: Video Abstract.

By synthesising publications from scientific journals, this article shows that levodopa/carbidopa intestinal gel (LCIG; also known as carbidopa/levodopa enteral suspension or the tradenames Duodopa® and Duopa®) may have benefits for patients with advanced Parkinson's disease that last for 12 months or more. Pills taken by mouth for Parkinson's disease often do not work as well after a few years. This means the symptoms of Parkinson's disease, such as shaking or slow movements, etc., re-emerge despite medication (known as 'off'-time). To reduce the amount of 'off'-time, people with advancing Parkinson's disease may switch from pills to other types of treatments, for example, those that use devices to deliver the drug into the body, such as LCIG. LCIG has been available for many years and is known to help patients by reducing 'off'-time. Despite this, less is known about how long the benefits of LCIG last. By summarising all information available on the long-term use of LCIG, this report shows that when patients have been taking LCIG for at least 12 months, they have 2­4 h less 'off'-time each day than they did before starting the LCIG treatment. This effect is maintained for 3­5 years after starting LCIG treatment. There were no unexpected side effects with long-term use of LCIG. The time not spent in 'off' may allow people with advanced Parkinson's to increase their independence in daily activities.

Factors influencing Human papillomavirus (HPV) vaccination series completion in Mississippi Medicaid.

PURPOSE: To identify factors associated with Human Papillomavirus (HPV) vaccine series completion among vaccine initiators in Mississippi Medicaid. METHODS: 2013-2018 Mississippi Medicaid administrative claims data were analyzed. Female and male beneficiaries aged 9 to 26 years who initiated HPV vaccination in the identification period were assessed for completion of age-appropriate number of recommended doses within a period of 12 months. Sex-stratified multivariable logistic regression was used to examine factors associated with HPV vaccine series completion in the study sample. RESULTS: A total of 18,110 female and 18,186 male beneficiaries initiated HPV vaccine between January 1, 2014 and June 30, 2017. Most of the initiators belonged to ages 11 to 12 years, African American race, managed care plans and Central Mississippi public health region. The vaccine series completion rate was 34% for females and 30% for males. Younger age at initiation was a significant predictor of vaccine series completion in both sexes. Specifically, initiators in age groups 9 to 10 and 11 to 12 years, respectively, had greater odds of completion, while initiators aged 15 to 26 years had lower odds of completion compared to initiators aged 13 to 14 years. Female and male beneficiaries in managed care plans (vs. fee-for-service) and of African American race (vs. Caucasians) had lower odds of completing the vaccine series. Female and male beneficiaries who initiated HPV vaccine series with a pediatrician had the highest completion rates. CONCLUSION: HPV vaccination series completion rate in Mississippi Medicaid was suboptimal despite the high HPV-related cancer incidence in the state. HPV vaccine series completion is influenced by various sociodemographic factors. There is a need for robust education and public health programs to encourage completion of recommended doses.

Population characteristics associated with pharmacy-based influenza vaccination in United States survey data.

OBJECTIVES: To examine the population characteristics associated with the health behavior of receiving an influenza vaccine from a pharmacy-based setting. DESIGN: Secondary analysis of data from states that participated in an optional influenza module in the 2014 Behavioral Risk Factor Surveillance System, a state-based observational survey of U.S. adults. SETTING AND PARTICIPANTS: Analytic sample of 28,954 respondents from 8 states and Puerto Rico who reported receiving an influenza vaccination in the past year. MAIN OUTCOME MEASURES: The main outcome was a self-reported categoric variable indicating the setting of the most recent seasonal influenza vaccination: doctor's office, pharmacy-based store, or other setting. RESULTS: Multinomial logistic regression results showed that environmental, predisposing, enabling, and need factors in the Andersen model were salient features associated with odds of using pharmacy-based influenza vaccination settings instead of a doctor's office. Residents of states that allowed pharmacists as immunizers before 1999 reported greater use of pharmacy-based store settings (odds ratio [OR] 1.31). Compared with young adults, individuals 65 years of age and older were more likely to choose a pharmacy-based store than a doctor's office (OR 1.41) and less likely to use other community settings (OR 0.45). Compared with non-Hispanic whites, black respondents were less likely to use pharmacy-based store vaccination (OR 0.51), and multiracial and Hispanic respondents were more likely to use other settings (ORs 1.47 and 1.60, respectively). Enabling and need factors were also associated with setting. CONCLUSION: Based on this dataset of selected states from 2014, almost one-fourth of U.S. adults who reported receiving an annual influenza vaccination did so from a pharmacy-based store; 35% reported using other community-based settings that may enlist pharmacists as immunizers. There were striking disparities in use of nontraditional vaccination settings by age and race or ethnicity. Pharmacists and pharmacies should address missed opportunities for vaccination by targeting outreach efforts based on environmental and predisposing characteristics.