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.

A systematic review of the treatment of active anogenital warts with human papillomavirus vaccines.

BACKGROUND: Anogenital warts (AGWs) caused by the human papillomavirus (HPV) are a common manifestation of HPV infection. Treatment strategies generally include topical therapies to promote wart regression or removal through surgical or other means. These strategies are effective but are associated with high rates of recurrence. HPV vaccines are known to be effective for prevention of AGWs yet preliminary data suggest they may offer therapeutic benefit for regression of active AGWs. OBJECTIVES: This study aimed to determine the efficacy of HPV vaccines for treatment of active AGWs. METHODS: A systematic search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted in July 2023 with no limits on date of publication. The search was supplemented with a manual review of references from identified articles and pertinent review articles. Articles were included if they reported at least one patient with active AGWs who received at least one dose of any HPV vaccine. The primary outcome of interest was complete or partial regression of AGWs over any time period. Risk of bias was assessed for each study meeting inclusion criteria. RESULTS: Seven articles were included. These included 1 randomized controlled trial (RCT), 1 non-RCT, 3 case series, and 2 case reports. All were deemed to have a high risk of bias. Study results showed evidence that HPV vaccines may offer therapeutic benefits to those with active AGWs. Studies reported outcomes for both intralesional and systemically administered vaccines. Outcomes reported improvement according to both partial and complete regression of AGWs. CONCLUSION: This review found that there is evidence that HPV vaccines may have a role in the treatment of active AGWs. Findings support the notion that the vaccine should be offered to previously unvaccinated patients but the role of intralesional administration of the vaccine to vaccinated patients is still unclear.

Pharmacy-based sexually transmitted infection service implementation considerations: A scoping review.

BACKGROUND: Rates of sexually transmitted infections (STIs) are rising despite significant management efforts in traditional healthcare settings. The growing number of individuals affected by STIs demonstrates a gap in care. Pharmacy-based STI clinical services are a potential solution to improve care. OBJECTIVE: To identify and summarize research about the implementation of pharmacy-based STI services, focusing on program characteristics, barriers, facilitators, and pharmacist and patient experiences. METHODS: A search of PubMed, Embase, and Cochrane Database of Systematic Reviews was conducted for papers evaluating STI expanded-scope clinical services performed by regulated pharmacists in an outpatient/community pharmacy setting. Study setting, design, data collection method, outcomes, target infection, services offered, patient population, and barriers and facilitators are reported. RESULTS: Twelve studies, 11 cross-sectional and 1 randomized control trial, were identified in this review. All studies focused on chlamydia, and two included gonorrhea and trichomoniasis or syphilis. Eleven services investigated STI screening, with four also offering treatment, and two offering partner treatment. Overall, patients reported positive experiences, found the services accessible, and trusted pharmacists. Pharmacists recognized the importance of STI services, were keen, and felt comfortable performing clinical tasks. Patients described convenience as a key facilitator, and concerns about privacy, particularly at the pharmacy counter, and the stigma and fear of judgement associated with STIs as primary barriers. For facilitators, pharmacists reported increased job satisfaction and a sense of relieving the burden on traditional STI services; for barriers, pharmacists highlighted patient recruitment, communication challenges, and lack of remuneration. CONCLUSION: Research on pharmacy-based STI services includes predominately small-scale, cross-sectional studies, and focuses on chlamydia screening. Both patients and pharmacists perceive these services to be acceptable and feasible, though strategies addressing patient privacy and recruitment, pharmacist competency, training, and remuneration must be considered to support the success of pharmacy-based STI services.

What's been trending with OSCEs in pharmacy education over the last 20 years? A bibliometric review and content analysis.

BACKGROUND: Objective structured clinical examinations (OSCEs) remain an integral part of pharmacy education. This study aimed to characterize key researchers, areas, and themes in pharmacy education OSCEs using a bibliometric review with content analysis. METHODS: A bibliometric review was conducted on literature from over 23 years from January 2000 to May 2023. Articles focusing on any type of OSCE research in pharmacy education in both undergraduate and postgraduate sectors were included. Articles were excluded if they were not original articles or not published in English. A summative content analysis was also conducted to identify key topics. RESULTS: A total of 192 articles were included in the analysis. There were 242 institutions that contributed to the OSCE literature in pharmacy education, with the leading country being Canada. Most OSCE research came from developed countries and were descriptive studies based on single institution data. The top themes emerging from content analysis were student perceptions on OSCE station styles (n = 98), staff perception (n = 19), grade assessment of OSCEs (n = 145), interprofessional education (n = 11), standardized patients (n = 12), and rubric development and standard setting (n = 8). IMPLICATIONS: There has been a growth in virtual OSCEs, interprofessional OSCEs, and artificial intelligence OSCEs. Communication rubrics and minimizing assessor variability are still trending research areas. There is scope to conduct more research on evaluating specific types of OSCEs, when best to hold an OSCE, and comparing OSCEs to other assessments.

Improving equity of services for sexually transmitted infections through community pharmacies: A scoping review.

BACKGROUND: Pharmacists have the potential to improve care for marginalized populations. Stigmatized and racialized groups may not find traditional health services accessible in other settings. Research focused on health care access for these populations is fundamental in understanding how to improve health equity. OBJECTIVES: This scoping review aimed to determine how health equity is addressed within services offered through community pharmacies for sexually transmitted infections (STIs). METHODS: This scoping review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews Checklist. A comprehensive search strategy was developed with an academic librarian to capture studies containing search terms related to each of the following 3 topics: STIs, pharmacy, and underserved groups. PubMed and Embase were both searched up to July 2023 and search results were uploaded to the screening software Covidence. Two researchers independently screened titles, abstracts, and full texts. Articles were included if they reported evaluation of a pharmacy-based sexual health service and addressed health equity in service design or implementation. RESULTS: A total of 8 articles were identified that described services implemented for underserved groups. Four populations were identified: injection drug users, men who have sex with men, racial minorities, and those with low socioeconomic status. Equity was addressed through 2 mechanisms: location-based implementation of services in areas of high target population density or through specific targeting of marginalized populations in recruitment and promotion. All studies involved interventions for the prevention or testing services rather than assessment and treatment. CONCLUSIONS: Equity is not being readily addressed in pharmacy-based services for STIs yet evidence exists that considering equity in the design and implementation of services may improve reach to underserved populations.

The burden of an identity: Coping strategies for sexual and gender minority individuals in pharmacy practice.

PURPOSE: Sexual or gender minority (SGM) individuals are known to experience stigma and discrimination in pharmacy settings. It is also known that SGM individuals may delay or avoid care in pharmacies due to the stress associated with these experiences. Aside from avoidance, however, little is known about how SGM individuals cope with stigma and discrimination and how their coping strategies may influence their healthcare behaviors. Therefore, this study aimed to characterize how SGM individuals cope with stigma and discrimination associated with their SGM identity in pharmacy settings. METHODS: This was a qualitative study conducted using semistructured interviews. A total of 31 SGM individuals were recruited across 2 Canadian provinces. Interviews followed a topic guide designed according to the minority stress model to elicit participants' lived experiences in community pharmacies. Thematic analysis was used to identify and interpret themes. RESULTS: Five themes were identified that described coping strategies used by SGM individuals when encountering minority stress processes in pharmacy settings: avoidance (avoiding or withdrawing from care), seeking support (from people or settings), perseverance (when faced with no other option), concealment (of SGM identity), and lowering expectations (of pharmacist knowledge and competence). CONCLUSION: Our findings support the notion that individuals cope in different ways and across a wide spectrum of behaviors. Those who avoid care, conceal their SGM identity, or are forced to persevere through interactions may be at increased risk for both physical and mental health disparities. Those who seek support or lower expectations may also be at risk for reduced access to quality care.

New Zealand pharmacists' views regarding the current prescribing courses: questionnaire survey.

Introduction New Zealand pharmacists must complete a joint prescribing course offered by Otago and Auckland universities only, to be qualified as pharmacist prescribers. Aim To identify knowledge and perceptions of New Zealand registered pharmacists, who are not pharmacist prescribers, on: pharmacist prescribing roles, courses and perceived barriers and facilitators to course uptake. Methods Participants comprised registered practising New Zealand pharmacists (n = 4025), across all New Zealand regions. Invitations to participate in a questionnaire survey were sent in March 2021. Data were analysed using thematic analysis and descriptive statistics. Results The response rate was 12% (482/4025), with 94% community pharmacists. Almost two-thirds (65%) had over 10 years of working experience. Nearly all (95%) agreed that pharmacist prescribing would improve healthcare delivery in New Zealand. Most reported that barriers to pharmacist prescribing course uptake were funding, lack of institutional support, up-to-date pharmacological/pharmaceutical knowledge, and 2 years of experience in collaborative health team prerequisites for enrolment, finding medical supervisors, and lack of remuneration for prescribing roles. Discussion Pharmacist prescribing in New Zealand is still in its growing phase. Optimising uptake of prescribing courses and role requires a multi-level approach including all stakeholders. Government/policymakers should consider pharmacist prescribing training and remuneration in their funding plans. Employing institutions should provide required time and human resources (staff backfills). Training providers should consider methods of course delivery and assessment that are suitable for trainees in full-time employment.

Born This Way: Integrating LGBTQIA+ Identities as Pharmacy Practitioners.

Progression through the profession of pharmacy is filled with many milestones that can contribute to feelings of stress, rejection, and isolation. For Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and Asexual+(LGBTQIA+) students and practitioners, these feelings can be compounded by similar issues experienced by their sexual orientation or gender identity. Historically, LGBTQIA+ students, new practitioners, and seasoned professionals alike have lacked visible role models for how to intersect personal and professional identity in the pharmacy profession. In this paper, the authors describe experiences of intersecting personal queer identities with professional pharmacy identities; exploring barriers to integration and developing solutions to overcome these barriers. The authors also share how the formation of a collective of LGBTQIA+ practitioners and educators has led to a unified voice to advocate for the advancement of LGBTQIA+ healthcare in pharmacy education and practice. This manuscript will provide readers with a guide to navigate and address issues with the integration of personal and professional identity to lead to practice that validates personal identity as important, valuable, and affirmed.

Target users' acceptance of a pharmacist-led prescribing service for pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV).

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) is a highly effective way to reduce virus transmission. There have been increasing calls to improve access to PrEP in Canada. One way to improve access is by having more prescribers available. The objective of this study was to determine target users' acceptance of a PrEP-prescribing service by pharmacists in Nova Scotia. Methods: A triangulation, mixed-methods study was conducted consisting of an online survey and qualitative interviews underpinned by the Theoretical Framework of Acceptability (TFA) constructs (affective attitude, burden, ethicality, intervention coherence, opportunity cost, perceived effectiveness and self-efficacy). Participants were those eligible for PrEP in Nova Scotia (men who have sex with men or transgender women, persons who inject drugs and HIV-negative individuals in serodiscordant relationships). Descriptive statistics and ordinal logistic regression were used to analyze survey data. Interview data were deductively coded according to each TFA construct and then inductively coded to determine themes within each construct. Results: A total of 148 responses were captured by the survey, and 15 participants were interviewed. Participants supported pharmacists' prescribing PrEP across all TFA constructs from both survey and interview data. Identified concerns related to pharmacists' abilities to order and view lab results, pharmacists' knowledge and skills for sexual health and the potential for experiencing stigma within pharmacy settings. Conclusion: A pharmacist-led PrEP-prescribing service is acceptable to eligible populations in Nova Scotia. The feasibility of PrEP prescribing by pharmacists should be pursued as an intervention to increase access to PrEP.

Don't Forget About the Identifiers.

There has been a sharp increase in curricular programming that addresses the health needs of sexually and gender diverse (LGBTQIA+) individuals. Although this is a positive step forward for the academy, there is a need to address the impact of these sessions on LGBTQIA+ identifying students both inside and outside the classroom. The aim of this commentary is to provide strategies that may help to minimize stress processes for identifying students within and outside the classroom when developing, delivering, and providing feedback on content for LGBTQIA+ health. Eight strategies are proposed based on literature and personal experience when teaching LGBTQIA+ health. Strategies are grouped according to developing content, delivering content, and following up on questions and feedback. Promoting these strategies when developing, delivering, and following up on content for LGBTQIA+ health may reduce stress for identifying students and facilitate the creation of the safe teaching spaces we all aim to achieve.

The Impact of Moving Beyond Intersection to Integration of LGBTQIA+ Identities on Professional Identity Affirmation.

There have been active calls within pharmacy education literature for the profession to work toward dismantling systemic oppression by elevating the voices of commonly underrepresented and marginalized communities, including the lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual(LGBTQIA+) community. There has also been a simultaneously growing interest in understanding how the intersection of one's personal identity with one's professional identity may help to foster greater affirmation within the profession. However, what has not been explored is how intersecting personal and professional identities may enhance the strength of one's LGBTQIA+ identity and therefore result in creating cultures of affirmation in addition to meaningful participation in professional advocacy. We link our lived experiences to a theoretical perspective through the minority stress model to demonstrate how distal and proximal stresses may affect pharmacy professionals' ability to fully integrate their professional and personal identities. Additionally, we call on the academy to strategically address gaps in LGBTQIA+ knowledge, equity, and professional development through research, shifts in culture, and education.

Developing Research-Informed Guidance on Preparing Pharmacy Students to Care for Diverse Populations.

OBJECTIVE: The purpose of this study was to develop research-informed guidance on how to better prepare students for working with diverse populations through exposure to diversity representation within case-based learning materials. METHODS: This was a qualitative interpretive phenomenological study using audio-recorded semi-structured interviews for data collection. Interviews were conducted virtually with 15 recent program alumni from Dalhousie University and 15 members from underrepresented communities in Nova Scotia, Canada. Audio-recordings were transcribed verbatim and framework analysis was used to code and categorize data. Themes were interpreted from categorized data and a conceptual model was developed based on the results. RESULTS: The conceptual model highlighted that awareness of diversity and health equity paired with practice and application of learning were perceived to be important for preparing graduates for practice. It was found that awareness could be best achieved through exposure to diversity within cases. To effectively expose students, programs must deliberately identify diverse populations to include, seek perspectives and engagement from those populations when writing cases, ensure conscientious representation of diversity without reinforcing stereotypes, and provide resources for discussion and further learning. CONCLUSION: Through the development of a conceptual model, this study provided research-informed guidance representing diversity within case-based learning materials. Findings support the notion that representation of diversity must be deliberate, conscientious, and collaborative with those offering diverse perspectives and lived experiences.

Messaging preferences for the role of pharmacists in pharmacy education recruitment material.

INTRODUCTION: Applications to pharmacy programs are declining worldwide. Previous research suggests that positioning of recruitment material according to prospective students' preferences may increase interest in the profession and entry-to-practice programs. The aim of this study was to determine messaging preferences for the role of the pharmacist. METHODS: This was a best-worst choice survey conducted at one institution in one country. Participants included prospective students, current pharmacy students, and others representing the general public. Thirteen statements (plus one control) describing the role of the pharmacist were extracted from pharmacy program websites. Survey participants completed the best-worst choice analysis, and a conditional logit model was used to estimate statement preference coefficients. RESULTS: A total of 150 complete survey responses were collected. The top ranked statement was, "Pharmacists are health care professionals who are experts in medicines" and the least ranked statement was the control statement, "Pharmacists are experts in dispensing medications and counting tablets." No differences were observed between the different groups of survey respondents. Other highly ranked statements spoke to the expertise of the pharmacist and promoted a well-defined role. Catchy statements, such as "Pharmacists are medicines superheroes," were not ranked highly. CONCLUSIONS: This study found that current and prospective pharmacy students preferred descriptive and explicit messages that align with pharmacists' professional identity for promotion of the pharmacist's role.

Community pharmacists' acceptance of prescribing pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV).

Background: Pre-exposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) prevention is highly effective. Pharmacists can increase PrEP accessibility through pharmacist prescribing. This study aimed to determine pharmacists' acceptance of a pharmacist PrEP prescribing service in Nova Scotia. Methods: A triangulation mixed methods study consisting of an online survey and qualitative interviews was conducted with Nova Scotia community pharmacists. The survey questionnaire and qualitative interview guide were underpinned by the 7 constructs of the Theoretical Framework of Acceptability (affective attitude, burden, ethicality, opportunity costs, intervention coherence, perceived effectiveness and self-efficacy). Survey data were analyzed descriptively and with ordinal logistic regression to determine associations between variables. Interview transcripts were deductively coded according to the same constructs and then inductively coded to identify themes within each construct. Results: A total of 214 community pharmacists completed the survey, and 19 completed the interview. Pharmacists were positive about PrEP prescribing in the constructs of affective attitude (improved access), ethicality (benefits communities), intervention coherence (practice alignment) and self-efficacy (role). Pharmacists expressed concerns about burden (increased workload), opportunity costs (time to provide the service) and perceived effectiveness (education/training, public awareness, laboratory test ordering and reimbursement). Conclusion: A PrEP prescribing service has mixed acceptability to Nova Scotia pharmacists yet represents a model of service delivery to increase PrEP access to underserved populations. Future service development must consider pharmacists' workload, education and training as well as factors relating to laboratory test ordering and reimbursement.

Raising voices of 2SLGBTQIA+ patients: The intersection of minority stress and systemic oppression in pharmacy practice.

BACKGROUND: Two-spirit, lesbian, gay, bisexual, trans, queer, intersex, asexual, and other sex, sexual, and gender identities (2SLGBTQIA+) experience minority stress processes in pharmacy settings. Processes may be distal (objective prejudicial events) or proximal (subjective internalized feelings) and lead to delay or avoidance of care. The nature of these experiences in pharmacies and ways to reduce occurrence is largely unknown. OBJECTIVES: This study aimed to characterize 2SLGBTQIA+ individuals' perceived experiences in pharmacies according to the minority stress model (MSM) and to elicit patient-identified individual, interpersonal, and systemic strategies for reducing systemic oppression of 2SLGBTQIA+ individuals in pharmacy practice. METHODS: This was a qualitative phenomenological study using semistructured interviews. Thirty-one 2SLGBTQIA+ individuals from the Canadian Maritime provinces completed the study. Transcripts were coded according to domains of the MSM (distal and proximal processes) and the lens of systemic oppression (LOSO) (individual, interpersonal, and systemic factors). Framework analysis was used to identify themes within each theoretical domain. RESULTS: Distal and proximal minority stress processes were described by 2SLGBTQIA+ individuals in pharmacy settings. Distal processes included direct and indirect perceived discrimination and microaggressions. Proximal processes included expectation of rejection, concealment, and internalized self-stigma. Nine themes were identified according to the LOSO. Two related to the individual (knowledge and abilities, respect), 2 related to interpersonal relations (rapport and trust, holistic care), and 5 related to systemic factors (policies and procedures, representation and symbols, training/specialization, environment/privacy, technology). CONCLUSION: Findings support the notion that individual, interpersonal, and systemic strategies can be implemented to reduce or prevent minority stress processes from occurring in pharmacy practice. Future studies should evaluate these strategies to better understand effective ways to improve inclusivity for 2SLGBTQIA+ people in pharmacy settings.

A scoping review of the minority stress processes experienced by sexual and gender minority individuals in pharmacy settings: Implications for health care avoidance.

BACKGROUND: Sexual and gender minority (SGM) people may avoid or delay health care interactions. The minority stress model describes distal (discrimination, violence) and proximal (expectation of rejection, concealment, internalized self-dislike) stress processes as possible contributors to the health disparities and avoidance behaviors observed when encountered in health care settings. Pharmacies are accessible health care settings, yet the extent to which SGM individuals experience minority stress processes while using services at the pharmacies is unknown. OBJECTIVE: This scoping review aimed to identify distal and proximal minority stress processes experienced by SGM individuals and health care avoidance behaviors related to pharmacies or pharmacists. METHODS: An electronic search of PubMed, Embase, and PsycINFO databases was conducted to search for relevant literature up to September 2022. The search was supplemented with a review of reference lists and contact with experts in the field. Articles were included in the review if they described SGM individuals' perceived experiences within pharmacies or with pharmacists and reported an outcome that could be mapped to a distal or proximal minority stress process. RESULTS: Eleven articles met the eligibility criteria and were included in the review. Of these, 6 reported the presence of distal stress processes, such as perceived stigma, negative pharmacy staff attitudes, and a lack of awareness of population needs. For proximal stress processes, 5 articles reported on concealment, 4 reported on expectation of rejection, and 1 reported on internalized transphobia. Developing rapport and increasing competence were identified as ways to help mediate the impact of minority stress processes. CONCLUSION: Minority stress processes and avoidance behaviors are experienced by SGM individuals that relate to pharmacies and pharmacists. Coordinated efforts between professional stakeholders are required to reduce minority stress processes and ensure pharmacy-based services are accessible to all individuals.

Pharmacy postgraduate education transformation: pharmacist preferences for microcredentials.

OBJECTIVES: To explore micro-credentialing for postgraduate study in pharmacy practice. METHODS: An online survey of practicing or intern pharmacists in New Zealand was designed to identify learner preferences for education, determine interest and demand for microcredentials and elicit preferred 'willingness-to-pay' thresholds. KEY FINDINGS: A total of 430 responses were obtained. A stacked microcredential programme was preferred by 88% over traditional courses. Interest, skill development and career development were the top-ranked aspects. Participants favoured the lowest cost option ($300 NZD per microcredential). CONCLUSIONS: Pharmacists in New Zealand are supportive of microcredentials for postgraduate study as an alternative to traditional programmes.

Mental effort in the assessment of critical reflection: Implications for assessment quality and scoring.

INTRODUCTION: Critical reflection is a mainstay in the training of health professionals, yet assessment of reflection is commonly described as difficult, taxing, and resulting in inconsistent scoring across assessors. At the same time, there is evidence from experiential and simulation settings that assessors' mental effort may explain assessor variability, which could be a target for simplifications in assessment design. Assessors' mental effort for assessment of reflection is currently unknown. This study aimed to determine reliability of rubric scoring of critical reflection, variation in pass-fail rates, and the relationship between reflection scores and assessors' perceived mental effort. METHODS: Eleven assessors were recruited to assess six reflection assignments using a published rubric. Mental effort was measured using the Paas scale for each assignment assessed and was correlated with rubric scores for each assignment. RESULTS: Findings showed inconsistency in scoring between assessors, resulting in varying pass rates for each assignment (55-100%). All assignments demonstrated negative correlations between rubric scores and perceived mental effort (r = -0.115 to -0.649). CONCLUSIONS: Findings support the notion that more work should be done to optimize assessment of critical reflection. Future studies should focus on disentangling the influence on mental effort of scoring tools, assignment structures, and writing quality.