"Nobody talks about it": Preconception health and care among women in the rural, Midwestern United States.

INTRODUCTION: Good preconception and interconception health are fundamental to optimizing women's health and reducing risk factors for adverse maternal-infant outcomes. Although rural women in the United States tend to experience health disparities, no published qualitative studies have focused on their preconception/interconception health. The purpose of this study was to determine what rural, Midwestern women perceive to be their most pressing health needs and effective ways to provide outreach and education regarding preconception/interconception health and care. METHODS: Non-pregnant, reproductive-age women in Hardin County, Ohio, regardless of parity, were recruited through convenience sampling. Semi-structured interviews with four domains (beliefs and behaviors; perceived needs; knowledge and information sources; barriers to care) were conducted in May-June 2021 until saturation was reached. Qualitative methods were used to analyze data and determine themes. Binomial tests were used to compare selected demographic characteristics of participants to the county's reproductive-age residential female population. RESULTS: Nineteen women aged 20-44 years were individually interviewed. Comparing race/ethnicity, education, and insurance status, participants appeared to be representative of the county population. Four themes were identified: (1) needs regarding healthcare and other resources; (2) lack of preconception/interconception care and perceived unimportance due to intergenerational knowledge transfer and paucity of healthcare providers; (3) difference in understanding of the term "women's health" and low health literacy; and (4) suggested interventions including education and outreach. CONCLUSION: Interviews with rural Midwestern women revealed needs regarding preconception/interconception health and care and potential ways to raise awareness. These findings can inform strategies to improve rural women's health and birth outcomes.

Ohio Community Pharmacist Interest and Participation in Community-Clinical Linkages.

BACKGROUND: Community-clinical linkages have been promoted as a means to improve population health. The community pharmacy is an ideal location for these partnerships to occur due to the expertise of the community pharmacist. While the need for these partnerships exists, there are limited data regarding community pharmacists' current participation in such programs. OBJECTIVE: The purpose of this analysis was to assess Ohio community pharmacists' involvement and interest in community-clinical linkages. METHODS: An electronic survey tool containing 26 questions was developed to assess Ohio community pharmacists' participation in community-clinical linkages and interest to develop such partnerships. The tool was sent via email to a random sample of 500 pharmacists registered in Ohio and practicing in a community setting. Chi-square or Fisher exact nonparametric statistical tests were used as appropriate to identify whether there were any significant differences in current partnership or interest to partner with a prescriber who refers patients to their community pharmacy based on education (Bachelor of Science or Doctor of Pharmacy degree) or pharmacy location (urban, suburban, or rural). RESULTS: Nine emails were undeliverable, leaving a sample of 491 pharmacists. Ninety-three (19%) responded to the survey. Sixteen respondents (17%) indicated that they currently partner with a prescriber who refers patients to their pharmacy for assistance with medications or chronic disease state management; this practice was more often reported in urban settings (p=0.022). Of those not currently participating in such a partnership, 53 (57%) were interested in developing one. Thirty-two respondents (34%) reported providing referrals for at least 1 type of screening or counseling service. For some types of services, pharmacists reported that they provide the service in the pharmacy and/or were interested to develop the service in the pharmacy rather than provide a referral. However, for any given service there were a number of pharmacists who expressed interest in providing referrals although they were not currently doing so. CONCLUSION: This sample of Ohio community pharmacists reported limited participation in community-clinical linkages but interest to develop them. Further studies should explore the pharmacists' role and impact in such programs.

Pharmacists' perceptions of advancing public health priorities through medication therapy management.

BACKGROUND: Public health priorities can be addressed by pharmacists through channels such as medication therapy management (MTM) to optimize patient and population outcomes. However, no studies have specifically assessed pharmacists' perceptions of addressing public health priorities through MTM. OBJECTIVE: The objective of this study was to assess pharmacists' opinions regarding the feasibility and appropriateness of addressing seven areas of public health priority through MTM services to impact public health in direct patient care settings. METHODS: An anonymous 37-question electronic survey was conducted to evaluate Ohio pharmacists' opinions of advancing seven public health priorities identified from Healthy People 2020 (family planning, preconception care, smoking cessation, immunizations, nutrition/biometric wellness assessments, point-of-care testing, fall prevention) through MTM activities; to identify potential barriers; and to collect demographic information. The cross-sectional survey was sent to a random sample of 500 pharmacists registered with the Ohio State Board of Pharmacy. RESULTS: Seventy-six pharmacists responded to the survey, resulting in a 16% response rate. On average, it took respondents 5-10 minutes to complete the survey. The majority of respondents thought that each of the seven public health priorities were "important" or "very important" to patient health; the most commonly identified areas included smoking cessation, immunizations, and fall prevention (97.5%). When asked to indicate which of the seven areas they thought they could potentially have a role to provide services through MTM, on average pharmacists picked 4 of the priority areas. Only 6.6% indicated there was no role for pharmacists to provide MTM services for any of the listed categories. Staffing, time, and reimbursement represented the most commonly perceived barriers for pharmacists in providing MTM services. Fifty-seven percent indicated an interest in learning more about MTM, with 98% of responders selecting continuing education as the preferred source. CONCLUSION: The majority of pharmacists indicated they could make an impact on public health priorities through MTM services.

Women's involvement in clinical trials: historical perspective and future implications.

The importance of considering the differences between the male and female sex in clinical decision-making is crucial. However, it has been acknowledged in recent decades that clinical trials have not always adequately enrolled women or analyzed sex-specific differences in the data. As these deficiencies have hindered the progress of understanding women's response to medications, agencies in the United States have worked towards the inclusion of women in clinical trials and appropriate analysis of sex-specific data from clinical trials. This review outlines the history and progress of women's inclusion in clinical trials for prescription drugs and presents considerations for researchers, clinicians, and academicians on this issue.

Impact of an online educational program on pharmacy students' knowledge of folic acid and neural tube defects.

PURPOSE: Pharmacy students must receive adequate training regarding folic acid for the prevention of neural tube defects (NTDs). Pharmacy students' knowledge should be evaluated and effective methods utilized to improve it, if needed. The objective of this study was to assess baseline knowledge among third-year students in a 0-6 Doctor of Pharmacy program and to evaluate the impact of an online educational video. METHODS: Baseline knowledge was assessed by a pretest adapted with permission from the March of Dimes (MOD). Students watched a 30-minute MOD video and completed a posttest. Nine months later, students completed a longitudinal posttest. Analysis of variance was used to assess differences in the percentage of correct responses to each question. RESULTS: A total of 133 (90.5%) students completed the educational program and 105 (78.9%) completed the longitudinal test. Statistically significant improvements in knowledge from baseline were seen for 9 of 10 questions on the posttest and for 6 of 10 questions on the longitudinal test. CONCLUSION: Online videos are tools to teach pharmacy students key information regarding folic acid and NTD; however, material should be reinforced in experiential education as well. Counseling women of childbearing potential about folic acid fulfills an important public health need.