Considerations of gender-affirming care for transgender and gender-diverse youth.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Implementation of pharmacist-led services for sexual and gender minorities: A multisite descriptive report.

PURPOSE: This paper compares and contrasts the implementation of pharmacist-led services for 3 different sexual and gender minority populations across California, Mississippi, and Florida. SUMMARY: Implementation of pharmacist-led services tailored to sexual and gender minorities may be a potential mechanism to address health disparities in these populations. Clinical pharmacists have the potential to provide care with cultural humility and improve health outcomes by optimizing medication regimens, reducing adverse drug events, enhancing medication acquisition, and improving medication adherence. CONCLUSION: The services provided by clinical pharmacists varied across sites and included management of gender-affirming hormone therapy, HIV antiretroviral medication adherence programming, primary care and chronic disease state management, and involvement in care related to mental health, psychiatry, and substance use as well as sexual health. Various legislative and regulatory barriers and differences in scope of practice for pharmacists were also identified. This paper advocates for the expansion of pharmacy-led services and the adoption of a culturally humble approach to patient care.

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.

Patients' Perceived Level of Clinician Knowledge of Transgender Health Care, Self-rated Health, and Psychological Distress Among Transgender Adults.

Importance: Transgender, gender nonbinary, and genderqueer people are at increased risk for negative health outcomes, and medical school education is currently lacking on inclusion of these topics. However, there is little evidence of an association of clinician knowledge with the health of transgender people. Objective: To evaluate the associations of patients' perceptions of clinician knowledge with self-rated health and severe psychological distress among transgender people. Design, Setting, and Participants: In this cross-sectional study, a secondary data analysis of the 2015 US Transgender Survey (a survey of transgender, gender nonbinary, and genderqueer adults conducted across 50 states) Washington, DC, US territories, and US military bases in 2015 was performed. Data were analyzed from February to November 2022. Exposures: Patients' perception of their clinician's knowledge about transgender health care. Main Outcomes and Measures: Self-rated health, dichotomized as poor or fair vs excellent, very good, or good, and severe psychological distress (scoring a validated threshold of ≥13 on the Kessler Psychological Distress Scale). Results: The sample included a total of 27 715 respondents (9238 transgender women [33.3%; 55.1% weighted; 95% CI, 53.4%-56.7%], 22 658 non-Hispanic White individuals [81.8%; 65.6% weighted; 95% CI, 63.7%-67.5%], and 4085 individuals aged 45-64 years [14.7%; 33.8% weighted; 95% CI, 32.0%-35.5%]). Of 23 318 individuals who answered questions regarding their perceptions of their clinicians' level of knowledge, 5732 (24.6%) reported their clinician knows almost everything about transgender care, 4083 (17.5%) reported their clinician knows most things, 3446 (14.8%) reported their clinician knows some things, 2680 (11.5%) reported their clinician knows almost nothing, and 7337 (31.5%) reported they were unsure. Nearly 1 in 4 transgender adults (5612 of 23 557 individuals [23.8%]) reported having to teach their clinician about transgender people. In total, 3955 respondents (19.4%; 20.8% weighted; 95% CI, 19.2%-22.6%) reported fair or poor self-rated health and 7392 (36.9%; 28.4% weighted, 95% CI, 26.9%-30.1%) met the criteria for severe psychological distress. After adjusting for covariates, compared with individuals who reported their clinician knows almost everything about transgender care, exposure to clinicians with lower perceived levels of knowledge about transgender care was associated with significantly higher odds of fair or poor self-rated health (adjusted odds ratio [aOR] for knowing almost nothing, 2.63; 95% CI, 1.76-3.94; aOR for unsure, 1.81; 95% CI, 1.28-2.56) and severe psychological distress (aOR for knowing almost nothing, 2.33; 95% CI, 1.61-3.37; aOR for unsure, 1.37; 95% CI, 1.05-1.79). Respondents who had to teach a clinician about transgender people had higher odds of reporting fair or poor self-rated health (aOR, 1.67; 95% CI, 1.31-2.13) and severe psychological distress (aOR, 1.49; 95% CI, 1.21-1.83) compared with those who did not. Conclusion and Relevance: The findings of this cross-sectional study suggest that there is an association between perceived clinician knowledge about transgender people and self-rated health and psychological distress among transgender people. These results highlight the importance of integration and enhancement of transgender health in medical education curriculum as a necessary intervention to improve the health of transgender people.

Residency application content and considerations based on residency director review of a fictitious CV: What really matters?

PURPOSE: This research was conducted to evaluate the influence of a pharmacy residency candidate's prior work or research experience on the potential for selection for an interview. Additionally, residency program directors (RPDs) were asked to evaluate the importance of letters of intent and recommendation, rank the importance of typical curriculum vitae (CV) items along with general preferences, and provide advice for a standout CV. METHODS: This cross-sectional, survey-based study recruited RPDs to review a work-focused or research-focused fictitious residency candidate CV and complete a 33-question survey regarding interest in interviewing the fictitious candidate and their general perceptions of significant factors in interview candidate selection. RESULTS: A total of 456 RPDs responded to the survey, with 229 respondents assigned to evaluate the work-focused CV and 227 assigned to review the research-focused CV. Among RPDs who provided CV evaluations, 81.2% (147/181) of those who reviewed the research-focused CV and 78.3% (137/175) of those who reviewed the work-focused CV gave a positive evaluation (P > 0.05). Work experience and extracurricular activities were considered the most important CV sections, and high-quality advanced pharmacy practice experience (APPE) rotations and pharmacy work experience were perceived to have the highest correlation with success in residency. CONCLUSION: This work supports the importance of candidates creating a well-rounded CV in preparing themselves for residency. Pharmacy-related work experience and high-quality APPE rotations seem to be key in an RPD's opinions of predicted success in a residency program. The CV remains a vital document in the residency candidate review process, and it deserves a high degree of effort in ensuring it adequately reflects professional experiences.

Development and Evaluation of a Pharmacist-Driven Vitamin D Protocol for a Cystic Fibrosis Clinic.

OBJECTIVE: Vitamin D deficiency is commonly found in patients with cystic fibrosis (CF) and can have a negative effect on patients who are not at target goal according to Cystic Fibrosis Foundation's Vitamin D Deficiency Clinical Care Guidelines. The objective of this study is to determine the effectiveness of a pharmacist-driven vitamin D protocol (PDVDP) in improving, achieving, and maintaining 25-hydroxyvitamin D levels of patients in a pediatric CF clinic. METHODS: A retrospective chart review was conducted for pediatric patients with CF from August 2018 to March 2020 to determine the percent of patients with improvement in 25-hydroxyvitamin D levels to target goal (≥ 30 ng/mL). Patients' 25-hydroxyvitamin D levels at 6, 12, and 18 months after automatic enrollment into the PDVDP were compared to determine if improvement occurred, and to calculate relative percent increase of 25-hydroxyvitamin D levels for these patients. RESULTS: The mean 25-hydroxyvitamin D levels of the patients at baseline before the protocol and 6, 12, and 18 months after enrollment in the protocol were 23.2, 33.3, 32.7, and 34.6 ng/mL, respectively. These results demonstrate mean 25-hydroxyvitamin D levels at all follow-up time points were significantly greater than baseline (p < 0.001). At 6 months, 50% (n = 20) of pediatric patients reached the target 25-hydroxyvitamin D levels. CONCLUSIONS: The PDVDP was effective in increasing the number of patients able to reach target 25-hydroxyvitamin D levels. Our PDVDP process may also be used at other CF clinics to improve vitamin D outcomes collaboratively with the interprofessional CF team.

Perceived wellness among pharmacy residents during COVID-19.

BACKGROUND: Well-being, burnout, and resiliency have been topics of discussion among health care providers over the last few years. Wellness can relate to many areas or domains in our lives such as financial, social, spiritual, physical, and occupational, whereas well-being is career focused. Wellness is multidimensional and encompasses different domains, and well-being usually focuses on a singular domain. Literature supports the study of well-being in health care workers; however, research is limited for assessing wellness in different domains of health care workers. OBJECTIVE: This study sought to describe perceived pharmacy resident wellness during the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A 67-item survey was sent by e-mail to eligible study participants, including any postgraduate year (PGY) 1, 2, or 24-month pharmacy resident completing/completed their training in June 2019-July 2020. The primary outcome was perceived resident wellness based on the 7 domains from Princeton UMatter Wellness Self-Assessment, developed to measure self-perceptions of wellness across dimensions. Descriptive statistics and participant scores were aggregated and presented as a total domain score. Statistics and scores were determined from completed surveys. RESULTS: A total of 418 participants accessed the survey, 384 met inclusion criteria, and 326 completed the survey. Of the participants, 77% were female with 85% completing a traditional PGY-1 residency program. The wellness domain with the lowest total was physical wellness, with a domain median of 23 of 28. The highest-scoring domain was social wellness, with a median of 27. CONCLUSION: Perceived resident wellness during COVID-19 was highest in the social domain and lowest in the physical wellness domain. Residency programming administrators could use this information to make improvements to orientation practices and wellness domain programming throughout the duration of residency training during a pandemic.

Determining student-level characteristics predictive of successful matching in PGY1 community-based residency programs: A curriculum vitae analysis.

INTRODUCTION: The purpose of this analysis was to determine which characteristics increase a candidate's likelihood of matching with a post-graduate year 1 (PGY1) community-based residency program (CBRP). METHODS: Current and former CBRP residents' curriculum vitae (CVs) were collected and reviewed utilizing a survey and standardized rubric. Eligible participants were current PGY1 CBRP residents or had completed a PGY1 program no earlier than 2015. Primary endpoints included number of participants with extensive leadership experience, relevant experiential rotations, presentation history, and involvement in pharmacy organizations. Descriptive statistics were performed to identify the most common characteristics and their relative quantities. RESULTS: A total of 50 eligible CVs were submitted and reviewed. The majority of participants had extensive (defined as four or more) presentation experiences, at least three mid- to high-level leadership experiences, multiple ambulatory/outpatient pharmacy experiential rotations, and involvement in pharmacy organizations. Few participants (26%) had previous teaching experience. CONCLUSIONS: Residency candidates who matched with CBRPs tended to have extensive mid- to high-level leadership experiences and presentation experience. Based on these findings, additional studies are warranted to compare existing and/or redesigned postgraduate training preparation curricula and their impact on residency match rates.

Perception of immunizations and vaccine recommendation sources for persons living with HIV compared with persons without HIV.

OBJECTIVES: To measure and compare the perception of immunizations, immunization status, and recommendation sources in persons living with HIV (PLWHs) and persons without HIV and determine a strategy for improving immunization rates by increasing awareness of pharmacy services. DESIGN: A 19-item survey based on the Health Belief Model assessed patients' perceptions and recommendation sources regarding immunization acceptance for specific vaccines: Tdap, pneumococcal, and hepatitis B (HepB). Survey items used a 5-point Likert-type scale assessing participants' perceptions, with questions identifying participants' most trusted sources of immunization information and patient demographics. Survey questions were designed to identify perceived susceptibility and severity of vaccine-preventable illness, barriers, benefits, and self-efficacy regarding immunization acceptance, and sources of patient-trusted immunization information. SETTING AND PARTICIPANTS: Survey recruitment occurred in Indiana and included any patient 18 years of age or older picking up medications at a specialty pharmacy predominantly serving PLWHs or a traditional community chain pharmacy. MAIN OUTCOME MEASURES: Primary outcomes included perceived barriers to immunization acceptance obtained from Likert-type scale questions, patient-reported immunization rates of selected vaccines (Tdap, pneumococcal pneumonia, and HepB), and trusted immunization recommendation sources. Logistic regression was performed to model association between perceived barriers, HIV status, and immunization recommendation sources. RESULTS: A total of 142 participants (68 PLWHs, 74 persons without HIV) completed the survey. PLWHs were more likely to have immunization barriers, but this was not statistically significant (odds ratio 2.537, 95% confidence interval 0.585-10.996). Both participant groups reported "family doctor" as the most trusted source, with only 5% selecting "pharmacist." Significantly fewer PLWHs reported completing the HepB series (18% vs. 52%; P = 0.0224). CONCLUSION: PLWHs possess barriers to immunization acceptance similar to persons without HIV yet report lower rates of HepB vaccine completion. Although pharmacists were less frequently selected as the most trusted source, additional studies on percptions of pharmacists' role in immunizing PLWHs should be considered.

Development of Low-Cost Locally Sourced Two-Component Compression Bandages in Western Kenya.

INTRODUCTION: Compression therapy is well-established standard of care for chronic leg ulcers from venous disease and lymphedema. Chronic leg ulcers and lymphedema have a significant impact on quality of life, driven by pain, foul odor, and restricted mobility. Provision of layered compression therapy in resource-limited settings, as in Western Kenya and other regions of sub-Saharan Africa, is a major challenge due to several barriers: availability, affordability, and access to healthcare facilities. When wound care providers from an Academic Model Providing Access to Healthcare (AMPATH) health center in Western Kenya noted that a donated, finite supply of two-component compression bandages was helping to heal chronic leg ulcers, they began to explore the potential of finding a local, sustainable solution. Dermatology and pharmacy teams from AMPATH collaborated with health center providers to address this need. METHODS: Following a literature review and examination of ingredients in prepackaged brand-name kits, essential components were identified: elastic crepe, gauze, and zinc oxide paste. All of these materials are locally available and routinely used for wound care. Two-component compression bandages were made by applying zinc oxide to dry gauze for the inner layer and using elastic crepe as the outer layer. Feedback from wound clinic providers was utilized to optimize the compression bandages for ease of use. RESULTS: Adjustments to assembly of the paste bandage included use of zinc oxide paste instead of zinc oxide ointment for easier gauze impregnation and cutting the inner layer gauze in half lengthwise to facilitate easier bandaging of the leg, such that there were two rolls of zinc-impregnated gauze each measuring 5 inches × 2 m. Adjustments to use of the compression bandage have included increasing the frequency of bandage changes from 7 to 3 days during the rainy seasons, when it is difficult to keep the bandage dry. Continuous local acquisition of all components led to lower price quotes for bulk materials, driving down the production cost and enabling a cost to the patient of 200 KSh (2 USD) per two-component compression bandage kit. Wound care providers have provided anecdotal reports of healed chronic leg ulcers (from venous stasis, trauma), improved lymphedema, and patient tolerance of compression. CONCLUSIONS: Low-cost locally sourced two-component compression bandages have been developed for use in Western Kenya. Their use has been initiated at an AMPATH health center and is poised to meet the need for affordable compression therapy options in Western Kenya. Studies evaluating their efficacy in chronic leg ulcers and Kaposi sarcoma lymphedema are ongoing. Future work should address adaptation of compression bandages for optimal use in Western Kenya and evaluate reproducibility of these bandages in similar settings, as well as consider home- or community-based care delivery models to mitigate transportation costs associated with accessing healthcare facilities.