Addressing COVID-19 vaccine hesitancy in rural community pharmacies: a protocol for a stepped wedge randomized clinical trial.

BACKGROUND: Uptake of COVID-19 vaccines remains problematically low in the USA, especially in rural areas. COVID-19 vaccine hesitancy is associated with lower uptake, which translates to higher susceptibility to SARS-CoV-2 variants in communities where vaccination coverage is low. Because community pharmacists are among the most accessible and trusted health professionals in rural areas, this randomized clinical trial will examine implementation strategies to support rural pharmacists in delivering an adapted evidence-based intervention to reduce COVID-19 vaccine hesitancy. METHODS: We will use an incomplete stepped wedge trial design in which we will randomize 30 rural pharmacies (unit of analysis) to determine the effectiveness and incremental cost-effectiveness of a standard implementation approach (consisting of online training that describes the vaccine hesitancy intervention, live webinar, and resource website) compared to adding on a virtual facilitation approach (provided by a trained facilitator in support of the delivery of the vaccine hesitancy counseling intervention by pharmacists). The intervention (ASORT) has been adapted from an evidence-based vaccine communication intervention for HPV vaccines through a partnership with rural pharmacies in a practice-based research network in seven southern US states. ASORT teaches pharmacists how to identify persons eligible for COVID-19 vaccination (including a booster), solicit and address vaccine concerns in a non-confrontational way, recommend the vaccine, and repeat the steps later if needed. The primary trial outcome is fidelity to the ASORT intervention, which will be determined through ratings of recordings of pharmacists delivering the intervention. The secondary outcome is the effectiveness of the intervention, determined by rates of patients who agree to be vaccinated after receiving the intervention. Other secondary outcomes include feasibility, acceptability, adoption, reach, and cost. Cost-effectiveness and budget impact analyses will be conducted to maximize the potential for future dissemination and sustainability. Mixed methods will provide triangulation, expansion, and explanation of quantitative findings. DISCUSSION: This trial contributes to a growing evidence base on vaccine hesitancy interventions and virtual-only facilitation of evidenced-based practices in community health settings. The trial will provide the first estimate of the relative value of different implementation strategies in pharmacy settings. TRIAL REGISTRATION: NCT05926544 (clinicaltrials.gov); 07/03/2023.

Rural community pharmacies' preparedness for and responses to COVID-19.

BACKGROUND: Few studies have documented rural community pharmacy disaster preparedness. OBJECTIVES: To: (1) describe rural community pharmacies' preparedness for and responses to COVID-19 and (2) examine whether responses vary by level of pharmacy rurality. METHODS: A convenience sample of rural community pharmacists completed an online survey (62% response rate) that assessed: (a) demographic characteristics; (b) COVID-19 information source use; (c) interest in COVID-19 testing; (d) infection control procedures; (e) disaster preparedness training, and (f) medication supply impacts. Descriptive statistics were calculated and differences by pharmacy rurality were explored. RESULTS: Pharmacists used the CDC (87%), state health departments (77%), and state pharmacy associations (71%) for COVID-19 information, with half receiving conflicting information. Most pharmacists (78%) were interested in offering COVID-19 testing but needed personal protective equipment and training to do so. Only 10% had received disaster preparedness training in the past five years. Although 73% had disaster preparedness plans, 27% were deemed inadequate for the pandemic. Nearly 70% experienced negative impacts in medication supply. There were few differences by rurality level. CONCLUSION: Rural pharmacies may be better positioned to respond to pandemics if they had disaster preparedness training, updated disaster preparedness plans, and received regular policy guidance from professional bodies.

Reprint of: Impact of elective on students' perceptions of treating patients with a substance use disorder.

OBJECTIVE: To evaluate the impact of a substance use disorder (SUD) elective curriculum on students' perceptions of treating patients with SUDs using the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). METHODS: In 2017, a third-year pharmacy elective, conceptualizing SUD as a chronic, relapsing brain disease with psychosocial and societal influencers, was introduced. A linked pre- and postcourse assessment using the DDPPQ was carried out for the following categories: role adequacy, role support, job satisfaction, role-related self-esteem, and role legitimacy. RESULTS: A total of 63 students were enrolled in the elective and 54 paired questionnaires were available for analysis. There was a statistically significant improvement in attitude across all 5 categories of the DDPPQ. CONCLUSION: Students' attitudes toward working with patients with SUD improved after completing the elective. This study indicates that teaching student pharmacists about effectively recognizing and treating SUDs may result in more willingness to work with these patients in the future.

Impact of elective on students' perceptions of treating patients with a substance use disorder.

OBJECTIVE: To evaluate the impact of a substance use disorder (SUD) elective curriculum on students' perceptions of treating patients with SUDs using the Drug and Drug Problems Perceptions Questionnaire (DDPPQ). METHODS: In 2017, a third-year pharmacy elective, conceptualizing SUD as a chronic, relapsing brain disease with psychosocial and societal influencers, was introduced. A linked pre- and postcourse assessment using the DDPPQ was carried out for the following categories: role adequacy, role support, job satisfaction, role-related self-esteem, and role legitimacy. RESULTS: A total of 63 students were enrolled in the elective and 54 paired questionnaires were available for analysis. There was a statistically significant improvement in attitude across all 5 categories of the DDPPQ. CONCLUSION: Students' attitudes toward working with patients with SUD improved after completing the elective. This study indicates that teaching student pharmacists about effectively recognizing and treating SUDs may result in more willingness to work with these patients in the future.

Characterization of gabapentin overdose using a poison center case series.

BACKGROUND: Gabapentin is an anticonvulsant that is being used for an increasing number of off-label indications. The purpose of this study is to document the clinical manifestations and outcomes of gabapentin exposures reported to poison centers. METHODS: A multicenter prospective observational study of all gabapentin exposures reported to three poisoncenters was conducted between 4/1/98 and 4/1/2000. Cases involving gabapentin only were evaluated. RESULTS: There were 20 cases with gabapentin as the sole substance in doses ranging from 50 mg to 35 g. Ten of the 20 cases involved children and adolescents. Clinical effects developed early and resolved within 10 hours in most patients. Seven cases were managed in the home with only observation. Four of these patients remained asymptomatic. Effects reported in the three symptomatic patients were drowsiness (3) and ataxia (1). Thirteen patients were managed in a health care facility. Nine were symptomatic with reported effects of drowsiness (6), dizziness (3), nausea/vomiting (2), tachycardia (2), and hypotension (2). None of the patients were admitted for medical care. CONCLUSION: In this cases series, gabapentin exposures caused no or minimal toxicity.