Perceptions and predictors of intention to receive the COVID-19 vaccine.

BACKGROUND: The control of the Coronavirus Disease 2019 (COVID-19) pandemic may be dependent on widespread receipt of an effective vaccine. It is important to understand patient health-related behaviors and perceptions to guide public health vaccination strategies. OBJECTIVES: To examine perceptions of COVID-19 and vaccination beliefs, and identify predictors of intention to receive the COVID-19 vaccine in the US. METHODS: A cross-sectional, web-based survey guided by the Health Belief Model was conducted using a web-based Qualtrics survey panel of US adults. The main outcome was the intention to receive the COVID-19 vaccine if offered. Additional measures included: demographics, perceptions of COVID-19 severity, risk and susceptibility, views of a potential COVID-19 vaccine, virus and vaccine information sources, vaccine beliefs and behaviors, and seasonal flu vaccine history. RESULTS: A total of 1047 complete responses were included. Females had lower odds of intending to receive the COVID-19 vaccine than males (AOR = 0.54, 95% CI: 0.36-0.80). Those with a two-year degree/some college had lower odds of intending to receive the COVID-19 vaccine compared to those with a high school degree/GED (AOR = 0.59, 95% CI: 0.36-0.97). Respondents who perceived the severity of the virus to be higher, perceived a greater COVID-19 vaccine benefit, and perceived greater general vaccine benefits had higher odds of intending to receive a COVID-19 vaccine (AOR = 1.44, 95% CI: 1.09-1.91; AOR = 2.82, 95% CI: 2.24-3.56; AOR = 1.77, 95% CI 1.41-2.21, respectively). CONCLUSIONS: In this study, intention to receive the COVID-19 vaccine varied across demographics, perceived virus severity, COVID-19 vaccine and general vaccine beliefs. Successful implementation of a COVID-19 immunization strategy by healthcare providers and public health officials will need to incorporate diverse COVID-19 vaccination education strategies tailored to patients' health beliefs.

Community pharmacists in Virginia dispensing naloxone under a standing order: A qualitative study.

BACKGROUND: In 2016, the Virginia Health Commissioner signed a standing order into law allowing licensed pharmacists to dispense opioid receptor antagonists (ORAs) for overdose reversal. OBJECTIVES: Using the theory of planned behavior as an initial guide to study development, the aim of this qualitative study was to explore community pharmacists' attitudes, subjective norm, perceived behavioral control, and behavioral intention toward dispensing ORAs under a standing order in Virginia. METHODS: Semi-structured interviews were conducted with community pharmacists across the Commonwealth between June 2018 and October 2019. Interviews were recorded, transcribed verbatim, and thematically analyzed. RESULTS: Twenty-one community pharmacists were interviewed. Pharmacists were confused about the specifics and the processes involved with dispensing naloxone under the standing order. Furthermore, many recognized the underuse of the standing order. Positive attitudes focused on the life-saving action of ORAs. Negative attitudes included encouraging risky behaviors by patients, negatively affecting the patient-pharmacist relationship, offending or contributing to stigmatizing patrons, and having liability issues to the pharmacy. Subjective norms regarding dispensing of ORAs under the standing order were perceived to be favorable among peer pharmacists and primary care and emergency department physicians but may be seen as profit-seeking by patients. Barriers to service provision included lack of guidance from corporate offices (in chain pharmacies), inadequate training, patient out-of-pocket costs, reimbursement issues, inadequate staffing and time, and stigma. Facilitators comprised the existence of practice site-specific protocols, the REVIVE! training, technician support, increased community awareness, physician collaboration, pharmacist training, and employer guidance. Whereas some pharmacists intended to become more familiarized with the standing order, others did not intend to actively identify patients who were at risk of an opioid overdose. CONCLUSION: Pharmacists expressed mixed behavioral intention toward dispensing ORAs under the standing order. Future research should focus on quantifying the uptake of the standing order at the state level.

Antidepressant Use and Incident Urinary Incontinence: A Literature Review.

OBJECTIVE: To review available data examining antidepressant use and incident urinary incontinence (UI). DATA SOURCES: PubMed was used to conduct the literature search for this review. In the primary search, the term "antidepressive agents" was searched as a medical subject heading, a pharmacological action, and a keyword phrase. This choice was made so that any relevant articles would include complete results for antidepressive agents. "Antidepressive agents" was combined with the key phrase "drug-induced urinary incontinence" to complete this primary search. STUDY SELECTION: Relevant articles published in English and examining human subjects were included. DATA EXTRACTION: The study authors determined appropriateness of articles for inclusion, focusing on those examining antidepressant-associated UI. DATA SYNTHESIS: This literature review identified three cohort studies and 11 case reports examining various associations between antidepressant use and incident UI. CONCLUSION: All 11 case reports and 1 cohort study reviewed suggest an association between antidepressant use and incident UI. It remains unclear which drugs are most problematic and which patients are at greatest risk, and more data are needed to confirm an association, especially in older adults. Comprehensive medication reviews should be employed by pharmacists to identify potential medication-related causes of UI.

Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic.

BACKGROUND: Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people. OBJECTIVES: To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia. METHODS: The study sample was selected from an existing database that included sociodemographic, health-related information, and medication-related problems identified during a pharmacist-provided medication review conducted during October 2008-September 2009. Patients experiencing or at risk of homelessness who were ≥18 years old with at least one behavioral health condition who had a medication review were eligible for the study. A qualitative content analysis of the pharmacist documentation describing the patient's reason(s) for medication nonadherence was conducted. The Behavioral Model for Vulnerable Populations was the theoretical framework. The outcome variable was self-reported medication nonadherence. Descriptive and multivariate (logistic regression) statistics were used. RESULTS: A total of 426 individuals met study criteria. The mean age was 44.7 ± 10.2 years. Most patients were African-American (60.5%) and female (51.6%). The content analysis identified patient-related factors (74.8%), therapy-related factors (11.8%), and social or economic factors (8.8%) as the most common reasons for patients' medication nonadherence. Patients with post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI: 0.19-0.87) were less likely to have a medication adherence problem identified during the medication review. CONCLUSIONS: The content analysis identified patient-related factors as the most common reason for nonadherence with behavioral health medications. In the quantitative analysis, patients with a PTSD diagnosis were less likely to have nonadherence identified which may be related to their reluctance to self-report nonadherence and their diagnosis, which warrants further study.

Homeless patients' use of urban emergency departments in the United States.

Data from the 2009-2010 National Hospital Ambulatory Care Survey-Emergency Department were used to compare homeless patients' utilization of the urban emergency department (ED) in the United States with nonhomeless patients and to examine the relationship between homelessness and demographics and ED utilization measures. The weighted sample size was 200 645 347. A total of 1 302 256 patients (0.65%) were homeless. Homeless patients were significantly more likely to be older, male, have self-pay, have no charge/charity or other as payment type, arrive via ambulance, have a longer ED visit, and a past visit to the same ED in the last year.

Student pharmacists' perceptions and awareness of community pharmacy practice residency programs.

OBJECTIVES: To assess student exposure to types of pharmacy practice, evaluate awareness and perceptions of community pharmacy residencies, and identify areas of postgraduate training of interest to student pharmacists. DESIGN: Cross-sectional, descriptive, online survey study. SETTING: United States, January to April 2008. PARTICIPANTS: Student pharmacists in the final 2 years of the doctor of pharmacy (PharmD) program. INTERVENTION: An online survey was administered to students in the final 2 years of the PharmD program at randomly selected schools of pharmacy by region throughout the United States. MAIN OUTCOME MEASURES: Awareness of student pharmacists regarding community pharmacy residencies and interest in postgraduate training. RESULTS: 254 surveys were completed during the study period. Of the respondents, 95% had previous experience working in a community pharmacy setting. Nearly 90% were aware of community pharmacy residencies. Students who indicated opportunities to publish (odds ratio 2.4 [95% CI 1.34-4.1]), teaching students (2.1 [1.36-3.14]), enjoying the job atmosphere (4.9 [1.54-15.60]), and clinically challenging (4.3 [2.15-8.67]) as desirable career attributes were more likely to be interested in postgraduate training. No significant differences existed in the information sources sought by students interested in community pharmacy residency programs (CPRPs) compared with those interested in other types of postgraduate training. CONCLUSION: The significant predicators of student pharmacists interested in pursuing postgraduate training are in alignment with CPRP training. Further research is needed to market the value of CPRPs through the identified information sources.

The use of the health belief model to assess predictors of intent to receive the novel (2009) H1N1 influenza vaccine.

OBJECTIVES: 1) Assess participants' perceptions of severity, risk, and susceptibility to the novel H1N1 influenza virus and/or vaccine, vaccine benefits and barriers, and cues to action and 2) Identify predictors of participants' intention to receive the novel H1N1 vaccine. DESIGN: Cross-sectional, descriptive study SETTING: Local grocery store chain and university in the central Virginia area PARTICIPANTS: Convenience sample of adult college students and grocery store patrons INTERVENTION: Participants filled out an anonymous, self-administered questionnaire based upon the Health Belief Model. MAIN OUTCOME MEASURES: Participants' predictors of intention to receive the novel H1N1 vaccine RESULTS: A total of 664 participants completed a questionnaire. The majority of participants were aged 25-64 years old (66.9%). The majority were female (69.1%), Caucasian (73.7%), and felt at risk for getting sick from the virus (70.3%). Most disagreed that they would die from the virus (68.0%). Participants received novel H1N1 vaccine recommendations from their physicians (28.2%), pharmacists (20.7%), and nurses (16.1%). The majority intended to receive the H1N1 vaccine (58.1%). Participants were significantly more likely to intend to receive the H1N1 vaccine if they had lower scores on the perceived vaccine barriers domain (OR= 0.57, CI: 0.35-0.93). Physicians' recommendations (OR=0.26, CI: 0.11-0.62) and 2008 seasonal flu vaccination (OR=0.45, CI: 0.24-0.83) were significant predictors of intention to receive the H1N1 vaccine. CONCLUSIONS: Most participants felt at risk for getting the novel H1N1 virus and intended to receive the novel H1N1 vaccine. Educating patients about vaccine benefits and increasing healthcare professionals' vaccine recommendations may increase vaccination rates in future pandemics.

Implementation of a personal medication record program in an independent living facility.

OBJECTIVE: To describe the process of implementing a "Vial of Life" [Lifesaving Information for Emergencies] program in an independent living facility. SETTING: An independent living facility in the Richmond, Virginia, area. PRACTICE DESCRIPTION: The average age of the residents is 79.75 years, with 75% of the population being female. The facility offers social, cultural, and recreational activities, health and wellness programs, a salon, and outdoor activities. PRACTICE INNOVATION: Implementing the Vial of Life Project into an independent living facility. MAIN OUTCOME MEASUREMENTS: The number of patients who have participated in the Vial of Life Project; the implementation experience and student exposure to the implementation process. RESULTS: There were 12 residents out of 83 total who elected to receive the service from a pharmacist. This resulted in a 14.45% participation rate. In addition, the faculty and students were exposed to the program and its implementation in an independent living facility. CONCLUSION: The Vial of Life Project has allowed for increase in access to the pharmacist for education and medication reviews.

Integration of collaborative medication therapy management in a safety net patient-centered medical home.

OBJECTIVE: To describe the integration of collaborative medication therapy management (CMTM) into a safety net patient-centered medical home (PCMH). SETTING: Federally qualified Health Care for the Homeless clinic in Richmond, VA, from October 2008 to June 2010. PRACTICE DESCRIPTION: A CMTM model was developed by pharmacists, physicians, nurse practitioners, and social workers and integrated with a PCMH. CMTM, as delivered, consisted of (1) medication assessment, (2) development of care plan, and (3) follow-up. PRACTICE INNOVATION: CMTM is integrated with the medical and mental health clinics of PCMH in a safety net setting that serves homeless individuals. MAIN OUTCOME MEASURES: Number of patients having a CMTM encounter, number and type of medication-related problems identified for a subset of patients in the mental health and medical clinics, pharmacist recommendations, and acceptance rate of pharmacist recommendations. RESULTS: Since October 2008, 695 patients have had a CMTM encounter. An analysis of 209 patients in the mental health clinic indicated that 425 medication-related problems were identified (2.0/patient). Pharmacists made 452 recommendations to resolve problems, and 384 (85%) pharmacist recommendations were accepted by providers and/or patients. For 40 patients in the medical clinic, 205 medication-related problems were identified (5.1/patient). Pharmacists made 217 recommendations to resolve the problems, and 194 (89%) recommendations were accepted. CONCLUSION: Integrating CMTM with a safety net PCMH was a valuable patient-centered strategy for addressing medication-related problems among homeless individuals. The high acceptance rate of pharmacist recommendations demonstrates the successful integration of pharmacist services.

Development and Implementation of an Academic-Community Partnership to Enhance Care among Homeless Persons.

An academic-community partnership between a Health Care for the Homeless (HCH) clinic and a school of pharmacy was created in 2005 to provide medication education and identify medication related problems. The urban community based HCH clinic in the Richmond, VA area provides primary health care to the homeless, uninsured and underinsured. The center also offers eye care, dental care, mental health and psychiatric care, substance abuse services, case management, laundry and shower facilities, and mail services at no charge to those in need. Pharmacist services are provided in the mental health and medical clinics. A satisfaction survey showed that the providers and staff (n = 13) in the clinic were very satisfied with the integration of pharmacist services. The quality and safety of medication use has improved as a result of the academic-community collaborative. Education and research initiatives have also resulted from the collaborative. This manuscript describes the implementation, outcomes and benefits of the partnership for both the HCH clinic and the school of pharmacy.

Medication reconciliation: an important piece of the medication puzzle.

Medication errors continue to cause significant morbidity and mortality. This, in turn, costs the health care system millions of dollars each year in preventable costs. Medication reconciliation, an important piece of medication therapy management (MTM), is vital to reducing medication errors. By verifying, clarifying, and reconciling medications at each point of care, pharmacists can play a vital role in improving health care and lowering costs. This case study describes an MTM session with a 66-year-old Caucasian female who is referred by the nurse practitioner in the clinic for pharmacist services. The patient has a history of portal hypertension, alcoholic liver damage, and chronic obstructive pulmonary disease. After obtaining a detailed history, the pharmacist identified significant medication-related problems including polypharmacy, nonadherence, drug-alcohol interactions, and inappropriate use of medication. After discussions with the patient and her nurse practitioner, a medication plan was created for the patient to follow.

Implementation of a comprehensive pretravel health program in a supermarket chain pharmacy.

OBJECTIVE: To describe the procedures for implementing a comprehensive pretravel health program in a supermarket chain pharmacy. SETTING: Central Virginia (Richmond, Fredericksburg, Williamsburg, and Roanoke) between 2000 and 2008. PRACTICE DESCRIPTION: Ukrop's is a local supermarket chain with 29 stores, 20 of which have pharmacies. Ukrop's Pharmacy offers enhanced patient care services, including medication therapy management, wellness services, diabetes education and management, smoking cessation, and immunizations. PRACTICE INNOVATION: Comprehensive pretravel health program. MAIN OUTCOME MEASURES: Number of patients participating in the pretravel health program and number of vaccinations administered by pharmacists. RESULTS: An average of 1,000 patients per year participate in the pretravel health program, and approximately 1,900 vaccines are administered each year. CONCLUSION: A comprehensive pretravel program is a successful service in a supermarket chain pharmacy. It provides another option for travelers seeking pretravel health care.

Revealing undetected problems with medication therapy management services.

Implementation of Medication Therapy Management (MTM) services under the Medicare Modernization Act of 2003 has highlighted the innovative roles that pharmacists are assuming in progressive, community-based practice settings. MTM underscores the vital role that community pharmacists have in helping patients achieve desirable therapeutic outcomes and reduce health care expenses. Pharmacists can: 1) obtain detailed medication histories, 2) assess patient adherence and the development of side effects, 3) educate patients on their medications and disease states, and 4) perform cost-effective therapeutic interchanges in collaboration with prescribers. This case describes an MTM session with a 68-year-old Caucasian male who is a regular prescription customer at a local grocery-store chain pharmacy. The patient was screened and identified by his Medicare Part D plan as one who qualifies for MTM services. He has a history of dyslipidemia, depression, and epilepsy. The patient was contacted by the pharmacist to participate in a MTM appointment to discuss his current medications and disease states. After obtaining a detailed history, the pharmacist identified significant medication-related problems including inappropriate prescribing of medication, self-treatment, and the patient's lack of knowledge concerning his medications. After discussions with the patient and his health care providers, a medication plan was created for the patient to follow. Open communication among the patient, pharmacist, and prescribers is a crucial component to ensure the success of MTM services.