Ambulatory care pharmacy practice: Findings from the 2019 National Pharmacist Workforce Survey.

PURPOSE: The purpose of this study was to describe the demographics, training, clinical specialties, and practice activities of ambulatory care pharmacists using data from the 2019 National Pharmacist Workforce Study (NPWS). SUMMARY: The 2019 NPWS was conducted using a 3-contact electronic survey sent to a random sample of 94,803 pharmacists using the National Association of Boards of Pharmacy Foundation e-Profile system. The 2019 NPWS had a response rate of 67.3% (5,705/8,466), based on the number of prospective respondents who clicked the survey link. A subset of pharmacists' responses (n = 4,557) was used for this analysis, which included those who selected an employment status of "practicing as a pharmacist." Of the 4,557 actively practicing pharmacists responding, 338 (8.0%) reported working in the ambulatory care setting. Ambulatory care pharmacists were predominately White (71.6%), women (67.5%), and/or between the ages of 31 and 40 years (36.9%). A total of 41.3% had completed PGY1 residency training, 14% had completed PGY2 residency training, and 29.3% had completed one or more board certifications. Their most common clinical specialty areas were anticoagulation (21.7%), endocrinology (19.7%), hematology/oncology (16.2%), and primary care (16.2%). A total of 49.6% reported using a collaborative practice agreement. CONCLUSION: Ambulatory care pharmacists reported more training and certifications than the overall sample of pharmacists. These pharmacists practiced in a variety of clinical specialty areas and engaged in a range of in-person and telecommunication medication management activities. This study provides a baseline assessment of the ambulatory care pharmacist workforce that can be used to assess changes over time.

Leadership aspiration: An intersectional analysis of racial and gender equity in pharmacy.

BACKGROUND: The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, underrepresented groups face various barriers and limitations to their successes. OBJECTIVES: The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership. METHODS: The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics. RESULTS: Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (± $73,701) for Other men to $112,384 (± $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r = 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 ± $88,898). CONCLUSION: Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepresented pharmacists into leadership positions.

Identifying Services Provided in Community Pharmacy Practice Settings.

Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.

Exploring the moderating role of job resources in how job demands influence burnout and professional fulfillment among U.S. pharmacists.

BACKGROUND: Job stress, burnout, and fulfillment can be modeled using the Job Demands and Resources model (JD-R). OBJECTIVE: This study explores the relationship between job demands and burnout and professional fulfillment in pharmacists, and the moderating role of job resources. METHODS: Data were obtained from the 2019 National Pharmacist Workforce Survey of a random sample of U.S. licensed pharmacists. The survey assessed pharmacist demographics (age, gender, and work setting), job demands (workload and work-home conflict), job resources (job control, time spent in various work activities, and social support), as well as burnout and professional fulfillment. Hierarchical regression analyses were used to assess the relationship between job demands-resources variables and pharmacists' professional fulfillment and burnout. Moderation was assessed by including interaction terms (job demands x job resources) in the regression models. The change in marginal mean burnout and professional fulfillment for different combinations of job demands and job resources was used to assess the salience of significant moderation effects. RESULTS: Women and community pharmacists accounted for 64.8% and 45.8% of the study sample, respectively. Age was negatively associated with burnout. Job demands were positively associated with burnout and negatively associated with professional fulfillment, and the converse was true for job resources. Significant moderation effects were observed for 7 out of 12 interaction terms assessed. The moderating effect of job resources was more salient under varying conditions of job demands in 5 out of 7 instances where significant interaction effects were observed. CONCLUSION: While pharmacist characteristics explained a significant amount of variation in burnout and professional fulfillment, also considering the moderating effects of job resources on the association of job demands with burnout and professional fulfillment identified additional information, such as the increased importance of job control and task variety in high workload environments.

Preparing for the spread of patient-reported outcome (PRO) data collection from primary care to community pharmacy: a mixed-methods study.

BACKGROUND: Medication non-adherence is a significant public health problem. Patient-reported outcomes (PROs) offer a rich data source to facilitate resolution of medication non-adherence. PatientToc™ is an electronic PRO data collection software originally implemented at primary care practices in California, United States (US). Currently, the use of standardized PRO data collection systems in US community pharmacies is limited. Thus, we are conducting a two-phase evaluation of the spread and scale of PatientToc™ to US Midwestern community pharmacies. This report focuses on the first phase of the evaluation. The objective of this phase was to prepare for implementation of PatientToc™ in community pharmacies by conducting a pre-implementation developmental formative evaluation to (1) identify potential barriers, facilitators, and actionable recommendations to PatientToc™ implementation and (2) create a draft implementation toolkit. METHODS: Data collection consisted of demographics, observations, audio-recorded contextual inquiries, and semi-structured interviews with staff (e.g., primary care providers, pharmacists, pharmacy technicians) and patients during 1-day site visits to a purposive sample of (1) primary care practices currently using PatientToc™ and (2) community pharmacies in Indiana, Wisconsin, and Minnesota interested in the future use of PatientToc™. Post-visit site observation debriefs were also audio-recorded. Verbatim transcripts of all recordings were coded using deductive/inductive approaches and intra-/inter-site summaries were produced identifying potential barriers, facilitators, and actionable recommendations mapped to the Consolidated Framework for Implementation Research constructs. A stakeholder advisory panel engaged in an Evidence-Based Quality Improvement (EBQI) implementation process. This included "member checking" and prioritizing findings, and feedback on the adapted PatientToc™ application, implementation strategies, and accompanying toolkit for community pharmacy implementation. RESULTS: Two primary care practices, nine pharmacies, and 89 individuals participated. Eight major themes (four barriers and four facilitators) and 14 recommendations were identified. Throughout the four EBQI sessions, the panel (1) confirmed findings; (2) designated high priority recommendations: (a) explain PatientToc™ and its benefits clearly and simply to patients, (b) ensure patients can complete questionnaires within 10 min, and (c) provide hands-on training/resources for pharmacy teams; and (3) provided feedback on the adapted PatientToc™ application and finalized toolkit items for initial community pharmacy implementation. CONCLUSIONS: Adoption of electronically captured PROs in community pharmacies is warranted. The implementation strategies systematically developed in this study can serve as a model for implementation of technology-driven health information patient care services, in the understudied context of community pharmacies.

Use of the Professional Fulfillment Index in Pharmacists: A Confirmatory Factor Analysis.

Most research on pharmacist professional wellbeing has focused on measuring burnout. However, using valid and reliable instruments to assess professional fulfillment in pharmacists can expand understanding of pharmacists' professional wellbeing. This study aimed to (1) establish the validity of the Professional Fulfillment Index (PFI) for a sample of pharmacists licensed in the United States (US) using confirmatory factor analysis (CFA), and (2) compare the professional wellbeing of pharmacists across demographics and work settings. Data for this study were obtained from the 2019 National Pharmacy Workforce Survey (NPWS). The survey assessed pharmacist professional wellbeing using the PFI. The model fit of the PFI was assessed using CFA. Multiple linear regression was used to compare pharmacist wellbeing across demographics and work settings. The CFA affirmed that the PFI possesses a satisfactory model fit for use in pharmacists. Regression analysis showed higher burnout (work exhaustion and interpersonal disengagement) was associated with decreasing age, being female, working more hours, and working in a community pharmacy. Higher professional fulfillment was associated with men, and working in non-community pharmacy work settings. The PFI is a psychometrically reliable and valid instrument for assessing the professional wellbeing of pharmacists.

Snapshot of unemployed pharmacists from the 2019 National Pharmacy Workforce Survey.

BACKGROUND: Prior national surveys have quantified unemployment in the pharmacy workforce, and recent surveys have occurred in a changing environment, with increased numbers of pharmacists in the labor market. OBJECTIVES: We sought to investigate the rate of unemployment and situations of unemployed pharmacists. METHODS: Data from the 2019 National Pharmacist Workforce Survey were analyzed, focusing on an initial question about employment status and follow-up questions for unemployed respondents about whether they were seeking a job, the reason they were unemployed, and how long they had been unemployed. RESULTS: Overall, 4.4% of the respondents were unemployed, with higher rates occurring for female pharmacists, older pharmacist cohorts, and respondents of color, with the highest rate occurring (9.3%) for Black pharmacists. Most (74.4%) of the unemployed pharmacists were seeking a job in pharmacy, but 16.6% were not seeking any job. Nearly two-thirds of the unemployed pharmacist respondents had left the workforce involuntarily, with men at higher rates than women. The youngest cohort of unemployed pharmacists was the least likely to be forced to leave and more likely to leave for workplace-related or personal reasons. Black pharmacists had the overall highest rate of leaving the workforce involuntarily. On average, the unemployed pharmacists had been out of work nearly 2 years (19.2 months), and the periods out of work ranged widely. Those seeking a job in pharmacy predominantly (75.7%) had been unemployed for 1 year or less. More than half of the pharmacists involuntarily unemployed had been unemployed for 6 months or less. CONCLUSION: An increased rate of unemployment and a higher proportion of those unemployed seeking work occurred in this most recent national survey of the pharmacist workforce. Differences in the extent of unemployment and whether leaving the workforce was voluntary or involuntary occurred in pharmacists of color and in some age cohorts.

An intersectional review of discrimination and harassment experiences in pharmacy: Findings from the 2019 National Pharmacist Workforce Survey.

BACKGROUND: Most pharmacists in the United States are women, and the profession is becoming more racially diverse. The recent increase in political and social movements in the United States has heightened our awareness of the importance of better understanding the experiences of underrepresented individuals and groups. Little is known about discrimination and harassment in the profession of pharmacy in the United States. OBJECTIVES: The purpose of this study was to provide evidence that discrimination and harassment exist in the pharmacy profession and explore differences in discrimination and harassment using the intersectionality of race and sex. METHODS: The 2019 National Pharmacist Workforce Survey (NPWS) utilized an electronic survey that was distributed using a 3-contact Dillman approach by email to a randomized sample of 96,110 licensed pharmacists from all 50 U.S. states using the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS included a new battery of questions to assess the prevalence of discrimination and harassment in pharmacy. RESULTS: The most common bases of discrimination experienced were based on age (31.2%), sex (29%), and race or ethnicity (16.6%). The most common type of harassment experienced was "hearing demeaning comments related to race or ethnicity" at 15.6%. The intersectionality analysis revealed different experiences among sex or race combinations. Black and Asian male pharmacists had the highest rate of "hearing demeaning comments about race or ethnicity." Nonwhite pharmacists were more likely to experience harassment from customers or patients compared with their white colleagues. Black female pharmacists had the highest rate of being "very unsatisfied" with the results of reporting discrimination and harassment to their employer. CONCLUSION: Discrimination, including harassment and sexual harassment, is illegal, immoral, and unjust. As the profession of pharmacy continues to become more diverse, there must be a conscious, systemic, and sustained effort to create and maintain workplaces that are safe, equitable, and free of discrimination.

National Pharmacist Workforce Study (NPWS): Description of 2019 Survey Methods and Assessment of Nonresponse Bias.

National Pharmacist Workforce Studies (NPWS) have been conducted in the U.S. every five years since 2000. This article describes the online survey methods used for the latest NPWS conducted in 2019 and provides an assessment for nonresponse bias. Three waves of emails containing a link to the online survey were sent to a random sample of about 96,000 pharmacists licensed in the United States. The survey asked about pharmacist employment, work activities, work-life balance, practice characteristics, pharmacist demographics and training. A total of 5467 usable responses were received, for a usable response rate of 5.8%. To assess for nonresponse bias, respondent characteristics were compared to the population of U.S. pharmacists and a benchmark, while a wave analysis compared early and late respondents. The pharmacist sample-population comparison and the benchmark comparison showed that the NPWS respondents had a higher percentage of female pharmacists and a lower proportion of young pharmacists compared to the population of U.S. pharmacists and the benchmark sample. In some contrast, the wave analysis showed that the early respondents had a higher percentage of males and older pharmacists compared to the late respondents. Both the wave analysis and the benchmark comparison showed that the NPWS respondents (and early respondents) had a lower percent of pharmacists with a PharmD degree than did the late respondents and the benchmark group. These differences should be considered when interpreting the findings from the 2019 NPWS.

Does evidence matter? Comparative effectiveness research and prescribing of Type 2 diabetes mellitus drugs.

Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, limited research assesses the translation of CER into clinical practice. The objective of this study was to analyze the association between CER evidence and prescribing trends within two markets of Type 2 diabetes mellitus. Methods: A retrospective analysis to determine the prescribing trends from 2006 to 2016 and an electronic literature search to identify CER comparing different drugs was conducted. Results: In glucagon-like peptide-1 (GLP-1) agonists market, CER showed superiority of Liraglutide. Prescribing of Exenatide twice daily dropped by 50% points as Liraglutide entered the market. In dipeptidyl peptidase-4 (DPP4) inhibitors market, CER did not suggest conclusive superiority. Nevertheless, Sitagliptin, the first entrant, continued to dominate throughout. Conclusion: CER evidence appeared to be associated with prescribing trends in GLP-1 agonists market; however, no associations were found in DPP4 inhibitors market. The translation of evidence into practice can be limited by the availability of superiority trials and timing of their availability.

Associations between Work Activity and Work Setting Categories and Dimensions of Pharmacists' Quality of Work Life.

The goal for this study was to use data from the most recently conducted National Pharmacist Workforce Survey to compare eight components of quality of work life for actively practicing pharmacists in the United States categorized by (1) work activity and (2) work setting. The eight components of quality of work life were: (1) time stress; (2) responsibility stress; (3) level of control; (4) work in harmony with home life; (5) home life in harmony with work; (6) job satisfaction; (7) professional commitment; and (8) organizational commitment. Data for this study were obtained from the 2014 National Pharmacist Workforce Survey. For inclusion in analysis, respondents needed to report that they were practicing as a pharmacist. In addition, they needed to provide usable responses for both their percent time devoted to medication providing and to patient care services. This resulted in a total of 1191 responses for the analysis. Data were analyzed using cluster analysis, factor analysis, Cronbach coefficient alpha, chi-square analysis, ANOVA, and linear regression. The findings provide a description of pharmacists’ quality of work life in 2014 and show how type of work, variety of work, and work setting categories are associated with quality of work life for pharmacists.

Influences on the frequency and type of community pharmacy services.

OBJECTIVES: To describe services provided by community pharmacies and to identify factors associated with services being provided in community pharmacies. DESIGN: Cross-sectional national mail survey. SETTING AND PARTICIPANTS: Pharmacists actively practicing in community pharmacies (independent, chain, mass merchandisers, and supermarkets). OUTCOME MEASURES: Frequency and type of pharmacy services available in a community pharmacy, including medication therapy management, immunization, adjusting medication therapy, medication reconciliation, disease state management, health screening or coaching, complex nonsterile compounding, and point-of-care testing. RESULTS: With a 48.4% response rate, the survey showed that community pharmacies offered on average 3 of the 8 services studied. Pharmacy chains and supermarket pharmacies reported providing significantly more services than did mass merchandise pharmacies. The number of pharmacy services provided was positively associated with involvement in an interprofessional care team, innovativeness, and perceived workload. The number of pharmacy services was negatively correlated with having 3.5 or more pharmacy technicians on duty. CONCLUSION: Pharmacy chains and supermarkets are providing the most pharmacy services among community pharmacy settings. The number of services provided was associated with innovativeness, technician staffing, and perceived workload. Also, involvement with an interprofessional care team supported greater service delivery. Community pharmacies vary in their provision of services beyond dispensing.

Exploring pharmacists' perceived job alternatives: Results from the 2014 National Pharmacist Workforce Survey.

OBJECTIVE: To examine the association between pharmacists' demographics, practice variables, worklife attitudes (e.g., work environment stress, control in the work environment, professional commitment, work-home conflict, and organizational commitment), and their perceived job alternatives. DESIGN: Cross-sectional descriptive study. SETTING: A representative nationwide sample of licensed pharmacists in the United States, 2014. PARTICIPANTS: A total of 1574 practicing pharmacists. MAIN OUTCOME MEASURES: A previously validated Likert-type scale was used to measure perceived job alternatives. Pharmacists reported their perception on how easy it would be to find a better job with the use of 17 common organizational characteristics. The higher the score, the easier they perceived it would be to find a new job. RESULTS: The perceived job alternatives scale manifested 4 constructs: environmental conditions, professional opportunities, compensation, and coworkers. Multivariate regression analysis showed that organizational commitment was the most influential worklife attitude and was negatively associated with all constructs except better compensation. The higher professional commitment and environmental stress, the easier pharmacists perceive it would be to find a new job with better environmental conditions, such as better professional treatment by management. Younger pharmacists indicated higher perceived levels of ease in finding a job with better environmental conditions and professional opportunities. Male pharmacists also reported a higher perceived level of ease in finding an alternate job with better professional opportunities. White pharmacists perceived it would be easier to find a new job with better environmental aspects and compensation. No statistical significance was observed in perceived job alternatives among pharmacists practicing in different primary work settings after adjusting for other variables. CONCLUSION: Demographics and worklife attitudes were found to affect perceived availability of job alternatives. Organizational commitment was the most important factor inversely associated with pharmacists' perceptions of better job alternatives. Employers may retain pharmacists by constantly maintaining pharmacists' sense of belonging to their organizations.

The Impact of a Pricing Policy Change on Retail Prices of Medicines in Egypt.

OBJECTIVES: To describe the products with price changes and assess the impact of price changes on the products' price and affordability within the context of the Egyptian market. METHODS: A descriptive pre-post observational study was conducted. We selected March through June 2013 as the post-change observation period. A matching pre-change observation period, one year earlier, was selected to be consistent with potential seasonal variation in product use. RESULTS: It was found that 65.7% of the products with price changes were low-priced generic products. The overall average percent change in price was 24.7%. Before decree #499 implementation, the average affordability of the low-, medium-, and high-priced products was 0.25 days' wage, 2 days' wage, and more than 100 days' wage, respectively. After the implementation, the cost increase for the low- and medium-priced products was less than 0.1 days' wage, whereas the high-priced products' cost decreased by 11 days' wage. CONCLUSIONS: The policy change resulted in both price decreases and increases without substantive implications on affordability.

Trends in pharmacist participation in the workforce, 2009 to 2014.

OBJECTIVES: To examine changes from 2009 to 2014 in variables related to whether, how much, and where licensed pharmacists worked as pharmacists. Comparisons were made separately for men and women pharmacists. DESIGN: Data were obtained from 2 cross-sectional, descriptive surveys of licensed pharmacists and represented 1394 pharmacists in 2009 and 2446 pharmacists in 2014. The useable response rates to the surveys were 52.3% and 48.2%, respectively. SETTING: United States. MAIN OUTCOME MEASURES: We examined the work status, the work setting, work position, and age distribution of actively practicing pharmacists. We studied the proportion of pharmacists working part-time overall and by age group and determined full-time equivalents (FTEs) by age group. RESULTS: From 2009 to 2014, the proportion of licensed pharmacists that reported actively practicing pharmacy decreased for both men and women pharmacists. A significantly larger proportion of men pharmacists reported being retired in 2014 compared with 2009. In 2014, women represented a majority of actively practicing pharmacists and pharmacists in management positions. The proportion of actively practicing women pharmacists that worked part-time decreased from 2009 to 2014, and the FTE contribution of women pharmacists was approximately equal to men pharmacists in 2014. The proportion of pharmacists working in community practice settings decreased from 2009 to 2014. CONCLUSION: The period 2009 to 2014 appears to have been a time of great change in the pharmacist workforce and for work participation by pharmacists, reinforcing the need to continue to monitor changes that affect work participation by pharmacists.

Health Behavior Change after Blood Pressure Feedback.

Better understanding is needed for antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This study aimed to assess health behavior change after receiving a report of elevated blood pressure among African Americans and Caucasians younger than 50 years old. We used the Coronary Artery Risk Development in Young Adults (CARDIA) repository dataset. By examination year twenty, 424 out of 2,478 Caucasian and 2,637 African American participants had received feedback from the CARDIA study due to elevated blood pressure readings. Blood pressure was measured by trained CARDIA researchers at the participant's home and was repeatedly recorded at seven examinations over twenty years. A feedback/referral letter was sent to participants with an elevated blood pressure reading. On average, participants first had an elevated blood pressure reading at the age of 34. After receiving the feedback letter, 44% of the previously undiagnosed participants received a formal diagnosis. In addition, 23% initiated the use of antihypertensive medication if they had not received medication treatment before. Among the participants with at-risk lifestyle behaviors, 40% reduced alcohol consumption, 14% increased exercise level, 11% stopped smoking, and 8% reached normal weight. While none of the studied patient factors were associated with lifestyle modification, age had a positive impact on antihypertensive medication initiation (p<0.05). We found no evidence of differences in health behavior change between African American and Caucasian participants after receiving the feedback letter. This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure outside of healthcare settings. Although additional referral care and behavior interventions are needed to facilitate medication initiation and lifestyle modification, our observations suggest that providing blood pressure feedback may have promise as part of a multi-method approach involving blood pressure screening and follow up.

Assessing Unmet and Latent Demand for Pharmacists at the State Level.

BACKGROUND: Past reports suggest that a near balance has been reached in the supply and demand for pharmacists in the US. Although data on the level of supply of pharmacists is available, there is no continuous and systematic tracking of the level of demand (unmet and latent) for pharmacists at state level. Unmet demand, an established construct in pharmacy workforce, is important to measure the number of vacancies and assess pharmacist shortage consistently over time. Latent demand or potential demand is a novel construct and has never been measured in pharmacy workforce. With the increase in supply, it is important to measure the potential demand that could be budgeted in pharmacies in the near future. OBJECTIVE: The objective of this study was to measure the unmet and latent demand for pharmacists and explore the association between latent demand and workload characteristics in community and hospital pharmacies in Wisconsin in 2011-12. METHODS: The study used a cross-sectional, descriptive survey design. A sample of community pharmacies (n=1,064) and hospital pharmacies (n=126) licensed in Wisconsin in 2011-12 was identified. Key informants (managers/owners) of sampled pharmacies were sent a one-page cover letter explaining the purpose of the study and requesting participation and a three page survey form. The main outcome measures of the study were total number of FTE pharmacist positions vacant, presence of adequate staff size, additional number of FTE pharmacist positions needed to attain adequate staff size, prescription volume, daily census, hospital size and number of hours prescription department is open. Descriptive statistics were calculated for all the pharmacies collectively, then separately for community and hospital pharmacies. Pharmacy setting, vacancies and workload characteristics of pharmacies with and without latent demand were compared using chi-squared test of independence and/or t-test. Sample weights were calculated and used in all the analyses to weigh the estimates to all pharmacies in Wisconsin. RESULTS: Overall response rate to the survey was 50.1%. Of the total number of FTE pharmacist positions budgeted in Wisconsin, 54.3 FTE positions (1.5%) were reported vacant in 2011-12. Approximately 28.2% of the community and hospital pharmacies reported the presence of latent demand. Latent demand was significantly associated with higher workload in community pharmacies and larger bed size in hospital pharmacies. CONCLUSION: There appeared to be a balance between the supply and demand for pharmacists in Wisconsin in 2011-12. There is a potential for additional FTE positions (latent demand) to be budgeted in pharmacies to attain adequate pharmacist staff size. It is important to consistently track the level of unmet and latent demand for pharmacists in Wisconsin and combine this information with other workforce characteristics to guide the decision making of pharmacy workforce planners and pharmacy managers.

Content analysis of false and misleading claims in television advertising for prescription and nonprescription drugs.

BACKGROUND: False and misleading advertising for drugs can harm consumers and the healthcare system, and previous research has demonstrated that physician-targeted drug advertisements may be misleading. However, there is a dearth of research comparing consumer-targeted drug advertising to evidence to evaluate whether misleading or false information is being presented in these ads. OBJECTIVE: To compare claims in consumer-targeted television drug advertising to evidence, in order to evaluate the frequency of false or misleading television drug advertising targeted to consumers. DESIGN: A content analysis of a cross-section of television advertisements for prescription and nonprescription drugs aired from 2008 through 2010. We analyzed commercial segments containing prescription and nonprescription drug advertisements randomly selected from the Vanderbilt Television News Archive, a census of national news broadcasts. MAIN MEASURES: For each advertisement, the most-emphasized claim in each ad was identified based on claim iteration, mode of communication, duration and placement. This claim was then compared to evidence by trained coders, and categorized as being objectively true, potentially misleading, or false. Potentially misleading claims omitted important information, exaggerated information, made lifestyle associations, or expressed opinions. False claims were factually false or unsubstantiated. KEY RESULTS: Of the most emphasized claims in prescription (n = 84) and nonprescription (n = 84) drug advertisements, 33 % were objectively true, 57 % were potentially misleading and 10 % were false. In prescription drug ads, there were more objectively true claims (43 %) and fewer false claims (2 %) than in nonprescription drug ads (23 % objectively true, 7 % false). There were similar numbers of potentially misleading claims in prescription (55 %) and nonprescription (61 %) drug ads. CONCLUSIONS: Potentially misleading claims are prevalent throughout consumer-targeted prescription and nonprescription drug advertising on television. These results are in conflict with proponents who argue the social value of drug advertising is found in informing consumers about drugs.

The effect of the Medicare Part D benzodiazepine exclusion on the utilization patterns of benzodiazepines and substitute medications.

BACKGROUND: Although the benzodiazepine exclusion policy in the U.S. Medicare Part D drug coverage program has been studied, little information is available on individual use and switching patterns between benzodiazepines and substitute medications. Patients voluntarily were continuing or stopping benzodiazepines or switching to substitute medications. These individual-level outcomes can provide information beneficial to providers and policymakers to better understand the intended and unintended consequences of exclusion policies. OBJECTIVE: The objective was to determine the effect of the Medicare Part D benzodiazepine exclusion on the utilization patterns of benzodiazepines and substitute medications by a select group of Medicare beneficiaries for a year following implementation of the exclusion. This research focused on the examination of the within-person patterns of benzodiazepine use and factors associated with these patterns. METHODS: A quasi-experimental, comparative study was used to analyze prescription patterns and multinomial regression models were applied to investigate factors predicting different benzodiazepine use patterns. Pharmacy dispensing data for continuously eligible Medicare beneficiaries with at least one benzodiazepine fill in 2005 were reduced to a comparison group of 216 individuals with continual coverage and an intervention group of 250 individuals who lost coverage for benzodiazepines. Four individual patients' drug use patterns, continuation, switch, fluid movement, and cessation were identified by sorting and arraying pharmacy dispensing data to apply systematic drug file review. Multinomial regression models were used to examine the impact of coverage, demographic, medical, economic, and pharmaceutical factors. RESULTS: Significantly more Medicare seniors who lost benzodiazepine coverage switched to potential substitute medications than those who continued to have coverage. Interestingly, 12 percent of affected seniors and 6 percent of unaffected seniors switched from and back to benzodiazepines (fluid movement). Zolpidem was the most popular substitute agent despite being an expensive brand-name drug. Regression models revealed that affected individuals had nearly two times the odds of engaging in switch-related patterns than those who had continuous coverage. Also, women were twice as likely to discontinue benzodiazepines as men. CONCLUSIONS: More seniors who lost benzodiazepine coverage engaged in medication switching, and women were more likely to stop benzodiazepines after the implementation of the exclusion policy.

State Medicaid programs missed $220 million in uncaptured savings as generic fluoxetine came to market, 2001-05.

Patent expiration of brand-name pharmaceuticals creates opportunities for large savings for state Medicaid programs because generic versions of medications frequently represent a lower-cost alternative. State Medicaid programs that quickly recognize the availability of generics and adjust their drug payments in response to falling market prices can obtain the greatest benefit. We examined one such case: the movement to generic fluoxetine following patent expiration for Prozac, a widely prescribed antidepressant and an expensive drug for Medicaid. We found large differences in states' responses to generic availability. States took between two and ten calendar quarters to reach 90 percent use of generic rather than brand-name fluoxetine and four to eight quarters to achieve a 50 percent decrease in reimbursement per pill. We estimated that states failed to realize $220 million in uncaptured savings during 2001-05. By coordinating their efforts, perhaps with federal help, states could gain access in a more timely way to market prices for generic drugs and, hence, take greater advantage of the savings that those drugs offer.