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1.
Res Social Adm Pharm ; 18(1): 2157-2163, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33903066

RESUMO

Video-reflexive ethnography (VRE) is a qualitative methodology that explores the complex nature of healthcare 'as it really is'. Its collaborative and reflexive process invites stakeholders (e.g. pharmacists and pharmacy support staff) to participate in analysing their everyday work practices as captured on video footage. Through close collaboration with practitioners and attention to their work contexts, VRE may be a useful methodology to engage a time-poor pharmacy workforce in research about themselves, encouraging more practitioner involvement in practice-based research. Aside from research, VRE has also been used effectively as an intervention to facilitate learning and change in healthcare settings, and could be effective in provoking change in otherwise resistant pharmacy environments. Much like traditional ethnographic approaches, VRE researchers have relied on being present 'in the field' to observe, record and make sense of practices with participants. The COVID-19 pandemic however, has introduced restrictions around travel and physical distancing, which has required researchers to contemplate the conduct of VRE 'at a distance', and to imagine new ways in which the methodological 'closeness' to stakeholders and their workplace contexts can be maintained when researchers cannot be on site. In this commentary, we outline the rationale for participatory methods, in the form of VRE, in pharmacy research. We describe the underlying principles of this innovative methodology, and offer examples of how VRE can be used in pharmacy research. Finally, we offer a reflexive account of how we have adapted the method for use in community pharmacy research, to adapt to physical distancing, without sacrificing its methodological principles. This paper offers not only a new methodology to examine the complexity of pharmacy work, but demonstrates also the responsiveness of VRE itself to complexity, and the potential breadth of future research applications in pharmacy both during and beyond the current pandemic.


Assuntos
COVID-19 , Farmácias , Pesquisa em Farmácia , Antropologia Cultural , Pesquisa Participativa Baseada na Comunidade , Humanos , Pandemias , Farmacêuticos , SARS-CoV-2
2.
Harm Reduct J ; 18(1): 115, 2021 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-34789270

RESUMO

Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe exchange programs (SEPs) in the United States remains inadequate. This nationally representative study examined associations between obtaining syringes from pharmacies, SEPs, and sterilizing syringes with bleach and risk of syringe borrowing, lending and reusing syringes in a pooled cross-sectional dataset of 1737 PWID from the 2002-2019 National Survey on Drug Use and Health. Logistic regression was used to produce odds ratios (OR) of the odds of injection drug behaviors after adjusting for obtaining syringes from SEPs, pharmacies, the street, and other sources and potential confounders of race, ethnicity, sex, education, and insurance coverage. Obtaining syringes through SEPs was associated with lower odds of borrowing (OR = .4, CI95% = .2, .9, p = .022) and reusing syringes (OR = .3, CI95% = .2, .6, < .001) compared to obtaining syringes on the street. Obtaining syringes from pharmacies was associated with lower odds of borrowing (OR = .5, CI95% = .3, .9, p = .037) and lending (OR = .5 CI95% = .3, .9, p = .020) syringes. Using bleach to clean syringes was associated with increased odds of borrowing (OR = 2.0, CI95% = 1.3, 3.0, p = .002), lending (OR = 2.0, CI95% = 1.3, 3.0, p = .002) and reusing syringes (OR = 2.4, CI95% = 1.6, 3.6, p < .001). Our findings support provision of syringes through pharmacies and SEPs as a gold-standard strategy of reducing sharing and reuse of syringes in the US.


Assuntos
Infecções por HIV , Preparações Farmacêuticas , Farmácias , Farmácia , Abuso de Substâncias por Via Intravenosa , Estudos Transversais , Humanos , Uso Comum de Agulhas e Seringas , Programas de Troca de Agulhas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas , Estados Unidos/epidemiologia
3.
Am J Prev Med ; 61(6): e289-e295, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34801208

RESUMO

INTRODUCTION: Improving access to naloxone is an important public health strategy in the U.S. This study examines the state-level trends in naloxone dispensing from 2012 to 2019 for all 50 states and the District of Columbia. METHODS: Data from IQVIA Xponent were used to examine the trends and geographic inequality in annual naloxone dispensing rates and the number of naloxone prescriptions dispensed per high-dose opioid prescription from 2012 to 2019 and from 2016 to 2019 to correspond with the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain release. Annual percentage change was estimated using linear regression. Analyses were conducted in 2020. RESULTS: Naloxone dispensing rates and the number of naloxone prescriptions per 100 high-dose opioid prescriptions increased from 2012 to 2019 across all states and the District of Columbia. Average state-level naloxone dispensing rates increased from 0.55 per 100,000 population in 2012 to 45.60 in 2016 and 292.31 in 2019. Similarly, the average number of naloxone prescriptions per 100 high-dose opioid prescriptions increased from 0.002 in 2012 to 0.24 in 2016 and 3.04 in 2019. Across both measures of naloxone dispensing, the geographic inequality gap increased during the study period. In 2019, the number of naloxone prescriptions dispensed per 100 high-dose opioid prescriptions ranged from 1.04 to 16.64 across states. CONCLUSIONS: Despite increases in naloxone dispensing across all states, dispensing rates remain low, with substantial variation and increasing disparities over time at the state level. This information may be helpful in efforts to improve naloxone access and in designing state-specific intervention programs.


Assuntos
Farmácias , Farmácia , Analgésicos Opioides/uso terapêutico , Prescrições de Medicamentos , Humanos , Naloxona , Padrões de Prática Médica , Estados Unidos
4.
BMC Health Serv Res ; 21(1): 1253, 2021 Nov 20.
Artigo em Inglês | MEDLINE | ID: mdl-34798895

RESUMO

BACKGROUND: Minor ailments are "self-limiting conditions which may be diagnosed and managed without a medical intervention". A cluster randomised controlled trial (cRCT) was designed to evaluate the clinical, humanistic and economic outcomes of a Minor Ailment Service (MAS) in community pharmacy (CP) compared with usual care (UC). METHODS: The cRCT was conducted for 6 months from December 2017. The pharmacist-patient intervention consisted of a standardised face-to-face consultation on a web-based program using co-developed protocols, pharmacists' training, practice change facilitators and patients' educational material. Patients requesting a non-prescription medication (direct product request) or presenting minor ailments received MAS or UC and were followed-up by telephone 10-days after the consultation. The primary economic outcomes were incremental cost-utility ratio (ICUR) of the service and health related quality of life (HRQoL). Total costs included health system, CPs and patient direct costs: health professionals' consultation time, medication costs, pharmacists' training costs, investment of the pharmacy and consultation costs within the 10 days following the initial consultation. The HRQoL was obtained using the EuroQoL 5D-5L at the time of the consultation and at 10-days follow up. A sensitivity analysis was carried out using bootstrapping. There were two sub-group analyses undertaken, for symptom presentation and direct product requests, to evaluate possible differences. RESULTS: A total of 808 patients (323 MAS and 485 UC) were recruited in 27 CPs with 42 pharmacists (20 MAS and 22 UC). 64.7% (n = 523) of patients responded to follow-up after their consultation in CP. MAS patients gained an additional 0.0003 QALYs (p = 0.053). When considering only MAS patients presenting with symptoms, the ICUR was 24,733€/QALY with a 47.4% probability of cost-effectiveness (willingness to pay of 25,000€/QALY). Although when considering patients presenting for a direct product request, MAS was the dominant strategy with a 93.69% probability of cost-effectiveness. CONCLUSIONS: Expanding community pharmacists' scope through MAS may benefit health systems. To be fully cost effective, MAS should not only include consultations arising from symptom presentation but also include an oversight of self-selected products by patients. MAS increase patient safety through the appropriate use of non-prescription medication and through the direct referral of patients to GP. TRIAL REGISTRATION: ISRCTN, ISRCTN17235323 . Registered 07/05/2021 - Retrospectively registered.


Assuntos
Farmácias , Análise Custo-Benefício , Humanos , Farmacêuticos , Qualidade de Vida , Telefone
5.
Wiad Lek ; 74(9 cz 1): 2169-2174, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34725295

RESUMO

OBJECTIVE: The aim: This article aims to raise awareness and stimulate serious discussion about the dangers of illegal Internet pharmacies for patient safety and public health, the necessity to improve legal instruments, and unite the efforts of governments, professional organizations, and civil society for combating this activity. PATIENTS AND METHODS: Materials and methods: This study is based on the Medicrime Convention, empirical and analytical data of the WHO, Interpol, Europol, NABF, Directive 2011/62/EU of the European Parliament and of the Council of June 8, 2011, the regulatory acts and juridical practice of Ukraine, experts interview of pharmacy practicians, analysis of websites. Totally 18 laws and papers, 34 court judgments, 50 websites were analyzed, six experts were interviewed. Dialectical, comparative, analytic, synthetic, system analyses and sociological research methods were used. RESULTS: Results: Illegal Internet pharmacies are widespread in Europe, especially during the COVID-19 pandemic. This black market poses a severe threat to patient safety and public health as falsifying, substandard, and smuggled medicines are sold through these channels. Without any exception, all illegal pharmacies sell prescription drugs without any prescriptions. Regulatory and protective legal instruments at the national and international levels are insufficient to counter the Internet trade in medicines. CONCLUSION: Conclusions: The widespread proliferation of illegal Internet pharmacies in Europe requires European states to work together to protect patient safety and public health. A legal mechanism needs to be established to exchange information and combat illegal pharmaceutical activities on the Internet at the international level. At the national level, it is necessary to strengthen control over the wholesale of prescription medications to prevent them from entering the black market.


Assuntos
COVID-19 , Farmácias , Europa (Continente) , Humanos , Internet , Pandemias , Saúde Pública , SARS-CoV-2
6.
Cien Saude Colet ; 26(suppl 3): 5081-5088, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34787200

RESUMO

The objective of this study was to analyze the use and access to medications for type 2 diabetes among older people registered in the family health strategy in Ribeirão Preto, São Paulo. A population-based household survey was undertaken with 338 older adults selected using two-stage cluster sampling. Pharmacotherapy of diabetes and access to medications was investigated using a structured questionnaire administered by means of face-to-face interviews. The number of medicines used to treat diabetes ranged between 1 and 4. Respondents predominantly used only oral antidiabetic agents. The use of metformin and sulfonylureas on their own was reported by 37.9% and 9.8% of respondents, respectively. Frequency of insulin use was greatest in the 80 years and overage group (38.9%). The large majority of respondents (96.4%) had full access to medicines. Means of payment was "free of charge" in 78.1% of the respondents and public pharmacies were the main source of medication (74.8%). The most commonly used oral antidiabetic was metformin, which is consistent with current treatment guidelines. However, the findings show inappropriate medication use among older people, more specifically the use of sulfonylureas on their own. The findings of this study highlight the important role played by the public health service in providing medications for type 2 diabetes.


Assuntos
Diabetes Mellitus Tipo 2 , Farmácias , Idoso , Brasil , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Hipoglicemiantes
7.
J Med Internet Res ; 23(11): e31483, 2021 11 03.
Artigo em Inglês | MEDLINE | ID: mdl-34730542

RESUMO

BACKGROUND: Patient engagement is a worldwide trend in health care. Patient portals have the potential to increase patients' knowledge about their health and care and therefore enhance patient engagement. Portal users' experiences are needed to determine if these portals work appropriately and if there are barriers to achieving the aims that were set before their implementation. OBJECTIVE: The aim of this study is to analyze pharmacy customers' experiences of the Finnish nationwide patient portal My Kanta in terms of benefits, problems, and potential improvements. METHODS: A questionnaire survey was conducted among pharmacy customers in the spring of 2019. The questionnaires (N=2866) were distributed from 18 community pharmacies across mainland Finland to customers aged ≥18 years who were purchasing prescription medicines for themselves or their children aged <18 years. Using open-ended questions, customers were asked about their experiences of the benefits and problems of My Kanta and what improvements could be made. Their responses were encoded and categorized using inductive content analysis, stored in SPSS Statistics for Windows, and analyzed using frequencies. RESULTS: Of the 2866 questionnaires, a total of 994 (34.68%) questionnaires were included in the analysis. Most respondents were My Kanta users (820/994, 82.5%); of these 820 users, 667 (81.3%) reported at least one benefit, 311 (37.9%) reported at least one problem, and 327 (39.9%) reported at least one potential improvement when using My Kanta. The most commonly mentioned benefits were opportunities to view health data (290/667, 43.5%) and prescriptions (247/667, 37%) and to renew prescriptions (220/667, 33%). The most extensively reported problems with My Kanta were that the portal lacks health data (71/311, 22.8%), navigating the service and searching for information is difficult (68/311, 21.9%), and the delay before health data are incorporated into the service (41/311, 13.2%). The most frequently suggested potential improvements were that My Kanta needs more comprehensive health data (89/327, 27.2%); the service should be easier to navigate and information easier to access (71/327, 21.7%); the service should have more functions (51/327, 15.6%); and health data should be entered into the portal more promptly (47/327, 14.4%). CONCLUSIONS: Pharmacy customers reported more benefits than problems or potential improvements regarding the use of My Kanta. The service is useful for viewing health data and prescriptions and for renewing prescriptions. However, portal users would like to see more data and functions available in the portal and data searches to be made easier. These improvements could make the data and functions provided by the portal easier to view and use and hence promote patient engagement.


Assuntos
Portais do Paciente , Assistência Farmacêutica , Farmácias , Farmácia , Adolescente , Adulto , Criança , Estudos Transversais , Humanos , Inquéritos e Questionários
8.
Am J Manag Care ; 27(11): e395-e399, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34784148

RESUMO

OBJECTIVES: To assess the effectiveness of a proactive provider intervention in prompting prior authorization (PA) submissions or provider response prior to PA expiration for medically complex Medicaid patients. STUDY DESIGN: Pre-post outreach study with data from pharmacy claims and provider outreach. METHODS: The intervention and historical comparison (control) groups included expired PAs from December 2019 to February 2020 and from December 2018 to February 2019, respectively. Provider outreach, including telephonic and fax attempts, was conducted over a 2-week period prior to PA expiration. Outcomes were classified as positive or negative based on provider conversation coupled with the result (eg, PA submission) for the intervention group and based solely on pharmacy claims for the control group. The primary end point was the percentage of positive outcomes between the groups, analyzed via χ2 test. The time from PA expiration to the new PA submission was evaluated via t test. RESULTS: A total of 342 outreach attempts were conducted for 270 PAs representing 193 unique patients. Outreach was more likely to result in positive outcomes in the intervention group vs no outreach in the control group (87% vs 25%; P < .00001). On average, PAs were submitted 3.5 days prior to expiration in the intervention group vs 13.0 days after expiration in the control group (t = -7.50; P < .00001). CONCLUSIONS: Proactive outreach resulted in a greater percentage of PA submissions and a significantly reduced time to PA submission. These findings provide important information for payers in guiding clinical programs to enhance continuity of care among at-risk populations.


Assuntos
Assistência Farmacêutica , Farmácias , Humanos , Medicaid , Autorização Prévia , Estudos Retrospectivos , Estados Unidos
9.
J Int AIDS Soc ; 24 Suppl 6: e25814, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34713589

RESUMO

INTRODUCTION: The advent of COVID-19 has put pressure on health systems as they implement measures to reduce the risk of transmission to people living with HIV (PLHIV) and healthcare workers. For two out-of-facility individual differentiated service delivery (DSD) models, we assessed acceptability of antiretroviral therapy (ART) distribution through private pharmacies and reach of home delivery of ART through courier services during the COVID-19 pandemic in Botswana. METHODS: From 24 July to 24 August 2020, we conducted exit interviews with PLHIV receiving ART from 10 high-volume public facilities in Gaborone, and mapped and conducted an online survey with private pharmacies to assess willingness and capacity to dispense ART to PLHIV enrolled in the Botswana national ART program. We piloted ART home delivery from September 2020 to January 2021 in Gaborone and Kweneng East districts for PLHIV accessing ART at two Tebelopele Wellness Clinics. We used cascade analysis to measure the enrolment and eventual reach (percentage of those reached amongst those who are eligible) of ART home delivery. RESULTS: Sixty-one PLHIV and 42 private pharmacies participated. Of the PLHIV interviewed, 37 (61%) indicated willingness to access ART from private pharmacies and pay BWP50 (∼US$4) per refill for a maximum of two refills per year. All private pharmacies surveyed were willing to provide ART, and 26 (62%) would charge a dispensing fee (range = BWP50-100; ∼US$4-8) per refill. All pharmacies operated 12 h/day, 6 days/week and on public holidays. In the home delivery pilot, 650 PLHIV were due for refills, 69.5% (n = 452) of whom were eligible for home delivery. Of these, 361 were successfully offered home delivery and 303 enrolled (enrolment = 83.9%: female = 87.2%, male = 77.8%, p = 0.013). A total of 276 deliveries were made, a reach of 61%. CONCLUSIONS: Providing ART through private pharmacies and home delivery was acceptable in Botswana during COVID-19. Surveyed pharmacies were willing and able to dispense ART to PLHIV attending public sector facilities for free or for a nominal fee. Additionally, using courier services for ART home delivery is a novel and viable model in countries with a reliable courier service like Botswana and should be scaled up, particularly in urban areas.


Assuntos
COVID-19 , Infecções por HIV , Farmácias , Botsuana , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pandemias , SARS-CoV-2
11.
BMJ Glob Health ; 6(10)2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34615661

RESUMO

BACKGROUND: Of the estimated 10 million people affected by (TB) each year, one-third are never diagnosed. Delayed case detection within the private healthcare sector has been identified as a particular problem in some settings, leading to considerable morbidity, mortality and community transmission. Using unannounced standardised patient (SP) visits to the pharmacies, we aimed to evaluate the performance of private pharmacies in the detection and treatment of TB. METHODS: A cross-sectional study was undertaken at randomly selected private pharmacies within 40 districts of Vietnam. Trained actors implemented two standardised clinical scenarios of presumptive TB and presumptive multidrug-resistant TB (MDR-TB). Outcomes were the proportion of SPs referred for medical assessment and the proportion inappropriately receiving broad-spectrum antibiotics. Logistic regression evaluated predictors of SPs' referral. RESULTS: In total, 638 SP encounters were conducted, of which only 155 (24.3%) were referred for medical assessment; 511 (80·1%) were inappropriately offered antibiotics. A higher proportion of SPs were referred without having been given antibiotics if they had presumptive MDR-TB (68/320, 21.3%) versus presumptive TB (17/318, 5.3%; adjusted OR=4.8, 95% CI 2.9 to 7.8). Pharmacies offered antibiotics without a prescription to 89.9% of SPs with presumptive TB and 70.3% with presumptive MDR-TB, with no clear follow-up plan. CONCLUSIONS: Few SPs with presumptive TB were appropriately referred for medical assessment by private pharmacies. Interventions to improve appropriate TB referral within the private pharmacy sector are urgently required to reduce the number of undiagnosed TB cases in Vietnam and similar high-prevalence settings.


Assuntos
Farmácias , Farmácia , Tuberculose , Estudos Transversais , Humanos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologia , Vietnã/epidemiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-34682409

RESUMO

Managing medicine shortages consumes ample time of pharmacists worldwide. This study aimed to explore the strategies and resources being utilized by community pharmacists to tackle a typical shortage problem. Qualitative face-to-face interviews were conducted. A total of 31 community pharmacists from three cities (Lahore, Multan, and Dera Ghazi Khan) in Pakistan were sampled, using a purposive approach. All interviews were audio taped, transcribed verbatim, and subjected to thematic analysis. The analysis yielded five broad themes and eighteen subthemes. The themes highlighted (1) the current scenarios of medicine shortages in a community setting, (2) barriers encountered during the shortage management, (3) impacts, (4) corrective actions performed for handling shortages and (4) future interventions. Participants reported that medicine shortages were frequent. Unethical activities such as black marketing, stockpiling, bias distribution and bulk purchasing were the main barriers. With respect to managing shortages, maintaining inventories was the most common proactive approach, while the recommendation of alternative drugs to patients was the most common counteractive approach. Based on the findings, management strategies for current shortages in community pharmacies are insufficient. Shortages would continue unless potential barriers are addressed through proper monitoring of the sale and consumption of drugs, fair distribution, early communication, and collaboration.


Assuntos
Serviços Comunitários de Farmácia , Farmácias , Atitude do Pessoal de Saúde , Humanos , Paquistão , Farmacêuticos , Papel Profissional
13.
BMC Public Health ; 21(1): 1800, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620152

RESUMO

BACKGROUND: Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. METHODS: In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores (n = 31) and their clients (n = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. RESULTS: A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement. CONCLUSIONS: Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.


Assuntos
Medicamentos Essenciais , Farmácias , Antibacterianos/uso terapêutico , Humanos , Indonésia , Automedicação
14.
Am J Manag Care ; 27(10): 425-431, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34668671

RESUMO

OBJECTIVES: To evaluate the impact of a collaborative effort of a Medicare Advantage and prescription drug (MAPD) plan and community pharmacies to improve vaccination rates for pneumonia and influenza. STUDY DESIGN: This quasiexperimental, cluster-randomized intervention study used MAPD data to assess the impact of community pharmacists on vaccination rates. Pharmacies in specific regions (districts) were randomly assigned to intervention or control groups. Intervention pharmacies received reports of patients with a gap in influenza (aged 19-89 years) and/or pneumococcal (aged 65-89 years) vaccinations based on medical and pharmacy claims history. Vaccine-naïve patients were offered vaccinations. METHODS: The vaccination rates for the previously vaccine-naïve patients utilizing intervention and control pharmacies were compared 6 months post randomization. Inverse probability weighted hierarchical generalized linear models determined the odds of receiving pneumonia and influenza vaccinations for intervention and control groups, controlling for baseline clinical and demographic characteristics. RESULTS: Intervention and control groups had similar ages in the pneumococcal older-adult cohort (mean age, 73.0 vs 73.4 years, respectively; P = .1255). The intervention group was older than the control group in the influenza cohort (mean age, 67.7 vs 66.4 years, respectively; P = .0006). Slightly more than half of each cohort were women, and the proportion of women was not significantly different between the intervention and control groups in each cohort. In multivariable analyses, intervention pharmacies were associated with higher odds of delivering pneumococcal (odds ratio [OR], 1.91; 95% CI, 1.26-2.87) and influenza (OR, 2.18; 95% CI, 1.37-3.46) vaccinations than control pharmacies. CONCLUSIONS: A health plan-enabled, pharmacist-led intervention was effective in increasing the number of older adults receiving pneumococcal vaccination and individuals receiving influenza vaccination.


Assuntos
Serviços Comunitários de Farmácia , Influenza Humana , Medicare Part C , Farmácias , Farmácia , Idoso , Feminino , Humanos , Influenza Humana/tratamento farmacológico , Influenza Humana/prevenção & controle , Estados Unidos , Vacinação
15.
Am J Manag Care ; 27(10): 432-437, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34668672

RESUMO

OBJECTIVES: To evaluate whether hospital entry into the 340B Drug Pricing Program, which entitles eligible hospitals to discounts on drug purchases and intends for hospitals to use associated savings to devote more resources to the care of low-income populations, is associated with changes in hospital provision of uncompensated care. STUDY DESIGN: We analyzed secondary data on 340B participation and uncompensated care provision among general acute care hospitals and critical access hospitals from 2003 to 2015. We constructed an annual, hospital-level data set on hospital 340B participation from the Office of Pharmacy Information Systems and on uncompensated care provision from the Hospital Cost Reporting Information System. METHODS: Focusing on 2 periods of program expansion, we separately analyzed trends in uncompensated care costs for 340B-eligible general acute care hospitals and critical access hospitals, stratified by year of 340B program entry, including a stratum of eligible hospitals that never participated. We used a differences-in-differences approach to quantify whether there were differential changes in provision of uncompensated care after hospitals enter the 340B program relative to hospitals that did not participate or had not yet entered. RESULTS: We do not find evidence that hospitals increased provision of uncompensated care after entry into the 340B program differentially more than hospitals that never entered or had not yet entered the program. CONCLUSIONS: Relying on hospitals to invest surplus into care for the underserved without marginal incentives to do so or strong oversight may not be an effective strategy to expand safety-net care.


Assuntos
Farmácias , Cuidados de Saúde não Remunerados , Custos e Análise de Custo , Custos de Medicamentos , Hospitais , Humanos
16.
Afr J Prim Health Care Fam Med ; 13(1): e1-e11, 2021 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-34636605

RESUMO

BACKGROUND: Limited availability of medicines in public facilities and unaffordable prices in the private sector act as barriers to medicines' access. Patients in Eswatini may be forced to buy medicine from the private sector resulting from chronic medicines' shortages in public health facilities. The extent to which they can afford to do so is unknown. AIM: To determine the availability, price and affordability of medicines in the retail pharmacies in Eswatini, and to compare the results regionally and internationally. SETTING: Retail pharmacy sector in the four administrative regions of Eswatini. METHODS: Data on availability, price and affordability to patients for 50 medicines in the originator brand (OB) and the lowest priced generic (LPG) equivalent, were collated using the standardised World Health Organization/Health Action International methodology from 32 retail pharmacies in the four regions of Eswatini. Prices were then compared with selected countries. RESULTS: The overall mean availability of all medicines in selected retail pharmacies was 38.5%; standard deviation [s.d.] = 20.4% for OBs and 80.9%; s.d. = 19.0% for LPGs. The overall median price ratio (MPR) in the surveyed pharmacies was 18.61 for the OBs and 4.67 for LPGs. Most standard treatments with LPGs cost less than a day's wages whilst for OBs cost more than a day's wages. The differences between Eswatini and South African prices were statistically significant. CONCLUSION: Drug pricing policies and price monitoring tools are needed for the whole pharmaceutical chain in Eswatini to monitor availability, affordability and accessibility of medicines to the general populace.


Assuntos
Farmácias , Farmácia , Custos e Análise de Custo , Essuatíni , Acesso aos Serviços de Saúde , Humanos , Prescrições , Setor Público , Inquéritos e Questionários
17.
BMC Health Serv Res ; 21(1): 1147, 2021 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-34688303

RESUMO

BACKGROUND: Changes in pharmacy models of care, services and funding have been occurring internationally, moving away from the traditional dispensing role to more extended patient-facing roles utilising pharmacists' clinical skills. This study aimed to identify the extended services offered by community pharmacy in Aotearoa New Zealand and the barriers and facilitators to extended services provision. The study is unique in that it includes intern (pre-registration) pharmacists. METHODS: An online survey, conducted in 2018, of all pharmacists and intern (pre-registration) pharmacists working in a community pharmacy. Data were analysed using descriptive statistics and regression analyses. RESULTS: The results are based on replies from 553 community pharmacists and 59 intern pharmacists (response rate: 19 and 26% respectively). Both pharmacists (83%) and interns (85%) want to work at the top of their scope of practice. Wide variation exists in the specific services individual pharmacists offer. Most pharmacists were accredited to supply the emergency contraceptive pill (95%), sildenafil for erectile dysfunction (86%) and trimethoprim for uncomplicated urinary tract infection (85%). Fewer were able to immunise (34%) or to supply selected oral contraceptives (44%). Just under a quarter could provide a Medicines Use Review (MUR) or Community Pharmacy Anticoagulation Management Service (CPAMS). Of the pharmacists not already accredited, 85% intended to gain accreditation to supply selected oral contraceptives, 40% to become vaccinators, 37% to offer CPAMS and 30% MUR. Interns expressed strong interest in becoming accredited for all extended services. Poisson regression analyses showed key factors supporting the likelihood of providing extended services were owner and management support and appropriate space and equipment. Being excited about the opportunities in community pharmacy, having employer funding and time for training and sufficient support staff were also statistically significant. CONCLUSIONS: Pharmacists need time and a supportive management structure to enable them to deliver extended services. Health policy with a greater strategic emphasis on funding services and pharmacist training, and developing technician support roles, will help to minimise or eliminate some of the barriers to role expansion both in Aotearoa New Zealand and internationally.


Assuntos
Serviços Comunitários de Farmácia , Farmácias , Atitude do Pessoal de Saúde , Humanos , Masculino , Nova Zelândia , Farmacêuticos , Papel Profissional
18.
Curr Pharm Teach Learn ; 13(10): 1339-1345, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34521529

RESUMO

INTRODUCTION: Objectives include (1) To create an opportunity for students enrolled in pharmacy programs to enhance their presentation skills by delivering research podium presentations at a regional conference; (2) To probe students' experience about podium presentations at the inaugural American Association for the Advancement of Science Pacific Division (AAAS PD) - American Association of Colleges of Pharmacy Students' Symposium; and (3) To introduce student pharmacists to science-oriented research. METHODS: The student presenters were asked to anonymously answer 15 questions before and after the symposium. Question topics included factual information about students' background and favorability perceptions about symposia. Scores were compared between pharmacy students and non-pharmacy students, and favorability ratings were compared before and after the symposium. RESULTS: Thirteen students delivered their podium presentations at the symposium entitled "Pharmaceutical Research and Development: From Bench to Patient-Centered Care" that was held in Pomona, California at the 99th Annual Meeting of the AAAS PD in 2018. Pharmacy and non-pharmacy students provided similar responses on favorability perceptions. Post-symposium perceptions were more favorable towards symposia compared to pre-symposium scores. CONCLUSIONS: Favorability scores revealed a positive perception of the event and what it offered in terms of scientific benefits, networking opportunities, and enhancing soft skills. Participating students had the chance to (1) prepare and independently deliver a podium presentation on pharmacy-related research topics at a regional meeting; (2) network and learn from each other and professionals in the audience about pharmacy research; and (3) practice soft skills such as communication, time-management, teamwork, scientific writing, and presentation skills.


Assuntos
Educação em Farmácia , Assistência Farmacêutica , Farmácias , Farmácia , Estudantes de Farmácia , Humanos
19.
Artigo em Inglês | MEDLINE | ID: mdl-34574509

RESUMO

Community pharmacies are among the most easily accessible health services. Considering the major impact of COVID-19 in social terms, the purpose was to analyse the evolution of the relationship between community pharmacies and customers during the pandemic in 2020 and to understand which strategies should be implemented in the future. The data have been collected from May to December 2020. Pharmacists administered a questionnaire, also available online, to all customers that agreed to participate. The total number of respondents was 502. The results obtained confirm a generally high level of satisfaction with pharmacies among customers and appreciation for the role of community pharmacies. For the future, the priority is to monitor the situation to break down social inequalities. A task that can be entrusted to the branch of the healthcare service ideally suited to this end: local medicine, of which the community pharmacy is an essential element. The post-pandemic pharmacy will need to have the skills to provide accurate and reliable information on issues, including broad topics such as prevention and lifestyle to fight "syndemic" (two or more factors that work together to make a disease worse) and "infodemic" (too much information including false or misleading information during a disease outbreak).


Assuntos
COVID-19 , Serviços Comunitários de Farmácia , Farmácias , Humanos , Itália/epidemiologia , Pandemias , Farmacêuticos , Papel Profissional , SARS-CoV-2 , Inquéritos e Questionários
20.
BMC Health Serv Res ; 21(1): 1017, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34565354

RESUMO

BACKGROUND: Finnish community pharmacies have undergone digitalization during the past decade. The introduction of the electronic prescription has had a significant impact on pharmacy workflows, such as the dispensing process. This inevitably has significant sociotechnical implications. We examine the impact of digitalization on the dispensing process and the sociotechnical orientation of a pharmacy. METHODS: We utilize data collected in customer service situations in Finnish community pharmacies at two points in time: in the traditional workflow, when electronic prescriptions were not in use, and in the new direct dispensing workflow, which is the usual delivery model in the case of electronic prescriptions. We analyze this data in terms of changes in workflow efficiency. We also draw on existing literature to build a conceptual model for digitalization in the pharmacy sector from a sociotechnical standpoint. RESULTS: In the Finnish environment, the results, based on our study sample, show that with electronic prescriptions and the direct dispensing model, the delivery time for a single medication over the counter was reduced by 13%. The results also indicate that the process has become more predictable, as the variation in terms of the workflow lead time has decreased. CONCLUSIONS: The results indicate that the dispensing process has become more efficient in terms of time and throughput as well as more technically oriented and predictable. From a sociotechnical perspective, the results indicate that the technical subsystem has strengthened, and pharmacies have adapted to the new technology in the dispensing process.


Assuntos
Serviços Comunitários de Farmácia , Prescrição Eletrônica , Farmácias , Finlândia , Humanos , Fluxo de Trabalho
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