Kentucky pharmacists' perceptions regarding provision of hormonal contraception.

BACKGROUND: Although Kentucky pharmacists recently gained authority to provide protocol-driven care for 13 conditions, provision of prescription hormonal contraception (HC) services is not currently authorized. A board-approved protocol allowing for provision of nonprescription over-the-counter (OTC) emergency contraception (EC) was recently approved by the Kentucky Board of Pharmacy but has yet to be implemented. OBJECTIVES: The objectives of this study were (1) to assess Kentucky pharmacists' interest in providing prescription HC and OTC EC services via protocol and (2) to identify perceived benefits/barriers regarding provision of prescription HC. METHODS: An online questionnaire was disseminated electronically to a convenience sample of Kentucky pharmacists. The questionnaire collected (1) demographic information, (2) opinions regarding provision of prescription HC and OTC EC, and (3) perceived benefits and barriers regarding provision of prescription HC. For analysis, responses were limited to pharmacists in community-based practice. McNemar's test was used to identify statistically significant differences in support by dosage form. In addition, a multivariable logistic regression model was used to examine associations between demographic factors and support for pharmacist provision of prescription HC. RESULTS: We received 151 responses from community-based pharmacists. Support for provision of prescription HC was highest for oral (61%) and transdermal (54%) forms. We found no statistically significant differences in support among demographic factors other than number of years in practice, with more recent graduates being at higher odds of support. In addition, time, reimbursement, training, and belief in the need for pelvic exams were the most commonly cited barriers to implementation. With regard to OTC EC provision, pharmacists were largely supportive (62%) and confident in their abilities. CONCLUSIONS: Community-based pharmacists in Kentucky are supportive of provision of oral, vaginal, and transdermal prescription HC as well as OTC EC via protocol. Barriers, including time, reimbursement, training, and belief in the need for pelvic exams, should be addressed to increase support for prescription HC provision.

Prescription and over-the-counter medication record integration: A holistic patient-centered approach.

OBJECTIVE: Nonprescription or over-the-counter (OTC) medications play a crucial role in a patient's ability to make choices to manage his or her own health care. Often these nonprescription choices are unknown to health care practitioners and thus are often not included as part of patients' health records. The exclusion of these therapies can pose risks to patient safety. There is a significant need to address the capture of OTC medication use in both the physician and pharmacy electronic health records (EHRs) and during the practitioner-patient medication history and reconciliation process. DATA SOURCES: On October 26, 2016, the National Association of Chain Drug Stores Foundation hosted a forum for a select group of health care industry professionals to work on a series of recommendations to improve the documentation of OTC medication use by patients. This diverse group of more than a dozen stakeholders included community pharmacy leaders from multiple chain pharmacies, pharmacy system vendors, e-prescribing vendors, health information technology experts, and multiple industry representatives, including individuals from the public sector. This commentary is a summary of the insights and suggestions where the group was in general agreement. SUMMARY: Successful OTC medication EHR integration will require system-level buy-in across multiple layers of the health care industry to improve patient safety. Forum participants suggested incremental steps that could be taken by multiple stakeholders to lay the foundation for integration within an appropriate regulatory structure. CONCLUSION: Based on the results of the stakeholder forum, an agreement formed around one approach that the group supported as feasible: the creation of a consistent and uniform identification method for OTC medications in cooperation with government regulatory authorities.

Patient-perceived content and formatting expectations for prescription container labeling.

OBJECTIVES: The objectives of the study were to identify patient expectations for prescription label content and formatting and to explore how United States Pharmacopeia Chapter 17 Standards for prescription container labeling meet patient expectations. DESIGN: Focus group. SETTING: St. Louis, Missouri, in July and August 2014. PARTICIPANTS: Patients 18 years and older who were taking at least 2 chronic prescription medications and managing their medications independently. MAIN OUTCOME MEASURE: Qualitative themes. INTERVENTION: Not applicable. METHODS: Five focus groups (17 total participants) were conducted in St. Louis in 2014. Focus groups were audio-recorded and consent was obtained from the participants. The audio files were professionally transcribed. Atlas.ti software (version 7.5.3) was used to analyze the transcript data, which were then coded to identify key themes. To ensure consistency of interpretation, a constant comparative analytic framework approach was used. RESULTS: Analysis produced 6 themes related to patient perceptions and expectations of prescription label content and formatting: importance of drug name, dose, and directions; lack of side effects on the label; improved organization and larger font size; using the color red; lack of familiarity with auxiliary labels; and the importance of pharmacy information. Themes focused on how patients use prescription labels and the relative value of different aspects of prescription container labeling. CONCLUSIONS: Patient-perceived prescription content and formatting expectations for prescription container labeling were generally consistent with published USP Chapter 17 guidelines. The importance of pharmacy phone numbers, white space, and highlighting were noteworthy.

Impact of COVID-19 on Pharmacy Education and Practice: Strategies to Boost Advocacy and Unity among Health Care Organizations.

The global COVID-19 pandemic impacted pharmacy education and changed the pharmacists' scope of practice at the federal and state levels. Based on the Amended Public Readiness and Emergency Preparedness Act, pharmacists were authorized to provide essential services, including testing, treatments, and immunizations at various practice settings. Specifically, the United States Food and Drug Administration issued emergency use authorization for several medications, vaccines, and medical devices. The pandemic also affected the regulatory landscape for pharmacists, pharmacy education, access to care, and delivery of pharmacy services in-person and through telehealth. The pandemic's specific impact on pharmacy education heightened awareness of the well-being of the Academy. This commentary will highlight the impact of COVID-19 on both pharmacy education and practice. It will also provide strategies that educators, researchers, and practitioners can take into future research and action to help promote advocacy and unity among pharmacy organizations.

Using Technology to Enhance Teaching and Learning in Pharmacy Education.

It was a privilege to serve as guest editors in Pharmacy for the Special Issue 'Technology-Enhanced Pharmacy Teaching and Learning Strategies' [...].

Development and Implementation of an Influenza Point-Of-Care Testing Service in a Chain Community Pharmacy Setting.

Point-of-care testing is becoming increasingly commonplace in community pharmacy settings. These tests are often used in the management of chronic disease, such as blood sugar, hemoglobin A1c and lipid levels, but can also be used for acute conditions such as influenza infection and group A streptococcus pharyngitis. When used for these acute infections, point-of-care tests can allow for pharmacist-initiated treatment. In this study, an influenza point-of-care testing service was developed and implemented in a chain community pharmacy setting and a retrospective review was conducted to assess the service. Of patients tested, 29% tested positive for influenza A and/or B; 92% of patients testing positive received a prescription as a result. While health insurance cannot be billed for the service due to current pharmacy reimbursement practices, this did not appear to negatively affect patient willingness to participate. As point-of-care testing services become more commonplace in community pharmacy settings, patient awareness will similarly increase and allow for more widespread access to acute outpatient care.

Relative Risk of Adverse Events and Treatment Discontinuations Between Older and Non-Older Adults Treated with Antimuscarinics for Overactive Bladder: A Systematic Review and Meta-Analysis.

INTRODUCTION: Overactive bladder (OAB) affects adults of all ages. The risk for medication-related adverse events (AEs) may differ between age groups, given age-related changes in pharmacokinetics and pharmacodynamics. No previous study has differentiated the risk of AEs between older and non-older adults with OAB. OBJECTIVE: Our objective was to assess the risk of AEs and treatment discontinuations between older and non-older adults with OAB initiated on an antimuscarinic. METHODS: We searched MEDLINE (PubMed interface), Embase, SCOPUS, and Cochrane Central Register for Controlled Trials in a previous analysis in February 2015 and repeated the search in August 2018, with no additional studies identified. Studies that delineated AEs or treatment discontinuations between the older and non-older (age <65 years) subjects were included. RESULTS: Six studies that made nine comparisons between older and non-older subjects met the inclusion criteria. The AEs of dry mouth (46.7%), constipation (10.3%), and headache (7.7%) were most frequently reported. Older subjects were more likely to experience dry mouth (relative risk [RR] 1.09; 95% confidence interval [CI] 1.00-1.19), constipation (RR 1.92; 95% CI 1.52-2.43), dizziness (RR 2.37; 95% CI 1.21-4.62), and urinary retention (RR 4.17; 95% CI 1.76-9.89) than were non-older subjects. Headache was less likely to occur in older subjects (RR 0.58; 95% CI 0.40-0.86). Treatment discontinuations due to AEs were more likely to occur in the older subjects (RR 1.59; 95% CI 1.20-2.11). CONCLUSION: Treatment of OAB with antimuscarinics in the older population resulted in significantly higher rates of AEs, barring headache, when compared with non-older subjects.

Adverse events and treatment discontinuations of antimuscarinics for the treatment of overactive bladder in older adults: A systematic review and meta-analysis.

INTRODUCTION: Antimuscarinics should be used with caution in older adults with overactive bladder (OAB) due to anticholinergic adverse events (AEs). Systematic reviews and meta-analyses (SRMAs) have analyzed safety-related outcomes but have not specified risk in the elderly, the population at highest risk for AEs. The aim of this review is to explore and evaluate AEs and treatment discontinuations in adults 65 or older taking antimuscarinics for OAB. METHODS: Keywords were searched in MEDLINE, EMBASE, SCOPUS, and Cochrane Central Register for Controlled Trials. Randomized controlled trials (RCTs) along with sub-analyses and pooled analyses that compared antimuscarinics to placebo or another antimuscarinic were performed in February 2015. Studies assessing AEs or treatment discontinuations in a population of adults 65 or older were included. The Jadad Criteria and McHarm Tool were used to assess the quality of the trials. RESULTS: A total of 16 studies met the inclusion criteria. Eighty AEs and 27 reasons for treatment discontinuation were described in the included studies and further explored. Anticholinergic AEs were more common in antimuscarinics compared to placebo. Incidence of dizziness, dyspepsia, and urinary retention with fesoterodine, headache with darifenacin, and urinary tract infections with solifenacin were significantly higher compared to placebo. Treatment discontinuation due to AEs and dry mouth were higher in the antimuscarinics when compared to placebo in older adults. CONCLUSIONS: Treatment for overactive bladder using antimuscarinics in adults aged 65 or older resulted in significant increases in risk for several AEs compared to placebo including anticholinergic and non-anticholinergic AEs.

Faculty perception of team-based learning over multiple semesters.

INTRODUCTION: Perspectives from faculty regarding team-based learning (TBL) are not well understood. Previous studies describe faculty preference for TBL due to increased student interaction despite requiring increased time for design. The perception of changes in faculty workload over multiple semesters has not been measured. This research evaluates faculty workload and perceived student engagement after implementing TBL in a required non-prescription medication course over multiple semesters. METHODS: TBL was implemented in the non-prescription medication course and continued for three consecutive semesters. Faculty members' perception of TBL was captured using an anonymous survey. The survey was an 11 item questionnaire with five Likert-type response options to identify changes in workload, training, and student interaction using TBL. RESULTS: Twenty-eight total responses were collected from 10 faculty members who taught in at least one of the four semesters. Results were aggregated based on the number of semesters faculty continually taught in the course. More respondents agreed than disagreed that participation from and interactions with students increased with the TBL course compared to traditional lectures. However, more respondents believed the TBL course approach was more difficult and reported increased workload in the initial semester taught. Enjoyment of teaching increased for a majority of respondents. DISCUSSION AND CONCLUSIONS: This is the first study to explore the impact of TBL implementation over multiple semesters. These data can be used to help implement TBL in pharmacy school curricula.

A review of cardiovascular and renal function monitoring: a consideration of older adults with HIV.

The prevalence of human immunodeficiency virus (HIV) infection in older and elderly adults is significant worldwide. This population poses new challenges and opportunities in the management of HIV. In addition to the risks affecting HIV patients of all ages, including risk of opportunistic infection and medication resistance, age-related changes in physiology, higher comorbidity burdens, increased use of medications, and potential adverse drug reactions to HIV medications all factor into the care of older adults with HIV. The risk and progression of cardiovascular and renal comorbidities may be higher in the older adult HIV population and in patients taking specific HIV medications. Understanding these risks is essential when managing a new type of patient: the older adult with HIV.