Assessing community pharmacy services in health professional shortage areas across Wisconsin.

BACKGROUND: Primary care health professional shortage areas (HPSAs) lack sufficient primary care providers to meet their health care needs, which contributes to worse health outcomes within underserved populations. Community pharmacies are commonly located in HPSAs and provide nondispensing services that can help address unmet health care needs. However, there is limited data on the nature, scope, and reimbursement for community pharmacy services. OBJECTIVES: Using survey data from the state of Wisconsin, this study compares the prevalence of and reimbursement for services provided by community pharmacies in primary care HPSAs and non-HPSAs and describes barriers to pharmacy service implementation. METHODS: A survey tool on pharmacy services, reimbursement, and barriers to service implementation was developed, pilot tested, and administered to every community pharmacy in Wisconsin. Data were collected via mail and online over two waves of survey administration from November 2021 to May 2022. Pearson's chi-squared and t tests were used to compare the prevalence of and reimbursement for services between HPSA and non-HPSA pharmacies. Content analysis was used to identify themes that described barriers to pharmacy service implementation. RESULTS: Responses were received from 287 of 774 eligible community pharmacies (37.1%). HPSA pharmacies were significantly more likely to be in rural areas. Regardless of pharmacy location, community pharmacies reported commonly providing a variety of services, but reimbursement for these services was considerably less frequent. The prevalence of reimbursement was <50% for two-thirds of services. Pharmacy staffing, time, and financial issues were the most commonly reported barriers to service implementation. CONCLUSIONS: Community pharmacies provide a diverse set of services to meet the health care needs of their patients, but often do so with inadequate staffing or reimbursement. Action is needed to support community pharmacies in meeting the health care needs of their communities and to ensure patient access to medications and pharmacy services.

Illustrating access to community pharmacies in Wisconsin.

OBJECTIVES: Community pharmacists also play a vital public health role in increasing access to health care services and information during times of public health crisis. To examine access to community pharmacies in Wisconsin and the relationship between pharmacy locations and primary care health professional shortage areas (HPSAs). METHODS: A list of licensed pharmacies in Wisconsin was screened to identify community pharmacies. Rural-urban commuting area codes were used to classify the rurality of pharmacy locations. Descriptive measures and pharmacy location maps were used to assess access to community pharmacies in the state as well as the relationship between pharmacy locations and primary care HPSAs. Spatial analysis was conducted to estimate the percentage of the population that lives within 10-, 20-, and 30-minute drive times of each community pharmacy. RESULTS: Of the 837 community pharmacies in Wisconsin, 73 (68.5%) were located in metropolitan areas, 95 (11.4%) in micropolitan areas, 112 (13.4%) in small towns, and 57 (6.8%) in rural areas. A total of 265 (31.7%) community pharmacies were located in a primary care HPSA. The drive-time analysis found that 99.7% of the population lives within 30 minutes of a pharmacy, 98.7% within 20 minutes of a pharmacy, and 89.3% within 10 minutes of a pharmacy. CONCLUSIONS: Nearly the entire Wisconsin population has convenient access to community pharmacies. Community pharmacies are ideally located in underserved areas with shortages of other health professionals, which may provide an opportunity for pharmacists to take on additional clinical roles to support health care providers and facilities in these areas.

Evaluating Community Readiness to Implement Environmental and Policy-Based Alcohol Abuse Prevention Strategies in Wisconsin.

BACKGROUND: Matching evidence-based alcohol prevention strategies with a community's readiness to support those strategies is the basis for the Tri-Ethnic Community Readiness Model (CRM). The purpose of this evaluation was to assess the association of a community's readiness to address alcohol abuse in their community with the implementation of environmental and policy-based strategies. METHODS: Twenty-one substance abuse prevention coalitions in Wisconsin participated in a pre-post intervention group-only evaluation using the CRM. As part of a Substance Abuse and Mental Health Services Administration (SAMHSA) grant, all grantees were obligated by the Wisconsin Department of Health Services to implement environmental and policy-based strategies focused on one of three priority areas: young adult binge drinking, underage drinking, and alcohol-related motor-vehicle injuries and fatalities. RESULTS: At baseline, all communities (n=21) scored at or below a Stage 4 (on a scale of 1-9) readiness level ("preparedness"). The mean change in community readiness over the three-year period (2009-2011) was significant, but was less than one complete CRM stage (0.77, p=<0.001; 95% CI: 0.49, 1.05). CONCLUSION: These findings suggest that implementation of environmental and policy-based strategies may improve a community's progression in perceived readiness to address alcohol abuse regardless of the community's baseline level of readiness to address alcohol abuse. RECOMMENDATION: An assessment specific for measuring community readiness for policy-related strategies should be developed. The assessment would include community-level factors (e.g. community climate) for implementing policy-related prevention strategies, and not assume a linear readiness model.

Determinants of personal health record use: a large population study at Cleveland Clinic.

While research in other domains leads us to expect that some patients will be more predisposed to technology adoption than others, the factors that indicate propensity for use are not clear. In this study, researchers extracted the demographic and usage information of 63,295 people who had registered to use eCleveland Clinic MyChart. Of those, 12,101 had never logged onto the system and were termed registered never users. Registered users are more likely to be Caucasian and married than registered never users. The only predictors of degree of PHR use among the registered users are number of diagnoses from the EMR problem list and the number of clinical encounters. Hence, Cleveland Clinic's PHR portal appears to be most useful to patients who are sicker and greater consumers of healthcare.

Bilateral Vaginocutaneous Fistulas Three Years following the Insertion of a "Tension-Free" Vaginal Tape.

We present a rare complication of fistula following the insertion of a transvaginal tape and the literature surrounding fistula formation following this procedure.