An assessment of the psychometric properties of the Coping Strategies Questionnaire - Sickle Cell Disease (CSQ-SCD) among adults in the United States.

BACKGROUND: Previous studies have reported conflicting factor structures of the Coping Strategies Questionnaire - Sickle Cell Disease (CSQ-SCD). This study examined the psychometric properties of the CSQ-SCD among adults with SCD in the United States. METHODS: This study implemented a cross-sectional study design with web-based self-administered surveys. Individuals with SCD were recruited via an online panel. Psychometric properties, including factorial and construct validity, and internal consistency reliability, of the CSQ-SCD were assessed. RESULTS: A total of 196 adults with SCD completed the survey. Confirmatory factor analysis (CFA), using maximum likelihood estimation and the 13 subscale scores as factor indicators, supported a three-factor model for the CSQ-SCD compared to a two-factor model. Model fit statistics for the three-factor model were: Chi-square [df] = 227.084 [62]; CFI = 0.817; TLI = 0.770; RMSEA [90% CI] = 0.117 [0.101-0.133]; SRMR = 0.096. All standardized factor loadings (except for the subscales isolation, resting, taking fluids, and praying and hoping) were > 0.5 and statistically significant, indicating evidence of convergent validity. Correlations between all subscales (except praying and hoping) were lower than hypothesized; however, model testing revealed that the three latent factors, active coping, affective coping, and passive adherence coping were not perfectly correlated, suggesting discriminant validity. Internal consistency reliabilities for the active coping factor (α = 0.803) and affective coping factor (α = 0.787) were satisfactory, however, reliability was inadequate for the passive adherence coping factor (α = 0.531). Given this overall pattern of results, a follow-up exploratory factor analysis (EFA) was also conducted. The new factor structure extracted by EFA supported a three-factor structure (based on the results of a parallel analysis), wherein the subscale of praying and hoping loaded on the active coping factor. CONCLUSIONS: Overall, the CSQ-SCD was found to have less than adequate psychometric validity in our sample of adults with SCD. These results provide clarification around the conflicting factor structure results reported in the literature and demonstrate a need for the future development of a SCD specific coping instrument.

Defining rural spaces within pharmacy practice research: Current practice and implications.

The literature suggests that community pharmacies are a critical buffer to poor health for rural spaces, which are disproportionately impacted by a lack of facilities, providers, and resources. Yet, the actual impact is hard to measure because location is not often considered in assessments of community pharmacy practice. We explored the definitions applied to rural spaces in community pharmacy practice-based research studies that explicitly discuss rural pharmacy practice in 2 U.S. based pharmacy practice research publications. Across both journals, we identified 10 articles that used 8 different definitions of "rural" including both a variety of federal designations and idiosyncratic definitions developed just for that research. A consensus definition in rural community pharmacy practice research could make comparison across studies possible, help to build the evidence base for rurally focused interventions, and ultimately improve patient outcomes in this setting.

RURAL-CP: a rural community pharmacy practice-based research network in the USA.

INTRODUCTION: To strengthen and demonstrate the ability of rural pharmacists to address their communities' health needs, we developed the first multi-state rural community pharmacy practice-based research network (PBRN) in the USA called the Rural Research Alliance of Community Pharmacies (RURAL-CP). Our objective is to describe the process for developing RURAL-CP and discuss challenges to creating a PBRN during the pandemic. METHODS: We conducted a literature review of community pharmacy PBRNs and met with expert consultants to gain insight into PBRN best practices. We obtained funding to hire a postdoctoral research associate, conducted site visits, and administered a baseline survey, which assessed many aspects of the pharmacy, including staffing, services, and organizational climate. Pharmacy site visits were initially conducted in-person but were later adapted to a virtual format due to the pandemic. RESULTS: RURAL-CP is now a PBRN registered with the Agency for Healthcare Research and Quality within the USA. Currently, 95 pharmacies across five southeastern states are enrolled. Conducting site visits was critical for developing rapport, demonstrating our commitment to engage with pharmacy staff, and appreciating the needs of each pharmacy. RURAL-CP pharmacists' main research priority was expanding reimbursable pharmacy services, especially for diabetes patients. Since enrollment, network pharmacists have participated in two COVID-19 surveys. DISCUSSION: RURAL-CP has been instrumental in identifying rural pharmacists' research priorities. COVID-19 provided an early test of the network infrastructure, which allowed us to quickly assess COVID-19 training and resource needs. We are refining policies and infrastructure to support future implementation research with network pharmacies.

Food Insecurity in a Sample of Informal Caregivers in 4 Southern US States.

INTRODUCTION: Given the disproportionate burden of food insecurity in the southern US states and the high prevalence of caregiving in this area, we assessed caregiving-related predictors of food insecurity among caregivers in 4 southern US states. METHODS: We used data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS) for individuals aged 18 years or older who resided in Alabama, Louisiana, Mississippi, and Tennessee to assess the association between caregiving status and food insecurity, accounting for the complex survey design of BRFSS. Caregiving-related predictors of food insecurity were identified by using multivariable logistic regression. RESULTS: Weighted counts of caregivers and noncaregivers were 356,198 and 652,737, respectively. Prevalence of food insecurity was higher among caregivers than noncaregivers (35.9% vs 25.9%). Adjusting for sociodemographic predictors, caregivers had 56% (95% CI, 1.30-1.87; P < .001) higher odds of food insecurity than noncaregivers. Among caregivers, those caring for a spouse or a partner (adjusted odds ratio [aOR] = 1.7; 95% CI, 1.02-2.85; P = .04) had significantly higher odds of food insecurity compared with those caring for parents or parents-in-law. Caregivers who had been caregiving for 6 months to 2 years had higher odds of food insecurity compared with those who had been caregiving for less than 6 months (aOR = 1.88; 95% CI, 1.12-3.16; P = .02). Caregivers who reported a need for support services had higher odds of food insecurity compared with those who did not (aOR = 3.38; 95% CI, 2.19-5.21; P < .001). Caregivers caring for people with musculoskeletal conditions, compared with people with neurologic conditions, had higher odds of food insecurity (aOR = 3.47; 95% CI, 1.52-7.91; P = .003). CONCLUSION: Caregiver screening for food insecurity in health care settings and linkage to appropriate food and caregiving support resources should be prioritized by future health policies.

Retroactive application of the EPIS framework to promote future implementation success in community pharmacy clinical interventions.

BACKGROUND: The assessment of the implementation process of a clinical intervention in a community pharmacy setting can reveal useful insights for future implementation efforts. OBJECTIVE: We aimed to examine the implementation of a community pharmacist-led prospective registry and practice tool (RxING, Epidemiology Research Coordinating Center and the University of Alberta) designed to reduce cardiovascular risk among patients with diabetes and to assess how the participating pharmacists could be supported at each of these stages. METHODS: Semistructured interviews were conducted developed using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. The EPIS framework was used to evaluate the implementation of an online, guideline-driven tool (RxING tool) designed to help pharmacists implement and document the care of patients with diabetes by a group of community pharmacies located in Alberta, Canada. RESULTS: In relation to the preparation phase, responses focused more on suitability of the work environments and less on workflow adjustment. With regard to the implementation stage, participants mentioned that often the pharmacy manager or owner received the training to operate the RxING tool, complicating their ability to engage in regular patient recruitment and follow-up. Most pharmacies did not have specific goals relating to patient recruitment and retention. Concerns hindering sustainability of the evidence-based practice centered around the time-consuming online documentation process and patient retention. Finally, innovation factors identified from the pharmacists' responses were related to patient recruitment and streamlining the documentation process. CONCLUSIONS: This study identified 17 key recommendations that should be considered when designing and implementing future community pharmacy-led projects. In particular, providing assistance and training to pharmacies on-site, specific planning for program roll-out, identifying participating staff who have the time to engage with the program, and troubleshooting how to best integrate programs in normal workflow processes are some key recommendations.

Rural community pharmacists' ability and interest in administering COVID-19 vaccines in the Southern United States.

BACKGROUND: Community pharmacists are often the most accessible health professional in rural areas, which makes them well positioned to increase vaccine access in their communities. This study sought to document rural pharmacists' ability to and interest in administering coronavirus disease 2019 (COVID-19) vaccinations. METHODS: A sample of community pharmacists participating in a rural community pharmacy practice-based research network in the United States completed an online survey that assessed (1) demographic characteristics, (2) previous COVID-19 vaccine training, and (3) ability to administer COVID-19 vaccines. Data were collected between late December 2020 and mid-February 2021. Descriptive statistics and correlations were calculated. RESULTS: A total of 69 of 106 pharmacists completed the survey (response rate = 65%). Approximately half of pharmacists were ready (52%) or actively taking steps (39%) to provide COVID-19 vaccines in the next 6 months. Pharmacies had a median of 2 staff members who were authorized to administer COVID-19 vaccines. Almost half (46%) estimated they could administer more than 30 vaccinations per day. Most pharmacies could store vaccines at standard refrigeration (90%) and freezing (83%) levels needed for thawed and premixed vaccines, respectively. Most pharmacists planned to access COVID-19 vaccines through an agreement with a state or local public health entity (48%) or by ordering through group purchasing organizations (46%). Only 23% of pharmacists had received any COVID-19 vaccine training, and only 48% very much wanted to get the vaccine themselves. Several variables, including pharmacy type and pharmacists' vaccine attitudes and previous COVID-19 training, were significantly associated (P < 0.05) with the anticipated number of COVID-19 vaccines pharmacies could administer daily. CONCLUSION: Even early in the nation's COVID-19 vaccine rollout, most rural pharmacies were interested in and preparing to administer COVID-19 vaccines. Few rural pharmacists had received COVID-19 training, and many expressed some hesitancy to receive the vaccine themselves. The number of vaccines pharmacists could administer varied with pharmacy and pharmacist characteristics.

Approaches to assessing the provider experience with clinical pharmacogenomic information: a scoping review.

PURPOSE: Barriers to the implementation of pharmacogenomics in clinical practice have been thoroughly discussed over the past decade. METHODS: The objective of this scoping review was to characterize the peer-reviewed literature surrounding the experiences and actions of prescribers, pharmacists, or genetic counselors when using pharmacogenomic information in real-world or hypothetical research settings. RESULTS: A total of 33 studies were included in the scoping review. The majority of studies were conducted in the United States (70%), used quantitative or mixed methods (79%) with physician or pharmacist respondents (100%). The qualitative content analysis revealed five major methodological approaches: hypothetical clinical case scenarios, real-world studies evaluating prescriber response to recommendations or alerts, cross-sectional quantitative surveys, cross-sectional qualitative surveys/interviews, and a quasi-experimental real-world study. CONCLUSION: The findings of this scoping review can guide further research on the factors needed to successfully integrate pharmacogenomics into clinical care.

An exploration of key barriers to healthcare providers' use of food prescription (FRx) interventions in the rural South.

OBJECTIVE: The purpose of this exploratory study was to examine the attitude towards food prescriptions (FRx) interventions among clinicians and identify potential barriers to their use in clinical practice. DESIGN: The current study employed an exploratory research design using in-depth semi-structured interviews. Research participants were selected from primary care facilities, family practice offices and obesity clinics located in Mississippi and Louisiana. SETTING: Providers selected for participation in the current study serve predominantly rural, low-income communities in the US South. PARTICIPANTS: From an original population of fifty healthcare providers that included physicians, registered dieticians and nurse practitioners, from Oxford, Tupelo, Batesville, Jackson, and Charleston, MS and New Orleans, LA. Fifteen healthcare providers agreed to participate, including three physicians, four registered dieticians, three nurses and three nurse practitioners. RESULTS: The current study found that while healthcare providers expressed a desire to use FRx interventions, there was a universal lack of understanding by healthcare providers of what FRx interventions were, how they were implemented and what outcomes they were likely to influence. CONCLUSIONS: The current study identified key bottlenecks in the use of FRx interventions at the clinic level and data provided evidence for two key recommendations: (1) development and validation of a screening tool to be used by clinicians for enrolling patients in such interventions and (2) implementation of nutrition education in primary professional training, as well as in continuing education.

Community pharmacist perceptions of increased technician responsibility.

BACKGROUND: Pharmacists have struggled to find time to spend on clinical tasks. As such, regulatory steps have been taken by some states to expand the scope of practice for community pharmacy technicians. OBJECTIVE: The objective of this study was to determine what settings and characteristics predict pharmacists' comfort levels with technicians giving or receiving verbal prescriptions, performing nonclinical medication therapy management tasks, administering vaccinations, and verifying prescriptions. METHODS: This study employed a national Internet-based survey of community pharmacists using a health care marketing research panel. The Consolidated Framework for Implementation Research (CFIR) was used as a theoretical basis for inquiry, particularly the CFIR domains of "outer setting," "inner setting," and "individual characteristics." As the outcome variable of this study, the respondents were asked to report their comfort levels with technicians performing the 4 advanced tasks. Four multivariable linear regression models identified statistically significant predictors of pharmacists' comfort with each task. Repeated measures analysis of variance (ANOVA) was used to compare the pharmacists' comfort levels among tasks. RESULTS: For all 4 tasks, pharmacists who believed that technicians had the ability to complete each task were more comfortable with technicians completing those tasks. In addition, pharmacists with perceptions of stronger technician interest in advanced tasks were found to be more comfortable with technicians taking on more responsibility for all tasks except vaccine administration. Repeated measures ANOVA found that pharmacists' comfort levels differed on all 4 tasks. CONCLUSION: This study found that the CFIR domains of inner setting (pharmacy location) and individual characteristics (perceptions of technicians and pharmacist education) affect pharmacists' level of comfort with technicians taking on additional responsibilities, but outer setting variables such as regulations do not. This suggests that pharmacist characteristics may affect the expansion of technician task responsibilities, no matter what state regulations allow.

Preemptive pharmacogenetic testing: exploring the knowledge and perspectives of US payers.

PURPOSE: Preemptive pharmacogenetic testing aims to optimize medication use by having genetic information at the point of prescribing. Payers' decisions influence implementation of this technology. We investigated US payers' knowledge, awareness, and perspectives on preemptive pharmacogenetic testing. METHODS: A qualitative study was conducted using semistructured interviews. Participants were screened for eligibility through an online survey. A blended inductive and deductive approach was used to analyze the transcripts. Two authors conducted an iterative reading process to code and categorize the data. RESULTS: Medical or pharmacy directors from 14 payer organizations covering 122 million US lives were interviewed. Three concept domains and ten dimensions were developed. Key findings include clinical utility concerns and limited exposure to preemptive germ-line testing, continued preference for outcomes from randomized controlled trials, interest in guideline development, importance of demonstrating an impact on clinical decision making, concerns of downstream costs and benefit predictability, and the impact of public stakeholders such as the Food and Drug Administration and Centers for Medicare and Medicaid Services. CONCLUSION: Both barriers and potential facilitators exist to developing cohesive reimbursement policy for pharmacogenetics, and there are unique challenges for the preemptive testing model. Prospective outcome studies, more precisely defining target populations, and predictive economic models are important considerations for future research.

Youth access to indoor tanning salons in urban versus rural/suburban communities.

BACKGROUND/PURPOSE: Research suggests that youth proximity to tanning salons may promote use; however, little is known about tanning salon proximity to schools. We assessed the proximity of tanning salons to schools in urban versus rural/suburban communities across Worcester County, Massachusetts (population > 800K). To put findings in context, we compared school proximity to tanning salons to school proximity to McDonald's restaurants, a large franchise that also caters to young people. MATERIALS & METHODS: Accessibility was measured by ArcGIS 10.2 Network Analyzer (ESRI, Redlands, CA, USA) and the most current road network data layer from Massachusetts Department of Transportation (MassDOT). RESULTS: A total of 145 schools were observed in the study area, of which about 39% of schools were within 1 mile from a tanning salon. Urban schools (53.41%) had a higher proportion within 1 mile of a tanning salon than rural/suburban schools (17.54%; P < .001). More schools (39.31%) were within 1 mile of a tanning salon than schools within 1 mile of a McDonald's (22.70%; P < .001). CONCLUSIONS: Schools may be particularly impactful for implementing skin cancer prevention programing.

Do community pharmacist performance evaluations capture the modern pharmacist's role? Mapping competencies assessed in Canadian community pharmacy performance evaluation templates against the General Level Framework.

OBJECTIVES: Feedback on community pharmacists' practice is limited after graduation and often comes in the form of annual performance evaluations by pharmacy managers based on company-provided templates. The objective of this study was to examine the relevance of these review processes to all aspects of community pharmacy practice. METHODS: Competencies evaluated in performance evaluation templates used by pharmacy organizations were mapped to the General Level Framework (GLF)-a tool developed to assess the competency of general-level pharmacy practitioners-and studied in hospital and community practice settings. The competencies were further assessed with consideration of their applicability to the current scope of practice of Canadian community pharmacy practice. RESULTS: Performance evaluation templates from 7 community pharmacy organizations in Canada were obtained and evaluated. Performance evaluations mapped most closely to the GLF tool related to personal competencies (e.g., organization, communication, and teamwork), with the lowest level of congruence observed among competencies specific to patient care activities. Few evaluations considered recent expansions of scope in place across various Canadian provinces, such as ordering and interpreting laboratory tests or pharmacist prescribing. CONCLUSION: Performance evaluation can be a valuable tool to improve quality of care and the professional development of pharmacists; however, these tools should be reexamined to ensure that feedback on the most valuable aspects of a pharmacist's professional practice is the focus. As pharmacy practice continues to evolve toward greater direct patient care activities, so too should our evaluation tools align with this increasingly recognized role.

Patient perceptions of a pharmacy star rating model.

OBJECTIVES: To identify patients' understanding of what constitutes a "quality pharmacy" and to obtain their feedback regarding the development and use of the pharmacy star rating model, a pharmacy-specific aggregate performance score based on the Centers for Medicare and Medicaid Services' Medicare Star Rating. DESIGN: Prospective cross-sectional study. SETTING AND PARTICIPANTS: Focus groups were conducted in Arizona, California, Mississippi, Maryland, and the District of Columbia, and one-on-one interviews were conducted in Indiana. Eligible patients were required to routinely use a community pharmacy. MAIN OUTCOME MEASURES: Consumer insights on their experiences with their pharmacies and their input on the pharmacy star rating model were attained. Key themes from the focus groups and interviews were obtained through the use of qualitative data analyses. RESULTS: Forty-nine subjects from 5 states and DC participated in 6 focus groups and 4 one-on-one interviews. Eighty-eight percent of participants reported currently taking at least 1 medication, and 87% reported having at least 1 health condition. The 7 themes identified during qualitative analysis included patient care, relational factors for choosing a pharmacy, physical factors for choosing a pharmacy, factors related to use of the pharmacy star rating model, reliability of the pharmacy star rating model, trust in pharmacists, and measures of pharmacy quality. Most participants agreed that the ratings would be useful and could aid in selecting a pharmacy, especially if they were moving to a new place or if they were dissatisfied with their current pharmacy. CONCLUSION: Pharmacy quality measures are new to patients. Therefore, training and education will need to be provided to patients, as pharmacies begin to offer additional clinical services, such as medication therapy management and diabetes education. The use of the pharmacy star rating model was dependent on the participants' situation when choosing a pharmacy.

Randomized Trial of the Effect of Pharmacist Prescribing on Improving Blood Pressure in the Community: The Alberta Clinical Trial in Optimizing Hypertension (RxACTION).

BACKGROUND: Hypertension control rates remain suboptimal. Pharmacists' scope of practice is evolving, and their position in the community may be ideal for improving hypertension care. We aimed to study the impact of pharmacist prescribing on blood pressure (BP) control in community-dwelling patients. METHODS AND RESULTS: We designed a patient-level, randomized, controlled trial, enrolling adults with above-target BP (as defined by Canadian guidelines) through community pharmacies, hospitals, or primary care teams in 23 communities in Alberta. Intervention group patients received an assessment of BP and cardiovascular risk, education on hypertension, prescribing of antihypertensive medications, laboratory monitoring, and monthly follow-up visits for 6 months (all by their pharmacist). Control group patients received a wallet card for BP recording, written hypertension information, and usual care from their pharmacist and physician. Primary outcome was the change in systolic BP at 6 months. A total of 248 patients (mean age, 64 years; 49% male) were enrolled. Baseline mean±SD systolic/diastolic BP was 150±14/84±11 mm Hg. The intervention group had a mean±SE reduction in systolic BP at 6 months of 18.3±1.2 compared with 11.8±1.9 mm Hg in the control group, an adjusted difference of 6.6±1.9 mm Hg (P=0.0006). The adjusted odds of patients achieving BP targets was 2.32 (95% confidence interval, 1.17-4.15 in favor of the intervention). CONCLUSIONS: Pharmacist prescribing for patients with hypertension resulted in a clinically important and statistically significant reduction in BP. Policy makers should consider an expanded role for pharmacists, including prescribing, to address the burden of hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00878566.

Understanding pharmacist success in practice: A scoping review.

OBJECTIVES: The objective was to identify literature providing a description of characteristics contributing to pharmacists' individual level success in providing advanced patient care. DESIGN: An interpretive scoping review was conducted to synthesize knowledge and address the study objective. SETTING: Searches were undertaken in Ovid MEDLINE (1946-2015), EMBASE (1974-2015), and International Pharmaceutical Abstracts (1970-2015). PARTICIPANTS: Not applicable. MAIN OUTCOME MEASURES: Specific keywords used in the search included: motivation, attitude, career, clinical competence, certification, pursuit of an expanded scope of practice, pharmacist, and success. This was not intended to be an exhaustive list, and every effort was made to be inclusive as the search revealed additional words and phrases of interest. RESULTS: A total of 93 articles were initially identified, 10 articles met inclusion criteria and were retained for full-text analysis. Most of the included articles were published in the United States (70%). One-third of the articles conducted semi-structured interviews, one-third of the articles were editorials or commentaries, and the remaining articles collected data using surveys, knowledge assessments, and observation. Content analysis of the extracted definitions of success yielded 2 themes; "what successful pharmacists do" and "what successful pharmacists should be." CONCLUSION: Professional organizations representing pharmacy have made significant strides in advocating for pharmacists' provision of advanced patient care. If pharmacists are to successfully provide advanced patient care a more specific and practically-oriented understanding that accounts for individual and environmental factors of how to achieve individual-level success is needed.

A randomized trial of a community-based approach to dyslipidemia management: Pharmacist prescribing to achieve cholesterol targets (RxACT Study).

BACKGROUND: Dyslipidemia is an important risk factor for cardiovascular disease but is suboptimally managed. Pharmacists are accessible primary care professionals and with expanded scopes of practice (including prescribing), could identify and manage patients with dyslipidemia. We sought to evaluate the effect of pharmacist prescribing of dyslipidemia medications on the proportion of participants achieving target LDL-cholesterol (LDL-c) levels. METHODS: We conducted a randomized controlled trial in 14 community pharmacies in Alberta, Canada. We enrolled adults with uncontrolled dyslipidemia as defined by the 2009 Canadian Dyslipidemia Guidelines. Intervention was pharmacist-directed dyslipidemia care, including assessment of cardiovascular risk, review of LDL-c, prescribing of medications, health behaviour interventions and follow-up every 6 weeks for 6 months. Usual care patients received their lipid results and a pamphlet on cardiovascular disease and usual care from their physician and pharmacist. Primary outcome was the proportion of participants achieving their target LDL-c (<2 mmol/L or ≥50% reduction) at 6 months between groups. RESULTS: We enrolled 99 patients with a mean (SD) age of 63 (13) years, 49% male and baseline LDL-c of 3.37 mmol/L (0.98). Proportion of patients achieving LDL-c target was 43% intervention versus 18% control (p = 0.007). Adjusted odds of achieving target LDL-c were 3.3 times higher for the intervention group (p = 0.031), who also achieved greater reduction in LDL-c (1.12 mmol/L, SE = 0.112) versus control (0.42 mmol/L, SE = 0.109), for an adjusted mean difference of 0.546 mmol/L (SE = 0.157), p < 0.001. CONCLUSION: Pharmacist prescribing resulted in >3-fold more patients achieving target LDL-c levels. This could have major public health implications.

Pay-for-performance remuneration for pharmacist prescribers' management of hypertension: A substudy of the RxACTION trial.

BACKGROUND: To be sustainable, pharmacists providing direct patient care must receive appropriate payment for these services. This prespecified substudy of the RxACTION trial (a randomized trial of pharmacist prescribing vs usual care in patients with above-target blood pressure [BP]) aimed to determine if BP reduction achieved differed between patients whose pharmacist was paid by pay-for-performance (P4P) vs fee-for-service (FFS). METHODS: Within RxACTION, patients with elevated BP assigned to the pharmacist prescribing group were further randomized to P4P or FFS payment for the pharmacist. In FFS, pharmacists received $150 for the initial visit and $75 for follow-up visits. P4P included FFS payments plus incentives of $125 and $250 for each patient who reached 50% and 100% of the BP target, respectively. The primary outcome was difference in change in systolic BP between P4P and FFS groups. RESULTS: A total of 89 patients were randomized to P4P and 92 to the FFS group. Patients' average (SD) age was 63.0 (13.2) years, 49% were male and 76% were on antihypertensive drug therapy at baseline, taking a median of 2 (interquartile range = 1) medications. Mean systolic BP reductions in the P4P and FFS groups were 19.7 (SD = 18.4) vs 17.0 (SD = 16.4) mmHg, respectively (p = 0.47 for the comparison of deltas and p = 0.29 after multivariate adjustment). CONCLUSIONS: This trial of pharmacist prescribing found substantial reductions in systolic BP among poorly controlled hypertensive individuals but with no appreciable difference when pharmacists were paid by P4P vs FFS.

Relationship between personality traits and pharmacist performance in a pharmacy practice research trial.

BACKGROUND: Pharmacy practice research is one avenue through which new pharmacy services can be integrated into daily pharmacy practice. However, pharmacists' participation in this research has not been well characterized. Drawing from the literature on work performance and personality traits, 4 hypotheses were developed to gain insight into pharmacists' performance in a pharmacy practice research trial. METHODS: This study was an observational, cross-sectional survey of pharmacists participating in a research trial. All pharmacists were asked to complete the Big Five Inventory (BFI), a validated, reliable instrument of personality traits. These results were then compared with measures of pharmacists' performance in the trial. RESULTS: Thirty pharmacists expressed interest in participating in the trial; 23 completed the BFI and 14 actively participated in the pharmacy practice research trial. No statistically significant differences were identified in the examination of the predetermined hypotheses. Exploratory analyses revealed significant relationships between the BFI trait of extroversion and pharmacists' participation in the study, obtaining prescribing authority for the study and the number of patients lost to follow-up. DISCUSSION: In addition to identifying a number of personality traits that have been shared by other samples of pharmacists, this work suggests the possibility of an interaction between pharmacists' personality traits and their performance in a pharmacy practice research trial. CONCLUSION: Future research should better characterize the relationship between pharmacists' personality traits and participation in pharmacy practice research trials to gain insight into the context of pharmacy practice and how pharmacists are integrating this research into their practices.

Mixed messages: The Blueprint for Pharmacy and a communication gap.

BACKGROUND: More than 5 years ago, the Blueprint for Pharmacy developed a plan for transitioning pharmacy practice toward more patient-centred care. Much of the strategy for change involves communicating the new vision. OBJECTIVE: To evaluate the communication of the Vision for Pharmacy by the organizations and corporations that signed the Blueprint for Pharmacy's Commitment to Act. METHODS: The list of 88 signatories of the Commitment to Act was obtained from the Blueprint for Pharmacy document. The website of each of these signatories was searched for all references to the Blueprint for Pharmacy or Vision for Pharmacy. Each of the identified references was then analyzed using summative content analysis. RESULTS: A total of 934 references were identified from the webpages of the 88 signatories. Of these references, 549 were merely links to the Blueprint for Pharmacy's website, 350 of the references provided some detailed information about the Blueprint for Pharmacy and only 35 references provided any specific plans to transition pharmacy practice. CONCLUSION: Widespread proliferation of the Vision for Pharmacy has not been achieved. One possible explanation for this is that communication of the vision by the signatories has been incomplete. To ensure the success of future communications, change leaders must develop strategies that consider how individual pharmacists and pharmacies understand the message.

Caregivers' Perspectives of Pharmacist Intervention in Children's Antibiotic Prescriptions for Upper Respiratory Tract Infections.

Background: Community pharmacists can help fight antimicrobial resistance by intervening in children's antibiotic prescriptions for upper respiratory tract infections (URTIs). However, caregivers' attitudes and perspectives on this are unknown. Objective: To evaluate children's caregivers' acceptability of pharmacists intervening in their antibiotic prescriptions for URTIs with respect to their knowledge of and attitude toward pharmacists and knowledge, beliefs, and behaviors related to antibiotics. Methods: A 69-item survey was created and sent to a panel of caregivers. ANCOVA and path analysis were used to evaluate the relationship between caregiver characteristics and their acceptability of pharmacists intervening in children's antibiotic prescriptions for URTIs. Results: Responses from 246 caregivers who met the inclusion and exclusion criteria were analyzed. Mean caregivers' acceptability of pharmacists intervening in children's antibiotic prescriptions for URTIs was 3.25 out of 5 (±1.01). The ANCOVA model (adjusted R2 = .636) showed positive attitude toward pharmacists and being more accepting of health advice from pharmacists since the start of the COVID-19 pandemic were associated with higher caregiver acceptability of pharmacists intervening in children's antibiotic prescriptions. Caregivers with better relationships with their pharmacist also tend to have better attitudes toward pharmacists. Not wanting antibiotics for symptom relief was associated with decreased acceptability scores. Conclusion: Overall caregiver acceptability of pharmacists intervening in antibiotic prescriptions was slightly above neutral. Building a relationship with caregivers could help change their attitude and increase the acceptability of pharmacists intervening in children's antibiotic prescriptions. Caregivers seeking symptomatic relief may be more open to non-antibiotic alternatives.