Perspectives and perceived barriers to pharmacist-prescribed tobacco cessation services in the community pharmacy setting.

OBJECTIVE(S): Tobacco use is a leading cause of preventable morbidity and mortality in the United States. Community pharmacists are in an advantageous position to increase patient accessibility to tobacco cessation medications and counseling. Pharmacists are permitted to prescribe or furnish tobacco cessation medications in 13 states with varying requirements and limitations. The primary objective of this study was to evaluate the perspectives and perceived barriers that pharmacy personnel have in providing pharmacist-prescribed tobacco cessation services in the community pharmacy setting. The secondary objectives were to evaluate current practices of the 5 A's model and to identify additional training needed to provide the service. METHODS: This study was a descriptive cross-sectional electronic survey of pharmacy personnel from a large grocery pharmacy chain. The respondents were asked about their demographics, current practices of the 5 A's model, perceived barriers and attitudes toward pharmacist-prescribed tobacco cessation services, and additional training needed to provide the service. RESULTS: The survey received 79 responses from pharmacists. The results showed that 92.4% (73/79) of the respondents agreed that community pharmacists should provide tobacco cessation services. The biggest barrier identified was "lack of time during normal workflow to deliver tobacco cessation services" at 54.4% (43/79). Regarding the 5 A's model, 74.7% (59/79) of the pharmacists responded "never" or "somewhat infrequently" to how often they practice the "Ask" step, with other steps in the 5 A's model reported at similar frequencies. The top 3 additional trainings that the pharmacists identified were "strategies developing a follow-up plan with patients," "incorporating service into workflow," and "strategies providing counseling on tobacco cessation." CONCLUSION: Efforts should be made to give community pharmacy personnel more time and guidance to provide patient care services beyond traditional dispensing roles to provide tobacco cessation services.

Chronic Drug-Induced Liver Injury from Labetalol during the Postpartum Period: A Case Report.

Drug-induced liver injury (DILI) is a common cause of transaminitis in pregnancy. A 34-year-old G3P2012 presented 3 weeks postpartum for preeclampsia with severe features. After receiving acute antihypertensive medications, she was discharged home with labetalol. She presented 5 months later with general malaise, scleral icterus, nausea, and mild right upper quadrant pain and found to have significantly elevated transaminitis. She had a negative infectious, autoimmune, biliary, and steatohepatitis workup. A liver biopsy was performed supporting the diagnosis of DILI. After patient self-discontinued labetalol, her hepatitis significantly improved. However, she developed chronic DILI and liver enzymes normalized during her subsequent pregnancy at 34 weeks. Patient's written consent was obtained for this case report. Chronic DILI secondary to labetalol use is a rare and potentially fatal condition that should be considered on the differential for transaminitis during pregnancy and postpartum period.