Strengthening pandemic preparedness through pharmacy and public health collaborations: Findings from a facilitated discussion exercise

BackgroundCommunity pharmacists are key partners to public health agencies during pandemics and other emergencies. Community pharmacy and public health agencies can establish memoranda of understanding (MOUs) for dispensing and administering medical countermeasures and providing related services to affected population(s) during a public health incident.ObjectiveThe objective of this facilitated discussion exercise was to identify the strengths and opportunities associated with the activation of a statewide pharmacy–public health agencies MOU with community pharmacists on the basis of a simulated pandemic influenza event.MethodsA facilitated discussion exercise was held in the Puget Sound region of the State of Washington in May 2017. The participants included pharmacists from 2 community pharmacy organizations, emergency preparedness officials from 2 local health departments and the state health department, staff of the state pharmacy association, and faculty from a school of pharmacy. The evaluators recorded the discussions and observations, augmented by a postexercise telephone call with participants from each of the participating community pharmacy organizations. Key themes from the exercise are reported.ResultsFive themes were identified during the facilitated discussion exercise. Two themes described the strengths of the MOU and its operational plan: (1) collaboration strengthens preparedness and response planning, and (2) an MOU provides a framework for effective collaboration. Three themes acknowledged the opportunities to optimize activation of the existing MOU: (1) early and active engagement between health department personnel and community pharmacists, (2) establishing pharmacy policies and procedures to support readiness and response, and (3) addressing the training or other educational needs of community pharmacists.ConclusionThis exercise provided community pharmacists and public health agency personnel an opportunity to better plan for responding to a pandemic. The open dialogue in this facilitated discussion allowed the exercise participants to identify the strengths, priorities, and perspectives as well as the gaps in the MOU operational plan. The lessons learned in this exercise can inform the community pharmacy and public health response to the coronavirus disease pandemic.     

Clinical impact of a community pharmacy-based health and wellness introductory pharmacy practice experience

ObjectiveTo assess the clinical impact of an intensive community pharmacy-based Health and Wellness Introductory Pharmacy Practice Experience (IPPE) completed by second-year (P2) student pharmacists.DesignThe Health and Wellness IPPE was a 1-week rotation developed to provide P2 student pharmacists with opportunities to provide clinical services to patients within the community pharmacy setting. Student pharmacists administered immunizations, performed blood pressure screenings and blood glucose measurements, and provided education to patients under the guidance of licensed pharmacist preceptors.Setting and participantsSecond-year student pharmacists completing a required Health and Wellness IPPE rotation in the community pharmacy setting.Outcomes measuredStudent pharmacist interventions were assessed to determine the course’s clinical impact, and preceptors were surveyed regarding the feasibility of student pharmacists performing clinical services at their training sites.ResultsA total of 147 student pharmacists completed the IPPE at 89 community pharmacy training sites and administered 9392 injections, 90% of which were influenza vaccinations. Student pharmacists performed 3458 patient health assessments, including measuring patients’ blood pressure and blood glucose and reviewing patient education materials. Most preceptors indicated that core activities were feasible during the experience.ConclusionThis study found that implementing a concentrated IPPE focused on immunizations and health screenings allowed student pharmacists to enhance their clinical skills and fulfill a large public health need, improving patient outcomes. Future studies should explore utilizing student pharmacists in community pharmacy settings to expand clinical services offered beyond these 2 services, such as diabetes risk tests, influenza point-of-care testing, and smoking cessation counseling.     

Community pharmacy interventions to improve antibiotic stewardship and implications for pharmacy education: A narrative overview

BackgroundAntibiotic resistance is one of the world's most pressing public health problems, resulting in over 23,000 deaths per year. One of the main contributing factors to antimicrobial resistance is antibiotic misuse and overuse. Community pharmacists can play a role in reducing antibiotic resistance, since they are one of the most accessible healthcare professionals.ObjectiveThe purpose of this paper is to describe community pharmacy interventions and strategies to reduce antibiotic misuse and overuse and to discuss the implications for pharmacy training.MethodsA narrative overview strategy was employed to identify papers on antibiotic stewardship and the role of the community pharmacist. Our review examined potential stewardship strategies and interventions within community pharmacy practice that provide opportunities for pharmacists to engage or lead in the reduction of antimicrobial resistance.ResultsWe describe five promising community pharmacist-led intervention strategies: Collaborative Practice Agreements (CPAs), point-of-care (POC) testing, patient consultations, academic detailing and serving as an advocate for patients and other healthcare providersConclusionsThis review highlights topics that may warrant increased attention in pharmacy school curricula. Pharmacy schools may want to consider modifying their curricula to address the shifts in practice of the community pharmacist – emphasizing the expanded role of the pharmacist in patient care and public health issues such as outpatient antibiotic stewardship.     

Meeting the challenge of public health information delivery in the digital age

ObjectiveTo discuss the current status of public health messaging and how pharmacists can become more active participants.SummaryPublic health needs can be addressed by using Internet videos as a model to disseminate medical information. Introducing student pharmacists to new ways of developing and delivering targeted public health messages can increase their awareness that public health intervention is part of the emerging scope of practice.ConclusionFor pharmacy to affect change in public health at the local and national level, pharmacists should consider providing public health advocacy messages through virtual platforms.     

Formation of a statewide community pharmacy practice-based research network: Pharmacist opinions on research participation and engagement

ObjectiveTo gather the insights and opinions of pharmacist stakeholders to inform the creation of a community pharmacy practice-based research network (PBRN) in Pennsylvania.DesignA stakeholder advisory board of pharmacists, patients, and researchers was established to guide this research. This was a qualitative study using a semistructured interview guide.Setting and participantsCommunity pharmacists from the Pennsylvania Pharmacist Care Network.Outcome measuresThemes were identified that describe pharmacist insights and opinions on research participation and preferences for engagement in the PBRN.ResultsA total of 16 pharmacists participated in the study. The pharmacists believed that participating in research would help demonstrate their value and commitment to improving patients’ health. Enhancing patient-pharmacist relationships and driving innovation were additional benefits that were reported. The pharmacists believed that they could effectively leverage their relationships with patients to engage them in research opportunities. The pharmacists reported that they would like to share research ideas and successful research practices with other members of the PBRN.ConclusionGathering pharmacists’ opinions on participating in research was an important step in developing a community pharmacy PBRN that meets stakeholder needs. The results of this study can help others who seek to form community pharmacy PBRNs that facilitate stakeholder-driven research.     

The corporatization of community pharmacy: Implications for service provision,the public health function,and pharmacy's claims to professional status in the United Kingdom

BackgroundPharmacy has experienced both incomplete professionalization and deprofessionalization. Since the late 1970s, a concerted attempt has been made to re-professionalize pharmacy in the United Kingdom (UK) through role extension—a key feature of which has been a drive for greater pharmacy involvement in public health. However, the continual corporatization of the UK community pharmacy sector may reduce the professional autonomy of pharmacists and may threaten to constrain attempts at reprofessionalization.ObjectivesThe objectives of the research: to examine the public health activities of community pharmacists in the UK; to explore the attitudes of community pharmacists toward recent relevant UK policy and barriers to the development of their public health function; and, to investigate associations between activity, attitudes, and the type of community pharmacy worked in (eg, supermarket, chain, independent).MethodsA self-completion postal questionnaire was sent to a random sample of practicing community pharmacists, stratified for country and sex, within Great Britain (n = 1998), with a follow-up to nonresponders 4 weeks later. Data were analyzed using SPSS (SPSS Inc., Chicago, IL, USA) (v12.0). A final response rate of 51% (n = 1023/1998) was achieved.ResultsThe level of provision of emergency hormonal contraception on a patient group direction, supervised administration of medicines, and needle-exchange schemes was lower in supermarket pharmacies than in the other types of pharmacy. Respondents believed that supermarkets and the major multiple pharmacy chains held an advantageous position in terms of attracting financing for service development despite suggesting that the premises of such pharmacies may not be the most suitable for the provision of such services.ConclusionsA mixed market in community pharmacy may be required to maintain a comprehensive range of pharmacy-based public health services and provide maximum benefit to all patients. Longitudinal monitoring is recommended to ensure that service provision is adequate across the pharmacy network.     

Local and global volunteer opportunities for pharmacists to contribute to public health

There are many local and global volunteer opportunities for pharmacists to contribute to public health initiatives that help promote health, prevent disease and improve access to care. This article provides perspective and guidance for pharmacists and student pharmacists who desire to take part in volunteer initiatives related to local and global public health needs. The case examples provided are limited to activities that occurred strictly in a volunteer capacity. Pharmacists serving in a volunteer capacity have an opportunity to broaden their depth of practice and patient care responsibilities. Their skills sets and knowledge can be applied in a variety of public health settings to help meet the health care needs of the communities and patients they serve. Emergency response and caring for the underserved are recurring themes within the volunteer opportunities afforded to pharmacists. Examples include, but are not limited to, the US Medical Reserve Corps, health departments, health centres and clinics, medical service trips and disaster relief. Regardless of setting, the volunteer pharmacist will need to consider scope of practice limitations and certain legal protections. An array of volunteer opportunities exists for pharmacists and student pharmacists in the public health arena. Participating in these events allows pharmacists to expand their practice experiences while contributing to public health needs and outreach.     

Using qualitative,community-based input to steer post–coronavirus disease 2019 pharmacy practice in substance use

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has had a disproportionately negative impact on individuals with a substance use disorder (SUD). A rapidly changing public health and treatment environment has resulted in increased needs for pharmacist engagement in SUD-focused patient care.ObjectivesThis study used semistructured interviews of SUD professionals to evaluate where they believe pharmacy practice could better support people at risk of or having SUD in light of challenges posed by the COVID-19 pandemic.MethodsProfessionals dedicated to the care of individuals with SUD were recruited from a large community substance use coalition to participate in a qualitative study examining how pharmacists could take a more active role in SUD prevention, intervention, recovery, and harm reduction (HR). A consensual qualitative research approach was used in data analysis.ResultsDomains identified in analysis included pharmacists as educators of patients and communities, pharmacists as educators of health care providers, pharmacists as advocates for individuals with SUD, the need for increased pharmacist engagement owing to COVID-19 challenges for individuals with SUD, the need for expanded pharmacy practice interventions, and the need for pharmacist self-development.ConclusionIncreased medication counseling, HR practices, addressing stigma, and community-level education focused on SUD were among the most commonly reported areas for pharmacy practice development. In addition, the urgent need to adjust pharmacy practice in response to the COVID-19 pandemic was also identified by interviewees.     

Views, attitudes and self-assessed training needs of Scottish community pharmacists to public health practice and competence

Objective To assess the education and training needs of community pharmacists to support the delivery of an expanded public health role. Setting Community pharmacy in Scotland. Method Two focus groups of community pharmacists (n = 4 in each) in geographically distinct regions of Scotland explored issues of public health function, competencies and education and training. Findings from thematic analysis were used to develop a draft postal questionnaire. Following piloting, pharmacist managers from a random sample of 500 community pharmacies in Scotland were contacted by telephone to ascertain the number of pharmacists working in each pharmacy in the following 14-day period. A survey pack containing questionnaires for each identified pharmacist working in the study period was sent by post to the pharmacist manager in each pharmacy. The questionnaire contained items on: demographics; views and attitudes towards: public health; competencies for public health practitioners; and education and training needs. One postal reminder was sent 2 weeks later. Main Outcome Measures Main themes identified from focus group discussions; questionnaire response rate; views and attitudes towards public health competencies and education and training. Results Four hundred and fifteen managers agreed to participate, providing 904 potential participants. The response rate was 25% (223/904). Most (n = 179, 80%) were aware of the term ‘pharmaceutical public health’. While a majority saw the importance of public health to their practice (n = 177, 79%) agreeing/strongly agreeing, they were less comfortable with the term ‘specialist’. Respondents viewed competencies relating to health promotion (n = 192, 86%) more relevant than surveillance (n = 70, 31%), risk management (n = 29, 13%) and strategic developments (n = 12, 5%). Responses indicated a desire for education and training with more than half (n = 121, 54%) agreeing/strongly agreeing that they had a need now, with 69% (n = 153) expressing a future need. Conclusion Results should be interpreted with caution due to the response rate. However, this research highlights the self assessed gap in competence related to pharmaceutical public health for community pharmacists in Scotland.     

Using an OSCE to assess the potential for assistive technology to enhance communication between student pharmacists and simulated patients who are deaf/hard of hearing

ObjectivesTo evaluate the usefulness of assistive technology in health care interactions between student pharmacists and simulated patients who are deaf/hard of hearing and to assess changes in confidence and comfort levels (among both groups) when using assistive technology.MethodsForty-nine second-year student pharmacists were enrolled in a pharmacy communication laboratory course and 8 undergraduate students were recruited during Fall 2019. The first communication laboratory interaction consisted of student pharmacists using their normal mode of communication with role-played patients who are deaf/hard of hearing to establish baseline measures; a pretest survey was administered to each participant at the conclusion of this 10-minute laboratory interaction. In the second laboratory interaction, student pharmacists used the app to assist in communicating with the simulated patients who are deaf/hard of hearing. Posttests were administered at the conclusion of this laboratory interaction.ResultsMost student pharmacists and simulated patients who are deaf/hard of hearing reported feeling able to effectively communicate their needs to the other individual in their dyad (pharmacist or patient) during their health care interactions. Using an iPad (Apple Inc) app to communicate significantly increased student pharmacist and simulated patient comfort with health care communication from preintervention to postintervention.ConclusionThe use of assistive technology in simulated communication laboratory interactions can enhance student pharmacist comfort in health care interactions with patients who are deaf/hard of hearing.     

Opinions and experiences of Indiana pharmacists and student pharmacists: The need for addiction and substance abuse education in the United States

BackgroundSubstance abuse and addiction are growing public health problems. Pharmacists are potentially in a position to be of great assistance in ameliorating these threats yet might not be receiving the education and training to do so effectively.ObjectiveTo assess the relative perceived importance of substance abuse topics in pharmacy education among student pharmacists and pharmacy practitioners in the state of Indiana.MethodsQuestionnaires were administered in class to students at Purdue University College of Pharmacy and via direct mail to the home addresses of randomly selected licensed Indiana pharmacists in 2009 to elicit information on the relevance and interest for particular topics within addiction education, prior education received regarding addiction, and the frequency of professional interactions that involved addiction.ResultsThree hundred fifty students (74%) and 625 pharmacists (26%) responded to the survey. The average interest across all surveyed topics was 3.18/4.00 for students and 3.47/4.00 for practitioners. Areas rated highly by both groups included withdrawal, pain management, and recognition of signs and symptoms of addiction in patients. Qualitative responses from practitioners suggest strong interest in further education in this area and a perceived need for increased educational exposure during the student pharmacist experience. The average pharmacist respondent spent 6.94% of the time dealing with people who were addicted, and 22.2% had independent addiction education.ConclusionsPharmacists and pharmacy student respondents overwhelmingly felt that educational preparation in this area is important. A significant portion of time in practice is spent managing addiction-related issues, and further educational opportunities are being pursued beyond graduation to fulfill the educational needs of the practitioner respondents.     

Pharmacist provider status: Geoprocessing analysis of pharmacy locations,medically underserved areas,populations, and health professional shortage areas

BackgroundPayment reform for pharmacists is both an important and urgent issue that needs to be addressed.Objective(s)The purpose of this paper is to assess the use of medically underserved areas, medically underserved populations, and primary care health professional shortage areas in The Pharmacy and Medically Underserved Areas Enhancement Act; and provide policy recommendations for national pharmacy associations to achieve provider status.MethodsPharmacy location addresses were determined using public domain data from the National Plan & Provider Enumeration System (NPPES) National Provider Identifier (NPI) Registry. Medically Underserved Areas/Populations (MUAs/MUPs) and Health Professional Shortage Areas (HPSAs) were gathered through public data provided by the Health Resources and Services Administration as Keyhole Markup Language (KML) files. Addresses and KML files were analyzed and mapped using the geographic information software, QGIS. A series of maps depicting the location of all MUAs/MUPs, HPSAs, HPSA facility locations, and community pharmacy locations in the U.S. were then created. These maps were overlayed, and geoprocessing tools were used to create the analysis.ResultsAfter analyzing all community pharmacy locations in the United States, we found that only 56% are located within a current MUA/MUP or HPSA. The percentage of pharmacies in healthcare underserved areas differs widely between states from the lowest in New Jersey of 18.26% of pharmacies to the highest of Guam, the Northern Mariana Islands and the Virgin Islands with 100% of pharmacies.ConclusionsAligning the pharmacist business model to be comparable to other health care professionals will ensure patients receive access to pharmacist-provided cognitive patient care services, which have higher value than product-centered services. Future attempts to recognize pharmacists as providers and allow for their reimbursement under Medicare Part B should consider strategies to increase the number of pharmacists that are eligible to participate in order to exemplify value to the public and elected leaders.