Impact of a multi-component immunization intervention on pneumococcal and herpes zoster vaccinations: A randomized controlled trial of community pharmacies in 2 states

BackgroundThe purpose of this study was to assess the impact of the We Immunize Program on structures, processes, and outcomes of pneumococcal and herpes zoster pharmacy-based immunization services.MethodsPharmacy-technician pairs from 62 Alabama and California community pharmacies participated in a 6-month randomized controlled trial (intervention = 30/control = 32). All received immunization update training; intervention participants also received practical strategies training and monthly telephonic expert feedback. Completion of immunization service structure and process activities were analyzed using Fisher's Exact and one-way Mann-Whitney U tests. The primary outcome, change in number of pneumococcal, herpes zoster, and total vaccine doses administered, was assessed using one-way Wilcoxon signed rank and Mann-Whitney U tests. Associations between program and vaccine doses across time were explored using generalized estimating equations (GEE).ResultsIntervention pharmacies completed more structure (median 12.00 versus 9.00, p = 0.200) and process activities (median 8.00 versus 7.00, p = 0.048) compared to control. Statistically significant increases in the median number of pneumococcal vaccine doses (7.50–12.00 doses, p = 0.007), and total vaccine doses (12.50–28.00 doses, p = 0.014) were seen from baseline to post-intervention within the intervention group. However, these changes were not statistically significant when compared to the control group (pneumococcal p = 0.136, total p = 0.202). Changes in median herpes zoster vaccine doses did not reach significance among intervention (8.50–9.00, p = 0.307) or control (9.00–13.00, p = 0.127) pharmacies.ConclusionsPractical strategies training combined with tailored expert feedback enhanced existing pneumococcal immunization services in community pharmacies.Clinical trial registrationClinicalTrials.gov identifier: NCT02615470.     

Drug information resources at community pharmacies in Amman,Jordan

Objectives The aim of this study was to investigate the drug information resources available in community pharmacies in Amman, Jordan. Methods A total of 156 private community (retail) pharmacies in different parts of Amman, the capital of Jordan, were recruited by personal contact. Pharmacists at the sample pharmacies completed a self‐administered questionnaire that consisted of two sections. The first section elicited the drug information resources available in their pharmacies. The second section presented five mock medicines information scenarios and asked respondents to identify the most suitable information resource to be used from a given list. Answers then were coded and entered into SPSS for Windows for statistical analysis. Key findings All pharmacies had at least one reference book, but most were outdated. The Monthly Index of Medical Specialties (MIMS) was the most commonly found (n =101; 64.7%), and 40.4% (n = 63) had internet access. Only 19.2% (n = 30) of the respondents reported getting medicines information directly from pharmaceutical companies, usually through pharmaceutical representatives. Most pharmacists could identify appropriate information resources for drug dosing and side effects but did not fare well for medicine identification, drug interactions and primary research evidence. Conclusions The quality of drug information resources in private community pharmacies in Amman is far from optimal. This will affect the quality of information provided to patients and prescribers and have an adverse effect on the role that pharmacists can play in the health system in Jordan.     

儿童预防接种信息管理系统在免疫接种率分析中的应用

目的探讨儿童预防接种信息管理系统在免疫接种率分析中的应用效果。方法选取9 755例本地儿童,232例流动儿童作为研究对象,应用儿童预防接种信息管理系统,分析5种疫苗接种率。结果流动儿童的疫苗接种率、及时接种率、合格接种率分别为98.01%、85.64%、97.25%;本地儿童的疫苗接种率、及时接种率、合格接种率分别为99.68%、90.78%、99.24%。结论应用儿童预防接种信息管理系统,能够方便、迅速地查询流动儿童及本地儿童的免疫接种信息,为流动儿童提供了及时接种机会,也很好地解决了因儿童流动造成的接种管理困难问题。     

Assessing barriers and increasing use of immunization information systems in independent community pharmacies: Study protocol for a randomized controlled trial

BackgroundAs the number of providers administering vaccines increases, including pharmacists, there is a concern of fragmented immunization records in state and regional immunization information systems (IIS). In order for IIS to have complete records, it is critical that each provider administering vaccines, including pharmacists, participate and update the IIS each time a vaccine is administered to a patient. In Alabama, provider participation in the state IIS is not mandatory; as a result, less than 25% of adults over the age of 19 have immunization data recorded. IIS participation among independent pharmacies is of particular concern as approximately 40% of Alabama pharmacies are independently owned, but only 27% of these are enrolled in the IIS.ObjectiveThe objective of this report is to describe a study protocol to assess the impact of an IIS training program among community pharmacies’ IIS enrollment and actual participation rates.MethodsThe research design is a randomized controlled trial. Study participants are Alabama pharmacists who work in independently owned pharmacies that currently provide at least one type of non-seasonal vaccine and are not currently enrolled in the Alabama IIS. Multiple outcomes including awareness, knowledge, attitudes, intention, IIS enrollment, and IIS participation will be compared between intervention and control groups across three time points (baseline, one-month, and three-months). Individual and organizational factors will be measured to identify any possible associations with outcomes.ImplicationsThe expected outcome is to create an effective training program that is scalable and ready for dissemination. If successful, this training program can be replicated and used to significantly impact the completeness and accuracy of IIS across the U.S., providing the potential for IIS to be used consistently in assessing immunization status and recommending additional vaccines in the pharmacy setting, thereby improving vaccination coverage and making the provision of immunizations safe and efficient.     

Effects of a management technician on structured working in Dutch community pharmacies

OBJECTIVE: To study the effects of 'stepwise working with the help of a management technician' on structured working with regard to patient education in a sample of Dutch community pharmacies. METHODS: The intervention program provided the management technician with knowledge, tools and skills needed for the organisation of patient education activities in her community pharmacy. Twenty-eight pharmacies were selected for the study. After matching, each pharmacy was randomly assigned to either the experimental or control group. In the pharmacies of the experimental group, a technician was selected to become the management technician. MAIN OUTCOME MEASURES: Pharmacy technicians were assessed by means of written questionnaires at baseline and immediately after the intervention (12 months). The outcomes were the variables that were directly targeted by the intervention, and included technicians' perception of the availability of policy plans, support for patient education activities towards their implementation, evaluation, and provisions for continuity. RESULTS: After 12 months, the following indicators for structured working were noted to have increased in the experimental group compared to the control group: the technicians in the experimental group more often reported an awareness of policy plans, less lack of continuity of activities, support and evaluation for implementing patient education activities. We also observed that the control group had a higher baseline level and the effects on support and evaluation showed differences between pharmacies. The observed increases were more pronounced in pharmac higher exposure to the intervention, and in the case of support and evaluation relevant in this more exposed group. CONCLUSION: We found indications for effects of the intervention program, especially in the pharmacies with increased exposure. However, results could be influenced by regression to the mean, as the control group started with a higher mean than the experimental group. We conclude that technicians' participation in the management of patient education activities appears to be effective when she has a minimum of hours to spend on this task in her pharmacy.     

Needs and use of drug information sources in community pharmacies: a questionnaire based survey in German-speaking Switzerland

OBJECTIVES: To explore the types of drug information used by pharmacists in daily practice, their needs and wishes concerning drug information and their opinions about future changes of pharmacy practice. METHODS: Postal survey to a random sample of 223 (26% out of 859) community pharmacies from the German-speaking part of Switzerland. The 48-item questionnaires were processed automatically with the Cardiff TELEform-Software. In addition, a telephone-survey to a random sample of 20 non-responders was performed in order to test for non-response bias. RESULTS: A total of 108 pharmacists (response rate 48%) reported that the official Swiss drug reference book is still the most popular source of drug information used to solve all kinds of drug related problems. The Internet as a source of drug information is of minor importance, even though 88% of the pharmacies have Internet access. Deficits in drug information were reported for paediatrics, phytotherapy, drugs during pregnancy/lactation and for therapy guidelines. According to 35% of the pharmacists, the importance of offering drug information to customers will increase in the future. Most of the pharmacists are not afraid that Internet pharmacies would replace them. CONCLUSIONS: The results show that the majority of the community pharmacists are only partially satisfied with the sources of drug information currently available. The Internet still plays a minor role for solving drug-related problems in daily practice, even though the available infrastructure makes the community pharmacies able to use the Internet more frequently. The pharmacists need more websites tailored to their needs. The pharmacists have clear visions about possible future developments. They do, however, have to adopt quickly to the changes ahead in order to remain competitive.     

Pandemic preparedness of community pharmacies for COVID-19

BackgroundCommunity pharmacies provide an important healthcare service, which is broadly established, and constitutes the preferred and initial contact for members of the community. The significant value of community pharmacies was further highlighted during the COVID-19 pandemic crisis.ObjectiveThe assessment of community pharmacies preparedness for the COVID-19 pandemic.MethodsA cross‐sectional interview survey of 1018 community pharmacies working in four regions of Egypt (South, East, Centre, and North). Data collection was conducted from 8–19 April 2020.ResultsAvailability of personal protective equipment (PPE) and medication was better than alcohol (70% conc.). Home delivery services were available in 49.1% of pharmacies. Infection control measures covering interactions between staff were in place in up to 99.5% of pharmacies. Conversely, there was less frequent availability of contactless payment (29.1%), hand sanitizers (62.1%) or masks (86.5%) for customer use, or a separate area for patients with suspected COVID-19 (64%). Verbal customer education (90.4%) was used preferably to written (81.3%). Despite high clinical knowledge and awareness (97.6%–99.2%), only 8.8% of pharmacists had reported suspected COVID-19 cases, however this varied significantly with pharmacist demographics (geographic region P < 0.001; pandemic training p < 0.001; position p = 0.019; age p = 0.046).ConclusionsGovernment and policymakers strive to mitigate the shortage of PPE and medication. More attention should be given to infection control measures around interactions between staff and customers to ensure community pharmacists are fit and able to provide continuity in their important role. Educating customers using regularly-updated posters, banners or signs will contribute to decreasing contact with patients, and reducing the number and duration of visits to the pharmacy. Pandemic preparedness of community pharmacists must also extend to reporting procedures. By avoiding under-reporting or over-reporting, community pharmacists will contribute to accurate monitoring of the national spread of infection.     

Diary cards and the assessment of cough symptoms in community pharmacies

The aim of this study is to compare cough symptom assessment and medication efficacy as recorded in a diary card with that obtained through direct questioning by a pharmacist. Clients visiting six pharmacies, purchasing a cough medication and meeting the inclusion criteria were recruited. They were asked to fill out diary cards to obtain a daily retrospective assessment of symptoms and medication efficacy. After three days the subjects returned to the pharmacy and were asked to recall their symptoms through a structured questionnaire administered by the pharmacist.48 clients were recruited to the study and of these 44 (92% completed the study. A good correlation was obtained between ratings of medication efficacy as recorded by diary cards and recall. Symptom assessment also showed a statistically significant correlation for days two and three only.For studies assessing symptoms over a 48 hour period, detailed poststudy assessments may not be required. The study provides further evidence for the viability of clinical trials conducted through community pharmacies.     

The development of a sleep disorder screening program in Australian community pharmacies

Objective To develop, pilot and determine the feasibility of a sleep-specific screening and awareness program in community pharmacies. Setting The screening was piloted in five Australian community pharmacies. Method The Pharmacy Tool for Assessment of Sleep Health was constructed by drawing on known relationships between sleep disorders, and lifestyle factors, medical conditions and medications. Four validated instruments were used in the screening tool: the Epworth Sleepiness Scale (ESS), Insomnia Severity Index (ISI), Multivariable Apnea Prediction Index (MAPI) and International Restless Legs Syndrome Study Group Screening Criteria (IRLS). These instruments were used to predict the participant’s risk of a sleep disorder and the results were compared with reported lifestyle, medical and medication factors. On-site training of consenting pharmacists was provided, followed by an eight week client recruiting and screening period. Feedback was elicited from participating pharmacists and clients. Main outcome measure The feasibility of, and trends found from, the developed screening tool and protocol. Results Of 167 clients who requested or were invited to participate by pharmacists, 84 (50.3%) were screened. Analysis of collected data indicated that 33.3%, 21.4% and 27.4% of participants were at risk of having or developing insomnia, obstructive sleep apnea (OSA) and restless legs syndrome (RLS) respectively, while 38.1% were not at risk of any of the screened disorders. OSA odds increased 12.8 times (95% CI: 3.2–50.4) with diabetes and 4.9 times (1.2–20.9) with opioid use, while shift workers were 8.4 times (1.6–43.2) more likely to have insomnia. Participants and pharmacists reported the screening protocol and instrument was user friendly and feasible. Conclusion The development and pilot of this screening tool was successful. The prevalence of sleep disorders in the sampled population was high but generally consistent with previous studies on the general population. Furthermore, associations found may form a foundation for a clinical algorithm to identify those at a higher risk of having or developing a sleep disorder. Further work is required to validate this screening tool in the community pharmacy context.     

The role of the community pharmacist in fulfilling information needs of patients starting oral antidiabetics

BackgroundCommunity pharmacy is in the middle of a paradigm shift from provider of medication to provider of care around medication. Much of this care involves giving information to patients so as to maximize pharmacotherapy outcomes; however, this is not necessarily recognized by patients. The initiation of chronic medication for diseases, such as type 2 diabetes mellitus (T2DM), arouses much uncertainty in patients, and it is not certain how information provision roles by pharmacists are viewed.ObjectivesTo obtain insight in the information needs of patients who have recently started treatment with oral antidiabetics and to investigate the opportunities for pharmacy regarding the provision of information for patients with T2DM.MethodsA qualitative study with both semistructured telephone interviews and patient focus group discussions was conducted. Individual patients' comments were categorized and used in a strengths, weaknesses, opportunities, and threats (SWOT) analysis exploring the role of the community pharmacist in the field of providing information at the moment of initiation of T2DM oral medication.ResultsFrom interviews with 42 patients and 2 focus groups, discussions emerged that the general practitioner (GP) does not fulfill all information needs. For the pharmacist, there is an opportunity, as patients feel a need for information and like to discuss drug-related issues. SWOT analysis revealed main strengths of the pharmacy as “expertise” and “service and kindness.” Together with more cooperation with GPs and nurse practitioners, these strengths give the pharmacist the opportunity to further develop pharmaceutical care activities.ConclusionPharmacists are challenged to increase their visibility as health care provider while keeping logistic service on a high level and improving cooperation with other health care providers.