An observational survey assessing the extent of PrEP and PEP furnishing in San Francisco Bay Area pharmacies

BackgroundHuman immunodeficiency virus (HIV) remains prevalent in the United States despite medications that reduce the risk of infection, primarily pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP). In 2019, California authorized pharmacists to furnish PrEP and PEP under Senate Bill 159 (SB-159).ObjectiveAssess implementation of SB159 in San Francisco Bay Area community and mail-order pharmacies.MethodsWe conducted an observational, cross-sectional survey of independent community and mail-order pharmacies in the 9-county San Francisco Bay Area to identify those that were in the process of furnishing, actively furnished, or furnished under a collaborative practice agreement (CPA). We conducted interviews with furnishing pharmacies in April 2021, focusing on the barriers to and successes of implementation, as well as the impact of coronavirus disease 2019 (COVID-19), and qualitatively analyzed them.ResultsOf the 209 pharmacies contacted, 6 furnished under SB-159 (2.9%), 2 were in the process of furnishing under SB-159, and 1 furnished under a CPA. Six pharmacies and 7 pharmacists were interviewed. Barriers to implementation and furnishing included COVID-19, laboratory tests, lack of time and staff, cost to pharmacy, refill limitation, lack of patient awareness, difficulty arranging follow-up care, and vague wording of the policy. Facilitators to implementation included collaborations with clinics and health centers, privacy, increased accessibility, increased need in the patient population, and the pharmacy culture.ConclusionBarriers and facilitators to PrEP and PEP furnishing were consistent across pharmacies, suggesting strategies that could be replicated and potential improvements to SB-159.     

Implementation of a method for glucose measurements in community pharmacies

Objectives We aimed to implement a method for glucose measurements that could be used as a comparison method for asessing patients' self‐monitoring of blood glucose. Further, we investigated whether pharmacies could achieve an analytical quality comparable to glucose measurements performed in general practice. Methods Sixteen Norwegian pharmacy employees were trained in glucose measurement, quality control and blood sampling. The comparison method, HemoCue Glucose 201⁺, was validated in four steps: (1) estimation of the variation between the HemoCue instruments to be used at the 16 pharmacies, (2) comparison between HemoCue results and a laboratory glucose method, (3) monitoring quality by internal quality controls and (4) an external quality‐assessment scheme. The pharmacies' results of the external quality assessment were compared to those of 359 general practices. Key findings The coefficient of variation for HemoCue instruments was 6.1% at the low level and 1.7% at the normal and high levels. Bias was negligible at the normal level. The coefficients of variation for internal quality controls were 4.5, 1.5 and 1.2% for the low, normal and high levels, respectively. All pharmacies achieved good precision and acceptable or good trueness in the external quality assessment. The pharmacies exhibited significantly lower variation between sites (2.2 and 1.2%) than general practices (3.8 and 2.9%) on both external quality‐assessment samples. Conclusions Given correct training and the establishment of a system of quality assurance, pharmacies are capable of obtaining glucose measurements that can be used as comparison measurements for controlling patients' meters. The pharmacies had external quality‐assessment results comparable to general practice.     

Access to emergency hormonal contraception from community pharmacies and family planning clinics

AIMS: To evaluate differences in the time taken to access progestogen-only emergency hormonal contraception (EHC) by young women from family planning (FP) or community pharmacy settings. METHODS: An observational study of 203 women requesting EHC from FP clinics and community pharmacies in South-west Kent Primary Care Trust (PCT) from December 2002 to October 2003. RESULTS: Access to EHC from community pharmacy was significantly faster than from FP clinics (16 h vs. 41 h, P<0.001). Older teenagers tended to seek EHC more quickly and were more likely to have had a contraceptive failure rather than have used no contraception at all. CONCLUSION: The results provide further support for pharmacist involvement in the supply of EHC.     

Implementation study of an intermediate medication review in Belgian community pharmacies

BackgroundThe Association of Pharmacists in Belgium (APB) and local pharmacy associations launched a pilot project in collaboration with research teams from three Belgian universities to study the impact and implementation-related issues of a medication review (MR) service type 2a in Belgian community pharmacies.ObjectiveThe aim of this paper is to describe the implementation process of the MR service and to present the implementation evaluation of the pilot study (testing stage).MethodsThe pilot project was a prospective observational study using mixed methods. The implementation evaluation was based on the RE-AIM model and the framework for the implementation of services in pharmacy (FISpH). Collected implementation outcomes were classified into four dimensions: reach, adoption, implementation and intent of maintenance.ResultsDuring the testing stage, 80 pharmacies participated in the study, but 25 dropped out (31%), mainly because of a reported lack of time (adoption). The 55 remaining pharmacies included 457 patients. Recruiting patients into the service was challenging for pharmacists as 48.5% of patients refused the pharmacists' proposal (reach). Internal organizational factors were major barriers for pharmacists, followed by the lack of adoption by the pharmacy team. Large pharmacies in which pharmacy owner led the project were observed to be more proactive in implementing the MR service by integrating organizational strategies to assist the implementation process (implementation). Interviewed pharmacists perceived this new service as a professionally satisfying activity. Among participating pharmacists, 92.5% found this service feasible in practice, but believed it required adapted resources to reorganize the internal pharmacy workload, additional support, such as broad-based media campaigns to increase physicians' and patients’ awareness and attitudes towards the service, and modified software (maintenance).ConclusionsThe medication review service was implemented in 68% of participating pilot Belgian community pharmacies but would require adapted resources and supports for larger scale implementation.     

Implementation of cognitive pharmaceutical services in Danish community pharmacies — perceptions of strategists and practitioners

Objective To understand how projects for the implementation of cognitive pharmaceutical services (CPS) are perceived as facilitators of change from the perspectives of practitioners and strategists. Setting Sixteen community pharmacies in Denmark and three organisations working on implementing CPS in pharmacy practice. Method Twenty semi‐structured interviews were conducted with practitioners (pharmacy staff and owners) in ‘professionally active’ pharmacies, and eight interviews were conducted with ‘professional strategists’ in the field of pharmacy practice. Informants were asked about their goals for participation in and development of projects regarding implementation of CPS, and about change strategies used for implementation. An interview guide based on organisational theory was used, and an organisational theory framework formed the basis of the analysis. Key findings Eleven goals for the development of projects relating to CPS implementation from the strategist's perspective were identified. From the practitioners' perspective, nine goals for participation in such projects were identified. The two groups share four categories of goals regarding: competence development; implementation of CPS; marketing of the pharmacy; and improvement of patients' drug use and outcomes. Other goals from the two perspectives predominantly differ from each other. Two metaphors were developed as images of the two different ways of perceiving CPS projects. The strategists develop projects as ‘standard menus’, and the practitioners select projects in which to participate as if they were one of many dishes on a ‘buffet’. Strategies for change were also identified. The humanistic change strategy predominated from both groups of informants' perspective. Conclusion While they have some goals in common, there is a clear difference in the perspectives of strategists and practitioners in the development of and participation in CPS‐related projects. The metaphors ‘standard menu’ and ‘buffet’ are two ways of understanding implementation. If these metaphors are accepted as a premise in the field of pharmacy practice, future work with implementation of CPS should take these differences into account.     

The sale of emergency hormonal contraception in community pharmacies in the UK: the views of users

Sales of emergency hormonal contraception (EHC) in community pharmacies began in 2001 This study set out to explore the views of a small group of women purchasing EHC in community pharmacies, using qualitative techniques Users were broadly positive about pharmacy sales of EHC, citing access, convenience and confidentiality as key benefits Four out of 12 respondents made a decision to engage in unprotected intercourse because they were aware that EHC was available from the pharmacy More research is required to explore the impact of pharmacy sales of EHC on unprotected intercourse and sexually transmitted infections     

Characterizing specialized compounding in community pharmacies

BackgroundCompounding is a traditional role of pharmacists that declined with the availability of manufactured medicines. Compounding is now increasingly offered by community pharmacies as a specialized service, and there are calls for regulatory and practice standard changes. However, the characteristics of specialized compounding are not well understood.ObjectivesThe objective of this study was to conduct an in-depth exploration of the motivations, experiences, and practices of pharmacists who deliver “specialized compounding services” in Australian pharmacies.MethodsIn-depth interviews of 18 pharmacists responsible for compounding in pharmacies offering specialized compounding were conducted using a semistructured interview guide based on an organizational framework. Participants were selected using purposive sampling. Characteristics of specialized compounding practice compared with routine compounding and routine dispensing were explored. Interviews were audiotaped and transcribed verbatim, then analyzed using the method of “constant comparison” to identify emergent themes.ResultsPharmacists providing specialized compounding reported that compared with their prior routine practice, they used a greater variety of ingredients and dosage forms for more clinical conditions, used different equipment and processes, and had upgraded facilities for handling compounded products. Patient and physician interactions were more involved and in the case of physicians, more collaborative compared with routine dispensing. Participants reported feeling more empowered in their roles, with improved professional satisfaction.ConclusionsPharmacists in specialized compounding pharmacies report greater collaboration and interaction with prescribers and patients compared with their routine compounding and dispensing. This contributed to perceptions of empowerment and increased professional satisfaction. Specialized compounding may also be an avenue for reprofessionalization. The organization of compounding as a specialized service should be considered in proposed changes to compounding regulations and practice standards.