Community pharmacists in Virginia dispensing naloxone under a standing order: A qualitative study

BackgroundIn 2016, the Virginia Health Commissioner signed a standing order into law allowing licensed pharmacists to dispense opioid receptor antagonists (ORAs) for overdose reversal.ObjectivesUsing the theory of planned behavior as an initial guide to study development, the aim of this qualitative study was to explore community pharmacists’ attitudes, subjective norm, perceived behavioral control, and behavioral intention toward dispensing ORAs under a standing order in Virginia.MethodsSemi-structured interviews were conducted with community pharmacists across the Commonwealth between June 2018 and October 2019. Interviews were recorded, transcribed verbatim, and thematically analyzed.ResultsTwenty-one community pharmacists were interviewed. Pharmacists were confused about the specifics and the processes involved with dispensing naloxone under the standing order. Furthermore, many recognized the underuse of the standing order. Positive attitudes focused on the life-saving action of ORAs. Negative attitudes included encouraging risky behaviors by patients, negatively affecting the patient-pharmacist relationship, offending or contributing to stigmatizing patrons, and having liability issues to the pharmacy. Subjective norms regarding dispensing of ORAs under the standing order were perceived to be favorable among peer pharmacists and primary care and emergency department physicians but may be seen as profit-seeking by patients. Barriers to service provision included lack of guidance from corporate offices (in chain pharmacies), inadequate training, patient out-of-pocket costs, reimbursement issues, inadequate staffing and time, and stigma. Facilitators comprised the existence of practice site-specific protocols, the REVIVE! training, technician support, increased community awareness, physician collaboration, pharmacist training, and employer guidance. Whereas some pharmacists intended to become more familiarized with the standing order, others did not intend to actively identify patients who were at risk of an opioid overdose.ConclusionPharmacists expressed mixed behavioral intention toward dispensing ORAs under the standing order. Future research should focus on quantifying the uptake of the standing order at the state level.     

Economic analysis of strategic behavior in dispensing pharmacies in the separation of dispensing and prescribing functions

In recent years, the system for the separation of dispensing and prescribing functions (SDP) has progressed in Japan. However, because of the failure of the healthcare system, it is difficult to estimate how the system of SDP contributes to the improvement of patient utility and welfare. In this paper, I try to evaluate the SDP by analyzing the strategic behavior of dispensing pharmacies, employing some economic models under imperfect information. In these models, quality is characterized as a strategic variable in monopolistic or duopolistic competition. As a result, I show that competition among dispensing pharmacies in the SDP raises the quality of pharmaceutical services, but there is some possibility of "excess entry" with free entry.     

Attitudes and availability: A comparison of naloxone dispensing across chain and independent pharmacies in rural and urban areas in Alabama

BackgroundFatal opioid overdoses remain the leading cause of accidental deaths in the United States, which have contributed to implementation of standing order laws that allow pharmacists to dispense naloxone to patients. Although pharmacy distribution of naloxone is a promising approach to increase access to this intervention, understanding barriers preventing greater uptake of this service is needed.MethodsData for the current study were collected via telephone survey assessing the availability of various formulations of naloxone at chain and independent pharmacies in rural and urban areas in Birmingham, Alabama (N = 222). Pharmacists’ attitudes toward naloxone and potential barriers of pharmacy naloxone distribution were also assessed. One-way analysis of variance (ANOVA) and logistic regression analyses were utilized to examine differences in stocking of naloxone in chain and independent pharmacies and to determine predictors of the number of kits dispensed by pharmacies.ResultsIndependent pharmacies were less likely to have naloxone in stock, especially those in rural areas. Furthermore, rural pharmacies required more time to obtain all four formulations of naloxone, and offered less extensive training on naloxone use. Pharmacists endorsing the belief that naloxone allows avoidance of emergent treatment in an overdose situation was associated with fewer dispensed kits by the pharmacies. Over 80% of pharmacists endorsed at least one negative belief about naloxone (e.g., allowing riskier opioid use). Pharmacists noted cost to patients and the pharmacy as contributing to not dispensing more naloxone kits.ConclusionThe current study demonstrates the lower availability of naloxone stocked at pharmacies in independent versus chain pharmacies, particularly in rural communities. This study also highlights several barriers preventing greater naloxone dispensing including pharmacists’ attitudes and costs of naloxone. The potential benefit of standing order laws is not being fully actualized due to the structural and attitudinal barriers identified in this study. Strategies to increase naloxone access through pharmacy dispensing are discussed.     

Data collection methods for analyzing the quality of the dispensing in pharmacies

Objective: To review and discuss the advantages and limitations of the different data collection methods for analyzing the dispensing quality in community pharmacies. Methods: A bibliographic search was carried out in MEDLINE (19802000). Articles with Medical Subject Heading (Mesh) pharmacieswritten in English and Spanish that evaluated the quality of dispensing (structure, process or outcome) were selected.Results: Various data collection methods were observed. To analyze the quality of the structure, questionnaires and pharmacist interviews were used. To analyze the quality of the process, selfcompleted records, external observers and simulated clients were used. For analyzing the quality of the outcome, questionnaires, client interviews, and biologic samples were collected. Conclusions: The analysis of quality of structure can be useful as a first approach, however, this method may lack sensitivity. On the other hand, the analysis of outcome may be excessively complex and difficult to use, except for experimental or observational studies with large resources. Therefore, an analysis of the quality of the process is the best option. Methods utilizing external observers and simulated clients may best conjugate both internal and external validity.     

Medication errors: a baseline survey of dispensing errors reported in community pharmacies

The results of a baseline survey of medication errors made by community pharmacists are presented The mean error rate in this study was 0.26 % however, there was considerable variation in error rate between pharmacies Almost half of the pharmacists indicated that they had under‐reported errors that had occurred in their pharmacy Of the errors reported, the majority were classified as a nearmiss, and relatively few reached the patient     

医院配方室配方差错的统计分析和应对策略

目的；通过对配方差错的分析，以便采取相应管理措施，减少配方差错。方法：将3个配方室的10年配方差错汇总，按部门，年龄和差错类型分别分析。结果：在103次差错中，急诊、住院和门诊配方室的差错率和差错百分率分别为0.00067%,0.0016%,0.0013%及5.8%，41.8%,52.4%。20岁以下、21-30岁、31-40岁、41-50岁和51-60岁年龄段的人均差错数和差错百分率分别为4.0，2.1,2.4,2.7,4.0和19.4%，30.1%，23.3%,15.5%,11.7%。取药品种、数量、理解、复核、剂量剂型和错发病人的差错百分率分别为36.9%，7.8%,12.6%,27.2%,8.7%和6.8%。结论：针对差错，采取有力管理措施，可有效地减少配方差错。     

门诊药房药品调配差错及防范措施的系统性分析

目的 了解国内医院门诊药房调配差错及有效防控措施现状,以期进一步提高药品调配工作质量.方法 检索中文期刊数据库2015—2020年二、三级医院门诊药房调配差错及其采取措施后的质量持续改进的文献,汇总分析改进前后不同差错类型及其数量,原因分析及其改进措施等内容.结果 检索得到的146篇文献中纳入分析的有13篇(三级医院1...