Pharmacists’ knowledge,perspectives, and experiences with mifepristone dispensing for medication abortion

BackgroundThe U.S. Food and Drug Administration (FDA) restricts dispensing of mifepristone for medication abortion to certified health care providers at clinical facilities, thus prohibiting pharmacist dispensing. Allowing mifepristone dispensing by pharmacists could improve access to medication abortion.ObjectiveTo assess the feasibility of pharmacists dispensing mifepristone to patients who have undergone evaluation for eligibility and counseling for medication abortion by a clinician.MethodsBefore providing a study training on medication abortion, we administered baseline surveys to pharmacists who participated in a multisite mifepristone-dispensing intervention. The survey assessed medication abortion knowledge—using a 15-item score—and perceptions about the benefits and challenges of the model. We administered follow-up surveys in the study’s final month that also assessed the pharmacists’ satisfaction and experiences with mifepristone dispensing. To investigate the association of the study intervention with the pharmacists’ knowledge, perceptions, and experiences dispensing mifepristone, we conducted multivariable linear regression analyses using generalized estimating equation models, accounting for clustering by individual.ResultsAmong the 72 pharmacists invited from 6 pharmacies, 47 (65%) completed the baseline surveys, and 56 (78%) received training. At the study’s end (mean 18 months later), 43 of the 56 pharmacists who received training (77%) completed the follow-up surveys. At follow-up, 36 (83%) respondents were very or somewhat satisfied with mifepristone dispensing, and 24 (56%) reported experiencing no challenges dispensing mifepristone. Four (6%) of the 72 pharmacists invited objected to participating in mifepristone dispensing. In regression analyses, average knowledge scores, perceived ease of implementation, and level of support for the pharmacist-dispensing model were higher at follow-up (P < 0.001).ConclusionMost pharmacists were willing to be trained, dispensed mifepristone with few challenges when given the opportunity, were satisfied with the model, and had higher knowledge levels at follow-up. Our findings support removal of FDA’s restriction on pharmacist dispensing of mifepristone.     

Expanding pharmacists’ roles: Pharmacists’ perspectives on barriers and facilitators to collaborative practice

ObjectiveThe pharmacy profession is shifting from transactional dispensing of medication to a more comprehensive, patient-centered model of care. Collaborative practice agreements (CPAs) extend the role of a pharmacist to initiate, monitor, modify, and discontinue drug therapies and provide other clinical services. Although collaborative practice has been shown to improve health system efficiency and patient outcomes, little is known about how pharmacists perceive CPAs. To explore pharmacists’ perspectives of CPAs, including barriers and facilitators to CPA implementation.MethodsSemistructured key informant interviews were used to elicit information from licensed pharmacists practicing in a variety of settings in Arizona. Thematic analysis was used to identify key qualitative themes.ResultsSeventeen interviews of pharmacists with (n = 11, 64.7%) and without (n = 6, 35.3%) CPAs were conducted in April-May 2019. The pharmacists saw their role in CPAs as supportive, filling a care gap for overburdened providers. A heightened sense of job satisfaction was reported owing to increased pharmacist autonomy, application of advanced knowledge and clinical skills, and ability to have a positive impact on patients’ health. Challenges to the implementation of CPAs included liability and billing issues, logistic concerns, some experiences with provider hesitancy, and lack of information and resources to establish and maintain a CPA. The barriers could be overcome with conscious team-building efforts to establish trust and prove the worth of pharmacists in health care teams; strategic engagement of stakeholders in the development of CPAs, including billing and legal departments; and mentorship in the CPA creation process.ConclusionsThe pharmacists in this study enjoyed practicing collaboratively and had overall positive perceptions of CPAs. As health worker shortages become more dire and pharmacy practice evolves to expand the role of pharmacists in providing direct patient care, CPAs will be an important tool for restructuring care tasks within health systems.     

MSWs with and without long‐term substance abuse training: Agency,community, and personal outcomes

Behavioral outcomes in agency, community, and personal arenas were examined for 81 social workers with Masters degrees (MSWs) who completed a clinical postgraduate substance abuse (SA) training program (trainees) and a matched group of 78 MSWs not enrolled in such a program (comparison subjects). Subject self‐report data was collected via telephone interviews of 30–40 min. With little or limited prior SA training, trainees took this clinical training to a broader level: they were significantly more likely than comparison subjects to provide agency SA training, receive SA training and supervision outside the agency, engage in SA community service, present SA papers at conferences, and intervene with their SA‐troubled significant others. With more MSW students now receiving SA training in their graduate programs, the impact of such postgraduate education is likely to be even greater.     

Pharmacists’ roles in emergency and disasters: COVID-19 as an example

BackgroundEmergencies and disasters are major threats to health care systems. Coronavirus Disease 2019 (COVID-19) is at the center of a recent emergency situation that requires increased attention from health care professionals, including pharmacists. This study was aimed at providing an overview of pharmacists’ roles in disasters and formulating a definition of expected roles and tasks through which they can perform these roles properly.MethodsA systematic review was conducted utilizing a literature search performed on the Medline, EMBASE and PubMed databases. The last search occurred on 14 July 2020. Data were extracted and recorded on a data extraction sheet by the reviewers, then categorized using the prevention, preparedness, response, and recovery (PPRR) model. Study quality was evaluated using the Critical Appraisal Skills Program (CASP) checklist.ResultsFifteen articles addressing pharmacists’ roles in disasters were included. Of these, three addressed pharmacists’ roles during the COVID-19 pandemic. Pharmacists’ roles in the prevention of emergencies, including COVID-19, are focused on chronic disease medication supply and education. Regarding pharmacists’ preparedness to perform their roles in disasters, they were more focused on health policy and population health planning, especially regarding the COVID-19 pandemic. Direct patient care continues to support patients through medication availability, and pharmacists’ clinical roles are examples of their response to disasters. In addition, pharmacists have an important role in disaster recovery that involves several activities, such as restocking emergency kits and reestablishing normal stock. Studies were generally of a reasonable quality. However, some limitations were noted among studies, and higher quality studies that contribute to existing knowledge are needed.ConclusionHealth care systems’ utilization of pharmacists’ new roles can result in a well-prepared disaster response, as observed during the COVID-19 pandemic. Pharmacists’ engagement in decision-making processes and adequate demonstration of pharmacists’ nontraditional roles in the literature can facilitate the health care community’s acceptance of such roles.     

Modafinil combined with cognitive training is associated with improved learning in healthy volunteers – A randomised controlled trial

Improving cognition in people with neuropsychiatric disorders remains a major clinical target. By themselves pharmacological and non-pharmacological approaches have shown only modest effects in improving cognition. In the present study we tested a recently-proposed methodology to combine CT with a ‘cognitive-enhancing’ drug to improve cognitive test scores and expanded on previous approaches by delivering combination drug and CT, over a long intervention of repeated sessions, and used multiple tasks to reveal the cognitive processes being enhanced. We also aimed to determine whether gains from this combination approach generalised to untrained tests. In this proof of principle randomised-controlled trial thirty-three healthy volunteers were randomised to receive either modafinil or placebo combined with daily cognitive training over two weeks. Volunteers were trained on tasks of new-language learning, working memory and verbal learning following 200 mg modafinil or placebo for ten days. Improvements in trained and untrained tasks were measured. Rate of new-language learning was significantly enhanced with modafinil, and effects were greatest over the first five sessions. Modafinil improved within-day learning rather than between-day retention. No enhancement of gains with modafinil was observed in working memory nor rate of verbal learning. Gains in all tasks were retained post drug-administration, but transfer effects to broad cognitive abilities were not seen. This study shows that combining CT with modafinil specifically elevates learning over early training sessions compared to CT with placebo and provides a proof of principle experimental paradigm for pharmacological enhancement of cognitive remediation.     

Pharmacists’ knowledge and attitudes toward medication therapy management service and the associated challenges and barriers for its implementation

BackgroundThe literature demonstrated a positive impact of medication therapy management (MTM) services provided by the pharmacists to improve the overall health outcomes. Nevertheless, limited data is available with regard to MTM service implementation by community pharmacists and its associated factors in Jordan.ObjectiveTo evaluate community pharmacists’ knowledge, attitude and practice of MTM service and to explore the challenges and barriers for its implementation.MethodsThe present cross-sectional study utilized a validated online survey which was filled by community pharmacists in different areas across Jordan. In addition to the socio-demographic variables, the study questionnaire evaluated pharmacists’ knowledge and attitudes towards MTM service, extent of MTM implementation and its associated challenges and barriers.ResultsA total of 250 pharmacists completed the survey. The study pharmacists showed moderate knowledge level (median of the total knowledge score = 6 (4–7) out of 10) and positive attitude (median of the attitude score was 23 (19–26) out of 30) towards MTM services. The participating pharmacists recognized performing or obtaining necessary assessments of patient’s health status as the most frequently provided MTM service (84.8%), while the least one was documenting the care delivered and communicating essential information to other healthcare providers (62%). Furthermore, collecting patient-related information was the most commonly recognized challenge to MTM service provision (36.8%), followed by referring the patient to a physician or consultant (36%) and collaboration with them (35.6%). The most reported barrier was negative physician attitudes (40.4%), followed by the lack of training on MTM provision (38.4%), and lack of adequate support staff (37.2%).ConclusionEfforts are needed to enhance collaboration between pharmacists and other health care professional, to develop documentation systems that would preserve and facilitate access to patient information, and to implement appropriate training programs which aim to overcome the challenges and barriers for MTM implementation.     

Bisphosphonates for Osteoporosis in Patients with Renal Insufficiency: Pharmacists’ Practices and Beliefs

Background:Clinicians often face challenges in deciding how to treat osteoporosis in patients with chronic kidney disease. As background to offering guidance to health care providers, it is important to understand their practices and beliefs.Objectives:To describe the practices and beliefs of pharmacists regarding use of bisphosphonates for patients with osteoporosis and chronic kidney disease.Methods:A cross-sectional survey of pharmacists working in hospitals and related health care settings was conducted. A 34-item online questionnaire was developed consisting of 4 sections: demographic characteristics, practices, beliefs, and comfort level with making decisions about osteoporosis treatment. An e-mail invitation was sent to members of the Canadian Society of Hospital Pharmacists (n = 2499) in November 2012.Results:A total of 367 pharmacists completed the survey. Most of the respondents were women (258 [70%]), had more than 10 years in practice (213 [58%]), and were providing care to 1 or more osteoporosis patients per week (212 [58%]). Over one-third (150 [41%]) stated that they would use a bisphosphonate for patients with creatinine clearance (CrCl) of 15–30 mL/min, but more than half (207 [56%]) stated that they would avoid a bisphosphonate (and recommend another medication) for patients with CrCl below 15 mL/min. Forty-eight percent (176/363) agreed that oral bisphosphonates could be used for patients with renal failure (defined as CrCl < 30 mL/min), so long as dosage adjustments are made. More than half (206/363 [57%]) believed that the adverse effects of oral bisphosphonates increase for patients with renal failure. Respondents expressed a low level of comfort in assessing and initiating osteoporosis treatment for patients with renal failure.Conclusions:Pharmacists had varying beliefs about managing osteoporosis in patients with chronic kidney disease. This study highlights the need for practice tools and targeted education addressing the use of bisphosphonates for these patients.     

Are substance use, abuse and dependence associated with study participation? Predictors of offspring nonparticipation in a twin-family study

OBJECTIVE: Although epidemiologic studies have reported that problem drinking is associated with nonresponse to surveys, it is unclear whether parents' alcoholism is associated with nonresponse in their offspring. This question is particularly important to family studies of alcoholism. In the current study we constructed a model of offspring nonparticipation in a twin-family design and computed weights to recapture the distribution of offspring alcohol abuse and dependence. METHOD: In 1999, the first wave of a longitudinal study of offspring of alcoholic twins was conducted via telephone interview with members of the Vietnam Era Twin Registry. The target offspring sample consisted of 2,096 male and female children, of whom 1,270 were successfully interviewed. Offspring response status was classified as participation, refusal or unavailable/no consent. Stepwise logistic regression models were used to identify variables that were significantly associated with one or both types of offspring nonparticipation. A multinomial logit procedure with backward deletion was then used to build a model of the three levels of child response. RESULTS: Paternal alcoholism was not significantly associated with offspring nonresponse, although offspring nonparticipation because of not being located, or being deceased, disabled or unavailable was associated with current paternal smoking, paternal divorce and paternal marital status (after adjustment for other predictor variables). CONCLUSIONS: The most important conclusion to be drawn from current results is that the alcohol abuse and dependence history of fathers should not bias analyses in family studies of alcoholism when data are collected via telephone interview. Study limitations and directions for future research are discussed.     

Medical students’ training needs and attitudes on substance abuse: implications for medical education in Greece

Abstract

The present study is concerned with the outcomes from a training programme on addiction counselling addressed to medical students in Greece. The programme is the result of a collaborative curriculum development between KETHEA, a drug treatment organisation for heroin addicts, and HeLMSIC, a human rights organisation of medical students in Greece. The programme was developed as a response to the absence of relevant courses within the medical schools in this country. The study presents the local context in relation to heroin use, access to treatment and training curricula. The study also presents a small-scale research conducted on medical students’ beliefs and attitudes about their understanding about drug use. Research findings suggest that actions towards developing a holistic learning framework comprising core elements about drug use treatment and recovery are important for a better response to the needs of drug users and heroin addicts in Greece.     

Cabenuva®: Differentiated service delivery and the community Pharmacists’ roles in achieving UNAIDS 2030 target in Nigeria

The approval of the novel long-acting HIV injection; Cabenuva®- Cabotegravir and Rilpivirine injectable formulation) and the recent call by the World Health Organization for promoting community-based ART management, underscore the remarkable progress towards meeting the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95–95–95 targets by 2030.As the availability of antiretroviral therapy (ART) for the treatment of HIV/AIDS has increased in resource-limited settings, there has been a move to develop and implement alternative treatment delivery models such as Differentiated Service Delivery (DSD) in high prevalence countries to meet the global targets for HIV treatment while maintaining the quality of care. However, there is limited data on the involvement of community pharmacies in the delivery of ART within the community. Although, in western countries, several studies have documented the different roles community pharmacists can play in the management of HIV/AIDS. Community pharmacists are the most accessible and first points of health care for most clients. They are trusted, highly trained health care professionals. They should be incorporated and allowed to administer the Cabenuva® injection if the battle against the HIV pandemic is to be totally won. In this paper, we, therefore, aim to explore how the community pharmacist can be positioned in HIV service delivery regarding the administration of the Novel long-acting Cabenuva® injection formulation. It is therefore recommended that the Nigerian government embrace community pharmacy-led drug administration initiatives and embark on accredited training programmes for the profession in line with drug administration services. The government should also put in place necessary funding mechanisms for community pharmacists for the extra workload placed on them in administering injection drug formulation in their respective pharmacies.     

How does the Canadian juvenile justice system respond to detained youth with substance use associated problems? Gaps, challenges, and emerging issues

Despite a juvenile justice system that, since its inception in 1908, has been predicated on meeting the rehabilitative needs of youth, Canada has few specialized programs for substance misusing young offenders, preferring more holistic approaches. This is in keeping with an addictions treatment system that has evolved recently in the direction of more integrated services within the general health care and social services delivery systems. In addition, Canada has tended to emphasize community-based over institutional treatment programs. Nevertheless, for youth in conflict with the law, "substance abuse" is recognized as a significant risk factor for recidivism. The approximately 9000 young persons held in custodial facilities on any given day across the country are exposed to a variety of programs aimed at reducing antisocial behavior and hence, re-offending. Some of these have a substance use component. Programs for Aboriginal youth offer some of the most innovative approaches for particular drug use problems. This article provides an overview of the Canadian response and elaborates features of some programs, particularly Multisystemic Therapy, mainly in the province of Ontario. Few programs have received adequate evaluation, however, and the need for systematic assessment is crucial for the development of future effective interventions for youth with multiple drug and other problems.     

Parental substance abuse and risks to children’s safety,health and psychological development

Abstract

Aims: This study looks at the connection between parents’ substance abuse and their 0–6 years old children’s somatic and psychological health. Methods: A retrospective population-based cohort study based on Finnish health care and social welfare registers. The participants were all children born in Finland in 1997 (N?=?58,667) and 2002 (N?=?55,146) and their biological parents. Children were followed up for hospitalisations because of injuries, somatic illness and psychiatric disorders. The association between hospitalisations and parents’ substance abuse as well as living with the abusing parent were estimated using logistic regression. Findings: Children’s hospitalisations for all reasons were more prevalent if the mother or the father had a substance abuse problem. Mother’s substance abuse increased the children’s risk of hospitalisations for somatic illness (OR?=?1.34) and psychiatric disorders (OR?=?1.33, father’s substance abuse increased the risk of hospitalisation because of psychiatric disorders (OR?=?1.18). The risks were even higher if both parents were substance abusers. Conclusions: Parents’ substance abuse can cause a variety of harms to children, which may be related to unsafe environment, long-standing stress, and non-adequate responding to the child’s needs. Multi-professional work with substance abusing parents and their children is crucial in order to reduce children’s risks for poor health.     

Pharmacists’ role,work practices,and safety measures against COVID-19: A comparative study

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic poses a great challenge to health systems and their most accessible assets—community pharmacies. Pharmacists faced many challenges such as incorporating safety measures, changes in working schedule and workload, and meeting specific patients’ needs.ObjectivesThis study aimed to explore and compare the community pharmacists’ roles, practices, implemented safety measures, and psychological toll in Croatia and Serbia during the COVID-19 pandemic.MethodsA cross-sectional study employing an online survey was conducted in 2 countries over a period of 6 weeks during 2020. The survey consisted of 65 items that explored sociodemographic characteristics of participants and their workplaces, including safety measures, pharmaceutical care, and their psychology while working during the COVID-19 pandemic.ResultsIn total, 574 pharmacists participated in the study, of which, 90% were female, with a mean age of 38 years (interquartile range 30.5–47). The study identified new pharmacists’ roles that evolved during the COVID-19 pandemic: manufacturing hand sanitizers in community pharmacies, online patient counseling, and home delivery of medicines. Croatian and Serbian pharmacists exhibited disparities in their incorporated safety measures (higher for Croatia; P ≤ 0.001) and satisfaction with work organization and counseling activities (higher for Serbia; P < 0.001). Serbian participants were less satisfied with the public perception of their role during the pandemic, and overall satisfaction was low, with a negative impact on mood and productivity.ConclusionsThe study revealed the implications for community pharmacists during the pandemic in both countries. The extent of systematic and logistical support provided to them during the pandemic could be an explanation for the highlighted differences. It is imperative to develop a more effective strategy to counter potential health crises to ensure a better response from primary care pharmacists in the future.