Empowering Public Health Pharmacy Practice-Moving from Collaborative Practice Agreements to Provider Status in the U.S.
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ABSTRACT:
SUBMITTER: Cernasev A
PROVIDER: S-EPMC8005938 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundEarly and accessible testing for influenza with point-of-care testing (POCT) can be a critical factor for deciding to begin antiviral treatment. More than 10,000 pharmacies across the USA offer Clinical Laboratory Improvement Amendments-waived POCT for infectious diseases, such as influenza A/B. Knowledge of barriers and facilitators to large-scale POCT implementation may be useful in scaling POCT for influenza test-and-treat services (Flu POCT). The objective of this study was to explore the experiences of pharmacists who were early adopters of Flu POCT and treatment under collaborative practice agreement in community pharmacy settings.MethodsQualitative research design with in-depth, semi-structured virtual video interviews of licensed US community pharmacists. Interview questions were derived from the Consolidated Framework for Implementation Research (CFIR). Interviewees were selected via a purposeful sampling of pharmacists who were enrolled in a nationwide clinical trial involving pharmacy-based influenza test-and-treat under a collaborative agreement. Interviews were recorded and transcribed. A deductive analytic approach was used via constructs from the CFIR.ResultsSix pharmacists were interviewed. Interviews ranged from 28 to 70 min, with an average length of 46 min. Four broad themes emerged from the data, and each had corresponding subthemes and supporting quotes: influence of the Flu POCT service characteristics on pharmacy implementation, influence of factors outside of the pharmacy setting in Flu POCT implementation, factors within the pharmacy setting influencing implementation, and process of implementing Flu POCT. A novel pharmacy-based Flu POCT implementation framework is presented.ConclusionsImplementation of community pharmacy-based Flu POCT services is feasible; but, a thorough understanding of both barriers and facilitators to their implementation is needed to increase the spread and scale of these programs. Specifically, pharmacy stakeholders should focus efforts on increasing patient and provider awareness, pharmacist acceptance, leadership support, and support of health providers external to the pharmacy to improve implementation success.
| S-EPMC9287716 | biostudies-literature
Project description:The imperative to increase seafood supply while dealing with its overfished local stocks has pushed the European Union (EU) and its Member States to fish in the Exclusive Economic Zones of other countries through various types of fishing agreements for decades. Although European public fishing agreements are commented on regularly and considered to be transparent, this is the first global and historical study on the fee regime that governs them. We find that the EU has subsidized these agreements at an average of 75% of their cost (financial contribution agreed upon in the agreements), while private European business interests paid the equivalent of 1.5% of the value of the fish that was eventually landed. This raises questions of fisheries benefit-sharing and resource-use equity that the EU has the potential to address during the nearly completed reform of its Common Fisheries Policy.
| S-EPMC3842348 | biostudies-literature
Project description:BackgroundPhysical assessment in pharmacy practice is not a new concept, yet the idea is still unfamiliar to many people. Canadian pharmacy graduates are expected to be trained in physical examination as it relates to drug therapy. However, standard delivery of course content in this area has not been clearly established, and previous publications have reported low uptake of this practice despite formal training. To aid the future development of a physical assessment course for pharmacists that is relevant to practice and will contribute to patient care, it is important to gather insight from practising pharmacists, health care providers and the public.ObjectiveTo determine the type of physical assessment skills that would be of value to pharmacy practice and the benefits and barriers of these skills in practice from the perspectives of pharmacists, health care providers and the public.MethodsThis was a cross-sectional online survey of pharmacists, nonpharmacist health care providers and the public. Descriptive statistics and thematic analysis were used to describe data.ResultsA total of 348 respondents (98 pharmacists, 154 nonpharmacist health care providers, 96 public) completed the survey. Most (64%) nonpharmacist providers were physiotherapists or occupational therapists (only 6.5% physicians). Most respondents felt that performing basic vital signs was relevant to pharmacy practice (79% pharmacists, 69% other providers, 79% public) and felt confident and comfortable about pharmacists using these skills. Palpation, percussion and auscultation were rated less favourably (<50% for most respondents). Nonpharmacist providers tended to be less favourable than pharmacist and public respondents. Seven themes related to benefits and 13 themes related to disadvantages of pharmacists performing physical assessment were identified.ConclusionThese findings provide insight into opinions about the value of pharmacists performing physical assessments. Consensus recommendations on performance expectations to improve recognition of pharmacists in this area is needed in the future. Can Pharm J (Ott) 2021;154:xx-xx.
| S-EPMC8165886 | biostudies-literature
Project description:OBJECTIVES: To (1) investigate the relationships between students' characteristics and their (a) perceptions of research in general and (b) attitudes towards pharmacy practice research; (2) identify strategies that could be used by pharmacy educators to promote research interest in pharmacy practice; and (3) identify perceived barriers to the pursuit or completion of a pharmacy practice research degree. METHODS: A survey was administered to all students enrolled in each year of the four-year pharmacy undergraduate program, University of Sydney, Australia. Perceptions of research in general were measured using 4 items on a five-point semantic-differential scale and attitudes towards pharmacy practice research were measured using 16 items on a five-point Likert scale. Student characteristics were also collected as were responses to open-ended questions which were analysed using content analysis. RESULTS: In total 853 students participated and completed the survey (83% response rate). Participants' characteristics were associated with some but not all aspects of research and pharmacy practice research. It appeared that positive attitudes and perspectives were influenced strongly by exposure to the 'research' process through projects, friends or mentors, previous degrees or having future intentions to pursue a research degree. Results from both the quantitative and qualitative analyses suggest positive attitudes and perceptions of research can be nurtured through the formal inclusion in research processes, particularly the utility of practice research in clinical practice across the four years of study. Participants indicated there was a lack of awareness of the needs, benefits and career opportunities associated with pharmacy practice research and voiced clear impediments in their career path with respect to the choice of practice research-related careers. CONCLUSIONS: Future research should investigate changes in perceptions and attitudes in a single cohort over the four-year degree, other factors influencing students' perceptions and attitudes, and evaluate the effectiveness of research promoting strategies and programs.
| S-EPMC4582744 | biostudies-literature
Project description:ObjectiveThe widespread deployment of electronic health records (EHRs) has introduced new sources of error and inefficiencies to the process of ordering medications in the hospital setting. Existing work identifies orders that require pharmacy intervention by comparing them to a patient's medical records. In this work, we develop a machine learning model for identifying medication orders requiring intervention using only provider behavior and other contextual features that may reflect these new sources of inefficiencies.Materials and methodsData on providers' actions in the EHR system and pharmacy orders were collected over a 2-week period in a major metropolitan hospital system. A classification model was then built to identify orders requiring pharmacist intervention. We tune the model to the context in which it would be deployed and evaluate global and local feature importance.ResultsThe resultant model had an area under the receiver-operator characteristic curve of 0.91 and an area under the precision-recall curve of 0.44.ConclusionsProviders' actions can serve as useful predictors in identifying medication orders that require pharmacy intervention. Careful model tuning for the clinical context in which the model is deployed can help to create an effective tool for improving health outcomes without using sensitive patient data.
| S-EPMC8490931 | biostudies-literature
Project description:U.S. Vietnamese have high cervical cancer incidence and low human papillomavirus (HPV) vaccine initiation. Using the P3 model, we explored practice-, provider-, and patient-level determinants of U.S. Vietnamese parents' HPV vaccine decision-making for their adolescents. We conducted a cross-sectional, online survey (04/2020-12/2020) with U.S. Vietnamese parents who had ≥ 1 adolescent ages 9-18. We assessed HPV vaccination outcomes (initiation, willingness to initiate, completion) and provider recommendation. Modified Poisson regressions were used to identify practice-, provider- and patient-level correlates of outcomes. The sample (n = 408) was 44 years old on average; 83% were female and 85% had a Bachelor's degree. Around half of adolescents were female (51%) and 13-18 year old (54%). Only 41 and 23% of parents had initiated and completed the HPV vaccine series for their child, respectively. Initiation was associated with receiving provider recommendation (either low- or high-quality), while willingness to initiate was associated with receiving high-quality recommendation. Both initiation and willingness to initiate was negatively associated with parental perception that their child was too young for a "sexually transmitted infection (STI)-preventing vaccine." Provider recommendation was associated with higher parental U.S. acculturation and the child being older and female. Provider-facing interventions should promote high-quality, age-based, gender-neutral HPV vaccine recommendation. These and population- and individual-facing interventions should recognize the need for additional parental education, particularly related to misconceptions regarding STI prevention.
| S-EPMC8600911 | biostudies-literature
Project description:Understanding models of pharmacy education and practice in low-to-middle income countries (LMIC) can drive best practices and resource utilization. However, there is a paucity of literature in this setting. The purpose of this report is to describe the length and breadth of pharmacy education and training in Tanzania as well as pharmacy practice models at 3 institutions. Lessons learned and implications for global pharmacy practice described herein aim to advance the profession and pharmacists' impact in LMIC settings. The Muhimbili campus is located in Dar es Salaam, the largest city in Tanzania, a LMIC in East Africa, and is comprised of 3 institutes and a health professions school. Despite variance in patient populations, all Muhimbili institutions have developed pharmacy services in outpatient and inpatient pharmacies, central pharmacy stores, intensive care units, and operating theaters. Unique pharmacy practice areas result from a variance in patient populations serviced and include services in pharmacovigilence/drug information, compounding, oncology, nephrology, and emergency departments. Medication availability and the complexity and time commitment of patient billing are consistent challenges, and multidisciplinary collaboration a common strength across the 3 institutions. Pharmacists at Muhimbili perform innovative and critical functions to support optimal patient care tailored to specific patient populations. The detailed review of these services can serve as a model for pharmacy practice at other health systems in LMIC and beyond.
| S-EPMC7995494 | biostudies-literature
Project description:Pharmacogenomics (i.e., the application of genetic information in predicting an individual's response to drug therapy) plays an increasingly important role in drug development and decision-making regarding precision medicine. This has been shown to reduce the risk of adverse events and improve patient health-care outcomes through targeted therapies and dosing. As the field of pharmacogenomics rapidly evolves, the role of pharmacists in the education, implementation, and research applications of pharmacogenomics is becoming increasingly recognized. This paper aims to provide an overview and current perspectives of pharmacogenomics in contemporary clinical pharmacy practice and to discuss the future directions on advancing pharmacogenomics education, application, and research in pharmacy practice.
| S-EPMC6850702 | biostudies-literature
Project description:BACKGROUND:Next-generation sequencing (NGS) is increasingly being translated into routine public health practice, affecting the surveillance and control of many pathogens. The purpose of this scoping review is to identify and characterize the recent literature concerning the application of bacterial pathogen genomics for public health practice and to assess the added value, challenges, and needs related to its implementation from an epidemiologist's perspective. METHODS:In this scoping review, a systematic PubMed search with forward and backward snowballing was performed to identify manuscripts in English published between January 2015 and September 2018. Included studies had to describe the application of NGS on bacterial isolates within a public health setting. The studied pathogen, year of publication, country, number of isolates, sampling fraction, setting, public health application, study aim, level of implementation, time orientation of the NGS analyses, and key findings were extracted from each study. Due to a large heterogeneity of settings, applications, pathogens, and study measurements, a descriptive narrative synthesis of the eligible studies was performed. RESULTS:Out of the 275 included articles, 164 were outbreak investigations, 70 focused on strategy-oriented surveillance, and 41 on control-oriented surveillance. Main applications included the use of whole-genome sequencing (WGS) data for (1) source tracing, (2) early outbreak detection, (3) unraveling transmission dynamics, (4) monitoring drug resistance, (5) detecting cross-border transmission events, (6) identifying the emergence of strains with enhanced virulence or zoonotic potential, and (7) assessing the impact of prevention and control programs. The superior resolution over conventional typing methods to infer transmission routes was reported as an added value, as well as the ability to simultaneously characterize the resistome and virulome of the studied pathogen. However, the full potential of pathogen genomics can only be reached through its integration with high-quality contextual data. CONCLUSIONS:For several pathogens, it is time for a shift from proof-of-concept studies to routine use of WGS during outbreak investigations and surveillance activities. However, some implementation challenges from the epidemiologist's perspective remain, such as data integration, quality of contextual data, sampling strategies, and meaningful interpretations. Interdisciplinary, inter-sectoral, and international collaborations are key for an appropriate genomics-informed surveillance.
| S-EPMC6692930 | biostudies-literature
Project description:In an effort to explore new knowledge and to develop meaningful collaborations for improving child health, the First Pan African Workshop on Newborn Screening was convened in June 2019 in Rabat, Morocco. Participants included an informal network of newborn screening stakeholders from across Africa and global experts in newborn screening and sickle cell disease. Over 150 attendees, representing 20 countries, were present including 11 African countries. The agenda focused on newborn screening rationale, techniques, system development, implementation barriers, ongoing research, and collaborations both globally and across Africa. We provide an overview of the workshop and a description of the newborn screening activities in the 11 African countries represented at the workshop, with a focus on sickle cell disease.
| S-EPMC7295888 | biostudies-literature