Browsing by Subject "Pharmacy"
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Item Adolescent and Young Adults’ Ability to Self-Screen for Contraindications to Contraception and the Role of Chronic Illness(Elsevier, 2021) Wilkinson, Tracey A.; Meredith, Ashley H.; Rafie, Sally; Katz, Amy J.; Vielott, Thomas L.; Meagher, Carolyn G.; Ott, Mary A.; Pediatrics, School of MedicinePurpose: Multiple states allow pharmacists to prescribe hormonal contraception but can have age restrictions. The study objective was to examine how age influences adolescents' and young adults' (AYAs) ability to self-report potential contraindications to hormonal contraception compared with physician reports (our "gold standard"). Methods: Between February 2017 and August 2018, girls aged 14-21 years and their physicians were recruited in outpatient adolescent primary and subspecialty care clinics. Screeners were completed separately for medical conditions that are potential contraindications to hormonal contraception as defined by the Centers for Disease Control Medical Eligibility Criteria. Overall, discordance was defined as differences between the patient's and provider's answers, and potential unsafe discordance was defined as AYAs underreporting of contraindications. Multivariable logistic regression was used to examine predictors of overall and unsafe discordance. Results: Of 394 AYA/physician pairs, 45% were from subspecialty clinics, 35% identified as African American, the mean age was 16.7 ± 1.9 years, and 38% were sexually active. Fifty percent of patients reported potential contraindications to hormonal contraception. There was only an 18% rate of unsafe discordance, with no statistical difference by age but a higher rate in subspecialty clinics (28% vs. 10%). No variables were predictive of higher rates of unsafe discordance in general or subspecialty clinics. Conclusions: Potential overall and unsafe discordance between AYAs' and physicians' reports of medical contraindications to combined hormonal contraception were not related to younger age and thus support expansion of pharmacy access to adolescents. Pediatric subspecialists need to proactively address hormonal contraceptive needs and safety as pharmacy access expands.Item Assessment of Adolescent Decision-Making Capacity for Pharmacy Access to Hormonal Contraception(Elsevier, 2023) Wilkinson, Tracey A.; Meredith, Ashley H.; Katz, Amy J.; Meagher, Carolyn G.; Ott, Mary A.; Pediatrics, School of MedicineObjectives: To examine adolescents' decision-making capacity for pharmacsist-prescribed hormonal contraception. Study design: A subset of 60 females, ages 14-21, were recruited to complete the MacArthur Competence Assessment Tool-Treatment. Overall scores were compared by age and demographic factors and variation examined. Results: Participants scored high on the MacArthur Competence Assessment Tool-Treatment with little variation in the scores (18.8 [±1.9]/20 total points). Factors such as chronic illness, health literacy, and family affluence were not associated with of overall scores. Conclusions: Adolescents and young adults have the capacity to make decisions regarding contraception in the pharmacy access settings.Item A Crisis of Conscience: Pharmacists Decide Not to Dispense Contraception(University of Houston, 2005-12-06) Alexander, Archie AItem Effectiveness and implementability of state-level naloxone access policies: Expert consensus from an online modified-Delphi process(Elsevier, 2021) Smart, Rosanna; Grant, Sean; Social and Behavioral Sciences, School of Public HealthBackground: Naloxone distribution, a key global strategy to prevent fatal opioid overdose, has been a recent target of legislation in the U.S., but there is insufficient empirical evidence from causal inference methods to identify which components of these policies successfully reduce opioid-related harms. This study aimed to examine expert consensus on the effectiveness and implementability of various state-level naloxone policies. Methods: We used the online ExpertLens platform to conduct a three-round modified-Delphi process with a purposive sample of 46 key stakeholders (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with naloxone policy expertise. The Effectiveness Panel (n = 24) rated average effects of 15 types of policies on naloxone pharmacy distribution, opioid use disorder (OUD) prevalence, nonfatal opioid-related overdoses, and opioid-related overdose mortality. The Implementation Panel (n = 22) rated the same policies on acceptability, feasibility, affordability, and equitability. We compared ratings across policies using medians and inter-percentile ranges, with consensus measured using the RAND/UCLA Appropriateness Method Inter-Percentile Range Adjusted for Symmetry technique. Results: Experts reached consensus on all items. Except for liability protections and required provision of education or training, experts perceived all policies to generate moderate-to-large increases in naloxone pharmacy distribution. However, only three policies were expected to yield substantive decreases on fatal overdose: statewide standing/protocol order, over-the-counter supply, and statewide "free naloxone." Of these, experts rated only statewide standing/protocol orders as highly affordable and equitable, and unlikely to generate meaningful population-level effects on OUD or nonfatal opioid-related overdose. Across all policies, experts rated naloxone prescribing mandates relatively lower in acceptability, feasibility, affordability, and equitability. Conclusion: Experts believe statewide standing/protocol orders are an effective, implementable, and equitable policy for addressing opioid-related overdose mortality. While experts believe many other broad policies are effective in reducing opioid-related harms, they also believe these policies face implementation challenges related to cost and reaching vulnerable populations.Item Emergency Contraception Counseling in California Community Pharmacies: A Mystery Caller Study(MDPI, 2019-04-23) Ditmars, Lindsay; Rafie, Sally; Kashou, Gellan; Cleland, Kelly; Bayer, Lisa; Wilkinson, Tracey A.; Pediatrics, School of MedicineThis study was conducted to determine which emergency contraception (EC) methods are offered by community pharmacists in response to patient calls. Female mystery callers called all community pharmacies in two California cities using standardized scripts. The callers inquired about options available to prevent pregnancy after sex and whether that method was available at the pharmacy, using follow-up probes if necessary. A total of 239 calls were completed in San Diego (n = 127, 53%) and San Francisco (n = 112, 47%). Pharmacists indicated availability at most sites (n = 220, 92%) with option(s) reported as levonorgestrel only (LNG; n = 211, 88.3%), both ulipristal acetate (UPA) and LNG (n = 4, 1.6%), UPA only (n = 1, 0.4%), or non-specific EC (n = 4, 1.7%). Nineteen pharmacies (7.9%) did not have EC available on the day of the call. Following additional probing, some pharmacists discussed UPA (n = 49, 20.5%) or the copper intrauterine device (n = 1, 0.4%) as EC options. LNG EC products were available same-day in 90.1% of pharmacies, whereas UPA was available same-day in 9.6% of pharmacies. The majority of pharmacies called in this study offered and stocked at least one EC option, but the focus of discussions was on LNG and matched what was in stock and available.Item Expert views on state-level naloxone access laws: a qualitative analysis of an online modified-Delphi process(BMC, 2022-06-08) Grant, Sean; Smart, Rosanna; Social and Behavioral Sciences, School of Public HealthBackground: Expanding availability to naloxone is a core harm reduction strategy in efforts to address the opioid epidemic. In the US, state-level legislation is a prominent mechanism to expand naloxone availability through various venues, such as community pharmacies. This qualitative study aimed to identify and summarize the views of experts on state-level naloxone access laws. Methods: We conducted a three-round modified-Delphi process using the online ExpertLens platform. Participants included 46 key stakeholders representing various groups (advocates, healthcare providers, human/social service practitioners, policymakers, and researchers) with expertise naloxone access laws. Participants commented on the effectiveness and implementability of 15 state-level naloxone access laws (NALs). We thematically analyzed participant comments to summarize views on NALs overall and specific types of NAL. Results: Participants commented that the effectiveness of NALs in reducing opioid-related mortality depends on their ability to make sustained, significant impacts on population-level naloxone availability. Participants generally believed that increased naloxone availability does not have appreciable negative impacts on the prevalence of opioid misuse, opioid use disorder (OUD), and non-fatal opioid overdoses. Implementation barriers include stigma among the general public, affordability of naloxone, and reliance on an inequitable healthcare system. Conclusions: Experts believe NALs that significantly increase naloxone access are associated with less overdose mortality without risking substantial unintended public health outcomes. To maximize impacts, high-value NALs should explicitly counter existing healthcare system inequities, address stigmatization of opioid use and naloxone, maintain reasonable prices for purchasing naloxone, and target settings beyond community pharmacies to distribute naloxone.Item A mixed-methods study of pharmacy instructors' early experiences with a teaching electronic medical record(Elsevier, 2021-09) Adeoye-Olatunde, Omolola A.; Vlashyn, Olga O.; Illingworth Plake, Kimberly S.; Woodyard, Jamie L.; Weber, Zachary A.; Litzelman, Debra K.; Russ-Jara, Alissa L.; Medicine, School of MedicineIntroduction As use of electronic medical records (EMRs) increases in healthcare, multiple accreditation organizations recommend training future clinicians on EMRs as part of the academic curriculum. Therefore, some pharmacy programs now utilize an academic EMR. Our objective was to examine pharmacy instructors' early experiences with a commercially available teaching EMR (tEMR) in order to identify current and future priorities along with benefits and barriers to academic EMR use in pharmacy education. Methods We conducted semi-structured interviews and a web-based survey with pharmacy instructors. Interview and survey data analyses consisted of hybrid inductive/deductive approaches to coding data and descriptive statistics, respectively. We mapped themes to the Pharmacists' Patient Care Process (PPCP). Results Seven instructors participated in interviews, and 10 completed the survey. We identified 25 interview themes that were generally congruent with survey responses. A noted benefit of the tEMR was providing a large repository of real-life patient data. Instructors' current priorities for tEMR activities primarily aligned with “collect,” “assess,” and “plan” steps of the PPCP. One reported barrier was insufficient training regarding the tEMR capabilities. Instructors offered innovative ideas for future academic EMR use, including pharmacokinetics, incident reporting, and longitudinal cases. Conclusions Study findings are most applicable to pharmacy programs in the early stages of academic EMR adoption. We identified opportunities for pharmacy programs to facilitate innovative, future use of academic EMRs, including curriculum planning, so pharmacy students gain experience using EMR functions for each PPCP step and develop more advanced EMR skills.Item Pharmacist-Led Implementation of Brief Tobacco Cessation Interventions during Mobile Health Access Events(MDPI, 2023-04-07) Hudmon, Karen Suchanek; Czarnik, Julia S.; Lahey, Alexa M.; Crowe, Susie J.; Conklin, Megan; Corelli, Robin L.; Gonzalvo, Jasmine D.; Ellis Hilts, Katy; Health Policy and Management, School of Public HealthTo address gaps in care for individuals from under-resourced communities disproportionately affected by tobacco use, this pharmacist-led demonstration project evaluated the feasibility of implementing tobacco use screening and brief cessation interventions during mobile health access events. A brief tobacco use survey was administered verbally during events at two food pantries and one homeless shelter in Indiana to assess the interest and potential demand for tobacco cessation assistance. Individuals currently using tobacco were advised to quit, assessed for their readiness to quit, and, if interested, offered a tobacco quitline card. Data were logged prospectively, analyzed using descriptive statistics, and group differences were assessed by site type (pantry versus shelter). Across 11 events (7 at food pantries and 4 at the homeless shelter), 639 individuals were assessed for tobacco use (n = 552 at food pantries; n = 87 at the homeless shelter). Among these, 189 self-reported current use (29.6%); 23.7% at food pantries, and 66.7% at the homeless shelter (p < 0.0001). About half indicated readiness to quit within 2 months; of these, 9 out of 10 accepted a tobacco quitline card. The results suggest that pharmacist-led health events at sites serving populations that are under-resourced afford unique opportunities to interface with and provide brief interventions for people who use tobacco.Item Pharmacists Re-Licensure 2004 and 2008 Survey Report(2010-08) Zollinger, Terrell W.; Kochhar, Komal; West, Jessica M.; Varma, Ram A.The 2004 and 2008 Indiana pharmacist re-licensure survey was implemented through a collaborative partnership with the Indiana State Department of Health (ISDH) and the Indiana Professional Licensing Agency (IPLA). All pharmacists who renewed their license electronically during the 2004 and 2008 re- licensure periods were asked to complete an electronic survey. This report summarizes the responses to the survey items to provide a detailed description of the pharmacist workforce in the state of Indiana.Item Pharmacists Re-Licensure 2010 Survey Report(2012-05) Lewis, Cynthia K.; Sheff, Zachary T.; Zollinger, Terrell W.The 2010 Indiana pharmacist re-licensure survey was implemented through a collaborative partnership with the Indiana State Department of Health (ISDH) and the Indiana Professional Licensing Agency (IPLA). All pharmacists who renewed their license electronically during the 2010 re-licensure period were asked to complete an electronic survey. This report summarizes the responses to the survey items to provide a detailed description of the pharmacist workforce in the state of Indiana.