Journal of the American Pharmacists Association最新文献

{"title":"Ensuring Safety in Cytotoxic Drug Preparation: A Systematic Review of Guidelines Addressing Education for Pharmacy Professionals.","authors":"Fernando Moreira, Ângelo Jesus, Cláudia Pinho, Marlene Santos, Mélanie Serdoura, Agostinho Cruz","doi":"10.1016/j.japh.2025.102352","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102352","url":null,"abstract":"<p><strong>Background: </strong>Chemotherapy preparation involves the use of specific techniques and equipment, given the need to maintain preparation sterility and its strict prescribed composition, and avoid occupational exposure to cytotoxic agents.</p><p><strong>Objective: </strong>This study aims to identify the most relevant contents for pharmacy professionals' education and training programs and to elucidate the evaluation procedure these professionals should follow when handling cytotoxics.</p><p><strong>Methods: </strong>We adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in conducting and reporting this systematic review. We conducted a literature search in PubMed, Cochrane, and LILACS to identify guidelines on cytotoxic drug preparation published between 2004 and 2024. Inclusion criteria included guidelines written in English, Spanish, or Portuguese that addressed the education, training, and/or evaluation of pharmacy professionals involved in handling cytotoxic drugs. We excluded guidelines developed for other health professionals (e.g. nurses) and guidelines exclusively addressing the manipulation of oral dosage forms. Citation searching was also performed to avoid search biases. Three researchers independently selected 20 guidelines that met the inclusion criteria, out of 3781 unique references identified. Four appraisers assessed the guidelines using the AGREE-II tool.</p><p><strong>Results: </strong>Recommendations for training in cytotoxic drug handling generally included pre-initiation and periodic assessment. Personal protective equipment and engineering controls use, spill management, and aseptic technique were the most frequently mentioned specific training contents. We have developed a training proposal based on the guidelines, with four training levels that address the specific identified content. Each level presents potential competency assessment strategies.</p><p><strong>Conclusion: </strong>Included publications frequently recognized that conducting educational programs before and during the preparation of cytotoxic drugs was important and the combination of theoretical and practical learning seems of the utmost relevance. The development or update of guidelines in this area should prioritize their effective applicability to facilitate their implementation.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102352"},"PeriodicalIF":2.5,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric analysis of United States and global obstetrical pharmacy literature from 1994 to 2023.","authors":"Stephen M Small","doi":"10.1016/j.japh.2025.102345","DOIUrl":"10.1016/j.japh.2025.102345","url":null,"abstract":"<p><strong>Background: </strong>Federal research policy in the U.S. changed in the early 1990s to include more pregnant patients in clinical research. However, pregnancy outcomes in the United States have gradually declined over the past few decades. Little research has been conducted to characterize U.S. obstetrical pharmacy publications and compare them with global trends.</p><p><strong>Objectives: </strong>This study aimed to measure the volume and types of U.S. and non-U.S. obstetrical pharmacy literature over 30 years to characterize research in this specialty. The secondary objectives included measuring trends in authorship and citations and performing a text-mining analysis of obstetrical pharmacy publications.</p><p><strong>Methods: </strong>This bibliometric analysis used the Web of Science database to identify obstetrical pharmacy documents published between 1994 and 2023 in the United States and non-U.S. countries. Articles were included if they contained obstetrical or pregnancy topics and were within the pharmacy and pharmacology research areas. Data on document types, citations, authors, and common words were collected and analyzed using descriptive statistics.</p><p><strong>Results: </strong>A total of 12,190 obstetrical pharmacy documents met the inclusion criteria, representing only 2.8% of global obstetrical publications. The United States had the most documents (29.6%), followed by China (10.7%), Italy (5%), the United Kingdom (3.2%), and Canada (3.2%). U.S. and non-U.S. documents increased exponentially (R² = 0.9485 and 0.979, respectively) over the 30 years. Text-mining analysis showed that both groups had common research topics and interests.</p><p><strong>Conclusion: </strong>Pharmacy documents represent a small proportion of obstetrical publications amidst worsening maternal outcomes in the United States. Despite the exponential growth in obstetrical publication frequency, the overall contribution from the United States is at risk of being superseded by that of China. High international collaboration and citations of U.S. documents may provide opportunities to increase future scientific production in this area and improve patient outcomes.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102345"},"PeriodicalIF":2.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacy harm reduction practices to help reduce opioid overdoses, Arizona 2023.","authors":"Beth E Meyerson, Sara Richter, Rosalie Gordon, Ethan P Y Chang, Nina Vadiei, Lori A Eldridge, Elias O Higbie, Ava A Pal, Addison Seckar-Martinez, Kylee Newgass, Heather M Lorenz, Irene Garnett","doi":"10.1016/j.japh.2025.102348","DOIUrl":"10.1016/j.japh.2025.102348","url":null,"abstract":"<p><strong>Background: </strong>Characterizing pharmacies based on their practices, community need for such practices and pharmacy type could advance pharmacy-based intervention precision to reinforce or increase pharmacy practices related to reducing opioid overdose deaths.</p><p><strong>Objective: </strong>To measure a combination of 3 pharmacy practices focused on opioid overdose death reduction and explore whether there are discernable groupings related to practices, pharmacy characteristics, and community characteristics.</p><p><strong>Methods: </strong>A telephone survey was conducted between August 1, 2023 and October 8, 2023 with the pharmacist on duty at 921 Arizona community pharmacies. The survey measured pharmacy characteristics, buprenorphine stocking, buprenorphine and naltrexone dispensing, likelihood of methadone dispensing for opioid use disorder (OUD) when legally permitted, and interest in state-subsidized naloxone dispensing.</p><p><strong>Results: </strong>A response rate of 22.6% was achieved (N = 208). The vast majority (93.8%) of pharmacies stocked buprenorphine and dispensed buprenorphine or naltrexone. About half (47.6%) were very likely or somewhat likely to dispense methadone for OUD when permitted. Metropolitan pharmacies were less likely to dispense methadone compared to rural pharmacies (45.1% Vs. 75.0%). Among pharmacies not likely to dispense methadone, 85.3% were located in counties with opioid overdose death rates above the national average. About half of pharmacies indicated interest in enrolling as a distributor of state-subsidized naloxone. When considered together as pharmacy practices, 26% of pharmacies reported frequent buprenorphine or naltrexone dispensing, expressed interest in subsidized naloxone dispensing and a likelihood of methadone dispensing. Latent class analysis yielded 4 distinct groups of pharmacies ranging from those only dispensing buprenorphine or naltrexone frequently to adopters of the 3 pharmacy practices related to opioid overdose reduction in the community. The 'adopters' who frequently dispensed buprenorphine or naltrexone, who had interest in subsidized naloxone, and would likely dispense methadone for OUD tended to be in metropolitan or small/rural areas but tended not to be mass merchandizers.</p><p><strong>Conclusion: </strong>An emerging group of pharmacies shows potential for greater adoption of pharmacy practices to reduce opioid overdose. Larger, multistate studies will help verify pharmacy latent class groups for greater precision of pharmacy practice interventions to reduce opioid overdose in communities. It is crucial to explore why pharmacies in higher need counties are not likely to adopt practices related to opioid overdose reduction.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102348"},"PeriodicalIF":2.5,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of a Pharmacist-led Outpatient Penicillin Allergy Testing Clinic.","authors":"Eric Linn, Michael Sanchez, Brekk DelHomme, Meera Baldeosingh, Theodore Heierman, John Perry, Adam Fier","doi":"10.1016/j.japh.2025.102346","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102346","url":null,"abstract":"<p><strong>Background: </strong>Penicillin allergies affect approximately 10% of the population, leading to increased healthcare costs, treatment failures, and multidrug resistant organisms.</p><p><strong>Objective: </strong>To determine the feasibility of implementing a pharmacist-led outpatient penicillin allergy testing program.</p><p><strong>Methods: </strong>This single-site, retrospective cohort study was conducted from July 2022 through December 2023. The study site consisted of an outpatient clinic within a non-academic community hospital. The primary outcome was the percentage of patients who had their penicillin allergy de-labeled. Secondary outcomes included percentage of patients who received appropriate antibiotics following allergy de-labeling, incidence and type of IgE mediated penicillin reactions, number of patients who were relabeled with a penicillin allergy, number of orthopedic patients with a post-operative surgical site infection, average reimbursement per patient, and average appointment time.</p><p><strong>Results: </strong>A total of 457 outpatients received penicillin allergy testing during the study period. Physician specialties who referred patients were orthopedics, obstetrician-gynecologists, infectious disease, urology, urogynecology, cardiothoracic surgeons, and primary care providers. For the primary outcome, 439 patients (96%) were successfully de-labeled. All de-labeled patients received appropriate antibiotics following testing. There were 17 patients who developed minor itching with or without a localized rash following the amoxicillin, and one patient had a delayed reaction of rash 12 hours after the amoxicillin that resolved with an antihistamine. One patient had their penicillin allergy re-labeled. Of the 192 orthopedic patients, 0 patients had a post-operative surgical site infection. The average reimbursement was $423 per patient with the average appointment lasting 96 minutes.</p><p><strong>Conclusion: </strong>Pharmacists, in collaboration with multiple physician specialties, successfully implemented an outpatient penicillin allergy testing service to safely de-label patients and support antimicrobial stewardship.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102346"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to optimize aseptic medicine services: Qualitative insights from pharmacists' experience.","authors":"Chairun Wiedyaningsih, Fita Rahmawati, Chintya Gilang Ghaisani, Niken Nur Widyakusuma","doi":"10.1016/j.japh.2025.102342","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102342","url":null,"abstract":"<p><strong>Background: </strong>Pharmacy aseptic services are essential for many critical hospital services as they provide sterile and controlled environments under which highly qualified staff prepare injectable medicines. Although quantitative studies on problems of aseptic medicine services have been previously documented, there is a paucity of data to explain the cause of those problems.</p><p><strong>Objectives: </strong>This study aimed to examine practical challenges experienced by pharmacists during aseptic medicine services.</p><p><strong>Methods: </strong>This was a qualitative study conducted using semi-structured interviews. The participants were pharmacists working in various inpatient clinical environments in Yogyakarta Province, Indonesia. Participants were purposefully recruited through maximum variation and snowball sampling. The interview guide was developed after comprehensive literature review and discussions with some experts related to concepts in aseptic medicine service. Data were collected from April to August 2023 and analyzed via reflexive thematic analysis using the NVivo software.</p><p><strong>Results: </strong>A total of 19 pharmacists working in 12 hospitals (7 public and 5 private) across the five regions in Yogyakarta Province were interviewed. The challenges in aseptic services can be grouped into five themes: (1) unreliable physical facilities and equipment are the problems that should be solved, (2) Shortage of the quality and quantity of human resources hinder the optimum aseptic medicine services, (3) Competence, responsible, and accountable aseptic dispensing services management are needed to counter issues related work delegation, supervision, coordination and communication between health staff, (4) Various problems of production systems are needed to be considered, (5) There is lack of pharmacist involvement in board of directors in making policy regarding aseptic services.</p><p><strong>Conclusion: </strong>By addressing the five main themes of challenges to aseptic medicine services, institutional leadership can begin to improve the patient safety and hospital performance. Incorporating experienced pharmacists into the decision- making processes at the executive level is a strategy to address these challenges.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102342"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Mental Health First Aid Training in Hospital and Community Pharmacists: A Systematic Review.","authors":"Trisha Joy Advincula, Mindraani Abubakar, Rogie Royce Carandang","doi":"10.1016/j.japh.2025.102344","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102344","url":null,"abstract":"<p><strong>Background: </strong>Mental health is essential for overall well-being but is often overlooked or stigmatized. Mental Health First Aid (MHFA) provides initial support to reduce stigma, encourage help-seeking, and guide individuals toward appropriate care. While MHFA equips healthcare providers to address rising mental health needs, its impact on pharmacists remains underexplored, warranting this systematic review.</p><p><strong>Objective: </strong>This systematic review aimed to comprehensively synthesize the effects of MHFA training for pharmacists on their knowledge, attitudes, and competency in providing mental health support.</p><p><strong>Methods: </strong>The authors systematically searched nine electronic databases, gray literature, and reference lists of included articles. Article selection was based on predefined criteria, and outcomes were analyzed using narrative synthesis. The review included nine articles from 1,258 identified studies, representing diverse study designs and populations. Risk of bias and the certainty of evidence were assessed using appropriate tools.</p><p><strong>Results: </strong>The positive effects of MHFA training have been observed, including enhanced understanding of mental health conditions, reduced stigma surrounding mental health, and increased confidence and skills in mental health interventions among hospital and community pharmacists. Most pharmacists recognize the importance of MHFA training and demonstrate a strong willingness to engage in both initial and ongoing training. However, mixed effects were noted regarding their preparedness to administer MHFA.</p><p><strong>Conclusion: </strong>Pharmacists who completed MHFA training were found to engage in conversations about mental health more frequently, offer compassionate support, and demonstrate a willingness to assist individuals struggling with mental health crises. Future research utilizing robust study designs should investigate whether MHFA training significantly benefits patients and pharmacists.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102344"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing In-Person versus Telephone Medicare Counseling: Beneficiary Satisfaction, Cost-Savings, and Plan Selection Decisions from 2014-2021.","authors":"Asia White, Nicholas McCormick, Yi Zhao, Kavon Diggs, Salisa C Westrick, Lindsey Hohmann","doi":"10.1016/j.japh.2025.102350","DOIUrl":"https://doi.org/10.1016/j.japh.2025.102350","url":null,"abstract":"<p><strong>Background: </strong>A pharmacy school and a State Health Insurance Assistance Program developed a Medicare plan selection assistance program in 2013. In 2020, the program changed from in-person to telephone counseling.</p><p><strong>Objective: </strong>To compare the impact of in-person versus telephone Medicare counseling on beneficiary satisfaction, cost-savings, and plan selection decisions.</p><p><strong>Methods: </strong>Outcomes were assessed via anonymous post-counseling survey, including: 1) program satisfaction (4-items); 2) annual cost-savings (2-items); and 3) plan selection decisions (1-item). Beneficiary satisfaction was measured using a Likert-type scale (1=strongly disagree, 5=strongly agree). Projected cost-savings was calculated as the difference between the total annual drug plus premium costs of the patient's current versus newly selected plan (actual costs-savings) or least expensive plan option (potential cost-savings) for the next benefit year. Plan selection decision was measured via multiple-choice with response categories of \"enrolled in or selected a new plan,\" \"undecided,\" or \"stayed with their current plan.\" Differences in mean satisfaction scale scores, cost-savings, and plan selection decisions between in-person (2014-2019) and telephone counseling (2020-2021) were analyzed using Mann-Whitney U and Fisher's Exact tests. Predictors of plan selection decision were assessed via logistic regression.</p><p><strong>Results: </strong>Beneficiaries (N=632; in-person n=564; telephone n=68) were mostly female (59.8%), White (52.1%), and 69 years on average. The overall mean[SD] satisfaction scale score was higher among recipients of in-person (4.55[0.575]) versus telephone counseling (4.30[0.645]; p=0.002), but there was no statistically significant difference in mean projected annual cost-savings. Further, in-person versus telephone counseling recipients more often enrolled in or selected a new plan (46.5% vs 27.8%; p<0.05), while telephone versus in-person recipients were more frequently undecided (37.0% vs 24.4%; p<0.05). Overall satisfaction (aOR=11.548; p=0.009) and potential cost-savings (aOR=1.001; p=0.020) predicted selection of a new plan.</p><p><strong>Conclusion: </strong>In-person counseling resulted in a greater proportion of beneficiaries selecting a new plan whereas telephone counseling resulted in greater decision inertia.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102350"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143415865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dare 2 Discuss social media campaign: An educational initiative to improve opioid use disorder discussions between the pharmacist and patient.","authors":"Oliver Frenzel, Isaiah Ratz, Anna Skarphol, Amy Werremeyer","doi":"10.1016/j.japh.2025.102343","DOIUrl":"10.1016/j.japh.2025.102343","url":null,"abstract":"<p><strong>Background: </strong>Opioid use disorder (OUD) is a chronic substance use disorder that currently results in significant morbidity and mortality within the United States. The Opioid and Naloxone Education program is a pharmacy-centered opioid risk screening process to identify patients at risk for OUD and opioid overdose. Three years after inception, data indicated patients screened as high-risk for OUD were receiving opioid safety interventions; however the evaluation noted a lack of OUD education with patients.</p><p><strong>Objective: </strong>To describe and assess an educational initiative for pharmacists which is delivered via social media for the improvement of pharmacist-patient communication surrounding OUD education.</p><p><strong>Methods: </strong>The initiative was named 'Dare 2 Discuss' and video content was developed to align with prior research citing challenges to health care provider-patient OUD education. Data to evaluate pharmacist interventions/education delivered to patients was collected by a pharmacy services documentation platform and social media performance was captured by each respective social media dashboard.</p><p><strong>Results: </strong>The first video was posted on October 1, 2022 and the last video was posted on April 10, 2023. Each video took approximately 2.5 hours to create and averaged 42 seconds in length (17-168 seconds). On average, videos received 233 Facebook views (55-489 views) and 527 Instagram views (232-1434 views). The postintervention phase indicated that patient receipt of OUD education by the pharmacist increased by 23% and patient receipt of community support services information increased by 68%.</p><p><strong>Conclusion: </strong>'Dare 2 Discuss' campaign may have improved pharmacist self-efficacy with subsequent adjustment of patient education techniques when addressing OUD conversations. These findings highlight the feasibility of a social media-delivered educational initiative to have a potential impact on factors associated with the opioid crisis and risk-reduction education by pharmacists. Creating relevant and easy-to-digest educational materials for health professionals is an important step in advancing practice and improving patient care. Results from the Dare 2 Discuss campaign suggest that this educational initiative may be an effective method to reach a broad number of pharmacists to improve patient interactions.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102343"},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the impact of pharmacy-led RxChange interventions on medication use and cost outcomes for electronic prescriptions.","authors":"Yifan Zheng, Jun Gong, Corey A Lester","doi":"10.1016/j.japh.2025.102349","DOIUrl":"10.1016/j.japh.2025.102349","url":null,"abstract":"<p><strong>Background: </strong>The RxChange process provides a streamlined solution within electronic prescribing workflows for a pharmacist-led team to address prescription issues with providers. Its use and effectiveness need to be evaluated to enhance pharmacy-provider communication, improve patient access to care, and increase patient safety.</p><p><strong>Objective: </strong>To assess the use of the RxChange process on e-prescription content, cost, and changes related to medication safety.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of national RxChange transactions from 2022 to 2023, using stratified random sampling. All data was obtained from Surescripts. The dataset directly included RxChange response data, shared under agreements to provide limited, time-shifted, and de-identified information. We measured the changes in active ingredients, strengths, dose forms, therapeutic classes, and associated costs before and after the RxChange process. Cost analysis was based on data from the 2021 Medical Expenditure Panel Survey by comparing medication unit costs before and after interventions. Additionally, we analyzed the associations between adverse drug reaction (ADR) codes and the resulting medication modifications.</p><p><strong>Results: </strong>Our analysis included 1,361,528 RxChange transaction records, focusing on 721,415 prescriber-approved transactions. Medication data mapping using RxNorm API was successful in 93.4% of these records, with 31.3% undergoing significant modifications due to pharmacy interventions. Of these, 43,293 records were linked to cost data, revealing an average unit cost saving of $3.5. Strength changes emerged as the most frequent medication adjustment, particularly in therapeutic interchange scenarios. Out-of-stock situations led to most complex modifications involving simultaneous multiple changes in ingredients, strength, and dose form. ADR-related RxChange requests mostly prompted simultaneous strength and ingredient adjustments in 25.8% of ADR-related transactions.</p><p><strong>Conclusions: </strong>The study concludes that pharmacy-initiated RxChange communications within the electronic prescription workflow play a crucial role in enhancing e-prescription quality and making pharmacy team interventions more traceable. The findings highlight the importance of pharmacy-provider collaboration in addressing prescribing challenges, facilitating medication adjustments, and supporting efforts to improve medication safety through the RxChange process.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102349"},"PeriodicalIF":2.5,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing pharmacy deserts and designing a model to minimize inequities in pharmacy distribution in Virginia.","authors":"Joseph Boyle, Rachel Wittenauer, Shreya Ramella, Caroline Juran, John D Bucheit, Evan M Sisson, Jean-Venable Goode Kelly, Sharon S Gatewood, Teresa M Salgado","doi":"10.1016/j.japh.2025.102334","DOIUrl":"10.1016/j.japh.2025.102334","url":null,"abstract":"<p><strong>Background: </strong>Pharmacy closures have become increasingly prevalent in the United States in recent years. Previous literature highlights socioeconomic and racial disparities in the distribution of pharmacy deserts.</p><p><strong>Objectives: </strong>To identify and characterize pharmacy deserts in Virginia and to simulate potential locations to minimize inequities in pharmacy distribution.</p><p><strong>Methods: </strong>This cross-sectional study used active pharmacy permits data from the Virginia Board of Pharmacy to identify census tracts considered pharmacy deserts by simultaneously satisfying 2 criteria: 1) low-income status (>20% residents living below the federal poverty line, or median household income <80% of a local comparator); and 2) low-access to pharmacies (distance >1, 5, or 10 miles for urban, suburban, and rural census tracts, respectively). Demographic and socioeconomic characteristics of desert vs. nondesert tracts were compared using Wilcoxon rank-sum tests. Locations within identified pharmacy deserts were randomly generated in 10,000 independent iterations.</p><p><strong>Results: </strong>Of 2198 census tracts, 51 were considered pharmacy deserts, and 69 met the low-access criterion only. Pharmacy deserts were significantly more common in urban census tracts (5.5%), followed by rural (2.9%), and suburban (0.1%). Compared to nondesert, pharmacy desert tracts had significantly lower percentage of residents under 18 year-old, greater percentage of Black residents, uninsured, with Medicare or Medicaid coverage only, lower median household income, and greater percentage of residents living in poverty. Through geospatial simulation, 44 locations were identified where adding pharmacy services could significantly improve access, each potentially benefiting over 10,000 individuals.</p><p><strong>Conclusion: </strong>Fifty-one tracts in Virginia, primarily in urban areas, were considered pharmacy deserts. Compared to nondeserts, pharmacy desert status was associated with a lower proportion of residents under 18 year-old, greater proportion of Black and uninsured/publicly insured residents, and high poverty level, highlighting disparities in pharmacy access. Geospatial simulation identified several locations where placement of pharmacy services could benefit the largest number of residents living in desert tracts.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102334"},"PeriodicalIF":2.5,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}