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Background: To better address their patients' needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included community pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting characteristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice., (© Individual authors.)

Background: Medication non-adherence is a significant public health problem. Patient-reported outcomes (PROs) offer a rich data source to facilitate resolution of medication non-adherence. PatientToc™ is an electronic PRO data collection software originally implemented at primary care practices in California, United States (US). Currently, the use of standardized PRO data collection systems in US community pharmacies is limited. Thus, we are conducting a two-phase evaluation of the spread and scale of PatientToc™ to US Midwestern community pharmacies. This report focuses on the first phase of the evaluation. The objective of this phase was to prepare for implementation of PatientToc™ in community pharmacies by conducting a pre-implementation developmental formative evaluation to (1) identify potential barriers, facilitators, and actionable recommendations to PatientToc™ implementation and (2) create a draft implementation toolkit., Methods: Data collection consisted of demographics, observations, audio-recorded contextual inquiries, and semi-structured interviews with staff (e.g., primary care providers, pharmacists, pharmacy technicians) and patients during 1-day site visits to a purposive sample of (1) primary care practices currently using PatientToc™ and (2) community pharmacies in Indiana, Wisconsin, and Minnesota interested in the future use of PatientToc™. Post-visit site observation debriefs were also audio-recorded. Verbatim transcripts of all recordings were coded using deductive/inductive approaches and intra-/inter-site summaries were produced identifying potential barriers, facilitators, and actionable recommendations mapped to the Consolidated Framework for Implementation Research constructs. A stakeholder advisory panel engaged in an Evidence-Based Quality Improvement (EBQI) implementation process. This included "member checking" and prioritizing findings, and feedback on the adapted PatientToc™ application, implementation strategies, and accompanying toolkit for community pharmacy implementation., Results: Two primary care practices, nine pharmacies, and 89 individuals participated. Eight major themes (four barriers and four facilitators) and 14 recommendations were identified. Throughout the four EBQI sessions, the panel (1) confirmed findings; (2) designated high priority recommendations: (a) explain PatientToc™ and its benefits clearly and simply to patients, (b) ensure patients can complete questionnaires within 10 min, and (c) provide hands-on training/resources for pharmacy teams; and (3) provided feedback on the adapted PatientToc™ application and finalized toolkit items for initial community pharmacy implementation., Conclusions: Adoption of electronically captured PROs in community pharmacies is warranted. The implementation strategies systematically developed in this study can serve as a model for implementation of technology-driven health information patient care services, in the understudied context of community pharmacies., (© 2022. The Author(s).)

Most research on pharmacist professional wellbeing has focused on measuring burnout. However, using valid and reliable instruments to assess professional fulfillment in pharmacists can expand understanding of pharmacists' professional wellbeing. This study aimed to (1) establish the validity of the Professional Fulfillment Index (PFI) for a sample of pharmacists licensed in the United States (US) using confirmatory factor analysis (CFA), and (2) compare the professional wellbeing of pharmacists across demographics and work settings. Data for this study were obtained from the 2019 National Pharmacy Workforce Survey (NPWS). The survey assessed pharmacist professional wellbeing using the PFI. The model fit of the PFI was assessed using CFA. Multiple linear regression was used to compare pharmacist wellbeing across demographics and work settings. The CFA affirmed that the PFI possesses a satisfactory model fit for use in pharmacists. Regression analysis showed higher burnout (work exhaustion and interpersonal disengagement) was associated with decreasing age, being female, working more hours, and working in a community pharmacy. Higher professional fulfillment was associated with men, and working in non-community pharmacy work settings. The PFI is a psychometrically reliable and valid instrument for assessing the professional wellbeing of pharmacists.

National Pharmacist Workforce Studies (NPWS) have been conducted in the U.S. every five years since 2000. This article describes the online survey methods used for the latest NPWS conducted in 2019 and provides an assessment for nonresponse bias. Three waves of emails containing a link to the online survey were sent to a random sample of about 96,000 pharmacists licensed in the United States. The survey asked about pharmacist employment, work activities, work-life balance, practice characteristics, pharmacist demographics and training. A total of 5467 usable responses were received, for a usable response rate of 5.8%. To assess for nonresponse bias, respondent characteristics were compared to the population of U.S. pharmacists and a benchmark, while a wave analysis compared early and late respondents. The pharmacist sample-population comparison and the benchmark comparison showed that the NPWS respondents had a higher percentage of female pharmacists and a lower proportion of young pharmacists compared to the population of U.S. pharmacists and the benchmark sample. In some contrast, the wave analysis showed that the early respondents had a higher percentage of males and older pharmacists compared to the late respondents. Both the wave analysis and the benchmark comparison showed that the NPWS respondents (and early respondents) had a lower percent of pharmacists with a PharmD degree than did the late respondents and the benchmark group. These differences should be considered when interpreting the findings from the 2019 NPWS.

Aim: Comparative effectiveness research (CER) can help ascertain value of new drugs; however, limited research assesses the translation of CER into clinical practice. The objective of this study was to analyze the association between CER evidence and prescribing trends within two markets of Type 2 diabetes mellitus. Methods: A retrospective analysis to determine the prescribing trends from 2006 to 2016 and an electronic literature search to identify CER comparing different drugs was conducted. Results: In glucagon-like peptide-1 (GLP-1) agonists market, CER showed superiority of Liraglutide. Prescribing of Exenatide twice daily dropped by 50% points as Liraglutide entered the market. In dipeptidyl peptidase-4 (DPP4) inhibitors market, CER did not suggest conclusive superiority. Nevertheless, Sitagliptin, the first entrant, continued to dominate throughout. Conclusion: CER evidence appeared to be associated with prescribing trends in GLP-1 agonists market; however, no associations were found in DPP4 inhibitors market. The translation of evidence into practice can be limited by the availability of superiority trials and timing of their availability.

The goal for this study was to use data from the most recently conducted National Pharmacist Workforce Survey to compare eight components of quality of work life for actively practicing pharmacists in the United States categorized by (1) work activity and (2) work setting. The eight components of quality of work life were: (1) time stress; (2) responsibility stress; (3) level of control; (4) work in harmony with home life; (5) home life in harmony with work; (6) job satisfaction; (7) professional commitment; and (8) organizational commitment. Data for this study were obtained from the 2014 National Pharmacist Workforce Survey. For inclusion in analysis, respondents needed to report that they were practicing as a pharmacist. In addition, they needed to provide usable responses for both their percent time devoted to medication providing and to patient care services. This resulted in a total of 1191 responses for the analysis. Data were analyzed using cluster analysis, factor analysis, Cronbach coefficient alpha, chi-square analysis, ANOVA, and linear regression. The findings provide a description of pharmacists’ quality of work life in 2014 and show how type of work, variety of work, and work setting categories are associated with quality of work life for pharmacists.

Objectives: To describe the products with price changes and assess the impact of price changes on the products' price and affordability within the context of the Egyptian market., Methods: A descriptive pre-post observational study was conducted. We selected March through June 2013 as the post-change observation period. A matching pre-change observation period, one year earlier, was selected to be consistent with potential seasonal variation in product use., Results: It was found that 65.7% of the products with price changes were low-priced generic products. The overall average percent change in price was 24.7%. Before decree #499 implementation, the average affordability of the low-, medium-, and high-priced products was 0.25 days' wage, 2 days' wage, and more than 100 days' wage, respectively. After the implementation, the cost increase for the low- and medium-priced products was less than 0.1 days' wage, whereas the high-priced products' cost decreased by 11 days' wage., Conclusions: The policy change resulted in both price decreases and increases without substantive implications on affordability., (Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Better understanding is needed for antihypertensive medication initiation and lifestyle modification among younger populations with elevated blood pressure. This study aimed to assess health behavior change after receiving a report of elevated blood pressure among African Americans and Caucasians younger than 50 years old. We used the Coronary Artery Risk Development in Young Adults (CARDIA) repository dataset. By examination year twenty, 424 out of 2,478 Caucasian and 2,637 African American participants had received feedback from the CARDIA study due to elevated blood pressure readings. Blood pressure was measured by trained CARDIA researchers at the participant's home and was repeatedly recorded at seven examinations over twenty years. A feedback/referral letter was sent to participants with an elevated blood pressure reading. On average, participants first had an elevated blood pressure reading at the age of 34. After receiving the feedback letter, 44% of the previously undiagnosed participants received a formal diagnosis. In addition, 23% initiated the use of antihypertensive medication if they had not received medication treatment before. Among the participants with at-risk lifestyle behaviors, 40% reduced alcohol consumption, 14% increased exercise level, 11% stopped smoking, and 8% reached normal weight. While none of the studied patient factors were associated with lifestyle modification, age had a positive impact on antihypertensive medication initiation (p<0.05). We found no evidence of differences in health behavior change between African American and Caucasian participants after receiving the feedback letter. This research is one of the first to study what followed after receiving a feedback letter about elevated blood pressure outside of healthcare settings. Although additional referral care and behavior interventions are needed to facilitate medication initiation and lifestyle modification, our observations suggest that providing blood pressure feedback may have promise as part of a multi-method approach involving blood pressure screening and follow up.

Background: Past reports suggest that a near balance has been reached in the supply and demand for pharmacists in the US. Although data on the level of supply of pharmacists is available, there is no continuous and systematic tracking of the level of demand (unmet and latent) for pharmacists at state level. Unmet demand, an established construct in pharmacy workforce, is important to measure the number of vacancies and assess pharmacist shortage consistently over time. Latent demand or potential demand is a novel construct and has never been measured in pharmacy workforce. With the increase in supply, it is important to measure the potential demand that could be budgeted in pharmacies in the near future., Objective: The objective of this study was to measure the unmet and latent demand for pharmacists and explore the association between latent demand and workload characteristics in community and hospital pharmacies in Wisconsin in 2011-12., Methods: The study used a cross-sectional, descriptive survey design. A sample of community pharmacies (n=1,064) and hospital pharmacies (n=126) licensed in Wisconsin in 2011-12 was identified. Key informants (managers/owners) of sampled pharmacies were sent a one-page cover letter explaining the purpose of the study and requesting participation and a three page survey form. The main outcome measures of the study were total number of FTE pharmacist positions vacant, presence of adequate staff size, additional number of FTE pharmacist positions needed to attain adequate staff size, prescription volume, daily census, hospital size and number of hours prescription department is open. Descriptive statistics were calculated for all the pharmacies collectively, then separately for community and hospital pharmacies. Pharmacy setting, vacancies and workload characteristics of pharmacies with and without latent demand were compared using chi-squared test of independence and/or t-test. Sample weights were calculated and used in all the analyses to weigh the estimates to all pharmacies in Wisconsin., Results: Overall response rate to the survey was 50.1%. Of the total number of FTE pharmacist positions budgeted in Wisconsin, 54.3 FTE positions (1.5%) were reported vacant in 2011-12. Approximately 28.2% of the community and hospital pharmacies reported the presence of latent demand. Latent demand was significantly associated with higher workload in community pharmacies and larger bed size in hospital pharmacies., Conclusion: There appeared to be a balance between the supply and demand for pharmacists in Wisconsin in 2011-12. There is a potential for additional FTE positions (latent demand) to be budgeted in pharmacies to attain adequate pharmacist staff size. It is important to consistently track the level of unmet and latent demand for pharmacists in Wisconsin and combine this information with other workforce characteristics to guide the decision making of pharmacy workforce planners and pharmacy managers.

Background: False and misleading advertising for drugs can harm consumers and the healthcare system, and previous research has demonstrated that physician-targeted drug advertisements may be misleading. However, there is a dearth of research comparing consumer-targeted drug advertising to evidence to evaluate whether misleading or false information is being presented in these ads., Objective: To compare claims in consumer-targeted television drug advertising to evidence, in order to evaluate the frequency of false or misleading television drug advertising targeted to consumers., Design: A content analysis of a cross-section of television advertisements for prescription and nonprescription drugs aired from 2008 through 2010. We analyzed commercial segments containing prescription and nonprescription drug advertisements randomly selected from the Vanderbilt Television News Archive, a census of national news broadcasts., Main Measures: For each advertisement, the most-emphasized claim in each ad was identified based on claim iteration, mode of communication, duration and placement. This claim was then compared to evidence by trained coders, and categorized as being objectively true, potentially misleading, or false. Potentially misleading claims omitted important information, exaggerated information, made lifestyle associations, or expressed opinions. False claims were factually false or unsubstantiated., Key Results: Of the most emphasized claims in prescription (n = 84) and nonprescription (n = 84) drug advertisements, 33 % were objectively true, 57 % were potentially misleading and 10 % were false. In prescription drug ads, there were more objectively true claims (43 %) and fewer false claims (2 %) than in nonprescription drug ads (23 % objectively true, 7 % false). There were similar numbers of potentially misleading claims in prescription (55 %) and nonprescription (61 %) drug ads., Conclusions: Potentially misleading claims are prevalent throughout consumer-targeted prescription and nonprescription drug advertising on television. These results are in conflict with proponents who argue the social value of drug advertising is found in informing consumers about drugs.

Background: Under the 1995 Wisconsin Act 27, the biennial budget, Wisconsin Medicaid was required to develop an incentive-based pharmacy payment system for pharmaceutical care (PC) services. Started on July 1, 1996, the Wisconsin Medicaid Pharmaceutical Care Program (WMPCP) is the longest currently ongoing Medicaid program to compensate pharmacists for nondispensing services. The program reimburses pharmacies for providing PC services that increase patient compliance or prevent potential adverse drug problems by paying an enhanced PC dispensing fee. Pharmacists can bill for PC services provided to Wisconsin Medicaid fee-for-service and SeniorCare (i.e., state prescription drug assistance program for low-income seniors) beneficiaries., Objectives: To examine trends in (a) the number of pharmacies participating in the WMPCP and the intensity of participation among participating pharmacies; and (b) frequencies of reason, action, result, and level-of-service (time) codes associated with PC service claims from July 1, 1996, through June 30, 2007, which represents Wisconsin state fiscal years (SFYs) 1997 through 2007., Methods: A retrospective, longitudinal, and descriptive research design was used to analyze all paid claims for PC services provided to Wisconsin Medicaid fee-for-service and SeniorCare recipients during SFYs 1997 through 2007. The total number of paid PC claims and the average number of claims paid per pharmacy were examined to determine trends in pharmacy participation. Mean annual reimbursement amounts for PC per claim and per pharmacy were calculated. Reason, action, result, and level-of-service (time) codes that appeared in the claims were grouped into categories and analyzed to characterize the total number of claims paid overall and per SFY., Results: During the study period, one-half (n = 601) of the approximately 1,200 licensed pharmacies in the state of Wisconsin were paid for a claim through the WMPCP. However, intensity of participation in the WMPCP was low, with 57% of all participating pharmacies being paid for 10 or fewer PC claims and 19% paid for only 1 PC claim over the 11-year study period. The growth in claims per year coupled with smaller growth in the number of participating pharmacies resulted in a trend of growth in the mean number of claims per participating pharmacy in the program. The proportion of total WMPCP claims accounted for by the top 10 pharmacies with the highest volume of PC claims varied from 46.6% to 80.2% per year. Patient behaviors (e.g., early or late refills) and drug use issues/problems (e.g., patient complaints or symptoms) were the most common reasons for pharmacists to provide PC services (62% of all PC claims), although drug choice reasons (e.g., product selection opportunity) were more common after 2004. The majority (55.1%) of PC services took 15 minutes or less of pharmacists' time. The total dollar amount paid to pharmacies for PC services was $876,822 between SFYs 1997 and 2007, with an overall mean of $1,459 paid per participating pharmacy., Conclusions: Trends in pharmacy participation and claims volume showed growth, albeit limited, in PC program participation with a majority of paid claims dealing with patient behaviors and drug use issues or problems that consumed a small amount of pharmacists' time (15 minutes or less). The intensity of participation (claims per pharmacy) increased over time, suggesting that some pharmacies may have developed effective systems for participating and successfully submitting claims to WMPCP for enhanced dispensing fees. Further evaluation of the impact and implications of this program for patients, pharmacists, and the state is needed to gauge overall program success and provide evidence or guidance for continued or expanded PC initiatives.

Objective: To compare practice settings and activities of pharmacists with bachelor of science (BS) in pharmacy and doctor of pharmacy (PharmD) degrees., Methods: Data from the 2009 National Pharmacist Workforce Survey instrument were analyzed. Multivariate regression was used to examine the association of the PharmD degree with time spent in dispensing and patient care., Results: The survey response rate by pharmacists was 52%, and 562 usable responses met our inclusion criteria. Sixty-three percent of BS and 39% of PharmD pharmacists were employed in community pharmacies, compared with 21% of BS and 38% of PharmD pharmacists employed in hospital pharmacy settings. Practicing in a community setting had the strongest influence on time spent in dispensing and time spent in patient care. Among respondents with PharmD degrees, a residency was associated with less time in dispensing and more time in patient care., Conclusion: Time spent in dispensing and patient care were influenced more by practice setting than by educational degree and residency training.

This study examines the association between types of prescription drug insurance coverage and the unit cost of dispensed drugs. Logistic regression and ordinary least squares regression were used to assess differences in the use of brand name and generic drugs and the unit cost of dispensed brand name or generic drugs across four insurance categories: Medicaid, private third party, indemnity, and uninsured. The results show that private third-party and indemnity prescriptions were more likely to be dispensed with brand name drugs. Also, indemnity patients and the uninsured were dispensed brand name and generic drugs with lower unit costs. The findings have ramifications for the design of prescription drug insurance benefits and suggest that physicians may respond to the economic situation of their patients when prescribing drugs.

Although prescription drugs do not appear to be a primary source of recent surges in Medicaid spending, their share of Medicaid expenditures has risen despite efforts to control costs. As part of a general concern with prescription drug policy, Congress mandated a study of the adequacy of Medicaid payments to pharmacies. In this study, several data sources were used to develop 1991 estimates of average pharmacy ingredient and dispensing costs. A simulation was used to estimate the amounts States pay. Nationally, simulated payments averaged 96 percent of estimated costs overall but were lower for dispensing costs (79 percent) and higher for ingredient costs (102 percent).

The effects of removing propoxyphene napsylate products from the Wisconsin Medicaid drug program formulary were examined. Internal analgesic expenditures and usage data for 3-month periods before and after the removal were compared (April through June 1984 versus the same period in 1985). After adjusting for price and reimbursement changes between the two study periods, overall expenditures were slightly higher after removal of these products. Expenditures per recipient, prescription, and unit all increased, as did the number of prescriptions per recipient. Expenditures, prescriptions, and recipients increased more for propoxyphene hydrochloride products as substitutes for propoxyphene napsylate products than for products in any other category. Increases also occurred for nonsteroidal anti-inflammatory products, suggesting they may have been chosen as replacement therapy. The proportion of napsylate prescriptions converted to hydrochloride prescriptions was larger for institutional patients than for noninstitutional patients. Although program expenditures did not decrease, as intended by the formulary change, other qualitative outcomes also should be considered, such as any therapeutic advantages the replacement products may have had for the patients.

Potential impacts from two methods of changing prescription drug ingredient reimbursement in the Wisconsin Medicaid program were estimated. Current reimbursement amounts were compared with those resulting from either direct prices for eight manufacturers' products and average wholesale price less 10.5 percent for other products or wholesaler cost plus 5.01 percent for all products. The resulting overall average ingredient cost reimbursement reductions were 6.64 percent ($0.56 per prescription) and 6.94 percent ($0.59 per prescription) for the two methods, respectively. The results should be viewed from the perspective of both program savings and reduced pharmacists' revenues.

Accurate payment for the acquisition costs of drug products dispensed is an important consideration in a third-party prescription drug program. Two alternative methods of estimating these costs among pharmacies were derived and compared. First, pharmacists were surveyed to determine the purchase discounts offered to them by wholesalers. A 10.00% modal and 11.35% mean discount resulted for 73 responding pharmacists. Second, cost-plus percents derived from gross profit margins of wholesalers were calculated and applied to wholesaler product costs to estimate pharmacy level acquisition costs. Cost-plus percents derived from National Median and Southwestern Region wholesaler figures were 9.27% and 10.10%, respectively. A comparison showed the two methods of estimating acquisition costs would result in similar acquisition cost estimates. Adopting a cost-plus estimating approach is recommended because it avoids potential pricing manipulations by wholesalers and manufacturers that would negate improvements in drug product reimbursement accuracy.