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Background Although Kentucky pharmacists recently gained authority to provide protocol-driven care for 13 conditions, provision of prescription hormonal contraception (HC) services is not currently authorized. A board-approved protocol allowing for provision of nonprescription over-the-counter (OTC) emergency contraception (EC) was recently approved by the Kentucky Board of Pharmacy but has yet to be implemented. Objectives The objectives of this study were (1) to assess Kentucky pharmacists’ interest in providing prescription HC and OTC EC services via protocol and (2) to identify perceived benefits/barriers regarding provision of prescription HC. Methods An online questionnaire was disseminated electronically to a convenience sample of Kentucky pharmacists. The questionnaire collected (1) demographic information, (2) opinions regarding provision of prescription HC and OTC EC, and (3) perceived benefits and barriers regarding provision of prescription HC. For analysis, responses were limited to pharmacists in community-based practice. McNemar’s test was used to identify statistically significant differences in support by dosage form. In addition, a multivariable logistic regression model was used to examine associations between demographic factors and support for pharmacist provision of prescription HC. Results We received 151 responses from community-based pharmacists. Support for provision of prescription HC was highest for oral (61%) and transdermal (54%) forms. We found no statistically significant differences in support among demographic factors other than number of years in practice, with more recent graduates being at higher odds of support. In addition, time, reimbursement, training, and belief in the need for pelvic exams were the most commonly cited barriers to implementation. With regard to OTC EC provision, pharmacists were largely supportive (62%) and confident in their abilities. Conclusions Community-based pharmacists in Kentucky are supportive of provision of oral, vaginal, and transdermal prescription HC as well as OTC EC via protocol. Barriers, including time, reimbursement, training, and belief in the need for pelvic exams, should be addressed to increase support for prescription HC provision.

Objectives To provide a brief history of Facebook and online social networking and discuss how it has contributed and can contribute in the future to a paradigm change in social communications. Setting When student pharmacists complete school and enter practice, they encounter enhanced expectations to act appropriately and professionally. Facebook expands the dilemma of separating private and public life—a challenge for individuals in all professions. From the standpoint of a professional association, Facebook provides a tremendous opportunity to reach out to members in an unprecedented way. Pharmacy organizations are beginning to use these new tools to increase communication and dissemination of information. Conclusion The popularity of Facebook has brought the issue of online social networking to the forefront of professional and organizational discussions. The issues of privacy, identity protection, and e-professionalism are likely to reappear as pharmacists and student pharmacists continue to communicate via online networks. The potential exists for organizations to harness this organizational and communication power for their own interests. Further study is needed regarding the interaction between online social networking applications and the profession of pharmacy.

Policies exist at many levels and impact the practice of pharmacy in a wide variety of ways. Some pharmacists may seek advanced education related to policy development and assessment. In this article, policy is defined and the various ways the term is used with regard to the profession are reviewed with selected examples provided. Sources of information about policy-related degree programs offered both by educational units primarily focusing on pharmacy and units outside the specialty area are emphasized along with points to consider in making a decision. Examples of career opportunities are provided and questions to consider are presented.

Objective: To develop, implement, and evaluate a pilot “Pharmacy 101” seminar designed to provide faculty, staff, and graduate students with an overview and orientation to the pharmacy profession and academic pharmacy. Design: Objectives and specific topics for inclusion for the seminar were developed and refined based on input from the Office of the Dean as well as Chairs of both College Departments. Assessment: The seminar has been offered on three separate occasions. The first two offerings were open to the entire college community, whereas the third session was delivered as part of the college of pharmacy’s new graduate student orientation. At the initial offering, participants voluntarily completed an initial evaluation and a postseminar evaluation 60 days later. For the second and third sessions, all participants were asked to complete an initial evaluation and a 15-item pre and post multiple-choice test instrument. Fourteen individuals completed the initial seminar offering, seven the second, and 15 participants took part in the graduate student section. Responses to initial evaluations from all three cohorts were positive and constructive. The pre and post test instruments used in the second and third cohorts demonstrated consistent learning. Conclusion: This seminar appeared to meet its objectives. Similar seminars can be developed to improve faculty, staff, and graduate student productivity and job satisfaction. Future considerations include expansion into a required component of

A variety of challenges facing the health care system in general and the profession of pharmacy in particular creates a need for pharmacists who have completed advanced education and training in administration. Some may choose to look outside academic pharmacy for graduate degree programs in administration. Four types of administrative degrees — MBA, MHA, MPA, and MPH — are described. A list of factors to be considered by a person thinking about pursuing graduate education in this area is presented and discussed. The admission process is described as it may typically occur for such programs in order to familiarize pharmacists with what criteria are likely to be used. An informed evaluation of the alternatives available will help students select the program best suited to their career goals.

Some pharmacists have used a power of attorney document for quite some time when submitting orders for controlled substances. This is authorized by Drug Enforcement Administration (DEA) regulations. Increasingly pharmacists are encountering power of attorney documents in another context – durable powers of attorney authorizing an Agent to make health care decision for the Principal. Medicare requirements have greatly expanded use of such advance directives. Thus, pharmacists may encounter these documents with both professional and personal issues. Types of power of attorney documents are reviewed with the differences highlighted. A variety of legal requirements that may apply are discussed and situations where such documents may prove helpful are listed. Issues related to the Agent are discussed, because pharmacists may find themselves in this role or in the role of advising someone selecting an Agent. How to revoke such legal documents is described as well.

Pharmacies are a potential site for access to sterile syringes as a means for preventing human immunodeficiency virus (HIV), but the type and extent of their utility is uncertain. To examine pharmacy syringe purchase, we conducted a standardized, multistate study in urban and rural areas of four states in which attempts to purchase syringes were documented. Of 1,600 overall purchase attempts, 35% were refused. Colorado (25%) and Connecticut (28%) had significantly lower rates of refusal than Kentucky (41%) and Missouri (47%). Furthermore, urban settings had higher rates of refusal (40%) than rural settings (31%, P

Objective To examine pharmacists' attitudes and practices surrounding human immunodeficiency virus (HIV) prevention among injection drug users. Design Focus groups. Setting Urban and rural sites in Colorado, Connecticut, Kentucky, and Missouri. Patients or Other Participants: Eight focus groups, with 4 to 11 pharmacists participating in each group. Interventions Transcripts of focus group discussions were evaluated for common themes by the authors and through the use of NUD*IST. Main Outcome Measures Willingness to sell syringes to all customers, views on syringe exchange programs (SEPs), knowledge of laws governing syringe sales and racial, ethnic, or gender biases in syringe selling practices. Results Two pharmacists established their own policies of selling syringes to everyone, and three expressed a willingness to have their pharmacies serve as SEPs. A total of 20% of the pharmacists expressed an interest in learning more about the efficacy of SEPs and distribution of syringes by pharmacists, and were willing to change their views based on this information. Many also indicated a general willingness to work with SEPs or to participate in the effort to curb the spread of HIV. However, a majority of pharmacists opposed having SEPs in their pharmacies and reported selling syringes only within specific limits: to known diabetics, to individuals who looked reasonable, or to individuals who presented a logical explanation. No racial, ethnic, or gender bias was observed. Conclusion Opinions among pharmacists varied across and within sites. While a majority of pharmacists would not establish SEPs in their own pharmacies, nearly all would participate in other HIV-prevention programs. Educational programs for pharmacists may be valuable in HIV-prevention efforts.

Objective To examine injection drug users (IDUs) opinions and behavior regarding purchase of sterile syringes from pharmacies. Design Focus groups. Setting Urban and rural sites in Colorado, Connecticut, Kentucky, and Missouri. Patients or Other Participants: Eight focus groups, with 4 to 15 IDU participants per group. Interventions Transcripts of focus group discussions were evaluated for common themes by the authors and through the use of the software program NUD*IST. Main Outcome Measures Knowledge of human immunodeficiency virus (HIV), pharmacy use, barriers to access from pharmacies, high-risk and risk-reducing behavior, and rural/urban difference. Results Almost all participants knew the importance of using sterile syringes for disease prevention and reported buying syringes from pharmacies more than from any other source. Two IDUs believed pharmacists knew the syringes were being used for injecting drugs and perceived pharmacists' sales of syringes to be an attempt to contribute to HIV prevention. Most IDUs reported that sterile syringes were relativity easy to buy from pharmacies, but most also reported barriers to access, such as having to buy in packs of 50 or 100, being made to sign a book, having to make up a story about being diabetic, or having the feeling that the pharmacists were demeaning them. While the majority of IDUs reported properly cleaning or not sharing syringes and safely disposing of them, others reported inadequate cleaning of syringes and instances of sharing syringes or of improper disposal. There were few differences in IDUs' reported ability to buy syringes among states or between urban and rural sites, although the data suggest that IDUs could buy syringes more easily in the urban settings. Conclusion For the most part, participants understood the need for sterile syringes in order to protect themselves from HIV, hepatitis B virus, and hepatitis C virus and saw pharmacies as the best source of sterile syringes. Although these data are not generalizable, they suggest that pharmacists can and do serve as HIV-prevention service providers in their communities.

*Objective: The goal of this project was to categorize and classify bulletin board postings pertaining to pharmaceutical policy from both the professional and lay press. Methods: Bulletin board postings were used to supplement in-class discussion to keep students, faculty and staff up-to-date on emerging trends. A bulletin board located in the main classroom area of the College of Pharmacy Building where students would pass by on the way to class and congregate during break periods was used to display articles from various sources concerning topics related to pharmaceutical policy. Information is presented about the primary subject matters addressed in the articles, the types of publications from which they were drawn, and the top ten sources of articles displayed. Results: This project showed that coverage of issues related to pharmacists is predominantly seen in newspapers and most pertinent issues are business related. Conclusions: It can be seen from this analysis that the issues facing pharmacists are varied. The pharmaceutical policy field is transforming and many of these changes are very relevant to the general population. This is seen from the coverage of all of these issues in the lay press.

Widespread use of social media applications like Facebook, YouTube, and Twitter has introduced new complexities to the legal and ethical environment of higher education. Social communications have traditionally been considered private; however, now that much of this information is published online to the public, more insight is available to students' attitudes, opinions, and character. Pharmacy educators and administrators may struggle with the myriad of ethical and legal issues pertaining to social media communications and relationships with and among students. This article seeks to clarify some of these issues with a review of the legal facets and pertinent court cases related to social media. In addition, 5 core ethical issues are identified and discussed. The article concludes with recommendations for pharmacy educators with regard to preparing for and addressing potential legal issues pertaining to social media.

To compare the regulations of state boards of pharmacy for pharmacist intern supervision and review publications of service-learning experiences in pharmacy curricula for methods of supervision.Online state pharmacy statutes and board of pharmacy regulations were searched to characterize which states' regulations included provisions for the supervision of pharmacist interns, permitted nonpharmacist supervision for student volunteers, and included provisions on interns participating in the practice of pharmacy. Additionally, a PubMed search was conducted for articles describing the supervision of service-learning experiences of pharmacy students at various colleges and schools of pharmacy.The state boards of pharmacy in all 51 jurisdictions included regulations for the supervision of pharmacist interns. Regulations specifically permitted only pharmacist supervision of interns in 45 (88%) jurisdictions, and 3 (6%) states included provisions allowing nonpharmacist supervision of pharmacist interns. Provisions allowing nonpharmacist supervision on a case-by-case basis existed in 6 (12%) jurisdictions. Among the 32 identified reports of service-learning experiences offered in pharmacy curricula, 14 contained the words "supervision" or "supervise," and 9 indirectly described methods of student supervision.State boards of pharmacy regulations largely prohibited nonpharmacist supervision of pharmacy students, and reports of pharmacy student service-learning experiences frequently omitted descriptions of student supervision. Boards of pharmacy should consider revising existing regulations to address the growing need for service-learning in pharmacy curricula.

In the United States the number of elderly and their percentage of the total population continues to increase. The large majority will never require care in an institution, yet they are faced with increasing health problems and decreased mobility, and almost half require prescription drugs to pursue activities of daily living. In this paper selected patterns of pharmacy patronage among a sample of elderly are presented. Overall, the percentage of elderly requiring prescriptions reflects national estimates and no significant difference is found in the expressed need for prescriptions between black and respondents. ‘Neighborhood’ pharmacies are perceived as being very important, but relatively few use the most geographically convenient. Nevertheless, the large majority of elderly are satisfied with distances they presently have to travel to purchase prescriptions. The observed travel patterns for prescription purchases suggest that conventional wisdom pertaining to the nature of the pharmacy journey, the notion of convenience and the traditional concept of neighborhood among the elderly should be reexamined.

The legality of state requirements that professionals participate in continuing professional education is discussed. The historical development of the requirement in pharmacy is reviewed, and the legal doctrine of police power is considered as the basis for legal requirements in this area. The need for a statutory basis for this condition is presented, and court cases wherein such requirements have been challenged are reviewed. There must be statutory authorization for imposing continuing education requirements for professionals, and the statute and regulations affecting the rule must not infringe on an individual's constitutional rights.

Tax issues related to sales of medications to outpatients by pharmacies in nonprofit hospitals are described. Hospitals are increasing their emphasis on development of ambulatory-care programs. Two aspects of the tax implications of such services are (1) whether revenue from sales of medications to ambulatory patients constitutes "unrelated business income" for the nonprofit hospital and thus is taxable and (2) whether engaging in dispensing of medications to ambulatory patients might jeopardize the tax-exempt status of the hospital. Various rulings from the Internal Revenue Service and court cases are reviewed. Sales of medications to members of the general public who are unrelated to the hospital are taxable. Sales of medications for the convenience of hospital patients, and irregular and intermittent sales to the public by a pharmacy that normally serves only "patients," are tax exempt. Sales of medications to the public probably do not jeopardize the tax-exempt status of a hospital so long as the primary purpose of the hospital is consistent with permissible tax-exempt purposes.

Liability issues of hospitals with contract-managed pharmaceutical services are discussed. The number of hospitals with pharmaceutical services operated by outside organizations is rapidly increasing. Because pharmacy personnel are employed by the contractor rather than the hospital, a hospital's liability for the actions of these employees is related to the specific agreement between the hospital and the contractor. Application of the doctrine of respondeat superior to these contractual arrangements and specific factors determining the degree of control that the hospital has over contracted employees are discussed. Hospitals contemplating the use of contract-managed pharmaceutical services should determine the exact nature of their liability for the actions of contracted employees.

As the pharmacist's clinical role expands he is confronted with legal questions concerning actual or proposed activities. A number of papers have appeared in the literature of pharmacy which address the potential legal liability of the pharmacist who engages in clinical activity but most are written in terms of general principles of law with few specific circumstances addressed. In this article, legal questions raised by clinical pharmacists in the course of their everyday practices are evaluated and discussed. Among the issues presented are use of an FDA-approved drug for an unapproved use, informed consent in administration of unapproved drugs, the role of the pharmacist in managing hypertensive patients visiting a hospital-based clinic, the legality of a pharmacist administering injectible drugs, the legality of permitting Pharm.D. students to draw blood, and the application of the Federal Food, Drug and Cosmetic Act to the preparation of aluminum hydroxide cookies for dialysis patients. The specific questions are answered and the legal standard of care expected of pharmacists performing clinical functions is discussed. While no cases have been decided yet concerning newer clinical activities, some precedent can be found in past cases. Approaches to handling these questions should be of value in addressing future legal issues presented as pharmacists further seek to better utilize their knowledge.