Includes bibliographical references.

Systematic review of medication synchronization in community pharmacy practice -- The proportion, conditions, and predictors of emergency department visits that can be potentially managed by pharmacists with expanded scope of practice -- A theoretically informed survey of the views and experiences of practicing pharmacists on research conduct, dissemination and translation -- A case study of the implementation and sustainability of medication reviews in older patients by clinical pharmacists -- Benzodiazepine use risk: Understanding patient specific risk perceptions and medication beliefs -- Framework for assessing pharmacy value -- Depression treatment use among stroke individuals with depression: A cross-sectional analysis of the Medical Expenditure Panel Survey -- How the quality of essential medicines is perceived and maintained through the pharmaceutical supply chain: A perspective from stakeholders in Nigeria -- Applying participatory design to a pharmacy system intervention -- Partnering with the Department of Insurance: Coordinating a clinical and regulatory review of formulary benefit designs -- Partnering with the Department of Insurance: Coordinating a clinical and regulatory review of formulary benefit designs -- The prevalence of drivers under the influence of medical cannabis must be considered within proper context -- Visibility of evidence-based pharmacy on PubMed – Identity crisis? -- Methodological aspects when assessing the inter-rater reliability of medication error classification – A response to a letter to editor -- Free InterApp ARV: The subsequent version of SIMARV® to analyse the clinical relevance of drug interactions with antiretroviral agents in patients with HIV/AIDS -- Healthcare professionals’ competence in using inhaler devices: A wake-up call for immediate action in low-income countries -- Can existing tools predict older adults' willingness to deprescribe? Considerations for D-PRESCRIBE's post-hoc secondary analysis.

[Article Title: Systematic review of medication synchronization in community pharmacy practice/ Michael Patti, Chelsea Phillips Renfro, Rachael Posey, Gabrielle Wu, Kea Turner and Stefanie P. Ferreri, p. 1281-1288]

Abstract:

Background
Medication non-adherence costs more than 100 billion dollars in avoidable hospitalizations yearly. As a result, community pharmacies have implemented medication synchronization programs to improve adherence. One function of most medication synchronization programs is the alignment of all of a patient's medications to refill on a single date. While aligning refills is a standard aspect of most programs, other features vary making it difficult to identify which program components lead to improved adherence.

Objective
To review available literature and identify core components of medication synchronization and associated implementation techniques in community pharmacy.

Methods
A systematic review was performed by searching electronic databases for studies, reviews, and other sources for grey literature discussing medication synchronization in community pharmacy settings. Studies were eligible for inclusion if they documented the operation of medication synchronization program in a community pharmacy. A framework analysis identified common themes present in the literature.

Results
Twenty-six studies met criteria for final inclusion in this review. The majority of studies were retrospective cohorts, commentaries, and implementation guides. A wide variety of core components were included as part of medication synchronization program descriptions in the available literature. Several core components were identified as consistent throughout most of the published literature. These components were the identification and enrollment of patients, inclusion of a medication review and patient assessment, the alignment of refills, a formal process for preparation of medications, and the delivery of medications and other services.

Conclusions
This review identified several common themes of medication synchronization in the literature, which could help standardize medication synchronization within community pharmacy and facilitate future research. Themes found in this review provide the foundation upon which a consensus definition of medication synchronization can be built.

https://doi.org/10.1016/j.sapharm.2018.11.008

[Article Title: The proportion, conditions, and predictors of emergency department visits that can be potentially managed by pharmacists with expanded scope of practice/ Mhd Wasem Alsabbagh and Sherilyn K.D. Houle, p. 1289-1297]

Abstract:

Background
Pharmacists have been shown to be beneficial for inclusion in emergency department (ED) services; however, little has been done to assess these benefits with pharmacists having even wider scopes of practice, including limited prescribing authority.

Objectives
The aims of this study were to determine the proportion of ED visits that can potentially be managed by pharmacists, the most prevalent conditions within these cases, and the factors associated with patients presenting with such cases to the ED.

Methods
This was a retrospective quantitative cohort study using administrative databases from 2010 to 2017. Among all unscheduled ED visits in Ontario, all visits with a Family Practice Sensitive Condition and Canadian Triage and Acuity Scale score of IV or V were identified, in addition to conditions that can be managed by pharmacists with expanded scope. Logistic regression was performed to identify determinants of having a potentially pharmacist-manageable condition.

Results
Of 34,550,020 ED visits identified, 12.4% (n = 4,293,807) were considered FPSC with CTAS IV or V. Of these, 1,494,887 (34.8%) were for conditions considered to be potentially manageable by pharmacists, representing 4.3% of all ED visits. The most frequent diagnoses observed were: acute pharyngitis, conjunctivitis, rash and other nonspecific skin eruption, otitis externa, cough, acute sinusitis, and dermatitis. Female gender, having a family physician or presenting with a CTAS of IV were associated with higher odds of presenting to the ED, while increased age and income were associated with lower odds.

Conclusions
Under an expanded scope, pharmacists could potentially have managed nearly 1.5 million cases presenting to the ED over the study period. The introduction of ED-based or community pharmacists practicing under an expanded scope may have a positive impact on overcrowding in EDs.

https://doi.org/10.1016/j.sapharm.2018.12.003

[Article Title: A theoretically informed survey of the views and experiences of practicing pharmacists on research conduct, dissemination and translation/ Derek Stewart, Scott Cunningham, Alison Strath, Andrew MacLure, Kathrine Gibson-Smith, Gordon F. Rushworth, Tobias Dreischulte, Christopher Nicolson, David Pfleger, Dawn Tiernan and Katie MacLure, p. 1298-1308]

Abstract:

Background
While studies have reported pharmacists’ perspectives of research involvement, almost all are limited by sector, have little focus on research translation and have not incorporated behavior change theory.

Objective
To determine pharmacists’ views and experiences of research conduct, dissemination and translation.

Methods
This was an electronic cross-sectional survey of pharmacists across six Scottish health board areas. Survey items were: demographics; research activities (e.g. conduct, dissemination) in the last two years; research interests, experience and confidence in research tasks (e.g. proposal writing, data collection); and Likert statements on research conduct and dissemination, and translating research findings to practice. Conduct/dissemination and translation items were based on the Theoretical Domains Framework (TDF). Data were analysed using descriptive and inferential statistics, and principal component analysis (PCA) of TDF items. Following determination of internal consistency, scores for each component were calculated.

Results
The response rate was 19.4% (136/701), with 17 (12.5%) currently involved in research. Responses were more positive for interest in research than experience or confidence. PCA of research conduct/dissemination items identified three internally reliable components of support/opportunities, motivation/outcomes, and roles/characteristics. Component scores for support/opportunities to participate in research were most negative. PCA of translation items identified three internally reliable components of current practices/abilities, consequences and support. Scores for all three components were positive, being most positive for consequences of research translation. Those in secondary care, with a postgraduate qualification and prescribers scored higher for interest, experience, confidence, and for most components (p < 0.05).

Conclusion
A minority of pharmacists are involved in the research conduct/dissemination and these are more likely to be highly qualified individuals based in secondary care. Given the need to develop and evaluate new models of pharmaceutical care, involvement should be extended to all practice settings. Study findings could be used to develop behavior change interventions targeting individuals and organizations.

https://doi.org/10.1016/j.sapharm.2018.12.005

[Article Title: A case study of the implementation and sustainability of medication reviews in older patients by clinical pharmacists/ Thomas G.H. Kempen, Ulrika Gillespie, Maria Färdborg, Jennifer McIntosh, Alpana Mair and Derek Stewart, p. 1309-1316]

Abstract:

Background
Medication reviews have been introduced as healthcare interventions to decrease inappropriate polypharmacy in older patients, but implementation in practice is challenging.

Objective
This case study aimed to explore the events, actions and other factors that were involved in the implementation and sustainability of medication reviews in older patients by clinical pharmacists in Region Uppsala, Sweden.

Methods
A case study design informed by change management principles (Kotter) and normalization process theory, consisting of a review of published and grey literature, key informant interviews and focus group triangulation. Findings from additional literature review and interviews were integrated into a final thematic analysis. Ten healthcare professionals, managers and policy makers participated as key informants. The study included data up to 2015.

Results
Factors were identified across all Kotter's principles and normalization process theory domains, ranging from the first evidence on inappropriate polypharmacy in the 1980s until the creation of permanent clinical pharmacist positions in recent years. Examples of facilitating factors were a national focus on quality of care for the elderly, multiprofessional teamwork, key individuals with different professions, education, financial support and local evidence. Barriers included an unclear allocation of tasks and responsibilities, a lack of time and continuity, and a lack of a national plan for implementation, monitoring and evaluation.

Conclusions
Multiple factors across the full range of change management and implementation principles were involved in the implementation and sustainability. A systems approach, including these factors, should be considered in similar future initiatives, both in Sweden and settings in other countries.

https://doi.org/10.1016/j.sapharm.2018.12.006

[Article Title: Benzodiazepine use risk: Understanding patient specific risk perceptions and medication beliefs/ Fatema-Tun-Naher Sake, Keith Wong, Delwyn J. Bartlett and Bandana Saini, p. 1317-1325]

Abstract:

Background
Benzodiazepines are widely prescribed psychotropic medications. These medications have the potential to cause alertness impairing effects and their prolonged use is associated with serious adverse effects. Despite the listed adverse health outcomes and provision of warnings, many benzodiazepine users tend to ignore the safety information and use them inappropriately.

Objective
To elicit the risk perceptions of benzodiazepine users and explore the association of risk perceptions with their socio-demographic factors or medication use profiles (e.g. past withdrawal attempt, length of use and future willingness to try behavioural alternatives).

Methods
Point of purchase surveys were conducted with patients who were supplied benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included questions about patient's demographic characteristics, their past attempt for withdrawing benzodiazepines and their future intention to consider alternative behavioural therapies. The validated Beliefs about Medications Questionnaire (BMQ-specific) and a customised scale assessing risk perception were included in the survey. Data obtained from the surveys were entered into the IBM SPSS package (Version 22.0) and subjected to descriptive, correlational and regression analyses.

Results
Seventy-five patients (67% female, a mean age of 54.3) obtaining benzodiazepines from 12 pharmacies were recruited for the survey. Participant's beliefs regarding potential side effects of benzodiazepines and their level of education were significantly associated with their risk perception scores. While the overall risk perception scores did not influence patient's previous attempts to withdraw benzodiazepines, the risk perception score about immediate effects of benzodiazepines (within 3–4 h of consumption) was a predictor of preference for behavioural therapies. Eighty-three percent (n = 62) of the participants believed that pharmacists can play a key role in improving risk perceptions of consumers around benzodiazepine use.

Conclusions
Individual patient characteristics and their beliefs about medications significantly influence their perception of risk about benzodiazepine use. The findings of this study suggest that pharmacist support can be utilized in effective risk communication, promoting the safe use of benzodiazepines and in facilitating the uptake of relevant behavioural interventions as alternatives to benzodiazepines.

https://doi.org/10.1016/j.sapharm.2018.12.007

[Article Title: Framework for assessing pharmacy value/ Benjamin Y. Urick and Julie M. Urmie, p. 1326-1337]

Abstract:

Introduction
Excess spending and poor quality in the US healthcare system has led to proliferation of performance-based payment models. These models have the potential to enhance value by creating a meritocratic system whereby providers delivering the best patient care are rewarded, while providers failing to provide such care are given incentives to improve.

However, early experience suggests that unless these systems are appropriately designed, payments can be withheld from high performers, bonuses paid to low performers, and health disparities can be worsened. Performance-based payments are new to community pharmacies, and opportunity exists to strengthen pharmacy value measurement and potentially avoid problems observed with other performance-based payment models.

Model construction and application
This article describes the process by which a framework to assess community pharmacy value was developed, then applies the framework to produce a draft composite pharmacy performance measure. The pharmacy value framework addresses potential shortcomings of existing community pharmacy performance measures through four key principles: 1) theory-based quality and spending measures, 2) scoring which accounts for measure reliability, 3) full risk-adjustment, and 4) a value matrix to identify high and low value pharmacies. Based on these principles, a draft community pharmacy composite performance measure was developed, and was successful in dividing community pharmacies into high, typical, and low value categories.

Conclusion
By using this framework to develop future composite measures, payers may find closer alignment between performance-based payments and actual pharmacy performance. This early work is intended to encourage further research into the establishment of a scientifically firm foundation for pharmacy performance measurement. More testing is needed to determine reliability, validity, and comparative superiority of any composite measure derived from this framework before it is used to support performance-based pharmacy payment models.

https://doi.org/10.1016/j.sapharm.2018.12.008

[Article Title: Depression treatment use among stroke individuals with depression: A cross-sectional analysis of the Medical Expenditure Panel Survey/ Raj Desai and Kalyani Sonawane, p. 1338-1343]

Abstract:

Background
Depression is the most prevalent psychiatric comorbidity among stroke individuals. Despite the effectiveness of antidepressants and psychotherapy, data on the use of these treatments among stroke survivors is limited.

Objective
The main objective of this study was to document prevalence of antidepressant use, types of antidepressants utilized, and adherence to antidepressants among stroke individuals.

Methods
Retrospective, cross-sectional data obtained from the Medical Expenditure Panel Surveys (MEPS), for the years 2011, 2013 and 2015, was utilized for this study. Treatment for depression was categorized into three mutually exclusive categories: 1) antidepressants only, 2) antidepressants and psychotherapy (combination), and 3) No treatment. Adherence to antidepressants was measured using the Proportion of Days Covered (PDC) ratio. Adherence between antidepressant only and combination therapy group was compared using Student's t-test. A multinomial logistic regression analysis was used to further examine the association between patient characteristics and likelihood of receiving depression treatment.

Results
A total of 759 stroke individuals with comorbid depression were identified. Of these, 51.2% utilized only antidepressants, 12.6% utilized a combination treatment of antidepressants and psychotherapy and 31.7% did not receive treatment for depression. Selective Serotonin Reuptake Inhibitors (SSRI's) was the most commonly used antidepressants in the stroke population. Males (P = 0.04), age group of 40–64 years (P < 0.001), and African Americans (P = 0.02) constituted for the highest proportions of untreated stroke survivors. Among treated stroke individuals, adherence was higher for combination therapy users compared to those using antidepressants only (mean PDC = 65.8 ± 6.89 and 57.6 ± 3.74, respectively).

Conclusion
Almost 70% of stroke individuals received some form of treatment for depression and several patient-related factors (gender, age, race, marital status, and comorbidity burden) were associated with the utilization of depression treatment. Future researchers need to investigate the factors responsible for lack of depression treatment in stroke individuals and policy makers should aim for a more patient centered care.

https://doi.org/10.1016/j.sapharm.2018.11.009

[Article Title: How the quality of essential medicines is perceived and maintained through the pharmaceutical supply chain: A perspective from stakeholders in Nigeria/ Chioma Amadi and Emma K. Tsui, p. 1344-1357]

Abstract:

Background
Limited access to essential medicines for maternal and child health is a preventable cause of pregnancy-related deaths. This remains a predominant challenge in Nigeria, where sub-standard and falsified medications have historically been associated with maternal mortality. An in-depth understanding of perceptions surrounding quality assurance of essential medicines is pertinent for developing effective and sustainable interventions.

Objective
To examine stakeholder perspectives on quality control of essential medicines for maternal and child health, while characterizing pharmaceutical distribution of medicines in Nigeria.

Methods
Key informant interviews were conducted with a purposive sample of 26 participants between January and June 2018. Eligible participants included: pharmacists, pharmaceutical sales representatives (pharm reps), supply chain employees of pharmaceutical industries and regulatory agency personnel, working in the public or private health sector in either of the four states: Lagos, Enugu, Imo or Port-Harcourt. A 6-item survey was administered to collect demographic information on the participants. This was followed by 15 semi-structured questions to gather qualitative data on the subject matter.

Results
Verifying vendor credibility and use of identifiable regulatory markers were the most common methods adopted by pharmacists and pharm reps with the intent to control quality of medicines. Key challenges in assuring quality included: inefficiency of regulatory agencies, illicit sales of prescription medicines by patent medicine vendors, existence of open markets and failed policy implementation. While pharmacists and pharm reps solicited improved regulations and policy implementation; NAFDAC personnel primarily recommended an increased government funding to improve their efficiency.

Conclusion
Beyond stakeholder recommendations, a fervent and consistent commitment on the part of the government is needed to improve quality assurance in Nigeria's pharmaceutical system. Public-private partnerships should be explored to address funding limitations to quality assurance. Future studies need to examine challenges and opportunities surrounding policy implementation, and regulatory enforcement in pharmaceutical distribution.

https://doi.org/10.1016/j.sapharm.2018.11.011

[Article Title: Applying participatory design to a pharmacy system intervention/ Apoorva Reddy, Corey A. Lester, Jamie A. Stone, Richard J. Holden, Cynthia H. Phelan and Michelle A. Chui, p. 1358-1367]

Abstract:

Background
Stakeholder engagement is an important component of the research process for improving the use and uptake of patient-centered health care innovations. Participatory design (PD), a method that utilizes the involvement of patients and other stakeholders, is well-suited for the design of multifaceted interventions in complex work systems, such as community pharmacies, that have diverse and dynamic end-users.

Objective
The objective is to describe a blueprint for how to use PD when designing a community pharmacy intervention. This paper outlines the steps of PD and highlights the advantages and disadvantages of this method.

Methods
PD is explained step-wise to underscore the considerations required of researchers unfamiliar with PD. This includes the development of a tailored PD approach, PD session preparatory work, data collection, and intervention development and evaluation. The stakeholders recruited for the community pharmacy intervention were pharmacy staff and older adult patients who received prescriptions at the pharmacy corporation in which the intervention was being implemented. The PD process was a series of six adaptive sessions: (1) problem identification, (2) solution generation, (3) convergence, (4) prototyping, (5) initial evaluation, and (6) formative evaluation.

Results
A description of the PD process to design a community pharmacy intervention is provided. The process led to the development of a patient-centered prototype. The advantages of using PD included the opportunity to clarify problems faced by stakeholders, generation of novel solutions to incorporate into the intervention, and the ability to vet and fine-tune stakeholder design ideas in an iterative fashion. The insight gained was unprecedented and invaluable to the researchers. The biggest challenge of employing PD was the time-sensitive and time-intensive nature of developing each session, collecting data, and reflecting on the results in order to design subsequent sessions.

Conclusions
The PD process led to the development of a patient-centered prototype. PD enabled stakeholders to generate creative solutions and provide unique insight on addressing issues faced in healthcare redesign research and specifically in community pharmacies.

https://doi.org/10.1016/j.sapharm.2018.11.012

[Article Title: Partnering with the Department of Insurance: Coordinating a clinical and regulatory review of formulary benefit designs/ Carriann Smith and Annette McFarland, p. 1368-1371]

Abstract: This case report summarizes a partnership between Butler University College of Pharmacy and Health Sciences and the Indiana Department of Insurance. The report outlines the review of qualified health plans sold on the marketplace. Details are provided on how the College responded to requests by the department to provide a more comprehensive review of marketplace formularies. This included the development of clinical appropriateness tools for multiple disease states. The aim of this partnership was to improve prescription coverage for Indiana residents and address formulary design discrimination.

https://doi.org/10.1016/j.sapharm.2018.12.002