Impact of the COVID-19 pandemic on pharmacists practicing in community pharmacies in the state of Nebraska.

BACKGROUND: The rapid increase in COVID-19 combined with uncertainty surrounding transmission and treatment protocols resulted in unprecedented burnout amongst health care workers. As other health care workers scrambled to support patients, community pharmacists quickly responded to the pandemic by extending their services. This constantly changing environment amongst other factors created a high degree of psychological burden associated with COVID-19 for pharmacists. Although studies have examined the psychological impact of the pandemic on frontline health care workers, pharmacists are rarely included in these studies. OBJECTIVE: To examine the impact of COVID-19 on work and personal well-being from the perspective of pharmacists practicing in community pharmacies in Nebraska. METHODS: A cross-sectional online survey collected data from pharmacists with an active Nebraska Pharmacist license (N=2763) from November 2022 to January 2023. The survey was a hybrid of researcher-developed items and the validated abbreviated Maslach Burnout Inventory (aMBI). The aMBI is a 9-item Likert-scale scored instrument, which captures three domains of burnout: Personal Accomplishment; Emotional Exhaustion; and Depersonalization. Data was analyzed using IBM SPSS Statistics version 27. RESULTS: The response rate to the survey was 12.3% (n=339). Mean age of the respondents was 44.8 years with an average of 18.7 years in practice. Most respondents (n = 113, 50.7%) practiced in a community pharmacy followed by hospital (n = 72, 32.3%). 55.8% of community pharmacists reported that they considered leaving their current employer. Chi-square analysis confirmed that community pharmacists are more burned out than noncommunity pharmacists. CONCLUSIONS: Pharmacists realized they had not been recognized for their contributions as frontline health care workers, which motivated them to consider leaving their employer and even the profession of pharmacy. This study found community pharmacists are burned out more than non-community pharmacists. Within community pharmacies, it was found that pharmacists practicing at corporate-owned community pharmacies had increased burnout compared to those practicing in independent community pharmacies.

A survey of university students on attitudes, behaviors, and intentions toward influenza vaccination.

Objective To determine attitudes, behaviors, and intentions of university students regarding influenza vaccination.ParticipantsUndergraduate, graduate, and professional students enrolled at a private, midwestern university.Methods A 24-item electronic survey was designed and distributed after literature review and inputs from experts on immunizations. Bivariate tests were performed to observe differences between various subgroups of respondents (age, gender, race/ethnicity, housing, and academic program). Multivariate logistic regression was performed to find associations with their vaccination preferences.Results Of 3,267 complete responses (36.3% of total students), 75% reported obtaining influenza vaccination in 2016-2017. Vaccination rates were highest for Asian (81.0%) and lowest for Black students (59.6%). Health professional student vaccination rates of 89.3% were achieved with a vaccination mandate in place. Lowest immunization rates were identified for law (47.1%) and business (52.7%) students. Positive promotional factors were identified.Conclusions Access to free, on-campus vaccinations, mandates and promotional efforts are associated with high influenza vaccination rates.

Independent community pharmacies' provision of enhanced services: A mixed methods approach.

BACKGROUND: The pharmacy profession continues to broaden toward a patient-centered care practice. Pharmacy members of formal enhanced services networks are embracing this practice. However, descriptions of how pharmacies adopt a patient-centered care practice by providing enhanced services are not widely known. OBJECTIVES: To explore the pharmacy services of Nebraska independent community pharmacists within the context of the pharmacy profession's transition toward patient-centered care and determine if pharmacy participation in a formal enhanced pharmacy services network is associated with the provision of enhanced services. METHODS: A mixed methods approach was used by first conducting a cross-sectional quantitative survey, followed by a small qualitative study to further explain the survey findings. The survey of 193 Nebraska independent community pharmacies included members and nonmembers of the Nebraska Enhanced Services Pharmacies (NESP) network. Data were collected on the enhanced services offered. Survey analyses used descriptive and inferential statistics. Qualitative data on reasons for offering enhanced services and their profitability were subsequently collected using a focus group of 3 independent community pharmacy owners. The interview transcript analysis used coding to generate major themes. RESULTS: The survey response rate was 59%. Across all respondents, the average number of enhanced services offered was 17.3 out of 47 services studied. NESP members provided more enhanced services (x¯ = 20) than non-NESP members (x¯ = 16), P = 0.003. NESP membership was associated with the opinion that offering enhanced services increases profits, P = 0.016. The major themes were "NESP members have always been taking care of people" and "Profitability from enhanced services is key for sustainability of independent community pharmacies." CONCLUSION: Independent community pharmacies provide a range of enhanced services. NESP members provided more enhanced services than non-NESP members and focused on taking care of people by providing enhanced services. NESP membership may provide opportunities for pharmacies to offer more enhanced services to patients with the intent to improve patient-centered care.

National survey of diabetes self-management program coordinators views about pharmacists' roles in diabetes education.

OBJECTIVES: To examine the viewpoints of diabetes self-management training (DSMT) program coordinators about the roles and engagement of pharmacists who participate in DSMT programs, and the engagement between community pharmacies and DSMT programs by developing and administering a nationwide survey. DESIGN: A mixed-methods exploratory sequential design; initial qualitative phase followed by a quantitative phase. Six in-depth interviews of DSMT program coordinators and intensive literature review informed the development of a 20-item survey instrument. Survey responses were descriptively analyzed, and themes were generated from context analysis of open-ended questions to generate the overall findings. SETTING AND PARTICIPANTS: The survey was distributed in 2017 to 742 active American Association of Diabetes Educators DSMT program coordinators in the United States. OUTCOME MEASURES: Proportion of DSMT programs engaging pharmacists and description of pharmacist's roles. Content areas pharmacists teach in DSMT programs. Challenges faced by pharmacists in completing 1000 direct patient hours as a prerequisite for attaining Certified Diabetes Educator certification and strategies used to overcome them. Perceived benefits of pharmacist involvement by coordinators and patients. RESULTS: One-third of DSMT programs have pharmacists involved with most using pharmacists as educators. Coordinators believe that pharmacist care is highly beneficial to patients and recognize that community pharmacist's care is an added benefit to patients. However, collaborative practices are not well established between community pharmacists and DSMT programs. Program coordinators identified challenges they face when trying to involve community pharmacists in program delivery. CONCLUSION: Coordinators of DSMT programs and their patients see pharmacists' care as highly beneficial within DSMT programs. Increasing participation and scope of community pharmacists' involvement is desired by both DSMT coordinators and the patients they serve. There is substantial growth potential for both greater involvement of pharmacists in DSMT programs and enhancing links to community pharmacists' care.

Patient safety perspectives of providers and nurses: the experience of a rural ambulatory care practice using an EHR with E-prescribing.

PURPOSE: The purpose of this study was to identify and describe safety improvements and concerns indicated by providers and nurses in a rural community ambulatory care practice using an electronic health record with an e-prescribing feature (EHR with eRx). METHODS: Two focus groups were conducted; 1 with providers and the other with nurses. Participants responded to questions and discussed their perceptions of safety improvements and concerns with use of an EHR with eRx. Transcripts were analyzed using sequential and continuous analytic methods. FINDINGS: Three themes centered on efficiency and patient safety emerged from data analysis: (1) EHR with eRx adoption has led to new improvements and concerns for patient safety, (2) the EHR with eRx has affected efficiency in the clinic, and (3) EHR with eRx adoption has led to workarounds. CONCLUSIONS: Concerns remain among providers and nurses regarding the use of EHR with eRx applications, although concerns differed between groups. Therefore, When EHR improvements are planned, it is important to consider the differing needs of the professionals who deliver care.

Critical care transportation by paramedics: a cross-sectional survey.

OBJECTIVE: The purpose of this study was to gather data from paramedics practicing in the critical care transport setting to guide development of the education, training, and clinical practices for certification as a critical care paramedic. METHODS: A paper survey of 1991 randomly selected nationally registered (NREMT) paramedics was conducted. Nine paramedics with residences in small US Pacific Island territories were not included in the survey. RESULTS: We received 610 responses (30.6%). Respondents that stated that they provided critical care transport services reported using pediatric skills and equipment the most and intracranial pressure monitoring the least. Paramedics served as the primary provider for pediatric patients (72.5%), 12-lead electrocardiogram (66.3%), intravenous infusion pump (76.7%), mechanical ventilator (66.9%), central line management (63.1%), and chest tube management (63.3%). Paramedics served in a team member capacity most often with neonatal isolette (71.8%), intra-aortic balloon pump (79.2%), and ICP monitoring (64.9%). The majority provided ground critical care transport (249) compared to 44 rotor-wing and 6 fixed-wing. Sixteen respondents reported serving as primary providers on combinations of ground, rotor-, and fixed-wing services. CONCLUSIONS: Paramedics reported being the primary provider on the critical care transport team and performing skills while using equipment and administering medications that exceeded their education and training as paramedic and, at times, without the benefit of any additional education or training. National appreciation of this reality should spur development of standardized education, licensing or certification, and continuing education to prepare paramedics for their role as critical care medical providers.

The relationship between physician practice characteristics and physician adoption of electronic health records.

BACKGROUND: Health information technologies, such as electronic health records (EHRs), can potentially improve patient safety in our health care system. The potential advantages include increased quality and more efficiency in the care of patients. Adoption of EHRs has been slow despite these advantages and a national call for EHR implementation. PURPOSES: This article explores factors associated with the adoption of EHR systems using organizational theory to derive hypotheses as to why physicians would adopt EHRs. METHODOLOGY/APPROACH: : A survey was administered to all office-based physicians in Nebraska and South Dakota using a modified Dillman technique between July and November 2007. The main outcome variable measured physician EHR adoption status at three levels: not planning to use an EHR, planning to use an EHR, and using an EHR. Factors associated with EHR status were analyzed using a multinomial logistic regression. FINDINGS: Approximately 30% of physicians reported using an EHR in his or her practice. Physicians adopting EHRs were younger and had access to internal health information technologies support. In addition, working in an independent practice decreased the likelihood of physicians using and adopting EHRs. PRACTICE IMPLICATIONS: This research provides further evidence of the barriers impeding EHR adoption. One such barrier includes the lack of access to internal information technology support staff versus having to outsource for technical support services. From a resource dependency perspective, barriers illustrated by this example may place undue dependencies on physicians if they pursue an EHR system. By addressing these barriers, physicians may be in a better position to adopt EHR system into his or her practice.

Interobserver reliability in the interpretation of diagnostic lumbar MRI and nuclear imaging.

BACKGROUND CONTEXT: Assessment of patients with complaints of low back or leg pain varies with the subspecialty of the treating physician. The evaluation of the spine patient may include magnetic resonance imaging (MRI), bone scan, or single-photon emission computed tomography (SPECT) imaging. The interpretation of these tests and the examiner's biases will impact the outcome of patient treatment and the cost to the health-care system. PURPOSE: To evaluate interobserver reliability of MRI and nuclear imaging studies and determine the predictability of nuclear medicine results based upon MRI findings. STUDY DESIGN/SETTING: Retrospective radiographic review for patients with low back pain. MRI, planar bone scan imaging, and SPECT imaging techniques were evaluated. PATIENT SAMPLE: Seventeen patients (80 lumbar levels) who presented to an orthopedic spine specialist with a complaint of mechanical low back or leg pain were randomly selected. Inclusion criteria were age greater than 21 years and a workup that included MRI, bone scan, and SPECT scan images. OUTCOME MEASURES: Interobserver reliability was determined using kappa values (0.6 to <0.8=substantial; 0.8-1=perfect). Interobserver reliability was evaluated for all studies and compared with a "group consensus." METHODS: A team of orthopedists and radiologists of varying experience levels were assembled to interpret the imaging studies. All readings were performed independently followed by group interpretation and discussion. The reviewers were asked to assess each lumbar level (L1-L2 through L5-S1). Phase one: Is the level degenerative? Is there a spondylolisthesis present? Does the level have Modic changes on MRI? Phase two: Based on the MRI, will the planar bone scan be positive? After this prediction, was the planar scan positive? Identify the lesion location (anterior column vs. posterior column). Phase three: Based on their assessment and predicted results on planar bone scan, was the SPECT scan able to improve this assessment? RESULTS: High kappa values were demonstrated in the identification of a degenerative disc, spondylolisthesis, and Modic change (0.773, 0.728, and 0.669, respectively). Bone scan and SPECT scan yielded poorer kappa results (0.539 and 0.460, respectively). Reviewer-predicted bone scan results demonstrated a positive predictive value of 68% and a negative predictive value of 84%. Predicated SPECT results were similar (positive predictive value 66% and negative predictive value 84%). SPECT identified 24% more lesions in the lumbar spine when compared with bone scan. CONCLUSIONS: MRI interpretation of the lumbar spine is comparable between specialties. Nuclear imaging studies (bone scan/SPECT) demonstrated a poorer correlation between examiners. The presence of MRI changes enables an accurate prediction of bone scan or SPECT scan findings. SPECT scan demonstrates an increased sensitivity in the detection of spinal abnormalities and the ability to localize a lesion when compared with planar bone scan.

Resource use in treating alcohol- and drug-related diagnoses.

OBJECTIVE: This study examined the variations in hospital resource use in the treatment of alcohol and drug diagnoses. Specifically, the study tested 2 hypotheses: 1). patients treated in teaching hospitals will have shorter lengths of stay and lower hospital charges than patients treated in nonteaching hospitals; and 2). patients treated in hospitals with more experience treating these conditions will have shorter lengths of stay and lower hospital charges. DESIGN: A retrospective cross-sectional study design used data from the 1996 Health Care Utilization Project to test the proposed hypotheses. PATIENTS/PARTICIPANTS: The population for this study consisted of patients over 18 years old with an acute alcohol- or drug-related discharge diagnostic related group code. MEASUREMENT AND MAIN RESULTS: The variables of interest were teaching hospital status, as defined by the Council of Teaching Hospitals, and hospital experience, defined as the ratio of alcohol- and drug-related diagnoses to the hospital's total admissions. Measures of hospital resource use included the patient's length of stay and total hospital charges. Patients treated at hospitals with relatively more experience in treating alcohol- and drug-related diagnoses had 10.3% (US dollars 321) lower total charges (P =.017). CONCLUSIONS: Similar to research for high-volume surgical hospitals, these findings confirm that hospitals that have greater experience with complex medical conditions such as alcohol and drug intoxication and withdrawal may be more efficient. This important finding provides a rationale for further exploration of the key factors associated with higher quality and more efficient care for complex medical conditions.