Obstacles and approaches for the implementation of external long-term prescription dispensing for chronic diseases / 中国药房

The policy of long-term prescription for chronic diseases in China is gradually being improved and implemented， and external long-term prescription dispensing is being encouraged. The long-term prescription policy runs through the links of drug supply， equipment， use and policy， involving government departments such as medical security and health， as well as stakeholders such as patients， medical institutions and designated detail pharmacies. There are still some problems in the external dispensing of long-term prescriptions， such as the disunity of drug catalogue and the need for coordination among regulatory parties in the policy link； the need to improve the participation enthusiasm and service ability in the equipment link； the increased difficulty of prescription management， the need to improve the circulation platform in the use link. The promotion of external long-term prescription policy requires health insurance， medical service， and the medicine industry co-development， multi-party participation， and policy coordination. Among them， the “dual channel” policy， the policy of centralized medicine procurement， and the pharmacy included in outpatient overall management policy have all played a positive role in promoting the implementation of external long-term prescription dispensing for chronic diseases. It is necessary to improve supporting policies and implement regulatory responsibilities in the policy link， promote drug classification and service capabilities in the equipment link， improve the electronic prescription circulation platform， and strengthen prescription management in use link， so as to promote the implementation of external long-term prescription dispensing.

Antibiotic-Dispensing Patterns and Awareness of Anti-microbial Resistance Among the Community Pharmacists in South-Central India.

Background Anti-microbial resistance (AMR) is an ongoing epidemic contributing to extremely high healthcare costs and hospital admissions. Inappropriate dispensing of antibiotics is one of the root causes of AMR. Hence, our study aimed to assess antibiotic-dispensing patterns and AMR awareness among pharmacists from South-Central India. Methodology This cross-sectional observational study was conducted over a period of two months from June to July 2023. The pharmacies in urban and semi-urban areas of coastal and central districts of the Indian state of Andhra Pradesh were surveyed. Data were collected using a predesigned questionnaire for antibiotic-dispensing patterns and awareness of AMR, as approved by the Institutional Ethics Committee of Aster Ramesh Hospital, Vijayawada, India. The data were collected and analyzed descriptively by cross-tabulation. Results Among the 389 pharmacies that responded, 78% (n = 303) were dispensing antibiotics over the counter (OTC) and 22% (n = 86) were dispensing antibiotics only for valid prescriptions. It was found that antibiotics were dispensed OTC for common ailments such as the common cold, cough, sore throat, nasal congestion, fever, diarrhea, and urinary tract infections. As per the World Health Organization-recommended Access, Watch, and Reserve (AWaRe) criterion, antibiotics under the Watch group such as macrolides (azithromycin), fluoroquinolones (ciprofloxacin, norfloxacin, levofloxacin, and ofloxacin) and third-generation cephalosporins (cefixime and cefpodoxime) were found to be widely dispensed OTC. The most common antibiotics dispensed OTC were azithromycin (54.1%), amoxicillin (47.5%), cefixime (40%), amoxicillin + clavulanic acid (15.2%), ofloxacin (13.5%), ciprofloxacin (10%), and doxycycline (6.6%). Among the OTC dispensers, 82.5% (n = 250) were unaware of AMR and 17.5% were partially aware. However, 57% (n = 49) were unaware of AMR and its effects, in pharmacies dispensing antibiotics for valid prescriptions. Conclusion Our findings aggregate evidence on the alarming trend of inappropriate antibiotic-dispensing patterns that may further exacerbate AMR. Strict regulatory enforcement and periodical monitoring to regulate antibiotic dispensing to control unethical dispensing are inevitably necessary.

Influences on treatment-seeking and antibiotic use for common illnesses in eastern China.

BACKGROUND: Antibiotic resistance rates remain high in China where antibiotics are widely used for common illnesses. This study aimed to investigate the influences on people's decisions on treatment and antibiotic use for common illnesses in eastern China. METHODS: Semi-structured interviews were conducted with 29 patients recruited through convenience sampling between July 2020 and January 2021 in one hospital in County A in Zhejiang Province, and one hospital and one village clinic in County B in Jiangsu Province, respectively. All interviews were audio-recorded, transcribed verbatim and thematically analysed. This study is nested in a larger interdisciplinary mixed method project and we also compared our qualitative findings with quantitative results from a household survey conducted as part of this wider project. RESULTS: Participants' decisions about treatment-seeking and antibiotic use for common illnesses were found to be influenced by four interactive domains. (i) Self-evaluation of illness severity: Participants tend to self-treat minor conditions with ordinary medicines first and do not resort to antibiotics unless the condition worsens or is considered inflammation- related. Visiting healthcare facilities is seen as the final option. (ii) Access to and trust in care: These treatment-seeking practices are also associated with the perception, in contrast with retail pharmacies, hospitals provide professional and trustworthy care but are difficult to access, and hence require visiting only for severe illness. (iii) Prior experience: previous medical treatment and experiences of self-medication also influence participants' treatment decisions including the use of antibiotics. (iv) Medication characteristics: Participants view antibiotics as powerful medicines with harms and risks, requiring consumers to carefully trade off benefits and harms before use. CONCLUSIONS: People's treatment decisions in relation to antibiotic use in eastern China are influenced by an interplay of lay conceptual models of illnesses and antibiotics and broader organisational, social, and contextual factors. Interventions focusing on individual education to incorporate biomedical knowledge into lay understandings, and reducing situational and social incentives for self-medicating with antibiotics by strengthening access to quality professional care, would be helpful in promoting antibiotic stewardship.

Contracting retail pharmacies as a source of essential medicines for public sector clients in low- and middle-income countries: a scoping review of key considerations, challenges, and opportunities.

BACKGROUND: Insurances in high-income countries (HIC) often contract with private community pharmacies to dispense medicines to outpatients. In contrast, dispensing of medicines in low- and middle-income countries (LMICs) often lacks such contractual arrangements. Furthermore, many LMICs lack sufficient investment in supply chains and financial and human resources to guarantee stock levels and services at public medicine-dispensing institutions. Countries striving to achieve universal health coverage (UHC) can, in principle, incorporate retail pharmacies into their supply chains to expand access to essential medicines (EMs). The objectives of this paper are (a) to identify and analyze key considerations, opportunities and challenges for public payers when contracting out the supply and dispensing of medicines to retail pharmacies and (b) to provide examples of strategies and policies to address these challenges. METHODS: A targeted literature strategy was used to conduct this scoping review. We created an analytical framework of key dimensions: (1) governance (including medicine and pharmacy regulation); (2) contracting (3) reimbursement; (4) medicine affordability (5) equitable access; and (6) quality of care (including 'patient-centered' pharmaceutical care). Using this framework, we selected a mix of three HIC and four LMIC case studies and analyzed the opportunities and challenges encountered when contracting retail pharmacies. RESULTS: From this analysis, we identified a set of opportunities and challenges that should be considered by public payers considering public-private contracting: (1) balancing business viability with medicine affordability; (2) incentivizing equitable access to medicines; (3) ensuring quality of care and delivery of services; (4) ensuring product quality; (5) task-sharing from primary care providers to pharmacies and (6) securing human resources and related capacity constraints to ensure sustainability of the contract. CONCLUSION: Public-private partnerships offer opportunities to improve access to EMs. Nonetheless, managing these agreements is complex and is influenced by a variety of factors. For effective contractual partnerships, a systems approach is needed in which business, industry and regulatory contexts are considered in tandem with the health system. Special attention should be devoted to rapidly changing health contexts and systems, such as changes in patient preferences and market developments brought about by the COVID-19 pandemic.

Grey model forecasting analysis of licensed pharmacist staffing in retail pharmacies in western China / 中国药房

OBJECTIVE To predict the development trends of licensed pharmacist staffing in retail pharmacies within the western China and provide reference for the formulation of policies related to licensed pharmacists. METHODS Based on the data of retail pharmacies and licensed pharmacists in the western China from 2016 to 2022， a grey model was constructed to analyze and predict the number development trends of retail pharmacies and licensed pharmacists in the western China from 2023 to 2026. RESULTS Currently， the 1∶1 staffing requirement for licensed pharmacists and retail pharmacies had been met in Shaanxi， Guangxi and Gansu. Based on current trends， Inner Mongolia， Chongqing， Yunnan， and Qinghai were expected to meet the 1∶1 staffing requirement for licensed pharmacists and retail pharmacies between 2023 and 2026. Sichuan and Xinjiang were also expected to meet this requirement in the future. However， there was still a significant gap in Guizhou， Xizang， and Ningxia towards achieving the above goals. CONCLUSIONS There is still a discrepancy between the deployment of licensed pharmacists and the national requirements in certain western provinces. Local authorities should formulate relevant policies according to local circumstances. Regions that have already met or will soon achieve the staffing requirement for licensed pharmacists should continue to enhance the quantity and quality of their licensed pharmacist workforce. In areas where meet this criterion in the short term is not feasible， it is necessary to strengthen the development of the licensed pharmacist workforce， and control the number of new retail pharmacies.

Opioid Litigation: Lessons Learned from a Retail Pharmacy Settlement.

As the opioid epidemic continues in the United States and ongoing litigation seeks to hold contributors responsible, state governments have initiated lawsuits against retail pharmacies for their role in contributing to the crisis. This article summarizes an action the State of West Virginia brought against CVS, which the parties recently settled in the fall of 2022. This article examines the unique position of retail pharmacies like CVS, which often serve as both distributors and dispensers, in contributing to the oversaturation and illicit diversion of opioid prescriptions. The article concludes by assessing the viability of potential causes of action against retail pharmacies in opioid litigation.

Study on the spatial distribution and related factors of medical insurance designated retail pharmacies in Guiyang / 中国药房

OBJECTIVE To pr ovide theoretic support for Guiyang to scientifically guide the development of drug retail industry and implement national health policies . METHODS The data were collected through statistical yearbook ，data cloud ， coordinate acquisition device of Application Programming Interface of Baidu map and so on. The spatial distribution characteristics and accessibility of medical insurance designated retail pharmacies （shorted for “designated pharmacies ”）in Guiyang were analyzed by spatial analysis based on Geographic Information System. The related factors for the distribution of designated pharmacies in Guiyang were analyzed by statistical method. RESULTS The number of designated pharmacies ，designated pharmacies per thousand people and designated pharmacies per 10 km2 in Guiyang increased from 2 018，0.41 and 2.51 in 2020 to 2 500，0.42 and 3.11 in 2021，with growth rates of 23.89％，2.44％ and 23.90％ respectively. The service area of the designated pharmacies that residents of Guiyang reached within 15 minutes on foot was 10.27％ of the total service area of designated pharmacies in Guiyang. The results of correlation analysis showed that the correlation coefficients between the regional gross regional production ，total retail sales of consumer goods ，population，urban per capita disposable income and the number of designated pharmacies in Guiyang were 0.999，0.999，0.977 and 0.992，respectively （all P＜0.05）. CONCLUSIONS The distribution of designated pharmacies is insufficient in Guiyang ，the development of designated pharmacies in various administrative regions is uneven ，and the layout of pharmacies is significantly affected by economic and demographic factors. It is suggested that the local government should explore the strategy of scientifically and reasonably expanding the coverage of designated pharmacies in urban and rural areas，promote the rational layout of pharmacies with appropriate economic and demographic policies ，and pay attention to improving the service capacity of designated pharmacies ，so as to improve the quality of life of the people and guide the healthy and high-quality development of drug retail industry.

Analysis of the Implementation Status of the Classification Management Policies for Retail Pharmacies in Guangdong Province Based on Thematic Framework Analysis / 中国药房

OBJECTIVE：To provide assistance for the smooth implementation of classification management policies of retail pharmacies in Guangdong province and the scientific supervision of retail pharmacies by relevant departments. METHODS ：In this study，key interviews were conducted among 68 interviewees，involving experts from Guangdong drug regulatory department ，head of retail pharmacies and research experts on relevant policies of universities. The current situation ，problems and suggestions of the classification management policy of retail pharmacies in Guangdong province were summarized. RESULTS & CONCLUSIONS ： The implementation of the classification management policies for retail pharmacies in Guangdong province operated well. Drug regulatory authorities at all levels could conduct daily supervision in accordance with policy requirements. Retail pharmacies operated in strict accordance with the classification management policy and established a relatively complete quality management system. However ，there were still problems such as difficulty in policy implementation ，insufficient policy clarity ，increased regulatory pressure and regulatory risks from government regulatory agencies ，rising operating costs and increasing pressure in retail pharmacies，the large gap of licensed pharmacists ，difficult to investigate and deal with “affiliation of certificate ”behavior，and difficult survival for remote pharmacies ，and the impact on the convenience of drug use of the public. It is suggested to improve the content of the policy ，introduce related supporting measures ，strengthen the construction of the supervisory team ，increase policy publicity，improve the ways and methods to investigate and deal with the “affiliation of certificate ”behavior of licensed pharmacists， and help retail pharmacies to diversify their operations and chain operations. It is recommended that relevant government departments should further improve the content of the policy and actively adjust the supervision methods to make the policy better implemented.

Investigation and Analysis of the Understanding of Pharmacy Practitioners in Retail Pharmacies and Parents to Children’s OTC Drug Knowledge / 中国药房

OBJECTIVE：To standardize the use of children’s over-the-counter（OTC）drugs in China，control the risk of children’s self medication and ensure the safety of children’s medication. METHODS：The questionnaire was randomly distributed to pharmacy practitioners in retail pharmacies in 13/parents in 16 provinces and municipalities directly under the central government. The results of questionnaire survey were analyzed descriptively. The corresponding suggestions were put forward for the problems existing in the use of OTC drugs for children among pharmacy practitioners in retail pharmacies and parents.RESULTS：Totally 5 367 people filled the questionnaire at pharmacies，and 5 353 questionnaires were filled validly with effective rate of 99.74％；the number of consumers（parents）who filled the questionnaires was 6 111，and 5 094 questionnaires were filled validly with effective rate of 83.36％. The results of survey showed that 93.67％ of retail pharmacies were equipped with 1-2licensed pharmacists；most of the employees in pharmacies had college degree（46.59％），and their professional knowledge was relatively weak，and only 30.00％ of them were very familiar with pharmaceutical professional knowledge. Pharmacy practitioners could provide basic pharmaceutical care，but they were not sensitive to the information of children’s age and weight；only 44.11％of the practitioners would approve the dosage according to the age and weight of the children；98.09％ of pharmacies would regularly conduct OTC drugs knowledge training，but they did not pay attention to the knowledge of children related to drug use. About half of the pharmacy practitioners were very clear about the indications，usage and dosage，precautions of OTC drugs forchildren. About 70％ of parents did not fully understand the difference between prescription drugs，green OTC drugs and red OTC drugs，and did not know the risk of home OTC treatment；63.06％ of parents chose OTC drugs according to their previous experience， and 23.05％ of parents relied on drug advertisements to choose OTC drugs； 92.64％ of parents would read the drug instruction carefully before using OTC drugs， but they had blind spots in understanding many contents of the drug instruction. In the process of OTC drug use，46.21％ of parents had used adult OTC drugs for their children，and 41.54％ of parents did not convert the amount of children；52.89％ of parents said that their children suffered from adverse reactions after taking OTC drugs. CONCLUSIONS：The pharmacy practitioners have low education on the whole，professional level needs to be improved，their understanding of children’s OTC drugs is not comprehensive enough，and there is a lack oftraining on children’s medication knowledge. Parents have a poor awareness of children’s OTC drugs，and there are many problems in the process of using children’s OTC drugs，such as inaccurate dosage，using adult’s drugs. It is suggested that we should improve the access standard of pharmacy practitioners and increase the number of licensed pharmacists；organize special training on safe drug use for children to improve the pharmaceutical service ability of pharmacies；strengthen the supervision of retail pharmacies and formulate pharmaceutical care standards for the use of OTC drugs for children；strengthen the publicity and education on rational drug use for children and popularize the knowledge of safe drug use of OTC drugs for children；give full play to the guiding role of pharmacists and pay attention to the medication guidance of parents.

Study on the Distribution ，Drug Supply and Quantity of Licensed Pharmacists in Retail Pharmacies around 5 Third Grade Class A Hospitals from Beijing / 中国药房

OBJECTIVE： To investigate the distribution， drug supply and quantity of licensed pharmacists in retail pharmacies around Third Grade Class A Hospitals， and to provide reference for decision-making of related management departments. METHODS： Field investigation and questionnaire survey were used to investigate the distribution， type， operating area， annual turnover， drug type， ranking of consumption sum， daily prescription amount and pharmacist allocation of 5 Third Grade Class A Hospitals in Beijing and general information of 100 surveyed pharmacists in 2017. RESULTS： There were 43 retail pharmacies in total within 1 km of 5 Third Grade Class A Hospitals， with an average of 8.60 retail pharmacies for each hospital. The number of retail pharmacies with distance between 200-400 m and 800-1 000 m was the largest （11）， of which 21 （48.84％） were chain drugstores. The operating area of 38 pharmacies （88.37％） was in the range of 100-175 m2， mainly ranging 100-125 m2 （16 pharmacies， 37.21％）. The annual turnover of 40 pharmacies were counted and ranged 50-10 000 ten thousand yuan， among which the pharmacies 0-200 m away from the hospital had the highest annual turnover. The average variety of drugs （prescription drugs and over-the-counter drugs） was 2 511 kinds. 34 pharmacies （79.07％） had more varieties of over-the-counter drugs than prescription drugs， and the consumption sum of over-the-counter drugs was higher than that of prescription drugs in 26 pharmacies （60.47％）. Top 3 drugs in the list of consumption sum were antineoplastic drugs， cardiovascular drugs and anti-infective drugs. Average daily prescriptions of 28 drugstores （65.11％） were less than 10 pieces； average daily prescription were more than 20 pieces in only 7 pharmacies （16.28％）. On average， each pharmacy had 7.4 staff members and 1.37 licensed pharmacists. 58 staff members’ first degree was junior college （58％）， 38 staff members’ first degree was technical secondary school or high school （38％）， and only 3 （3％） staff members’ first degree was undergraduates or above. CONCLUSIONS： With the gradual promotion of “health care policy” and the outflow of more hospital prescriptions， the retail pharmacies around hospitals should increase their numbers， expand the operating area， accelerate the construction of licensed pharmacists and improve the education level of pharmacists so as to improve the pharmaceutical care ability.

A survey of knowledge, attitude, and practices of private retail pharmacies staff in tuberculosis care: study from Dera Ismail Khan City, Pakistan.

BACKGROUND: In order to engage pharmacies in tuberculosis (TB) care, a survey was conducted in the Dera Ismail (DI) Khan City of the Khyber Pakhtoon Khwa province, Pakistan. The objectives were to; 1) characterize the retail pharmacies; 2) determine knowledge of the staff on various aspects of pulmonary TB; 3) determine practices related to the sale of anti-TB drugs, and referrals of presumptive TB patient, and willingness to participate in the National Tuberculosis Control Programme's (NTP) Directly Observed Treatment Short-Course (DOTS) strategy. METHODS: A cross-sectional survey was conducted by using a structured questionnaire to collect data from pharmacy staff at all the private retail pharmacies of the DI khan city. RESULTS: All the interviewed staff (n = 82) were males, only 38% had formal training as pharmacist (5%) or as a pharmacy assistant (33%). Pharmacies established for a longer period were better staffed and had high customer load. About 92% of the interviewed staff knew that persistent cough is a symptom for TB, 82% knew that TB is diagnosed by examination of sputum. Almost 66% of the pharmacy staff did not know multi-drug resistance TB as a consequence of improper treatment. Those with formal training and longer experience in retail pharmacy had better knowledge of various aspects of TB as compared to the staff with no formal pharmacy training and lesser experience (p < 0.01). Only 57% were aware of NTP while only 30% had heard of the DOTS strategy. All reported sale of first-line TB drugs as fixed dose combinations. The majority (80%) referred presumptive TB patients to chest physicians and no patient was referred to the NTP. Nearly 83% of the interviewed staff was willing to be involved in TB control efforts by getting training and referring patients to the DOTS facility. CONCLUSION: There was shortage of professionally qualified and female staff in private retail pharmacies. Knowledge of professionally qualified staff about TB seemed sufficient to identify presumptive TB patients; however, their knowledge about NTP and DOTS was poor, and referral practices to NTP and DOTS centers were suboptimal. Majority of staff was willing to be involved in TB control efforts.

Exploratory study of the dispensing patterns of vaccines by a sample of community pharmacies in Southern Africa.

INTRODUCTION: Vaccination is one of the most cost-effective healthcare interventions. Pharmacies in South Africa provide a vaccination service where childhood immunizations, some travel vaccines and vaccines for specific populations are dispensed and administered, but little has been published on which vaccines are dispensed and at what cost. AREAS COVERED: This retrospective drug utilization study determined the dispensing patterns of vaccines in community pharmacies during 2015 with the focus on the types and cost of vaccines dispensed in ATC group J07. EXPERT COMMENTARY: Of the 140 902 vaccines dispensed to 79 415 patients, viral vaccines (J07B) accounted for most of the prescriptions (82.7% of volume; 62.3% of cost), followed by bacterial vaccines (J07A) (17.1% of volume; 37.5% of cost), and bacterial and viral vaccines combined (0.2% of volume; 0.3% of cost). There was an increase in the dispensing patterns of viral vaccines (J07B) in the period just before the winter months. Half of all vaccines (50.4%) were for the influenza vaccine (J07BB01). This vaccine accounted for only 15.6% of the total cost of vaccines. The most expensive vaccines were pneumococcal polysaccharide conjugate vaccine (13-valent adsorbed, pre-filled syringe) (J07AL01), followed by human papillomavirus bivalent vaccine (J07BM02).

Investigation on the Situation of Pharmaceutical Care in Retail Pharmacies in Hefei / 中国药房

OBJECTIVE:To provide reference for improving the pharmaceutical care ability of the retail pharmacies.METHODS:The questionnaires were designed to investigate 180 licensed pharmacists from 180 retail pharmacies.The survey data were analyzed statistically.RESULTS:A total of 180 questionnaires were sent out,and 150 effective questionnaires were collected with effective recovery rate of 83.33％.Among 150 investigated pharmacists,the junior college degree or lower accounted for 74.67％,and the professionals of pharmacy or related only accounted for 44.66％;the pharmacists who always and often provided medication guidance accounted for 72.67％ and 21.33％,respectively;the pharmacists who always and often developed prescription review accounted for 53.33％ and 27.33％,respectively;the pharmacists who always and often collected complaint suggestions accounted for 50.67％ and 35.33％,respectively;the pharmacists who always and often established medication history both only accounted for 1.33％;the pharmacists who always and often retrospected drug use of patients accounted for 18.67％ and 14.00％,respectively;the pharmacists who always and often conducted lectures on health education and drug use accounted for 4.00％ and 6.00％,respectively;the pharmacists who satisfied with the work accounted for 58.67％.CONCLUSIONS:Recently,the degree and professional ability of the licensed pharmacists are relatively low in retail pharmacies in Hefei.The pharmaceutical care contents of drugstores are unitary,the work satisfaction degree of the licensed pharmacists is unsatisfactory.Although they can provide the patients with drug use guidance basically,the projects such as carrying out prescription auditing and collecting complaint suggestions need to be further strengthened.Less work has been done in establishing medication history and retrospecting drug use.So,we need to take some measures to improve the pharmaceutical care ability of retail pharmacies effectively.

Study on the Implementation Status,Difficulties and Countermeasures of Retail Pharmacies'Classifica-tion Management in China / 中国药房

OBJECTIVE:To provide reference for improving classification management and specifying standards of retail phar-macies in China. METHODS:The implementation status and standards of retail pharmacies'classification management in China were analyzed by using the method of comparative analysis. In view of the effects of classification management on retail pharmacy and its implementation difficulties,corresponding improvement measures were put forward. RESULTS & CONCLUSIONS:There are difference in the implementation status and standards of retail pharmacies'classification management in the national provinces and cities. Since the implementation of pilot in 2007,the main effects include retail pharmacies facing the survival of the fittest whipsaws pattern,the remote township small retail pharmacies facing a transition;the main implementation difficulties include gov-ernment failing to give a full propoganda the classification management of retail pharmacies,the construction of licensed pharma-cist team to be strengthened. It is suggested to include the ability of pharmaceutical care and credit level into the standard,imple-ment dynamic management,and complement classification management of retail pharmacies with the construction of licensed phar-macist team.

Establishment of the Talent Training Mode for Pharmaceutical Specialty in Retail Pharmacies Based on the Modern Apprenticeship / 中国药房

OBJECTIVE:To establish the talent training mode for pharmaceutical specialty in retail pharmacies based on mod-ern apprenticeship,and improve the teaching quality of pharmacy major in vocational colleges. METHODS:According to the basic content of talent training program,the contents including the talent training goal orientation,the recruitment mode,the teaching plan formulation,the curriculum system development,the teaching arrangement,the length of schooling and the certificate acquisi-tion were studied to analyze the feasibility of carrying out the modern apprenticeship of pharmaceutical specialty in retail pharma-cies. RESULTS:Pharmaceutical talents should master the necessary medicine theory,knowledge of relevant laws,regulations and stores management;the trained people could be an enterprise recruitment of employees,enrolled high school students or the two-screening-students;the practical skills training should be highlighted,both sides of school and enterprise should work together to develop the teaching plan formulation;and the curriculum development committee was established to determine the level of knowledge and ability that the retail pharmacies must know and to give the formation of the course;double subject education,dou-ble tutor teaching,work and study alternation were used in the teaching implementation;and flexible educational system was de-signed. CONCLUSIONS:The establishment of talent training mode for pharmaceutical specialty in retail pharmacies based on mod-ern apprenticeship can improve the teaching quality of pharmacy major in vocational colleges. However,the establishment of course system should consider the sustainable development of students,and cautiously set targeted courses based on the characteris-tics of talents requirements in retail pharmacies.

Factors affecting adoption and implementation of AHRQ health literacy tools in pharmacies.

BACKGROUND: Pharmacies are key sources of medication information for patients, yet few effectively serve patients with low health literacy. The Agency for Healthcare Research and Quality (AHRQ) supported the development of four health literacy tools for pharmacists to address this problem, and to help assess and improve pharmacies' health literacy practices. OBJECTIVES: This study aimed to understand the facilitators and barriers to the adoption and implementation of AHRQ's health literacy tools, particularly a tool to assess a pharmacy's health literacy practices. METHODS: We conducted a comparative, multiple-case study of eight pharmacies, guided by an adaptation of Rogers's Diffusion of Innovations model. Data were collected and triangulated through interviews, site visit observations, and the review of documents, and analyzed on the factors affecting pharmacies' adoption decisions and implementation of the tools. RESULTS: Factors important to pharmacies' decision to adopt the health literacy tools included awareness of health literacy; a culture of innovation; a change champion; the relative advantage and compatibility of the tools; and an invitation to utilize and receive support to use the tools. The barriers included a lack of leadership support, limited staff time, and a perception of the tools as complex with limited value. For implementation, the primary facilitators were buy-in from leadership, qualified staff, college-affiliated change champions, the adaptability and organization of the tool, and support. Barriers to implementation were limited leadership buy-in, prioritization of other activities, lack of qualified staff, and tool complexity. CONCLUSIONS: If pharmacists are provided tools that could ultimately improve their health literacy practices and patient-centered services; and the tools have a clear relative advantage, are simple as well adaptable, and the pharmacists are supported in their efforts - either by colleagues or by collaborating with colleges of pharmacy-then there could be important progress toward achieving the goals of the National Action Plan for Health Literacy.

Access to antibiotics in New Delhi, India: implications for antibiotic policy.

OBJECTIVE: The present survey was conducted to investigate the price and availability of a basket of 24 essential antibiotics and eight high-end antibiotics at various levels of health care in public and private sector in National Capital Territory of Delhi, India using standardized WHO/HAI methodology. METHODS: DATA ON PROCUREMENT PRICE AND AVAILABILITY WAS COLLECTED FROM THREE PUBLIC HEALTHCARE PROVIDERS IN THE STATE: the federal (central) government, state government and Municipal Corporation of Delhi (MCD). Overall a total of 83 public facilities, 68 primary care, 10 secondary cares and 5 tertiary care facilities were surveyed. Data was also collected from private retail (n = 40) and chain pharmacies (n = 40) of a leading corporate house. Prices were compared to an international reference price (expressed as median price ratio-MPR). RESULTS: PUBLIC SECTOR: Delhi state government has its essential medicine list (Delhi state EML) and was using Delhi state EML 2007 for procurement; the other two agencies had their own procurement list. All the antibiotics procured including second and third generation antibiotics except for injections were available at primary care facilities. Antibiotic available were on the basis of supply rather than rationality or the Delhi state EML and none was 100% available. There was sub-optimal availability of some essential antibiotics while other non-essential ones were freely available. Availability of antibiotics at tertiary care facilities was also sub-optimal. Private sector: Availability of antibiotics was good. For most of the antibiotics the most expensive and popular trade names were often available. High-end antibiotics, meropenam, gemifloxacin, and moxifloxacin were commonly available. In retail pharmacies some newer generation non-essential antibiotics like gemifloxacin were priced lower than the highest-priced generic of amoxicillin + clavulanic acid, azithromycin, and cefuroxime aexitl. CONCLUSIONS: Inappropriate availability and pricing of newer generation antibiotics, which may currently be bought without prescription, is likely to lead to their over-use and increased resistance. All providers should follow the EML of whichever of the three concerned Delhi public sector agencies that it is under and these EMLs should follow the essential medicine concept. The Indian regulatory authorities need to consider urgently, drug schedules and pricing policies that will curtail inappropriate access to new generation antibiotics.