Retroactive application of the EPIS framework to promote future implementation success in community pharmacy clinical interventions.

BACKGROUND: The assessment of the implementation process of a clinical intervention in a community pharmacy setting can reveal useful insights for future implementation efforts. OBJECTIVE: We aimed to examine the implementation of a community pharmacist-led prospective registry and practice tool (RxING, Epidemiology Research Coordinating Center and the University of Alberta) designed to reduce cardiovascular risk among patients with diabetes and to assess how the participating pharmacists could be supported at each of these stages. METHODS: Semistructured interviews were conducted developed using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. The EPIS framework was used to evaluate the implementation of an online, guideline-driven tool (RxING tool) designed to help pharmacists implement and document the care of patients with diabetes by a group of community pharmacies located in Alberta, Canada. RESULTS: In relation to the preparation phase, responses focused more on suitability of the work environments and less on workflow adjustment. With regard to the implementation stage, participants mentioned that often the pharmacy manager or owner received the training to operate the RxING tool, complicating their ability to engage in regular patient recruitment and follow-up. Most pharmacies did not have specific goals relating to patient recruitment and retention. Concerns hindering sustainability of the evidence-based practice centered around the time-consuming online documentation process and patient retention. Finally, innovation factors identified from the pharmacists' responses were related to patient recruitment and streamlining the documentation process. CONCLUSIONS: This study identified 17 key recommendations that should be considered when designing and implementing future community pharmacy-led projects. In particular, providing assistance and training to pharmacies on-site, specific planning for program roll-out, identifying participating staff who have the time to engage with the program, and troubleshooting how to best integrate programs in normal workflow processes are some key recommendations.

Association between a usual source of care and influenza vaccination rates among pregnant women.

PURPOSE: Pregnant women and infants less than 6 months of age have a higher risk of complications from influenza. Vaccination is recommended for pregnant women to decrease risk of infection and hospitalizations between both the women themselves and infants. However, vaccination rates remain low in pregnant women. The objective of this study was to determine the association between having a usual source of care and seasonal influenza vaccination rates among women who were pregnant between 2012 and 2016. METHODS: A retrospective study was conducted using pooled data from the 2012-2016 Medical Expenditure Panel Survey. Frequencies of seasonal influenza vaccinations and other sociodemographic factors were estimated. A multivariable log-binomial regression model was used to examine the association between having a usual source of care and seasonal influenza vaccination rates. RESULTS: The weighted influenza vaccination rate among pregnant women was 54.5%. About one third did not have a usual source of care. The adjusted prevalence ratio of receiving an influenza vaccine for pregnant women without a usual source of care was 0.76 (95% confidence interval = 0.60-0.98). The top three main reasons for not having a usual source of care were being seldom or never sick (55.7%), not having health insurance (10.6%), and having recently moved to an area (9.9%). CONCLUSIONS: Pregnant women without a usual source of care had significantly lower probability of being vaccinated against seasonal influenza. Improving access to care through greater insurance coverage, addressing cost barriers, and providing patient education may help improve vaccination rates in this population.

Adherence to treatment for polycystic ovarian syndrome: A systematic review.

BACKGROUND: Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders of women of reproductive age. Treatment plans for this chronic condition frequently include long-term use of a combination of medication and lifestyle interventions. However, treatment outcomes are dependent on adherence to treatment regimens. This study aimed to systematically review the literature for reported adherence to treatments for PCOS. METHODS: A systematic search of Embase, Cochrane, PubMed, CINAHL, PsychINFO, SCOPUS, and International Pharmaceutical Abstracts from inception until January 2019 utilizing the terms PCOS, adherence, and patient compliance was conducted. A total of 179 possible articles were identified. RESULTS: Fourteen articles reporting adherence data were included in the review. Self-report was the most commonly reported method of measuring adherence. Adherence to lifestyle interventions, such as prescribed diets and physical activity, was reported in ten studies and adherence to medications was reported in seven studies, with some reporting both. CONCLUSIONS: Minimal data are available regarding factors associated with adherence in patients with PCOS. Diverse methods of adherence assessment are utilized. Future studies of PCOS treatments should effectively assess and report adherence data as it is essential to evaluating the effectiveness of PCOS treatments and is critically needed to guide clinician efforts to facilitate optimal outcomes for patients.