Pharmacist, prescriber, and drug policy expert opinions on gabapentinoid misuse.

BACKGROUND: Gabapentinoids (gabapentin and pregabalin) are widely used in clinical practice, but recent evidence indicates that they carry an increased risk of misuse. As healthcare professionals (HCPs) and policymakers plan different strategies to promote harm reduction, it is important to understand different interested party viewpoints. OBJECTIVE: To explore prescriber, pharmacist, and drug policy expert (DPE) awareness, opinions, and experiences regarding gabapentinoid misuse. METHODS: A qualitative description study using individual semi-structured virtual interviews was conducted between February and April 2021. Participants included prescribers (physicians, physician assistants [PA], or nurse practitioners [NP]) and pharmacists practicing in outpatient, ambulatory, or community-based healthcare settings; individuals with relevant drug policy expertise were also included. Qualtrics (Provo, Utah) and Zoom (San Jose, California) were used to facilitate quantitative (for initial screening and participant characteristics) and qualitative (interview) data collection. Data were coded and organized into themes in NVivo (QSR International; Burlington, Massachusetts) using thematic analysis steps. RESULTS: A total of 43 individuals participated in this study, including 16 (37.2%) pharmacists, 13 (30.2%) physicians, seven (16.3%) NPs, four (9.3%) DPEs, two (4.7%) pharmacist/DPEs, and one (2.3%) PA. Results were organized along four themes: (1) challenges/opportunities in gabapentinoid use; (2) gabapentinoid misuse awareness; (3) solutions to gabapentinoid misuse and (4) contributing barriers in pain management. Participants invoked different opinions in their consideration of gabapentinoid misuse, including the desire for harm reduction, the limitations of the current healthcare and insurance system, the lack of options for pain and substance use disorder treatment, and the influence of patient expectations. CONCLUSIONS: Gabapentinoid misuse was commonly framed in comparative fashion to ongoing concerns with opioids, and proposed solutions often focused less on regulatory control and more toward patient and HCP education and an overhaul of the health system approach to substance use and healthcare overall.

Coordinated speech therapy, physiotherapy, and pharmaceutical care telehealth for people with Parkinson disease in rural communities: an exploratory, 8-week cohort study for feasibility, safety, and signal of efficacy.

INTRODUCTION: The potential for coordinated, multidisciplinary telehealth to help connect people with Parkinson disease (PD) in rural areas to PD specialists is crucial in optimizing care. Therefore, this study aimed to test the feasibility, safety, and signal of efficacy of a coordinated telehealth program, consisting of speech therapy, physiotherapy, and pharmaceutical care, for people with PD living in some rural US communities. METHODS: Fifteen individuals with PD living in rural Wyoming and Nevada, USA, participated in this single-cohort, 8-week pilot study. Participants were assessed before and after 8 weeks of coordinated, one-on-one telehealth using the following outcomes: (1) feasibility: session attendance and withdrawal rate; (2) safety: adverse events; and (3) signal of efficacy: Communication Effectiveness Survey, acoustic data (intensity, duration, work (intensity times duration)), Parkinson's Fatigue Scale, 30 second Sit-to-Stand test, Parkinson's Disease Questionnaire - 39, Movement Disorder Society Unified Parkinson's Disease Rating Scale - Part III, and medication adherence. RESULTS: Average attendance was greater than 85% for all participants. There were no serious adverse events and only nine minor events during treatment sessions (0.9% of all treatment sessions had a participant report of an adverse event); all nine cases resolved without medical attention. Although 14 of 16 outcomes had effect sizes trending in the direction of improvement, only two were statistically significant using non-parametric analyses: 30 second Sit-to-Stand (pre-test median=11.0 (interquartile range (IQR)=6.0); post-test median=12.0 (IQR=3.0) and acoustic data work (pre-test median=756.0 dB s (IQR=198.4); post-test median=876.3 dB s (IQR=455.5), p<0.05. CONCLUSION: A coordinated, multidisciplinary telehealth program was safe and feasible for people in rural communities who have PD. This telehealth program also yielded a signal of efficacy for most of the outcomes measured in the study.

Consumer's Opinion on a Pharmacist's Role in Nutritional Counseling.

BACKGROUND: Nutrition has become an increasing health concern. From fad diets to exercise programs, the consumer seems to be consulting multiple resources that all provide a different answer in the process of obtaining optimal health. Easily accessible pharmacists may be the sources to answer crucial nutritional issues facing society today. METHODS: Using the results of a previous study about food perceptions among lean and non-lean populations, interview questions were created to determine the populations' nutrition and pharmacist's role knowledge. Nutrition knowledge among lean vs. non-lean consumers was assessed by determining experience with pharmacist nutritional counseling, how experience perceptions differed, and how these perceptions can shape a pharmacist's role. Audio recorded interviews were conducted in a rural setting. Seventy-two English speaking, ambulatory, lean (BMI ≤ 24) and non-lean (BMI ≥ 25) residents between the ages 25-71 years participated in the study in a small western United States town. RESULTS: 26.3% of consumers obtained nutrition information from the internet; however, the internet and healthcare providers were considered the most trustworthy. When asked about the pharmacist's role in nutrition counseling, 32.7% believed that pharmacists were not a reliable source based on education background. Another 10.2% thought pharmacists were too busy for counseling. DISCUSSION: This study indicates the consumers' knowledge on pharmacists' education, willingness to seek out nutrition knowledge, and a pharmacist's ability to provide nutrition counseling can differ between lean and non-lean consumers. Lean consumers tend to have more interaction with a pharmacist whereas non-lean consumers do not. CONCLUSION: As a profession, pharmacists should educate consumers on reliable nutrition resources, a pharmacist's education, and how they use their role to provide consumers with nutrition knowledge.

Medication Education Provided to School-Aged Children: A Systematic Scoping Review.

OBJECTIVES: To characterize the educational interventions regarding prescription and nonprescription medication use for school-aged children, we systematically reviewed evidence of programs available for this age group. METHODS: Searches in PubMed, CINAHL, EMBASE, ERIC, and International Pharmaceutical Abstracts were conducted. Search terms focused on: population education, school-age children, and medications. Studies were excluded if they were specific to a particular disease state or class of medication, drugs of misuse and illicit drugs. Data extraction included study design, location, educational intervention and duration, research methods, and main findings. RESULTS: We found 14 studies representing 8 separate projects. Six projects were identified in the gray literature. Projects ranged from individual sessions to national programs. Quantitative studies showed improvement in knowledge, medication literacy, and confidence. The adoption of medication education strategies was dependent on the educator's comfort level and beliefs regarding medication safety. CONCLUSIONS: Credible medication education resources are available and have been shown to improve students' knowledge. There remains a need for multifaceted implementation and evaluation strategies. Strategies and resources are available to implement interventions in communities to address medication education in school-age children. Frameworks should be used to facilitate the implementation of effective health promotion strategies around safe-medication use for school-aged children.

Considering Health Care Needs in a Rural Parkinson Disease Community.

BACKGROUND: People living with Parkinson disease (PD) have multiple health care needs that intensify over time, because the disease is both chronic and degenerative. Past research indicates that issues with mobility, financial constraints, and lack of support networks impede access to health care for people with PD. These challenges are elevated for individuals who live in rural communities due to the lack of local health care professionals and specialists and support resources, and the need to travel to see providers/specialists. The research objective was to have PD community stakeholders identify health care barriers and resources as well as possibilities for improved health care in a rural state. METHODS: Focus groups were conducted in the context of a community-based participatory research (CBPR) approach. Focus group data collection helped create comfort and parity in the discussion, while a CBPR approach allows for authenticity of the findings because members of the community in question are involved as researchers. The responses were recorded and transcribed verbatim. Coding and organizing of themes was completed manually and using NVIVO 10 software. RESULTS: Qualitative analysis revealed three main themes, PD issues, access issues, and stigma. These themes described disease-related stigma and concerns about disease progression and treatment, as well as challenges in accessing information, providers, and support by the PD stakeholders. The study results provided insight into the needs of people living with PD in rural communities. CONCLUSIONS: Rural PD stakeholders proposed the use of technology (e.g., telehealth) to provide support to improve health care for people with PD.

Understanding Food Preferences and Their Connection to Health Perception among Lean and Non-Lean Populations in a Rural State.

Lipid metabolism and dietary choices directly affect the outcome of overall weight management in both lean and non-lean individuals. However, the perception of consuming spicy foods has diverse meaning among people. To understand this, it is essential to have thorough knowledge on how food preference is tied to health outcomes. The aim of this study is to enhance the understanding of how food preference affects the health outcome and perception in lean and non-lean populations. A mixed methods study was conducted via analysis of consumers' food choices and compared the data based on age, gender, and body weight. The participants in audio recorded interviews were comprised of residents from a single town in a rural state. The study shows that most participants were aware of the implications that food choices had on their health status and it emphasizes the importance of understanding the differences between consumption of spicy and non-spicy foods. Spicy food consumption was associated with decreased overall portion size as well as increased satisfaction following the meal. Environmental factors, such as the influence of family and friends, impacted spicy food consumption according to most participants. The outcome of the study provides a comprehensive understanding of food preferences from a relatively large exploratory study. The observations made here show rudimentary associations between physical attributes and levels of food consumption. Future studies could further identify how certain attributes relate to food choices and levels of spicy food consumption in greater detail.

Pharmacy and primary care perspectives on e-prescribing in a rural community: A focused ethnography.

BACKGROUND: Electronic prescribing (ERx) is the ability for prescriber to send a digital prescription directly to a pharmacist through a dedicated secure network. A number of federally funded incentives such as the health information technology for economic and clinical health (HITECH) and Meaningful Use standards have led to ERx implementation. ERx is an integral part of primary care practice and today most community pharmacies are enabled to accept e-prescriptions. Little is known about the experience of rural pharmacists, primary care providers and patients regarding e-prescribing. This paper reports on the results of ERx from their perspectives. The findings are a portion of a larger qualitative descriptive study focused on the meaning of Meaningful Use in remote rural communities. One remote rural community in the Pacific Northwest was used for this research endeavor. OBJECTIVES: Explore understandings of e-prescribing from both pharmacist and primary care provider perspective. Explore patients' understandings and experiences of e-prescribing. METHODS: The conceptual model for this research was the Ecological Transactional Model. This model informed the research design, interview questions and analysis. A qualitative descriptive methodology - focused ethnography was used for this study. Six key informant interviews, 14 patient interviews and 15 hours of participant observation provided the data. Data analysis occurred collectively between a social pharmacy researcher, a primary care nurse practitioner-researcher and pharmacy graduate students. The research qualitatively identified contextual understandings and dimensions of ERx in this setting. RESULTS: Based on a focused ethnographic methodology, contextual understandings of rurality and role identity, both pharmacist and primary care provider, were explored. Perspectives on ERx of patients, clinic manager and RN staff were also elicited. Three dimensions of ERx were identified - technological, structural and communication. DISCUSSION: The structural, technological and communication dimensions are essential in understanding e-prescribing across settings and addressing digital divides in our health care system. Implications for interprofessional pharmacy education were addressed. Understanding the rural context and the need for role adaptability has implications for health care policy. Additional research is needed on the role of the rural pharmacist and how best to interact with primary care providers and patients.

Older adults' drug benefit beliefs: construct definition and measure development.

BACKGROUND: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 provides coverage of outpatient prescription drugs for Medicare beneficiaries. Although much has been learned since the program's implementation, a context within which this information can be understood is lacking. OBJECTIVE: The purpose of this study was to develop a reliable and valid multi-item instrument measuring beliefs about Medicare prescription drug benefits. METHODS: Survey items were generated using focus group transcripts, other surveys on the Medicare Part "D" program, and past studies of choice and satisfaction in drug insurance programs. Using data from the survey pilot test, item and reliability analyses were used to reduce and refine an initial pool of items. Data then were collected from a cross-sectional, mail survey of older adults living in Minnesota. Data were analyzed using exploratory factor analysis. Summated rating scales then were constructed and assessed further using reliability analyses. Construct validity of summated scales was examined by comparing scale scores across response categories of survey items that collected information on general political attitudes, perceptions of the Medicare Part "D" program, health status, and health care utilization and demographics. RESULTS: The adjusted response rate for the main survey was 55.98% (744/1329). Iterative factor analysis produced 2 interpretable scales. The first, termed "access/equity" (13 items, Cronbach's alpha=0.89) measures beliefs that a Medicare drug benefit should both provide affordable prescription drugs for beneficiaries and do this in a manner that is equitable for all participants. The second, termed "comprehensibility" (6 items, Cronbach's alpha=0.80) assesses beliefs that regulations governing a Medicare drug benefit should be easily understood. Discriminant validity tests suggest that these measures behave in a manner consistent with related research in these areas. CONCLUSIONS: Measures of 2 facets of older adults' drug benefit beliefs were developed using a multiple step procedure. Future research could focus on developing a better understanding of other facets of these beliefs and sound methods of measurement.

Market dynamics of community pharmacies in Minnesota.

BACKGROUND: From a pharmacist workforce perspective, an understanding of pharmacy location is important for monitoring access points for pharmacist services such as medication dispensing, medication counseling, medication therapy management, and disease management. OBJECTIVE: To understand access to community pharmacies, our goal was to describe changes in pharmacy mix (independent vs chain) between 1992 and 2002 for 87 counties in Minnesota. Study objectives were to describe the association of (1) change in population density, (2) metropolitan designation, change in (3) proportion of nonwhite population, (4) proportion of elderly population, and (5) household income with change in (a) number of community pharmacies overall, (b) number of chain pharmacies, (c) number of independent pharmacies, and (d) the independent-to-total community pharmacy ratio. METHODS: Records from the State of Minnesota Board of Pharmacy were used to examine changes in the community pharmacy mix from 1992 to 2002. Data on county level demographics in 1990 and 2000 were obtained from the US Census Bureau and Datanet. Chi-square analysis was used to test the relationships between the independent and dependent variables. RESULTS: As of 2002, every county in Minnesota had at least one pharmacy as was the case in 1992. The ratio of independent to chain pharmacies changed from approximately 2:1 in 1992 to approximately 1:1 in 2002. Chi-square results revealed that change in population density was significantly associated with change in the number of community pharmacies overall (P<0.001) and with change in chain pharmacies (P=0.03). The findings revealed an interesting u-shaped pattern for the association between population density and change in independent pharmacies. CONCLUSIONS: It appears that chain pharmacies follow changes in population density for making decisions about market entry and exit. The results suggest that some independent pharmacies might be closing due to chain competition in high population density growth areas. However, there was also evidence to suggest that population density decline may be an important determinant of independent pharmacy closures. In such environments, chain pharmacies are not likely to open new pharmacies to replace the independent pharmacy. Such a market dynamic may lead to access problems for citizens of these counties in the future.

Older adults' drug benefit beliefs: a focus group study.

OBJECTIVES: The Medicare Prescription Drug Improvement and Modernization Act will provide drug benefits for a large proportion of persons aged 65 years and older in the United States. Few studies have examined the beliefs and attitudes of older adults with respect to prescription drug insurance programs. The objective of this study was to better understand the nature and range of older adults. beliefs regarding prescription drug benefits. METHODS: This study employed a qualitative, focus group design. Three focus groups with a total of 19 community dwelling adults aged 65 years and older were conducted in June 2003. The participants were members of the Minnesota Seniors Federation and included persons with and without prescription drug insurance. Discussions were structured and guided by an interview schedule developed a priori. The focus groups were audiotaped and transcribed verbatim. Thematic textual analysis was used to identify codes and categories from the language and ideas of the group participants. RESULTS: Study participants identified a variety of important drug benefit facets. The common themes identified from the 3 groups were: (1) prescription drug access, (2) drug benefit comprehensibility, (3) powerful others, (4) affordability, and (5) equity. CONCLUSION: Older adults view drug benefits as complex entities composed of at least 5 dimensions. In addition to more commonly discussed issues such as access and affordability, seniors evaluate several other aspects of drug insurance programs such as fairness, the ease with which plan terms can be understood, and the degree to which outside actors influence plan policies.

Distinguishing characteristics of patients who seek more information or request a prescription in response to direct-to-consumer advertisements.

OBJECTIVE: The objective of this study was to examine demographic and psychographic profiles of individuals who sought additional information or requested a prescription drug based on a direct-to-consumer advertisement. METHODS: A cross-sectional descriptive survey was used for collecting data from a random sample of 200 Minnesotans during Fall 2002. Chi-square and Mann-Whitney U tests were used as nonparametric tests for assessing differences in distributions between our categories of study subjects. RESULTS: Out of 177 deliverable surveys, 81 (46%) were returned. Of these, 80 surveys were usable for analysis. The results showed that the distinguishing characteristics of individuals who sought additional information based on an advertisement were associated with demographic variables such as number of drugs taken daily and monthly out-of-pocket expenditures for prescription drugs. In contrast, distinguishing characteristics of individuals who requested prescription drugs (in addition to seeking information) based on an advertisement were psychographic in nature such as (1) viewing themselves as having greater influence on their physician, (2) having a stronger relationship with their physician, (3) expressing greater satisfaction with their current therapy, (4) viewing prescriptions as less of a burden, and (5) having higher outcome expectations for prescription drugs compared to the respondents who did not ask for a prescription drug based on a direct-to-consumer advertisement. CONCLUSIONS: Distinguishing characteristics of information seekers were demographic in nature, whereas those characteristics of prescription requesters were psychographic in nature.