Direct pharmacy access to hormonal contraception: California physician and advanced practice clinician views.

BACKGROUND: The United States has high rates of unintended pregnancy, and many women report difficulties in obtaining contraception. Pharmacy access would expand access to hormonal contraception. STUDY DESIGN: A qualitative study using a structured interview guide was conducted with 20 reproductive health practitioners including physicians and advanced practice clinicians in California in 2008-2009. RESULTS: Most respondents considered the current prescription-only model of access to hormonal contraception to be too restrictive. Some reported a preference for a pharmacy access model where women could obtain contraceptives directly from a pharmacist, bypassing the clinic visit. Many providers believed that method continuation and compliance would improve with pharmacy access to contraception. The most common concern reported was pharmacist refusal to provide services. CONCLUSIONS: Overall, providers viewed increased access to hormonal contraception as an important public health service and supported pharmacy access. They thought that pharmacy access can be accomplished through pharmacist education and training. Additional research is needed to test the hypothesis generated by this qualitative study that physicians and advanced practice clinicians would welcome an enhanced role of pharmacists in the provision of hormonal contraception.

Risks, benefits, and issues in creating a behind-the-counter category of medications.

OBJECTIVE: To examine the issues surrounding the development and implementation of a behind-the-counter (BTC) category of medications. DATA SOURCES: Testimony from organizations submitting comments to the Food and Drug Administration (FDA) panel hearings in November 2007, the 2009 final report of the U. S. General Accounting Office regarding a BTC drug category, literature review of research that has been conducted, experiences from other countries, and publically available information from agencies in charge of regulating medications similar to BTC. SUMMARY: Based on evidence attained from the current work, the following six recommendations regarding a BTC category of medications are provided. (1) Demonstration needs to occur that the risks and/or costs of BTC are outweighed by benefits, positive measurable outcomes, and financial savings to society. (2) Sufficient resources, including personnel, equipment, and facilities, need to be available for the appropriate provision of BTC services and to ensure ongoing monitoring and controls. (3) An appropriate compensation structure needs to be developed. (4) Encounters and outcomes should be documented in an electronic record, the information should be shared with other health care providers involved in patients' care, and interprofessional collaboration and communication should occur. (5) Criteria for designating candidates for transition, ongoing review for safety, and reverse transition must be developed. (6) Applicable lessons learned from other countries should be incorporated into BTC strategies. In addition to implementation recommendations, we also summarize additional evidence that needs to be gathered to optimize the BTC model. CONCLUSION: Based on the accumulated evidence, comments to FDA's request, and information from other countries, implementation of a BTC model probably is feasible in the United States. However, the optimal model remains uncertain and various aspects of a program need to be prioritized and rigorously tested.

Estudio de errores de dispensación en Oficinas de Farmacia de Valencia / No disponible

El presente trabajo tiene como objetivo diseñar un método para detectar errores de dispensación en la Oficina de Farmacia, cuantificando y clasificando dichos errores, así como identificar algunas variables que ayuden a establecer medidas de prevención. Para ello se estudiaron 21.703 oportunidades de error en once farmacias comunitarias de Valencia de lunes a sábado, ambos inclusive, durante 4 semanas. El índice Global de Error de Dispensación (IGED) obtenido ha sido de 0,23%. De los 50 errores detectados, 18 (36%) consistieron en la dispensación de un medicamento equivocado, y en 11 de estos, el error se asocia a la similitud de nombres comerciales de los medicamentos implicados. Cabe destacar que en un 62% de los casos, los errores llegan al paciente. Como conclusión, nos parece que el método es capaz de detectar, cuantificar y clasificar errores de dispensación en Oficina de Farmacia, así como que el IGED se puede utilizar como indicador de calidad interno de dispensación (AU)

The objective of the present study is to design a method to detect, quantify and clasify dispensing errors at community pharmacies, and also to identify some associated factors which would help to stablish prevention measures. For this purpose, 21.703 oportunities of error were studied at eleven community pharmacies in Valencia (Spain), from Monday to Saturday for four weeks. Global Dispensing Error Rate (IGED) found was 0,23 %. Eighteen (36 %) of the fifty detected errors were wrong drug dispensing errors. Eleven of these errors were due to look-alike problems with brand names. In 62 % of the cases, the errors achieve patients. It is concluded that the method designed is able to detect, quantify and classify dispensing errors at community pharmacies. Furthermore, Global Dispensing Error Rate (IGED) can be used as a dispensing good quality indicator (AU)