Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population

Overview of Key Findings In 2014, the overall mean vaccination rate in urban areas was 4.66 compared to a mean vaccination rate of 2.81 in rural areas, indicating a 40% lower mean vaccination rate in rural communities. The majority of pneumococcal vaccine services delivered to fee-for-service Medicare beneficiaries were provided by primary care providers, although pharmacy providers delivered close to one-fourth (22.2%) of these services. The proportion of pneumococcal vaccine services delivered by pharmacy providers was significantly greater in rural versus urban counties (29.4% vs. 21.1%). Consistent with previous literature, county characteristics positively associated with pneumococcal vaccine service delivery include increasing age of residents, more female residents, and availability of inpatient hospital services, while rurality, poverty, and greater overall health status were negatively associated with delivery of pneumococcal vaccine services

Pharmacists\u27 Role in Harm Reduction: A Survey Assessment of Kentucky Community Pharmacists\u27 Willingness to Participate in Syringe/Needle Exchange

Background: Pharmacists\u27 role in harm reduction is expanding in many states, yet there are limited data on pharmacists\u27 willingness to participate in harm reduction activities. This study assessed community pharmacists\u27 willingness to participate in one harm reduction initiative: syringe/needle exchange. Methods: In 2015, all Kentucky pharmacists with active licenses were emailed a survey that examined attitudes towards participation in syringe/needle exchange. Response frequencies were calculated for community pharmacist respondents. Ordinal logistic regression estimated the impact of community pharmacist characteristics and attitudes on willingness to provide clean needles/syringes to people who inject drugs and to dispose of used syringes/needles, where both dependent variables were defined as Likert-type questions on a scale of 1 (not at all willing) to 6 (very willing). Results: Of 4699 practicing Kentucky pharmacists, 1282 pharmacists responded (response rate = 27.3%); the majority (n = 827) were community pharmacists. Community pharmacists were divided on willingness to provide clean needles/syringes, with 39.1% not willing (score 1 or 2 of 6) and 30% very willing (score 5 or 6 of 6). Few were willing to dispose of used needles/syringes, with only 18.7% willing. Community pharmacists who agreed that pharmacists could have significant public health impact by providing access to clean needles expressed 3.56 times more willingness to provide clean needles (95% CI 3.06-4.15), and 2.04 times more willingness to dispose of used needles (95% CI 1.77-2.35). Chain/supermarket pharmacists (n = 485, 58.6% of community pharmacies) were 39% less likely to express willingness to dispose of used needles (95% CI 0.43-0.87) when compared with independent community pharmacists (n = 342, 41.4% of community pharmacies). Independent pharmacists reported different barriers (workflow) than their chain/supermarket pharmacist colleagues (concerns of clientele). Conclusions: Kentucky community pharmacists were more willing to provide clean needles than to dispose of used needles. Strategies to mitigate barriers to participation in syringe/needle exchange are warranted

Association of Naloxone Coprescription Laws With Naloxone Prescription Dispensing in the United States

Importance: To mitigate the opioid overdose crisis, states have implemented a variety of legal interventions aimed at increasing access to the opioid antagonist naloxone. Recently, Virginia and Vermont mandated the coprescription of naloxone for potentially at-risk patients. Objective: To assess the association between naloxone coprescription legal mandates and naloxone dispensing in retail pharmacies. Design, Setting, and Participants: This was a population-based, state-level cohort study. The sample included all prescriptions dispensed for naloxone in the retail pharmacy setting contained in IQVIA\u27s national prescription audit, which represents 90% of all retail pharmacies in the United States. The unit of observation was state-month and the study period was January 1, 2011, to December 31, 2017. Exposures: State legal intervention mandating naloxone coprescription. Main Outcomes and Measures: Number of naloxone prescriptions dispensed. State rates of naloxone prescriptions dispensed per month per 100 000 standard population were calculated. Results: The rate of naloxone dispensing increased after implementation of legal mandates for naloxone coprescription. An estimated 88 naloxone prescriptions per 100 000 were dispensed in Virginia and 111 prescriptions per 100 000 were dispensed in Vermont during the first full month the legal requirement was effective. In comparison, 16 naloxone prescriptions per 100 000 were dispensed in the 10 states (including the District of Columbia) with the highest opioid overdose death rates and 6 prescriptions per 100 000 were dispensed in the 39 remaining states. The number of naloxone prescriptions dispensed was associated with the legal mandate for naloxone coprescription (incidence rate ratio [IRR], 7.75; 95% CI, 1.22-49.35). Implementation of the naloxone coprescription mandate was associated with an estimated 214 additional naloxone prescriptions dispensed per month in the period following the mandates, holding all other variables constant. Among covariates, naloxone access laws (IRR, 1.37; 1.05-1.78), opioid overdose death rates (IRR, 1.06; 95% CI, 1.04-1.08), the percentage of naloxone prescriptions paid by third-party payers (IRR 1.009; 1.008-1.010), and time (IRR, 1.06; 95% CI, 1.05-1.07) were significantly associated with naloxone prescription dispensing. Conclusions and Relevance: These study findings suggest that legally mandated naloxone prescription for those at risk for opioid overdose may be associated with substantial increases in naloxone dispensing and further reduction in opioid-related harm

Update: Rural/Urban Disparities in Pneumococcal Vaccine Service Delivery Among the Fee-for-Service Medicare Population, 2012-2015

Overview of Key Findings Between 2014 and 2015, the number of pneumococcal vaccine services delivered to fee-for-service (FFS) Medicare beneficiaries increased by 380% as a result of uptake of PCV13 vaccine. Continued disparities in delivery of pneumococcal vaccine services to FFS Medicare beneficiaries in rural and urban communities are noted, with a 63% higher vaccination rate observed in urban areas. The majority of pneumococcal vaccine services delivered to FFS Medicare beneficiaries were provided by primary care providers, although pharmacy providers delivered close to one-fourth (24.2%) of these services. Pharmacy providers in rural communities play an increasing role in pneumococcal vaccine service delivery, providing one-third (33.5%) of vaccines in 2015

Medicare-Paid Naloxone: Trends in Non-Metropolitan and Metropolitan Areas

Overview of Key Findings Medicare pays for the largest share (\u3e 30%) of naloxone dispensed from retail pharmacies in non-metropolitan areas. Medicare-paid dispensing has grown since 2013, but from 2017-2018 dispensing growth in non-metropolitan areas slowed considerably compared to metropolitan areas (42% v 121%, respectively). As of 2018, the rate of naloxone dispensing to Medicare enrollees in metropolitan areas was approximately double that in non-metropolitan areas (4.9 v 2.9 per 1,000 enrollees, respectively)

Stakeholder Theory and Marketing: Moving from a Firm-Centric to a Societal Perspective

This essay is inspired by the ideas and research examined in the special section on “Stakeholder Marketing” of the Journal of Public Policy & Marketing in 2010. The authors argue that stakeholder marketing is slowly coalescing with the broader thinking that has occurred in the stakeholder management and ethics literature streams during the past quarter century. However, the predominant view of stakeholders that many marketers advocate is still primarily pragmatic and company centric. The position advanced herein is that stronger forms of stakeholder marketing that reflect more normative, macro/societal, and network-focused orientations are necessary. The authors briefly explain and justify these characteristics in the context of the growing “prosociety” and “proenvironment” perspectives—orientations that are also in keeping with the public policy focus of this journal. Under the “hard form” of stakeholder theory, which the authors endorse, marketing managers must realize that serving stakeholders sometimes requires sacrificing maximum profits to mitigate outcomes that would inflict major damage on other stakeholders, especially society

Prescription Drug Monitoring Program Utilization in Kentucky Community Pharmacies

OBJECTIVE: Identify characteristics of Kentucky community pharmacists and community pharmacists\u27 practice environment associated with utilization of the Kentucky All Schedule Prescription Electronic Reporting Program (KASPER). METHODS: Surveys were mailed to all 1,018 Kentucky pharmacists with a KASPER account and an additional 1,000 licensed pharmacists without an account. Bivariate analyses examined the association between KASPER utilization and practice type (independent or chain) and practice location (rural or urban). A multivariate Poisson regression model with robust error variance estimated risk ratios (RR) of KASPER utilization by characteristics of pharmacists\u27 practice environment. RESULTS: Responses were received from 563 pharmacists (response rate 27.9%). Of these, 402 responses from community pharmacists were included in the analyses. A majority of responding pharmacists (84%) indicated they or someone in their pharmacy had requested a patient\u27s controlled substance history since KASPER\u27s inception. Bivariate results showed that pharmacists who practiced in independent pharmacies reported greater KASPER utilization (94%) than pharmacists in chain pharmacies (75%; p CONCLUSION: Utilization of KASPER differs by community pharmacists\u27 practice environment, predominantly by practice type and location. Understanding characteristics of community pharmacists and community pharmacists\u27 practice environment associated with PDMP use is necessary to remove barriers to access and increase utilization thereby increasing PDMP effectiveness

Changes in Buprenorphine Prescribing during the COVID-19 Pandemic in Kentucky

Buprenorphine is a medication approved by the U.S. Food and Drug Administration (FDA) to treat opioid use disorder (OUD). There were concerns that the COVID-19-related restrictions would interfere with the in-person prescribing of buprenorphine. In response to the COVID-19 public health emergency declaration, the Drug Enforcement Administration (DEA), partnering with the Substance Abuse and Mental Health Services Administration (SAMHSA), adopted policies to relax buprenorphine prescribing regulations [1], authorizing practitioners to prescribe buprenorphine to existing patients via telemedicine (as of Mar 16, 2020) and new patients via telephone without first having an in-person or telemedicine visit (as of Mar 31, 2020)[2]. This study evaluated the significance of the immediate changes in buprenorphine prescribing in Kentucky after the implementation of the new federal policies on buprenorphine prescribing for OUD treatment

Variation in reproductive timing for the northern long-eared myotis (\u3ci\u3eMyotis septentrionalis\u3c/i\u3e) across Nebraska

The northern long-eared myotis (Myotis septentrionalis), a federally threatened species, occurs in extreme northern, eastern, and southern Nebraska. These regions vary in climate due to geographic location, topography, and elevation. During a 1-week period in early July 2015, we surveyed bats across the state and observed striking variation in the reproductive status for M. septentrionalis. We examined whether or not growing degree days, an abiotic climatic factor used mainly for agricultural practices, was associated with this reproductive variation in a mammalian species. In early July, we captured only pregnant females in the Pine Ridge region of northwestern Nebraska, the region with the lowest number of growing degree days. In contrast, we captured both lactating females and flying young along the Republican River in south-central Nebraska near the border with Kansas, an area with a high, but intermediate number of growing degree days. Along the Missouri River, in extreme east-central Nebraska, along the border with Iowa, we documented lactating females with no evidence of volant young. This locality had the highest number of growing degree days. Phenotypic plasticity in timing of births for M. septentrionalis appears to be, in part, related to climatic differences across Nebraska, a relationship commonly observed for plants and invertebrates. Our study demonstrates that reproductive phenology can vary significantly across the distribution of a species and needs to be considered when making management decisions for imperiled species. Delayed reproduction in cooler regions of the species’ range presents risks to reproductive female M. septentrionalis and their nonvolant offspring, even with current protective measures. In areas with short growing seasons, restrictions on the timing of tree-cutting should be expanded beyond 31 July in more northerly parts of the species’ distribution, so as not to hinder reproductive success during the time when juvenile bats are unable to fly. RESUMEN.—El murciélago de orejas largas del norte (Myotis septentrionalis) una especie amenazada, se distribuye en los extremos norte, este y sur de Nebraska. El clima en estas regiones varía debido a la ubicación geográfica, la topografía y la elevación. Durante un período de una semana, a principios de julio del 2015, muestreamos murciélagos en todo el estado y observamos una notable variación en el estado reproductivo de M. septentrionalis. Analizamos, si el aumento en la temperatura diaria (factor climático abiótico utilizado principalmente en prácticas agrícolas) se asoció con la variación reproductiva en esta especie de mamíferos. A principios de julio, sólo capturamos hembras preñadas en la región de Pine Ridge al noroeste de Nebraska, una región con el menor número de días con aumento en la temperatura. Por el contrario, capturamos hembras lactantes y crías volando a lo largo del río Republican en el extremo centro-sur de Nebraska, cerca de la frontera con Kansas, un área con un alto pero intermitente aumento en la tempera - tura diaria. A lo largo del río Missouri, en el extremo este-central de Nebraska, y a lo largo de la frontera con Iowa, documentamos hembras lactantes sin evidencia de volantones. Esta localidad mostró el valor más alto de aumento en la temperatura diaria. La plasticidad fenotípica al momento del nacimiento de un M. septentrionalis pareciera estar, en parte, relacionada a las diferencias climáticas de Nebraska, una relación comúnmente observada en plantas e invertebrados. Nuestro estudio demuestra que la fenología reproductiva puede variar significativamente a través de la distribución de la especie, factor que debe ser considerado en el momento de tomar decisiones relacionadas al control y a las medidas de preservación de especies en peligro de extinción. En las regiones más frías del rango de distribución de la especie se observó una reproducción retrasada, siendo esto un riesgo para la hembra reproductora y sus crías no voladoras, incluso con las medidas de protección actuales. En las áreas con temporadas de cultivo cortas, las restricciones en cuanto a la tala de árboles deberían extenderse más allá del 31 de julio en las partes más al norte de su distribución, con el fin de no obstaculizar el éxito reproductivo durante el período en que los murciélagos jóvenes no pueden volar