The Australian pharmacist workforce: distribution and predictors of practising outside of metropolitan and regional areas in 2019

Objective: This study describes the distribution of the Australian pharmacists' workforce using a range of indicators and identifies predictors of practising outside of metropolitan and regional areas. Methods: A cross-sectional description of the 2019 pharmacy workforce. Pharmacists who completed the 2019 workforce survey as reported in the Australian National Health Workforce Dataset (NHWDS). The main outcome measures were the number of pharmacists per 100 000, the proportion working less than 35 h a week, the proportion with primary qualification from overseas (outside of Australia and New Zealand) and the proportion aged 65 years or older. Additionally, predictors of practising outside of metropolitan and regional areas were also identified. Key findings: Nationally, there were 102 pharmacists/100 000 with one-third working less than 35 h a week. About 10% of pharmacists obtained their primary qualification from overseas and 4% were 65 years old or older. Males were more likely to practise outside of metropolitan and regional areas [OR, 1.40 (1.30-1.50); P < 0.001], while younger people were less likely to practise outside of these locations [OR, 0.71 (0.66-0.76); P < 0.001]. Those who had obtained their primary qualification overseas were also more likely to practise outside of metropolitan and regional areas. Conclusions: Analysis of the 2019 NHWDS suggests an uneven distribution of the pharmacist workforce. Also, three predictors of practising outside of major cities and regional centres were identified

Factors that influence pharmacists' efforts in addressing substance use in Nigeria: An exploratory study

Introduction: Substance use is a major global public health problem. Over the years, the burden of substance use has increased worldwide, with Nigeria having a prevalence that is substantially above the global average. Tackling this challenge requires a collaborative effort between different health professionals. Despite the critical roles pharmacists could play in substance use prevention and management, exploration of pharmacists' role in mitigating substance use in society has received limited attention in most sub-Saharan countries. In this study, we explored the experiences of pharmacists in substance use prevention and management. Methods: We conducted semi-structured interviews to explore pharmacists' perceptions of their roles in the prevention and management of substance use in Nigeria. Following data transcription, we conducted a thematic content analysis. Results: The four major themes that emerged included 1) the extent of pharmacists' involvement in the decision-making process for addressing substance use, 2) factors that influence pharmacists efforts in addressing substance use in Nigeria, 3) how to improve rational prescribing practices and, 4) capacity building to enhance pharmacists participation in addressing substance use. Conclusion: Pharmacists have the opportunity to play critical roles in the prevention and management of substance use, but several individual and systemic challenges limit their full potential. Addressing these challenges is crucial in increasing pharmacists' participation in preventing and managing substance use

Sustaining Rural Pharmacy Workforce Understanding Key Attributes for Enhanced Retention and Recruitment

Objective: To pilot the Pharmacist Community Apgar Questionnaire (PharmCAQ) and evaluate its usability and capacity to develop a greater understanding of the unique factors that impact the rural recruitment and retention of pharmacists. Design: Cross-sectional design involving face-to-face, telephone or video conferencing interviews. Setting: Twelve rural communities across Tasmania and Western Victoria, Australia. Participants: Participants (n = 24) included pharmacists, a Director of Clinical Services, pharmacy practice managers and senior pharmacy assistants. Main Outcome Measures: Interviews enabled the completion of the PharmCAQ, which assigns quantitative values to 50 key factors to ascertain a community\u27s strengths and challenges associated with recruitment and retention and their relative importance to the pharmacist workforce. Results: The cumulative PharmCAQ scores indicated the tool was sensitive enough to differentiate high- and low-performing communities. Overall, the highest-rated factors considered most vital to pharmacist recruitment and retention were the reputation of the pharmacy, the ability of the pharmacist to be independent and autonomous, the loyalty of the community to the pharmacy, the level and stability of monetary compensation and the breadth of tasks available to a pharmacist. Conclusions: This study identified the strengths and challenges of participating communities and provided an insight into the shared factors to consider in recruiting and retaining pharmacists. Further, each community has unique strengths that can further be promoted in recruitment, flagging where limited resources are best used to address site specific challenges. This is more likely to ensure the matching of the right candidate with the right community

Sustaining rural pharmacy workforce understanding key attributes for enhanced retention and recruitment

Objective: To pilot the Pharmacist Community Apgar Questionnaire (PharmCAQ) and evaluate its usability and capacity to develop a greater understanding of the unique factors that impact the rural recruitment and retention of pharmacists. Design: Cross-sectional design involving face-to-face, telephone or video conferencing interviews. Setting: Twelve rural communities across Tasmania and Western Victoria, Australia. Participants: Participants (n = 24) included pharmacists, a Director of Clinical Services, pharmacy practice managers and senior pharmacy assistants. Main Outcome Measures: Interviews enabled the completion of the PharmCAQ, which assigns quantitative values to 50 key factors to ascertain a community's strengths and challenges associated with recruitment and retention and their relative importance to the pharmacist workforce. Results: The cumulative PharmCAQ scores indicated the tool was sensitive enough to differentiate high- and low-performing communities. Overall, the highest-rated factors considered most vital to pharmacist recruitment and retention were the reputation of the pharmacy, the ability of the pharmacist to be independent and autonomous, the loyalty of the community to the pharmacy, the level and stability of monetary compensation and the breadth of tasks available to a pharmacist. Conclusions: This study identified the strengths and challenges of participating communities and provided an insight into the shared factors to consider in recruiting and retaining pharmacists. Further, each community has unique strengths that can further be promoted in recruitment, flagging where limited resources are best used to address site specific challenges. This is more likely to ensure the matching of the right candidate with the right community. © 2022 The Authors. Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Vorapaxar: A novel agent to be considered in the secondary prevention of myocardial infarction

Patients receiving therapy for the secondary prevention of myocardial infarction (MI) are still at high risk of a major cardiovascular event or death despite the use of currently available treatment strategy. Vorapaxar, an oral protease-activated receptor antagonist, is a novel antiplatelet drug that has been recently approved to provide further risk reduction. The results of two Phase III trials (thrombin receptor antagonists for clinical event reduction and the TRA 2 °P-TIMI 50) have showed that vorapaxar, in addition to standard of care therapy, has the potential to provide further risk reduction in patients with prior MI. A search was made on PubMed on articles related to clinical trials and clinical consideration with the use of vorapaxar. This review article summarizes the results of Phase II trials, Phase III trials, subgroup analysis, precautions, and drug interaction with the use of vorapaxar

Perception of Bowel Cancer Information Overload: A Cross-Sectional Study

Objective: To identify levels of bowel cancer information overload and associated predictors. Methods: A cross-sectional online survey of Tasmanians ≥18 years measured bowel cancer information overload using a modified Cancer Information Overload Scale. Descriptive statistics summarized participants’ demographic and information overload data; linear regression investigated information overload predictors. Results: The analysis included 3,701 Tasmanians (75.8% female). Above 50% of participants disagreed/strongly disagreed with the statements favoring information overload. Significant predictors of bowel cancer information overload included current smokers, body mass index, lower educational attainment, and living less rurally. Conclusion: In this study bowel cancer information overload was associated with lower educational attainment, current smokers, higher body mass index, and living less rurally

Strategies to increase the pharmacist workforce in rural and remote Australia: a scoping review

IntroductionDespite reports suggesting an oversupply of pharmacists, there is currently an inadequate supply in rural and remote Australia. This can lead to a reduction in pharmaceutical services for an already vulnerable population. The objective of this study was to identify strategies for increasing the pharmacist workforce and factors associated with retention in rural and remote Australia Methods: Database searches of Ovid Medline (Medline and Embase), CINAHL and Scopus were conducted. Full text of relevant studies conducted in Australia, reported in English and published between 2000 and 2019 were retrieved. The record titles were independently screened by two investigators, after which abstracts of disputed articles were collected for further evaluation. Where agreement could not be reached, a third independent investigator screened the residual articles for inclusion or exclusion.Results:Overall, 13 articles focusing on the pharmacy profession were retrieved. Strategies that have been employed to increase the rural and remote pharmacist workforce include the establishment of pharmacy schools in rural areas, inclusion of rural content in undergraduate pharmacy curriculum, enrolment of students from rural backgrounds, rural placement and employment of sessional pharmacists. Factors associated with retention were personal, workplace or community factors.Conclusion:There is limited research focusing on the recruitment and retention of pharmacists in rural and remote Australia. Given that pharmacies in rural and remote areas are very accessible and often function as one-stop health hubs, additional personal, workplace and community support should be provided for rural pharmacists and pharmacy students undergoing placements in rural and remote communities

Like, comment, tag, share: Facebook interactions in health research

Background and objectives: A key aspect of the Internet that facilitates research is social media, especially the meteoric rise in the use of Facebook as one of the primary applications for social connectivity. Facebook can be considered a rich source of data due to the high amounts of demographic information shared by users and stored in the system, as well as the way in which users share their thoughts and behaviour in their natural environment. This report focuses on one functionality that as yet remained under-discussed and perhaps under-utilised as a tool in health research – the ability for participants or interested parties to leave comments directly on Facebook posts relating to research projects. Further, this report provides some considerations for researchers intending to use Facebook in recruiting participants for research. Methods: The study was a Bowel Cancer Awareness Study conducted by the Centre for Rural Health, University of Tasmania to assess bowel cancer risk awareness in Tasmania. Participants were recruited to complete a survey on LimeSurveyTM via a Facebook page used to advertise the study. Several comments were made on the Facebook page over a three-month period, which were then further categorised and thematically analysed. Specifically, these comments were reviewed to determine how valuable Facebook comments can be for research. Results: The Facebook advertisement for the survey reached 136,640 people at a cost of $0.04 (4 cents) per person. From the range of comments received, four separate functions of these comments became apparent upon analysis – the capacity to ask questions, the ability to interact with others, promotion of the survey, and suggestions for future research. Discussion: From the bowel cancer awareness study, we found that Facebook comments on our study page allowed for an opportunity for ongoing contact with respondents, opportunity to receive feedback, address concerns and harness future research ideas. The ability to further utilize the potential for Facebook comments to enrich data collection and health research warrants a continuous and sustained interest, as research methodology progressively utilises the Internet and social media platforms as an effective and affordable option