THE CONTRIBUTION OF NORTH DAKOTA'S COMMUNITY PHARMACIES TO THE STATE'S ECONOMY

A pharmacist shortage, mail and internet competition, thinning margins, and third-party payer issues are some of the issues challenging community pharmacies. Those challenges have raised concerns about the long-term viability of independent community pharmacies, especially those in rural areas. In addition to a pharmacy's role in the delivery of prescription drugs, community pharmacies also play an important role in the state and local economies, again, especially in rural communities. Community pharmacies consistently have been classified as a business that provides essential services. Because of the issues and challenges facing community pharmacies and their role as an essential service, this study was undertaken to quantify the economic contribution North Dakota's community pharmacies make to the state's economy and to examine community pharmacies' business characteristics, services provided, and other issues. This study estimates all relevant expenditures and returns associated with North Dakota's community pharmacies.Economic impact, pharmacy, pharmacists, drug stores, Health Economics and Policy,

Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016

BACKGROUND: While naloxone, the overdose reversal medication, has been available for decades, factors associated with its availability through pharmacies remain unclear. Studies suggest that policy and pharmacist beliefs may impact availability. Indiana passed a standing order law for naloxone in 2015 to increase access to naloxone. OBJECTIVE: To identify factors associated with community pharmacy naloxone stocking and dispensing following the enactment of a statewide naloxone standing order. METHODS: A 2016 cross-sectional census of Indiana community pharmacists was conducted following a naloxone standing order. Community, pharmacy, and pharmacist characteristics, and pharmacist attitudes about naloxone dispensing, access, and perceptions of the standing order were measured. Modified Poisson and binary logistic regression models attempted to predict naloxone stocking and dispensing, respectively. RESULTS: Over half (58.1%) of pharmacies stocked naloxone, yet 23.6% of pharmacists dispensed it. Most (72.5%) pharmacists believed the standing order would increase naloxone stocking, and 66.5% believed it would increase dispensing. Chain pharmacies were 3.2 times as likely to stock naloxone. Naloxone stocking was 1.6 times as likely in pharmacies with more than one full-time pharmacist. Pharmacies where pharmacists received naloxone continuing education in the past two years were 1.3 times as likely to stock naloxone. The attempted dispensing model yielded no improvement over the constant-only model. CONCLUSIONS: Pharmacies with larger capacity took advantage of the naloxone standing order. Predictors of pharmacist naloxone dispensing should continue to be explored to maximize naloxone access

Quality safeguards and regulation of online pharmacies

Using econometric evidence, this article confirms that distribution of medicines online is split into two market segments of very diverse quality, and identifies the factors that drive quality and quality assurance in this activity. Unlike fraudulent, ‘rogue,’ websites, which offer scant guarantees and usually sell just a few medicines without prescription, online pharmacies offering insurance coverage and linked to conventional pharmacies typically sell a whole range of drugs, require third-party medical prescriptions and provide abundant information to patients. It is shown that, where online pharmacies are allowed to act legally, market forces enhance quality, as private insurers require professional standards, and specialized third parties make a business of certifying them. Furthermore, older online pharmacies and those running conventional operations offer higher quality, probably because of reputational investments. Overall, this evidence supports licensing online pharmacies, especially considering that prohibiting them is ineffective against fraudulent sites.E-Commerce, pharmacies, regulation, quality assurance

Assessing excess profits from different entry regulations

Entry regulations affecting professional services such as pharmacies are common practice in many European countries. We assess the impact of entry regulations on profits estimating a structural model of entry using the information provided by a policy experiment. We use the case of different regional policies governing the opening of new pharmacies in Spain to show that structural models of entry ought to be estimated with data from policy experiments to pin down how entry regulations change payoffs functions of the incumbents. Contrary to the public interest rationales, regulations are not boosting only small town pharmacies payoffs nor increasing all pharmacies payoffs alike. The gains from regulations are very unevenly distributed,suggesting that private interests are shaping the current mix of entry and markup regulations.Entry, regulation, professional services

A systematic review of the nature of dispensing errors in hospital pharmacies

Background: Dispensing errors are common in hospital pharmacies. Investigating dispensing errors is important for identifying the factors involved and developing strategies to reduce their occurrence. Objectives: To review published studies exploring the incidence and types of dispensing errors in hospital pharmacies and factors contributing to these errors. Methods: Electronic databases including PubMed, Scopus, Ovid, and Web of Science were searched for articles published between January 2000 and January 2015. Inclusion criteria were: studies published in English, and studies investigating type, incidence and factors contributing to dispensing errors in hospital pharmacies. One researcher searched for all relevant published articles, screened all titles and abstracts, and obtained complete articles. A second researcher assessed the titles, abstracts, and complete articles to verify the reliability of the selected articles. Key findings: Fifteen studies met the inclusion criteria all of which were conducted in just four countries. Reviewing incident reports and direct observation were the main methods used to investigate dispensing errors. Dispensing error rates varied between countries (0.015%–33.5%) depending on the dispensing system, research method, and classification of dispensing error types. The most frequent dispensing errors reported were dispensing the wrong medicine, dispensing the wrong drug strength, and dispensing the wrong dosage form. The most common factors associated with dispensing errors were: high workload, low staffing, mix-up of look-alike/sound-alike drugs, lack of knowledge/experience, distractions/interruptions, and communication problems within the dispensary team. Conclusion: Studies relating to dispensing errors in hospital pharmacies are few in number and have been conducted in just four countries. The majority of these studies focused on the investigation of dispensing error types with no mention of contributing factors or strategies for reducing dispensing errors. Others studies are thus needed to investigate dispensing errors in hospital pharmacies, and a combined approach is recommended to investigate contributing factors associated with dispensing errors and explore strategies for reducing these errors.Peer reviewe

Community Pharmacy: an untapped patient data resource

As community pharmacy services become more patient centred they will be increasingly reliant on access to good quality patient information. This paper describes how the information which is currently available in community pharmacies can be used to enhance service delivery and patient care. With integration of community pharmacy and medical practice records on the horizon the opportunities this will provide are also considered. The community pharmacy held patient medication record, which is the central information repository, has been used to identify non-adherence, to prompt the pharmacist to clinically review prescriptions, identify patients for additional services and to identify those patients at greater risk of adverse drug events. Whilst active recording of patient consultations for treatment over the counter may improve the quality of consultations and information held, the lost benefits of anonymity afforded by community pharmacies needs to be considered. Recording of pharmacy staff activities enables workload to be monitored, remuneration to be justified and critical incidents to be learned from but is not routine practice. Centralisation of records between community pharmacies enables practices to be compared and consistent problems to be identified. By integrating pharmacy and medical practice records, patient behaviour with respect to medicines can be more closely monitored and should prevent duplication of effort. When using patient information stored in a community pharmacy it is however important to consider the reason why information was recorded in the first instance and whether it is appropriate to use it for a different purpose without additional patient consent. Community pharmacies currently have access to large amounts of information which if stored and used appropriately can significantly enhance the quality of provided services and patient care. Integrating records increases opportunities to enhance patient care yet further. Whilst community pharmacies have significant amounts of information available to them this is frequently untapped

Are Hospital Pharmacies More Efficient if They Employ Nurses?

This paper assesses the efficiency of utilizing nurses in Washington State hospital pharmacies. We take the perspective of a pharmacy department manager and model an input oriented hospital pharmacy production process. Data envelopment analysis (DEA) is used to examine both scale efficiency and technical efficiency, and differences across hospital pharmacies that use and do not use nurse staffing are analyzed using cross-tabulations and nonparametric hypothesis tests. The results indicate that the use of nurse staffing does not significantly impact either scale or technical efficiency. Thus, permitting nurses to play a greater role in hospital pharmacies does not adversely affect efficiency. This paper has important policy implications for hospital administrators and pharmacists.

Individual and county-level factors associated with use of multiple prescribers and multiple pharmacies to obtain opioid prescriptions in California.

Use of multiple prescribers and pharmacies is a means by which some individuals misuse opioids. Community characteristics may be important determinants of the likelihood of this phenomenon independent of individual-level factors. This was a retrospective cohort study with individual-level data derived from Californias statewide prescription drug monitoring program (PDMP) and county-level socioeconomic status (SES) data derived from the United States Census. Zero-truncated negative binomial (ZTNB) regression was used to model the association of individual factors (age, gender, drug schedule and drug dose type) and county SES factors (ethnicity, adult educational attainment, median household income, and physician availability) with the number of prescribers and the number of pharmacies that an individual used during a single year (2006). The incidence rates of new prescriber use and new pharmacy use for opioid prescriptions declined across increasing age groups. Males had a lower incidence rate of new prescriber use and new pharmacy use than females. The total number of licensed physicians and surgeons in a county was positively, linearly, and independently associated with the number of prescribers and pharmacies that individuals used for prescription opioids. In summary, younger age, female gender, and living in counties with more licensed physicians and surgeons were associated with use of more prescribers and/or more pharmacies for obtaining prescription opioids

State Prescription Drug Price Web Sites: How Useful to Consumers?

Compares ten sites and identifies key limitations due to data omissions, gaps between insured and uninsured consumers, and varied program implementation. Presents alternative policy options such as requiring price lists from pharmacies

Method of Stimulation of Pharmacy Workers Involved in the Government Program “Available Medicines”

The aim is to study the current state of the organization of work in pharmacies under the government program “Available medicines” and to create proposals for the improvement of material incentives to increase the motivation of workers of such pharmacies.Materials and methods. The research used the general methods of scientific knowledge: analysis and synthesis, analogy and comparison; method of questioning to determine the actual state and opinions of specialists on the organization of work in the conditions of pharmacy participation in the program "Available medicines".Results and discussion. In the course of the study, the problem of lack of incentives and motivation for the work of pharmacy workers under the Government program "Available medicines" has been highlighted. According to the results of the survey of specialists of three different forms of pharmacy' ownership, participating in the program of reimbursement of the cost of drugs, it was found that the volume and intensity of work of workers has significantly increased, and wages have remained at the same level. The number of operations performed by employees in such pharmacies has considerably increased, which is related to the registration and maintenance of recipes under the program "Available medicines". The questionnaire survey has showed that the best option for optimizing the organization of remuneration in the prevailing conditions would be to pay extra for work (overpays). It was found that the number of recipes taken by one pharmacist per day varies considerably in different pharmacies, and there are also differences in the duration of the work of pharmacies under the reimbursement program during the month. To increase the motivation of pharmacists to work in the prevailing conditions, the method of calculating the additional payment for work in the conditions of the program "Available medicines" for each chemist's worker is offered individually in accordance with the post based on a formula that takes into account the intensity of labor using the intensity coefficient and the percentage of the additional payment.Conclusions. The conducted researches have shown that the increased intensity of labor, which takes place in pharmacies working under the program "Available medicines", is the basis for the calculation of additional payments. The application of the system of material stimulation of the work of pharmacists based on the proposed methodology will allow compensating additional labor of specialists, taking into account the intensity of their work