Journal Of The American Pharmacists Association[JOURNAL]
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200 papers
Healthcare utilization and costs associated with changes in medication adherence around the 80% threshold in patients with cardiovascular disease.
Peasah SK, Lee T, Huang Y … +3 more , Inneh A, Patel U, Good CB
J Am Pharm Assoc (2003) · 2026 · PMID 41895603 · Publisher ↗
BACKGROUND: Health care utilization and cost impacts, of medication adherence above or below the 80% threshold, remains unclear for cardiometabolic medications. OBJECTIVE: To evaluate the differences in cardiovascular-re...
BACKGROUND: Health care utilization and cost impacts, of medication adherence above or below the 80% threshold, remains unclear for cardiometabolic medications. OBJECTIVE: To evaluate the differences in cardiovascular-related emergency department (ED) visits and total cost-of-care associated with changes in medication adherence around the 80% threshold. METHODS: Retrospective observational analysis of claims spanning from Jan 1, 2021, to June 30, 2023. Patients aged 50-80 years with a history of cardiovascular disease and specific cardiometabolic medications were followed for 12 months, and prepost index-fill outcomes compared. Patients were categorized into pre- and postindex groups: 3 pre-index groups (Pre1-moderate, Pre2-high, Pre3-very-high) based on their pre-index 12-month adherence [postindex adherence (PDC)] and 4 post-index groups based on postindex PDC (Post0-low, Post1-moderate, Post2-high, Post3-very-high), for 4 medication classes (antidiabetics, direct oral coagulants [DOACs], antiplatelets, and antiheart-failure meds [HF]). Group definitions: Post0-low (PDC ≤ 69%), Pre1-moderate or Post1-moderate (PDC 70-<80%), Pre2-high or Post2-high (PDC 80-<90%), and Pre3-very-high or Post3-very-high (PDC ≥ 90). Outcomes included per-member-per-year total cost-of-care, and cardiovascular-related ED visits. RESULTS: There were 55,934 (antidiabetics), 46,290 (DOACs), 65,659 (antiplatelets), and 49, 670 (HF) patients in the final sample. Most of the patients in the HF (46%-53%) and DOAC (51%-57%) groups were in the 70+ age group. Among patients in the antidiabetic (45%-47%) and antiplatelet (39%-43%) groups, the majority were in the 60-69 age group. In general, patients who moved from a lower adherence group to a higher adherence group had lower total cost-of-care in almost all groups and medication classes. Moving from PDC ≥ 90 to PDC <90%, total cost-of-care was higher in all 4 medication classes. CONCLUSION: Improving adherence to and beyond the traditional 80% target was associated with lower total cost-of-care.
Community pharmacy practice transformation: Evaluating sustainability of patient care services.
Ferreri SP, Bacci JL, Doucette WR … +6 more , Daly C, McDonough R, Roller J, McGivney MS, Smith MG, Coley KC
J Am Pharm Assoc (2003) · 2026 · PMID 41881423 · Publisher ↗
BACKGROUND: Flip the Pharmacy (FtP) is a transformation initiative that "flips" community pharmacies from a primarily dispensing model to providing patient care services. More than 450 pharmacies nationwide engaged in th...
BACKGROUND: Flip the Pharmacy (FtP) is a transformation initiative that "flips" community pharmacies from a primarily dispensing model to providing patient care services. More than 450 pharmacies nationwide engaged in the first cohort of FtP. Previous studies demonstrated FtP support was effective in practice transformation. However, it is unknown to what extent patient care services continued once FtP ended. OBJECTIVE: To evaluate the sustainability of patient care services at community pharmacies participating in FtP. METHODS: An online survey was emailed to key informants. Survey questions were adapted from the National Health Services (NHS) Sustainability Model which identifies barriers and facilitators to sustainment in 3 domains: process, staff, and organization. The survey evaluated continued offerings of patient care services, addition of new patient care services, integration of services with personnel, continued use of FtP resources, and pharmacy characteristics. Descriptive statistics were calculated for survey variables. Linear regression was used to test if process factors, staff factors, organization factors, continued use of resources, or payment explained service sustainability. RESULTS: The response rate was 45% (n = 210). Almost all respondents (n = 209, 99.5%) reported that one patient care service continued. Reported sustainability scores for each domain were 75.2% (process), 81.6% (staff) and 78.1% (organization). All domains achieved more than 55% indicating optimism of initiative sustainment. More than half of pharmacies (56.7%) offered a new patient care service. Most respondents continued to utilize FtP resources at least some of the time each month. Linear regression revealed service sustainment was positively associated with the process component of NHS sustainability measure (ß = 0.324; P < 0.001), the continued use of FtP resources (ß = 0.246; P < 0.001), and service payment (ß = 0.148; P = 0.028). CONCLUSION: Community pharmacies engaged in FtP demonstrated ability to sustain patient care services.
Impact of pharmacist intervention to promote adult human papillomavirus vaccination in a primary care clinic.
Wardwell B, Salvo MC, Carey J
J Am Pharm Assoc (2003) · 2026 · PMID 41881422 · Publisher ↗
BACKGROUND: Human Papillomavirus (HPV) is linked to several cancers including those of the back of the throat, cervical, anal, vulvar, penile, and vaginal. Receiving the HPV vaccine decreases cases of these cancers. OBJE...
BACKGROUND: Human Papillomavirus (HPV) is linked to several cancers including those of the back of the throat, cervical, anal, vulvar, penile, and vaginal. Receiving the HPV vaccine decreases cases of these cancers. OBJECTIVE: The objective of this initiative was to evaluate if pharmacist entry of a pending order for the HPV vaccine increases its administration in a primary care setting. METHODS: A pre-post quality improvement initiative was conducted from November 2024 through April 2025. The intervention included an embedded ambulatory care pharmacist identifying eligible patients for HPV vaccination and entering a pending order for the HPV vaccine's administration in patients' charts before their primary care provider appointment. RESULTS: A total of 158 vaccine orders were entered as pending for provider review. Of the 158 orders, 53 (33.5%) were discussed during appointments, resulting in 21 (39.6%) patients receiving their first HPV vaccine. Of these patients, seven (33.3%) completed the HPV vaccine series. Of the 105 orders not discussed, 57 (54.2%) patients missed or rescheduled their appointments. CONCLUSION: Pharmacist entry of a pending order for the HPV vaccine in patients' charts prompted provider-patient shared clinical decision-making and furthered discussions about HPV vaccination.
Improving pharmacy-based HPV vaccine delivery through communication training: Findings from a pilot feasibility study.
Shah PD, Schwartz J, Bacci JL … +5 more , Calo WA, Ko LK, Glascock M, Li L, Watabayashi K
J Am Pharm Assoc (2003) · 2026 Mar · PMID 41866129 · Full text
BACKGROUND: HPV vaccination coverage among U.S. adolescents remains below national targets. Community pharmacies are highly accessible vaccination venues, but staff need to enhance practical skills to identify vaccine-el...
BACKGROUND: HPV vaccination coverage among U.S. adolescents remains below national targets. Community pharmacies are highly accessible vaccination venues, but staff need to enhance practical skills to identify vaccine-eligible adolescents and communicate effectively with parents. OBJECTIVES: To evaluate the acceptability and feasibility of a team-based HPV vaccine communication training for pharmacy staff. METHODS: We used a single-group pre/post-test design in three community pharmacies in Washington state between December 2022-May 2023. The prerecorded online vaccine communication training integrated vaccine eligibility forecasting with 5A's counseling and Announcement Approach recommendation language. Pharmacy staff involved in adolescent immunizations completed baseline (n=18) and follow-up (n=13) online surveys assessing behavioral outcomes related to adolescent HPV vaccination before and after completing the training. Adolescent vaccination counts were audited for pre- (February-May 2022) and post-implementation (February-May 2023) periods. RESULTS: The proportion of staff reporting strong HPV vaccine recommendations increased from 22% pre-implementation to 67% post-implementation (p=0.016). The proportion of staff recommending HPV vaccination starting at ages 9-12 increased from 33% to 50% for both female and male adolescents, though this was not statistically significant (p=0.324). Self-efficacy improved for personal interactions (mean 2.8 to 3.4; p=0.004), goal setting (2.7 to 3.5; p=0.004), and addressing hesitancy (2.6 to 3.3; p=0.010). Post-implementation, staff rated the acceptability (mean 4.1/5), appropriateness (4.0/5), and feasibility (4.1/5) of pharmacy-based HPV vaccination favorably. Vaccination audits showed increased HPV doses at one pharmacy (2 doses to 20 doses) and no change at the other pharmacy (1 dose to 1 dose). The third pharmacy did not administer any adolescent vaccinations during the post-implementation period. CONCLUSION: A team-based HPV vaccine communication training was acceptable and feasible and improved staff-reported HPV recommendation behaviors, with heterogeneous short-term changes in HPV vaccination delivery. Larger multisite studies with longer observation periods are needed to evaluate effects on vaccination uptake.
TikTokfluence: The rise of GLP-1 receptor agonists in the age of social media health trends.
Günaltay MM, Kartal N
J Am Pharm Assoc (2003) · 2026 · PMID 41866128 · Publisher ↗
OBJECTIVES: To evaluate the quality, reliability, and thematic content of user-generated videos on TikTok concerning glucagon-like peptide-1 (GLP-1) receptor agonists. METHODS: This cross-sectional study analyzed the top...
OBJECTIVES: To evaluate the quality, reliability, and thematic content of user-generated videos on TikTok concerning glucagon-like peptide-1 (GLP-1) receptor agonists. METHODS: This cross-sectional study analyzed the top 400 most popular videos using the hashtags #Ozempic, #Semaglutide, #Mounjaro, and #Tirzepatide. A dual approach was employed, incorporating qualitative thematic analysis and quantitative scoring. The JAMA Internet Health Information Criteria and the DISCERN Consumer Health Information Evaluation Tool were utilized to assess the quality and reliability of the health information provided. RESULTS: Of the analyzed content, 98% was produced by individual users or influencers. The reliability-based information quality score for these accounts was significantly lower than that of health care professionals (34.53 vs. 52.31). No significant correlation was observed between engagement metrics (views and likes) and information quality. A significant proportion of the content contained risky or misleading information, particularly regarding side effects and safe usage. CONCLUSION: The findings suggest that the TikTok algorithm prioritizes engagement over content quality. There is a substantial communication deficit regarding GLP-1 receptor agonists on social media, necessitating better public health strategies to combat misinformation.
Administration of vaccines and injectable medications beyond 9 to 5: A cross-sectional analysis of over 1.2 million injection appointments scheduled at Canadian community pharmacies.
Houle SKD, Bhaidani S, Rehmanji T … +1 more , Alsabbagh MW
J Am Pharm Assoc (2003) · 2026 · PMID 41866127 · Publisher ↗
BACKGROUND: Community pharmacies are highly accessed for vaccination and other injection services. The COVID-19 pandemic accelerated changes in work practices and in health care delivery, influencing patient preferences...
BACKGROUND: Community pharmacies are highly accessed for vaccination and other injection services. The COVID-19 pandemic accelerated changes in work practices and in health care delivery, influencing patient preferences for timely and convenient care. OBJECTIVE: This research examines patient-level and organizational factors associated with the administration of injections at Canadian community pharmacies during hours where other primary care providers may not be available. METHODS: A cross-sectional retrospective analysis of appointments for injection services (vaccines and injectable medications) at community pharmacies through software from MedEssist or MedMe Health from January to December 2023 was performed. Appointments outside the hours of 9 AM to 5 PM on weekdays, on weekends, or on federal or statutory holidays were considered to fall during "off-clinic" hours when other health care settings where injections are provided may not be available. A multivariable logistic regression was performed to identify patient, pharmacy, community, or product factors associated with scheduling appointments during "off-clinic" hours. RESULTS: Of 1,226,903 appointments scheduled, 27.0% were during off-clinic hours, ranging from 9.1% among banner or independent pharmacies to 34.0% among chain pharmacies. Scheduling of appointments during "off-clinic" hours was positively associated with younger age (OR 1.74, 95%CI 1.69, 1.79 for age <18 years vs. 18-49) and male gender (OR 1.05, 95%CI 1.03, 1.07 vs. female) and negatively associated with rural pharmacy location (OR 0.77, 95%CI 0.75, 0.80). CONCLUSION: Community pharmacies often provide care over extended hours, offering convenience and accessibility that can support vaccine uptake and injectable medication adherence. Younger patient age, male gender, and urban pharmacy location are associated with greater use of appointments outside of typical business hours.
Top facts about spirituality and spiritual care in pharmacy practice: A perspective for whole-person care.
Gavaza P
J Am Pharm Assoc (2003) · 2026 · PMID 41866126 · Publisher ↗
Religion and spirituality are central for many people and are increasingly viewed as essential to whole-person care. Spirituality affects health behaviors, outcomes, and patients' experiences, yet spiritual concerns ofte...
Religion and spirituality are central for many people and are increasingly viewed as essential to whole-person care. Spirituality affects health behaviors, outcomes, and patients' experiences, yet spiritual concerns often go unmet. Pharmacists frequently encounter spiritual issues and work in systems that require spiritual assessment, but many feel unprepared due to limited training and uncertainty about professional boundaries. Emerging evidence shows that some pharmacists already provide ethical, patient-centered spiritual care (SC) and that many patients are receptive to it. This article presents 10 key insights about spirituality in pharmacy and calls for stronger integration of SC through improved education, policy, research, and professional leadership.
Evaluation of clinical decision support to improve guideline directed medical therapy in patients with type 2 diabetes.
Ernst K, Zimmerman C, Sukul D … +5 more , Renner E, Wang L, Thompson AN, Adie S, Diez HL
J Am Pharm Assoc (2003) · 2026 Mar · PMID 41866125 · Publisher ↗
BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death for patients with type 2 diabetes (T2D). Recent clinical guidelines recommend earlier initiation of glucagon-like peptide-1 recepto...
BACKGROUND: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death for patients with type 2 diabetes (T2D). Recent clinical guidelines recommend earlier initiation of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with ASCVD, chronic kidney disease, and/or multiple risk factors. However, broader adoption among healthcare clinicians has been evolving, influenced by factors such as medication cost, clinical complexity, and established care pathways that may involve specialist management. While interruptive and non-interruptive clinical decision support (CDS) within electronic health records (EHRs) can help identify care gaps, their specific impact on prescribing these cardioprotective agents is not well defined. OBJECTIVE: This pilot study evaluated the use of CDS during specialist visits to facilitate guideline-directed medical therapy (GDMT) for patients with T2D and ASCVD in primary care. METHODS: We conducted a retrospective, single-center cohort study at a large academic medical center to assess an interruptive alert presented during interventional cardiology (IC) visits. When the IC clinician acknowledged the alert, an automated EHR message was sent to the patient's primary care provider (PCP), recommending initiation of a GLP-1 RA or SGLT2i. The primary outcome was the percentage of patients identified by the alert who were prescribed one of these medications. Secondary outcomes included documented reasons for not initiating GDMT and the provider type responsible for prescribing. Descriptive statistics were utilized. RESULTS: The alert was triggered for 134 eligible patients. PCPs addressed the alert in the EHR for 61 cases (45.5%), and 26 patients (19.4%) were started on a GLP-1 RA or SGLT2i. The most frequent reasons for not initiating therapy were medication cost (n = 7), 11.5%) and contraindications (n = 5), 8.2%). CONCLUSION: An interactive CDS prompted initiation of GDMT by primary care clinicians in nearly 20% of eligible T2D and ASCVD patients.
Performance validation of large language models for drug-drug interaction consultations: Potential pharmacist assistant in outpatient pharmaceutical services.
Zhang H, Wang A, He C … +2 more , Qiu S, An Z
J Am Pharm Assoc (2003) · 2026 · PMID 41864615 · Publisher ↗
BACKGROUND: The growing prevalence of polypharmacy and time constraints pose significant challenges for pharmacists in managing drug-drug interactions during outpatient consultations. While large language models (LLMs) s...
BACKGROUND: The growing prevalence of polypharmacy and time constraints pose significant challenges for pharmacists in managing drug-drug interactions during outpatient consultations. While large language models (LLMs) show potential in various medical applications, their practical utility in real-world pharmaceutical services particularly in providing accurate, context-aware drug-drug interaction advice, remains underexplored. OBJECTIVES: This study aims to evaluate the performance of LLMs in responding to real-world drug-drug interaction consultation queries. The goal is to assess their feasibility as assistive tools for pharmacists in delivering evidence-based, patient-specific medication guidance. METHODS: A total of 165 nonredundant drug-drug interaction queries were extracted from outpatient pharmacy consultations at Beijing Chao-Yang Hospital from January to May 2023. Responses from 4 LLMs were compared against answers provided by pharmacists. A scoring framework was applied to evaluate accuracy, depth of analysis, and practicality of administration advice. RESULTS: The LLMs demonstrated high consistency with pharmacists' responses, with rates of 84.85%-89.09%. Discrepancies arose primarily from incomplete pharmacist documentation, LLM drug misidentification, and differences in practical medication use advice. In scored evaluations, DeepSeek R1 achieved the highest score, achieving 3-4-point scores in 137 queries by integrating multi-perspective drug analysis and actionable administration strategies. CONCLUSION: LLMs, particularly those with advanced reasoning and internet retrieval capabilities, have the potential to support pharmacists in drug-drug interaction management by delivering accurate, context-specific recommendations. However, limitations such as potential hallucination and operational delays remain. LLMs should serve as complementary tools under pharmacist supervision to enhance consultation quality and efficiency, not as replacements for professional judgment. Further validation using clinical metrics is warranted before widespread adoption.
Socioeconomic and racial disparities in polypharmacy among U.S. adults: Evidence from NHANES 2011-2018.
Ling Y, Hou MX, Riaz M … +1 more , Rahman NU
J Am Pharm Assoc (2003) · 2026 · PMID 41862135 · Publisher ↗
BACKGROUND: Polypharmacy (PP) has become common among adults with chronic conditions and is associated with a range of adverse outcomes. Less is known about how medication burden is distributed across racial, ethnic, and...
BACKGROUND: Polypharmacy (PP) has become common among adults with chronic conditions and is associated with a range of adverse outcomes. Less is known about how medication burden is distributed across racial, ethnic, and socioeconomic groups in recent nationally representative U.S. OBJECTIVE: The objective of the study was to estimate the prevalence of PP among U.S. adults from 2011 to 2018 and to examine differences by race/ethnicity and socioeconomic status. METHODS: We analyzed data from National Health and Nutrition Examination Survey 2011-2018, including adults aged 20 years and older. PP was defined as the concurrent use of 5 or more prescription medications. Survey-weighted regression models were used to evaluate associations with income, education, race/ethnicity, and insurance status, with adjustment for age, sex, and multimorbidity. RESULTS: An estimated 15.9% (95% CI: 15.0% to 16.9%) of U.S. adults met criteria for PP, and approximately 4% to 6% reported use of 10 or more prescription drugs. Prevalence increased sharply with age and was higher among adults with lower income. Non-Hispanic White and Non-Hispanic Black adults had higher prevalence than Mexican Americans. Overall PP prevalence remained stable across survey cycles and observed racial/ethnic and socioeconomic differences persisted after accounting for multimorbidity. CONCLUSION: Nearly 1 in 6 U.S. adults is exposed to PP, with clear differences by socioeconomic position and race/ethnicity. These disparities persisted after adjustment for chronic disease burden, suggesting that differences in health care use and prescribing patterns may contribute, although causal interpretation is limited by the cross sectional design. Approaches to medication review and deprescribing that account for social and structural context may help reduce avoidable medication burden.
Medication adherence and persistence of newly initiated medications in older adults with diabetes.
Dombrowski SK, An J, Huang X … +14 more , Lewis M, Hayduk VA, Neugebauer R, O'Connor PJ, Schmittdiel J, Hooker SA, Karter AJ, Oshiro CES, Cassidy-Bushrow AE, Nance N, Nolan MB, Gilliam LK, Graham J, Wright EA
J Am Pharm Assoc (2003) · 2026 · PMID 41850681 · Publisher ↗
BACKGROUND: Older adults with type 2 diabetes (T2D) face increased complications compared with younger counterparts and the challenge of multimorbidity, which may result in complex medication burden, high-cost regimens,...
BACKGROUND: Older adults with type 2 diabetes (T2D) face increased complications compared with younger counterparts and the challenge of multimorbidity, which may result in complex medication burden, high-cost regimens, polypharmacy, and nonadherence. OBJECTIVES: This study sought to evaluate primary and secondary medication adherence and persistence patterns of newly initiated glucose-lowering medications in older adults with T2D. METHODS: This retrospective cohort study included adults aged 65 years and older with T2D newly prescribed a dipeptidyl peptidase-4 inhibitor (DPP4i), glucagon-like peptide-1 receptor agonist (GLP-1 RA), sodium-glucose cotransporter 2 inhibitor (SGLT2i), or sulfonylurea (SU) across 6 health care systems between 2014 and 2021. Medication order and dispensing data were used to quantify primary and secondary adherence and early- and late-stage persistence, during 365 days of follow-up. Multivariable logistic regression models determined associations between medication class and adherence, adjusting for site, demographics, and clinical characteristics. RESULTS: Among 109,118 older adults with T2D prescribed study medications, 1-year adherence was 42% for GLP-1 RA, 46% for DPP4i, 52% for SU, and 60% for SGLT2i. Primary adherence was 94% with little variation among classes. Secondary adherence and late-stage persistence among those who filled the first prescription were lowest for GLP-1 RA (60% and 61%) and highest for SGLT2i (81% and 84%). SGLT2i was associated with a higher adjusted odds of primary (odds ratio [OR] 1.14 [95% CI 1.00-1.30]) and secondary adherence (OR 2.41 [95% CI 2.24-2.59]) compared with GLP-1 RA. Select demographic and baseline clinical characteristics were associated with differences in adherence and persistence. CONCLUSIONS: Adherence to glucose-lowering medications in older adults with T2D varies by medication class, clinical characteristics, and demographics. To effectively address individual adherence and persistence, it is important to consider factors beyond the branded status of a drug when designing targeted interventions.
Documentation practices of cystic fibrosis pharmacists: An opportunity for discipline-wide quality improvement.
Phan H, Rosano JV, Huntman J … +4 more , Galipean J, Kormelink LN, Mayfield EK, Shanley L
J Am Pharm Assoc (2003) · 2026 · PMID 41850680 · Publisher ↗
BACKGROUND: As the pharmacists' role as part of cystic fibrosis (CF) care teams has expanded over the years and recently been redefined as "core" members, their effective electronic medical record (EMR) documentation con...
BACKGROUND: As the pharmacists' role as part of cystic fibrosis (CF) care teams has expanded over the years and recently been redefined as "core" members, their effective electronic medical record (EMR) documentation contributes to clear and effective communication and continuity of care. OBJECTIVES: This study aimed to evaluate current documentation practices and identify possible best practices and opportunities for standardization of pharmacists' documentation during CF clinic visits across centers. METHODS: An electronic, deidentified survey was distributed to pharmacists via the CF Foundation listserv from January 10, 2023 to January 27, 2023. Survey items included multiple-choice questions and an option to upload pharmacist note templates. Two investigators reviewed the templates for common components, reconciling discrepancies with a third reviewer. Components of interest included recommendations, drug interactions, therapy monitoring, adherence assessment, substance screening, medication access and storage, guideline adherence, vaccination recommendations, CF transmembrane conductance regulator modulator eligibility/monitoring, exacerbation history, treatment plan coproduction, transitions of care, and education. Descriptive analysis used Stata SE 16.0. RESULTS: Sixty pharmacists responded, with 94% practicing in the United States. Participants had varied CF care experience (1-10 years: 72.5%) and served pediatric (49%), adult (26.4%), and combined centers (24.5%). Most (84.6%) participated in joint provider visits, frequently in person or virtually (64%). Twenty-four EMR templates were collected, showing varied structures. Common elements were medication adherence and laboratory test results; less consistently included were drug interactions and coproduced goals. CONCLUSION: Pharmacist EMR documentation at CF centers is highly variable. Defining best practices and incorporating coproduction of care could enhance clarity and continuity.
Integrating immunization-trained pharmacy technicians into pharmacy workflow: A qualitative analysis of best practices.
DeMarco M, Waite NM, Houle SKD … +1 more , McKeirnan KC
J Am Pharm Assoc (2003) · 2026 · PMID 41825638 · Publisher ↗
BACKGROUND: To meet increasing patient vaccine needs in community pharmacies, immunization-trained regulated pharmacy technicians (RPhTs) practicing to their full scope within the vaccination workflow has emerged as a ke...
BACKGROUND: To meet increasing patient vaccine needs in community pharmacies, immunization-trained regulated pharmacy technicians (RPhTs) practicing to their full scope within the vaccination workflow has emerged as a key improvement that can relieve competing demands on the pharmacist. Given this potential, it is important to identify vaccine service delivery models that incorporate RPhTs in an efficient and effective manner. OBJECTIVE: This research describes self-identified best practices for optimal vaccination workflow and the subsequent impact on pharmacy workflow, professional motivations, and patient care outcomes among community pharmacies who have implemented RPhT vaccination. METHODS: Ten RPhT-pharmacist pairs that worked together completed individual semi structured interviews. Qualitative data were categorized using inductive thematic analysis to identify themes related to the RPhT's role in the vaccination workflow, important workflow influences, and associated impacts. RESULTS: Two vaccination workflow models were identified: (1) The "High-Efficiency Model," characterized by pharmacy assistants completing patient intake, managing patient flow, and monitoring while the RPhT administered vaccines during high-volume periods; and (2) The "Flex-and-Protect Model," where the RPhT conducted intake, administered vaccines, and supported the dispensary between vaccinations, which was used during periods of lower vaccine volume, a busy dispensary, or staff shortages to protect dispensary resources. The clinical role of the pharmacist in the vaccination workflow was consistent in both models. Integrating an RPhT injector improved pharmacist availability for clinical services, enabled better workload distribution, and reduced dispensary interruptions and errors. Increasing injector availability with RPhTs was a key strategy to improving patient access, decreasing wait times, and increasing recognition of RPhT contributions to patient care among both patients and pharmacists. CONCLUSION: Two workflow models were identified that optimized use of pharmacy staff skills and managed patient volume while considering dispensary needs and staffing. Future research should quantify impacts on workflow efficiency, wait times, medication errors, and pharmacist clinical care.
Is there a principal-agent problem between large retail-chain pharmacy corporations and community pharmacists?
Bounthavong M
J Am Pharm Assoc (2003) · 2026 · PMID 41802601 · Publisher ↗
Misalignment of incentives between large retail-chain pharmacy corporations and community pharmacists may explain inefficiencies in the community pharmacy retail market. I apply the principal-agent problem framework to e...
Misalignment of incentives between large retail-chain pharmacy corporations and community pharmacists may explain inefficiencies in the community pharmacy retail market. I apply the principal-agent problem framework to explain how these misalignments of incentives can lead to unsafe working conditions, increase medication errors, burnout and retention issues with community pharmacists, and financial instability on firms. The first part of the article describes the misalignment of incentives between the large retail-chain pharmacy corporations and community pharmacists followed by a comparison of the market value of the three major retail-chain pharmacy corporations and their association with community pharmacists' salaries and concludes with recommendations to address this principal-agent problem.
Implementing an electronic flowsheet for biologics requiring infusions and injections in inflammatory bowel disease.
Fann J, Murray M, DeClercq J … +2 more , Choi L, Whelchel K
J Am Pharm Assoc (2003) · 2026 · PMID 41802600 · Publisher ↗
BACKGROUND: Biologic medications for inflammatory bowel disease (IBD) may have complex dosing regimens requiring infusion dosing before transitioning to subcutaneous (SC) maintenance dosing. Transitions are time sensitiv...
BACKGROUND: Biologic medications for inflammatory bowel disease (IBD) may have complex dosing regimens requiring infusion dosing before transitioning to subcutaneous (SC) maintenance dosing. Transitions are time sensitive and require coordination of insurance approvals and medication access. OBJECTIVES: The objective was to streamline workflow and improve data visibility and reporting capabilities by implementing an electronic health record flowsheet to manage patients initiating medication requiring induction infusion(s) prior to SC dosing. PRACTICE DESCRIPTION: This innovation occurred at an academic health system IBD outpatient clinic with an integrated specialty pharmacy team and infusion pharmacist. PRACTICE INNOVATION: In July 2022, a flowsheet was implemented to merge workflow documentation for infusion and specialty pharmacists. The flowsheet contained data fields to track key information in the patient journey. Flowsheet data were easily viewable and prompted alert messages for the specialty pharmacists when key milestones were documented. Before implementation, reporting of patient journey data would have required extensive manual chart review. EVALUATION METHODS: Postimplementation pharmacist surveys were conducted, and flowsheet data from July 5, 2022 to January 31, 2025 was extracted. A descriptive analysis was completed. RESULTS: All pharmacists (n = 5) using the flowsheet completed a postimplementation survey. Overall satisfaction with the flowsheet was high [9.2 (scale of 0-10, 0 = strongly dissatisfied and 10 = strongly satisfied)]. All pharmacists strongly agreed (80%, n = 4) or agreed (20%, n = 1) the flowsheet increased visibility into patient's treatment status and strongly agreed (60%) or agreed (40%) that the flowsheet streamlined workflow. Postimplementation, previously unavailable data were pulled from the electronic health record. This allowed reporting of time from referral to first infusion dose [median 22 (interquartile range 15, 35) days] and capture rate for the institution's infusion centers (66%) and specialty pharmacy (52%). CONCLUSION: Implementing a flowsheet with alerts to manage patients initiating biologics for IBD that require infusion(s) before switching to SC dosing streamlined workflow, increased visibility, and improved data capture.
From spice to spotlight: Turmeric's safety concerns and the need for herbal education and enhanced regulation.
Helmer RS, Korankyi KA
J Am Pharm Assoc (2003) · 2026 · PMID 41802599 · Publisher ↗
Several mass media reports have linked turmeric supplements with drug-induced liver injury bringing herbal supplement safety into the public eye. These reports raise important areas of consideration for pharmacists, incl...
Several mass media reports have linked turmeric supplements with drug-induced liver injury bringing herbal supplement safety into the public eye. These reports raise important areas of consideration for pharmacists, including turmeric safety and efficacy, pharmacists' roles in ensuring safe supplement use, and pharmacist advocacy for improved supplement regulatory processes. Turmeric's main pharmacologically active form, curcumin, is reported to have antioxidant, antiviral, antibacterial, and anti-inflammatory properties. Turmeric supplements show generally positive, albeit weak, evidence in benefitting a variety of disease states such as arthritis, metabolic disorders, and depression. While turmeric's safety profile is largely benign, several cases of turmeric-induced liver injury have been reported with most patients having a successful dechallenge. Mechanisms of liver injury are considered idiopathic with a hepatocellular injury pattern. Few parallels exist regarding dosing, timing, or patient characteristics that may increase risk of turmeric-induced liver injury. However, pharmacists are uniquely qualified to assess medication safety and efficacy, which extends to dietary and herbal supplements. Pharmacists can use recent media headlines as a catalyst for reflection and education. Comprehensive professional development on common dietary and herbal supplements will aid pharmacists in providing public education regarding supplement safety and limitations in the supplement regulatory process. Enhanced knowledge and awareness may lead to increased advocacy for supplement regulatory reform to improve transparency, safety, and efficacy.
A multi-center survey on the prevalence of multiple pharmacy use in patients prescribed specialty medications.
Setoudeh S, Takhar S, Rhudy C … +5 more , Shi Y, Dumes A, Tran K, Brown DN, Whisler R
J Am Pharm Assoc (2003) · 2026 Mar · PMID 41794179 · Publisher ↗
BACKGROUND: Multiple pharmacy use (MPU) is common with approximately 38% of patients in the United States using two or more pharmacies. Current literature has not examined MPU prevalence in patients who use specialty med...
BACKGROUND: Multiple pharmacy use (MPU) is common with approximately 38% of patients in the United States using two or more pharmacies. Current literature has not examined MPU prevalence in patients who use specialty medications. OBJECTIVE: To estimate the prevalence of MPU among patients who use specialty medications. METHODS: This was a multi-center cross-sectional study across three medical institutions. Patients who use specialty medications for oncology, auto-immune diseases (AID), or multiple sclerosis (MS) were surveyed at each site. Inclusion criteria include age 18 or older, English-speaking, and specialty medication order placed in the past three months. Participants were asked 11 questions assessing MPU including methods of obtaining medication, and medication adherence. The primary outcome of this study was to estimate the prevalence of MPU among patients who use specialty medications. Secondary outcomes characterized other factors potentially impacting MPU and assessed the impact of MPU on medication adherence. RESULTS: A total of 401 participants using specialty medications for AID (n=160), MS (n=93), and oncology (n = 148) completed the survey. Three hundred and twenty-seven patients (81.5%) reported using multiple pharmacies. The top three reasons for MPU included convenience (49.5%), insurance requirement (33.9%), and cost (11.6%). The incidence of at least one missed dose within the last month was 18.9% for those using one pharmacy and 17.4% for those using multiple pharmacies. A total of 71 patients stated why they missed a dose within the past month. The common causes were forgetfulness (52%), other (34%), and side effects (8.5%). Adherence did not differ between those patients who experienced MPU compared to those who did not. CONCLUSION: Patients who use specialty medications have a higher prevalence of MPU compared to patients who do not use specialty medications. Prevalence of MPU was not associated with decreased self-reported adherence to specialty medications.
Semaglutide use in a patient with a long-term ileostomy: A case report highlighting clinical risks and evidence gaps.
Gaytan G, Pabon A, Rosario N
J Am Pharm Assoc (2003) · 2026 · PMID 41794178 · Publisher ↗
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, dulaglutide, liraglutide, and exenatide, are increasingly used to treat type 2 diabetes and support weight loss. These agents functi...
BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), such as semaglutide, dulaglutide, liraglutide, and exenatide, are increasingly used to treat type 2 diabetes and support weight loss. These agents function by enhancing glucose-dependent insulin secretion, suppressing inappropriate glucagon secretion, slowing gastric emptying, and regulating appetite through central nervous system pathways. Since semaglutide's approval in 2017 and U.S. market availability in 2018, its use has expanded significantly. However, there remains limited literature evaluating its safety and efficacy in patients with altered gastrointestinal anatomy, particularly those with ostomies. CASE SUMMARY: A 56-year-old Hispanic male with type 2 diabetes, body mass index (BMI) of 54.3, and an ileostomy placed in 2012 was prescribed semaglutide for glycemic control and weight loss by an endocrinology clinic. He continued intermittent use over an 18-month period without complications. Initially, semaglutide was associated with reduced appetite and weight loss of 19 pounds (from 278 lbs., BMI 54.3, to 259 lbs., BMI 50.6) over 5 months. He paused the medication 1 week prior to a scheduled colonoscopy and resumed 1 week after. Within 2 weeks of restarting, he experienced progressive slowing of gastrointestinal motility, including hard stools and bowel movements every other day. These symptoms culminated in fecal impaction requiring hospitalization later that month. He permanently discontinued semaglutide and has not resumed since. PRACTICE IMPLICATIONS: To date, no clinical trials or guidelines address the safety of GLP-1 RAs in patients with ileostomies or significant gastrointestinal alterations. This case emphasizes a critical gap in literature. While GLP-1 RAs offer metabolic benefits in type 2 diabetes and weight management, they may pose underrecognized risks in patients with altered bowel anatomy. Until further evidence is available, clinicians should exercise caution, perform individualized risk-benefit assessments, and consider close collaboration with gastroenterology. Further research is needed to evaluate the safety, tolerability, and pharmacokinetics of GLP-1 RAs in patients with ostomies.
Developing investigator guidance for pharmacy compensation for research participation: A report from the medication safety research network of Indiana (Rx-SafeNet).
Deng M, Ojo C, Riley-Jensen EG … +1 more , Snyder ME
J Am Pharm Assoc (2003) · 2026 · PMID 41791649 · Publisher ↗
BACKGROUND: Research compensation policies can play an important role in engaging clinicians, including pharmacists, in practice-based research. However, existing practice-based research network (PBRN) guidelines for com...
BACKGROUND: Research compensation policies can play an important role in engaging clinicians, including pharmacists, in practice-based research. However, existing practice-based research network (PBRN) guidelines for compensation are often absent, leading to potential challenges in recruitment and retention. OBJECTIVE: This study aims to explore pharmacist perspectives on appropriate compensation for various research activities and develop guidance for compensation best practices for a pharmacy PBRN. METHODS: A sequential, explanatory mixed-methods design was used. In phase 1, an online survey was distributed to all site coordinators within the Medication Safety Research Network of Indiana (Rx-SafeNet). In phase 2, a purposive sample of survey respondents was invited to participate in semistructured interviews to further explore experiences with research compensation and recommendations for best practices. Survey data were analyzed using descriptive statistics and qualitative interview transcripts were analyzed thematically. RESULTS: Survey respondents reported greater willingness to participate as compensation increased, with higher interest in lower effort activities (e.g., surveys) compared to resource intensive ones (e.g., interviews). Time-based compensation models were viewed as an appropriate approach to compensate pharmacists. Thirty seven percent of respondents preferred shared compensation between the individual and the pharmacy, while another 37 percent were unsure whether policies existed at their practice sites. Nonmonetary incentives such as CE credits and professional development reimbursement were less attractive than monetary incentives. Interview results emphasized the absence of formal pharmacy PBRN policies on compensation rates for different research activities. Participants highlighted the importance of transparent communication with leadership teams and advocated for models that recognize both time and the professional value of pharmacists' contributions. CONCLUSION: Findings provide a foundation for developing transparent, equitable, and sustainable compensation guidance to enhance pharmacist engagement in PBRN research. Future studies should examine pharmacy PBRN policies and evaluate whether pharmacist engagement improves after adoption of such models.
Examining the Auckland individualism-collectivism scale in an Australian sample of community pharmacists.
Razmovski-Naumovski V, Chan DKE, Dubbai H … +1 more , Day R
J Am Pharm Assoc (2003) · 2026 · PMID 41791648 · Publisher ↗
BACKGROUND: Exploring individualism and collectivism in pharmacists helps to understand how cultural values shape their professional behavior, patient care, teamwork, and decision-making. OBJECTIVE: This study explored t...
BACKGROUND: Exploring individualism and collectivism in pharmacists helps to understand how cultural values shape their professional behavior, patient care, teamwork, and decision-making. OBJECTIVE: This study explored the reliability and validity of the Auckland Individualism and Collectivism Scale (AICS), as well as the clustering of its dimensions, among community pharmacists. METHODS: The AICS was administered to practicing pharmacists (n = 193) in Brisbane, Australia, between January and March 2019. Internal consistency (Cronbach's α) and reliability (McDonald's ω) were assessed, and confirmatory factor analysis models were developed. Demographic variables-age, years of work experience, gender, and region of birth-were used to guide the formation of participant clusters. RESULTS: The AICS showed high internal consistency for the Advice, Compete, and Unique dimensions (α ≥ 0.77), but low internal consistency for the Responsibility and Harmony dimensions (α ≤ 0.59). Reliability showed adequate factor saturation for the Compete domain (ω ≥ 0.70) only. The first-order [χ = 590.17, df = 289; comparative fit index (CFI) = 0.83; Tucker-Lewis index (TLI) = 0.81; root mean square error of approximation (RMSEA) = 0.074, 90% CI: (0.065, 0.082); standardized root mean square residual (SRMR) = 0.089; Bayesian information criterion (BIC) = 14,616.06] and higher-order [χ = 603.31; df = 294; CFI = 0.83; TLI = 0.81; RMSEA = 0.074, 90% CI: (0.065, 0.082); SRMR = 0.095; BIC = 14,602.88] confirmatory factor analysis models showed moderate fits to the data. Pharmacists generally perceived themselves as Unique and Responsible, with responses ranging from "often" to "always" for these traits. For Harmony, responses varied between "occasionally" and "very often." However, responses for the Compete and Advice domains were mixed, depending on the specific questions asked. The absence of clear natural clustering among participants made it challenging to group them solely based on their individualism and collectivism scores and demographic characteristics. This result potentially reflects both the diverse workplace structures and the complex, fluid nature of cultural identity in Australia. CONCLUSION: These findings represent a preliminary assessment of the AICS in pharmacy professionals, with broader national sampling required to confirm its utility.
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