Objective:
To describe the prevalence of herbal medicine use among US adults and to assess factors associated with and predictors of herbal use.
Design:
The data for herbal products use were ...collected from the 2015 National Consumer Survey on the Medication Experience and Pharmacists’ Roles. Chi-square test was used to analyz factors associated with herbal use, and predictors of herbal use were assessed with logistic regression analysis.
Results:
Factors associated with herbal supplement use include age older than 70, having a higher than high school education, using prescription medications or over-the-counter (OTC) medications, and using a mail-order pharmacy.” All Disease state associated significantly with herbal use. Approximately thirty-eight percent of those who used herbals used prescription medications and 42% of those who used herbals also used an OTC medication. The most frequent conditions associated with herbal supplement use were a stroke (48.7%), cancer (43.1%), and arthritis (43.0%). Among herbal product users, factors that predicted use included having higher than school education, using OTC medications, using mail-order pharmacy, stroke, obesity, arthritis, and breathing problems.
Conclusions:
More than one-third of respondents reported using herbal supplements. Older age and higher education were associated with a higher use of herbal supplements. People with chronic diseases are more likely to use herbal medicines than others. OTC drug users and patients with stroke are more likely to use herbal medicines than others.
Medications stored in US households may pose risks to vulnerable populations and the environment, potentially increasing societal costs. Research regarding these aspects is scant, and interventions ...like medication reuse may alleviate negative consequences. The purpose of this study was to describe medications stored in US households, gauge their potential risk to minors (under 18 years of age), pets, and the environment, and estimate potential costs of unused medications.
A survey of 220 US Qualtrics panel members was completed regarding medications stored at home. Published literature guided data coding for risks to minors, pets, and the environment and for estimating potential costs of unused medications.
Of the 192 households who provided usable and complete data, 154 (80%) reported storing a medication at home. Most medications were taken daily for chronic diseases. The majority of households with residents or guests who are minors and those with pets reported storing medications with a high risk of poisoning in easily accessible areas such as counters. Regarding risk to the aquatic environment, 46% of the medications had published data regarding this risk. For those with published data, 42% presented a level of significant risk to the aquatic environment. Unused medications stored at home had an estimated potential cost of $98 million at a national level. Implications/Conclusions: Medications stored at home may pose risks to vulnerable populations and the environment. More research regarding medications stored in households and their risks is required to develop innovative interventions such as medication reuse to prevent any potential harm.
In closely monitored randomized controlled trials (RCTs), newer P2Y12 agents (ticagrelor and prasugrel) reduced cardiovascular outcomes compared with clopidogrel following percutaneous coronary ...intervention (PCI) in acute coronary syndrome. However, these RCTs indicated a higher bleeding risk with these newer agents. This study evaluated the comparative safety of each P2Y12 inhibitor on hospitalizations due to major bleeding in a real‐world population. This retrospective, propensity score‐matched (PSM) cohort study utilized the IBM MarketScan database over 6 years (2013–2018) to identify incident users of P2Y12 inhibitors with age ≥18 years. The primary safety outcome was hospitalization due to any major bleeding event including gastrointestinal, intracranial, and other serious forms of bleeding. In pairwise comparisons using Cox‐proportional hazards models, ticagrelor, prasugrel, and clopidogrel users were compared for the primary safety outcome at 30, 90, and 180 days following the first prescription of P2Y12 inhibitor after PCI. There were 21,719 (ticagrelor vs. clopidogrel), 11,513 (prasugrel vs. clopidogrel), and 11,065 (prasugrel vs. ticagrelor) PSM pairs. Overall, the risk of major bleeding was similar for all P2Y12 inhibitors. Hospitalization for major bleeding was generally lower among ticagrelor users vs. clopidogrel and higher among prasugrel users compared with clopidogrel. Importantly, a 66% higher risk of major bleeding at 90 days is suggested with prasugrel compared with clopidogrel (hazard ratio 1.66; 95% confidence interval, 1.11–2.48). This study indicated a higher short‐term bleeding risk with prasugrel compared with clopidogrel, which concurs with the results of RCTs.
Comparative effectiveness evaluation of newer P2Y12 inhibitors (prasugrel and ticagrelor) compared with clopidogrel after acute coronary syndrome (ACS) is limited in real‐world US populations. The ...objective of this study was to evaluate cardiovascular events based on ticagrelor, prasugrel, and clopidogrel use in a real‐world patient setting. This retrospective cohort study used the IBM MarketScan database (January 1, 2013, to December 31, 2018) to create three propensity score‐matched pairs: ticagrelor vs. clopidogrel (N = 21,719), prasugrel vs. clopidogrel (N = 11,513), and prasugrel vs. ticagrelor (N = 11,065). The primary outcome was a composite of myocardial ischemia, unstable angina, stroke, and heart failure hospitalization. These groups were compared in a time‐to‐event analysis for the primary outcome at 30, 90, and 180 days following P2Y12 inhibitors initiation after percutaneous coronary intervention. Compared with clopidogrel, ticagrelor use suggested a 10% reduction in the primary outcome at 90 days (hazard ratio (HR): 0.90, 95% confidence interval (CI): 0.82–0.99). There were no differences for all other matched pairs or follow‐up combinations. In the subgroup analysis of females, the results suggested a risk reduction of 27% for prasugrel at 30 days (HR: 0.73, 95% CI: 0.53–1.00) and 17% for ticagrelor at 90 days (HR: 0.83, 95% CI: 0.70–0.98) when compared with clopidogrel. Among patients treated with bare‐metal stents, the results suggested that prasugrel vs. ticagrelor was associated with a 55% and 33% reduced risk for the primary outcome at 30 days and 180 days, respectively. With limited evidence in the United States comparing these drugs, this study helps inform clinicians when choosing P2Y12 inhibitors after ACS.
Pharmacists' roles in health care systems are expanding. However, some patients are slow to accept and make use of this expanded role.
The objectives for this study were to identify and describe ...segments of pharmacists and patients based upon their perceptions of the pharmacist's role in serving as an advisor on medication use.
Data were collected from random samples of pharmacists and patients in 1995, 1998, 2001, 2004, 2007, and 2010. Overall, 1518 pharmacists (overall response rate = 47%) and 1278 patients (overall response rate = 42%) were surveyed from 1995 through 2010. Factor analysis was applied to a Counselor Role Orientation measure and identified three factors for use in segmentation analysis. The factors were: (1) Time Pressures, (2) Reliance on Physician, and (3) Pharmacist Restrictions. Segmentation analysis was conducted using a two-step cluster analysis with an agglomerative hierarchical clustering method and a log-likelihood (probability) distance measure. Descriptive statistics were used to describe identified segments.
Cluster analysis identified four segments which were named: (1) All Low, (2) Time Pressures, (3) Reliance On Physician, and (4) All High. The largest segment for pharmacists was Time Pressures (45% of pharmacists) and for patients was Reliance on Physician (50% of patients). Composition of the four segments was consistent over time between the years 1995 through 2010.
The pattern of findings suggested a cycle of dysfunction in which many pharmacists, hindered by Time Pressures, do not provide patient care beyond the dispensing of a product. In turn, patients, relying on their physician for advice about medications, do not acknowledge the pharmacist as an advisor for medications. This cycle has reinforced dysfunctional behaviors and creates no motivation for either party in this dyadic relationship to change.
Willingness to accept various pharmacist-provided services such as health promotion and medication management is still considered low. Evidence suggests that patient experience and socio-demographics ...partially explain patient willingness to use pharmacy services. However, the influence of a patient's relationship with their pharmacist may provide additional explanatory power.
The aims of the study were to 1 explore the willingness to accept pharmacy services across patients' relationship with pharmacists and 2 evaluate the association between the patient-pharmacist relationship and patients' willingness to accept pharmacist-provided services.
A total of 1521 respondents' data on the types of patient-pharmacist relationships and willingness to accept dispensing, drug information, medication management, and health promotional services were collected from the 2021 National Consumer Survey on Medication Experience and Pharmacists' Role. Willingness scores across the groups were evaluated using chi-square and analysis of variance. Binary logistic regression was used to investigate the associations between patient-pharmacist relationships and willingness to accept pharmacist-provided services.
More respondents were "definitely willing" to accept dispensing services (68.5%) and drug information (68.3%), while 56.5% and 50.1% were "definitely willing" to accept health promotion and medication management services, respectively. While respondents with "customer" and "client" archetype relationships were definitely willing to accept the 4 categories of pharmacy services, the highest proportion of respondents definitely willing to accept the services was observed among those with "partner" archetype relationships. Willingness scores increased significantly across the archetype relationships. Respondents with a "partner" archetype relationship had the highest and most significant odds ratio of accepting all the categories of pharmacist-provided services.
Willingness to accept services from pharmacists increased as the level of the patient-pharmacist relationship grew. Patients in "partner" archetype relationship were significantly more likely to accept all categories of pharmacist-provided services. Pharmacists are encouraged to embrace the patient-pharmacist relationship continuum to optimize patient care.
A strong patient-pharmacist relationship is tied to patients' trust and confidence in pharmacists and pharmacy services. While past research has described patient-pharmacist relationship archetypes ...(i.e., "customer," "client," "partner") with potential to help pharmacists initially understand patients' preferences and expectations of care and services, little is known about potential factors that underlie these preferences and expectations.
This study was aimed to 1 compare the prevalence of the current and desired patient-pharmacist relationships archetypes reported by patients and 2 identify the sociodemographic, health, and medication use and procurement factors predictive of the archetypes representing patients' current relationship with outpatient pharmacists.
Data from 1521 patients were collected via the 2021 National Consumer Survey on Medication Experience and Pharmacists' Role. Patient-pharmacist relationship distribution across patients' sociodemographic characteristics was explored using crosstabulations. Multinomial logistic regression was also used to investigate the association between patient sociodemographic characteristics and the current patient-pharmacist archetype relationships.
The mean age of the patients was 53.9 years and 57.3% were married. Thirty-two percent of the patients reported currently having a "Customer" relationship, while 17.9% and 15.2% reported having a "Client" and "Partner" archetype relationship, respectively. "Client" (25.2%) and "Partner" (20.2%) relationships were the most commonly preferred archetypal relationships. The odds ratios (OR) of having "Client" or "Partner" relationships increased with the number of patients' health conditions and medications. Patients who visited independently owned and clinic pharmacies had a higher OR of building professional relationships with a pharmacist.
The qualities of a patient-pharmacist relationship may be associated with key patient characteristics. Pharmacists can build relationships with patients informed by a continuum of patient preferences, expectations, and needs to optimize health outcomes.
This study applied a hermeneutic phenomenological approach to better understand pharmacy workplace wellbeing and resilience using respondents' written comments along with a blend of the researchers' ...understanding of the phenomenon and the published literature. Our goal was to apply this understanding to recommendations for the pharmacy workforce and corresponding future research. Data were obtained from the 2021 APhA/NASPA National State-Based Pharmacy Workplace Survey, launched in the United States in April 2021. Promotion of the online survey to pharmacy personnel was accomplished through social media, email, and online periodicals. Responses continued to be received through the end of 2021. A data file containing 6973 responses was downloaded on 7 January 2022 for analysis. Usable responses were from those who wrote an in-depth comment detailing stories and experiences related to pharmacy workplace and resilience. There were 614 respondents who wrote such comments. The findings revealed that business models driven by mechanized assembly line processes, business metrics that supersede patient outcomes, and reduction of pharmacy personnel's professional judgement have contributed to the decline in the experience of providing patient care in today's health systems. The portrait of respondents' lived experiences regarding pharmacy workplace wellbeing and resilience was beyond the individual level and revealed the need for systems change. We propose several areas for expanded inquiry in this domain: (1) shared trauma, (2) professional responsibility and autonomy, (3) learned subjection, (4) moral injury and moral distress, (5) sociocultural effects, and (6) health systems change.
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