Publications

Pediatric vaccination rates in the United States lag national goals. Policies that expand pharmacy-based vaccinations among children could help improve vaccination rates. Opponents argue, however, that such policies will result in delayed or missed well-child visits as most children receive routine vaccinations in primary care settings. We evaluated the likelihood of having a timely well-child visit following a routine vaccination in pharmacies and primary care settings among children aged 4-17 years. We conducted a retrospective cohort analysis with commercial claims data from 2016-2019, using conditional logistic regression models. A timely well-child visit was defined as one within 12 months after a preceding well-child visit for primary analysis and 15 months for secondary analysis. Approximately 95% of the sample consisted of children with influenza among their index vaccine(s). The odds of having a timely well-child visit were similar between children who received vaccines in pharmacies and those who received them in primary care settings. Findings suggest that guardians or parents who choose pharmacy-based pediatric vaccinations for their commercially insured children do not forgo well-child visits and may actually be more likely to obtain a timely well-child visit. Extending pharmacy-based vaccinations to patients of all ages can help improve pediatric vaccination rates.

OBJECTIVE: To describe the creation of a curated, shared repository of pharmacogenomics cases for pharmacy educators and lessons learned during the process.

METHODS: The 2019-2020 American Association of Colleges of Pharmacy Pharmacogenomics Special Interest Group (PGx SIG) formed an ad-hoc committee charged with creating a pharmacogenomics patient case repository for educational use. Following a needs assessment, a standardized case framework was developed using the Pharmacists' Patient Care Process. A guidance document was also created for case authors. The maintenance of the repository and the involvement of students is also described.

RESULTS: A total of 44 pharmacogenomics cases were accepted at various levels of difficulty, including 17 introductory cases, 18 intermediate cases, and 9 advanced cases. These cases cover 9 therapeutic areas and are freely available in an online network and information sharing platform (i.e., AACP Connect). Over the last 36 months, cases have been downloaded 427 times.

CONCLUSION: The AACP Pharmacogenomics SIG successfully created a shared repository of educational pharmacogenomics cases using a standardized framework. This approach can serve as a model for other Sections, SIGs or educators who desire to develop their own case repository in another field of study. Future work will measure direct outcomes of this available resource in the academic setting.

Adults living in rural communities of Alabama have limited or no access to hearing healthcare for a variety of reasons. Hearing loss can result in decreased social contact, potentially leading to loneliness, and it has been associated with depression and cognitive decline. To improve access to hearing healthcare, the FDA released its Final Rule in 2022 stating that adults with perceived mild-to-moderate hearing loss can purchase over-the-counter hearing aids (OTC HAs) on their own without clearance from a physician or through the care of an audiologist. Current research suggests, however, that adults benefit from professional support when purchasing and setting their OTC HAs. Understanding how much support is needed and how to best provide the support will be necessary for successful OTC HA use. Considering that these devices can now be purchased at pharmacies, one model in rural areas could involve the pharmacy technician who could assist and support those with hearing loss in community pharmacies. This article outlines a pharmacy technician educational training program that will incorporate didactic, interactional, and experiential learning components to promote the use of OTC HAs. The outcomes from this project will provide the foundation for the development and implementation of one model for improving access to hearing healthcare in rural communities.

IMPORTANCE: Community pharmacies are crucial for public health, providing essential services such as medication dispensing, vaccinations, and point-of-care testing. Addressing disparities in pharmacy access, particularly in underserved rural and low-income areas, is critical for health equity.

OBJECTIVE: To identify areas in the US at risk of becoming pharmacy deserts through the development of a novel pharmacy vulnerability index.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study in the contiguous 48 states performed geographic information systems analysis of pharmacy data from the National Council for Prescription Drug Programs (NCPDP) dataQ. Participants included all open-door pharmacies (community or retail pharmacies open to the general public without restrictions on who can access its services) in the US as of February 2024. Statistical analysis was performed from July to August 2024.

EXPOSURE: The primary exposure was travel time to pharmacies across the US.

MAIN OUTCOMES AND MEASURES: A pharmacy desert was defined as a census tract where the travel time to the nearest pharmacy exceeds the supermarket access time for that region and urbanicity level. Building on this definition, a pharmacy vulnerability index was developed, which indicates the number of pharmacies that would need to close for a census tract to become a pharmacy desert. Tracts with a pharmacy vulnerability index of 1, depending solely on a single pharmacy for access, were identified as at risk of becoming deserts. Subpopulation totals and percentages living in pharmacy deserts or relying on keystone pharmacies were computed, and then stratified by urbanicity and race.

RESULTS: Among 321.3 million individuals (39.7 million [12.3%] Black, 59.0 million [18.2%] Hispanic, 195.0 million [60.3%] White) in the contiguous US, 57.1 million (17.7%) were identified as living in pharmacy deserts, with 28.9 million (8.9%) additionally relying on a single pharmacy for access. Small rural areas were particularly affected, with a higher dependency on single pharmacies (4.1 million individuals [14.3%]).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of pharmacy access in the US, significant disparities in pharmacy access were identified, especially pronounced in small rural areas. Targeted policy interventions, such as incremental reimbursement rates or other monetary incentives, are needed to ensure the financial sustainability of pharmacies that serve as the sole source of pharmacy services in at-risk areas.

PURPOSE: We compare trends in gabapentinoid and opioid utilization overall and by economic development category. We also sought to predict future trends and assess correlations in gabapentinoid and opioid utilization.

METHODS: We conducted a repeated cross-sectional analysis of retail prescriptions for 72 countries from Q1 2012 to Q3 2023. We measured standardized units/1000 population for gabapentinoid and opioid sales, stratified by development category, and used time-series models to predict trends for the following 3 years. Granger causality tests examined predictive relationships between gabapentinoid and opioid sales.

RESULTS: Global gabapentinoid annual sales rose by 114.5% from 2012 to 2022, with a higher increase in developing (180.9%) than developed economies (110.0%). In contrast, annual opioid sales declined globally by 25.4%, with a 27.9% decrease in developed and a 16.8% increase in developing economies. Assuming current trends persist over the following 3 years, gabapentinoid quarterly sales are forecasted to rise by 7.7% in developed and 18.6% in developing economies, while opioid quarterly sales are expected to decrease by 9.5% and increase by 15.1%, respectively. Granger causality tests indicated that gabapentinoids may predict opioid sales globally for the following year, but opioids did not predict gabapentinoid sales.

CONCLUSION: We evaluated the global trends in gabapentinoid and opioid sales, suggesting important differences in pain management practices across developed and developing economies. Our findings highlight the need to ensure the safe use of gabapentinoids and opioids while balancing proper pain management.

IMPORTANCE: Medicare beneficiaries with disabilities have excess opioid-related morbidity and mortality. A 2019 Medicare opioid safety policy was designed to address high-risk opioid prescribing and related harms by limiting the initial duration to 7 days and restricting high daily dosage across multiple prescribers.

OBJECTIVE: To evaluate the association of the 2019 Medicare opioid 7-day and 90-morphine milligram equivalence (MME) safety edits with opioid use among beneficiaries with disabilities.

DESIGN, SETTING, AND PARTICIPANTS: This interrupted time-series study used claims data from Optum's deidentified Clinformatics Data Mart database to assess changes in opioid prescriptions and use among Medicare Advantage beneficiaries (younger than 65 years) with disability entitlements from June 2016 to September 2021. The analysis compared opioid use outcomes before and after the safety policy was implemented in 2019 (including the COVID-19 pandemic) in 2 cohorts of patients (new to opioids vs long-term opioid use). Data analyses were performed from September 2023 to October 2024.

EXPOSURES: Implementation of the Medicare opioid 7-day and 90-MME safety edits in January 2019.

MAIN OUTCOMES AND MEASURES: Likelihood of an initial opioid prescription more than 7 days' supply and 30-day total MME; likelihood of development of long-term opioid use in a new-to-opioid cohort; the number of concurrent multiple-prescriber high-dosage episodes in a long-term opioid cohort.

RESULTS: The new-to-opioids cohort included 476 859 person-index months (mean [SD] age, 55.7 [7.8] years; 281 536 [59.0%] women). The long-term opioid cohort included 3 295 299 person-index months (mean [SD] age, 56.3 years [6.6]; 1 887 547 [57.3%] men and 1 407 752 [42.7%] women). The 7-day safety edit was associated with immediate and sustained reductions in the likelihood of an initial opioid prescription filled for more than 7 days' supply (start of the post-policy period: 46.7 % reduction; 99.5% CI, -48.3% to -45.2%; end of study period: 43.8% reduction; 99.5% CI, -45.7% to -41.9%). In contrast, moderate immediate reductions in the likelihood of development into long-term opioid use (13.8% reduction; 99.5% CI, -20.5% to -7.2%) diminished by the end of the study period (4.0% reduction; 99.5% CI, -10.4% to 2.4%). The 90-MME safety edit was associated with an immediate 36.1% reduction (99.5% CI, -42.8% to -29.4%) in the number of concurrent multiple-prescriber high-dosage episodes, which was reversed when the COVID-19 flexibility rolled back the 90-MME edit.

CONCLUSIONS AND RELEVANCE: The findings of this interrupted time-series study of Medicare Advantage beneficiaries younger than 65 years with disabilities show that the 2019 Medicare opioid safety policy was associated with shorter initial duration of opioid prescriptions and fewer concurrent multiple prescriber high-dosage prescriptions of opioids. Given that downstream reductions appeared to be transient, further interventions are needed to address the clinical and social risk factors for opioid misuse among beneficiaries with disabilities.

OBJECTIVES: Identifying people with possible dementia in health care systems is important to study outcomes and target improvements in care. This study sought to compare the performance of diagnostic codes and Minimum Data Set (MDS)-based measures for identifying dementia and cognitive impairment in older veteran nursing home residents.

DESIGN: Retrospective, cross-sectional analysis.

SETTING AND PARTICIPANTS: We used real-world health care data from the Veterans Affairs (VA) Residential History File, VA Corporate Data Warehouse (CDW), Medicare claims, and the MDS to assemble a cohort of VA Community Living Center (CLC) admissions over 2015 to 2021 for veterans aged ≥ 65 with dual VA and Medicare enrollment (n = 54,234).

METHODS: We defined 3 measures of possible dementia: (1) claims/CDW diagnoses using Chronic Conditions Warehouse (CCW) algorithms for Alzheimer's disease or non-Alzheimer's dementia; (2) MDS active diagnosis items for Alzheimer's disease and non-Alzheimer's dementia; and (3) MDS Cognitive Function Scale (CFS) assessment indicating at least mild cognitive impairment. We calculated proportions identified with each definition, and sensitivity, specificity, and positive predictive value of claims/CDW diagnoses and MDS indicators for dementia for identifying CFS impairment.

RESULTS: Among VA CLC residents, 61.4% met at least 1 criterion for possible dementia (38.6% claims/CDW, 23.3% MDS active diagnosis, 50.8% CFS). Diagnoses from claims/CDW had 56.5% sensitivity and 80.0% specificity for identifying veterans with CFS cognitive impairment. Active diagnoses from the MDS exhibited poorer sensitivity (38.1%), but higher specificity (92.0%) identifying veterans with cognitive impairment on the CFS.

CONCLUSIONS AND IMPLICATIONS: Consistent with what has been reported in Medicare nursing home residents, we observed only partial overlap between indicators of possible dementia across diagnosis codes and other indicators vs cognitive assessments in MDS. Our findings support the utility of these measures for identifying individuals with possible dementia across different systems, but further work is needed to understand implications when using diagnosis codes or cognitive assessments.