scholarly journals Use of research evidence varied in efforts to expand specific pharmacist autonomous prescriptive authority: an evaluation and recommendations to increase research utilization

2022 ◽  
Vol 20 (1) ◽  
Author(s):  
Akshara Kumar ◽  
Amber Bivins Ray ◽  
Carrie Blanchard
Keyword(s):  
Research Evidence ◽  
Research Utilization ◽  
Document Analysis ◽  
The United States ◽  
Scope Of Practice ◽  
Successful Implementation ◽  
Policy Document ◽  
Policy Makers ◽  
Prescriptive Authority ◽  
Pharmacist Prescribing

Abstract Background An expanding body of literature shows that pharmacists’ interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists’ scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study investigated how stakeholders utilized research evidence when developing expanded scope of practice policies in their respective states. Methods Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, semi-structured interviews with policy-makers and pharmacy advocates were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy-making process. Investigators analysed findings from the transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted. Results Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policy-makers and researchers, and leveraging pharmacy practice stakeholders. Conclusions Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practise at the top of their license.

Use of Research Evidence Varied in Efforts to Expand Pharmacist Prescriptive Authority: Recommendations to Increase Research Utilization

2020 ◽  
Author(s):  
Akshara Kumar ◽  
Amber Bivins Ray ◽  
Carrie Blanchard
Keyword(s):  
Research Evidence ◽  
Research Utilization ◽  
Document Analysis ◽  
The United States ◽  
Scope Of Practice ◽  
Successful Implementation ◽  
Policy Document ◽  
Prescriptive Authority ◽  
Pharmacist Prescribing ◽  
Research Engagement

Abstract Background: An expanding body of literature shows that pharmacists’ interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists’ scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study hopes to investigate stakeholder utilization of research evidence to expand scope of practice in their respective states.Methods: Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, a systemized review and semi-structured interviews were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy make process. Investigators analyzed findings from the systemize review and transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted. Results: Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. The systemized review yielded no relevant peer-review literature regarding evidence utilization, so gray literature and interviews were analyzed. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policymakers and researchers, and leveraging pharmacy practice stakeholders.Conclusions: Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practice at the top of their license.

scholarly journals Pharmacist Outlooks on Prescribing Hormonal Contraception Following Statewide Scope of Practice Expansion

Pharmacy ◽  
2019 ◽  
Vol 7 (3) ◽  
pp. 96 ◽  
Author(s):  
Sally Rafie ◽  
Emily Richards ◽  
Samantha Rafie ◽  
Sharon Landau ◽  
Tracey Wilkinson
Keyword(s):  
Hormonal Contraception ◽  
Community Pharmacists ◽  
The United States ◽  
Scope Of Practice ◽  
Successful Implementation ◽  
State Legislation ◽  
Protocol Development ◽  
A Chain ◽  
Access To Contraception ◽  
Improve Access

In an effort to increase access to contraception, the pharmacist scope of practice is being expanded to allow prescribing. While this is being accomplished in the United States by a variety of models, legislation that allows pharmacists to prescribe hormonal contraception under a statewide protocol is the most common. This study was designed to explore the outlooks of pharmacists regarding prescribing contraception in the period following the first state legislation and prior to statewide protocol development and availability. A qualitative study of community pharmacists in California using structured phone interviews explored their opinions regarding access to contraception in pharmacies and outlooks regarding prescribing. Data were analyzed using an inductive approach to identify themes. Among the thirty participants, the majority worked in a chain pharmacy. Themes were identified in five overarching domains: Pharmacist barriers, system barriers, patient issues, safety concerns, and pharmacist role. Most were unfamiliar with the new law, yet were interested in expanding access for patient benefit despite foreseeing challenges with implementing the service in community pharmacies. Barriers will need to be addressed and requisite training disseminated widely to facilitate successful implementation and thus improve access on a broad scale. Further research following protocol implementation is needed to understand service implementation, as well as patient utilization and satisfaction.

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

The First Decade of Effort: Progress Toward a Hospital Information System at the UCLA Hospital, Los Angeles, California

1970 ◽  
Vol 09 (02) ◽  
pp. 75-80
Author(s):  
B. G. Lamson ◽  
W. S. Russell ◽  
J. Fullmore ◽  
W. E. Nix
Keyword(s):  
Los Angeles ◽  
Medical Record ◽  
Communication Systems ◽  
The United States ◽  
Computer Applications ◽  
Record Management ◽  
Successful Implementation ◽  
Accounting System ◽  
Accrual Accounting ◽  
Medical Specialties

Total information and communication systems within hospitals have been designed, but successful complete implementation, to date, has not been achieved. Limited applications with both patient medical data, notably in the clinical laboratories, and in the hospital accounting offices have been numerous. Although total programs are not yet a reality, it is apparent that the computer will serve ultimately many communication requirements, both medical and financial, within the hospital.Sound hospital management requires that costs of all component operations be known in order that value judgments concerning worth and efficiency may be made. Accrual accounting systems which match revenue and expense over the same time period are a prerequisite. Cash and modified cash hospital accounting cannot provide current reliable data for sound decision making.Costs of hospital operations cannot be evaluated unless related to the characteristics of the patient service load. Average per diem costs mean little except when large similar populations of patients are being compared. A modern hospital accrual accounting system should be able to provide information concerning the costs of caring for specific diseases in patients with known age and sex and disease severity characteristics. Without information of this type, it will not be possible to objectively evaluate alternative systems of financing and organizing patient care.Medical record management offers the promise of prospective use of patient disease information in the planning and scheduling of facilities. The prose content of medical record summaries, such as diagnostic statements in tissue pathology, radiology, and admission and discharge diagnoses, may be susceptible to non-coded, full prose input into computer controlled diagnostic files. Thesauri in the several medical specialties will be necessary for this achievement.There is little immediate prospect for complete hospital communication systems that can be made available as a package to any hospital without substantial local alteration. Pilot projects in teaching centers should be viewed for the time being as opportunities to define objectives, evaluate feasibility, and determine degree of risk and expense.A brief survey of applications in the United States which have been successfully implemented or which appear suitable for successful implementation is recorded.Eleven general principles which have been associated with successful implementation of computer applications within the UCLA Hospital are enumerated.

Water Resources Management in the Semi-Arid Central Valley of California

1987 ◽  
Vol 19 (9) ◽  
pp. 97-106
Author(s):  
J. J. Vasconcelos
Keyword(s):  
Resource Management ◽  
Ground Water ◽  
Water Resource ◽  
Water Resource Management ◽  
Arid Regions ◽  
Central Valley ◽  
The United States ◽  
Policy Makers ◽  
Ground Water Resource ◽  
Semi Arid

Hater resource managers in semi-arid regions are faced with some unique problems. The wide variations in precipitation and stream flows in semi-arid regions increase man's dependence on the ground water resource for an ample and reliable supply of water. Proper management of the ground water resource is absolutely essential to the economic well being of semi-arid regions. Historians have discovered the remains of vanished advanced civilizations based on irrigated agriculture which were ignorant of the importance of proper ground water resource management. In the United States a great deal of effort is presently being expended in the study and control of toxic discharges to the ground water resource. What many public policy makers fail to understand is that the potential loss to society resulting from the mineralization of the ground water resource is potentially much greater than the loss caused by toxic wastes discharges, particularly in developing countries. Appropriations for ground water resource management studies in developed countries such as the United States are presently much less than those for toxic wastes management and should be increased. It is the reponsibility of the water resource professional to emphasize to public policy makers the importance of ground water resource management. Applications of ground water resource management models in the semi-arid Central Valley of California are presented. The results demonstrate the need for proper ground water resource management practices in semi-arid regions and the use of ground water management models as a valuable tool for the water resource manager.

OP48 Nursing Requirements In Long-Term Care: A Health Technology Assessment

2019 ◽  
Vol 35 (S1) ◽  
pp. 11-12
Author(s):  
Paula Corabian ◽  
Charles Yan ◽  
Susan Armijo-Olivo ◽  
Bing Guo
Keyword(s):  
Nursing Care ◽  
Nursing Staff ◽  
Real World ◽  
Research Evidence ◽  
Long Term Care ◽  
Staff Time ◽  
Term Care ◽  
Policy Makers ◽  
The Relationship

IntroductionThe objectives of this study were to systematically review published research on the relationship between nursing staff coverage, care hours, and quality of care (QoC) in long-term care (LTC) facilities; and to conduct a real world evidence (RWE) analysis using Alberta real world data (RWD) to inform policy makers on whether any amendments could be made to current regulations.MethodsA systematic review (SR) of research evidence published between January 2000 and May 2018 on the relationship between nursing staff coverage, care hours, and QoC in LTC facilities was conducted. Panel data regressions using available RWD from Alberta, Canada, were performed to assess associations between nursing care hours and LTC outcomes. Outcomes of interest included quality indicators related to resident outcomes, hospital admissions, emergency room visits and family satisfaction. Nursing care hours considered in SR and RWE analysis included those provided by registered nurses (RNs) and licensed practical nurses (LPNs).ResultsThe SR found inconsistent and poor quality evidence relevant to the questions of interest, indicating a great uncertainty about the association between nursing staff time and type of coverage and QoC. Although some positive indications were suggested, major weaknesses of reviewed studies limited interpretation of SR results. RWE analysis found that impact of care hours on LTC outcomes was heterogeneous, dependent on outcome measurements. There was evidence that total staff, RN, and LPN hours had positive effects on some resident outcomes and magnitude of effect differed for different nursing staff.ConclusionsNo definitive conclusion could be drawn on whether changing nursing staff time or nursing staff coverage models would affect residents’ outcomes based on the research evidence gathered in the SR. RWE analysis helped to fill a gap in the available published literature and allowed policy makers to better understand the impact of revising current regulations based on actual outcomes.

Universality, Quality & Economics: Finding a Balance in Ontario and British Columbia

1994 ◽  
Vol 20 (1-2) ◽  
pp. 203-229
Author(s):  
John D. Blum
Keyword(s):  
Health Reform ◽  
New Ventures ◽  
The United States ◽  
High Price ◽  
Social Programs ◽  
Policy Makers ◽  
High Expectations ◽  
The Us ◽  
Acceptable Model ◽  
National Economies

National economies worldwide are in disarray, evidenced by escalating debts and growing deficits. As countries struggle with their faltering economies they are hard pressed to fulfill commitments of social programs made in more prosperous times, much less take on new government initiatives. The current experiences in health reform in the United States present an interesting example of the dilemmas governments now face when they embark on new ventures. While great political pressures have been launched and high expectations abound, the reality of American health reform quickly reveals that expanded access will come at a high price that won't be offset easily by conventional cost containment or market forces.In the search for an acceptable model for health reform, it was popular for policy makers and academics to turn their attentions to the health systems of other nations. Recommendations were made that the US should adopt a German or Canadian solution for our health problems.

scholarly journals Shooting from the ‘Scrip: Scope of Practice Laws and Access to Immunizations in the Pharmacy Setting

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 444
Author(s):  
Charles Stoecker
Keyword(s):  
Positive Impact ◽  
National Level ◽  
State Level ◽  
The United States ◽  
Scope Of Practice ◽  
Patient Specific ◽  
Behavioral Risk ◽  
Influenza Immunization ◽  
Immunization Rates ◽  
The Impact

In the past two decades, most states in the United States have added authorization for pharmacists to administer some vaccinations. Expansions of this authority have also come with prescription requirements or other regulatory burdens. The objective of this study was to evaluate the impact of these expansions on influenza immunization rates in adults age 65 and over. A panel data, differences-in-differences regression framework to control for state-level unobserved confounders and shocks at the national level was used on a combination of a dataset of state-level statute and regulatory changes and influenza immunization data from the Behavioral Risk Factor Surveillance System. Giving pharmacists permission to vaccinate had a positive impact on adult influenza immunization rates of 1.4 percentage points for adults age 65 and over. This effect was diminished by the presence of laws requiring pharmacists to obtain patient-specific prescriptions. There was no evidence that allowing pharmacists to administer vaccinations led patients to have fewer annual check-ups with physicians or not have a usual source of health care. Expanding pharmacists’ scope of practice laws to include administering the influenza vaccine had a positive impact on influenza shot uptake. This may have implications for relaxing restrictions on other forms of care that could be provided by pharmacists.

scholarly journals COVID-TRACK: world and USA SARS-COV-2 testing and COVID-19 tracking

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ye Emma Zohner ◽  
Jeffrey S. Morris
Keyword(s):  
Web Application ◽  
The United States ◽  
Mitigation Strategies ◽  
Time Lags ◽  
Policy Makers ◽  
Major Health ◽  
Dynamic Representation ◽  
Graphical Displays ◽  
The Usa ◽  
User Friendly

Abstract Background The COVID-19 pandemic has caused major health and socio-economic disruptions worldwide. Accurate investigation of emerging data is crucial to inform policy makers as they construct viral mitigation strategies. Complications such as variable testing rates and time lags in counting cases, hospitalizations and deaths make it challenging to accurately track and identify true infectious surges from available data, and requires a multi-modal approach that simultaneously considers testing, incidence, hospitalizations, and deaths. Although many websites and applications report a subset of these data, none of them provide graphical displays capable of comparing different states or countries on all these measures as well as various useful quantities derived from them. Here we introduce a freely available dynamic representation tool, COVID-TRACK, that allows the user to simultaneously assess time trends in these measures and compare various states or countries, equipping them with a tool to investigate the potential effects of the different mitigation strategies and timelines used by various jurisdictions. Findings COVID-TRACK is a Python based web-application that provides a platform for tracking testing, incidence, hospitalizations, and deaths related to COVID-19 along with various derived quantities. Our application makes the comparison across states in the USA and countries in the world easy to explore, with useful transformation options including per capita, log scale, and/or moving averages. We illustrate its use by assessing various viral trends in the USA and Europe. Conclusion The COVID-TRACK web-application is a user-friendly analytical tool to compare data and trends related to the COVID-19 pandemic across areas in the United States and worldwide. Our tracking tool provides a unique platform where trends can be monitored across geographical areas in the coming months to watch how the pandemic waxes and wanes over time at different locations around the USA and the globe.

scholarly journals What If the Influenza Vaccine Did Not Offer Such Variable Protection?

2020 ◽  
Vol 222 (7) ◽  
pp. 1138-1144 ◽  
Author(s):  
Sarah M Bartsch ◽  
Elizabeth A Mitgang ◽  
Gail Geller ◽  
Sarah N Cox ◽  
Kelly J O’Shea ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
Compartment Model ◽  
Medical Costs ◽  
The United States ◽  
Individual Factors ◽  
Policy Makers ◽  
Direct Medical Costs ◽  
Productivity Losses ◽  
Potential Impact ◽  
The Impact

Abstract Background The protection that an influenza vaccine offers can vary significantly from person to person due to differences in immune systems, body types, and other factors. The question, then, is what is the value of efforts to reduce this variability such as making vaccines more personalized and tailored to individuals. Methods We developed a compartment model of the United States to simulate different influenza seasons and the impact of reducing the variability in responses to the influenza vaccine across the population. Results Going from a vaccine that varied in efficacy (0–30%) to one that had a uniform 30% efficacy for everyone averted 16.0–31.2 million cases, $1.9–$3.6 billion in direct medical costs, and $16.1–$42.7 billion in productivity losses. Going from 0–50% in efficacy to just 50% for everyone averted 27.7–38.6 million cases, $3.3–$4.6 billion in direct medical costs, and $28.8–$57.4 billion in productivity losses. Going from 0–70% to 70% averted 33.6–54.1 million cases, $4.0–$6.5 billion in direct medical costs, and $44.8–$64.7 billion in productivity losses. Conclusions This study quantifies for policy makers, funders, and vaccine developers and manufacturers the potential impact of efforts to reduce variability in the protection that influenza vaccines offer (eg, developing vaccines that are more personalized to different individual factors).

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