Background Community pharmacies are widely distributed and often located in areas with limited obstetric access, positioning pharmacists to help expand reproductive health services, including pregnancy prevention, preconception, and maternal care. Objective To evaluate women's perceived access to obstetric care and their interest in receiving pharmacist-delivered reproductive health services within community pharmacies across Georgia. Methods In this cross-sectional survey, women aged 18 to 45 years were recruited at community pharmacies purposively sampled within 90 minutes of four college of pharmacy campuses to include counties with both adequate and inadequate obstetric services. A 9-page REDCap instrument assessed demographics, reproductive history, health risk factors, and interest in services from the NASPA Maternal Health Service Set. Counties were classified by obstetric service adequacy and stratified by NCHS urbanicity code. Data were collected February through May 2022. Descriptive statistics and chi-square tests were used. Results Of 103 respondents, 79 were analyzed. Although 82% resided in metropolitan counties, 37% lived in counties with inadequate obstetric services; 52% of those with inadequate access were metropolitan residents, whereas all 14 non-metropolitan participants had inadequate access. Sixty-eight percent agreed that access to women's health care is a serious problem in their community. Overall, 89% expressed interest in at least one pharmacist-delivered service. Interest was not uniform: 7 of 22 services drew interest from 70% or more of participants, led by medication review in pregnancy (77%), hypertension screening and counseling (76%), vaccinations (75%), nausea medication recommendations in pregnancy (75%), and contraception prescribing (70%). Interest was lowest for alcohol (33%) and tobacco (38%) screening. No significant differences were observed between groups stratified by obstetric access. Conclusion Women in Georgia with limited obstetric access, both in metropolitan and non-metropolitan areas, reported modifiable risk factors and interest in pharmacist-delivered reproductive health services, supporting community pharmacies as a pragmatic setting for expanding access.
BACKGROUND:Patient-reported outcomes (PROs) are used to assess a variety of patient experiences including medication nonadherence. Community pharmacists are well-positioned to address medication adherence. OBJECTIVES:The objectives of this study were to 1) determine the adoption, acceptability, feasibility, fidelity, appropriateness, and costs of piloting PatientToc, adapted to collect medication adherence PROs in community pharmacies, 2) pilot an initial implementation strategy for PatientToc including a resource toolkit and external facilitation plan, and 3) identify adaptations to consider for scaling PatientToc to pharmacies beyond this pilot. METHODS:Qualitative and quantitative data were collected, with data sources varying by outcome. Adoption, acceptability, fidelity and feasibility were evaluated with both quantitative (i.e., PatientToc administrative data and/or researcher records) and qualitative data (i.e., interviews and observations.) Appropriateness was evaluated with qualitative data. Costs were evaluated with quantitative data. Quantitative data were analyzed using descriptive statistics. Qualitative interview data were deductively coded. Intra- and inter-site summaries were created to synthesize quantitative and qualitative data to identify potential adaptations to make to PatientToc and/or the implementation plan. RESULTS:Three pharmacies implemented PatientToc for two to three months. Adoption by staff was lower than what had been requested by the study team, resulting in pharmacies using PatientToc with an average (standard deviation, SD) of 27 (14) patients. Moreover, pharmacies demonstrated varying fidelity in using PatientToc as pharmacists completed documentation in 21-100% of patient encounters. Implementation costs included a per-site average of $1280 for equipment, advertisement, and supplies, $290 per month in pharmacy staff time and $630 per month in research support staff time. Community pharmacy teams and patients overall found the use of PatientToc appropriate, acceptable, and feasible but six potential adaptations were identified. CONCLUSION:Implementing an electronic application for collecting and using PROs in community pharmacies was possible but challenging and staff adoption was lower than expected.
BACKGROUND:Integration of pharmacogenomics (PGx) into clinical care has primarily occurred within academic medical centers. Clinical decision support (CDS) is vital to the incorporation of PGx into clinical care, however, efforts have not capitalized on the integration within community pharmacy settings. OBJECTIVE:To describe the implementation efforts for community pharmacy CDS alerts and assess effectiveness. METHODS:A retrospective manual chart review was conducted to evaluate the effectiveness of deploying PGx alerts across 14 community pharmacies within a single health system. A report was created to capture all PGx CDS alerts generated during the eight-month study period (October 2024-May 2025). Alerts were categorized as actionable when documentation was sparse for medication adjustments based on PGx results from the prescribing clinician upon transmission of the prescription to the community pharmacy. RESULTS:A total of 74 alerts were generated, of which 36 were unique alerts. Thirty-eight alerts were excluded as duplicates when the pharmacist re-entered the dispensing function. Clinicians adjusted 17 chemotherapy prescriptions prior to order transmission. Additionally, five alerts for chemotherapy medications were considered not actionable as the patient had previously tolerated therapy. The remaining 13 alerts comprised of 11 for clopidogrel and 2 for tramadol. Pharmacists intervened in 8 of the 11 clopidogrel orders which resulted in 3 medication modifications. The overall alert acceptance was 23%. CONCLUSION:This study describes one of the first institutions to deploy PGx alerts through the community pharmacy module across a health system's electronic health record. PGx alerts in the medication dispensing module provide an additional safeguard for precision medicine, enabling pharmacists to make targeted interventions and provide patient education. Continuous evaluation of PGx alerts affords opportunities for alert refinement and further optimizing patient care.
BACKGROUND:Treatment resistant hypertension (TRH) represents a major public health challenge in the United States, substantially increasing risks of major cardiovascular events. The racial and ethnic differences in prescribing patterns and outcomes of treatment resistant hypertension are not well characterized. OBJECTIVES:This study exams racial differences in TRH epidemiology, treatment and outcomes in a national sample of hypertensive adults. METHODS:We analyzed US adults (≥18 years) with hypertension from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 (N=4,174). Apparent treatment resistant hypertension (aTRH) was defined as uncontrolled blood pressure (systolic blood pressure, SBP≥130 mmHg or diastolic blood pressure, DBP≥80 mmHg) despite concurrent use of ≥3 antihypertensive classes including a diuretic or use of ≥4 medications regardless of blood pressure. Estimates were weighted to represent the US population. RESULTS:Among adults with hypertension, the overall prevalence of aTRH was 6.61 [CI: 5.58, 7.65]. Prevalence was the highest among non-Hispanic Blacks (9.57%), followed by non- Hispanic Whites (6.81%) and Hispanics (3.49%). Despite more antihypertensive medications (average number of antihypertensive medications: 3.87, 3.66 and 3.58 among Black, Whites and Hispanic participants, respectively; p <0.001), blood pressure levels were the highest among Black participants. Black participants had the lowest rate of BP control (10.5%) compared to Whites (23.8%) and Hispanics (14.4%) (Pdiff<0.01). CONCLUSIONS:Non-Hispanic Blacks bear disproportionate burden in aTRH while Hispanics are likely undertreated, although small sample size in the former group limits conclusive findings. Further research is needed to disentangle the interrelationship between TRH, race and ethnicity and mediating factors.
BACKGROUND:Hypomagnesemia is common after Roux-en-Y gastric bypass (RYGB) due to reduced gastrointestinal absorption; however, management becomes particularly challenging when renal magnesium wasting coexists. OBJECTIVES:This report describes refractory hypomagnesemia in a post-RYGB patient with confirmed renal magnesium wasting and evaluates the role of magnesium glycinate as an alternative oral replacement strategy to oral magnesium oxide and intravenous magnesium sulfate. CASE SUMMARY:A 56-year-old female with a history of RYGB and chronic malnutrition presented with bilateral lower-extremity weakness and neuropathic symptoms. Despite high-dose intravenous magnesium sulfate administered via total parenteral nutrition and intravenous supplementation, as well as oral magnesium oxide, serum magnesium levels remained persistently low (1.1-1.9 mg/dL) with only transient correction. A markedly elevated random urine magnesium level confirmed renal magnesium wasting as a contributing factor. Oral therapy was transitioned to magnesium glycinate, a chelated formulation with alternative absorption pathways. Following this change, serum magnesium improved to 2.0-2.1 mg/dL without further need for intravenous supplementation, and episodes of severe hypomagnesemia decreased. PRACTICE IMPLICATIONS:This case highlights the importance of evaluating both gastrointestinal malabsorption and renal losses when hypomagnesemia remains refractory to standard therapy in post-bariatric surgery patients. Magnesium glycinate may represent an effective long-term oral replacement option in patients with combined malabsorption and renal magnesium wasting. Further research is needed to guide formulation selection in this population.
BACKGROUND:Marijuana is a schedule I controlled substance under federal law, but the Drug Enforcement Administration has published a proposed rule to reschedule it to schedule III at the federal level. This may create an even more complex regulatory landscape for the drug, with potentially ongoing conflicts between federal and state law. OBJECTIVE:To evaluate the current scheduling of marijuana in the United States. METHODS:In January 2026, two researchers independently conducted a 50-state survey to identify the schedule of marijuana in all 50 states and D.C. Westlaw, a legal database, was used to conduct searches in each state using the following search terms: "marijuana, "controlled substance," "schedule," "cannabis," and "marihuana." RESULTS:Most states listed marijuana as a schedule I controlled substance (n=33; 65%), which is the most restrictive schedule and consistent with current federal law. A total of nine (18%) states did not schedule marijuana. A total of nine (18%) states included marijuana in another schedule or classification system, with two (4%) states having already adopted schedule III. CONCLUSIONS:This review of state laws highlights implications of potentially rescheduling marijuana to schedule III, including three post-change scenarios: (1) state law is stricter than federal, (2) federal law remains stricter, and (3) automatic change in schedule when state law defers to federal. This will likely create more regulatory complexity immediately post-change, and pharmacists must be mindful of their state's laws in practice to ensure compliance, particularly for states that become the stricter law on the topic.
BACKGROUND:Population aging in Asia heightens the demand for effective medication management, with rational drug use literacy (RDUL) being crucial for safe and appropriate medication use. However, evidence on socio-demographic determinants of RDUL remains limited. OBJECTIVE:To examine socio-demographic factors associated with RDUL among aging populations. METHODS:A systematic review and meta-analysis of observational studies was conducted through comprehensive searches of seven electronic databases, supplemented by grey literature and organizational library sources, covering publications up to May 2026. Eligible studies were selected based on inclusion criteria, and methodological quality was assessed using the Newcastle-Ottawa Scale (NOS). Pooled associations between socio-demographic factors and RDUL were estimated using random-effects models with restricted maximum likelihood (REML) and Hartung-Knapp-Sidik-Jonkman (HKSJ)confidence intervals. REML with Wald-type (WT) confidence intervals and fixed-effect models were used for sensitivity analyses. The protocol was registered in PROSPERO (CRD42025635989). RESULTS:Of the 21,702 records screened, nine studies were eligible. Seven were identified through database searches and two through hand searching. All were assessed as moderate to high quality. Education level was the only socio-demographic factor significantly associated with RDUL, whereby individuals with a higher education were 2.61 times more likely to achieve adequate RDUL compared with those with a lower education (95% CI: 1.75-3.89; p <0.001; I2 = 88.7%). Collective socio-demographic factors (age, sex, education, employment, marital, and living status) were significantly associated with RDUL (OR = 1.41; 95% CI: 1.19-1.68; p < 0.001; I2 = 94.6%). Of these, only education was significantly associated with RDUL, whereas the remaining factors showed no significant or robust associations. CONCLUSION:Education level was a key determinant of RDUL, with significance observed only for collective socio-demographic factors. However, evidence remains limited due to low robustness, few studies, and a lack of specific assessment tools.
