BACKGROUND:Post-stratification weighting adjusts sample respondent characteristics to align with population-level characteristics. Developing and evaluating weighting methods to reduce bias between sample and population characteristics can improve estimates of work and work-life characteristics. OBJECTIVES:(1) To examine differences in distributions of demographic variables between respondents to the 2024 National Pharmacist Workforce Study (NPWS) and a population-level data source and calculate proportional weights for each variable, (2) To develop and apply five weighting methods using proportional weights, and test the fit between weighted sample and population proportions, and (3) To quantify differences between weighted and unweighted sample estimates of work and work-life characteristics. METHODS:Using American Community Survey population characteristics (region, gender, five-year age categories, race, two-way age category x gender), we evaluated two weighting approaches using proportional weights alone and three using proportional weights and raking. Using a fit index, we evaluated the fit between weighted sample and population proportions. We compared unweighted versus weighted estimates for six work and two work-life characteristics. RESULTS:The unweighted NPWS respondent sample underrepresented younger, male and non-White pharmacists. Raking that used two-way gender x age categories, region, gender, and race produced weights that provided the best fit. Weighting shifted estimates of work and work-life characteristics consistent with hypotheses about the effects of age and gender. CONCLUSIONS:Post-stratification weights calculated by raking improved the representativeness of the 2024 NPWS respondent sample and refined estimates of pharmacist work characteristics. Data analysis of NPWS data could use weighting to improve estimate accuracy.

PURPOSE:The pharmacy workforce is experiencing persistent challenges related to employee well-being, staffing shortages, turnover, and evolving practice and payment models. Despite widespread recognition of these issues, progress has been hindered by fragmented workforce data and the absence of a coordinated national research strategy. The purpose of this commentary is to articulate a vision for a coordinated national pharmacy workforce research and data strategy, describe the infrastructure needed to accelerate evidence-based workforce solutions, and propose immediate research areas of focus. SUMMARY:Drawing on insights from the 2025 Implementing Solutions Summit 2.0, this commentary highlights critical limitations in the current approach to pharmacy workforce research, including inconsistent terminology and measures, siloed data collection, and limited capacity to conduct large, multi-site studies. These limitations impede benchmarking, supply and demand modeling, and the evaluation of workforce and workplace interventions. Expanding the scope and infrastructure of the existing Pharmacy Workforce Center (PWC) could address these gaps by leading workforce measurement standardization, conducting multi-site research studies, coordinating data aggregation through a centralized data warehouse, and developing more robust modeling of pharmacy workforce supply and demand. CONCLUSION:Broadening and strengthening the workforce research and data infrastructure within the existing PWC represents a necessary and critical next step for advancing the pharmacy workforce. A centralized national strategy is essential to generate robust and actionable evidence that supports pharmacy workforce sustainability, practice model advancement, as well as policy and payment reforms.

BACKGROUND:Pharmacists in chain and mass merchandiser pharmacies practice in standardized, corporate-driven environments where performance metrics and workload expectations often dictate daily activities. Few studies have systematically examined how specific work system characteristics such as autonomy, staffing, and feeling heard relate to pharmacists' perceptions of work-life outcomes in these pharmacies. Understanding relationships is critical as pharmacy organizations and pharmacists seek to address workplace issues magnified by COVID-19 and improve pharmacist retention and recruitment. OBJECTIVES:To examine the prevalence of work system characteristics across chain and mass merchandiser pharmacies, test associations between work system characteristics and pharmacists' perceptions of burnout (BO) and job turnover intention, and explore organizational strategies to improve pharmacist work-life. METHODS:Data were obtained from the 2022 National Pharmacist Workforce Study, a cross-sectional online survey of U.S. pharmacists. The Systems Engineering Initiative for Patient Safety 2.0 model guided the survey's domain content. Respondents practicing in large chain and mass merchandiser pharmacies (n = 662) responded to survey items about 6 work system characteristics, professional fulfillment (PF), BO, and turnover intention. Descriptive statistics and multivariate regression models were used to assess associations. RESULTS:Nearly 88% of pharmacists reported engaging in more work activities than when hired, 85% reported that workload metrics compromised safety, and 73% felt their organization did not listen to pharmacists' patient medication safety concerns. Regression models showed that autonomy and feeling heard about safety issues were the strongest predictors of PF and BO. CONCLUSION:Pharmacists' perceptions of not having control of how work is done in large chain and mass merchandiser pharmacies likely stem from how hierarchical organizations make decisions. Organizational strategies that increase local decision-making, reduce reliance on workload metrics, and provide autonomy to pharmacists are needed for workforce sustainability.

Purpose:This national survey aimed to describe the work settings, characteristics, employment activities, scope, functions, and challenges of the pharmacist workforce responsible for infectious diseases (ID) and antimicrobial stewardship (AMS)-related tasks in the U.S. Methods:An internet-based Qualtrics XM survey was distributed to 22,749 unique individuals with potential ID or AMS job responsibilities via email listservs for three national pharmacy organizations, and was open from 9/25/2024 to 10/24/2024. A respondent was considered engaged in ID/AMS activities if they reported involvement in at least one of 14 activities directly related to ID/AMS. Results:A total of 796 pharmacists with ID or AMS job responsibilities responded (3.5% response rate), with 607 working clinically or administratively in ID or AMS further categorized in four mutually exclusive groups based on formal and informal ID/AMS responsibilities. Respondents were predominantly female (66%), less than 40 years of age (59%) and white (82%). ID-specific training was completed by 41.8%, and 74% reported having student loan debt at graduation. Work-related activities were diverse and most frequently included: staffing or taking calls on weekends related to ID/AMS, AMS, educating learners or healthcare providers about ID-related topics, precepting learners, and conducting ID-related research and/or quality improvement projects. Respondents frequently indicated they lacked adequate job resources. Conclusions:The results highlight the extensive responsibilities placed on ID/AMS pharmacists to fulfill multiple roles. Pharmacists frequently lack ID-specific training or dedicated time for AMS responsibilities. The workforce is young, suggesting a need for both increased capacity for training programs and strategies for workforce retention.

PURPOSE:Centralized health-system specialty pharmacy (cHSSP) clinics are an emerging model in which pharmacists operate independently from individual specialty clinics and manage the use of specialty medications. As more health systems adopt cHSSP models, there is a need to understand the foundational components that support their effectiveness. This scoping review aimed to identify and synthesize reported structures, processes, and outcomes of cHSSP clinics using the Donabedian model as a guiding framework. METHODS:A literature search of PubMed was conducted for primary, peer-reviewed articles published between January 2014 and July 2024. Articles were included if they described US-based cHSSP clinics that operated independently from interprofessional specialty teams and provided clinical services related to specialty medication management. RESULTS:A total of 24 articles met the inclusion criteria. Structural elements included staffing with ambulatory care-trained pharmacists, use of scheduling assistants and pharmacy technicians, electronic health record access, and varied scopes of pharmacist prescribing authority. Key processes involved benefits coordination, prior authorization, disease state monitoring, adherence counseling, and care coordination. Reported outcomes included improved medication adherence and persistence, patient satisfaction, disease state control, cost containment, and medical provider satisfaction. CONCLUSION:This review highlights the variability, adaptability, and promising outcomes associated with cHSSP clinics and provides a foundation for future implementation and evaluation of these models in health systems.

INTRODUCTION:Women with low incomes are more likely than women with higher incomes to terminate pregnancies to prevent unwanted births. Terminations became less accessible in some states following the Dobbs v. Jackson Women's Health Organization ruling. As women would likely carry pregnancies for longer following Dobbs, we evaluated pre-post changes in the use of Medicaid-funded obstetric care following the ruling. METHODS:This study used a single group interrupted time series analysis design to assess pre-post changes in Medicaid health claims for obstetric care use. RESULTS:Use of obstetric care among women who were Black and women living in urban areas was most affected by Dobbs. Obstetric care use by these sociodemographic groups immediately increased after the ruling, followed by a decreasing trend in care use. CONCLUSIONS:States with policies that reduce access to abortion care need to prepare for the increased demand for Medicaid-funded obstetric care among women who now must carry their pregnancies to term.

BACKGROUND:To meet the demands of patients and communities during the coronavirus disease 2019 pandemic, community pharmacists expanded their time spent on various work activities. It is unknown how community pharmacists are spending their workday in practice activities after the pandemic. OBJECTIVES:The specific objectives of this project were to describe the time community pharmacists are spending on work activities and their perceptions of whether this time is decreasing, increasing, or not changing. In addition, the proportion of services delivered with an appointment was described, along with pharmacists' satisfaction with their time spent on these work activities. METHODS:The 2022 National Pharmacist Workforce Study was conducted via an online survey sent to a random sample of 93,990 licensed U.S. pharmacists. The survey allowed customization of questions based on the pharmacy practice setting. Community pharmacists were asked to report the percent of time spent, the number of hours in a week spent, the change in time spent since March 2020, the use of appointments, and satisfaction with time spent on work activities. RESULTS:Usable responses were gathered from 1971 community pharmacists. More than 75% of respondents reported an increase in time spent administering vaccines, and approximately 90% of respondents reported the use of appointments when administering vaccines. Respondents also reported spending a considerable amount of time providing advisory services (e.g., assisting with insurance) with at least 35% of respondents reporting time spent on these services increased. Lower satisfaction with time spent on work activities was found among respondents who reported working in large chains, mass merchandisers, or grocery chains than those working in independents and or small chains. CONCLUSION:Community pharmacists are increasing time spent on some work activities, such as vaccinations and advisory services, added to their normal workflow. Low satisfaction with time spent on work activities is a concern in some community pharmacy settings.

Background:Overemployment and underemployment are associated with fluctuations in labor supply and can negatively impact psychosocial aspects of work and worker health. Objectives:The objectives of this study were to 1) determine the prevalence and characteristics of underemployment, overemployment and matched employment among part-time pharmacists; 2) examine differences in actual and ideal hours worked for overemployed and underemployed part-time pharmacists; and 3) test associations between overemployment, underemployment and matched employment and part-time pharmacists' perceptions of job quality and work-life characteristics. Methods:Data for 636 pharmacists self-reporting working part-time (≤ 30 h/week) were extracted from the 2019 National Pharmacists Workforce Study. The difference in self-reported actual and ideal hours worked weekly was calculated and used to classify part-time pharmacists as overemployed, underemployed or matched employed. Differences between the variables were tested with multivariate ordinary least squares regression models. Results:Being matched employed was most common (41.3 %) followed by underemployed (34.9 %) and being overemployed (23.8 %). Of underemployed respondents, over half (54.1 %) reported wanting to work full-time, which likely is reflective of the relatively loose national pharmacist labor market in 2019. Overemployed and underemployed respondents reported significantly lower levels of several of the work-life characteristics relative to those with matched employment. Conclusion:The higher rate of underemployment among pharmacists working part-time is consistent with the surplus of US pharmacists in 2019. The results show that for pharmacists working part-time, a lack of control over how much they work is negatively associated with job quality and work-life characteristics relative to pharmacists with work schedule control.

Objective The COVID-19 pandemic resulted in health care workers experiencing temporary or permanent changes in employment due to layoffs, quits, and postpandemic increased job demand. Analyzing the association of the COVID-19 pandemic with employment changes and results of changes for practicing pharmacists and understanding the associations with demographic and work-related factors could inform practice, policy, and educational programs. This study aimed to explore the frequency, characteristics, and results of employment status changes (ESCs) experienced by pharmacists practicing pharmacy in March 2020 (ie, the start of the COVID-19 pandemic). Methods A descriptive, cross-sectional survey research design was used to collect data from a random sample of 93,990 licensed pharmacists in the United States. The study team developed an online survey questionnaire designed to assess the impacts of the COVID-19 pandemic on pharmacists’ work and work-life. The survey items used for this study related to ESCs, work-life characteristics, work characteristics in March 2020 and 2022, and demographic variables. A total of 4947 usable responses were received between November 2022 and January 2023. Results Overall, 36.4% of respondents reported experiencing an ESC and approximately 70% of those reporting an ESC reported experiencing just 1 ECS. Overall, 39.5% of respondents who experienced an ESC stopped working (ie, were unemployed) pursuant to an ESC. Respondents who experienced an ESC reported significantly lower levels of work exhaustion and interprofessional disengagement and significantly higher levels of professional fulfillment in their current employment than respondents that did not experience an ESC. Conclusion The overall increase in demand for workers in the health care sector appeared to provide opportunities for pharmacists, especially pharmacists with 1 to 10 years of experience, to change their employment situation, resulting in better work-life characteristics. Given projections of a pharmacist shortage, research, policy, and educational programs could determine the best practices to improve work settings and the work-life characteristics of practicing pharmacists to improve the health of the current pharmacist workforce.

Background: Community-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use. Objectives: To develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications. Methods: Two different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses. Results: The CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of con fidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into work flow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel. Conclusion: Both pharmacy-CBO models effectively identi fied clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models. (c) 2024 Published by Elsevier Inc. on behalf of the American Pharmacists Association.

PURPOSE:The purpose of this study was to describe the demographics, training, clinical specialties, and practice activities of ambulatory care pharmacists using data from the 2019 National Pharmacist Workforce Study (NPWS).SUMMARY:The 2019 NPWS was conducted using a 3-contact electronic survey sent to a random sample of 94,803 pharmacists using the National Association of Boards of Pharmacy Foundation e-Profile system. The 2019 NPWS had a response rate of 67.3% (5,705/8,466), based on the number of prospective respondents who clicked the survey link. A subset of pharmacists' responses (n = 4,557) was used for this analysis, which included those who selected an employment status of "practicing as a pharmacist." Of the 4,557 actively practicing pharmacists responding, 338 (8.0%) reported working in the ambulatory care setting. Ambulatory care pharmacists were predominately White (71.6%), women (67.5%), and/or between the ages of 31 and 40 years (36.9%). A total of 41.3% had completed PGY1 residency training, 14% had completed PGY2 residency training, and 29.3% had completed one or more board certifications. Their most common clinical specialty areas were anticoagulation (21.7%), endocrinology (19.7%), hematology/oncology (16.2%), and primary care (16.2%). A total of 49.6% reported using a collaborative practice agreement.CONCLUSION:Ambulatory care pharmacists reported more training and certifications than the overall sample of pharmacists. These pharmacists practiced in a variety of clinical specialty areas and engaged in a range of in-person and telecommunication medication management activities. This study provides a baseline assessment of the ambulatory care pharmacist workforce that can be used to assess changes over time.

Background: The glass ceiling is a metaphor used to describe an invisible barrier that prevents an underrepresented group from rising beyond a certain level. Among pharmacists, under-represented groups face various barriers and limitations to their successes.Objectives: The purpose of this study was to apply the intersectionality framework to data collected from the 2019 National Pharmacist Workforce Study (NPWS) to understand the association of gender and race with leadership aspiration among pharmacists, including differences in perceived barriers and attractors for pursuing leadership.Methods: The 2019 NPWS was conducted using an electronic Qualtrics survey. Three e-mails containing the survey link were sent to a systematic random sample of 94,803 pharmacists through the National Association of Boards of Pharmacy Foundation e-profile system. The 2019 NPWS had an overall response rate of 6% (5705/94,803). A total of 8466 pharmacists clicked on the survey link, resulting in a usable response rate of 67.3% (5705/8466). Data were analyzed in SPSS software using descriptive and Pearson's r and chi-square test statistics.Results: Black, Indigenous, and People of Color (BIPOC) pharmacists reported holding 10.7% of all leadership positions. Leadership positions included manager, assistant manager, executive, dean, director, chief pharmacy officer, owner or partner, and other leadership position types. White men and women reported the lowest interest in leadership (38.8% and 37.7%), whereas Black men (65.1%), Latinas (59.2%), Black women (58.5%), and Latinos (57.1%) had the highest interest in leadership. "The ability to make an impact" was the most frequently selected attractor for wanting to pursue leadership, selected by 92.5% and 79.6% of Black men and women, respectively, 77.8% of Other women, and 76.9% of Latinos. At graduation from pharmacy school, the student debt loan average of all graduation years ranged from $63,886 (+/- $73,701) for Other men to $112,384 (+/- $105,417) for Black women. Higher student loan debt was positively correlated with wanting to pursue a leadership position (r 1/4 0.22, P < 0.001). Black women graduating 2011-2019 had the highest student loan debt at graduation ($194,456 +/- $88,898).Conclusion: Interest in leadership positions by BIPOC pharmacists compared with reported leadership roles were inversely correlated. Understanding the discrepancy in interest in leadership and reported leadership positions held, particularly with relation to race and gender, is essential to understanding equity in pharmacy leadership. Further research is warranted to understand the factors that impede the ascension of women and underrepre-sented pharmacists into leadership positions. (c) 2022 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

BACKGROUND:Prescription drug monitoring programs (PDMPs) are state-based surveillance tools used to track controlled substances dispensed to patients and identify patients at-risk of misuse. Starting April 2017, Wisconsin required all prescribers access PDMP to review patient information before issuing a controlled substance prescription order for more than a 3-day supply. A primary goal of PDMP use mandates is to reduce avoidable prescribing and mitigate opioid related mortality and morbidity. Current literature has not evaluated the existence of a time point post-policy implementation, at which the trend in opioid dispensing changes, reflecting normalization/maintenance of opioid prescribing. OBJECTIVE:We sought to evaluate the impact of the PDMP use mandate on trends in opioid prescriptions dispensed and test a hypothesis that a change or inflection in opioid prescriptions dispensed occurred post-mandate implementation. METHODS:Interrupted Time Series Analysis (ITSA) design was used to examine whether the level (immediate impact) and trend in opioid prescribing changed significantly after the PDMP use mandate was implemented. We used a novel Change Point Analysis (CPA) approach to test the hypothesis i.e., identify if and when a change or inflection in opioid dispensing trend occurred after implementation of the PDMP use mandate. RESULTS:ITSA model results showed a significant drop in opioid prescriptions dispensed (p < 0.05) immediately after the mandate implementation (i.e., April 2017). Results of the CPA identified a significant inflection in opioid prescriptions dispensed starting January 2019 (21-months post-policy implementation). An ITSA model using the inflection point as an interruption showed that the trend in opioid prescriptions dispensed became flatter after the inflection point, suggesting normalization. CONCLUSION:Using a novel CPA approach, the findings showed an inflection in the trend in opioid prescriptions dispensed post-PDMP use mandate implementation, implying that most of the avoidable prescribing likely was curtailed. The results suggest that the patient information presumably accessed from the WI PDMP interface was useful in helping prescribers to make an informed clinical decision about opioid prescribing.

Background: Prescription medication labels are often constructed in a manner which hinders safe and appropriate use of medicines. The United States Pharmacopeia released voluntary standards to revise medication labels in an effort to support patients' understanding and improve medication use.Objective: To examine the impact of label changes on medication adherence before and after pharmacy implementation of the United States Pharmacopeia patient-centered prescription medication label standards.Methods: This study used a retrospective pre-post cohort design. Prescription fill claims data were obtained from a community health plan serving Medicaid patients for 1 independent community pharmacy organization across 8 retail pharmacy sites. We calculated medication possession ratios (MPR) and proportion of days covered (PDC) for medications used for contraception, asthma, hypertension, and depression from 15 months before to 13 months after implementation of the label changes.Results: Findings showed significant increases in mean MPR for asthma controller (increased by 0.111 [t = 0.290, P<0.0001]), antihypertensives (increased by 0.062 [t = 0.146, P < 0.0002]), and contraceptives medications (increased 0.133 [t = 0.209, P < 0.0001]) from preintervention to postintervention periods. Results also revealed increases in mean PDC for asthma con-trollers (increased by 0.193 [t = 0.267, P < 0.0001]), antihypertensives (increased by 0.067 [t = 0.175, P = 0.049]), and contraceptives (increased by 0.111 [t = 0.208, P < 0.0119]) from preintervention to postintervention periods. Conclusion: We report an association between a change to more patient-centered prescription medication labels and increased medication adherence based on MPR and PDC among Medicaid recipients.

Pharmacists working part-time have been identified in national workforce surveys but few analyses have focused on them, particularly related to whether their part-time status was voluntary or involuntary. This study aimed to: 1) describe the characteristics of pharmacists working part-time, and 2) compare voluntary part-time pharmacists with involuntary part-time pharmacists.

Background: Pharmacy-provided influenza vaccination services have become more prevalent among the older adult population. However, little is known about the characteristics of older adults associated with receiving the influenza vaccination at retail pharmacies and how these associated characteristics have changed. Objective: To examine characteristics of older adults associated with use of retail pharmacy-provided influenza vaccination services and how the characteristics changed between 2009 and 2015. Methods: The study used a retrospective, cross-sectional design with data from the 2009 and 2015 Medicare Current Beneficiary Survey. Older adults aged 65 and older who completed a community questionnaire and received the influenza vaccination during the previous winter were identified. Andersen's Behavioral Model of Health Services Use was the conceptual framework for inclusion of the population characteristics. A multivariable log-binomial regression was performed to estimate the association between the population characteristics and use of pharmacy-provided vaccination service, and the relative change in associations between 2009 and 2015. Survey weights were applied in all analyses. Results: The results showed older adults who were non-Hispanic black (compared to non-Hispanic white), who did not have secondary private insurance (compared to those who had), who did not have physician office visit (compared to those who had) and who lived in non-metro area (compared to those who lived in metro area) had become more likely to use pharmacy-provided influenza vaccination services in 2015 than in 2009. Conclusions: Pharmacy-provided influenza vaccination services appear to reduce access barriers for racially and socioeconomically disadvantaged older adults. Findings could help inform not only the retail pharmacies that provide vaccination services to better outreach to potential target populations but also policy makers about the disadvantaged populations that would benefit from the vaccination services provided by retail pharmacies.

Background: To better address their patients’ needs, community pharmacists are expanding from their traditional role of dispensing to managing medications and providing other care. Objective: This study characterized services reported by pharmacists practicing in community pharmacy settings in the 2019 National Pharmacist Workforce Study (NPWS). Methods: The 2019 NPWS was conducted via an online survey. E-mails containing survey links were sent to a systematic random sample of 96,110 U.S. pharmacists. The survey allowed tailoring of questions related to specific practice settings and for respondents in community pharmacies included reporting on delivery of twelve services. Other descriptive characteristic questions included pharmacy type, staffing, monitoring activities, self-reported workload, and respondent demographics. An index was created by summing the number of yes responses for the service questions. This index served as the dependent variable in an ordinary least squares regression examining the association of work setting chacateristics with the index. Results: Usable responses were received from 2,150 community pharmacists. The top four services were: administer vaccines (91.1%), patient medication assistance program (83.7%), naloxone dispensing (72.8%) and medication synchronization (67.2%). The regression model was significant, with supermarket pharmacies having a higher service index than large chains. Elevated service index scores were associated with more technicians on duty, CPESN participation, direct communication with primary care providers, practicing under a CPA and monitoring activities. Conclusions: Pharmacy operational characteristics were important influences on the delivery of services in community pharmacies. These findings can help inform the continuing transformation of community pharmacy practice.

INTRODUCTION TO THE PROBLEM:Occupational fatigue is a characteristic of excessive workload and depicts the limited capacity to complete demands. The impact of occupational fatigue has been studied outside of health care in fields such as transportation and heavy industry. Research in health care professionals such as physicians, medical residents, and nurses has demonstrated the potential for occupational fatigue to affect patient, employee, and organizational outcomes. A conceptual framework of occupational fatigue that is informed by a sociotechnical systems approach is needed to (1) describe the multidimensional facets of occupational fatigue, (2) explore individual and work system factors that may affect occupational fatigue, and (3) anticipate downstream implications of occupational fatigue on employee well-being, patient safety, and organizational outcomes.CONCEPTUAL FRAMEWORK OF OCCUPATIONAL FATIGUE:The health care professional occupational fatigue conceptual framework is outlined following the Systems Engineering Initiative for Patient Safety (SEIPS) model and adapted from the Conceptual Model of Occupational Fatigue in Nursing. Future research may apply this conceptual framework to health care professionals as a tool to describe occupational fatigue, identify the causes, and generate solutions. Interventions to mitigate and resolve occupational fatigue must address the entire sociotechnical system, not just individual or employee changes.

BACKGROUND: Cost-related nonadherence compromises successful and effective management of chronic disease. The Medicare Modernization Act of 2003 (MMA) and Patient Protection and Affordable Care Act of 2010 (ACA) aimed to increase the affordability of outpatient prescription drugs for older adults (older than age 64 years). The Medicare Part D prescription drug insurance coverage gap ("donut hole") created by the MMA was fully closed in 2020 by the ACA. OBJECTIVES: To (1) describe prescription drug coverage and financial hardship from purchasing prescription drugs among older American adults for 2021, (2) compare these results with findings from data collected before the MMA and during the progressive elimination of the Medicare Part D coverage gap, and (3) compute the likelihood for financial hardship from purchasing prescription drugs using variables for year, prescription drug insurance coverage, health-related information, and demographics. METHODS: Data were obtained from 4 nationally distributed, crosssectional surveys of older adults to track coverage for and financial hardship from purchasing prescription drugs. Surveys in 1998 and 2001 were mailed to national random samples of US seniors. Of 2,434 deliverable surveys, 700 (29%) provided useable data. Data were collected in 2015 and 2021 via online surveys sent to samples of US adults. Of 27,694 usable responses, 4,445 were from older adults. Descriptive statistics and logistic regression analyses described relationships among financial hardship and demographics, diagnoses, and daily prescription drug use. RESULTS: Five percent of older adults lacked prescription drug coverage in 2021, continuing a downward trend from 32% in 1998, 29% in 2001, and 9% in 2015. Contrastingly, 20% of older adults reported financial hardship from prescription drug purchases in 2021, bending an upward trend from 19% in 1998, 31% in 2001, and 36% in 2015. Financial hardship from purchasing prescription drugs was more likely to be reported by older adults lacking prescription drug insurance, taking multiple medications daily, and having a low annual household income across all survey years. The latter 2 of these 3 factors were still predictive of financial hardship from purchasing prescription drugs among older adults with prescription drug insurance. CONCLUSIONS: Financial hardship from purchasing prescription drugs is still experienced by many older adults after the full implementation of the MMA and ACA. Lacking prescription drug coverage, taking more than 5 prescription drugs daily, and a low annual household income may increase the likelihood of experiencing this financial hardship. Pharmacists can be a resource for older adults making choices about their prescription drug coverages and purchases. DISCLOSURES: Funding was provided by the American Association of Colleges of Pharmacy New Investigator Program, the University of Minnesota Grant-in-Aid of Research Program, the Peters Endowment for Pharmacy Practice Innovation, the Chapman University Research Program, and the University Minnesota Research Program.

Providing patient-centered care to manage chronic pain and opioid use disorder (OUD) is associated with improved health outcomes. However, adopting a holistic approach to providing care is often challenging in rural communities. This study aims to identify and contrast challenges to providing patient-centered care from the perspective of patients and providers. A participatory design approach was adopted to elicit the perceptions of providers and patients with lived experiences of chronic pain and/or OUD in Jefferson County, Wisconsin. Two focus groups were conducted with each stakeholder group to identify problems that participants face with respect to chronic pain management and OUD and possible solutions. Four interviews were conducted with providers experienced in chronic pain management. Analysis of focus group sessions and interviews show consensus among patients and providers that lack of behavioral health and recovery resources create barriers to effectively manage OUD and chronic pain. However, there was discordance among the two groups about other barriers such as patient and provider attitudes, tapering approach, and access to medications for OUD. This tension among patients and providers can influence patients' retention in therapy. More efforts are needed to mitigate stigma among providers in rural communities and support psychosocial needs of patients.