People experiencing homelessness (PEH) have complex healthcare and social service needs. Care coordination is one strategy used to help PEH navigate healthcare and social services, but gaps remain in understanding care coordination across health and social services sectors. mHealth technology has the potential to enhance care coordination for PEH. The study objectives were to: (1) understand healthcare and social services providers’ perspectives about care coordination for PEH, and (2) explore provider perceptions of how mHealth technology may facilitate the care coordination process for PEH. Twenty-six healthcare and social service providers were interviewed to obtain feedback on an existing mHealth intervention. A subset of questions from these interviews was analyzed to address the study aims. A thematic, deductive qualitative analysis utilized the Agency for Healthcare Research and Quality (AHRQ) Care Coordination Framework as a guide for the main themes. Subthemes were coded inductively; literature was used to define codes when appropriate. Using the AHRQ Care Coordination Framework, nine themes were developed: Align Resources with Patient and Population Needs; Assess and Prioritze Needs and Goals; Communication; Create a Proactive Plan of Care; Establish Accountability and Negotiate Responsibility; Facilitate Transitions; Link to Community Resources; Monitor, Follow-Up, and Respond to Changes; and Support Self-Management Goals. Subthemes were identified for each theme. Three ideas were salient across the themes and subthemes: Relational Continuity, Self-Care Agency, and Inter-Organization Collaboration. The context of homelessness, which included Accessibility, Competing Demands, Resource Scarcity and Awareness, and System Assumptions, was also essential for understanding care coordination for PEH. The analysis revealed that mHealth technology can be a tool to activate PEH by Increasing Awareness, Enhancing Self-Efficacy, and Enabling Self-Care. This study identified important mechanisms in coordinating care for PEH as described by healthcare and social service providers. These findings may help other providers to understand the key interplay of healthcare and social services for PEH along with mHealth interventions as potential facilitators of this process.

Background: Federally qualified health centers (FQHCs) use core quality measures to guide care and secure funding. One core measure is “Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet.” A pilot program at an FQHC utilized the clinical pharmacy team to improve appropriate aspirin prescribing. Clinical pharmacy technicians identified eligible patients through a best practice advisory (BPA) in the electronic health record and contacted individuals with IVD not prescribed aspirin to schedule a clinical pharmacist appointment. Pharmacists then conducted medication reconciliations and ordered aspirin when indicated. This study evaluated the impact of incorporating pharmacy technicians into the clinical pharmacy workflow on the IVD quality measure. Methods: This retrospective chart review compared aspirin prescriptions ordered from June to November 2023 between patients contacted by pharmacy technicians and those who were not. Demographics, outreach attempts, aspirin orders, and diagnosis codes were collected. Descriptive statistics and Fisher’s exact test were used for analysis. Results: Pharmacy technicians attempted to contact 65 eligible patients, with 49 successfully reached. Aspirin was prescribed for 3.1% of control patients vs 30.6% in patients successfully contacted by the pharmacy team ( P < .001). Resolved BPAs increased to 53.8% in the intervention group. Conclusion: A clinical pharmacy team significantly increased aspirin therapy among eligible patients with IVD, demonstrating the value of pharmacy team involvement on quality metrics. Future research should explore expanded integration of clinical pharmacy team services to enhance patient care.

Background: The Interactive Care Coordination and Navigation (iCAN) mobile health intervention aims to improve care coordination and reduce hospital and emergency department visits among people experiencing homelessness. Objective: This study aimed to conduct a three-part economic evaluation of iCAN, including a (1) cost analysis, (2) exploratory financial cost-benefit analysis, and (3) budget impact analysis (BIA). Methods: We collected cost and expenditure data from a randomized controlled trial of iCAN to conduct a cost analysis and exploratory financial cost-benefit analysis. Costs were classified as startup and recurring costs for participants and the program. Startup costs included participant supplies for each participant and SMS implementation costs. Recurring costs included the cost of recurring services, SMS text messaging platform maintenance, health information access fees, and personnel salaries. Using the per participant per year (PPPY) costs of iCAN, the minimum savings reduction in the average health care costs among people experiencing homelessness that would lead to a benefit-cost ratio >1 for iCAN was calculated. This savings threshold was calculated by dividing the PPPY cost of iCAN by the average health care costs among people experiencing homelessness multiplied by 100%. The benefit-cost ratio of iCAN was calculated under different savings thresholds from 0% (no savings) to 50%. Costs were calculated PPPY under different scenarios, and the results were used as inputs in a BIA. A probabilistic sensitivity analysis was conducted to incorporate uncertainty around cost estimates. Costs are in 2022 US $. Results: The total cost of iCAN was US $2865 PPPY, which was made up of US $265 in startup (9%) and US $2600 (91%) in recurring costs PPPY. The minimum savings threshold that would cause iCAN to have a positive return on investment is 7.8%. This means that if average health care costs (US $36,917) among people experiencing homelessness were reduced by more than 7.8% through iCAN, the financial benefits would outweigh the costs of the intervention. When health care costs are reduced by 25% ($9229/$36,917; equal to 56% [$9229/$16,609] of the average cost of an inpatient visit), the benefit-cost ratio is 3.22, which means that iCAN produces US $2.22 in health care savings per US $1 spent. The BIA estimated that implementing iCAN for 10,250 people experiencing homelessness over 5 years would have a financial cost of US $28.7 million, which could be reduced to US $2.2 million if at least 8% ($2880/$36,917) of average health care costs among people experiencing homelessness are reduced through the intervention. Conclusions: If average costs of emergency department and hospital visits among people experiencing homelessness were reduced by more than 7.8% ($2880/$36,917) through iCAN, the financial benefits would outweigh the costs of the intervention. As the savings threshold increases, it results in a higher benefit-cost ratio.

BACKGROUND: Mental health conditions are among the most frequent underlying causes of pregnancy-related death, and antidepressants may have a positive impact. However, adherence is suboptimal, little is known regarding antidepressant adherence trajectories postpartum women in the United States. OBJECTIVE: To describe antidepressant use among postpartum with Texas Medicaid and determine factors associated with adherence trajectories. METHODS: This retrospective analysis of Texas Medicaid claims (January 1, 2018, to June 30, 2022) included women aged 12 to years with at least 1 delivery, who were continuously enrolled 84 days before and 12 months after delivery, and who received an depressant within 90 days after delivery. The index date was the dispensing of an antidepressant after delivery. The dependent variable was antidepressant adherence, defined as the proportion of covered (PDC) and measured in 30-day increments for 270 days antidepressant initiation. The independent variables were guided by the Andersen Behavioral Model and included predisposing (age and race and ethnicity), enabling (urbanicity, prenatal care, and postpartum care), and need (baseline depression/anxiety, baseline substance use disorder [SUD], cesarean delivery, preterm birth, and pregnancy complications) factors. Group-based trajectory modeling (GBTM) was used to identify antidepressant adherence trajectory groups. Multinomial logistic regression was used to identify factors associated with adherence trajectory group membership. RESULTS: The included patients (N = 15,667) had a mean +/- SD age of 27.4 +/- 5.9 years, and 41.7% were White. Most resided in urban counties (78.0%) and had 6.4 +/- 3.5 prenatal visits, 3.1 +/- 2.8 postpartum visits, and 1.4 +/- 0.9 pregnancy complications. Nearly half (49.8%) had baseline depression/anxiety, 17.2% had baseline SUD, 37.4% had cesarean delivery, and 13.9% had preterm birth. At 270 days after antidepressant initiation, mean +/- SD adherence was 43.9 +/- 29.5, and the adherence rate (PDC >= 80) was 15.9%. During the 270 days follow-up, mean +/- SD persistence without a 30-day gap was 103 +/- 85.2 days, and the persistence rate (proportion persisting 180 days without a 30-day gap) was 22.1%. GBTM revealed 5 membership groups: consistent high (19.0%), fluctuating (22.5%), slowly decreasing (13.3%), and rapidly decreasing (21.8%) adherence and early and consistent nonadherence (23.4%). Patterns emerged with decreasing adherence at 2, 3, and 6 months after initiation. Increasing age, non-Black race, urban residence, increasing postpartum care visits, and baseline depression/anxiety were associated with the consistent high-adherence trajectory compared with most lower-adherence trajectories. However, baseline SUD and preterm birth were associated with membership in the less-adherent compared with the consistently adherent trajectory. CONCLUSIONS: Overall adherence and persistence were suboptimal, and GBTM revealed unique patterns of postpartum antidepressant adherence behaviors. To help impact maternal morbidity and mortality, adherence interventions should be tailored to women who are younger, Black, live in rural counties, have SUD, or had a preterm birth.

Background Disparities and healthcare inequities exist among marginalized ethnic and racial groups with continuous glucose monitoring (CGM) use. Current evidence surrounding the impact of CGM use on hemoglobin A1C (HbA1c) reduction beyond 6 months among underserved populations, including non-English speakers with type 2 diabetes in the Federally Qualified Health Center (FQHC) setting, is limited. Objective To evaluate the impact of CGM use on the first HbA1c measured between 12 and 24 months after CGM initiation among underserved populations with type 2 diabetes at a health system of FQHCs. Methods A retrospective, cross-sectional study was conducted among adults with type 2 diabetes participating in a FQHCs’ CGM program. Patients were eligible if they received CGM supplies between July 2020 to 2022 at an in-house pharmacy via indigent care coverage and had an HbA1c more than 8% within three months prior to CGM initiation. The primary outcome was the impact of CGM use on the first HbA1c measured between 12 and 24 months after CGM initiation. A post-hoc analysis was conducted to assess the change in HbA1c from baseline over time, in 6-month increments, up to 24 months. Descriptive and bivariate statistics were used for data analysis. Results Of 205 patients who were initially screened, 46 met study inclusion criteria. Baseline characteristics included 65% female, mean age 56 ± 11.2 years, 76% Hispanic/Latino/a ethnicity, and 54% Spanish-speaking. The primary outcome resulted in a statistically significant decrease in HbA1c (%) from 10.6 ± 1.7 at baseline to 8.6 ± 1.9 (P < 0.001) at the follow-up HbA1c measured between 12 and 24 months after CGM initiation. Conclusion In this analysis, CGM use led to a statistically significant and sustained reduction in HbA1c for up to 24 months among underserved populations with type 2 diabetes in the FQHC setting. Study findings suggest CGM use may offer long-term benefits in HbA1c reduction among underserved populations.

Despite the availability of highly effective HPV vaccines that can reduce HPV-associated cancer mortality, HPV vaccination rates in Texas rank 48th nationwide. Although evidence shows Latino parents are more accepting of HPV vaccination than non-Hispanic parents, this disparity in vaccination rates underscores the importance of understanding Latino parental HPV vaccine hesitancy. Latinos/as typically receive healthcare at Federally Qualified Health Centers (FQHCs), which often need support implementing and improving access to evidence based preventive services. However, the current literature around implementation comes from large integrated healthcare systems and there is limited research around what works in the FQHC settings with Latino/a patients. Preliminary data from our previous work suggest practice facilitation is a feasible approach for building the capacity in FQHCs to select and implement provider- and practice-level strategies for increasing vaccination rates. This proposal considers the HPV vaccine as the evidence-based intervention and describes the rational and study design for “TRUsted hEalth SYstem implementatioN stratEGIes to increase vaccination (TRUE SYNERGI)”, a hybrid type 2 study that uses previously-piloted implementation strategies (i.e., practice facilitation, provider education, among others) to influence provider recommendations (implementation outcome) and practice-level vaccination rates (effectiveness outcome). To test whether these facilitator-driven implementation strategies influence our implementation and effectiveness outcomes, we will use a stepped-wedge cluster randomized trial and randomize three FQHCs (n = 9 practices, 3 per FQHC) to three clusters. We will conduct baseline assessments at each practice, which will provide data to assist the practice facilitator in engaging with the providers and leadership to develop a tailored implementation plan for each practice. In addition, we will employ theory-guided, qualitative methods, to assess the complexity associated with context and the recipients involved in the implementation of strategies in practices, along with sustainability. The study will advance our understanding of what it means to conduct implementation research in resource limited practices that work with populations experiencing substantial disparities. Findings from the current study will inform national implementation efforts and contribute towards future research targeting dissemination and scale-up, key foci for health equity focused implementation research. Registered in ClinicalTrials.gov (NCT06598475) on September 9, 2024.

PurposeThe purpose of the study was to evaluate factors associated with pneumococcal vaccination among non-Hispanic Black adults with type 2 diabetes mellitus (T2DM).MethodsA cross-sectional, online survey was conducted in December 2023 using a Qualtrics research panel. Eligible participants were adults 19 years and older and non-Hispanic Blacks who self-reported a T2DM diagnosis. The survey comprised 55 items across 5 sections based on the health belief model. Descriptive and bivariate analyses and hierarchical binary logistic regression were used for data analysis.ResultsThere were 330 eligible participants. Two-thirds received at least 1 dose of the pneumococcal vaccine. Participants had a mean age of 51.4 ± 16.8 years; 63.9% were women. Higher perceived susceptibility and higher cues to action were significantly associated with pneumococcal vaccination. However, higher perceived susceptibility, higher severity, geographical location, and history of influenza vaccination emerged as significant predictors, and improved model predictive ability for pneumococcal vaccination was observed (Akaike information criterion = 384.1 vs 423.5) after controlling for sociodemographic and other factors (education level, income, geographical location, diabetes-related complications, treatment types, frequency of health visits, influenza vaccination history, pneumococcal disease history, general vaccine beliefs, perceived mistrust).ConclusionClinical, public health, and health policy programs should address these factors in planning educational campaigns and strategies to increase pneumococcal vaccination among non-Hispanic Black individuals with T2DM.

To determine which of the available predisposing, enabling, and need factors are related to receipt of postpartum depression (PPD) treatment among postpartum women with Texas Medicaid. This retrospective database analysis used Texas Medicaid claims (1/1/2018-6/30/2022) and included women 12–55 years, continuously enrolled 84 days pre- to 12 months post-delivery, with a PPD diagnosis. The outcome was receipt of PPD treatment (psychotherapy and/or antidepressant medication) within 12 months post-delivery. Independent variables were guided by the Andersen Behavioral Model and included predisposing (age, race/ethnicity), enabling (urbanicity, prenatal care), and need (depression/anxiety, substance use disorder [SUD], cesarean delivery, preterm birth, pregnancy complications) factors. Multivariable logistic regression was used. Included women (N = 25,976) were 26.7 ± 5.9 years and 42.1

INTRODUCTION:Ensuring the safety and accuracy of compounded sterile preparations (CSPs) is a crucial part of a pharmacist's role. The purpose of this study was to determine if intravenous (IV) admixture lab course activities improved students' confidence and comfort levels in compounding sterile preparations across campuses and terms. METHODS:This study examined pre- and post-survey results collected from third-year pharmacy students (P3s) who enrolled in the 2022 Basic IV Admixtures Lab course, delivered on two campuses, during the 5-week summer term or 10-week fall term. Confidence and comfort levels were measured using a 5-point Likert scale (1 = not confident/comfortable at all to 5 = completely confident/comfortable) with seven questions in each category. Helpfulness of required and optional course activities was measured with eleven questions using a 5-point Likert scale (1 = unhelpful to 5 = helpful). Descriptive statistics, paired t-tests, and ANOVA were used for data analysis. RESULTS:Ninety-eight students completed both pre- and post-surveys (94.2 % response rate). Student confidence and comfort level improved (p < 0.001) on all measured items after taking the course, with improvement in confidence ranging from 0.62 to 2.35 points and comfort level ranging from 0.62 to 2.18 points. No differences were found in mean improvement scores between terms or between campuses. The majority of required and optional activities had a high mean score of 4 and above on the helpfulness scale. CONCLUSION:The IV admixture lab course improved confidence and comfort levels in the preparation of CSPs regardless of which term and on which campus students took the course.

BACKGROUND:Medication adherence among people experiencing homelessness (PEH) is consistently low. There is limited research investigating the factors related to adherence in PEH. OBJECTIVE:To describe and examine the relationship between traditional and vulnerable predisposing, enabling, and need (PEN) factors and medication adherence among PEH. METHODS:A cross-sectional survey was conducted at two homeless services agencies in central Texas, from June to August 2024. PEH who were at least 18 years old, took at least one oral prescription for a chronic condition, used the healthcare system in the past six months, and communicated in English were eligible. The dependent variable, medication adherence, was measured using the nine-item Hill-Bone Medication Adherence Scale (1 = all of the time to 4 = none of the time), range 9 - 36; higher scores indicated higher adherence. The independent variables were the traditional and vulnerable PEN factors. Data analysis included descriptive, bivariate, and linear regression analyses. RESULTS:Participants (n = 150) were 49.0 (± 10.8) years old and were homeless for 5.0 (± 6.0) years. Most were male (72.0%), half (50.0%) were White, and a quarter (25.3%) were Hispanic. The mean adherence score was 29.6 ± 4.4/36, where 4.4 represents the standard deviation (SD). Substance use, psychological distress, affordability of medications, access to transportation, access to medication storage, competing needs/priorities, and number of medications were related to medication adherence (p < 0.05) in the bivariate analyses. After adjusting for independent variables, psychological distress (p = 0.0025) and medication affordability (p = 0.0055) were associated with medication adherence. CONCLUSION:Healthcare professionals can consider tailoring medication adherence counseling to focus on strategies to mitigate psychological distress and medication affordability challenges.

OBJECTIVE:1) Using time-stamped data from a medication adherence app, examine changes in students' adherence to a medication regimen before and after using a grade for adherence as an incentive; 2) Assess changes in perceptions of medication adherence and use of reminder aids across 3 time points (baseline, week 1, and week 2). METHODS:First-year student pharmacists (N = 103) enrolled in a Pharmacy Practice Lab completed two 1-week medication adherence simulations. Each week, students were prescribed a 5-medication regimen with timing and food requirements and instructed to log each dose taken in the app. Adherence was ungraded in the first week and graded in the second week. An 18-question survey assessed students' perceptions of barriers and beliefs related to adherence and the use of reminder aids at baseline and after each simulation. Paired t-tests, McNemar's test, and repeated-measures analysis of variance were used for data analysis. RESULTS:Mean adherence scores increased significantly from 68.8% in week 1 (ungraded) to 88.7% in week 2 (graded). Use of reminder aids increased significantly from 52.5% in week 1 to 95.0% in week 2. Students' perceptions of adherence evolved, with significant changes to 11 survey items. Students demonstrated greater recognition of barriers to adherence, such as busy schedules or forgetfulness, and a shift in beliefs about the complexity of maintaining a medication regimen. CONCLUSION:Grading served as an incentive to improve adherence and increased the use of reminder aids. Students' understanding of barriers to adherence also improved. Finally, the simulation facilitated learning about how motivational strategies (eg, incentives, reminders) can influence medication-taking behaviors in real-world settings.

Purpose: To determine college students' intentions to be Human Papillomavirus (HPV) vaccinated. Methods: The study was comprised of college students aged 18-45 years. A survey was developed based on the Theory of Planned Behavior (TPB). The significance of the TPB constructs-attitude, subjective norms, and perceived behavioral control-and an additional construct-knowledge-in predicting intention were assessed. Results: The regression model containing attitude, subjective norms and perceived behavioral control accounted for 40% of the variance in intention. Attitude and subjective norms were significant predictors, while perceived behavioral control was not. Provider recommendation was the only significant covariate. Knowledge did not significantly contribute to the model. Discussion: The TPB was useful in predicting HPV vaccination intentions. A focus on attitude, subjective norms and provider recommendation may be useful in creating new or enhancing existing interventions.

BACKGROUND:Many US hospitals and health systems have implemented well-being programs to address the clinician well-being and burnout crisis. Most community pharmacists experience at least one symptom of burnout, yet they have been overlooked for inclusion in well-being initiatives. OBJECTIVE:To explore community pharmacists' perceptions of how motivation and burnout impact patient care and how fulfillment of basic psychological needs (autonomy, competence, and relatedness) impacts motivation and well-being. METHODS:Focus groups were conducted with 20 community pharmacists. A semistructured focus group guide was developed using Self-Determination Theory (SDT). Transcriptions from the focus groups were analyzed using deductive qualitative analysis with SDT as a framework and inductive analysis to code subthemes. RESULTS:Our findings revealed that pharmacists who feel burnout experience depersonalization toward patients which lowers the quality of patient-pharmacist interactions. Pharmacists who did not feel burnout expressed a sense of professional fulfillment, which motivated them to provide patient-centered care. Pharmacists indicated that unrealistic expectations from patients and corporate management, such as pressure from patients to fill prescriptions quickly and management expectations to meet prescription fill quotas, negatively impacted autonomy. Conversely, having access to clinical information, workflow optimization, and realistic job expectations supported autonomy. Poor relationships with patients and coworkers negatively impacted relatedness and contributed to communication barriers, workplace negativity, and emotional detachment from work. Relatedness was facilitated by building relationships and mutual respect with patients and coworkers and cultivating a positive work culture. Expectations for perfection and the need for multitasking when understaffed diminished competency. Adequate staffing and allocation of time to complete job duties served to support competency. CONCLUSION:Community pharmacists are faced with situations that undermine autonomy, relatedness, and competency, which according to SDT need to be fulfilled to facilitate well-being.

Street medicine is a health delivery model designed to provide direct patient care to people experiencing unsheltered homelessness where they are physically located, whether that be on the streets or in encampments. The model has developed in response to the barriers people experiencing homelessness (PEH) encounter when accessing care through traditional points of access such as primary care clinics. Street medicine programs are rapidly emerging across the United States (U.S.) in response to the health needs and challenges associated with care access and coordination for unsheltered homeless individuals. Although street medicine is a rapidly growing field, existing street medicine programs have rarely been studied collectively, limiting our understanding of the nature, scope, and range of street medicine programs in the U.S. This study examined 13 programs from across the U.S. to develop a broad characterization of street medicine programs. Results from interviews with representatives from each of the 13 programs show that there is a high degree of variability among the structure, operations, and scope of care of street medicine programs. However, consistent among street medicine programs is the adoption of a patient-centered approach to care and the use of harm-reduction principles. Street medicine programs are also highly engaged with community partners and affiliate organizations that work in their local and regional areas. Because street medicine programs often serve as a bridge between formal healthcare entities and PEH, street medicine offers a strategy for reconnecting individuals to vital healthcare services.

OBJECTIVES:The purpose of this narrative review is to summarize the literature on well-being and burnout among community pharmacists in the U.S. and provide recommendations for future research.METHODS:Relevant literature was identified by searching PubMed for combinations of keywords such as "burnout" and "well-being" combined with "pharmacists." Titles and abstracts were reviewed for relevancy, and full text articles were reviewed when applicable.RESULTS:While burnout is defined by its 3 core symptoms of emotional exhaustion, depersonalization, and low personal accomplishment, well-being is more challenging to define and measure, which has led to it being less studied. Community pharmacists faced high rates of burnout, low quality of life (QOL), and extreme fatigue prior to the COVID-19 pandemic, a situation that has likely only worsened. Factors such as workload, the type of community pharmacy, the level of education or training of the pharmacist, and stress may be some of the contributors to high rates of burnout. Clinician burnout may be related to high rates of mental health disorders seen in pharmacists, may impact patient safety and satisfaction, and may affect productivity and costs to employers and the healthcare system overall. There has been no research into interventions or strategies to support well-being and reduce burnout among community pharmacists, but having a workplace that is perceived as supporting well-being may have some impact. Recommendations for future research include the following: (1) define well-being, (2) explore why various factors support well-being or contribute to burnout, (3) determine the impact of community pharmacists experiencing well-being or burnout, and (4) develop strategies to support well-being and reduce burnout that are specific to community pharmacy.CONCLUSION:There is a sparsity of evidence regarding community pharmacist well-being and burnout. Further research is needed to generate the evidence needed to support interventions that are specific to the unique work setting of community pharmacists.

This study aimed to compare survival outcomes of neoadjuvant (NAC) and adjuvant chemotherapy (AdC) within each breast cancer subtype and stage among older women. Older (≥ 66 years) women newly diagnosed with stage I–III invasive ductal breast cancer during 2010–2017 and treated with both chemotherapy and surgery within one year were identified from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Analyses were performed within each of six groups, jointly defined based on subtype (hormone receptor [HR]-positive/human epidermal growth factor receptor 2 [HER2]-negative, HER2 + , and triple-negative) and stage (I–II and III). Kaplan–Meier curves and multivariable Cox models were used to compare overall and recurrence-free survival between NAC and AdC, with optimal full matching performed for confounding adjustment. Among 8,495 included patients, 8,329 (20.6% received NAC) remained after matching. Before multiple testing adjustment, Cox models showed that NAC was associated with a lower hazard for death among stage III HER2 + patients (hazard ratio = 0.347, 95% confidence interval CI 0.161–0.745) but a higher hazard for death among triple-negative patients (stage I–II: hazard ratio = 1.558, 95% CI 1.024–2.370; stage III: hazard ratio = 2.453; 95% CI 1.254–4.797). A higher hazard for death/recurrence was associated with NAC among stage I–II HR + /HER2– patients (hazard ratio = 1.305, 95% CI 1.007–1.693). No significant difference remained after multiple testing adjustment. The opposite trends (before multiple testing adjustment) of survival comparisons for advanced HER2 + and triple-negative disease warrant further research. Caution is needed due to study limitations such as cancer stage validity.

Background: Discrimination experiences have been documented in various health care set-tings; little is known about discrimination experiences in the community pharmacy setting. Objectives: This study aimed to (1) describe perceived everyday discrimination, including racial discrimination, in community pharmacies, (2) examine factors associated with perceived everyday discrimination, (3) examine the relationship between perceived racial discrimination and delays in picking up prescriptions, and (4) examine the relationship between perceived racial discrimination and forgoing prescriptions. Methods: A cross-sectional survey was conducted in 2021 with a U.S. Qualtrics research panel. The 9-item Everyday Discrimination Scale (EDS) was used to assess perceived discrimination (range 9-45, higher scores indicate higher perceived discrimination). One question asked whether respondents perceived racial discrimination. Two questions asked whether re-spondents delayed or forwent getting a prescription(s) in the past year. Descriptive statistics were calculated for all variables. A generalized linear model examined factors associated with perceived discrimination; logistic regression examined the relationships between perceived racial discrimination and delays in getting or forgoing prescription(s). Results: Participants (n = 578) were 40.2 (+/- 16.5) years old. Most were white (55.5%), 24.4% were black, and 29.4% were Hispanic or Latino. The mean EDS score was 16.5 (+/- 8.8); 18.7% perceived racial discrimination. Overall, 36.3% and 33.0% reported a delay in getting and forgoing their prescriptions, respectively. Age (P < 0.0001), sexual identity or orientation (P = 0.010), ethnicity (P = 0.049), annual income (P = 0.012), and prescription insurance (P = 0.008) were associated with perceived discrimination. Those with perceived racial discrimination had significantly higher odds of a delay in getting their prescription(s) than those without perceived racial discrimination (odds ratio 2.6 [95% CI 1.3-5.3]). Conclusions: Study findings elucidate discrimination experiences in the community pharmacy and the impact of racial discrimination on individuals' decision in obtaining their medications in a timely manner. Community pharmacy staff need to recognize their implicit biases and obtain training on best practices that promote equitable treatment of diverse patients. (c) 2022 American Pharmacists Association (R). Published by Elsevier Inc. All rights reserved.

Community-engaged research (CER) is a collaborative approach used by health services researchers to integrate the voice of community stakeholders in research design to increase the relevance and impact of research in advancing health outcomes. CER is guided by principles such as leveraging strengths and resources of a community, ensuring research is mutually beneficial for all partners, facilitating co-learning among all partners, disseminating findings to all partners, and committing long term to a community. The level of community engagement can range on a continuum from outreach, consultations, and community-academic partnerships to community-based participatory research depending on the type and extent of community stakeholder involvement. Given pharmacists' accessibility to the public and role as the medication expert across the health care continuum, pharmacist researchers can use CER to authentically engage communities to better understand medication-related needs and design community-informed interventions to optimize medication outcomes. The purpose of this paper is to provide a practical overview of CER for pharmacist researchers by: (1) introducing the CER continuum and describing how CER principles can be used before, during, and after a study, (2) describing practical considerations for conducting CER, and (3) discussing two examples of CER in improving medication-related outcomes in health services research.

Information communication technology (ICT) is instrumental in pharmacists' current practice and emerging roles. One such role is prescribing, which requires the use of clinical guidelines and documentation of decision-making, commonly via ICT. Development and refinement of ICT should be guided by evaluation frameworks that describe or measure features of ICT and its implementation. In the context of pharmacist prescribing, these evaluation frameworks should be specific to health stakeholders and the pharmacy setting.To identify ICT evaluation frameworks from health-related literature and review frameworks relevant to the development, implementation, and evaluation of pharmacist prescribing.A database search of CINAHL, Cochrane Library, EMBASE, Medline (Ovid), ProQuest, Scopus, Web of Science and grey literature was conducted, using combinations of keywords relating to ‘ICT’, ‘utilization’, ‘usability’, and ‘evaluation framework’. Abstracts and titles were screened according to inclusion criteria. Identified evaluation frameworks were critiqued for relevance to pharmacy practice.Twenty-two articles were identified, describing the development or application of 20 evaluation frameworks. None of the frameworks was developed specifically for pharmacy practice. The Technology Acceptance Model (TAM), describing use behavior, behavior intention, perceived usefulness, and perceived ease of use, was the most widely utilized framework. The Information System Success (ISS) and Human-Organization and Technology Fit (HOT-fit) are notable evaluation frameworks that address user and organizational influences in health ICT utility, and factors of both can address the limitation of TAM.The findings call for development of an agile evaluation framework for the system under review; however, this can prove difficult due to the heterogenicity and complexity of the healthcare system, particularly contemporary pharmacy practice.While the TAM appears useful to evaluate user attitudes and intentions towards ICT, its relevance to ICT in contemporary community pharmacy practice requires exploration.

Advanced pancreatic cancer is synonymous with a high mortality rate, debilitating symptom profile, and minimal prolongation in overall survival. Therefore, health-related quality of life (HRQOL) is important in patients with pancreatic cancer (PwPC). In chronic conditions, patient activation is positively associated and higher HRQOL. However, no known study has evaluated patient activation, HRQOL, and their association in PwPC. A 43-item cross-sectional survey assessed patient activation and HRQOL of patients with locally advanced and metastatic pancreatic cancer undergoing chemotherapy. Variables were analyzed descriptively, and relationships were assessed using bivariate statistics (sig p < 0.05). Fifty-six patients participating in the study had an average age of 69.5 ± 11.1 years, and the majority were females (51.8