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Background Inappropriate dispensing of antibiotics at community pharmacies is an important driver of antimicrobial resistance (AMR), particularly in low- and middle-income countries. Thus, a better understanding of dispensing practices is crucial to inform national, regional, and global responses to AMR. This requires careful examination of the interactions between vendors and clients, sensitive to the context in which these interactions take place. Methods In 2019, we conducted a qualitative study to examine antibiotic dispensing practices and associated drivers in Indonesia, where self-medication with antibiotics purchased at community pharmacies and drug stores is widespread. Data collection involved 59 in-depth interviews with staff at pharmacies and drug stores ( n  = 31) and their clients ( n  = 28), conducted in an urban (Bekasi) and a semi-rural location (Tabalong) to capture different markets and different contexts of access to medicines. Interview transcripts were analysed using thematic content analysis. Results A common dispensing pattern was the direct request of antibiotics by clients, who walked into pharmacies or drug stores and asked for antibiotics without prescription, either by their generic/brand name or by showing an empty package or sample. A less common pattern was recommendation to use antibiotics by the vendor after the patient presented with symptoms. Drivers of inappropriate antibiotic dispensing included poor knowledge of antibiotics and AMR, financial incentives to maximise medicine sales in an increasingly competitive market, the unintended effects of health policy reforms to make antibiotics and other essential medicines freely available to all, and weak regulatory enforcement. Conclusions Inappropriate dispensing of antibiotics in community pharmacies and drug stores is the outcome of complex interactions between vendors and clients, shaped by wider and changing socio-economic processes. In Indonesia, as in many other LMICs with large and informal private sectors, concerted action should be taken to engage such providers in plans to reduce AMR. This would help avert unintended effects of market competition and adverse policy outcomes, as observed in this study.

Background Community pharmacists require access to consumers’ information about their medicines and health‐related conditions to make informed decisions regarding treatment options. Open communication between consumers and pharmacists is ideal although consumers are only likely to disclose relevant information if they feel that their privacy requirements are being acknowledged and adhered to. Objective This study sets out to explore community pharmacy privacy practices, experiences and expectations and the utilization of available space to achieve privacy. Methods Qualitative methods were used, comprising a series of face‐to‐face interviews with 25 pharmacists and 55 pharmacy customers in Perth, Western Australia, between June and August 2013. Results The use of private consultation areas for certain services and sensitive discussions was supported by pharmacists and consumers although there was recognition that workflow processes in some pharmacies may need to change to maximize the use of private areas. Pharmacy staff adopted various strategies to overcome privacy obstacles such as taking consumers to a quieter part of the pharmacy, avoiding exposure of sensitive items through packaging, lowering of voices, interacting during pharmacy quiet times and telephoning consumers. Pharmacy staff and consumers regularly had to apply judgement to achieve the required level of privacy. Discussion Management of privacy can be challenging in the community pharmacy environment, and on‐going work in this area is important. As community pharmacy practice is increasingly becoming more involved in advanced medication and disease state management services with unique privacy requirements, pharmacies’ layouts and systems to address privacy challenges require a proactive approach.

Significance & Background: Alpha Gal syndrome (AGS) is an acquired allergy caused by an IgE-mediated reaction to alpha-gal, or galactose-0-1,3-galactose, a sugar molecule found in mammalian meat such as beef, lamb, rabbit, pork and venison. It is also found in animal-based products such as milk, milk products and gelatin. Itis believed to occur after one is bitten by the lone star tick; however, current evidence is pointing towards other tick species as vectors. When exposed to alpha-gal, symptoms (which can be delayed) include hives, urticaria, angioedema, abdominal pain, nausea, vomiting and diarrhea. Anaphylaxis may also occur. Clinicians\" awareness of this syndrome is crucial as many medications contain animal products, for example, some heparin preparations can contain bovine or porcine sources. Specific to oncology, cetuximab, a chimeric monoclonal antibody targeting the epidermal growth factor receptor (EGFR) contains alpha-gal and can cause severe life-threatening infusion reactions. Purpose: The purpose of this presentation is to bring awareness to this growing allergy and its impact on oncology treatments. Development of an algorithm for diagnosis, education, medication reconciliation and close collaboration with pharmacists is warranted. Interventions: At this National Cancer Institute-Designated Cancer Center, a near-miss in administering heparin to a patient with suspected AGS prompted a workflow to effectively screen and manage medications for patients with AGS. Education for both staff and patients was developed. Results: Oncology providers now have access to a pharmacy workflow, which includes a review of patients\" current and newly prescribed medications. If a desired medication is contraindicated, the pharmacist may suggest using an alternative medication, adding premedications, consulting an allergist, or proceeding with the requested medication with an escalation of monitoring. Discussion: Alpha Gal syndrome is a growing concern for oncology providers. To effectively manage patients with AGS, education for patients and staff is crucial. Patients need to avoid mammalian meat and dairy products, avoid products and medications that contain alpha-gal or mammalian protein-derived additives, and report any allergy symptoms. Clinicians should treat the patient for allergic reactions as clinically appropriate.

BackgroundCorrect inhaler technique is essential for effective management of airways diseases. Errors in technique remain common amongst patients and healthcare professionals (HCP). UK Inhaler Group (UKIG) has developed an inhaler technique framework and standards document to support competency training of HCPs.1 We developed and validated an online Inhaler Technique Competency Test to offer a standardised and objective method of assessing whether HCP can identify correct/incorrect inhaler technique. The test features device-specific video scenarios aligned with UKIG standards. We aimed to assess the feasibility of this online assessment as an ongoing training and assessment tool.MethodsWe engaged local HCPs to complete the assessment. The test required users to view ten short videos of people using inhalers and identify the embedded errors within. Video device scenarios included pressurised metered-dose inhalers (pMDIs), four different dry powder inhalers (DPIs), and soft mist inhalers (SMIs). Data was analysed over a 6-month pilot, including completion rates, user demographics and scoring.ResultsForty-three users completed the assessment with 88% passing (score ≥69%) on first attempt. Most users worked in hospital settings (65%), followed by community care (23%), general practice (7%), and community pharmacy (2%). Roles included pharmacists (30%), doctors (21%), allied health professionals (21%), nurses (16%), and others (12%). Highest number of errors was found in assessing SMIs, followed by MDIs and then DPIs. Users made half the errors in assessing DPIs compared to SMIs. Users made the most errors in assessing device and dose preparation step, person’s posture, head tilt, mouth seal and the correct inspiratory manoeuvre for the device. Notably, only 26% had attended training in the past year but thirty (70%) of users support patients with inhaler education at least monthly with a third doing it daily. See table 1 for errors made per device assessment.Abstract P121 Table 1Assessing errors made by inhaler deviceConclusionsThe e-inhaler technique competency assessment provides a scalable, standardised, and validated tool for assessing inhaler technique competency online. This tool has potential utility in education, clinical practice, and quality assurance, and may support improved outcomes through better targeted technique training.ReferenceUK Inhaler Group (2019). Inhaler Standards and Competency Document. Available at: https://www.ukinhalergroup.co.uk/

Background Health reform has been an ongoing agenda in many countries with community pharmacy increasingly gaining attention for contributing to healthcare improvement. Likewise, multiple policy approaches have been introduced to improve community pharmacy practice in Indonesia yet no studies have evaluated their effectiveness. Therefore, this study aimed to identify and collate information on approaches intended to improve practice in Indonesian community pharmacy and subsequently examine the perceptions of key stakeholders in healthcare and community pharmacy about these approaches and the extent to which they have affected community pharmacists as a profession. Methods This study reviewed the grey literature related to community pharmacy policies published by government and pharmacy organisations in Indonesia since 2009 and broadened the search to other relevant databases. In-depth semi structured interviews were conducted with a wide range of key stakeholders in pharmacy and healthcare between February and August 2016 to evaluate these policy approaches. Results Seventeen policy documents were identified with the majority published by the Indonesian Pharmacists’ Association (8 documents) and Ministry of Health of Indonesia (6 documents). Most documents (15 documents), either the updated version or new policy, were published since 2014 indicating the recent enthusiasm of pharmacy stakeholders to improve community pharmacy practice. Twenty-nine key stakeholders participated in the study, and highlighted three main themes regarding the policy approaches: barriers to effective policy implementation, need for policy changes and strategies to cope with policy challenges. Poor policy enforcement was commonly expressed by participants as a major challenge, with participants anticipating the need for a unified stakeholder vision to improve the current situation. Participants also mentioned several local initiatives which they claimed were improving practice but evidence was lacking. Conclusion The introduction of policy initiatives within the past ten years has highlighted the enthusiasm of policy makers and pharmacy stakeholders to improve community pharmacy practice in Indonesia. However, some of the initiatives were conceived and enacted in a piecemeal, sometimes conflicting and uncoordinated way. Overall, fundamental and entrenched barriers to practice need to be overcome to create a more professional climate for the practice of pharmacy in Indonesia.

Pharmacies play a vital role in improving access to family planning (FP) services in urban areas. They complement the resource-limited public health system and are viewed as key access points for contraceptives among young people (10–24 years) and the general population. The Challenge Initiative East Africa (TCI EA), in collaboration with the health management teams of Mombasa, Kilifi, and the Nairobi counties in Kenya and the Kenya Pharmaceutical Association (KPA) piloted an innovative public-private partnership (PPP) engagement to improve access to quality FP services offered at pharmacies in urban areas. The pilot project built the capacity of pharmacists, strengthened the referral system to public health facilities, and made FP data accessible and visible to drive informed decision-making. This paper describes the strategies employed and the outcomes. The initiative targeted 150 pharmacies across the three counties from June 2019 to December 2020 period. Our assessment shows that this intervention delivered FP commodities to 43,632 FP client visits; 71% for female clients and 21% for males. Adjusting for couple years of protection and seasonality, this translates to about 2,800 annual FP clients obtaining modern contraception in a 12-month period, including 48% injectables, 25% oral contraception, 24% emergency contraception, and 3% condoms. The majority of clients (75%) were older than 24 years, 21% were 20–24 years, 3% were 15–19 years, and 1% were less than 15 years. In addition, 327 clients were referred to a public sector facility for other methods. This intervention demonstrates the potential of pharmacies in contributing to FP uptake and provides a framework for improving access to quality FP services by pharmacies. There is potential to scale such an approach beyond the 3 counties, given the involvement and reach of KPA and the Ministry of Health (MoH) health management teams.

To assess the non-prescription use of antibiotics and associated factors in Ambo Town, West Shoa, Oromia, Ethiopia. An institutional-based cross-sectional study design supported with the qualitative study was conducted in Ambo Town from February 1 to March 1, 2020. Data were collected using a pretested semi-structured questionnaire and in-depth interview guide questions. Simple random sampling was used to select retail outlets and systematic random sampling to select study participants. The data analysis was done using SPSS and univariate and multivariate binary logistic regression analysis was performed to identify factors associated with non-prescription use of antibiotics. Thematic framework analysis was applied for the qualitative data. From the 421 study sample, a total of 399 participants were interviewed with a 94.8% response rate. Among the study participants, 214 (53.6) were males, 228 (57.1%) were married, 191 (47.9%) were orthodox by religion, and 343 (86%) were Oromo by ethnicity. One hundred seventy-two (43.1%; 95% CI: 38.6, 48.1) of the participants had used non-prescribed antibiotics. Being male [AOR=2.21 95% CI: 1.276, 3.835], residing in rural area [AOR=3.659, 95% CI: 1.479, 9.054], holding diploma [AOR=0.120, 95% CI: 0.025, 0.591], and hold BSC degree [AOR=0.050, 95% CI: 0.007, 0.378], and being farmer [AOR=0.034, 95% CI: 0.004, 0.285] showed significant association with the non-prescription use of antibiotics. This study concluded that the non-prescription use of antibiotics 172 (43.1%) was relatively high. Being male, residing in a rural area, holding a diploma, BSc degree, and being a farmer were significantly associated with non-prescription use of antibiotics. So, West Shoa Zone regulatory body should actively focus on the prevention of non-prescription use of antibiotics through health communication and public awareness on the demerits of non-prescription use of antibiotics.

If you listen carefully to how members of the pharmacy profession within South Africa is speaking about itself now, a pattern emerges. In this edition you will learn that hospital colleagues are writing about evolution from basements/dispensaries to the bedside, about stewardship, innovation and learning from the giants who came before them. Young pharmacists are insisting that relevance and purpose matter more than where on the programme their session appears, and are asking older pharmacists and mentors, hard questions about mentorship, digital health and leadership. Educators are reflecting deeply on how we shape professional identity, not only competence, under conditions of uncertainty and constraint. I believe this will be a constant, the uncertainty and constraint as change is a constant; what matters ethically is not whether we can escape it, but whether we respond to it deliberately and responsibly in ways that honour our obligations to patients, colleagues and the public.

United States healthcare outcomes, including avoidable mortality rates, are among the worst of high-income countries despite the highest healthcare spending per capita. While community pharmacies contribute to chronic disease management and preventive medicine, they also offer consumer products that increase mortality risks and the prevalence of cardiovascular diseases, diabetes, cancer, and depression. To resolve these contradictions, our perspective article describes opportunities for major pharmacy chains (e.g., CVS Pharmacy and Walgreens) to introduce digital health aisles dedicated to prescription and over-the-counter digital therapeutics (DTx), together with mobile apps and wearables that support disease self-management, wellness, and well-being. We provide an evidence-based rationale for digital health aisles to replace spaces devoted to sugar-sweetened beverages and other unhealthy commodities (alcohol, tobacco) that may increase risks for premature death. We discuss how digital health aisles can serve as marketing and patient education resources, informing customers about commercially available DTx and other technologies that support healthy lifestyles. Since pharmacy practice requires symbiotic balancing between profit margins and patient-centered, value-based care, replacing health-harming products with health-promoting technologies could positively impact prevention of chronic diseases, as well as the physical and mental health of patients and caregivers who visit neighborhood pharmacies in order to pick up medicines.