Ryan Marotta

Recent study results indicate that antibiotic eye drops, despite being ineffective against viral infections and unnecessary for bacterial ones, are often prescribed for patients with acute conjunctivitis.

The study, conducted by the University of Michigan Kellogg Eye Center and published in Ophthalmology, evaluated data on 340,372 patients with a diagnosis of acute conjunctivitis over a 14-year period. Based on their analysis, the investigators determined that 58% of patients had prescriptions filled for antibiotic eye drops. Of these patients, 20% had prescriptions filled for antibiotic—steroid eye drops, which can potentially exacerbate the disease.

Notably, patients who received a diagnosis from a nonspecialist, such as a primary care physician or an urgent care provider, were found to be 2 to 3 times more likely to have prescriptions filled for antibiotic eye drops than those were who received a diagnosis from an eye care specialist, such as an ophthalmologist. Additionally, patients who had a prescription for an antibiotic filled were more likely to be white and better educated, more affluent, and younger than patients who did not do so.

“The study shows that current treatment decisions for pink eye are not based on evidence but are often driven more by type of health care practitioner making the diagnosis and the patient’s socioeconomic status than by medical reasons,” lead author Nakul Shekhawat, MD, MPH, said in a statement. “The potential negative consequences are difficult to justify as we move toward focusing on value in health care.”

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Antibiotics Are Overprescribed for Pink Eye

Amid an evolving health care landscape, pharmacists’ growing role in administering influenza and other vaccines can provide them with new opportunities to enhance their business and improve patient health.

Pharmacists’ scope of practice in immunizing patients has expanded significantly over the past few decades. Although laws and restrictions vary, pharmacists are now authorized to administer vaccines in all 50 states, the District of Columbia, and Puerto Rico.

 This shift has largely been a boon to patients, who often pay less to be vaccinated at a pharmacy than in a physician’s office.

 Furthermore, patients have found pharmacy-based immunization services to be more convenient and accessible than those offered at other health care settings, according to John Beckner, RPh, the senior director of strategic initiatives at the National Community Pharmacists Association.

“Over the years, [physicians] have relegated [immunizations] to pharmacists for a variety of reasons,” Beckner told 

. “Given the number of times patients visit pharmacies compared with the number of times they go to a physician’s office, it makes sense for them to get that service at a pharmacy.”

Beckner highlighted independent pharmacies as locations at which immunization services could thrive. Although independent pharmacies have not embraced these services as universally as their chain competitors, he noted, the high loyalty they have earned from their patients makes them ideal for vaccination locations.

“I think, certainly from an independent pharmacy standpoint, it’s all about relationships,” Beckner said. “Independent pharmacies have differentiated themselves over the years by the relationships that they have formed in their communities with patients and other health care providers.”

Independent pharmacists who are just beginning to offer immunization services should start slowly with influenza vaccines and pneumococcal vaccines, Beckner recommended; when they are ready, pharmacists can expand to other vaccines recommended by the CDC’s Advisory Committee on Immunization Practices, including those for zoster, tetanus, hepatitis, and measles, mumps, and rubella (MMR). When permitted by state law, pharmacists can also administer the MMR vaccine and other essential childhood vaccines to infants and children. Those who are unable to do so should at least educate parents on the importance of vaccination, he added.

If supported by local demographics, independent pharmacists should consider offering travel vaccine clinics in which they provide consultation and vaccination to potential travelers, Beckner suggested. He said success with these events could serve as a springboard toward other advanced health services, such as point-of-care testing and health screenings, which can help independent pharmacies to differentiate themselves from their competitors.

“By providing services such as immunizations, point-of-care testing, and health screenings, you are branding yourself as a health care destination,” he explained. “Combine that with the relationships you’ve formed and you have a very strong offering.”

Immunization services represent a significant financial opportunity for pharmacies as well, with the vaccine market expected to reach $49.27 billion by 2022, up from $32.31 billion in 2016, at a compound annual growth rate of 7.5%.

 Notably, pharmacists can generate revenue from both the immunization services and the additional business brought in by patients seeking vaccination. According to 1 estimate, “a 20% vaccination rate can drive a 6% increase in front-end sales.”

 Acknowledging this potential for profit, Beckner advised independent pharmacists to market their services by leveraging their relationships and reaching out to schools, churches, and other groups in their communities. It is also important, he added, for pharmacists to be familiar with reimbursement procedures and to bill for the both the vaccine and its administration.

“There is no question that immunizations can be an important source of revenue, but there are some idiosyncrasies with various plans in terms of being paid fairly for both products and services,” Beckner said. “Don’t sell yourself short; if you’re doing a half-hour travel consult, make sure you’re billing for it.”

With vaccination rates falling short of Healthy People 2020 goals,

 pharmacists have a particularly crucial role to play in promoting immunization among their patients, according to Beckner. Encouraging pharmacists to be proactive in screening patients and educating them on the benefits of vaccination, he also indicated that collaboration with other health care professionals was key to ensuring that patients receive all of their recommended vaccines.

“I think doctors and pharmacists can work together; particularly with vaccines that require a 2- or 3-dose series,” Beckner stated. “A patient might go to a doctor’s office for the first dose of a series and visit a pharmacy for subsequent doses.”

Ultimately, Beckner emphasized that pharmacy-based immunization services not only save costs and produce revenue, but also improve patient health and contribute to better outcomes, illustrating the value that pharmacists bring to the entire health care team.

“Offering differentiated services such as immunization is very important, but more and more, these services lead to improved outcomes and that’s where pharmacists can add value,” he said. “That’s hopefully where payors are going to take notice and look at the impact of pharmacists on total health care costs."

Pharmacist-administered immunizations: what does your state allow? American Pharmacists Association website. 

pharmacist.com/article/pharmacist-administered-immunizations-what-does-your-state-allow

. Published October 1, 2015. Accessed July 9, 2018.

Winegarden W. New study: patients could save time and money if neighborhood pharmacies can administer more vaccines. Pacific Research Institute website. 

pacificresearch.org/new-study-patients-could-save-time-and-money-if-neighborhood-pharmacies-can-administer-more-vaccines

. Published April 17, 2018. Accessed July 9, 2018.

Vaccine market by technology (live, conjugate, toxoid, recombinant), disease (influenza, DTaP, HPV, hepatitis, rotavirus, TT, polio, MMR, varicella, dengue, TB, rabies), route (IM, SC, ID, Oral), end user (Pediatric, Adult) & type - forecast to 2022. Markets and Markets website. 

marketsandmarkets.com/Market-Reports/vaccine-technologies-market-1155.html

. Published August 2017. Accessed July 9, 2018.

Dudzinski R. Immunizations: shot in the arm for retail pharmacy. 

chaindrugreview.com/immunizations-shot-in-the-arm-for-retail-pharmacy

Williams WW, Lu PJ, O’Halloran A, et al; CDC. Surveillance of vaccination coverage among adult populations-United States, 2014. 

. 2016;65(1):1-36. doi: 10.15585/mmwr.ss6501a1.

Let's Get Down to Business: The Value of Pharmacy Immunization

Recent study results suggest that tumor necrosis factor (TNF) inhibitors, an immunosuppressant drug class commonly used to reduce inflammation and relieve pain in patients with rheumatoid arthritis (RA), can be safely taken by pregnant women without causing harm to their babies.

, evaluated data on nearly 3000 children born to women with RA. Of those children, 380 were exposed to TNF inhibitors in utero. Based on their analysis, the researchers determined that although TNF inhibitors were capable of crossing the placenta, its use during pregnancy was not associated with a statistically significant increased risk of compromised immunity among offspring. Specifically, only 3.2% of children exposed to TNF inhibitors presented with serious infections compared with 2% of children born to mothers with RA who did not take TNF inhibitors.

“Knowing there is not necessarily an association between infections and these RA drugs will be very reassuring to expectant mothers,” said lead author E&#769;velyne Vinet, MD, PhD, in a statement. “It is important to highlight these findings so would-be mothers understand they can enjoy a normal pregnancy without being burdened by unnecessary stress.”

The study authors emphasized that further research is needed to affirm the safety of TNF inhibitors in pregnant women, and they advised health care providers to follow current recommendations when treating women with RA.

Study results suggest that tumor necrosis factor inhibitors can be safely taken by pregnant women without causing harm to their babies.

Rheumatoid Arthritis Medication May Be Safe for Expectant Mothers

The opioid reversal agent Narcan (naloxone) was reportedly used to save singer Demi Lovato’s life after an apparent drug overdose, 

TMZ.com noted that the singer had previously struggled with substance abuse issues, but at one point had remained sober from alcohol, cocaine, and opioids for 6 years.

In a recently issued recommendation, US Surgeon General Jerome M. Adams, MD, MPH, emphasized that naloxone can save lives, and encouraged Americans to carry and know how to use the drug. Additionally, an increasing number of states have enacted standing orders to make naloxone available without a prescription.

However, a 2016 study found that many pharmacists in Indiana had not dispensed Narcan to their patients, indicating that the medication was not being fully utilized. The Surgeon General Advisory encourages those at increased risk, their friends and family, and other potential witnesses, to be prepared to respond to an opioid overdose emergency, by obtaining naloxone. 

Individuals at higher risk include those who are misusing licit or illicit opioids, those taking higher doses of opioid pain medicine, and those taking benzodiazepine sleeping aides and opioid pain medicine concurrently, according to a statement from ADAPT Pharma.

 The advisory also encourages health care providers to provide patients opioid risk education and to prescribe or dispense naloxone to those at increased risk of an opioid overdose. The advisory also notes that the CDC advises health care providers to consider offering naloxone to individuals when factors that increase risk for overdose or concurrent benzodiazepine use are present. 

Demi Lovato Suffers Drug Overdose, 'Awake and Responsive' in Hospital. TMZ.com website. 

tmz.com/2018/07/24/demi-lovato-heroin-overdose

. Published July 24, 2018. Accessed July 24, 2018.

Meyerson BE, Agley JD, Davis A, et al. Predicting pharmacy naloxone stocking and dispensing following a statewide standing order, Indiana 2016. Drug Alcohol Depend. 2018:18; 187-19 doi: 10.1016/j.drugalcdep.2018.03.032.

ADAPT Pharma welcomes Surgeon General Naloxone Advisory strengthens partnerships to expand Narcan (naloxone HCl) nasal spray affordable access and awareness [news release]; April 5, 2018. adaptpharma.com/adapt_press_release/april-5-2018-adapt-pharma-welcomes-surgeon-general-naloxone-advisory/. Accessed June 19, 2018.

The opioid reversal agent Narcan (naloxone) was reportedly used to save singer Demi Lovato’s life after an apparent drug overdose, and pharmacists may get more questions this week about what this medication is used for and how to use it. A video below contains advice on how to answer those questions. 