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Objectives This study aims to understand acceptable strategies to enhance the COVID-19 vaccine uptake among mothers who have no intention to vaccinate their children. Methods In a cross-sectional study, using an online survey in March 2021, we evaluated the variables within the Health Belief Model (severity, susceptibility, benefits, barriers and cues to action) along with parents’ sociodemographic characteristics, previous COVID-19 infection, job loss due to COVID-19 pandemic and the presence of healthcare workers among the household. Total number of children in the household and their chronic health conditions were also assessed. Multivariable logistic regression was performed to evaluate the intention to vaccinate children against the COVID-19 and associations with other variables. Key findings The survey response rate was 32.30% (595/1842). Most of the participants were White (72.1%), 31–40 years old (55.46%) and married or in a cohabiting relationship (90.25). Out of 595 mothers with 3–15 years old children, 38.32% had no intention to vaccinate their children. Top factors associated with intention were perceived susceptibility (P = 0.002), benefits (P < 0.001), barriers (P < 0.001), cues to action (P < 0.001) and the presence of healthcare workers in the household (P = 0.032). The main barriers were concerns about vaccine safety, efficacy and side effects. The strongest cue to action was enough information being provided followed by doctors’ recommendations. Conclusions Strategies to increase vaccination for children lie in the process of convincing parents with providing reliable information on the vaccine safety, efficacy and side effects by paediatricians and other healthcare providers.

Objectives The purpose of this study was to evaluate the association between patients’ perceived relationship with their pharmacist and physicians and its association with their beliefs in medicine. Methods A cross-sectional design was used and 307 self-administered surveys were collected from adults, 45 years and above, in Houston, Texas via convenience sampling. Participants reported their general beliefs in medicine (perceived harm, perceived benefit and perceived medication overuse), perceived patient–pharmacist relationship, and perceived patient–physician relationship using a previously validated instrument adapted for this research. Perceived relationship constructs consisted of three domains each for pharmacist and physicians, namely trust/satisfaction, information sharing and patient involvement in treatment. Key findings The study participants were white (46.25%) females (54.72%) with a mean age of 58 (±13) years. The results indicate that the participants trusted and were satisfied with both their pharmacist and physician. Participants with higher trust/satisfaction with pharmacist consider medications as more beneficial. While participants with higher trust/satisfaction with their physicians were less likely to believe that doctors over-prescribe medicines, which may lead to medication over use. Information sharing by pharmacists was associated with a significant decrease in perception of general benefits of medications. Further participant's involvement in treatment decisions by the physician had a significant association with increased perceptions of benefits of medications. Conclusions Patients trust/satisfaction with their pharmacist leads to the belief that medications are more beneficial while a higher trust/satisfaction with physicians leads to lower beliefs in medicine, especially patients less likely to be adherent with appropriate medications.

Objective Generic-drug discount programmes (GDDPs) offer generic drugs at subsidized costs to both insured and uninsured consumers in the USA. Understanding predictors of intention to use GDDPs could help in developing interventions to direct more consumers to take advantage of such programmes. The objective of this study was to identify predictors of intention to use GDDPs using the theory of planned behaviour (TPB). Methods A paper-based survey was self-administered to randomly selected individuals from the greater Houston area in Texas, USA. The validated questionnaire included potential predictors of intention to use GDDPs that were derived and measured using the premise of TPB and the concept of awareness. Logistic regression was performed to evaluate if awareness, attitude towards GDDPs and generic drugs, perceived behavioural control (PBC) and subjective norms predicted intention to use GDDPs after controlling for demographics, income, number of chronic conditions and number of prescription drugs taken. Key findings A response rate of 59.5% was achieved (n = 663). Approximately 62.4% (414) respondents were aware of and 80% (528) had an intention to use GDDPs. After controlling for demographics and predisposing factors (current prescription drug use, chronic conditions and insurance status), attitude towards GDDPs (odds ratio, OR = 5.08; 95% confidence interval, CI = 3.228–8.003; P Conclusions Attitude towards GDDPs and generic drugs, PBC, location and race/ethnicity were significantly associated with intention to use GDDPs. Interventions by stakeholders to promote positive attitudes and highlighting the ease with which GDDPs can be used would be beneficial to eventually increase consumer utilization of GDDPs.

Objective The aim of this study was to examine the effect of drug-distribution methods on antiretroviral medication adherence in HIV-positive patients. Methods This was a longitudinal, retrospective study of an independent retail pharmacy providing complementary delivery services. Patients of 18 years of age or older receiving antiretroviral therapy were evaluated from 1 January to 30 June 2004. Patients were included if they had a minimum of one prescription claim for any antiretroviral medication during the study period and received state medication assistance. Using data obtained from computerized pharmacy records a medication possession ratio was calculated to assess adherence measured by pharmacy refill history over 6 months. To assess the consistency of adherence over time a modified medication possession ratio, termed the compliance/non-compliance index (CNI) at each refill, was developed and compared between each group. Key findings Of the 181 patients included in the study, those who had medications delivered had significantly better adherence (90.3% compared with 82.6%, P = 0.001) and CNI value (73.5% compared with 57.9%, P = 0.001) in comparison with those who picked up their medications. After controlling for age, gender, drug class, insurance type and time and distance from the pharmacy, use of medication-delivery services was significantly associated with adherence (P Conclusion Complementary medication-delivery services by pharmacies significantly increased adherence at each refill for antiretroviral therapy in HIV-positive patients. Further research is needed on how medication-distribution strategies can be implemented universally and the economic impact on cost of care to increase medication adherence in this high-risk population.

Purpose The effect of bar-code-assisted medication administration (BCMA) on nurses’ activities in an intensive care unit was evaluated. Methods A prospective, observational, time–motion study was conducted by considering two approaches to medication administration in an intensive care unit: paper-based medication administration (PBMA) and BCMA. The time spent on nursing activities was measured using a prevalidated time–motion observation instrument and categorized based on workflow factors such as direct patient care, indirect patient care, administration, and miscellaneous or other. A descriptive analysis was conducted with the amount of time spent on each of the nursing activities. A multivariate analysis of covariance was conducted to assess the difference between the two approaches for the amount of time spent on various categorized nursing activities. Covariates included in the analysis were patient characteristics, medication administration characteristics, and number of nurses involved in medication administration. Results A total of 101 PBMAs and 151 BCMAs were reviewed. The mean duration of total medication administration time was higher in the BCMA phase compared with the PBMA phase, as was the mean time spent on direct patient care activity. However, nurses spent less time on administration activity during BCMA. Statistical analysis revealed that the medication administration approach (BCMA versus PBMA) had a significant effect on time spent on direct patient care and medication administration activities. Conclusion The implementation of BCMA led to a reduction in the time spent by nurses on medication administration activities and increased the time spent on direct patient care activities.

Objectives The aim of this study was to evaluate the relationship of physicians' awareness and attitude with their practice behaviour to use the recommended wait and watch approach in the treatment of selected acute otitis media cases. Methods A cross-sectional survey of primary care physicians was conducted from May to July 2008 in the Houston metropolitan area, Texas, USA. Key findings Approximately 80% of the respondents (total, n = 89) were reportedly familiar with the recommendation to use the wait and watch approach. Most of the physicians agreed (82%) with the guideline, finding the recommendations reasonable and were comfortable (76%) using the approach. In children aged

Objectives The objective of this study was to examine the rates of occurrence of misuse of over-the-counter (OTC) medications in community-dwelling older adults. In addition we examined whether those who misused OTC medications had higher numbers of adverse drug events (ADEs). Methods The study was a cross-sectional study conducted in retirement homes and senior community centres in Houston, Texas, USA. Participants were community-dwelling older adults who (1) resided in retirement homes or visited senior community centres, (2) were responsible for managing their own medication regimens and (3) consumed OTC medications. Information regarding the use of OTC medications, conditions for which the OTC medication was used, ADEs and demographics was obtained using a combination of a self-administered questionnaire and a series of open-ended questions. Key findings Data were analysed using descriptive statistics, and chi-square and t tests. The response rate for the study was 66.5%. Approximately 18% of respondents misused OTC medications, and 23% experienced at least one ADE following consumption of OTC medications. Occurrence of ADEs was higher in patients who misused OTCs compared to those who did not. Conclusions Analyses indicated that older adults participating in this study misused OTC medications. As expected, those who misused OTC medications had higher numbers of ADEs. Results from this study highlight the need to monitor the appropriateness of use of OTC medications in community-dwelling older adults. This will enable more effective medication management in the older adult population.

The appropriate implementation of information technology has been perceived as an important tool for streamlining workflow, improving patient-care quality and safety, and reducing the cost of health care services.[1][1] The shortage of pharmacists[2][2],[3][3] and nurses[2][2] in the United States

In their recent commendable article, “A Cross-site Qualitative Study of Physician Order Entry,” Ash et al.1 concluded that collaboration and trust among organizational members and active engagement of clinicians are important factors in successfully implementing computerized physician order entry (CPOE) systems. The article contributed to our understanding of the reasons behind physicians' resistance and the factors that might promote successful CPOE implementations. Although the article mentioned “pharmacists as team members,” their role was not described explicitly. We would like to recommend active incorporation of clinical pharmacists in the health care team involved in using CPOE. Well-designed CPOE systems can improve the safety of patient care and reduce health care costs2–4 caused by medication errors. Yet, as the authors of this study mention, many physicians have been reluctant to use CPOE.1,6–9 From the physicians' perspective, CPOE generally takes more time than writing prescriptions on paper.6,9 Hence, most physicians still prefer the traditional method. It is important to note, however, that the CPOE process is a two-way communication between the physician and …