Background We characterized real‐world prescribing patterns of opioids and benzodiazepines (BZDs) for older adults to explore potential disparities by race and sex and to characterize patterns of co‐prescribing. Methods A retrospective evaluation was conducted using electronic health data for adults ≥65 years old who presented to one of 15 primary care practices between 2019 and 2020 (n = 25,141). Chronic opioid and BZD users had ≥4 prescriptions in the year prior, with at least one in the last 90 or 180 days, respectively. We compared demographic characteristics between all older adults versus chronic opioid and BZD users. We used logistic regression to identify characteristics (age, sex, race, Medicaid use, fall history) associated with opioid and BZD co‐prescribing. Results We identified 833 (3.3%) chronic opioid and 959 chronic BZD users (3.8%) among all older adults seen in these practices. Chronic opioid users were less likely to be Black (12.7% vs. 14.3%) or other non‐White race (1.4% vs. 4.3%), but more likely to be women (66.8% vs. 61.3%). A similar trend was observed for BZD users, with less prescribing among Black (5.4% vs. 14.3%) and other races (2.2% vs. 4.3%) older adults and greater prescribing among women (73.6% vs. 61.3%). Co‐prescribing was observed among 15% of opioid users and 13% of BZD users. Co‐prescribing was largely driven by the presence of relevant co‐morbid conditions including chronic pain, anxiety, and insomnia rather than demographic characteristics. Conclusions We observed notable disparities in opioid and BZD prescribing by sex and race among older adults in primary care. Future research should explore if such patterns reflect appropriate prescribing or are due to disparities in prescribing driven by biases related to perceived risks for misuse.

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Objective To evaluate practice transformation team (PTT) members' perceptions of the Flip the Pharmacy (FtP) initiative as a strategy for implementing and improving community pharmacy‐based patient care. Methods FtP is a national 2‐year practice transformation initiative for implementing enhanced patient care and medication optimization services at community pharmacies, launched in 2019 with 28 PTTs including over 500 pharmacy locations. Key informant interviews were conducted with team leads, coaches, and pharmacy champions from four PTTs that participated in the first FtP cohort. The interviews were conducted using semistructured interview guides based on the RE‐AIM framework and focused on participants' experiences in the first year of FtP. Interviews were audio‐recorded, transcribed, and analyzed using a rapid content analysis approach. Results Four leads, 8 coaches, and 8 pharmacy champions were interviewed from 4 PTTs from May to October 2021 and resulted in 10 themes: (1) community pharmacy practice experience is important when selecting coaches; (2) team readiness supports successful pharmacy practice transformation; (3) measures of patient care quality are needed; (4) payment and practice transformation opportunities happen in parallel; (5) successful practice transformation requires strategic involvement of the entire pharmacy team; (6) FtP practice transformation domains are synergistic; (7) change packages, coaching, and performance monitoring are core practice transformation supports; (8) pharmacy teams value opportunities to share and learn from each other; (9) sustaining patient care services is continuous; and (10) COVID‐19 accelerated practice transformation while creating new stress points. Conclusion Participants in this study perceived the FtP initiative as a helpful strategy implementing and improving community pharmacy‐based patient care. Future research should explore the sustainability of the FtP initiative and similar community pharmacy practice transformation efforts.

To support the successful integration of community pharmacies into value-based care models, research on the feasibility and effectiveness of novel pharmacist-provided patient care services is needed. The UNC Eshelman School of Pharmacy, supported by the National Association of Chain Drug Stores (NACDS) Foundation, designed the Community-based Valued-driven Care Initiative (CVCI) to (1) identify effective value-based patient care interventions that could be provided by community pharmacists, (2) implement and evaluate the feasibility of the selected patient care interventions, and (3) develop resources and create collaborative sustainability opportunities. The purpose of this manuscript is to describe recruitment strategies for CVCI and share lessons learned. The project team identified pharmacies for recruitment through a mixed data analysis followed by a “fit” evaluation. A total of 42 pharmacy organizations were identified for recruitment, 24 were successfully contacted, and 9 signed on to the project. During recruitment, pharmacies cited concerns regarding the financial sustainability of implementing and delivering the patient care services, challenges with staffing and infrastructure, and pharmacists’ comfort level. To foster participation, it was vital to have leadership buy-in, clear benefits from implementation, and assured sustainability beyond the research period.

As pharmacy practice shifts its focus toward population health care needs that serve public health, there is a need to understand community-based pharmacies’ contributions to the reduction in health disparities. A scoping review was conducted to identify what community-based pharmacies in the United States are doing to target racial and ethnic disparities in community-based pharmacies. Forty-two articles revealed that community-based pharmacy services addressed racial and ethnic inequities in a variety of ways, including the types of interventions employed, as well as the ethnicities and conditions of the sample populations. Future work should focus on ensuring interventions are carried out throughout pharmacy practice and accessible to all racial and ethnic minoritized populations.