Innovations in Pharmacy最新文献

Outcomes based payments contracting is in its infancy. The increased attention being given to rare disease place a premium on the ability to engage with payers to ensure that there is an analytical framework relevant to value claims contracting. Rare disease is not, of course, alone; many other chronic disease states may be suitable candidates and have been over the past 10 years or more. Rare disease, however stands apart: (i) the evidence base at product launch is limited; (ii) the therapy costs are often considered prohibitive; and (iii) the target patient population is small. At the same time, those seeking to implement an evidence-based engagement with health systems to support innovative rare disease interventions face a substantive technology assessment barrier. The focus in health technology assessment on assumption driven modeled cost-effectiveness simulations that support imaginary recommendations for cost-effective pricing and access is, however, an avoidable barrier. In the US, this barrier is the business model of the Institute for Clinical and Economic Review (ICER) and one endorsed by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Rare disease can be better served with other tools at our disposal with a proposed new start analytical framework in health technology assessment. The purpose of this brief note is to make the case that this proposed new start focused on single attribute value claims that meet the standards of normal science and fundamental evidence can not only dispense with the ICER imaginary modeling but, with a new start formulary submission package, integrate value claims with assessment protocols to set the stage for effective outcome-based contracting as the default standard for future payer negotiations.

Community pharmacists are among the most easily accessible healthcare practitioners and are usually the first point of contact with the public or community. This is often due to their accessibility, credibility, and widespread within the public sector making them essential members of the healthcare team with significant contributions to the delivery of public health care. Community pharmacists, in addition to their known educational and awareness-raising roles, may play an essential role in risk assessment and screening of patients, detection of symptoms of probable malignancy, and cancer treatments. The pharmacy profession has been evolving from dispensing roles into more patient-oriented outcomes and pharmacists are now participating in more clinical interventions. This places community pharmacists in the best position to provide the necessary knowledge and healthcare to benefit populations at risk of cancer. Active involvement of community pharmacists in the care and management of cancer will significantly contribute to screening and risk assessment, early detection, treatment and eradication of breast, cervical, lung, ovarian and other forms of cancer. As a result, the community pharmacy setting must the developed to maximize its full potential in cancer care.

Objective: To explore the impact of different lung cancer treatment modalities on survival time and mortality rates in older patients. Methods: The Surveillance Epidemiology and End Results (SEER) database was used to identify lung cancer patients aged ≥50 years old in the United States. Descriptive statistics and trend charts from 2000 to 2016 were generated. Regression analysis was performed among lung cancer patients to explore the association between survival time and treatment utilization (chemotherapy, radiation, and surgery). A regression model was also applied to explore the association between treatment modalities and odds of dying. Results: A total of 826,217 patients were diagnosed with lung cancer between 2000-2016. The number of lung cancer cases increased by 7%, and the average annual frequency was 48,529 cases per year. Survival, mortality, and treatment utilization varied over the years based on demographic, clinical characteristics, and social status. Five-year survival rate was less than 10% among the study population, and 84% of included lung cancer patients died. Chemotherapy was more commonly used (62%), followed by radiation (35%) and surgical interventions (22%). Chemotherapy and surgery showed a survival advantage. The odds of dying were two times higher among patients treated with surgery than those who were not (OR: 2.62, 95%Cl: 2.58-2.67). Conclusion: This study highlighted the importance of considering treatment modalities and individual patient characteristics, which may impact survival times and mortality rates among older lung cancer patients.

Background: Various visual tools are used to improve medication adherence in communication with the patient. Pharmaceutical pictograms are one such tool utilized within this communication process. Objective: The aim of this study is to investigate the eye movement of the participants and to recommend the most suitable location of pictograms on pharmaceutical packaging accordingly. It also aims to show whether there is a significant correlation between the effectiveness of pictograms and the health literacy, age, and gender of the participant. Methods: Forty-two participants were exposed to sixty stimuli showing four different pharmaceutical packages as an on-screen slide show. Participants were asked what they understood from the pictograms on the packaging, and their eye movements were examined using eye tracking to determine heat maps and areas of interest, and to measure the time to first fixation, total fixation duration, and percentage fixated. Results: The study revealed that the understanding level of the pictograms was determined at between 11.9 % and 71.43 %. Among the pictograms, only a small percentage 13% - namely numbers 12 and 13 which were prepared and validated by the FIP, achieved a score of 67%, the minimum level of comprehension in accordance with ISO 3684. We observed that participants fixated at least once on the pictograms up to 95% of the time. The pictograms were found to be most easily noticed at the center with a secondary focus area towards center-right parts of the packaging. Vertical design was highly engaging for participants regardless of health literacy. The significant relationship was found between the understanding of the pictograms and gender when mean values are examined. However, no significant relationship was between health literacy and pictogram comprehension level. Conclusions: This is the first study to have used eye tracking to analyze pictograms added to real pharmaceutical packaging on the market. Its findings can guide pharmaceutical companies to design their packaging in a way that prioritizes patient safety, and to place critical pictograms more effectively. These results can be adapted medication label design in hospitals to promote appropriate use. Studies to improve patient adherence by using pictograms should be diversified.

Purpose: To assess the impact of a pharmacist-led warfarin to DOAC conversion initiative during the COVID-19 pandemic. Methods: Patients who were prescribed warfarin and followed with the anticoagulation clinic for INR monitoring were assessed by outpatient clinical pharmacists as potential candidates for transition to DOACs from March-August 2020. Results: 530 patients were assessed for transition to DOACs, of which 373 (70.4%) were deemed by clinical pharmacists to be candidates for DOACs. Of the patients who were candidates for DOACs, 66 (17.7%) were transitioned from warfarin to a DOAC. Of the patients who transitioned to a DOAC, 59 (89.4%) remained on a DOAC after one year. Conclusion: Outpatient clinical pharmacists are an effective resource to help identify patients who are candidates for DOACs and assist with transition from warfarin. Further, high persistence rates with DOAC therapy after one year demonstrate the positive impact of the clinical pharmacist on medication adherence.

Globally, the COVID-19 pandemic has had a significant impact, given the rise in the demand for novel therapeutics such as vaccines that can be used in the treatment of COVID-19 patients. Compared to other regions of the world, gross vaccine inequity exists in Africa due to several factors tied to the acute lack of vaccines in the region. As a result, efforts are currently being made to ramp up the production of COVID-19 vaccines in the region. However, there are concerns that most countries in Africa lack the adequate pharmaceutical manufacturing capacity required to produce COVID-19 vaccines, and Zimbabwe is not an exception. This article, therefore, aims to evaluate the preparedness and readiness efforts of the Zimbabwean pharmaceutical industry in the production of COVID-19 vaccines.

The microbiome is the collection of commensal microorganisms along with their genomes inhabiting the human body. Despite the many known beneficial effects of these microbes on human health, the 2016 ACPE Standards for Doctor of Pharmacy curricula describe Medical Microbiology in Appendix 1 with a pathogen-centered focus. Over the last twenty years, evolving biotechnology has enabled a deeper understanding of the microbiome in the context of both wellness and disease. Retail stores are allocating increasing shelf space to commercial probiotic products, while the approach to PharmD training on the selection and use of these natural care products remains static, creating a disproportionate footprint between PharmD curricula and consumer markets. Looking to the future of patient care, we brief pharmacy educators on the current evidence and invite discussion around a proposed revision to the 2025 ACPE Standards that would add language recognizing the beneficial role of the commensal microbiota and expanding therapeutic applications of microbiome supplementation. We suggest a variety of opportunities within Doctor of Pharmacy curricula as leverage points for including relevant aspects of the microbiome in the training of future pharmacists.

Background: The American Diabetes Association recommends that people with diabetes should participate in diabetes self-management education, however data shows that many patients do not attend educational classes. Objectives: To examine the views of patients with diabetes who utilize services at an independent pharmacy in Richmond, Virginia regarding their (1) interest in attending diabetes self-management education and support (DSMES) services, (2) perceptions of a pharmacist leading DSMES services, (3) willingness to pay for DSMES services, and (4) relationship between self-reported diabetes management status with their willingness to attend DSMES services. Methods: A qualitative survey was administered over five months to patients with diabetes at an independent community pharmacy in Richmond, VA. The survey included 35 questions in a mixed format of Likert scale, dichotomous, and fill in the blank. Survey data was analyzed using univariate, bivariate, and/or multivariate analysis using SAS 9.4. Results: Twenty seven surveys were completed, 15% response rate. Patients were female (56.7%) with an average age of 69 ± 10.8 years. Caucasian race accounted for 90% of patients, 6.7% reported Black or African American, the remainder responded "other". Patients agreed they were interested in attending individual virtual and in person DSMES sessions with a rate of 52% and 87%, respectively. When asked about the full service of 9 group sessions, 33% responded disagree and 30% reported agree. 52% of patients reported belief that pharmacists had the knowledge to lead sessions. When asked about willingness to pay, patients mostly selected the lowest cost option ($25 - $35). Conclusion: Patients with diabetes are willing to participate in DSMES services and believe pharmacists can lead the sessions. It is important to continue to advocate for DSMES services so patients can understand the full benefits of the program and receive the best possible care.

Direct oral anticoagulants (DOACs) have become popular choices for both the treatment and prevention of thromboembolic events. However, these agents pose additional risks to patients due to complex dosing, insufficient monitoring, and inconsistent patient compliance. This study evaluates the appropriateness of DOAC prescribing for patients who received an order for apixaban or rivaroxaban over a 6-month period. The primary outcome is percentage of inappropriately prescribed DOAC regimens. Secondary outcomes include an effectiveness endpoint of stroke or embolism and a safety endpoint of major bleeding documented during or within 60 days of the initial visit as well as number of pharmacist clinical interventions. DOAC orders were appropriate 73% of the time. Of the 27% of inappropriate orders, approximately half were apixaban and half were rivaroxaban. The most common reason for an inappropriate order for apixaban was due to atrial fibrillation dosing, and the most common reason for an inappropriate rivaroxaban order was due to dose-indication mismatch. There were 30 pharmacist clinical interventions on DOAC orders that were documented during the 6-month period, and the most common reason for a pharmacist intervention was duplication with another anticoagulant.

⮚ Professional identity is an important component of practice change.⮚ Research on professional identity in pharmacy is limited, and this needs to change if we are to truly move practice in the 21st century.⮚ A unified professional identity is crucial for society to see pharmacists as healthcare providers.