Innovations in Pharmacy最新文献

Introduction: Community pharmacies across the country have been adapting the ways their patients receive medications and prescription information during the COVID-19 pandemic. In order to reduce the risk of COVID-19 infection, the CDC encouraged patients to use pharmacy drive-throughs, curbside pickup, or home delivery services to obtain medications. This research study is one of the first studies to analyze how patients utilize and access Medication Management Services (MMS) in the community pharmacy setting during the COVID-19 pandemic. Objective: To evaluate changes to patients' utilization of Medication Management Services in the community pharmacy setting during the COVID-19 pandemic. Methods: Eligible patients included persons 18 years old and older, and currently taking at least (1) chronic prescription medication in the last three months. Pharmacists were excluded from the study. Telephonic or video interviews were conducted with patients from community pharmacy settings. Descriptive statistics were used to summarize patient characteristics and responses to select interview questions. A qualitative thematic analysis was conducted with data collected from open-ended interview questions. Results: Thirty-five patients participated in interviews. Patients reported increased use of telehealth and technology, increases in quantity or days supply of medications, initiation of mail delivery services, and curbside pick-up. Five (14.3%) patients used telehealth or increased their technology usage due to the pandemic. Seven (20%) patients reported they were more proactive in refilling their medications. Eleven (31.4%) patients indicated they were currently using a prescription delivery service and were likely to continue the service. On the contrary, five (14.3%) patients experienced decreased healthcare professional interactions, while 3 (8.6%) patients encountered slowed pharmacy processing and 2 (5.7%) faced technology barriers. However, 58% of patients reported no changes to the way they utilized MMS during COVID-19. Conclusion: Like many other healthcare providers, the COVID-19 pandemic caused a shift in how community pharmacies care for the patients they serve. This study identified various changes in how the pandemic impacted the way patients accessed and utilized community pharmacy services. These findings can serve to inform community pharmacies on how to best serve their patients during this and future pandemic.

Background: The CDC has issued interim guidance on administering influenza vaccines amidst the COVID-19 pandemic including providing specific appointment times. A large chain pharmacy has adopted this guidance and is encouraging patients to make appointments rather than a walk-in visit for the influenza vaccination to help avoid large crowds. Objective(s): This study aims to determine the impact of the COVID-19 pandemic on influenza vaccination rates (2019 versus 2020 season) and patient appointments versus walk-in visits. The second goal of this study is to evaluate patient satisfaction with the influenza vaccination process. Methods: Influenza vaccine data was collected from the chain pharmacy online database from the first week in September to the last week in December during 2019 to 2020 and from 2020 to 2021. The second part of this study included a voluntary survey to be completed by the patient regarding satisfaction and thoughts about the 2020-2021 influenza vaccination process. Results: The six stores identified showed an overall 7.6% increase in influenza vaccination rates from the 2019-2020 season to the 2020-2021 season (p-value= 0.73). There were a total of 15 survey respondents amongst the stores of which 100% of the patients were at least slightly comfortable with the vaccination process and very satisfied overall. Conclusion: The six pharmacy locations within a large chain revealed that COVID-19 had a positive impact on influenza vaccination rates. Although these results were not statistically significant, this study sets the framework for future vaccination studies.

Background: This paper describes a series of integrative courses intentionally designed to prepare students for Advanced Pharmacy Practice Experiences (APPEs) in a block system curriculum. Innovation: Three integration blocks are interspersed throughout the didactic curriculum to serve as checkpoints to ensure competency as students progress in the curriculum, rather than waiting until the end to determine competency. Complex patient case discussions and a series of high-stakes assessments are used to reinforce and evaluate cumulative retention of knowledge, skills, and attitudes. Findings: Class of 2022 exam results showed that in the cohort of students who failed the high-stakes comprehensive knowledge assessment (CKA) and pharmacy calculations exams during the first integration block (IB), failure rates decreased in subsequent IBs, indicating early detection of knowledge deficiencies and either exam performance improvement in each IB or failure to progress to the next IB. A survey of the same cohort indicated that the final integration block prior to advanced pharmacy practice experiences (APPEs) helped improve confidence in applying key knowledge and skills into practice. Conclusion: The series of integration blocks designed and implemented at WesternU provides opportunities to reinforce knowledge and skills while requiring students to demonstrate maintenance of core competency as they progress through the curriculum.

Background: The role of clinical pharmacists in family medicine residency programs (FMRPs) has become increasingly commonplace in the last several years, with mixed responsibilities, however largely involving teaching and patient care. The COVID-19 pandemic affected all facets of healthcare, pharmacists included. Assessment of the impact of COVID-19 on the role of the pharmacist in FMRPs is needed. Methods: A survey tool was developed and distributed through two national listservs clinical pharmacists in FMRPs commonly subscribe to. Results: A total of 32 responses were received. The majority of pharmacist participants indicated no change in their overall time allocation to the FMRP. Patient care was affected by transitions to virtual or remote care for those in the outpatient setting, which in some cases were sustained changes. Teaching responsibilities increased for the majority, largely impacted by the need to transition to virtual platforms. Barriers to relationship development resulted from both of these transitions. Innovations and positive results were reported by participants in patient care, teaching, and research. Conclusions: These results highlight the many silver linings of the COVID-19 pandemic. The new challenges, such as the increased teaching need, use of virtual platforms and using creative ways to find connections and build relationships in an ongoing, semi-virtual world, are opportunities for continued innovation for clinical pharmacists as they fit within our strengths and scope within FMRPs.

Drug-induced Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) are rare but life-threatening immune-mediated drug reactions known as Severe Cutaneous Adverse Reactions (SCARs). These severe drug reactions have been associated with many commonly prescribed medications, including sulfonamides, allopurinol, carbamazepine, and several antiepileptic drugs including lamotrigine.¹ Although the risk of these adverse events is recognized by many medical providers, the risk may be overlooked when prescribing lamotrigine for mood disorders. Review of the literature and the experience of these cases suggest that the risk of lamotrigine-associated SCARs is increased when starting lamotrigine at high initial doses. Here we present and discuss two cases of SCARs attributed to high-dose lamotrigine prescribed for mood disorders. A third patient also presented with a SCAR related to high-dose lamotrigine prescribed for a mood disorder during this time but was lost to follow-up and was not reachable. All three patients presented to our hospital system from 2019-2020. Due to this clinical experience, we recommend that pharmacists and prescribers alike be alerted of the risk of severe cutaneous drug reactions when lamotrigine is prescribed, particularly at initial doses greater than 25 mg.

Background: Learning reflective practices and understanding the complexity of health literacy and health disparities need to start early in health professions training. The primary objective of this inquiry was to evaluate the feasibility and effectiveness of using reflection categorization for assessing learner progression on reflective practice development. The secondary objective was to evaluate student reflection as a strategy for introducing and advancing pre-professional learners' understanding of health literacy and health disparities. Case Description: Within an online undergraduate health literacy course, two written reflection assignments were coded using Kember's four categories: habitual action, understanding, reflection, and critical reflection. Students received feedback based on this reflection categorization to promote development of reflective practices. However, reflections were not graded using the reflection categorization. Case Themes: Most (78%) students were at the level of understanding for the first reflection. For the second reflection, 29% of students were at the reflection level, demonstrating health literacy application and describing the important contributing role of personal context to health outcomes. Sixteen (33%) students progressed in their level of reflection. Within the reflections, students discussed knowledge gained and plans for future application. Conclusion: Using a structured reflection activity allowed pre-health students to begin developing reflection practices. Through reflection, students were able to describe and apply health literacy and health disparities knowledge.

Background: Previous evaluation in the literature of ambulatory care pharmacist management on glycosylated hemoglobin (HgbA1c) has been positive, but often limited to 6 to 12 months of follow up. Objective: The objective of this study is to evaluate the impact of an ambulatory care pharmacist on HgbA1c among patients with diabetes in a primary care clinic over two years. Methods: Retrospective chart review was conducted on patients with type 2 diabetes managed by the ambulatory care pharmacist. Patients with at least one HgbA1c value ≥7% in the two-year pre-intervention period were included. The primary outcome was the change in mean HgbA1c from baseline to two years post-intervention. The secondary outcome was the change in mean of all HgbA1c values over two years pre-intervention compared to two years post-intervention. Results: Data for 116 patients was analyzed two years prior to and two years after ambulatory care pharmacist service initiation. The mean HgbA1c at baseline pre-intervention was 8.8% compared to a mean HgbA1c of 7.8% two years post-intervention. A total of 12.9% of patients (n=15) had a baseline HgbA1c of less than 7% pre-intervention, compared to 42.2% of patients (n=49) two years post-intervention (p<0.001). The overall mean HgbA1c was 8.8% in the two-year pre-intervention period and 8.2% in the two-year post-intervention period (p<0.001). Among patients with an overall mean HgbA1c ≥8% in the pre-intervention period, the mean HgbA1c was 9.8% pre-intervention and 8.7% post-intervention. Conclusion: Ambulatory care pharmacist interventions demonstrated a significant impact on HgbA1c reduction over two years of follow up.

The recent approval of novel, oral antivirals for the treatment of COVID-19 has significantly altered the outpatient management of patients diagnosed with COVID-19. From a community pharmacy perspective, the two treatment options for mild to moderate COVID-19 are Paxlovid™ (nirmatrelvir/ritonavir) and Lagevrio™ (molnupiravir). While the availability of these antivirals has expanded community pharmacists' capability to provide care for patients diagnosed with COVID-19, many community pharmacists may struggle to effectively operationalize these agents in practice. This commentary provides a review of Paxlovid™ and Lagevrio™ clarifying the differences between each medication and their respective places in therapy, as well as suggestions and best-practices to operationalize the provision of these services in community pharmacies. These considerations are necessary to support and inform community pharmacy practice when providing oral COVID-19 antiviral therapy.

Background: The prolonged multi-drug treatment regimen for tuberculosis (TB) can lead to non-adherence and unsuccessful treatment outcomes. Educational and psychological health models can be used to design cognitive and behavioral interventions to improve adherence and treatment outcomes. Objective: To determine the effect of cognitive and behavioral interventions on TB treatment outcomes. Methods: The quasi-experimental study conducted in six TB treatment centers involved reinforced medication education and adherence counseling (MEAC), designed from a structured validated psychometric scale. Data were collected three different times during the intensive and continuation phases of treatment from 463 TB patients (232 in the control and 231 in the intervention group). Baseline demographic and clinical characteristics were compared between the groups. The generalized estimating equation model was used to analyze the repeated measures by determining if treatment success was associated with the cognitive and behavioral interventions and medication adherence. Results: The males made up 290(62.6 %) of the population. The mean age was 36.75±13.9. Most of the TB patients were newly diagnosed 413(89.2%) and HIV negative 315(68%), with secondary level of education 216(46.6%). There was no significant difference in baseline characteristics between the groups. The intervention group was four times more likely to have treatment success (p<0.01; CI=1.5-8.4), compared to the control group. Medication-adherent TB patients were 24 times more likely to have treatment success than patients who did not adhere (p<0.001; 10.8-52.1). TB patients' emotions, attitudes, and perceptions of their medicines were predictors of treatment success (p<0.05; 1.0 - 1.1). Conclusion: The cognitive and behavioral interventions administered to TB patients improved successful treatment outcomes.

The American Association of Colleges of Pharmacy (AACP) Leadership Development Special Interest Group (LD SIG) created a Virtual Social Networking Hour (VSNH). The VSNH explored pharmacy leadership educators' connections through discussing topics of interest that influence current teaching and scholarship practices. The VSNH also served to connect members in the LD SIG through informal networking, which was vital during a time when in-person connection was heavily restricted due to the COVID-19 global pandemic. The VSNH functioned as both a space for members to connect with LD SIG leadership and other members of the LD SIG and a tool to areas of leadership development the SIG should explore in future programming. Each of the four sessions included a skeleton structure that grew organically based on the conversations of the attendees. Common themes of scholarship, adaptation to a virtual landscape, leadership, and student-focused endeavors were interwoven across all four sessions. The VSNHs have since become an integral component in LD SIG Programming.