Innovations in Pharmacy最新文献

Chronic Care Management (CCM) is a billable service that pharmacists can provide either in person or via telephone in ambulatory clinics or community pharmacies. Pharmacists may use this service to expand current roles in patient care and add billable services to an ambulatory care practice. The number of clinics employing CCM is steadily increasing, and to date, there has been limited information published to aid pharmacists who are considering implementing these services. The purpose of this study is to compare enrollment success in a clinic-based, pharmacist-led CCM service using three recruitment strategies to enroll patients: in person, telephone, and provider referred recruitment. This pilot study examined the success of three recruitment strategies using 94 patients eligible for CCM services in a rural health clinic. The primary outcome was successful enrollment in the CCM program with differences in recruitment strategy enrollment success examined using a Chi-square test. Overall, 42 of 94 patients (45%) were successfully enrolled in the CCM program with no statistical difference appreciated between telephone, in person, and provider referred recruitment. Nearly 33% (14/42) of patients enrolled in person, 40% (17/42) enrolled via telephone, and 26% (11/42) enrolled when referred from a provider. Ten patients (11%) declined enrollment outright. The remaining 42 patients were hesitant to enroll and requested follow up. In conclusion, there was no statistical difference in CCM enrollment success with in person, telephone, or provider referred recruitment, although more patients were enrolled via telephone than with the other two strategies. Pharmacists implementing new CCM programs may tailor their recruitment and enrollment strategy to suit their specific needs.

This commentary proposes that Rasch Measurement Theory (RMT) is an innovative method for assessments of patient-centric therapy response in hemophilia A and B, as they are in other disease states or target patient populations. RMT is a necessary and sufficient approach to moving from ordinal observations to interval measurement, which has arithmetic properties. This applies across the board in hemophilia and other disease states for clinical value claims, patient centric or subjective value claims as well as those for anticipated drug utilization and other medical care resources. The purpose of this commentary is to point out limitations regarding current methods for making claims regarding hemophilia response and to propose a new start in hemophilia studies to identify core claims that meet required measurement standards. This applies to both the development of new patient reported outcome instruments as well as the evaluation of existing instruments, with a focus on polytomous instruments and their sub-domains, to evaluate their possible application as measures that approximate RMT requirements.

Background: Pharmacogenomics (PGx) can provide more precision in determining causation of adverse drug reactions (ADRs) from drug-drug-gene interaction clinical application. Case Summary: Patient was an intermediate CYP2C19 metabolizer on stable therapy taking a low but therapeutic dose of sertraline for depression and anxiety over a period of 20 years. The patient then became hyponatremic and cognitively impaired after addition of cannabidiol (CBD) to this sertraline regimen. The proposed mechanism was drug-drug-gene interaction of CBD further inhibiting the CYP2C19 metabolism of sertraline and increasing drug exposure to produce moderate to severe hyponatremia and subsequent cognitive dysfunction. Practice Implications: Pharmacogenomics (PGx) testing may assist in etiology of patient symptoms from adverse drug reactions (ADRs) or drug-drug interactions by combining these with detection and application of drug-gene interactions. This case shows inhibition of CYP2C19 by CBD to further increase sertraline exposure, producing hyponatremia and subsequent cognitive dysfunction through CYP2C19 phenoconversion by CBD.

Background: Cost and lack of knowledge are key barriers to improving shingles vaccination rates in community pharmacies. A health literacy (HL) tailored infograph intervention addressing these barriers can enhance consumer interest in shingles vaccinations. Objectives: The objectives were to: 1) design a health literacy tailored shingles infograph addressing cost and knowledge about vaccination barriers, 2) determine consumer perceptions of infograph usefulness, and 3) determine factors associated with shingles vaccination plans. Methods: An infograph addressing the study objectives, and a 22-item self-administered questionnaire assessing shingles vaccine awareness, HL, infograph usefulness, and vaccination plans were designed. The infograph was pilot tested with pharmacists and two community-based focus groups. Inclusion criteria consisted of age-eligible consumers at one chain and three independent community pharmacies. Consenting participants first reviewed the infograph and then completed the survey. Descriptive statistics and multivariable logistic regression analyses were performed. Results: Of the 422 eligible consumers approached, 112 participated in the study, with 55.4% from the chain pharmacies. Participants were female (56%), white (94%), between 50-70 years old (77%), had adequate HL (96%) and aware of the shingles vaccine (87%). While only 8% of the respondents considered vaccinating on the survey date, 46% considered it in the future, and 29% planned to in the next six months. The infograph was useful (90%) in recognizing vaccination need, was readable (95.5%), and understandable (96%). Consumers who found the infograph useful were significantly more likely to have vaccination plans (OR= 4.06, CI: 1.37 - 11.9, p=0.016). Conclusion: A shingles vaccine infograph focused on key barriers to vaccination was well-received and useful in promoting consumers' vaccination plans.

The coronavirus disease 2019 (COVID-19) has altered the healthcare landscape for pharmacy practice and continues its global onslaught. As the COVID-19 vaccines began to reach the general population, many were left wondering where and when they would get the vaccine. With 90% of the American population living within 5 miles of a community pharmacy, vaccine distribution to these locations is vital for a successful vaccine campaign. The Biden Administration launched the Federal Retail Pharmacy Program (FRPP) in February 2021, a public-private partnership with 21 national pharmacy partners representing over 40,000 pharmacy locations to help expand the vaccine rollout. Community pharmacists are uniquely positioned to fulfill this mission by being a point of contact for the COVID-19 vaccination efforts. The FRPP has experienced some limitations, including the variable vaccine allocation, limited support from the healthcare system, and the lack of overwhelming public confidence in the vaccines. Improving the FRPP would require strong partnership with other healthcare professionals and the adoption of flexible vaccine dissemination. These can stem future pandemics.

Description of the problem: The establishment of hospital pharmacy internships helps promote the growth of student pharmacists alongside the standard pharmacy curriculum. These programs are vital to helping students expand their clinical knowledge, while also benefiting the host institution. Our objective was to characterize the value of a longitudinal internship program to both the institution and its interns. Description of the innovation: The Atrium Health Wake Forest Baptist (AHWFB) Pharmacy Intern Program is a unique program designed with a scaffolded concept that directly complements traditional pharmacy school curriculum and provides interns opportunities to complement tasks of health-system pharmacists. Starting with operational responsibilities in the central distribution pharmacy during the first year of the curriculum, the interns transition to more patient-facing roles during the second and third years. Throughout the course of the program, interns are also given opportunities to participate in research and professional development activities. An IRB-approved, retrospective, observational study was conducted to evaluate the benefits of the program to the institution and interns. Critical analysis: Intern interventions were quantitatively evaluated to determine institutional benefit. From October 2017 to June 2020, 16 interns completed a total of 7,191 interventions, which equates to approximately $1,295,825 of cost avoidance for the institution. A quality assurance survey was also conducted to evaluate the program's benefit to the interns. Fourteen of the 16 eligible interns participated in the survey. Of the 14 participating interns, 85.7% (n=12) strongly agreed with overall satisfaction of the program. Additionally, 71% (n=10) strongly agreed with feeling more professionally prepared than their classmates. Next steps: Implementing a scaffolded internship program has positively benefited AHWFB and the participating interns. The program's design allows for clinical and professional development alongside the pharmacy school curriculum.

Over the years, the African continent has been severely plagued by disease outbreaks, most of which have resulted in devastating pandemics. Despite having the greatest burden and impact of these disease outbreaks, regional efforts to develop and manufacture vaccines in the continent have been inadequate, with a potential impact on pandemic preparedness and readiness efforts in the continent. Given that disease outbreaks are still likely to occur in the future, we discuss the urgent need to intensify vaccine development and manufacturing in Africa based on the lessons learnt from emerging pandemics.

Individuals living in primary care health professional shortage areas (HPSAs) experience health inequities. Community pharmacists are healthcare professionals with an opportunity to provide care to underserved populations. The objective of this study was to compare non-dispensing services provided by Ohio community pharmacists in HPSAs and non-HPSAs.

Methods: An electronic, IRB-approved 19-item survey was sent to all Ohio community pharmacists practicing in full-county HPSAs and a random sample practicing in other counties (n=324). Questions assessed current provision of non-dispensing services as well as interest and barriers regarding such services.

Results: Seventy-four usable responses were received (23% response rate). Respondents in non-HPSAs were more likely to recognize their county's HPSA status than those in an HPSA (p=0.008). Pharmacies in non-HPSAs were significantly more likely to offer 11 or more non-dispensing services than those in HPSAs (p=0.002). Nearly 60% of respondents in non-HPSAs reported starting a new non-dispensing service during the COVID-19 pandemic compared to 27% of respondents in full HPSA counties (p=0.009). Most commonly reported barriers to providing non-dispensing services in both county types included lack of reimbursement (83%), workflow (82%), and space (70%). Respondents expressed interest in learning more information about public health and collaborative practice agreements.

Conclusion: While the need for non-dispensing services is great in HPSAs, community pharmacies in full-county HPSAs in Ohio were less likely to provide these services or begin novel services. Barriers must be addressed so that community pharmacists can provide more non-dispensing services in HPSAs to increase access to care and promote health equity.

Objective: To develop a valid and reliable scale to measure the public's propensity to self-medicate with OTC medicines. Method: Propensity construct items were obtained from the literature and also created as new entities. Three experts reviewed the item pool for face validity. Internal consistency was assessed using Cronbach's alpha. Test-retest reliability was estimated using Pearson correlation coefficients (r), Intraclass Correlation Coefficients (ICC) and paired sample t-tests. Further test-retest reliability assessed the degree of change in responses in a subset of subjects from time 1 to time 2 (one month apart) for each item on the scale. Results: From the pool, 16 items were assessed for applicability to the propensity construct. Factor Analysis identified four components and were labelled as purchase involvement, self-efficacy, awareness of care needed during self-medication, and the therapeutic usefulness of OTC medicines. The internal consistency of the 16-item scale was sufficient; overall alpha was 0.9 and each construct had an alpha of 0.7 to 0.8. Test-retest reliability coefficients (r) for the four components were reassuring, ranging from 0.4 to 0.5, while the ICC values ranged from 0.5 to 0.7. A paired sample t-test showed no statistically significant difference in the rating at the two iterations for each of the constructs, thereby suggesting good reliability of the data. Over 50% of respondents did not change their original response to the 7-point scales (strongly disagree (1) to strongly agree (7)) for 9 out of 16 items. Factor loading from Principal Component Analysis led to the reduction of the 16-items scale to a 15-item Propensity to Self-Medicate with OTC Medicines Scale. Conclusion: The developed tool for measuring the propensity to self-medicate with OTC medicines showed acceptable performance of internal consistency and reliability. The scale may have research potential in assessing the self-medication propensity of different cohorts of society.