Pub Date : 2017-06-25DOI: 10.1177/8755122517716472
Maryann R. Cooper, Bassem Almalki, Kristine C. Willett
Objective: To review nivolumab for the treatment of classical Hodgkin lymphoma (cHL). Data Sources: Literature searches were conducted in Medline (1946 to May week 3 2017), EMBASE (1974 to 2017 week 22), and Google Scholar using the terms Hodgkin lymphoma AND nivolumab. Study Selection and Data Extraction: Two clinical trials (phase I and phase II) were identified. Data Synthesis: Nivolumab inhibits programmed death receptor-1 allowing for increased T-cell mediated immune surveillance of tumors. Nivolumab was evaluated in cHL patients after failure of autologous stem cell transplantation and brentuximab vedotin consolidation. Patients received nivolumab 3 mg/kg every 2 weeks. In the phase I trial, the objective response rate was 87% (95% confidence interval [CI] = 66-97) and the rate of progression-free survival (PFS) at 24 weeks was 86% (95% CI = 62-95). The most common adverse events (AE) included rash (22%) and decreased platelet count (17%). Following extended follow-up at a median of 86 weeks, 50% of the initial responders maintained a durable response. In the phase II clinical trial, 53 patients (66.3%, 95% CI = 54.8-76.4) achieved an objective response and PFS at 6 months was 76.9% (95% CI = 64.9-85.3). The common AE were fatigue (25%), infusion-related reactions (20%), and rash (16%). After further follow-up at a median of 15.4 months, 12-month overall survival was 94.9% (median overall survival not reached). Conclusions: Nivolumab is an effective option in treating patients with relapsed/refractory cHL with an acceptable safety profile. Further studies are needed to investigate the role of nivolumab for the treatment of cHL.
目的:综述纳武单抗治疗经典霍奇金淋巴瘤(cHL)的疗效。数据来源:在Medline(1946年至2017年5月第3周)、EMBASE(1974年至2017年第22周)和谷歌Scholar中使用霍奇金淋巴瘤和尼武单抗进行文献检索。研究选择和数据提取:确定了两个临床试验(I期和II期)。数据综合:Nivolumab抑制程序性死亡受体-1，允许增加t细胞介导的肿瘤免疫监视。在自体干细胞移植和brentuximab vedotin巩固失败后的cHL患者中评估Nivolumab。患者每2周接受纳武单抗3mg /kg治疗。在I期试验中，客观缓解率为87%(95%置信区间[CI] = 66-97)， 24周无进展生存率(PFS)为86% (95% CI = 62-95)。最常见的不良事件(AE)包括皮疹(22%)和血小板计数下降(17%)。在中位数为86周的延长随访后，50%的初始应答者维持了持久的应答。在II期临床试验中，53名患者(66.3%，95% CI = 54.8-76.4)获得了客观缓解，6个月的PFS为76.9% (95% CI = 64.9-85.3)。常见的AE是疲劳(25%)、输液相关反应(20%)和皮疹(16%)。进一步随访中位时间为15.4个月，12个月总生存率为94.9%(中位总生存率未达到)。结论:Nivolumab是治疗复发/难治性cHL患者的有效选择，具有可接受的安全性。需要进一步的研究来调查纳武单抗在治疗cHL中的作用。
{"title":"Nivolumab for the Treatment of Classical Hodgkin Lymphoma","authors":"Maryann R. Cooper, Bassem Almalki, Kristine C. Willett","doi":"10.1177/8755122517716472","DOIUrl":"https://doi.org/10.1177/8755122517716472","url":null,"abstract":"Objective: To review nivolumab for the treatment of classical Hodgkin lymphoma (cHL). Data Sources: Literature searches were conducted in Medline (1946 to May week 3 2017), EMBASE (1974 to 2017 week 22), and Google Scholar using the terms Hodgkin lymphoma AND nivolumab. Study Selection and Data Extraction: Two clinical trials (phase I and phase II) were identified. Data Synthesis: Nivolumab inhibits programmed death receptor-1 allowing for increased T-cell mediated immune surveillance of tumors. Nivolumab was evaluated in cHL patients after failure of autologous stem cell transplantation and brentuximab vedotin consolidation. Patients received nivolumab 3 mg/kg every 2 weeks. In the phase I trial, the objective response rate was 87% (95% confidence interval [CI] = 66-97) and the rate of progression-free survival (PFS) at 24 weeks was 86% (95% CI = 62-95). The most common adverse events (AE) included rash (22%) and decreased platelet count (17%). Following extended follow-up at a median of 86 weeks, 50% of the initial responders maintained a durable response. In the phase II clinical trial, 53 patients (66.3%, 95% CI = 54.8-76.4) achieved an objective response and PFS at 6 months was 76.9% (95% CI = 64.9-85.3). The common AE were fatigue (25%), infusion-related reactions (20%), and rash (16%). After further follow-up at a median of 15.4 months, 12-month overall survival was 94.9% (median overall survival not reached). Conclusions: Nivolumab is an effective option in treating patients with relapsed/refractory cHL with an acceptable safety profile. Further studies are needed to investigate the role of nivolumab for the treatment of cHL.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"47 1","pages":"237 - 244"},"PeriodicalIF":1.0,"publicationDate":"2017-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78708252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-04DOI: 10.1177/8755122517702171
Surbhi Shah, John A. Galdo, Elizabeth D. Cox, M. Moreno, H. Young
Background: Adherence to long-term pharmacotherapy is problematic in the United States. Bubble packaging of medications has been touted to improve patients’ use of medications. Scant research has assessed bubble packaging’s impact on adherence to multiple medications. Objective: To compare medication adherence between patients receiving medications to address cardiovascular disease risk factors in bubble packages to those receiving medications in pill bottles. Methods: This retrospective cohort study utilized prescription dispensing records from an independent pharmacy. Patients receiving statins, β-blockers, angiotensin-converting enzyme inhibitors, or oral hypoglycemic agents were identified and grouped into those who received medications in bubble packages and those received medications in pill bottles. Adherence was assessed with medication possession ratios. Patients were classified as adherent if their medication possession ratio was 80% or more. Results: Receiving medications in bubble packaging was significantly associated with greater adherence compared to pill bottles (P < .001). In adjusted models, greater numbers of medications filled (P = .024) and increasing patient age (P = .018) were significantly associated with low adherence, while bubble packaging was not (P = .13). Stratified analyses revealed that bubble packaging was significantly associated with greater adherence when 4 or fewer medications are filled (P = .012) and for patients between 18 and 44 years of age (P = .023). Conclusion: Bubble packages can improve medication adherence. However, they may not resolve complex issues contributing to the problem of nonadherence, especially for older patients and those prescribed multiple medications.
{"title":"Impact of Bubble Packaging on Adherence to Long-Term Oral Medications Used to Prevent Cardiovascular Disease","authors":"Surbhi Shah, John A. Galdo, Elizabeth D. Cox, M. Moreno, H. Young","doi":"10.1177/8755122517702171","DOIUrl":"https://doi.org/10.1177/8755122517702171","url":null,"abstract":"Background: Adherence to long-term pharmacotherapy is problematic in the United States. Bubble packaging of medications has been touted to improve patients’ use of medications. Scant research has assessed bubble packaging’s impact on adherence to multiple medications. Objective: To compare medication adherence between patients receiving medications to address cardiovascular disease risk factors in bubble packages to those receiving medications in pill bottles. Methods: This retrospective cohort study utilized prescription dispensing records from an independent pharmacy. Patients receiving statins, β-blockers, angiotensin-converting enzyme inhibitors, or oral hypoglycemic agents were identified and grouped into those who received medications in bubble packages and those received medications in pill bottles. Adherence was assessed with medication possession ratios. Patients were classified as adherent if their medication possession ratio was 80% or more. Results: Receiving medications in bubble packaging was significantly associated with greater adherence compared to pill bottles (P < .001). In adjusted models, greater numbers of medications filled (P = .024) and increasing patient age (P = .018) were significantly associated with low adherence, while bubble packaging was not (P = .13). Stratified analyses revealed that bubble packaging was significantly associated with greater adherence when 4 or fewer medications are filled (P = .012) and for patients between 18 and 44 years of age (P = .023). Conclusion: Bubble packages can improve medication adherence. However, they may not resolve complex issues contributing to the problem of nonadherence, especially for older patients and those prescribed multiple medications.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"61 1","pages":"114 - 120"},"PeriodicalIF":1.0,"publicationDate":"2017-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75292559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1177/8755122516683519
Timothy P. Frost, A. Adams
Objective: The benefit of a tech-check-tech (TCT) practice model in institutional settings has been well documented. To date, few studies have explored TCT beyond institutional settings. This article summarizes the existing evidence in community pharmacy–based TCT research with respect to dispensing accuracy and pharmacist time devoted to direct patient care. Data Sources: A literature review was conducted using MEDLINE (January 1990 to August 2016), Google Scholar (January 1990 to August 2016), and EMBASE (January 1990 to August 2016) using the terms “tech* and check,” “tech-check-tech,” “checking technician,” and “accuracy checking tech*”. Bibliographies were reviewed to identify additional relevant literature. Study Selection and Data Extraction: Studies were included if they analyzed TCT and were conducted in a community pharmacy practice site, inclusive of chain, independent, mass merchant, supermarket, and mail order pharmacies. Studies were excluded if the TCT practice model was conducted in an institutional or long-term care setting. Survey data on theoretical models of TCT in community pharmacy practice settings were also excluded. Data Synthesis: Over the past 14 years, 4 studies were identified indicating TCT has been performed safely and effectively in community settings. The studies demonstrate that trained community technicians perform as accurately as pharmacists and that TCT increased the amount of pharmacist time devoted to clinical activities. In the 2 studies that reported accuracy rates, pharmacy technicians performed at least as accurately as pharmacists (99.445 vs 99.73%, P = .484; 99.95 vs 99.74, P < .05). Furthermore, 3 of the studies reported gains in pharmacist time, with increases between 9.1% and 19.18% of pharmacist time for consultative services. Conclusions: The present studies demonstrate that TCT can be safe and effective in community pharmacy practice settings, with results similar to those found in institutional settings. It is anticipated more states will explore TCT in community settings in the years ahead as a strategy to improve patient care.
目的:一个技术检查技术(TCT)实践模式在机构设置的好处已经得到了很好的记录。迄今为止，很少有研究在机构环境之外探索TCT。本文总结了基于社区药房的TCT研究中关于调剂准确性和药剂师用于直接患者护理的时间的现有证据。数据来源:使用MEDLINE(1990年1月至2016年8月)、Google Scholar(1990年1月至2016年8月)和EMBASE(1990年1月至2016年8月)进行文献综述，使用术语“技术*和检查”、“技术-检查-技术”、“检查技术员”和“准确性检查技术*”。查阅参考书目以确定其他相关文献。研究选择和数据提取:如果研究分析了TCT，并在社区药房实践现场进行，包括连锁，独立，大型商家，超市和邮购药房，则纳入研究。如果TCT实践模型在机构或长期护理环境中进行，则排除研究。社区药房实践环境中TCT理论模型的调查数据也被排除在外。数据综合:在过去14年中，确定了4项研究，表明在社区环境中安全有效地进行了TCT。这些研究表明，训练有素的社区技术人员的表现与药剂师一样准确，TCT增加了药剂师用于临床活动的时间。在报告准确率的两项研究中，药学技术人员的工作至少与药剂师一样准确(99.445 vs 99.73%， P = .484;99.95 vs 99.74, P < 0.05)。此外，其中3项研究报告了药剂师时间的增加，药剂师咨询服务的时间增加了9.1%到19.18%。结论:目前的研究表明，TCT在社区药房实践环境中是安全有效的，其结果与在机构环境中发现的结果相似。预计未来几年，更多的州将在社区环境中探索TCT，作为改善患者护理的一项战略。
{"title":"Tech-Check-Tech in Community Pharmacy Practice Settings","authors":"Timothy P. Frost, A. Adams","doi":"10.1177/8755122516683519","DOIUrl":"https://doi.org/10.1177/8755122516683519","url":null,"abstract":"Objective: The benefit of a tech-check-tech (TCT) practice model in institutional settings has been well documented. To date, few studies have explored TCT beyond institutional settings. This article summarizes the existing evidence in community pharmacy–based TCT research with respect to dispensing accuracy and pharmacist time devoted to direct patient care. Data Sources: A literature review was conducted using MEDLINE (January 1990 to August 2016), Google Scholar (January 1990 to August 2016), and EMBASE (January 1990 to August 2016) using the terms “tech* and check,” “tech-check-tech,” “checking technician,” and “accuracy checking tech*”. Bibliographies were reviewed to identify additional relevant literature. Study Selection and Data Extraction: Studies were included if they analyzed TCT and were conducted in a community pharmacy practice site, inclusive of chain, independent, mass merchant, supermarket, and mail order pharmacies. Studies were excluded if the TCT practice model was conducted in an institutional or long-term care setting. Survey data on theoretical models of TCT in community pharmacy practice settings were also excluded. Data Synthesis: Over the past 14 years, 4 studies were identified indicating TCT has been performed safely and effectively in community settings. The studies demonstrate that trained community technicians perform as accurately as pharmacists and that TCT increased the amount of pharmacist time devoted to clinical activities. In the 2 studies that reported accuracy rates, pharmacy technicians performed at least as accurately as pharmacists (99.445 vs 99.73%, P = .484; 99.95 vs 99.74, P < .05). Furthermore, 3 of the studies reported gains in pharmacist time, with increases between 9.1% and 19.18% of pharmacist time for consultative services. Conclusions: The present studies demonstrate that TCT can be safe and effective in community pharmacy practice settings, with results similar to those found in institutional settings. It is anticipated more states will explore TCT in community settings in the years ahead as a strategy to improve patient care.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"1 1","pages":"47 - 52"},"PeriodicalIF":1.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89984027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1177/8755122517690749
E. Rohrbach, Kelli N Webb, T. Costello
Background: Glycemic control using intravenous insulin infusions is an important component of hyperglycemic crisis treatment. Literature supports the use of standardized titration protocols; however, comparisons of specific methods are limited. Objective: Compare the safety and efficacy of 2 insulin infusion titration methods used in hyperglycemic crisis. Methods: A retrospective chart review was conducted including adults admitted to an inpatient facility from August 1, 2013, to August 1, 2015, who were treated for at least 4 hours with an intravenous insulin infusion. Primary efficacy outcomes of time to anion gap closure and time to goal blood glucose was studied in patients meeting criteria for diabetic ketoacidosis (n = 79), while the primary safety outcome of rates of hypoglycemia were compared among all study patients (n = 200). Results: The fixed-rate titration method had statistically shorter time to blood glucose <200 mg/dL compared to the multiplier titration group (6.1 [4.0] vs 8.8 [4.4], respectively; P = .018; mean time in hours [standard deviation]); however, no statistically significant difference was seen in the other primary efficacy and safety outcomes. Statistical improvements were found in secondary outcomes of intensive/progressive care units, length of stay, and infusion duration in the fixed-rate titration method, while less deviation from titration recommendations was found in the multiplier titration group. Conclusions: Significant differences seen in time to a goal blood glucose, deviation prevalence, and holds of the infusion for low blood glucose have identified areas for optimization, additional study, and staff education.
{"title":"Comparison of Two Intravenous Insulin Titration Methods in Hyperglycemic Crisis","authors":"E. Rohrbach, Kelli N Webb, T. Costello","doi":"10.1177/8755122517690749","DOIUrl":"https://doi.org/10.1177/8755122517690749","url":null,"abstract":"Background: Glycemic control using intravenous insulin infusions is an important component of hyperglycemic crisis treatment. Literature supports the use of standardized titration protocols; however, comparisons of specific methods are limited. Objective: Compare the safety and efficacy of 2 insulin infusion titration methods used in hyperglycemic crisis. Methods: A retrospective chart review was conducted including adults admitted to an inpatient facility from August 1, 2013, to August 1, 2015, who were treated for at least 4 hours with an intravenous insulin infusion. Primary efficacy outcomes of time to anion gap closure and time to goal blood glucose was studied in patients meeting criteria for diabetic ketoacidosis (n = 79), while the primary safety outcome of rates of hypoglycemia were compared among all study patients (n = 200). Results: The fixed-rate titration method had statistically shorter time to blood glucose <200 mg/dL compared to the multiplier titration group (6.1 [4.0] vs 8.8 [4.4], respectively; P = .018; mean time in hours [standard deviation]); however, no statistically significant difference was seen in the other primary efficacy and safety outcomes. Statistical improvements were found in secondary outcomes of intensive/progressive care units, length of stay, and infusion duration in the fixed-rate titration method, while less deviation from titration recommendations was found in the multiplier titration group. Conclusions: Significant differences seen in time to a goal blood glucose, deviation prevalence, and holds of the infusion for low blood glucose have identified areas for optimization, additional study, and staff education.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"34 1","pages":"72 - 77"},"PeriodicalIF":1.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75615726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-04-01DOI: 10.1177/8755122517691308
M. Goza, Benjamin D. Kulwicki, J. Akers, M. Klepser
Objective: To provide a review on the use, percent positive agreement (PPA), percent negative agreement (PNA), and utilization of Syphilis Health Check for syphilis screening in community pharmacies (in coordination with public health departments) in an effort to increase overall syphilis screening in high-risk populations. Data Sources: PubMed was searched for the following keywords: syphilis, sexually transmitted diseases, diagnosis, public health, point-of-care tests. The search included all dates up to December 2016. Study Selection: Data from studies including the use of the Syphilis Health Check Rapid Immunochromatographic Test were included. Data Synthesis: There are many existing tests to aid in the diagnosis of syphilis. The Syphilis Health Check was compared with these assays using PPA and PNA, where it demonstrated a high level of accuracy in the detection of syphilis antibodies. Conclusion: The Syphilis Health Check Rapid Immunochromatographic Test is a Clinical Laboratory Improvement Amendments–waived assay that has been shown to be easy to use and produces results in minutes. As one of the most accessible health care providers, pharmacists have an opportunity to join the fight against syphilis, and in collaboration with public health departments, screen a vast number of high-risk patients and deliver follow-up care as needed.
{"title":"Syphilis Screening","authors":"M. Goza, Benjamin D. Kulwicki, J. Akers, M. Klepser","doi":"10.1177/8755122517691308","DOIUrl":"https://doi.org/10.1177/8755122517691308","url":null,"abstract":"Objective: To provide a review on the use, percent positive agreement (PPA), percent negative agreement (PNA), and utilization of Syphilis Health Check for syphilis screening in community pharmacies (in coordination with public health departments) in an effort to increase overall syphilis screening in high-risk populations. Data Sources: PubMed was searched for the following keywords: syphilis, sexually transmitted diseases, diagnosis, public health, point-of-care tests. The search included all dates up to December 2016. Study Selection: Data from studies including the use of the Syphilis Health Check Rapid Immunochromatographic Test were included. Data Synthesis: There are many existing tests to aid in the diagnosis of syphilis. The Syphilis Health Check was compared with these assays using PPA and PNA, where it demonstrated a high level of accuracy in the detection of syphilis antibodies. Conclusion: The Syphilis Health Check Rapid Immunochromatographic Test is a Clinical Laboratory Improvement Amendments–waived assay that has been shown to be easy to use and produces results in minutes. As one of the most accessible health care providers, pharmacists have an opportunity to join the fight against syphilis, and in collaboration with public health departments, screen a vast number of high-risk patients and deliver follow-up care as needed.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"2 1","pages":"53 - 59"},"PeriodicalIF":1.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82026801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-27DOI: 10.1177/8755122517698975
Sarah M Westberg, Sarah K. Derr, E. Weinhandl, T. Adam, A. Brummel, J. Lahti, S. Reidt, Brian Sick, Kyle Skiermont, W. S. St. Peter
Background: Pharmacists influence health care outcomes through the identification and resolution of drug therapy problems (DTPs). Objective: The objectives of this study were to describe number, type, and severity of DTPs based on clinical significance and likelihood of harm in patients transitioning from hospital to home as assessed during a comprehensive medication management (CMM) visit with a pharmacist. Secondary objectives were to assess intrarater reliability in severity ratings and assess likelihood of harm for adverse drug reactions (ADR) by drug classes. Methods: Retrospective review of 408 patients having a face-to-face, telephonic, or virtual CMM visit within the Fairview Health System. Teams of 3 investigators reviewed each DTP from the electronic medical record for each of the 408 patients and assigned a severity score (0-10) for clinical significance and likelihood of harm. Main Results: The highest severity DTP classes were adherence and ADR. The lowest severity DTP class was unnecessary drug therapy. An average of 2.5 DTPs was found per patient at the index CMM visit following hospital discharge. The most common DTP classes were needs additional therapy and dose too low. There were statistically significant differences in DTP severity scoring between reviewer types, though differences were <5%. Drug classes with the highest severity ADR included diabetes, cardiovascular, and anticoagulant/antiplatelet agents. Conclusions: The DTP severity ratings indicated that reviewers found ADR and adherence DTPs were potentially the most severe. There were differences in DTP ratings between reviewer types, though clinical significance of these differences is unclear.
{"title":"Drug Therapy Problems Identified by Pharmacists Through Comprehensive Medication Management Following Hospital Discharge","authors":"Sarah M Westberg, Sarah K. Derr, E. Weinhandl, T. Adam, A. Brummel, J. Lahti, S. Reidt, Brian Sick, Kyle Skiermont, W. S. St. Peter","doi":"10.1177/8755122517698975","DOIUrl":"https://doi.org/10.1177/8755122517698975","url":null,"abstract":"Background: Pharmacists influence health care outcomes through the identification and resolution of drug therapy problems (DTPs). Objective: The objectives of this study were to describe number, type, and severity of DTPs based on clinical significance and likelihood of harm in patients transitioning from hospital to home as assessed during a comprehensive medication management (CMM) visit with a pharmacist. Secondary objectives were to assess intrarater reliability in severity ratings and assess likelihood of harm for adverse drug reactions (ADR) by drug classes. Methods: Retrospective review of 408 patients having a face-to-face, telephonic, or virtual CMM visit within the Fairview Health System. Teams of 3 investigators reviewed each DTP from the electronic medical record for each of the 408 patients and assigned a severity score (0-10) for clinical significance and likelihood of harm. Main Results: The highest severity DTP classes were adherence and ADR. The lowest severity DTP class was unnecessary drug therapy. An average of 2.5 DTPs was found per patient at the index CMM visit following hospital discharge. The most common DTP classes were needs additional therapy and dose too low. There were statistically significant differences in DTP severity scoring between reviewer types, though differences were <5%. Drug classes with the highest severity ADR included diabetes, cardiovascular, and anticoagulant/antiplatelet agents. Conclusions: The DTP severity ratings indicated that reviewers found ADR and adherence DTPs were potentially the most severe. There were differences in DTP ratings between reviewer types, though clinical significance of these differences is unclear.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"1079 1","pages":"107 - 96"},"PeriodicalIF":1.0,"publicationDate":"2017-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76698957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-23DOI: 10.1177/8755122517698976
K. Rieser, E. Rosenberg, Katherine Vogel Anderson
Background: Direct oral anticoagulants (DOACs) share many indications with warfarin but require less frequent follow-up and monitoring. There is limited data available on the prescribing of DOACs and appropriate laboratory monitoring in a real-world clinical setting. Objective: To determine if patients receiving care at 2 University of Florida (UF) Health Internal Medicine clinics are prescribed DOACs according to Food and Drug Administration (FDA)–approved labeling. Secondary objectives were to determine the percentage of patients receiving appropriate baseline laboratory tests prior to DOAC initiation and the frequency of laboratory monitoring. Methods: This retrospective chart review evaluated patients enrolled at 2 UF Health Internal Medicine practices within the UF Health system who were prescribed a DOAC between April 2014 and April 2015. Adherence to FDA-approved dosing recommendations and baseline laboratory tests were compared to previously published data. This study was approved by the UF Institutional Review Board. Results: A total of 194 patients met inclusion criteria. Ninety-six patients (49.5%) were on a DOAC prior to data collection; 98 patients (50.5%) started a DOAC during data collection. Of the 194 patients, 155 (79.9%) were prescribed DOACs per FDA-approved labeling (P = .0005); 79 (40.8%) obtained a complete blood count, serum creatinine, and liver function tests prior to DOAC initiation. Conclusions: Prescribing practices were significantly better than published data; however, 1 in 5 patients were not prescribed a DOAC according to FDA-approved labeling. Less than half of the patients started on a DOAC obtained the recommended labs prior to medication initiation.
{"title":"Evaluation of the Appropriateness of Direct Oral Anticoagulant Selection and Monitoring in the Outpatient Setting","authors":"K. Rieser, E. Rosenberg, Katherine Vogel Anderson","doi":"10.1177/8755122517698976","DOIUrl":"https://doi.org/10.1177/8755122517698976","url":null,"abstract":"Background: Direct oral anticoagulants (DOACs) share many indications with warfarin but require less frequent follow-up and monitoring. There is limited data available on the prescribing of DOACs and appropriate laboratory monitoring in a real-world clinical setting. Objective: To determine if patients receiving care at 2 University of Florida (UF) Health Internal Medicine clinics are prescribed DOACs according to Food and Drug Administration (FDA)–approved labeling. Secondary objectives were to determine the percentage of patients receiving appropriate baseline laboratory tests prior to DOAC initiation and the frequency of laboratory monitoring. Methods: This retrospective chart review evaluated patients enrolled at 2 UF Health Internal Medicine practices within the UF Health system who were prescribed a DOAC between April 2014 and April 2015. Adherence to FDA-approved dosing recommendations and baseline laboratory tests were compared to previously published data. This study was approved by the UF Institutional Review Board. Results: A total of 194 patients met inclusion criteria. Ninety-six patients (49.5%) were on a DOAC prior to data collection; 98 patients (50.5%) started a DOAC during data collection. Of the 194 patients, 155 (79.9%) were prescribed DOACs per FDA-approved labeling (P = .0005); 79 (40.8%) obtained a complete blood count, serum creatinine, and liver function tests prior to DOAC initiation. Conclusions: Prescribing practices were significantly better than published data; however, 1 in 5 patients were not prescribed a DOAC according to FDA-approved labeling. Less than half of the patients started on a DOAC obtained the recommended labs prior to medication initiation.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"3 1","pages":"108 - 113"},"PeriodicalIF":1.0,"publicationDate":"2017-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88398447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-15DOI: 10.1177/8755122517698164
Sharon K. Park, Miriam C. Purnell, M. K. Freeman, Racquel V. Reese, S. Varga
Background: Health care professionals commonly use mobile devices to retrieve drug information (DI) in clinical practice. The preference and frequency of such use by student pharmacists are not well understood. Objective: To investigate the preference and frequency of mobile phone application (app) use for retrieving DI among student pharmacists. Methods: DI specialists from 3 pharmacy schools generated a 13-question survey relating to students’ preference and frequency of DI app use via their mobile phone. The survey was tested and electronically disseminated to all current P1 through P4 students from all 3 schools. Data were collected for student demographics, availability of mobile phone and DI apps, frequency of using DI apps, and whether DI apps were purchased. Data were analyzed descriptively and statistically. Results: About 74% (n = 221) of students reported using their mobile phone apps for retrieving DI. About 95% of the students used 1 to 3 apps for DI purposes and more than 85% used them a few times a week or more. About 17.6% of the students reported purchasing apps for the purpose of finding DI and that purchased apps are more accurate (27.6%), more comprehensive (36.2%), and more current (26.2%), compared with free apps. Conclusions: Student pharmacists used 1 to 3 mobile apps, at least a few times a week for DI. Some students purchased apps for DI use in addition to free subscriptions from their school. Students perceived purchased DI apps being more accurate, more comprehensive, and more up to date than the free apps.
{"title":"Preference and Frequency of Mobile Phone App Use for Drug Information Among Student Pharmacists","authors":"Sharon K. Park, Miriam C. Purnell, M. K. Freeman, Racquel V. Reese, S. Varga","doi":"10.1177/8755122517698164","DOIUrl":"https://doi.org/10.1177/8755122517698164","url":null,"abstract":"Background: Health care professionals commonly use mobile devices to retrieve drug information (DI) in clinical practice. The preference and frequency of such use by student pharmacists are not well understood. Objective: To investigate the preference and frequency of mobile phone application (app) use for retrieving DI among student pharmacists. Methods: DI specialists from 3 pharmacy schools generated a 13-question survey relating to students’ preference and frequency of DI app use via their mobile phone. The survey was tested and electronically disseminated to all current P1 through P4 students from all 3 schools. Data were collected for student demographics, availability of mobile phone and DI apps, frequency of using DI apps, and whether DI apps were purchased. Data were analyzed descriptively and statistically. Results: About 74% (n = 221) of students reported using their mobile phone apps for retrieving DI. About 95% of the students used 1 to 3 apps for DI purposes and more than 85% used them a few times a week or more. About 17.6% of the students reported purchasing apps for the purpose of finding DI and that purchased apps are more accurate (27.6%), more comprehensive (36.2%), and more current (26.2%), compared with free apps. Conclusions: Student pharmacists used 1 to 3 mobile apps, at least a few times a week for DI. Some students purchased apps for DI use in addition to free subscriptions from their school. Students perceived purchased DI apps being more accurate, more comprehensive, and more up to date than the free apps.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"93 11","pages":"87 - 95"},"PeriodicalIF":1.0,"publicationDate":"2017-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72616143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-03-12DOI: 10.1177/8755122517697072
M. McLaughlin, J. Lin, R. Nguyen, Pratixa Patel, E. Fox
Drug shortages create significant challenges for patients and health care providers. Pharmacists play important roles in managing medication therapy during drug shortages. The management of drug shortages by the community pharmacist is an expanding role. Adverse drug reactions and delayed treatments are highlighted in the literature as some of the consequences of outpatient drug shortages; it is likely these harms are underreported. This commentary reviews examples and opportunities for the management of outpatient drug shortages.
{"title":"Unavailability of Outpatient Medications: Examples and Opportunities for Management","authors":"M. McLaughlin, J. Lin, R. Nguyen, Pratixa Patel, E. Fox","doi":"10.1177/8755122517697072","DOIUrl":"https://doi.org/10.1177/8755122517697072","url":null,"abstract":"Drug shortages create significant challenges for patients and health care providers. Pharmacists play important roles in managing medication therapy during drug shortages. The management of drug shortages by the community pharmacist is an expanding role. Adverse drug reactions and delayed treatments are highlighted in the literature as some of the consequences of outpatient drug shortages; it is likely these harms are underreported. This commentary reviews examples and opportunities for the management of outpatient drug shortages.","PeriodicalId":16796,"journal":{"name":"Journal of Pharmacy Technology","volume":"120 1","pages":"83 - 86"},"PeriodicalIF":1.0,"publicationDate":"2017-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77436684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：