Journal of the American Pharmacists Association最新文献

Background: The opioid overdose epidemic continues to worsen in the United States, with opioid-related deaths increasing by 13 folds from 2000 to 2022 in Wisconsin. Naloxone, an opioid antagonist, can save lives by reversing opioid overdose in a matter of minutes. However, naloxone access and utilization remain suboptimal.

Objective: This study examined the development and implementation of best practice alerting (BPA) processes within community pharmacies. This study assessed to what extent the BPA processes (1a) prompted pharmacists to discuss naloxone with high-risk patients; (1b) increased the number of naloxone prescriptions dispensed; and (2) evaluated the facilitators and barriers to implementing the BPA processes.

Methods: A pilot study was conducted to develop and implement a BPA process in three rural community pharmacies in Wisconsin. The process involved staff identifying high-risk patients, initiating naloxone discussions, and offering naloxone prescriptions. Quantitative monthly data were recorded by pharmacies. Semi-structured interviews were conducted with one pharmacist from each pharmacy to assess the implementation process and outcomes. Descriptive statistics were used to analyze quantitative data. Interview transcripts were analyzed for key themes describing facilitators and barriers to the implementation process.

Results: The naloxone alerting process resulted in a notable increase in naloxone discussions and naloxone prescriptions dispensed. Pharmacists reported that pharmacy staff buy-in and engagement, adequate staffing, developing meaningful partnerships, and using depersonalizing, destigmatizing, and normalizing approaches in discussing naloxone with patients were key facilitators. Key barriers included naloxone cost or co-payment and time constraints.

Conclusion: Implementing a BPA process in community pharmacies can notably increase naloxone prescribing for high-risk patients. Positive message framing, staffing, meaningful partnerships, and staff buy-in were key facilitators of implementation. Identified barriers were cost or co-payment and time constraints.

Background: Medication errors are known to be one of the most common type of error that occurs in healthcare, but similar data is limited for veterinary institutions. Pharmacists are not always present in veterinary hospitals therefore all staff members who are actively engaged in the dispensation of medications must be aware of the high incidence of medication errors that can occur.

Objectives: The objectives of this study were to quantify the amount of and assess the types of medication errors that occur frequently within a veterinary teaching hospital (including both large and small animal patients), identify the specific medications that are most often involved in these errors, and determine if the inclusion of pharmacist chart review decreases the number of medication error incident reports.

Methods: Incident reports between July 2019 and March 2023 and pharmacist chart review documents from September 2022 through March 2023 were collected and reviewed. The total number of incidents were quantified, and incidents were categorized by type of error and by medication involved. The number of incidents were compared for the period before and after the implementation of pharmacist chart review.

Results: Between July 2019 and March 2023, medication errors accounted for 66% (n = 685) of all incident reports (n=1,031) and of those medication errors, 51% (n = 351 out of n = 685) were errors due to an incorrect dose. Gabapentin, methadone, and butorphanol were the most common medications cited in medication error incident reports. Incident reports containing medication errors reduced after the implementation of pharmacist chart review from 62% (n = 352) to 48% (n = 240) (p = 0.0504).

Conclusion: While not statistically significant, the results of this indicate that the inclusion of daily pharmacist chart review may lead to a decrease in medication error incident reports that were submitted, warranting further study.

Background: Over ⅓ of Americans live in areas without access to mental health resources. Pharmacy personnel are a trusted and accessible resource in the community, allowing them to be a point of contact for individuals with behavioral health (BH) or social determinants of health (SDOH) needs. However, pharmacy personnel may not have the training or the confidence to provide that support.

Objectives: The purpose of this study was to identify the BH/SDOH training gaps of Pennsylvania pharmacy personnel.

Methods: An electronic needs survey was distributed to members of the Pennsylvania Pharmacists Association. Survey items elicited respondents' self-reported comfort in providing certain BH/SDOH services, self-reported access to related resources, and knowledge on true-false assessment questions. Demographic information (area of practice setting, type of community practice, job title, prior training) was selected a priori to determine if there were differences within the subcategories. Chi-squared tests were performed to determine statistical significance; α was set at 0.05.

Results: 140 respondents completed the survey, with 54% identifying as pharmacists and 52% practicing in a suburban setting. 41% of respondents reported feeling comfortable assessing an individual for risk of suicide or harm and 32% reported being able to refer patients to local homeless shelters. A minority of respondents answered all Mental Health First Aid-related assessment questions correctly (43%). A statistically significant higher percentage of pharmacists were comfortable providing information on BH compared to non-pharmacist personnel (64% vs 41%, p=0.01) but not for other services. There was no statistically significant difference in reported comfort by area of practice setting or by type of community practice.

Conclusions: This study demonstrates that pharmacy personnel have some level of experience and comfort with providing BH/SDOH services, but gaps remain. We expect that with additional training, pharmacy personnel can become advocates to help care for patients with BH/SDOH needs.

Background: Clinical pharmacist practitioners (CPPs) are embedded in several Duke Primary Care (DPC) clinic locations. CPPs are able to independently modify medications and order labs within protocol in collaboration with a supervising physician. Patient no-shows for CPP appointments are costly to clinics. The purpose of this study was to determine the impact of two interventions on patient no-show rates for CPP appointments and to identify barriers patients may face that lead to no-shows.

Objectives: Determine if the interventions were associated with a change in the no-show rate for embedded DPC CPP appointments.

Methods: Single-center, prospective, intervention study of no-show rates of DPC clinical pharmacist appointments. Appointments with patients under 18 years of age were excluded. Interventions were implemented between September 2023 to November 2023. The interventions consisted of a reminder message sent to the patient or a conversion of an in-person visit to a virtual visit if the patient was more than five minutes late. The intervention groups were compared to a control group from one year prior. A chi-square test was used to compare no-show rates.

Results: Total of 1645 appointments were included. The no-show rate was 20.4% in the control arm, 18.0% in the patient portal message arm and 15.7% in the virtual arm. Average estimated financial loss per day due to no-shows was numerically lower in the intervention groups compared to the control group.

Conclusion: The two intervention groups experienced numerically lower no-show rates in comparison to the control, but the differences were not statistically significant. We were not able to identify specific patient barriers that were associated with increased likelihood to no-show. More studies are needed to further evaluate the impact of these interventions. Next steps involve the feasibility and implementation of these interventions into clinic workflow on a long-term basis.

The debate over whether cannabis should be handled as a vilified substance or potential therapeutic entity has persisted over the past 50 years, coupled with or supported by a changing state-level regulatory landscape. Pharmacists must be aware of potential health implications and keep abreast of regulatory implications likely to result from potential state and national regulation changes. In this commentary, we highlight key considerations for pharmacists in the evolving cannabis regulatory landscape, including historical perspectives, current regulations, and future implications. Special attention to vulnerable populations is outlined, given the potential health consequences that must be considered if cannabis is rescheduled. The substantive public health implications associated with adult cannabis use (e.g., substance use/misuse, driving, lung health) are outside the scope of this commentary.

Background: In response to a multi-dose ophthalmic medication (topical eye drop) shortage, the health system had to evaluate the current policy for multi-dose medications and propose changes to the policy to provide patient care while managing the drug shortage. The use of multi-dose eye drops on multiple patients is accepted in ophthalmology care per the CMS updated guidance for ambulatory surgical centers. Prior to this, the use of multi-dose eye drops on multiple patients had not been in practice at our health system due to contamination risk from repeated use in the pre-operative setting. Given the ambiguity of the current policy with regards to multi-dose ophthalmic drop usage and the available literature, an updated policy was developed.

Objectives: The objective of this report is to describe the evaluation, assessment, and implementation of a policy change supporting the use of multi-dose ophthalmic medications on multiple patients.

Methods: Key stakeholders met and assessed the impact of the shortage and potential policy needs. After evaluation of available literature and regulatory guidance, the proposed change was brought through the necessary formulary, safety, and policy channels for review.

Results: After review of the available literature, a determination was made that there is sufficient support of the practice to use multi-dose eye drops in multiple patients provided there are appropriate infection control guidelines. The policy edits were approved by the appropriate committees, and subsequently the organization's policy oversight committee.

Conclusions: Our organization was able to make a substantial policy change through a collaborative, interdisciplinary review of literature and best practices to address a critical patient care need resulting from a medication shortage.

Background: Statin Use in Persons with Diabetes (SUPD) is a Centers for Medicare and Medicaid Services (CMS) star quality measure used in Medicare Part D. This measure assesses the Part D plans' success in prescribing statins to individuals with diabetes between the age of 40 - 75 years. This paper illustrates how pharmacists can improve SUPD star ratings by using a collaborative drug therapy management (CDTM) agreement to initiate statin therapy.

Methods: In 2023, pharmacists in a clinically integrated delivery network implemented a CDTM for closing SUPD gaps in care (GIC). Utilizing payer claims data, the pharmacists analyzed multiple years of SUPD results. Open GIC were categorized by practice location, provider, and measurement year. Results were stratified into providers with lower SUPD closure rates (less than 80%) and higher open GIC. Practice locations with the highest number of GIC were prioritized for the pharmacist intervention.

Results: By close of member year 2022, 7,529 individuals were identified as SUPD eligible individuals from within the employed medical group. Of the 7,529 patients, 85.4% were prescribed a statin, leaving 1,098 individuals, cared for by 277 providers with open GICs. There were 76 practice locations showing a range of 5 to 48 open GICs. Provider open GIC ranged from 1 to 13 (mean 2.57). By the end of measurement year 2023, pharmacists increased SUPD star ratings from 2 to 4 stars with two payers and from 2 to 3 stars with one payer.

Conclusion: Expanded CDTM law enables qualified pharmacists to play a pivotal role in influencing population health outcomes. With a CDTM agreement, pharmacists can overcome barriers to initiating statins for eligible individuals and thereby directly impact star ratings.

Background: Although the management of AF has improved over the years, suboptimal adherence to direct oral anticoagulants (DOACs) is a major health concern. Adherence and long-term persistence to DOACs declines over time resulting in increased risks of stroke, major bleeding and death. The objective of this study was to evaluate the association between adherence to DOACs and composite or bleeding events using marginal structural models (MSM).

Methods: A retrospective study was conducted using the Medicare Advantage Plan from January 2016-December 2020. Atrial fibrillation patients prescribed any DOACs were identified. Adherence was calculated using proportion of days covered (PDC). Patients with PDC ≥0.80 were considered adherent. Composite (stroke, systemic embolism, acute coronary syndrome) and bleeding (major and minor) events were calculated for each of the four time periods. A MSM was conducted to estimate the association between adherence and composite/bleeding events by controlling for time dependent covariates and time dependent exposure affected by the prior exposure.

Results: A total of 1969 patients with AF were included in the study. Adherence was suboptimal during all the five time periods, and it was ranging from 39.8% to 53.12%. This study did not find any significant association between adherence to DOACs and composite/bleeding events. The safety and efficacy outcomes were comparable among apixaban, rivaroxaban, and dabigatran.

Conclusion: This study revealed that adherence declined over time among elderly AF patients. Future studies should explore the association between adherence to DOACs and health outcomes for a longer duration of follow-up using MSM.

Background: The role of the pharmacist in reproductive health and contraception management continues to expand. Examination of the perspectives of patients, pharmacists, and other healthcare professionals can highlight both the benefits and challenges associated with pharmacist-administration of injectable contraception.

Objectives: The objective of this systematic review was to assess the feasibility, applicability, and satisfaction of patients, pharmacists, and other healthcare professionals regarding pharmacist-administered injectable contraception.

Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search of Medline and Embase databases, from inception through June 3, 2024, was conducted using a predefined search strategy to capture relevant records. Initial records were screened based on pre-specified inclusion criteria focusing on patient, pharmacist, and other healthcare professional outcomes related to the pharmacist-administration of injectable contraceptives. After deduplication and screening, three independent reviewers extracted data, with any disagreements resolved through discussion by a fourth reviewer. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized studies and the Appraisal Tool for Cross-Sectional Studies. A convergent integrated mixed-methods approach was utilized to analyze both qualitative and quantitative data.

Results: Five cross-sectional studies and one randomized controlled trial were included. Pharmacists were interested in administering injectable contraceptives and reported that implementation would positively impact patient access and convenience. Quantitative analysis demonstrated that pharmacists felt confident and capable in this role and expressed the need for further training and resources. Qualitative analysis highlighted patient satisfaction for the convenience and accessibility, specifically in rural areas. Barriers included insufficient training, lack of infrastructure, mixed acceptance among other healthcare professionals, reimbursement, and regulatory frameworks.

Conclusion: Pharmacist-administered injectable contraception appears to be beneficial, accessible, and convenient for patients while aligning with pharmacists' capabilities and professional roles. Barriers should be addressed when considering implementation. Future research should aim to broaden the evidence-based research across different regions and explore long-term outcomes.