Journal of the American Pharmacists Association最新文献

Background: Specialty pharmacies require unique patient-centric care, emphasizing high-cost medications, complex treatment regimens, and medications requiring special handling.

Objective: We conducted this study to assess the effect of specialty pharmacies on patient and healthcare provider (HCP) satisfaction and pharmacy practice-related outcomes.

Methods: This prospective, concurrent, and historically controlled cohort study was performed in an ambulatory care setting for over 6 months and included six specialties: neurology, pediatrics, dermatology, gastroenterology, pediatric liver transplantation, and medical genetics. The workflow of the pharmacy was redesigned to serve the objective of specialized counseling and dispensing windows. Patients who visited selected clinics during the study period were included. The primary endpoint was the weighted scores for patient and HCP satisfaction obtained via a validated satisfaction survey. The secondary endpoints included pharmacy operation-related outcomes, such as wait time, pharmacist intervention, and patient adherence to specialty medications.

Results: Of the 3,827 patients approached for study participation, 3,620 were recruited (94.5%). Of the 175 HCPs approached, 161 were recruited. Patient satisfaction scores improved from 4.27 to 4.69 after intervention (P < 0.05). Although there was no significant change in pharmacists' satisfaction, a significant improvement in other healthcare provider satisfaction was observed (3.7-4; P = 0.008). The average wait time was reduced from 25 to 12 min (P < 0.05). The number of documented pharmacist interventions was 3 per 100 patients. Patient adherence improved from 73.6% to 85.6% based on the number of days covered (P = 0.03).

Conclusion: Implementing specialty pharmacies improved the overall satisfaction of patients and healthcare providers and enhanced work efficiency, as demonstrated by reduced pharmacy waiting time and patient adherence to specialty medications.

Background: As polypharmacy, the use of over-the-counter (OTC) drugs, and herbal supplements become increasingly prevalent, the potential for adverse drug-drug interactions (DDIs) poses significant challenges to patient safety and healthcare outcomes.

Objectives: This study evaluates the capacity of Generative Pre-trained Transformer (GPT) models to accurately assess DDIs involving prescription drugs (Rx) with OTC medications and herbal supplements.

Methods: Leveraging a popular subscription-based tool (Lexicomp®), we compared the risk ratings assigned by these models to 43 Rx-OTC and 30 Rx-herbal supplement pairs.

Results: Our findings reveal that all models generally underperform, with accuracies below 50% and poor agreement with Lexicomp standards as measured by Cohen's kappa. Notably, GPT-4 and GPT-4o demonstrated a modest improvement in identifying higher-risk interactions compared to GPT-3.5.

Conclusion: These results highlight the challenges and limitations of using off-the-shelf Large Language Models (LLMs) for guidance in DDI assessment.

Background: Health systems have implemented pharmacy consolidated service centers to address increased patient volume, elevated drug costs, and decreased reimbursements. Assessing pharmacy productivity remains a challenge as metrics have historically been determined by calculations of variables that do not capture the actual work. Several investigators have demonstrated improved labor outcomes in health-system pharmacy with the use of novel productivity models. However, the utility of a novel productivity model at a pharmacy consolidated service center has not been assessed.

Objective: To develop a productivity model with validation by comparison to past time periods to represent work at a Pharmacy Consolidated Service Center.

Methods: The amount of time needed to complete work was determined by performing time studies. A Modified Delphi process was used to ensure appropriate perception of workload. Time standards for each category were averaged to determine the specific relative value units which were then multiplied by total biweekly orders and combined with fixed activities to determine the unit of service. Actual hours worked were obtained for six pay periods prior to compare tool productivity to actual productivity.

Results: Time studies were performed over a three-month period. Total average hours per pay period calculated by the tool for repackaging was 167.4 or 2.1 full-time equivalents (FTEs) and for warehousing was 176.8 or 2.2 FTEs. While tool productivity followed the same trends as historical calendar day productivity, it was consistently higher per pay period over the 12-week comparison.

Conclusion: By performing time studies, a productivity model was developed for a Pharmacy Consolidated Service Center that generated productivity data that correlates with 12 weeks of data using a historical model. This study provides the ability to assess trends over time with more precise evaluation of work leading to the discussion that this tool is superior to historical productivity models.

Background: While research has identified characteristics that improve students' chances of matching into a post-graduate year 1 (PGY1) residency, it is unclear how graduating from an online pharmacy program affects these chances. Our qualitative descriptive study aimed to explore perceptions of residency program directors (RPDs) towards online pharmacy students and how these perceptions may affect match rankings.

Methods: PGY1 RPDs were identified using the ASHP Residency Directory, recruited via email, and interviewed with a set of prespecified open-ended questions. Interviews were digitally recorded and transcribed, with transcripts being used to develop consensus codes and consequent themes and subthemes.

Results: Fourteen RPDs from a variety of residency program types were interviewed. Most RPDs had positive or neutral perceptions towards online pharmacy programs. Their perceptions of the students in these programs were mixed, with some extolling drive and motivation, while others assuming laziness as motivation for pursuing an online program. RPDs mentioned that being in an online pharmacy program could negatively affect students' skills, such as patient care and communication skills, while others felt it could positively affect self-advocacy and time management skills. Despite these concerns, RPDs reiterated they use the same criteria and advice as they would for traditional students and that it would not affect their ranking.

Conclusions: RPDs' perceptions towards online pharmacy programs and the students in them were mixed, with some being concerned the nature of these programs would negatively impact skills needed for residency. Despite these concerns, RPDs reiterated these students will be assessed no differently from traditional students.

Background: Glucagon-like peptide 1 (GLP-1) agonists like semaglutide have risen significantly in use in recent years as a therapeutic option for the management of obesity. Popular media serves as an information source for many patients, and depending on the content, may influence how a patient views a particular therapy.

Objective: To describe the content of online/print news articles published about semaglutide for weight loss.

Methods: Online websites and databases were used to access 8 major U.S. online/print news outlets, including the New York Times, Wall Street Journal, Washington Post, USA Today, Fox News, CNN, ABC News, and CBS News. Sources were searched for articles focusing on semaglutide and weight loss published in 2023. Articles were excluded if they focused on: (1) type 2 diabetes, (2) company press releases, or were (3) videos or transcripts of oral broadcasts/podcasts. A random sample of articles was chosen with equitable distribution across sources. Articles were assessed for the presence of data across 9 domains and 30 different content codes, stratified by news source.

Results: A total of 127 articles were analyzed, split almost equally between print (n = 63) and online (n = 64) sources. The vast majority of articles were news articles/analyses (122; 96.1%). The most popular primary focus of articles were social/popular aspects of GLP-1 agonists (22; 17.3%), followed by basic medication information (20; 15.8%), harms of the medication (20; 15.8%), and benefits of the medication (17; 13.4%). Print sources were more likely to report on the cash price (55.6% Vs. 28.1%, P = 0.002), lack of insurance (61.9% Vs. 21.9%, P < 0.001), and cost-effectiveness (11.1% Vs. 1.6%, P = 0.027) of the medication compared to online sources.

Conclusion: Online/print news articles regarding semaglutide for weight loss provide a variety of information about the medication, commonly focusing on social aspects of treatment.

Background: Federal-level legislation to recognize pharmacists as providers and thus allow insurance reimbursement for health services claims, not just prescription drug claims (known as provider status), has been advocated by the profession but is yet to be passed into federal law. Several state governments have enacted this recognition for commercial insurance and/or Medicaid plans. However, the impact of these laws on reimbursement and access to health services has yet to be explored empirically.

Objective: Compare commercial reimbursements for influenza and herpes zoster vaccinations for adults in provider status vs non-provider status states to determine whether these laws have had an intended effect of increasing reimbursement to pharmacists for provided services.

Methods: We used pharmaceutical and outpatient services claims from a national claims database, Marketscan, to examine payments made to pharmacies for all codes billed during vaccination visits. We then used a multivariable logistic regression model to compare the net revenue of vaccination visits in commercial provider status states versus non-provider-status states.

Results: Our dataset contained 2.3 million vaccination visits for influenza and herpes zoster during 2021-2022. We found that the odds of a vaccination visit having positive net revenue were slightly higher in provider status states (shingles OR: 1.03, p<0.001; influenza OR 1.01:, p<0.001). These findings are limited by the stark lack of health services claims by pharmacies in our dataset; only 0.4% of visits included any outpatient services claims, even among provider status states.

Conclusion: This indicates that pharmacists are not submitting claims for reimbursement to payors for health services they are providing. This absence could be due to several reasons and limits the ability to generate evidence about the effect of these laws on health and economic outcomes for patients and health systems. Further research is needed to identify and address barriers to implementation of provider status laws.

Background: There's limited information available about the range of harm reduction (HR) services provided by rural pharmacies.

Objective: This study's objectives are to describe the types of HR services offered by rural pharmacies and examine pharmacists' attitudes and willingness to offer those services.

Methods: A cross-sectional online survey was sent to pharmacists who are members of a practice-based research network for rural community pharmacies. Pharmacists reported the frequency to which their pharmacy engage in as well as their willingness to offer the following HR services: naloxone dispensing; buprenorphine dispensing; point of care testing for human immunodeficiency virus (HIV) and Hepatitis C (HCV); and non-prescription syringe (NPS) sales. Also, pharmacists' knowledge and willingness to sell drug test strips and attitudes towards people who inject drugs (PWID) were assessed. Descriptive statistics were calculated.

Results: A total of 61 pharmacists completed the survey (completion rate= 45.2%). Most reported dispensing naloxone 2-3 times per month (90.2%), and a third dispensed buprenorphine daily (32.8%). Only one pharmacy offered HIV testing, and none offered HCV testing. Most pharmacies (65.6%) had a policy regarding the sale of NPS, with 21.3% reporting they never dispense non-prescription syringes. Many pharmacists were willing to sell fentanyl test strips (67.2%) and xylazine test strips (50.8%). Pharmacists' most negative attitudes related to believing PWID customers make other customers feel uncomfortable and that providers keep patients on buprenorphine for too long.

Conclusions: Many rural community pharmacists engage in HR services and are willing to offer more. However, stigmatizing attitudes highlight the need for pharmacy-focused HR training to reduce stigma and increase knowledge.

Overdose prevention centers (OPCs) are places where people can bring previously obtained substances to use under the supervision of trained healthcare professionals who are prepared to intervene in the event of an overdose. Healthcare professionals, counselors and peer support provide services including naloxone distribution, provision of sterile injection equipment, counseling services, referrals to necessary providers, and above all, a safe and compassionate space for people to get the care they need. This is a method of harm reduction that has been used globally for decades and is now gaining traction in the United States. Pharmacists play a vital role in harm reduction for patients, and they should support the legalization and establishment of overdose prevention centers across the country to extend this essential service. A compelling body of evidence shows that overdose prevention centers reduce overdose deaths, emergency department visits for overdoses, wounds relating to injection drug use and reduce emergency medical service utilization in the area surrounding the centers. They also reduce drug use and discarded hazardous drug paraphernalia in public areas. Overdose prevention centers also provide wrap-around services that aid in holistic care of the person, including referrals to inpatient substance use treatment, detoxification, primary care, transportation and housing. It is the responsibility of pharmacists to advocate for the needs of patients, and overdose prevention centers will provide an effective avenue for pharmacists to deliver counseling and medication management services as part of care of the individual.

Background: Many pharmacy workplaces are so stressful that pharmacy personnel are unable to meet both clinical and nonclinical duties. Adjustments to training, roles, and responsibilities are not able to be made quickly enough to adapt to change and meet expanding responsibilities.

Objectives: Misalignment between a person's unique personality type and their work dynamics can be associated with a stress reaction, what that reaction looks like, and what strategies would be most effective for reducing stress. The objectives for this study were to: (1) assess variability in the personality types of pharmacy personnel, (2) explore variation in most satisfying job activities and perceptions of stress by personality type, and (3) receive feedback regarding the accuracy, applicability, and recommendations for improving a tool for addressing stress.

Methods: A self-administered online questionnaire was used for collecting data from 1098 pharmacy personnel licensed in Minnesota. After answering four Preferred Communication Style Questionnaire items, a personalized De-Stress Rx report was generated for each respondent's feedback by answering questions about the tool's accuracy, applicability to them for helping reduce or manage stress, and recommendations for improving its usefulness. Data were analyzed using content analysis and descriptive statistics.

Results: The findings showed variability in the personality types of pharmacy personnel and that both the most satisfying job activities and stress perceptions vary by personality type. A tool that was designed to address pharmacy personnel stress was found to be both accurate and applicable. Study participants encouraged the expansion of the tool to include resources for follow-up and implementation. Also, they recommended expansion to teach groups and leaders about how to apply this tool to whole organizations, group dynamics, and evolving practice settings.

Conclusion: We propose that the De-Stress Rx Tool can help reduce the stress that is inherent in current pharmacy work settings.

Background: The COVID-19 pandemic stressed the critical role of diagnostic testing in controlling the spread of infectious diseases. Due to their accessibility and presence in underserved areas, community pharmacies have become vital in decentralizing COVID-19 testing. Despite their potential, pharmacies face significant barriers in integrating testing services.

Objectives: This study aimed to assess the provision of COVID-19 diagnostic testing across community pharmacies in Alabama and investigate how various pharmacist and pharmacy characteristics, along with perceived barriers, influence the likelihood of offering COVID-19 testing services.

Methods: A cross-sectional study was conducted targeting 1172 community pharmacies in Alabama. Data were collected via a mixed-mode survey from February to April 2023, achieving a response rate of 20.5% (n = 240). The primary measure was the new Pharmacist Perceived COVID-19 Diagnostic Testing Barriers, a 9-item Likert scale. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with testing provision.

Results: Out of 240 pharmacies, 28.3% provided COVID-19 testing. Providers were significantly more likely to be corporately-owned (61.8%, P < 0.001); they also had higher prescription volumes (median 300, P < 0.001) compared to independent pharmacies. Lower perceived barriers in Organizational Logistics significantly increased the likelihood of offering testing (OR = 0.55, P = 0.028). In corporately-owned pharmacies, lower perceived personal exposure risk was a significant factor (OR = 0.65, P = 0.047), whereas independent pharmacies faced challenges related to regulatory compliance (OR = 0.35, P = 0.025).

Conclusion: The study highlights distinct barriers faced by corporately-owned and independent pharmacies. Corporately-owned pharmacies benefited from higher operational capacities but faced notable exposure concerns. Independent pharmacies, however, struggled with regulatory compliance, which impacted their testing service provision. Addressing the unique barriers different pharmacy settings face with tailored strategies is crucial for enhancing COVID-19 testing accessibility and strengthening public health efforts and pandemic preparedness.