Journal of the American Pharmacists Association最新文献

Background: Pharmacy aseptic services are essential for many critical hospital services as they provide sterile and controlled environments under which highly qualified staff prepare injectable medicines. Although quantitative studies on problems of aseptic medicine services have been previously documented, there is a paucity of data to explain the cause of those problems.

Objectives: This study aimed to examine practical challenges experienced by pharmacists during aseptic medicine services.

Methods: This was a qualitative study conducted using semi-structured interviews. The participants were pharmacists working in various inpatient clinical environments in Yogyakarta Province, Indonesia. Participants were purposefully recruited through maximum variation and snowball sampling. The interview guide was developed after comprehensive literature review and discussions with some experts related to concepts in aseptic medicine service. Data were collected from April to August 2023 and analyzed via reflexive thematic analysis using the NVivo software.

Results: A total of 19 pharmacists working in 12 hospitals (7 public and 5 private) across the five regions in Yogyakarta Province were interviewed. The challenges in aseptic services can be grouped into five themes: (1) unreliable physical facilities and equipment are the problems that should be solved, (2) Shortage of the quality and quantity of human resources hinder the optimum aseptic medicine services, (3) Competence, responsible, and accountable aseptic dispensing services management are needed to counter issues related work delegation, supervision, coordination and communication between health staff, (4) Various problems of production systems are needed to be considered, (5) There is lack of pharmacist involvement in board of directors in making policy regarding aseptic services.

Conclusion: By addressing the five main themes of challenges to aseptic medicine services, institutional leadership can begin to improve the patient safety and hospital performance. Incorporating experienced pharmacists into the decision- making processes at the executive level is a strategy to address these challenges.

Background: Mental health is essential for overall well-being but is often overlooked or stigmatized. Mental Health First Aid (MHFA) provides initial support to reduce stigma, encourage help-seeking, and guide individuals toward appropriate care. While MHFA equips healthcare providers to address rising mental health needs, its impact on pharmacists remains underexplored, warranting this systematic review.

Objective: This systematic review aimed to comprehensively synthesize the effects of MHFA training for pharmacists on their knowledge, attitudes, and competency in providing mental health support.

Methods: The authors systematically searched nine electronic databases, gray literature, and reference lists of included articles. Article selection was based on predefined criteria, and outcomes were analyzed using narrative synthesis. The review included nine articles from 1,258 identified studies, representing diverse study designs and populations. Risk of bias and the certainty of evidence were assessed using appropriate tools.

Results: The positive effects of MHFA training have been observed, including enhanced understanding of mental health conditions, reduced stigma surrounding mental health, and increased confidence and skills in mental health interventions among hospital and community pharmacists. Most pharmacists recognize the importance of MHFA training and demonstrate a strong willingness to engage in both initial and ongoing training. However, mixed effects were noted regarding their preparedness to administer MHFA.

Conclusion: Pharmacists who completed MHFA training were found to engage in conversations about mental health more frequently, offer compassionate support, and demonstrate a willingness to assist individuals struggling with mental health crises. Future research utilizing robust study designs should investigate whether MHFA training significantly benefits patients and pharmacists.

Background: A pharmacy school and a State Health Insurance Assistance Program developed a Medicare plan selection assistance program in 2013. In 2020, the program changed from in-person to telephone counseling.

Objective: To compare the impact of in-person versus telephone Medicare counseling on beneficiary satisfaction, cost-savings, and plan selection decisions.

Methods: Outcomes were assessed via anonymous post-counseling survey, including: 1) program satisfaction (4-items); 2) annual cost-savings (2-items); and 3) plan selection decisions (1-item). Beneficiary satisfaction was measured using a Likert-type scale (1=strongly disagree, 5=strongly agree). Projected cost-savings was calculated as the difference between the total annual drug plus premium costs of the patient's current versus newly selected plan (actual costs-savings) or least expensive plan option (potential cost-savings) for the next benefit year. Plan selection decision was measured via multiple-choice with response categories of "enrolled in or selected a new plan," "undecided," or "stayed with their current plan." Differences in mean satisfaction scale scores, cost-savings, and plan selection decisions between in-person (2014-2019) and telephone counseling (2020-2021) were analyzed using Mann-Whitney U and Fisher's Exact tests. Predictors of plan selection decision were assessed via logistic regression.

Results: Beneficiaries (N=632; in-person n=564; telephone n=68) were mostly female (59.8%), White (52.1%), and 69 years on average. The overall mean[SD] satisfaction scale score was higher among recipients of in-person (4.55[0.575]) versus telephone counseling (4.30[0.645]; p=0.002), but there was no statistically significant difference in mean projected annual cost-savings. Further, in-person versus telephone counseling recipients more often enrolled in or selected a new plan (46.5% vs 27.8%; p<0.05), while telephone versus in-person recipients were more frequently undecided (37.0% vs 24.4%; p<0.05). Overall satisfaction (aOR=11.548; p=0.009) and potential cost-savings (aOR=1.001; p=0.020) predicted selection of a new plan.

Conclusion: In-person counseling resulted in a greater proportion of beneficiaries selecting a new plan whereas telephone counseling resulted in greater decision inertia.

Background: Opioid use disorder (OUD) is a chronic substance use disorder that currently results in significant morbidity and mortality within the United States. The Opioid and Naloxone Education program is a pharmacy-centered opioid risk screening process to identify patients at risk for OUD and opioid overdose. Three years after inception, data indicated patients screened as high-risk for OUD were receiving opioid safety interventions; however the evaluation noted a lack of OUD education with patients.

Objective: To describe and assess an educational initiative for pharmacists which is delivered via social media for the improvement of pharmacist-patient communication surrounding OUD education.

Methods: The initiative was named 'Dare 2 Discuss' and video content was developed to align with prior research citing challenges to health care provider-patient OUD education. Data to evaluate pharmacist interventions/education delivered to patients was collected by a pharmacy services documentation platform and social media performance was captured by each respective social media dashboard.

Results: The first video was posted on October 1, 2022 and the last video was posted on April 10, 2023. Each video took approximately 2.5 hours to create and averaged 42 seconds in length (17-168 seconds). On average, videos received 233 Facebook views (55-489 views) and 527 Instagram views (232-1434 views). The postintervention phase indicated that patient receipt of OUD education by the pharmacist increased by 23% and patient receipt of community support services information increased by 68%.

Conclusion: 'Dare 2 Discuss' campaign may have improved pharmacist self-efficacy with subsequent adjustment of patient education techniques when addressing OUD conversations. These findings highlight the feasibility of a social media-delivered educational initiative to have a potential impact on factors associated with the opioid crisis and risk-reduction education by pharmacists. Creating relevant and easy-to-digest educational materials for health professionals is an important step in advancing practice and improving patient care. Results from the Dare 2 Discuss campaign suggest that this educational initiative may be an effective method to reach a broad number of pharmacists to improve patient interactions.

Background: The RxChange process provides a streamlined solution within electronic prescribing workflows for a pharmacist-led team to address prescription issues with providers. Its use and effectiveness need to be evaluated to enhance pharmacy-provider communication, improve patient access to care, and increase patient safety.

Objective: To assess the use of the RxChange process on e-prescription content, cost, and changes related to medication safety.

Methods: We conducted a retrospective analysis of national RxChange transactions from 2022 to 2023, using stratified random sampling. All data was obtained from Surescripts. The dataset directly included RxChange response data, shared under agreements to provide limited, time-shifted, and de-identified information. We measured the changes in active ingredients, strengths, dose forms, therapeutic classes, and associated costs before and after the RxChange process. Cost analysis was based on data from the 2021 Medical Expenditure Panel Survey by comparing medication unit costs before and after interventions. Additionally, we analyzed the associations between adverse drug reaction (ADR) codes and the resulting medication modifications.

Results: Our analysis included 1,361,528 RxChange transaction records, focusing on 721,415 prescriber-approved transactions. Medication data mapping using RxNorm API was successful in 93.4% of these records, with 31.3% undergoing significant modifications due to pharmacy interventions. Of these, 43,293 records were linked to cost data, revealing an average unit cost saving of $3.5. Strength changes emerged as the most frequent medication adjustment, particularly in therapeutic interchange scenarios. Out-of-stock situations led to most complex modifications involving simultaneous multiple changes in ingredients, strength, and dose form. ADR-related RxChange requests mostly prompted simultaneous strength and ingredient adjustments in 25.8% of ADR-related transactions.

Conclusions: The study concludes that pharmacy-initiated RxChange communications within the electronic prescription workflow play a crucial role in enhancing e-prescription quality and making pharmacy team interventions more traceable. The findings highlight the importance of pharmacy-provider collaboration in addressing prescribing challenges, facilitating medication adjustments, and supporting efforts to improve medication safety through the RxChange process.

Background: Pharmacy closures have become increasingly prevalent in the United States in recent years. Previous literature highlights socioeconomic and racial disparities in the distribution of pharmacy deserts.

Objectives: To identify and characterize pharmacy deserts in Virginia and to simulate potential locations to minimize inequities in pharmacy distribution.

Methods: This cross-sectional study used active pharmacy permits data from the Virginia Board of Pharmacy to identify census tracts considered pharmacy deserts by simultaneously satisfying 2 criteria: 1) low-income status (>20% residents living below the federal poverty line, or median household income <80% of a local comparator); and 2) low-access to pharmacies (distance >1, 5, or 10 miles for urban, suburban, and rural census tracts, respectively). Demographic and socioeconomic characteristics of desert vs. nondesert tracts were compared using Wilcoxon rank-sum tests. Locations within identified pharmacy deserts were randomly generated in 10,000 independent iterations.

Results: Of 2198 census tracts, 51 were considered pharmacy deserts, and 69 met the low-access criterion only. Pharmacy deserts were significantly more common in urban census tracts (5.5%), followed by rural (2.9%), and suburban (0.1%). Compared to nondesert, pharmacy desert tracts had significantly lower percentage of residents under 18 year-old, greater percentage of Black residents, uninsured, with Medicare or Medicaid coverage only, lower median household income, and greater percentage of residents living in poverty. Through geospatial simulation, 44 locations were identified where adding pharmacy services could significantly improve access, each potentially benefiting over 10,000 individuals.

Conclusion: Fifty-one tracts in Virginia, primarily in urban areas, were considered pharmacy deserts. Compared to nondeserts, pharmacy desert status was associated with a lower proportion of residents under 18 year-old, greater proportion of Black and uninsured/publicly insured residents, and high poverty level, highlighting disparities in pharmacy access. Geospatial simulation identified several locations where placement of pharmacy services could benefit the largest number of residents living in desert tracts.

Background: Opioids are effective for postoperative pain control but are no longer considered appropriate as the sole method for managing pain after surgery. Newer, multimodal approaches to pain control are increasingly being employed to decrease reliance on opioids, but patient-related outcomes are not consistently reported with these interventions.

Objective: This study evaluated the effect of implementing a new multimodal therapy order set, coupled with new patient education materials, on postoperative outcomes after complex shoulder surgery.

Methods: This retrospective cohort study compared outcomes from patients who received medications via the new multimodal therapy order set (order set cohort) and patients who did not (nonorder set cohort). All patients were contacted on postoperative days 1,7, and 14 to answer questions about postoperative pain and general measures of function. Data on opioid prescribing and use were collected. There were 2 primary endpoints: median morphine equivalent daily dose (MEDD) prescribed at 14 days postsurgery and median satisfaction with pain control at 14 days postsurgery.

Results: There were 16 patients included in the nonorder set cohort and 19 in the order set cohort. At 14 days postsurgery, the median MEDD prescribed was significantly less in the order set cohort than in the nonorder set cohort (P = 0.003), and there was no significant difference in patient satisfaction scores between groups.

Conclusion: The implementation of a multimodal order set, coupled with new patient education materials, resulted in a significant reduction in the median MEDD of prescribed opioids without negatively influencing patient satisfaction after complex shoulder interventions.

Background: The American Pharmacists Association Foundation Incentive Grant program provides funding for pharmacy learners to conduct community pharmacy-based research projects. Over the 30-year period since its inception, the number of grants awarded has grown through support from the Community Pharmacy Foundation.

Objective: The objective of this project was to describe the breakdown of project topics and geographic reach of Incentive Grant-funded projects from 1994 to 2024 and summarize the number of patients or survey respondents reached.

Methods: All available reports and supporting documents for the Incentive Grant program were reviewed using the American Pharmacists Association Foundation internal database. Projects were assigned a geographical region using US Census Bureau Divisions and categorized using focus areas from grant calls-for-proposals. Project impact was evaluated by summing the number of interventions reported in final reports.

Results: A total of 784 projects were conducted and 551 had final reports available. Thirteen project focus areas were identified, with a majority of projects related to cardiovascular disease management (21.1%), pharmacy workflow/processes (14%), and immunizations (13.3%). Projects were conducted most frequently in the U.S. regions of South Atlantic (27.4%), East North Central (24.2%), and West North Central (14.9%). Of 398 projects with intervention-level data reported (2004-2024), 100,547 interventions were made (86,616 patients impacted and 13,931 survey respondents reached).

Conclusion: The findings of this study serve as a summary of community pharmacy-based research over time, indicating the American Pharmacists Association Foundation Incentive Grant program has likely had a positive influence on community pharmacy-based research as evidenced by number of funded projects, geographic scope, participant impact, and breadth of project focus.

Background: Pharmacist-provided medication therapy management (MTM) services have demonstrated improved clinical outcomes for patients. MTM services could incorporate additional lifestyle and wellness counseling to potentially enhance health care for underserved patients.

Objective: To report the outcomes of a new pharmacist-provided MTM lifestyle and wellness counseling program for underserved rural Arizonans with diabetes and/or hypertension.

Methods: A community health center referred rural Arizonans with type 2 diabetes and/or hypertension to the MTM pharmacist for telephonic MTM lifestyle and wellness counseling between July 2020 and June 2023. Data were collected on clinical characteristics, adherence issues, and pharmacist recommendations. A nurse reviewed the patients' electronic health record to determine which recommendations had been accepted by the primary care provider after 90 days. Summary statistics were computed.

Results: For 93 patients in the program, pharmacists identified many drug-drug interactions, adverse drug reactions, utilization/cost concerns, and recommended preventative vaccines. Pharmacists provided counseling for exercise, nutrition, laboratory values, and disease state education. Twenty-nine patients reported missing any doses of their medications in the past 2 weeks. Patients used a variety of methods to remind them to take their medications. A total of 309 recommendations were made by the pharmacist averaging 3.3 ± 1.4 per patient. Of these, 113 (36.6%) were accepted within 90 days. The most common recommendations made were screening needed (n = 77) and vaccination due (n = 70). The most frequently accepted recommendations by the patients' provider were reinforcing lifestyle/disease self-management strategies (61.7%) and decreasing medication dose (60.0%).

Conclusion: This novel MTM lifestyle and wellness counseling program demonstrated some success for underserved Arizonans with diabetes and/or hypertension. Over one-third of recommendations made by the pharmacist to the patients' primary care provider were accepted, which is encouraging in showing the value of this program but suggests further work is needed to act upon them or understand why they are not implemented.