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Impact of a clinical pharmacist-led, artificial intelligence–supported medication adherence program on medication adherence performance, chronic disease control measures, and cost savings 临床药剂师主导、人工智能支持的用药依从性计划对用药依从性表现、慢性病控制措施和成本节约的影响。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-18 DOI: 10.1016/j.japh.2024.102271
Charles Worrall, David Shirley, Jeff Bullard, Ashley Dao, Taylor Morrisette

Background

Chronic diseases are the leading cause of disability and death in the United States. Clinical pharmacists have been shown to optimize health outcomes and reduce health care expenditures in patients with chronic diseases through improving medication adherence.

Objective

The primary objective of this study was to evaluate a pharmacist-led, artificial intelligence (AI)–supported medication adherence program on medication adherence, select disease control measures, and health care expenditures.

Methods

This was a multicenter, retrospective, quasi-experimental evaluation from January 2019 to December 2019 (preimplementation) and January 2021 to December 2021 (postimplementation). This pharmacy-driven service focuses on improving medication adherence and patient outcomes through AI-supported analytics, individual patient case review, and pharmacist-led individual patient outreach. The primary end point was to determine whether implementation improved medication adherence in 3 medication-related measures: medication adherence for hypertension (MAH), medication adherence for cholesterol (MAC), and medication adherence for diabetes (MAD). Secondary outcomes were to evaluate reductions in select chronic diseases control measures and cost savings of this service after implementation of this service.

Results

This medication adherence service was deployed across 10,477 patients: 60.6% of patients were in at least 1 medication-related measure, generating 2762 actionable medication adherence gaps. After the implementation of this pharmacist-led program, medication adherence improved in all 3 disease state measures (MAH 5.9% improvement, MAC 7.9% improvement, MAD, 6.4% improvement), and Medicare Star ratings also improved. The percentage of patients with diabetes who reached their A1c goal also increased (75.5%-81.7%). Furthermore, reductions in overall health care expenditures were seen per member per month in patients who were adherent in comparison with those who were nonadherent (hypertension 31% cost savings, hyperlipidemia 25% cost savings, diabetes 32% cost savings).

Conclusion

This clinical pharmacist–driven service leveraged technology and patient connection to increase medication adherence in patients with chronic disease states and led to improvement in select disease control measures and substantial health care cost savings.
背景:在美国,慢性病是导致残疾和死亡的主要原因。临床药剂师通过改善慢性病患者的用药依从性,已被证明能优化健康结果并减少医疗支出:本研究的主要目的是评估由药剂师主导、人工智能支持的用药依从性计划对用药依从性、特定疾病控制措施和医疗支出的影响:这是一项多中心、回顾性、准实验性评估,评估时间为 2019 年 1 月至 2019 年 12 月(实施前)和 2021 年 1 月至 2021 年 12 月(实施后)。这项药学驱动的服务侧重于通过人工智能支持的分析、个体患者病例审查和药剂师主导的个体患者外联活动,改善患者的用药依从性和治疗效果。主要终点是确定该服务的实施是否改善了三种用药相关指标的用药依从性:高血压用药依从性(MAH)、胆固醇用药依从性(MAC)和糖尿病用药依从性(MAD)。次要结果是评估实施这项服务后,某些慢性病控制措施的减少情况以及这项服务的成本节约情况:结果:10,477 名患者接受了这项服药依从性服务:60.6%的患者至少有一项用药相关措施,产生了 2762 个可操作的用药依从性差距。在实施这项由药剂师主导的计划后,三种疾病状态的用药依从性均有所改善(MAH:改善了 5.9%;MAC:改善了 7.9%;MAD:改善了 6.4%),医疗保险星级评价也有所提高。达到 A1c 目标的糖尿病患者比例也有所提高(从 75.5% 提高到 81.7%)。此外,与未坚持治疗的患者相比,坚持治疗的患者每人每月的总体医疗支出有所减少(高血压:节省 31% 的费用;高脂血症:节省 25% 的费用;糖尿病:节省 32% 的费用):这项由临床药剂师推动的服务利用技术和与患者的联系来提高慢性病患者的用药依从性,从而改善了选定的疾病控制措施,节省了大量医疗成本。
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引用次数: 0
Exploring worldwide training pathways that enable clinical pharmacy career development. 探索促进临床药学职业发展的培训途径:来自十三个国家的启示。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-15 DOI: 10.1016/j.japh.2024.102266
L Moura, A Costa, S Steurbaut, H Mota Filipe, S Leite, F Alves da Costa

Background: Pharmaceutical education is crucial for preparing pharmacists for evolving professional practice. The clinical component of pharmaceutical education and practice has grown and improved globally, though its implementation varies. Training pathways for clinical pharmacy careers vary worldwide.

Objective: This study aimed to explore training pathways enabling career development in clinical pharmacy.

Methods: In-depth interviews on clinical pharmacy career development were conducted with a purposive sample of academic and practice experts from thirteen countries, selected based on a prior literature review. Interviews were recorded following participants' consent, transcribed verbatim, thematically analyzed by one researcher, and verified by a second. Disagreements were resolved through discussion with a third researcher.

Results: In ten of the analyzed countries, the competencies required to perform clinical activities were considered the foundation of the pharmacy profession, suggesting that undergraduate education is sufficient to perform clinical pharmacy activities. Reported training-related success factors associated with the development of a career in clinical pharmacy included: interprofessional education, focus on the health context of each country, ensuring students' readiness, practice site partnerships, patient-centricity and patient contact, good mentorship and preceptorship, time and work flexibility of the candidates, effective training evaluation and, financial support for training. Conversely, shortage of mentors and teachers with clinical practice experience, slow responsiveness of the regulatory environment, insufficient funding, resistance to change, and education-practice mismatch were identified as training-related constraints.

Conclusion: Clinical activities form the foundation of the pharmacy profession in most countries, and undergraduate education directly provides the skills to undertake these, even though optional postgraduate education may be pursued. Understanding existing training pathways, including success factors and implementation challenges, can inform the creation, development, and optimization of education for clinical pharmacy careers.

背景:药学教育对于培养药剂师进行不断发展的专业实践至关重要。药学教育和实践中的临床部分在全球范围内得到了发展和改善,尽管其实施情况各不相同。世界各地临床药学职业的培训途径也不尽相同:本研究旨在探索促进临床药学职业发展的培训途径:方法:根据事先的文献综述,对来自 13 个国家的学术和实践专家进行了有关临床药学职业发展的深度访谈。访谈在征得参与者同意后进行录音,逐字记录,由一名研究人员进行主题分析,并由另一名研究人员进行核实。与第三位研究人员的分歧通过讨论解决:在所分析的 10 个国家中,从事临床活动所需的能力被认为是药学专业的基础,这表明本科教育足以胜任临床药学活动。据报告,与临床药学职业发展相关的培训成功因素包括:跨专业教育、关注每个国家的卫生背景、确保学生做好准备、实习基地合作、以病人为中心和与病人接触、良好的导师制和实习前指导、候选人的时间和工作灵活性、有效的培训评估以及对培训的财政支持。相反,具有临床实践经验的导师和教师短缺、监管环境反应迟缓、资金不足、抵制变革以及教育与实践不匹配被认为是与培训相关的制约因素:结论:在大多数国家,临床活动是药学专业的基础,本科教育直接提供了开展这些活动的技能,即使可以选择研究生教育。了解现有的培训途径,包括成功因素和实施挑战,可以为临床药学职业教育的创建、发展和优化提供参考。
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引用次数: 0
Pharmacists’ mental health support behaviours with simulated patients: a mixed-methods pilot study 药剂师对模拟患者的心理健康支持行为:一项混合方法试点研究。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-12 DOI: 10.1016/j.japh.2024.102263
Tina X. Ung, Sarira El-Den, Rebekah J. Moles, Jack C. Collins, Kevin Ou, Jenny Chen, Claire L. O’Reilly

Background

Simulated mental health role-plays provide a safe and relevant learning experience for pharmacy students, improving confidence in and attitudes toward providing mental health support. Little research explores the use of mental health role-plays, enacted by trained actors, with pharmacists.

Objectives

This study aimed to pilot the adaptation of simulated patient (SP) role-plays, from the university classroom with students, to a workshop with pharmacists, and explore pharmacists’ experiences.

Methods

Pharmacists attended a two-hour workshop. Trained actors enacted simulated scenarios (previously developed for pharmacy education) with pharmacist volunteers while being observed by peers, a workshop facilitator, and mental health consumer educator (MHCE). Pharmacists engaged in self-assessment immediately post-roleplay, followed by performance feedback and debrief discussions with MHCEs, workshop facilitators, and peers. Pharmacists completed pre- and post-workshop surveys exploring intended mental health support behaviours, then invited to participate in an interview exploring their workshop experiences and opinions about using mental health role-plays in clinical practice (via mystery shopping). Non-parametric tests were conducted to analyse role-play and survey scores, and thematic analyses were undertaken on interview transcripts.

Results

Thirty-five pharmacists attended the workshop. Fourteen role-plays were analysed. Pharmacist self-assessment scores were significantly lower than MHCE scores (P = 0.028). Overall, the role-plays significantly increased pharmacists’ intentions in supporting a person experiencing mental health crises such as suicide and psychosis, as well as encouraging other supports (P < 0.05). Four themes emerged from interviews (n = 4): realistic context for skills application and practice, benefits of observing, self-assessment and feedback, and integrating into clinical practice (via mystery shopping).

Conclusion

SP role-plays of mental health symptoms and crises, enacted by trained actors, may effectively assess and enhance pharmacists’ intended mental health support behaviours. It is recommended that the SP method is adapted into clinical practice, via repeated mystery shopping visits with immediate performance feedback, to shape pharmacists’ mental health support behaviours.
背景:模拟心理健康角色扮演为药剂学专业的学生提供了安全、相关的学习体验,提高了他们提供心理健康支持的信心和态度。但很少有研究探讨如何在药剂师中使用由训练有素的演员扮演的心理健康角色扮演:本研究旨在对模拟病人(SP)角色扮演进行试点,将其从大学课堂的学生角色扮演改编为药剂师的工作坊,并探索药剂师的经验:药剂师参加了一个两小时的研讨会。经过培训的演员与药剂师志愿者一起表演模拟场景(之前为药学教育开发),同时由同行、工作坊主持人和心理健康消费者教育者(MHCE)进行观察。药剂师在角色扮演结束后立即进行自我评估,然后与心理健康消费者教育者、工作坊主持人和同行进行表演反馈和汇报讨论。药剂师在工作坊前后填写了调查问卷,以探讨他们希望采取的心理健康支持行为,然后受邀参加访谈,以探讨他们的工作坊经验以及对在临床实践中使用心理健康角色扮演的看法(通过神秘购物)。对角色扮演和调查得分进行了非参数检验分析,并对访谈记录进行了主题分析:结果:35 名药剂师参加了研讨会。对 14 个角色扮演进行了分析。药剂师的自我评估分数明显低于 MHCE 分数(p=0.028)。总体而言,角色扮演大大提高了药剂师在支持自杀和精神病等精神健康危机患者以及鼓励其他支持方面的意愿(p 结论:由训练有素的演员扮演心理健康症状和危机的 SP 角色扮演,可以有效地评估和提高药剂师的心理健康支持行为意向。建议将 SP 方法应用到临床实践中,通过反复的神秘购物访问和即时的绩效反馈来塑造药剂师的心理健康支持行为。
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引用次数: 0
Single-center retrospective review of standard versus minimal monitoring for hepatitis C direct-acting antiviral therapy 丙型肝炎直接作用抗病毒疗法标准监测与最低限度监测的单中心回顾性研究。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-12 DOI: 10.1016/j.japh.2024.102265
Anita Yang, Neel Swamy, Jane Giang

Background

Highly effective direct-acting antiviral (DAA) therapies have transformed the landscape of hepatitis C virus (HCV) treatment. However, there continues to be limited data regarding the efficacy and safety of required in-person clinic visits (standard monitoring) versus completely telehealth clinic visits (minimal monitoring) during HCV therapy, which could delay practice adoption.

Objectives

This study aimed to assess the rates of undetectable HCV ribonucleic acid (RNA) in sustained viral load 12 weeks after therapy (SVR12) in standard versus minimal monitoring approaches during DAA.

Methods

A 12-month, single-center retrospective cohort study was conducted in treatment-naïve HCV-infected adults who received DAA therapy between May 1, 2020, and April 30, 2021. The standard monitoring group had ≥1 in-person clinic visit with HCV RNA laboratory monitoring during DAA treatment. The minimal monitoring group had entirely telehealth visits without HCV RNA laboratory monitoring during treatment. Both groups received telephonic touchpoints throughout DAA treatment from a clinical pharmacist practitioner and a nurse care coordinator. The primary outcome was SVR12.

Results

From May 2020 to April 2021, 133 patients with HCV met inclusion criteria and were treated with DAA (standard, n = 56; minimal, n = 77), with no differences in baseline demographics. Overall, total encounters during DAA treatment remained statistically significant in the standard than minimal monitoring group (standard, 2.1 ± 0.8, vs. minimal, 1.7 ± 0.9; P < .01). Although minimal monitoring had higher loss to follow-up rates (standard, 7.1%, vs. minimal, 18.2%; P = 0.06), the modified intention-to-treat analysis showed no differences in sustained virologic response (SVR) between standard and minimal monitoring approaches (standard, 98.1%, n = 51, vs. minimal, 95.3%, n = 60; P = 0.41).

Conclusions

This single-center retrospective cohort study demonstrated that minimal monitoring during HCV treatment was as effective in achieving SVR cure rates as standard monitoring. Eliminating required in-person clinic visits during DAA therapy alongside a collaborative approach may play a major role in overcoming barriers to HCV care in select patients.
背景:高效的直接作用抗病毒(DAA)疗法改变了丙型肝炎病毒(HCV)治疗的格局。然而,关于在 HCV 治疗过程中需要亲自到诊所就诊(标准监测)与完全远程医疗诊所就诊(最低监测)的疗效和安全性的数据仍然有限,这可能会延迟实践的采用:本研究旨在评估在 DAA 治疗期间,采用标准监测与最低监测方法治疗 12 周后持续病毒载量(SVR12)中检测不到 HCV RNA 的比率:在2020年1月5日至2021年3月4日期间,对接受DAA治疗的HCV感染成人进行了为期12个月的单中心回顾性队列研究。标准监测组在 DAA 治疗期间进行了 1 次以上的亲自门诊,并进行了 HCV RNA 实验室监测。最低监测组在治疗期间只进行了一次远程医疗就诊,未进行 HCV RNA 实验室监测。在整个 DAA 治疗期间,两组均接受临床药剂师和护士护理协调员的电话联系。主要结果是 SVR12:2020年5月至2021年4月,133名HCV患者符合纳入标准,接受了DAA治疗(标准组n=56;最小组:n=77),基线人口统计学无差异。总体而言,在 DAA 治疗期间,标准监测组的总就诊次数仍明显高于最低监测组(标准:2.1 ± 0.8;最低监测组:1.7 ± 0.9;P 结论:这是一项单中心回顾性队列研究:这项单中心回顾性队列研究表明,HCV 治疗期间的最低监测与标准监测一样,能有效实现 SVR 治愈率。在 DAA 治疗过程中取消所需的亲临诊所就诊,同时采取合作方法,可能会在克服特定患者接受 HCV 治疗的障碍方面发挥重要作用。
{"title":"Single-center retrospective review of standard versus minimal monitoring for hepatitis C direct-acting antiviral therapy","authors":"Anita Yang,&nbsp;Neel Swamy,&nbsp;Jane Giang","doi":"10.1016/j.japh.2024.102265","DOIUrl":"10.1016/j.japh.2024.102265","url":null,"abstract":"<div><h3>Background</h3><div>Highly effective direct-acting antiviral (DAA) therapies have transformed the landscape of hepatitis C virus (HCV) treatment. However, there continues to be limited data regarding the efficacy and safety of required in-person clinic visits (standard monitoring) versus completely telehealth clinic visits (minimal monitoring) during HCV therapy, which could delay practice adoption.</div></div><div><h3>Objectives</h3><div>This study aimed to assess the rates of undetectable HCV ribonucleic acid (RNA) in sustained viral load 12 weeks after therapy (SVR12) in standard versus minimal monitoring approaches during DAA.</div></div><div><h3>Methods</h3><div>A 12-month, single-center retrospective cohort study was conducted in treatment-naïve HCV-infected adults who received DAA therapy between May 1, 2020, and April 30, 2021. The standard monitoring group had ≥1 in-person clinic visit with HCV RNA laboratory monitoring during DAA treatment. The minimal monitoring group had entirely telehealth visits without HCV RNA laboratory monitoring during treatment. Both groups received telephonic touchpoints throughout DAA treatment from a clinical pharmacist practitioner and a nurse care coordinator. The primary outcome was SVR12.</div></div><div><h3>Results</h3><div>From May 2020 to April 2021, 133 patients with HCV met inclusion criteria and were treated with DAA (standard, n = 56; minimal, n = 77), with no differences in baseline demographics. Overall, total encounters during DAA treatment remained statistically significant in the standard than minimal monitoring group (standard, 2.1 ± 0.8, vs. minimal, 1.7 ± 0.9; <em>P</em> &lt; .01). Although minimal monitoring had higher loss to follow-up rates (standard, 7.1%, vs. minimal, 18.2%; <em>P</em> = 0.06), the modified intention-to-treat analysis showed no differences in sustained virologic response (SVR) between standard and minimal monitoring approaches (standard, 98.1%, n = 51, vs. minimal, 95.3%, n = 60; <em>P</em> = 0.41).</div></div><div><h3>Conclusions</h3><div>This single-center retrospective cohort study demonstrated that minimal monitoring during HCV treatment was as effective in achieving SVR cure rates as standard monitoring. Eliminating required in-person clinic visits during DAA therapy alongside a collaborative approach may play a major role in overcoming barriers to HCV care in select patients.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 1","pages":"Article 102265"},"PeriodicalIF":2.5,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142479219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Complexity of patient encounters within a clinically integrated community pharmacy network Medicaid payer program 临床综合社区药房网络医疗保险付款人计划中患者就诊的复杂性。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-11 DOI: 10.1016/j.japh.2024.102264
Joni C. Carroll, Katie Doong , Sneha Mitra , Melissa Somma McGivney, Stephanie Harriman McGrath, Kim C. Coley

Background

Community pharmacists frequently care for patients with complex medical and social needs; however, specific evidence on pharmacist perceptions of what makes a patient encounter complex has not been clearly characterized. There is a need to better understand specific factors that contribute to patient encounter complexity and demonstrate how pharmacists in community settings care for these individuals.

Objectives

The objectives of this programmatic case study were to: (1) elucidate factors that contributed to patient encounter complexity as a part of a Medicaid Managed Care Organization comprehensive medication management payer program in community pharmacies and (2) curate a series of patient case vignettes that provide evidence of pharmacists care for patients with complex medical and social needs within community pharmacies.

Methods

This qualitative programmatic case study utilized data from semi-structured interviews with community pharmacists who provided comprehensive medication management services to Medicaid patients in Pennsylvania. Pharmacists described their most complex patient encounter. Interviews were transcribed and independently coded by 2 investigators. The coded texts were grouped into categories, and a cross-case inductive thematic analysis was performed to identify complexity factors.

Results

Thirty pharmacists provided 48 patient case vignettes and 3 complexity factors emerged: (1) care coordination; (2) behavioral health support; and (3) social determinants of health. Representative patient case vignettes were selected to illustrate these factors.

Conclusion

Pharmacists, who participated in a community pharmacy Medicaid Managed Care Organization payer program, provided care to patients with complex health needs. In addition to medication-related problems, specific factors that increased pharmacist perception of encounter complexity were care coordination with other health care providers, behavioral health support, and addressing social determinants of health.
背景:社区药剂师经常为具有复杂医疗和社会需求的患者提供护理服务;然而,药剂师对患者就医复杂性的具体看法还没有明确的证据。我们需要更好地了解导致患者就医复杂性的具体因素,并展示社区药剂师是如何护理这些患者的:本计划案例研究的目标是(1) 阐明导致患者就医复杂性的因素,这些因素是社区药房中医疗补助管理性护理组织综合药物管理付款人计划的一部分;(2) 收集一系列患者案例,为药剂师在社区药房中护理具有复杂医疗和社会需求的患者提供证据:这项定性的项目案例研究利用了半结构化访谈的数据,访谈对象是为宾夕法尼亚州医疗补助计划患者提供综合药物管理服务的社区药剂师。药剂师描述了他们遇到的最复杂的病人。访谈内容由两名研究人员转录并独立编码。对编码文本进行分类,并进行跨病例归纳主题分析,以确定复杂性因素:30 位药剂师提供了 48 个患者案例,从中发现了三个复杂因素:(1)护理协调;(2)行为健康支持;(3)健康的社会决定因素。我们选择了具有代表性的患者案例来说明这些因素:参与社区药房医疗补助 MCO 付款人计划的药剂师为有复杂健康需求的患者提供了护理服务。除了与药物相关的问题外,增加药剂师对就诊复杂性认识的具体因素还包括与其他医疗服务提供者的护理协调、行为健康支持以及解决健康的社会决定因素。
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引用次数: 0
The Public Health Informatics Fellowship Program: Training pharmacists as data detectives. 公共卫生信息学奖学金计划:培训药剂师成为数据侦探。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-11 DOI: 10.1016/j.japh.2024.102216
Sena Seged, Kevin Lan, Sonya Zhan, Jessica Eloso, Bradley Biggers, Roua El Kalach
{"title":"The Public Health Informatics Fellowship Program: Training pharmacists as data detectives.","authors":"Sena Seged, Kevin Lan, Sonya Zhan, Jessica Eloso, Bradley Biggers, Roua El Kalach","doi":"10.1016/j.japh.2024.102216","DOIUrl":"https://doi.org/10.1016/j.japh.2024.102216","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":" ","pages":"102216"},"PeriodicalIF":2.5,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A positive change in student positivity about pharmacy 学生对药剂学的积极态度发生了积极变化。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-09 DOI: 10.1016/j.japh.2024.102261
David Nau PhD, Karen L. Kier, Diego C. Avello
{"title":"A positive change in student positivity about pharmacy","authors":"David Nau PhD,&nbsp;Karen L. Kier,&nbsp;Diego C. Avello","doi":"10.1016/j.japh.2024.102261","DOIUrl":"10.1016/j.japh.2024.102261","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 1","pages":"Article 102261"},"PeriodicalIF":2.5,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142401786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predisposing, enabling, and need factors influencing health-related quality of life among people with metabolic syndrome 影响代谢综合征患者健康相关生活质量的诱因、促成因素和需求因素。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-08 DOI: 10.1016/j.japh.2024.102255
Olajide A. Adekunle, Yun S. Wang, Ismaeel Yunusa, Marc L. Fleming, Enrique Seoane-Vazquez, Lawrence M. Brown

Background

Metabolic syndrome (MetS) continues to impact the health-related quality of life (HRQoL) of patients despite various available therapeutic interventions. There is a dearth of information on how patient-centered factors holistically predict HRQoL to provide more insights on addressing MetS.

Objective

To predict the HRQoL of patients with MetS in the Southern states, using the predisposing, enabling, and need factors.

Methods

The study adopted a cross-sectional approach in collecting 706 complete surveys on HRQoL assessment using the EQ-5D-5L survey and demographic characteristics based on the predisposing, enabling, and need factors of Andersen’s Behavioral model. The study focused on people with MetS in the southern states of the United States. Multinomial logistic regression was conducted to investigate the relationship between the number of comorbidities and each HRQoL dimension. Ordinal regression was used to explore factors predicting HRQoL. Sensitivity analysis was conducted using bootstrapping analysis to evaluate the regression’s robustness.

Results

Over 70% were females and 30% had at least a bachelor's degree, while 47% were married. Most respondents (71.1%) had no problem with self-care. However, 20.0% had severe problems with pain, while the highest proportion (8.6%) was observed for extreme problems with anxiety or depression. A unit increase in comorbidities resulted in higher odds of having extreme problems with mobility (odds ratio [OR] = 1.95), usual activities (OR = 1.73), and pain (OR = 1.70). Only 40.8% of the respondents had good HRQoL, compared to 26.2% with poor HRQoL. Age, race, geographical area, marital status, household income, number of prescription drugs, comorbidities, and body mass index were predictors of HRQoL.

Conclusion

An increase in comorbidities significantly increased the odds of having challenges with the HRQoL dimensions. Demographic, socioeconomic, and health-related factors significantly predicted HRQoL. Therefore, health care providers must consider these factors as a component of patient-centered care to address health disparities and promote optimal health outcomes among people with MetS.
简介尽管有各种治疗干预措施,代谢综合征(MetS)仍然影响着患者的健康相关生活质量(HRQoL)。以患者为中心的因素如何全面预测 HRQoL,从而为解决 MetS 问题提供更多见解,这方面的信息十分匮乏:利用诱发因素、有利因素和需求因素预测南方各州 MetS 患者的 HRQoL:研究采用横断面方法,收集了 706 份完整的调查问卷,内容涉及使用 EQ-5D-5L 调查进行的 HRQoL 评估,以及基于安徒生行为模型的倾向因素、有利因素和需求因素的人口特征。研究主要针对美国南部各州的 MetS 患者。研究采用多项式逻辑回归法调查合并症数量与各 HRQoL 维度之间的关系。顺序回归用于探究预测 HRQoL 的因素。采用引导分析法进行了敏感性分析,以评估回归的稳健性:超过 70% 的受访者为女性,30% 的受访者至少拥有学士学位,47% 的受访者已婚。大多数受访者(71.1%)在生活自理方面没有问题。然而,20.0%的受访者有严重的疼痛问题,而焦虑或抑郁的极端问题比例最高(8.6%)。合并症每增加一个单位,行动(OR = 1.95)、日常活动(OR = 1.73)和疼痛(OR = 1.70)方面出现极端问题的几率就会增加。只有 40.8% 的受访者具有良好的 HRQoL,而 26.2% 的受访者具有较差的 HRQoL。年龄、种族、地理区域、婚姻状况、家庭收入、处方药数量、合并症和体重指数是预测 HRQoL 的因素:结论:合并症的增加会显著增加在 HRQoL 方面遇到挑战的几率。人口、社会经济和健康相关因素对 HRQoL 有明显的预测作用。因此,医疗服务提供者必须考虑这些因素,将其作为以患者为中心的医疗服务的一个组成部分,以解决健康差异并促进 MetS 患者获得最佳健康结果。
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引用次数: 0
Implementing a letter template to expedite specialty medication appeal letter submission 实施信件模板,加快专科用药上诉信的提交。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-05 DOI: 10.1016/j.japh.2024.102262
Jessica Fann, Miranda Kozlicki, Kristen Whelchel

Background

Prior authorizations (PAs) for biologic medications, used to treat inflammatory bowel disease (IBD), are often denied by pharmacy benefits managers and can require a complex appeal process for patients to gain access to medication.

Objective

This quality improvement project evaluated the impact of implementing a standardized appeal letter template and customizable clinical rationale letter content on specialty pharmacist workflow and workload in an integrated hospital health system specialty pharmacy (HSSP) IBD clinic.

Practice description

This initiative was conducted in an IBD outpatient clinic at a tertiary academic medical center with an integrated HSSP whose specialty pharmacists work collaboratively with providers to manage specialty medications.

Practice innovation

A letter template was created in the electronic health record (EHR) for pharmacists to use when submitting appeal letters. The template automatically populates patient results from recent labs, imaging, and clinic visit notes as part of the appeal documentation. Clinical rationale letter content was developed for the most common appeal reasons using EHR functionality that allows the creation of standardized notes that can be shared among team members and customized at time of use.

Evaluation method

An analysis of 2 months of data preimplementation/postimplementation was conducted using descriptive statistics to report the number of appeals submitted, time from PA denial to appeal submission, and appeal approval rate. A pharmacist postimplementation satisfaction score was also collected.

Results

The number of appeals submitted preimplementation (n = 73) and postimplementation (n = 73) was the same. Postimplementation, 89% of appeals were submitted within 3 days of PA denial compared to 29% preimplementation. PA approval rate was high (93%) preimplementation and postimplementation. Overall pharmacist satisfaction was 9.7 out of 10.

Conclusion

Implementation of an appeal letter template and standardized clinical rationale letter content in the EHR led to decreased time to appeal submission and high specialty pharmacist satisfaction.
背景:用于治疗炎症性肠病(IBD)的生物制剂药物的优先授权(PA)经常被药房福利管理机构拒绝,患者需要经过复杂的上诉程序才能获得药物:本质量改进项目评估了在综合医院医疗系统专科药房(HSSP)IBD 诊所实施标准化上诉信模板和可定制临床理由书内容对专科药师工作流程和工作量的影响:这一举措是在一家拥有综合 HSSP 的三级学术医疗中心的 IBD 门诊中实施的,该中心的专科药师与医疗服务提供者合作管理专科药物:实践创新:在电子病历 (EHR) 中创建了一个信函模板,供药剂师在提交上诉信函时使用。该模板会自动将患者最近的化验、影像和门诊记录结果作为上诉文件的一部分。临床理由书的内容是针对最常见的上诉理由开发的,使用了 EHR 功能,可以创建标准化的说明,供团队成员共享,并在使用时进行定制:评估方法:使用描述性统计对实施前后两个月的数据进行分析,报告提交的上诉数量、从 PA 拒绝到上诉提交的时间以及上诉批准率。此外,还收集了药剂师在实施后的满意度评分:结果:实施前(73 人)和实施后(73 人)提交的上诉数量相同。与实施前的 29% 相比,实施后 89% 的上诉是在 PA 被拒绝后 3 天内提交的。PA 批准率在实施前和实施后都很高(93%)。药剂师的总体满意度为 9.7(满分 10 分):结论:在电子病历中实施上诉信模板和标准化临床理由信内容,缩短了提交上诉的时间,并提高了专科药剂师的满意度。
{"title":"Implementing a letter template to expedite specialty medication appeal letter submission","authors":"Jessica Fann,&nbsp;Miranda Kozlicki,&nbsp;Kristen Whelchel","doi":"10.1016/j.japh.2024.102262","DOIUrl":"10.1016/j.japh.2024.102262","url":null,"abstract":"<div><h3>Background</h3><div>Prior authorizations (PAs) for biologic medications, used to treat inflammatory bowel disease (IBD), are often denied by pharmacy benefits managers and can require a complex appeal process for patients to gain access to medication.</div></div><div><h3>Objective</h3><div>This quality improvement project evaluated the impact of implementing a standardized appeal letter template and customizable clinical rationale letter content on specialty pharmacist workflow and workload in an integrated hospital health system specialty pharmacy (HSSP) IBD clinic.</div></div><div><h3>Practice description</h3><div>This initiative was conducted in an IBD outpatient clinic at a tertiary academic medical center with an integrated HSSP whose specialty pharmacists work collaboratively with providers to manage specialty medications.</div></div><div><h3>Practice innovation</h3><div>A letter template was created in the electronic health record (EHR) for pharmacists to use when submitting appeal letters. The template automatically populates patient results from recent labs, imaging, and clinic visit notes as part of the appeal documentation. Clinical rationale letter content was developed for the most common appeal reasons using EHR functionality that allows the creation of standardized notes that can be shared among team members and customized at time of use.</div></div><div><h3>Evaluation method</h3><div>An analysis of 2 months of data preimplementation/postimplementation was conducted using descriptive statistics to report the number of appeals submitted, time from PA denial to appeal submission, and appeal approval rate. A pharmacist postimplementation satisfaction score was also collected.</div></div><div><h3>Results</h3><div>The number of appeals submitted preimplementation (n = 73) and postimplementation (n = 73) was the same. Postimplementation, 89% of appeals were submitted within 3 days of PA denial compared to 29% preimplementation. PA approval rate was high (93%) preimplementation and postimplementation. Overall pharmacist satisfaction was 9.7 out of 10.</div></div><div><h3>Conclusion</h3><div>Implementation of an appeal letter template and standardized clinical rationale letter content in the EHR led to decreased time to appeal submission and high specialty pharmacist satisfaction.</div></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":"65 1","pages":"Article 102262"},"PeriodicalIF":2.5,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Assessing student and patient perspectives on pharmacist-prescribed hormonal contraceptives 评估学生和患者对药剂师处方荷尔蒙避孕药的看法。
IF 2.5 4区 医学 Q3 PHARMACOLOGY & PHARMACY Pub Date : 2024-10-03 DOI: 10.1016/j.japh.2024.102259
Virginia Lemay PharmD, Audrey Whalen PharmD, Lisa Cohen PharmD, Jeffrey Bratberg PharmD

Background

Increasing convenient, accessible, and cost effective contraceptive access is critically important. Two-thirds of U.S. states permit pharmacists to prescribe hormonal contraceptives. Community pharmacies are ideal settings for patients to be offered contraceptive therapeutic options, including hormonal contraceptives, emergency contraception (EC), and over-the-counter (OTC) oral contraception.

Objective

The objective of this study was to assess college student and community pharmacy patients’ perspectives on pharmacist-prescribed hormonal contraceptives, likelihood of accessing contraceptives from a pharmacist, and perspectives regarding EC and OTC oral contraception.

Methods

The researchers conducted an observational study distributed to college students and patients accessing care at community-based pharmacies from October 2022 to February 2023. The survey population included those who were 18 years or older, English speaking, and recruited both in person and online. Survey questions assessed barriers to contraception access, perspectives toward pharmacist-prescribed hormonal contraception, likelihood of receiving pharmacist-prescribed hormonal contraception, as well as EC and OTC oral contraception at the community pharmacy. Results from the pharmacist and clinician surveys were previously published, therefore this report will focus on the student and patient data.

Results

Ninety-one percent of all respondents strongly agreed or agreed with pharmacist-prescribed hormonal contraception. Students and patients reported convenience, time-saving, and money saving as reasons for obtaining from their pharmacist. In regard to EC, 36% reported having ever purchased from a pharmacy and 58% were extremely or somewhat likely to purchase OTC oral contraception.

Conclusions

The majority of students and community pharmacy patients surveyed in Rhode Island support pharmacist-prescribed hormonal contraceptives. State-level policy advancements with reimbursement for services provide pharmacists an opportunity to provide contraceptive care for all people.
背景:提高避孕药具的便利性、可及性和成本效益至关重要。美国三分之二的州允许药剂师开具荷尔蒙避孕药具处方。社区药房是为患者提供避孕治疗选择的理想场所,包括激素避孕药、紧急避孕药(EC)和非处方(OTC)口服避孕药:本研究旨在评估大学生和社区药房患者对药剂师处方激素避孕药的看法、从药剂师处获得避孕药的可能性以及对紧急避孕药和非处方口服避孕药的看法:研究人员在 2022 年 10 月至 2023 年 2 月期间开展了一项观察性研究,调查对象是在社区药房就医的大学生和患者。调查对象包括年满 18 周岁、会讲英语的人,并同时进行了面谈和在线调查。调查问题评估了获得避孕药具的障碍、对药剂师处方激素避孕药具的看法、在社区药房接受药剂师处方激素避孕药具以及EC和OTC口服避孕药具的可能性。药剂师和临床医生的调查结果已于之前公布,因此本报告将重点关注学生和患者的数据:91%的受访者非常同意或同意药剂师开具激素避孕处方。学生和患者表示,方便、省时和省钱是他们从药剂师处获得避孕药具的原因。关于避孕药具,36% 的受访者表示曾在药店购买过,58% 的受访者表示极有可能或有点可能购买非处方药口服避孕药:结论:在罗德岛州接受调查的大多数学生和社区药房患者都支持药剂师处方激素避孕药。州一级的政策进步与服务补偿为药剂师提供了为所有人提供避孕护理的机会。
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引用次数: 0
期刊
Journal of the American Pharmacists Association
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