Pub Date : 2024-06-22DOI: 10.1016/j.japh.2024.102147
Background
The role of pharmacists in tobacco cessation has grown substantially in recent years, now including the ability to prescribe medications in many states. Although pharmacists can fill a gap in care by helping patients quit, other clinicians’ perceptions regarding referring patients to pharmacists for these services have not been described.
Objective
To characterize clinicians’ current referral patterns to pharmacists for tobacco cessation services, intention to refer in the future, and perceived barriers to and facilitators of referrals.
Methods
A cross-sectional survey was administered within a network of federally qualified health centers (FQHCs), which provides care to underserved patients. Guided by the Consolidated Framework for Implementation Research (CFIR), the survey assessed (a) clinicians’ sociodemographics, (b) interactions with pharmacists and referral practices, and (c) perceived barriers to and facilitators of patient referrals to network pharmacists for cessation assistance.
Results
Of 51 respondents (80% response), one third (n=17) reported referring one or more patients to a FQHC network pharmacist in the past for help with quitting tobacco. Most (84%) reported willingness to refer patients to pharmacists in the future, and 100% of the 17 clinicians who had previously referred patients strongly agreed that they would refer again in the future. For 8 of 12 CFIR measures (67%), significant differences were observed between clinicians who had previously referred patients to pharmacists and clinicians who had not.
Conclusion
Nonpharmacist clinicians in an FQHC expressed positive views toward a pharmacist-led tobacco cessation service, and prior experience with referrals was consistent with strong intentions for future referrals. Future studies should explore concerns regarding impact on workflow to identify and implement strategies for streamlining referrals for cessation services.
{"title":"Clinician attitudes toward referring patients to pharmacists for tobacco cessation services","authors":"","doi":"10.1016/j.japh.2024.102147","DOIUrl":"10.1016/j.japh.2024.102147","url":null,"abstract":"<div><h3>Background</h3><p>The role of pharmacists in tobacco cessation has grown substantially in recent years, now including the ability to prescribe medications in many states. Although pharmacists can fill a gap in care by helping patients quit, other clinicians’ perceptions regarding referring patients to pharmacists for these services have not been described.</p></div><div><h3>Objective</h3><p>To characterize clinicians’ current referral patterns to pharmacists for tobacco cessation services, intention to refer in the future, and perceived barriers to and facilitators of referrals.</p></div><div><h3>Methods</h3><p>A cross-sectional survey was administered within a network of federally qualified health centers (FQHCs), which provides care to underserved patients. Guided by the Consolidated Framework for Implementation Research (CFIR), the survey assessed (a) clinicians’ sociodemographics, (b) interactions with pharmacists and referral practices, and (c) perceived barriers to and facilitators of patient referrals to network pharmacists for cessation assistance.</p></div><div><h3>Results</h3><p>Of 51 respondents (80% response), one third (n=17) reported referring one or more patients to a FQHC network pharmacist in the past for help with quitting tobacco. Most (84%) reported willingness to refer patients to pharmacists in the future, and 100% of the 17 clinicians who had previously referred patients strongly agreed that they would refer again in the future. For 8 of 12 CFIR measures (67%), significant differences were observed between clinicians who had previously referred patients to pharmacists and clinicians who had not.</p></div><div><h3>Conclusion</h3><p>Nonpharmacist clinicians in an FQHC expressed positive views toward a pharmacist-led tobacco cessation service, and prior experience with referrals was consistent with strong intentions for future referrals. Future studies should explore concerns regarding impact on workflow to identify and implement strategies for streamlining referrals for cessation services.</p></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447482","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}
Background: Fentanyl test strips (FTS) are used to detect the presence of fentanyl in other substances, but Alabama pharmacists' opinions regarding FTS provision are unknown.
Objective: The purpose of this study was to assess the knowledge and perceptions of Alabama pharmacists regarding FTS and factors influencing pharmacists' FTS provision intentions across community pharmacy locations and types.
Methods: An anonymous cross-sectional survey was distributed via email to Alabama pharmacists employed in community (retail) pharmacies. The survey consisted of multiple-choice questions and 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree) informed by the Theory of Planned Behavior. Primary outcome measures included: knowledge; general attitudes; perceived benefits; perceived barriers; self-efficacy; subjective norms; perceived behavioral control (PBC); and intention regarding FTS provision. Outcomes were characterized using descriptive statistics and differences in scales scores across pharmacy locations (rural vs. urban) and types (corporately-vs. independently-owned) were assessed using Mann-Whitney U tests. Predictors of FTS provision intentions were evaluated using multiple linear regression (alpha=0.05).
Results: Respondents (N = 131; 3.82% response rate) were mostly female (64%) and Caucasian (92%). No respondents stocked FTS at their pharmacy and knowledge about FTS was low (mean[SD] knowledge score: 58.7% [15.1]). Despite the existence of perceived barriers (mean [SD] scale score: 3.2 [0.6]), pharmacists' general attitudes (3.4 [0.5]), perceived benefits (3.7 [0.6]), self-efficacy (3.1 [0.8]), and intentions (3.2[0.7]) were positive. While subjective norms were positive (3.5[0.6]), PBC over FTS decision-making was negative (2.7[0.8]). Subjective norms were higher (P = 0.040) and PBC was lower (P < 0.001) amongst corporately-versus independently-owned pharmacies, but no differences existed between rural and urban locations for any measures. Additionally, perceived benefits (β=0.342, P = 0.002), PBC (β = 0.133, P = 0.045), and self-efficacy (β = 0.142, P = 0.034) were positive predictors and perceived barriers (β = -0.211, P = 0.029) was a negative predictor of intention.
Conclusion: Alabama community pharmacists have positive attitudes regarding FTS, but future research should focus on strategies to increase PBC and overcome perceived barriers.
{"title":"Alabama community pharmacists' knowledge and perceptions regarding fentanyl test strips: A cross-sectional survey.","authors":"Shannon Woods, Erin Blythe, Giovanna Valle-Ramos, Jessica Richardson, Karen Pham, Kavon Diggs, Klaudia Harris, Yi Zhao, Lindsey Hohmann","doi":"10.1016/j.japh.2024.102148","DOIUrl":"10.1016/j.japh.2024.102148","url":null,"abstract":"<p><strong>Background: </strong>Fentanyl test strips (FTS) are used to detect the presence of fentanyl in other substances, but Alabama pharmacists' opinions regarding FTS provision are unknown.</p><p><strong>Objective: </strong>The purpose of this study was to assess the knowledge and perceptions of Alabama pharmacists regarding FTS and factors influencing pharmacists' FTS provision intentions across community pharmacy locations and types.</p><p><strong>Methods: </strong>An anonymous cross-sectional survey was distributed via email to Alabama pharmacists employed in community (retail) pharmacies. The survey consisted of multiple-choice questions and 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree) informed by the Theory of Planned Behavior. Primary outcome measures included: knowledge; general attitudes; perceived benefits; perceived barriers; self-efficacy; subjective norms; perceived behavioral control (PBC); and intention regarding FTS provision. Outcomes were characterized using descriptive statistics and differences in scales scores across pharmacy locations (rural vs. urban) and types (corporately-vs. independently-owned) were assessed using Mann-Whitney U tests. Predictors of FTS provision intentions were evaluated using multiple linear regression (alpha=0.05).</p><p><strong>Results: </strong>Respondents (N = 131; 3.82% response rate) were mostly female (64%) and Caucasian (92%). No respondents stocked FTS at their pharmacy and knowledge about FTS was low (mean[SD] knowledge score: 58.7% [15.1]). Despite the existence of perceived barriers (mean [SD] scale score: 3.2 [0.6]), pharmacists' general attitudes (3.4 [0.5]), perceived benefits (3.7 [0.6]), self-efficacy (3.1 [0.8]), and intentions (3.2[0.7]) were positive. While subjective norms were positive (3.5[0.6]), PBC over FTS decision-making was negative (2.7[0.8]). Subjective norms were higher (P = 0.040) and PBC was lower (P < 0.001) amongst corporately-versus independently-owned pharmacies, but no differences existed between rural and urban locations for any measures. Additionally, perceived benefits (β=0.342, P = 0.002), PBC (β = 0.133, P = 0.045), and self-efficacy (β = 0.142, P = 0.034) were positive predictors and perceived barriers (β = -0.211, P = 0.029) was a negative predictor of intention.</p><p><strong>Conclusion: </strong>Alabama community pharmacists have positive attitudes regarding FTS, but future research should focus on strategies to increase PBC and overcome perceived barriers.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447481","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}
Pub Date : 2024-06-06DOI: 10.1016/j.japh.2024.102137
Raechel T White, Kevin Cowart, Nicholas W Carris
{"title":"Ambulatory care pharmacy specialty training.","authors":"Raechel T White, Kevin Cowart, Nicholas W Carris","doi":"10.1016/j.japh.2024.102137","DOIUrl":"10.1016/j.japh.2024.102137","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288830","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}
Pub Date : 2024-06-06DOI: 10.1016/j.japh.2024.102136
Devin Lavender, Chelsea A Keedy
{"title":"In a time of advocating for continued advancement of pharmacy practice, why advocate for less specialization?","authors":"Devin Lavender, Chelsea A Keedy","doi":"10.1016/j.japh.2024.102136","DOIUrl":"10.1016/j.japh.2024.102136","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288832","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}
Pub Date : 2024-06-06DOI: 10.1016/j.japh.2024.102145
Prajakta H. Waghmare, Chien-Yu Huang, Heather A. Jaynes, Wendy M. Green, Margie E. Snyder, Alan J. Zillich
Background
An appointment-based medication synchronization (ABMS) is a service whuch aligns patients’ chronic medications to a predetermined routine pickup date and includes a comprehensive medication review or other clinical appointment at the pharmacy.
Objective(s)
We compared healthcare utilization outcomes (outpatient, inpatient, emergency department visits, and pharmacy utilization) of Medicare beneficiaries enrolled in a med-sync program to beneficiaries not enrolled in such a program.
Methods
This retrospective cohort study included Medicare beneficiaries obtaining medications from pharmacies providing ABMS. All Medicare inpatient, outpatient, emergency, and pharmacy claims data from 2014 to 2016 obtained from the Research Data Assistance Center. These pharmacy claims were used to create med-sync (n = 13,193) and non–med-sync cohorts (n = 156,987). All patients were followed longitudinally for 12 months before and after a 2015 index or enrollment date. Baseline characteristics were used to create a logistic regression model for propensity score matching. A 1:1 greedy nearest neighbor matching algorithm was adapted for sequentially matching both cohorts. Difference in differences (DID) was used to compare mean changes in health care utilization outcomes (outpatient, inpatient, ED visits, and pharmacy utilization) between cohorts.
Results
After matching, 13,193 beneficiaries in each cohort were used for analysis. DIDs for mean of health care utilizations were statistically significantly lower in the med-sync cohort than the non–med-sync cohort for outpatient visits (DID 0.012, P = 0.0073) and pharmacy utilization (DID 0.013, P < 0.0001). There was not a statistically significant DID for inpatient and ED visits between cohorts.
Conclusion
Outpatient and pharmacy utilization changes were statistically significantly lower in the med-sync cohort than the non–med-sync cohort in the 12 months after enrollment. Lower pharmacy utilization could be caused by reducing duplicate prescriptions during synchronized refills or optimization of therapy during medication reviews if patients are enrolled in appointment-based model med-sync.
{"title":"Health care resource utilization in Medicare beneficiaries obtaining medication synchronization","authors":"Prajakta H. Waghmare, Chien-Yu Huang, Heather A. Jaynes, Wendy M. Green, Margie E. Snyder, Alan J. Zillich","doi":"10.1016/j.japh.2024.102145","DOIUrl":"10.1016/j.japh.2024.102145","url":null,"abstract":"<div><h3>Background</h3><p>An appointment-based medication synchronization (ABMS) is a service whuch aligns patients’ chronic medications to a predetermined routine pickup date and includes a comprehensive medication review or other clinical appointment at the pharmacy.</p></div><div><h3>Objective(s)</h3><p>We compared healthcare utilization outcomes (outpatient, inpatient, emergency department visits, and pharmacy utilization) of Medicare beneficiaries enrolled in a med-sync program to beneficiaries not enrolled in such a program.</p></div><div><h3>Methods</h3><p>This retrospective cohort study included Medicare beneficiaries obtaining medications from pharmacies providing ABMS. All Medicare inpatient, outpatient, emergency, and pharmacy claims data from 2014 to 2016 obtained from the Research Data Assistance Center. These pharmacy claims were used to create med-sync (n = 13,193) and non–med-sync cohorts (n = 156,987). All patients were followed longitudinally for 12 months before and after a 2015 index or enrollment date. Baseline characteristics were used to create a logistic regression model for propensity score matching. A 1:1 greedy nearest neighbor matching algorithm was adapted for sequentially matching both cohorts. Difference in differences (DID) was used to compare mean changes in health care utilization outcomes (outpatient, inpatient, ED visits, and pharmacy utilization) between cohorts.</p></div><div><h3>Results</h3><p>After matching, 13,193 beneficiaries in each cohort were used for analysis. DIDs for mean of health care utilizations were statistically significantly lower in the med-sync cohort than the non–med-sync cohort for outpatient visits (DID 0.012, <em>P</em> = 0.0073) and pharmacy utilization (DID 0.013, <em>P</em> < 0.0001). There was not a statistically significant DID for inpatient and ED visits between cohorts.</p></div><div><h3>Conclusion</h3><p>Outpatient and pharmacy utilization changes were statistically significantly lower in the med-sync cohort than the non–med-sync cohort in the 12 months after enrollment. Lower pharmacy utilization could be caused by reducing duplicate prescriptions during synchronized refills or optimization of therapy during medication reviews if patients are enrolled in appointment-based model med-sync.</p></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293910","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}
Pub Date : 2024-06-06DOI: 10.1016/j.japh.2024.102135
Jean Y Moon, Sarah M Westberg, Todd D Sorensen
{"title":"Reimagining the ambulatory care training pathway.","authors":"Jean Y Moon, Sarah M Westberg, Todd D Sorensen","doi":"10.1016/j.japh.2024.102135","DOIUrl":"10.1016/j.japh.2024.102135","url":null,"abstract":"","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288843","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}
Pub Date : 2024-06-05DOI: 10.1016/j.japh.2024.102144
William R. Doucette, Kaley Wolff, Kari Trapskin, Helene McDowell, David A. Mott, Randal P. McDonough
Background
Community-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use.
Objectives
To develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications.
Methods
Two different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses.
Results
The CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel.
Conclusion
Both pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.
{"title":"Pharmacist-community-based organization collaboration to address health-related social needs","authors":"William R. Doucette, Kaley Wolff, Kari Trapskin, Helene McDowell, David A. Mott, Randal P. McDonough","doi":"10.1016/j.japh.2024.102144","DOIUrl":"10.1016/j.japh.2024.102144","url":null,"abstract":"<div><h3>Background</h3><p>Community-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use.</p></div><div><h3>Objectives</h3><p>To develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications.</p></div><div><h3>Methods</h3><p>Two different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses.</p></div><div><h3>Results</h3><p>The CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel.</p></div><div><h3>Conclusion</h3><p>Both pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.</p></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288842","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}
Pub Date : 2024-06-05DOI: 10.1016/j.japh.2024.102142
Elizabeth G Schlosser, Leandro Llambi, Thomas J Hoffman, Ana L Hincapie
In 2020, we published a description of the newly implemented centralized refill service (CRS) led by pharmacy technicians in our large community health system. Since that time, the CRS has been refined, updated, and expanded. We have also received many inquiries with common questions about the process from those who seek to implement a similar process. The purpose of this commentary is to 1) provide updates to the process in the 5 years since its implementation, and 2) provide additional insights on specific topics from inquiries to the organization.
{"title":"Updates to a pharmacy-technician driven centralized medication refill service in a large community health system.","authors":"Elizabeth G Schlosser, Leandro Llambi, Thomas J Hoffman, Ana L Hincapie","doi":"10.1016/j.japh.2024.102142","DOIUrl":"10.1016/j.japh.2024.102142","url":null,"abstract":"<p><p>In 2020, we published a description of the newly implemented centralized refill service (CRS) led by pharmacy technicians in our large community health system. Since that time, the CRS has been refined, updated, and expanded. We have also received many inquiries with common questions about the process from those who seek to implement a similar process. The purpose of this commentary is to 1) provide updates to the process in the 5 years since its implementation, and 2) provide additional insights on specific topics from inquiries to the organization.</p>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288844","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}
Pub Date : 2024-06-05DOI: 10.1016/j.japh.2024.102143
Background
Initiation of pharmacy automation and automated dispensing cabinets (ADCs) in hospitals has been shown to improve clinical, operational, and economical outcomes. Implementation of ADCs in surgical areas has lagged behind that of traditional inpatient hospitals settings.
Objectives
To assess the documented impact of ADCs in ambulatory surgery centers (ASCs), perioperative, and surgical care areas.
Methods
A systematic literature review (SLR) was conducted in PubMed and Google Scholar in November 2022. The SLR was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original research studies were included if they reported empirical data on ADCs in ASCs, perioperative areas, and surgical settings. The search criteria consisted of site locations in North America or Europe, with articles written in English and published since 1992. Outcomes of the studies were categorized as medication errors, controlled substance discrepancies, inventory management, user experience, and cost effectiveness.
Results
A total of nine studies met the inclusion criteria. Six assessed ADC impact on controlled-substance inventory management, with all finding reductions in controlled-substance discrepancies ranging from 16% to 62.5%. Two studies showed a reduction in medication errors from 23% in 1 study and to up to 100% after ADC implementation in the other. Three studies revealed a positive impact on user experience, with a range of 81% to 100% of healthcare providers across these settings being satisfied with ADC usage. Only 1 study showed post-ADC implementation labor cost savings due to reduction in labor hours, but was based on data from 3 decades ago.
Conclusions
ADC implementation in surgical settings was found to decrease medication errors, reduce controlled-substance discrepancies, improve inventory management, enhance user experience, and reduce labor hours although the evidence consisted of smaller-scale studies. Larger-scale studies are needed to support these findings, thereby fostering a more comprehensive view of the multifactorial impact of ADCs in these settings.
{"title":"Appraising the clinical, operational, and economic impacts of automated medication dispensing cabinets in perioperative and surgical settings: A systematic literature review","authors":"","doi":"10.1016/j.japh.2024.102143","DOIUrl":"10.1016/j.japh.2024.102143","url":null,"abstract":"<div><h3>Background</h3><p>Initiation of pharmacy automation and automated dispensing cabinets (ADCs) in hospitals has been shown to improve clinical, operational, and economical outcomes. Implementation of ADCs in surgical areas has lagged behind that of traditional inpatient hospitals settings.</p></div><div><h3>Objectives</h3><p>To assess the documented impact of ADCs in ambulatory surgery centers (ASCs), perioperative, and surgical care areas.</p></div><div><h3>Methods</h3><p>A systematic literature review (SLR) was conducted in PubMed and Google Scholar in November 2022. The SLR was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Original research studies were included if they reported empirical data on ADCs in ASCs, perioperative areas, and surgical settings. The search criteria consisted of site locations in North America or Europe, with articles written in English and published since 1992. Outcomes of the studies were categorized as medication errors, controlled substance discrepancies, inventory management, user experience, and cost effectiveness.</p></div><div><h3>Results</h3><p>A total of nine studies met the inclusion criteria. Six assessed ADC impact on controlled-substance inventory management, with all finding reductions in controlled-substance discrepancies ranging from 16% to 62.5%. Two studies showed a reduction in medication errors from 23% in 1 study and to up to 100% after ADC implementation in the other. Three studies revealed a positive impact on user experience, with a range of 81% to 100% of healthcare providers across these settings being satisfied with ADC usage. Only 1 study showed post-ADC implementation labor cost savings due to reduction in labor hours, but was based on data from 3 decades ago.</p></div><div><h3>Conclusions</h3><p>ADC implementation in surgical settings was found to decrease medication errors, reduce controlled-substance discrepancies, improve inventory management, enhance user experience, and reduce labor hours although the evidence consisted of smaller-scale studies. Larger-scale studies are needed to support these findings, thereby fostering a more comprehensive view of the multifactorial impact of ADCs in these settings.</p></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141288831","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}
Pub Date : 2024-06-04DOI: 10.1016/j.japh.2024.102141
Background
Multiple Myeloma (MM) is a chronic and incurable hematologic malignancy that is prevalent among the elderly. Interprofessional patient care showed superiority over physician-only care in multiple settings, including MM.
Objective
The primary objective of this study was to evaluate the impact of clinical pharmacist (CP)-led clinic and CPs interventions on MM patient care.
Practice Description
Real-world analysis of ambulatory patients with MM showed that CPs were central to the optimization of therapy and adherence to treatment schedules and supportive medications.
Practice Innovation
The CP-led MM Clinic was established with a collaborative prescribing agreement (CPA) in 2022 at the National Center for Cancer Care and Research in Qatar and was the first of its kind in the Middle East and North Africa region. This CPA allowed CPs to issue refills for supportive medications and order required laboratory tests.
Evaluation Methods
Data collected included the number of CP interventions, refills ordered by CPs, documentation of patient education, and medication reconciliations. The data were retrospectively collected and analyzed comparing ambulatory patients with MM treated before (2021) to those treated after the clinic implementation in 2022.
Results
The study population comprised 22 patients. A higher number of CPs interventions were documented post-clinic than preclinic (343 vs. 76, P = 0.004), with earlier initiation of bisphosphonate post-clinic (25 vs. 206 days, P = 0.008). There were also significant improvements in the introduction of risk appropriate venous thromboembolism prophylaxis (43% vs. 6%, P = 0.001) as well as vitamin D and calcium supplementation (100% vs. 68%, P = 0.02) post-clinic. Twenty-two medication refills for supportive medications and eight prechemotherapy laboratory investigations were ordered by CPs.
Conclusion
The CP-led clinic provided a timely link to care optimization for ambulatory MM patients. This innovative CPA model implemented in the clinic could potentially be applied to different cancer settings to optimize safe and effective patient care.
背景：多发性骨髓瘤（MM多发性骨髓瘤（MM）是一种慢性、无法治愈的血液系统恶性肿瘤，在老年人中很普遍。在包括多发性骨髓瘤在内的多种情况下，跨专业患者护理优于单纯的医生护理：本研究的主要目的是评估 CP 领导的诊所和 CPs 干预措施对 MM 患者护理的影响：对非住院 MM 患者进行的真实世界分析表明，临床药师（CPs）在优化治疗、遵守治疗计划和辅助用药方面发挥着核心作用：2022年，卡塔尔国家癌症护理和研究中心（NCCCR）通过合作处方协议（CPA）建立了由临床药师领导的MM诊所，这在中东和北非地区尚属首例。该 CPA 允许 CP 开具支持性药物的补充处方，并开具所需的实验室检查单：收集的数据包括 CP 干预的次数、CP 下达的补药指令、患者教育记录和药物对账。这些数据是通过回顾性收集和分析的，并将 2021 年之前治疗的非住院 MM 患者与 2022 年诊所实施后治疗的患者进行了比较：研究对象包括 20 名患者。门诊后记录的 CPs 干预次数高于门诊前（343 对 76，P=0.004），门诊后更早开始使用双膦酸盐（25 对 206 天，P=0.008）。此外，在诊疗后采用风险适当的静脉血栓栓塞症（VTE）预防措施（43% 对 6%，P=0.001）以及维生素 D 和钙补充剂（100% 对 68%，P=0.02）方面也有明显改善。由 CP 下达的支持性药物补充通知有 22 份，化疗前实验室检查有 8 份：由 CP 领导的门诊为非卧床 MM 患者提供了及时的护理优化链接。该诊所实施的这一创新 CPA 模式有可能应用于不同的癌症治疗环境，以优化安全有效的患者护理。
{"title":"Establishment of a clinical pharmacist-led multiple myeloma clinic with collaborative prescribing model at the national center for cancer care and research in Qatar","authors":"","doi":"10.1016/j.japh.2024.102141","DOIUrl":"10.1016/j.japh.2024.102141","url":null,"abstract":"<div><h3>Background</h3><p>Multiple Myeloma (MM) is a chronic and incurable hematologic malignancy that is prevalent among the elderly. Interprofessional patient care showed superiority over physician-only care in multiple settings, including MM.</p></div><div><h3>Objective</h3><p>The primary objective of this study was to evaluate the impact of clinical pharmacist (CP)-led clinic and CPs interventions on MM patient care.</p></div><div><h3>Practice Description</h3><p>Real-world analysis of ambulatory patients with MM showed that CPs were central to the optimization of therapy and adherence to treatment schedules and supportive medications.</p></div><div><h3>Practice Innovation</h3><p>The CP-led MM Clinic was established with a collaborative prescribing agreement (CPA) in 2022 at the National Center for Cancer Care and Research in Qatar and was the first of its kind in the Middle East and North Africa region. This CPA allowed CPs to issue refills for supportive medications and order required laboratory tests.</p></div><div><h3>Evaluation Methods</h3><p>Data collected included the number of CP interventions, refills ordered by CPs, documentation of patient education, and medication reconciliations. The data were retrospectively collected and analyzed comparing ambulatory patients with MM treated before (2021) to those treated after the clinic implementation in 2022.</p></div><div><h3>Results</h3><p>The study population comprised 22 patients. A higher number of CPs interventions were documented post-clinic than preclinic (343 vs. 76, <em>P</em> = 0.004), with earlier initiation of bisphosphonate post-clinic (25 vs. 206 days, <em>P</em> = 0.008). There were also significant improvements in the introduction of risk appropriate venous thromboembolism prophylaxis (43% vs. 6%, <em>P</em> = 0.001) as well as vitamin D and calcium supplementation (100% vs. 68%, <em>P</em> = 0.02) post-clinic. Twenty-two medication refills for supportive medications and eight prechemotherapy laboratory investigations were ordered by CPs.</p></div><div><h3>Conclusion</h3><p>The CP-led clinic provided a timely link to care optimization for ambulatory MM patients. This innovative CPA model implemented in the clinic could potentially be applied to different cancer settings to optimize safe and effective patient care.</p></div>","PeriodicalId":50015,"journal":{"name":"Journal of the American Pharmacists Association","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1544319124001614/pdfft?md5=164da70baa58718db38c2359aa24b652&pid=1-s2.0-S1544319124001614-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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