Innovations in pharmacy最新文献

Background: Guideline-directed medical therapy in patients with systolic heart failure (HF) has demonstrated improvement in morbidity and mortality rates. The FDA approved sacubitril/valsartan in 2015 to reduce the risk of cardiovascular death and hospitalization for HF. Objective: The purpose of this study was to evaluate the change in loop diuretic dose and the clinical outcomes of angiotensin receptor-neprilysin inhibitor (ARNI) therapy within a 90-day follow-up period. Methods: A retrospective chart review of 110 HF patients on concomitant ARNI and loop diuretic therapy at New York University Langone Health was conducted. The primary endpoint was a change in loop diuretic dose. Six secondary endpoints, including dose conversion from ACEi or ARB to ARNI therapy, were assessed. Results: Of the 110 HF patients, 72 did not receive diuretic dose adjustments, yet 40 (55.56%) experienced laboratory-dependent dehydration. Fifty-six percent of patients experienced an improvement in systolic blood pressure, and 52 percent experienced a decrease in diastolic blood pressure. Sixty percent of patients experienced an improvement in EF, with a median increase of 10.00% over a 90-day follow-up. A significant negative correlation between patients' age and absolute change in EF was identified (r= -0.28; p < 0.05), indicating that the increase in EF was stronger for younger patients. Eighteen hospitalizations occurred within a 90-day follow-up, with only 4 patients being admitted for heart failure exacerbation. Conclusion and Relevance: This study examines the real-world effects of ARNI therapy in patients with systolic heart failure. Optimization of HF medications, including ARNI therapy, remains an important factor for achieving the maximum benefits in heart failure management. ARNI therapy requires careful monitoring to ensure effective diuresis in symptomatic heart failure patients while avoiding adverse events. Future studies should address diuretic dose adjustment in conjunction with the administration of ARNI and sodium-glucose cotransporter-2 inhibitors.

In Africa, Nigeria can be regarded as the most populous country with a population size of 227 million people and also a lower-middle-income country. As at 2014, according to a report by WHO, 25% of the pharmaceutical products needed by Nigerians were delivered locally, while the remaining 75% are imported from nations such as India, UK and China, this performance indices indicate poor performance. Due to the heavy reliance on importation faced by the Nigeria's pharmaceutical industry, access to medicines that are essential has been limited and local production capacity has weakened. With the growing interest in plant-based therapies, dosage standardisation for many of these herbal products due to insufficient funding for extensive research into herbal medicine and insufficient clinical trials has made it difficult to assess the effectiveness of herbal treatment systematically and validate scientifically the traditional remedies. Limited facilities for in-vivo and in-vitro studies further limits knowledge advancement in pharmaceutical sciences. The effects of these situations have resulted into drug shortages, prolific substandard medicines and vulnerability to supply chain disruptions. Addressing these challenges requires a multifaceted approach involving policy reform, and the establishment of well-equipped pharmaceutical research and production facilities. Countries such as India and the United States have implemented initiatives backed up by the government which has enabled local companies to manufacture APIs, enhance self-sufficiency in healthcare and research capabilities. Nigeria can adopt similar strategies to reduce dependency on importation and promote innovation in the pharmaceutical sector.

Many populations face the barriers of high medication costs due to limited resources, especially those served by student-run free clinics (SRFCs). As part of the solution, patient assistance programs (PAPs) managed through pharmaceutical companies provide free medications to patients who are unable to afford them. Various PAP-related interventions have been proven to improve efficiency and patient care in SRFCs. The Jackson Free Clinic (JFC) serves some of the most vulnerable populations in Mississippi, which as a state has performed poorly nationally in a variety of healthcare metrics. Proximity to such a population and access to service from training health professionals provides a unique opportunity to create change by implementation of student-driven PAP services. The newly established PAP committee undertakes the tasks necessary to enroll, track, and dispense individual patients' medications received through enrollment in an assistance program specific to the needed medication. The hope of the PAP committee is to reduce the responsibility of medical and pharmacy teams, increase enrollment likelihood, improve medication adherence, decrease patient wait time, and improve patient care. The development of the PAP committee has shown the value of implementing an organized PAP formulary, a consistent organizational structure, and an all-inclusive written hand-guide, which has created an improved training environment for committee members. Other results reported by regional SRFCs have suggested the clinical and cost benefits of implementing PAPs, particularly a committee. The novel method employed at JFC requires additional research and development toward the larger effort of improving patient care, which we plan to investigate with future endeavors.

Letter to the Editor.

Background: The majority of older Americans are expected to need some level of institutional long term care. Community pharmacies are positioned to delay this need by supporting medication management. There are potential mechanisms for pharmacists to deliver long term care at home (Home LTC) services and bill insurers for services that may delay the transition to a higher level of care. Objectives: This project aims to evaluate the implementation of a community pharmacy delivered Home LTC service in a rural community. The objectives were to: 1) describe implementation and challenges of pharmacy-provided HOME LTC services, 2) attempt billing for Home LTC services, 3) describe pharmacist clinical interventions including drug therapy problems (DTPs) and 4) measure patient/caregiver satisfaction with the service. Methods: This was a pilot evaluation of a community pharmacist delivered intervention. Patient eligibility requirements include taking 6+ medications, having 3+ chronic conditions, and having 2+ limitations in activities of daily living (ADLs). All participants received a comprehensive medication review. Pharmacy staff prepared medications in monthly adherence packaging and delivery was offered. Home visits were performed by the pharmacist as needed. A post study survey assessed satisfaction and invited suggestions for improvement. Patient characteristics, DTPs, interventions, reimbursement attempts and amounts, and survey responses were documented, and analyzed descriptively. Results: Fourteen patients were enrolled in the study - 3 living in a group home and 7 were already receiving adherence packaging. All 14 patients received at least 1 clinical intervention, and 4 home visits were conducted. Seven patients (50%) completed the satisfaction survey and reported universally high satisfaction with the service elements. Conclusion: Overall, implementing a HOME LTC service was successful, however, the pharmacy failed to be reimbursed for service elements, including adherence packaging. Patients were satisfied with the service. Bridging the reimbursement gap is critical to sustainably provide patients with this desired service.

Occupational licensing reform is essential but challenging for state agencies. This paper presents a step-by-step framework for pharmacy licensing boards, inspired by the Idaho State Board of Pharmacy's (BOP) efforts, which achieved a 75% cut in regulatory page count while creating a more permissive practice environment. By establishing baselines, prioritizing reform areas, and setting clear reduction goals, the BOP streamlined licensing, modernized professional practice standards, and adopted technology-agnostic facility regulations. The transition to enforcement-centric accountability ensured public safety while fostering innovation and economic growth. Early results include increased pharmacy services, improved access, and significant industry investments. This framework offers a replicable approach for other licensing boards to reduce red tape, support economic growth, and enhance regulatory efficiency without compromising health and safety.

Introduction: Patients with heart failure with reduced ejection fraction (HFrEF) who are optimized on guideline-directed medical therapy (GDMT) have improved outcomes; however, medication access and affordability are potential barriers to achieving pharmacoequity. This study sought to compare rates of HFrEF GDMT prescribing at hospital discharge across prescription insurance status groups. Methods: This was a single-center, retrospective cohort study of adult HFrEF patients. Patients were grouped according to prescription insurance status. The primary outcome was the percentage of HFrEF patients prescribed quadruple GDMT at hospital discharge. Key secondary outcomes included the presence of contraindications to therapy and 30-day all-cause readmission rates. The study was approved by the Institutional Review Board at the University of Tennessee Health Science Center. Results: Among the 200 included patients, 63% were male and 92% were black. Discharge on quadruple GDMT across insurance groups was 18% for Medicare Part D, 24% for Medicaid, 24% for commercial, and 33% for uninsured. There was no difference between insurance groups in rates of prescribed quadruple GDMT at hospital discharge (p=0.302) or 30-day hospital readmission (p=0.665). Additionally, there was a significant increase in the number of uninsured patients on quadruple GDMT after hospitalization compared to pre-hospitalization (13% vs 33%, p=0.002). Eighty percent of all patients had a contraindication to at least one GDMT agent. Conclusion: There was no difference in rates of prescribed quadruple GDMT at hospital discharge based on insurance status. However, this study did elucidate the impact of medication access programs improving pharmacoequity in the uninsured patient population.

Purpose: While there is evidence that pharmacist-led medication counseling improves patient safety and outcomes, there is conflicting evidence of the impact of pharmacy students on patient care outcomes. The objective of this study is to investigate if pharmacy student-led new-start anticoagulant medication counseling has a similar effect on healthcare utilization compared to pharmacist-led new start anticoagulant medication counseling. Methods: This study is a multicenter retrospective cohort study. The primary outcome is a composite of unplanned patient contact (phone call or MyChart message) with healthcare providers, emergency department (ED) visits, and hospital readmission within 30 days of discharge. Patients at least 18 years old that are newly started on apixaban, rivaroxaban, or warfarin for a new pulmonary embolism or deep vein thrombosis were included. Student- and pharmacist-led counseling data was collected from seven medical centers in central Texas between January 1, 2022 and June 30, 2023 via chart review on Epic. Results: There were 575 patients included in this study. Of these, 165 (29%) patients were counseled by students, 84 (15%) patients were counseled by pharmacists, and 326 (57%) patients were not counseled at all. 440 (77%) patients had unplanned patient contact, ED visit, and/or readmission within 30 days of discharge. There was no difference in all-cause (p = 0.78) or bleeding-related (p = 0.23) composite unplanned patient contact, ED visits, and readmissions within 30 days of discharge between student- and pharmacist-led counseling. Conclusion: This study suggests that student-led versus pharmacist-led anticoagulant counseling shows no difference in patient outcomes and healthcare utilization.

Description of the problem: Forensic pharmacy is a scientific field in which trained forensic pharmacists apply their knowledge to assist law enforcement agencies in solving criminal cases. The role of forensic pharmacists is not emphasized in the pharmacy curriculum, and there is limited information about how faculty can introduce pharmacy students to this field. The innovation: A unique curricular activity was created to introduce first-year pharmacy students to the craft of forensic pharmacy and promote student learning of basic sciences. Thirteen teams (68 students total) participated in this activity. Each team watched an episode of a TV show, Forensic Files; prepared a report; and presented data covering factors contributing to the incident, safety measures, the roles a forensic pharmacist plays in various criminal cases, mechanisms of action, major toxicities, and indications for the drug or compound that contributed to the harm. Critical analysis: An anonymous survey tool was administered, with a 57% respondent rate, to assess the effectiveness of the activity. Approximately 70% of students agreed that the activity strengthened their knowledge in basic sciences, 75% agreed it promoted presentation and critical-thinking skills, and 80% agreed that the activity encouraged teamwork and self-directed learning. In addition, the activity promoted the six levels of Bloom's taxonomy to support student learning. Next steps: Faculty can generate elective courses to introduce pharmacy students to forensic pharmacy and use real-life forensic cases to strengthen student learning.