Innovations in pharmacy最新文献

Objectives: Pharmacists often advise patients on the use of over-the counter (OTC) medications. A class of medications that is growing in popularity is homeopathic products. Little is known about student pharmacist education about homeopathy. The objectives of this study were to: 1) describe homeopathic topics being taught in pharmacy schools and 2) evaluate faculty views about pharmacists' roles in counseling patients about homeopathic products. Method: An explanatory sequential mixed methods approach was used. Online surveys were distributed to 3,300 pharmacy practice faculty members representing all schools accredited in the US. Frequencies were calculated to describe faculty characteristics and their responses. Moreover, 18 interviews of faculty involved with teaching homeopathy were conducted to learn about homeopathy teaching and expectations about roles of pharmacists in counseling patients. Results: Survey data were collected from 365 respondents. Over half (84 of 137) of the responding pharmacy schools reported teaching homeopathy to pharmacy students. In addition, the responses from most of the interviewed faculty were summarized into two themes which emphasized that pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from taking homeopathic products. Conclusion: Over half of US pharmacy schools are teaching students about homeopathy topics. Further, there was support for pharmacists being able to counsel effectively about homeopathic products.

Objective: The aim of the present study is to determine similarities between patients with type 2 diabetes not on metformin therapy compared to patients on metformin therapy at a resident-led primary care clinic. Methods: An exploratory, single-center retrospective chart review was performed on patients 18 years and older with a documented diagnosis of type 2 diabetes seen at the University of Arkansas for Medical Sciences Family Medicine Clinic in Little Rock, Arkansas. Of the 2452 patients who met criteria for the study, 1085 patients did not have a documented metformin allergy. A subset of 216 patients who were not currently prescribed metformin and had no documented metformin allergy were further examined and compared to the 869 patients who were prescribed metformin. We sought to determine reasons for nonuse by evaluating their EPIC electronic health record. Information on these patients such as race, gender, hemoglobin A1c (A1c), kidney function, stated metformin intolerance, and comorbid disease states such as neuropathy, chronic kidney disease (CKD), ulcerative colitis, and irritable bowel syndrome were collected. Further examination was performed to determine why patients were not on metformin therapy and potential similarities between metformin intolerant patients. Results: The results of the study indicated a significant difference between metformin users and non-users in relation to body mass index (BMI) and diagnosis of CKD. Metformin non-users were found to have significantly lower mean BMI (30.87 vs. 35.43; p-value <0.0001), and significantly higher rates of CKD (25.93% vs 14.73%; p-value <0.0001) as compared to metformin users. BMI value of patients (coefficient: 0.2033, p value: <0.0001) was found to be significantly and positively correlated with metformin use, and CKD (coefficient: - 0.1191, p-value: <0.0001) was found to be significantly and negatively correlated with metformin use. A1c levels for patients not on metformin therapy were evaluated. Most non-metformin patients fell in prediabetic A1c levels ranging from 5-6.4% (84 patients; 38.89%), and 31 patients (14.35%) should be on insulin therapy according to guidelines. Conclusion: The results demonstrated that patients with lower BMI, CKD, or A1c in the prediabetic range were less likely to be prescribed metformin.

Background: The effects of climate change are major threats to health and well-being. While the profession of pharmacy can make a difference through patient care activities, sustainability, and advocacy, literature detailing U.S. pharmacist and student pharmacist views on this topic is scant. Objectives: To assess Ohio pharmacy interns' knowledge and beliefs regarding climate change and human health as well as its relevance to pharmacy practice and education, and to compare and contrast their perceptions with those of Ohio pharmacists previously surveyed. Methods: An anonymous 31-item electronic survey was emailed to a random sample of 500 pharmacy interns registered in Ohio with questions regarding climate change and health, climate change policy, potential roles for pharmacists and pharmacy interns, pharmacy education, and demographics. Data were analyzed using descriptive and nonparametric statistics, and responses collected from this study were compared with those from the Ohio pharmacist study conducted the previous year. Results: Ninety-two interns completed the survey. The majority of respondents thought climate change is happening (87%), will harm human health in their community (68%), and is relevant to pharmacists or pharmacy practice (62%). Compared to registered pharmacists, pharmacy interns more often acknowledged these statements and more often identified roles in climate action. Sixty-two percent somewhat or strongly agreed that there should be more education about climate change and health in the pharmacy curriculum. Conclusion: The majority of Ohio pharmacy interns participating in this survey recognized the impact of climate change on health, believed they have roles in mitigating its effects, and wanted to learn more about it. As these are the first data assessing U.S. pharmacy interns' perceptions of this topic, additional studies should be performed in other parts of the country. Increased education among student pharmacists may help propel the pharmacy profession to take the lead in climate action and sustainability.

Introduction: The primary objective of this study was to compare the incidence of antipsychotic use in those with venous thromboembolism (VTE) resulting in hospital admission. This study expands upon current knowledge regarding VTE risk and antipsychotic use and investigates potential risk factors and lab values that may precede antipsychotic-induced coagulopathy. Methods: This retrospective, case-control, chart review investigated patients admitted to an acute care hospital with either a VTE or non-VTE diagnosis. Primary outcome analysis compared the presence of an antipsychotic medication in patients who had a VTE versus those who did not. Secondary analysis included: 1) the duration, class, dose, frequency, and route of antipsychotic and 2) coagulation parameters, patient characteristics, and VTE risk factors. Results: Analysis included 400 participants with 200 participants in each group (VTE and non-VTE). Of the 51 patients who received an antipsychotic, 29 (56.9%) developed or presented with a VTE. However, there was no significant difference in VTE development between groups when controlled for antipsychotic use (OR 1.37, 95% CI 0.76-2.50, P-value=0.30). Conclusion: While primary study findings were not statistically significant, results support a weak association of exposure to antipsychotic(s) in VTE groups compared to control (non-VTE). Obesity significantly increased the odds of VTE whereas a history of type 2 diabetes significantly decreased the odds of VTE.

The American Society of Health-System Pharmacists (ASHP) aims to improve patient care by innovating pharmacy practices. ASHP-accredited pharmacy residencies require projects that enhance pharmacy practice, focusing on effective project management and quality improvement. However, only a few of these innovations smoothly become part of routine clinical practice. One solution worth exploring involves teaching Implementation Science in residencies. Exposing residents and mentors to Implementation Science offers two main benefits. First, it helps learn from failed interventions by considering alternative thoughts and grasping environmental influences, leading to smarter decisions in future implementations. Second, applying implementation science improves patient care by turning evidence-based practices into practical actions, ensuring better care, consistency across healthcare setups, fewer errors, and tailoring innovative services to specific institutional needs. Exposing pharmacy residents to implementation science pushes forward pharmacy practice by actively applying evidence-based innovations in broader pharmacy or clinical practice.

Objectives: Evaluating the adherence to HIV Pre-Exposure Prophylaxis (PrEP) is essential for increasing its utilization and decreasing the risk of HIV transmission among Davao City's vulnerable groups. Methods: The research method utilized in the study is a quantitative, retrospective, descriptive research design. This method was employed to retrospectively review the de-identified data, which involved the fill and refill dates of PrEP and tablets supplied, to calculate the Proportion of Days Covered (PDC) among individuals in Davao City from January 2021 to December 2023. The study also included some demographic characteristics such as age and gender. Results: From 178 data entries collected, the age group of 25 to 34 years old was found to have the highest HIV PrEP use (52.25%), followed by those between 18 to 24 (30.90%), 35 to 44 (13.48%), and 45 years old and older (3.37%). Out of 178, only 2 clients were female. Furthermore, 73.60% of the 178 entries in the pharmacy records were identified to be taking PrEP daily. Descriptive statistics showed that the frequency of adherent clients across the years were 36.36%, 44.74% and 38.46%, respectively. Furthermore, the average PDC through the years was found to be 70.13%, 80.48%, and 72.8%. Age did not significantly affect adherence to PrEP during the years investigated (p-values > 0.05). Conclusion: Adherence to PrEP improved consistently in 2022 but declined in 2023, showing erratic adherence rates. Furthermore, adherence to HIV PrEP in Davao City was found to be suboptimal and while there are clients who are adherent, many are not. The results emphasize the need for targeted interventions and suggest that other socio-behavioral factors may play a role in this. To improve adherence and prevent HIV contractions, both short-term actions like public education campaigns about HIV PrEP and long-term plans like incorporating PrEP into the community pharmacies can be contributive.

Objective: The objective of this commentary is to consider the fluctuations in pharmacy school enrollments and to review some of the strategies employed in other health care professions, as well as to consider policies that might lead to a closer balance between admissions to PharmD programs and employment opportunities. This balance provides job stability, decreased underemployment, and greater attractiveness to study pharmacy. Discussion: Pharmacy school entry requirements have been relaxed to enroll as many students as possible due to current declining applicant numbers. As a result, there are more pharmacist graduates than there are available jobs each year. As a result, the job outlook for pharmacists may go down in the future unless action is taken. Stricter entry requirements could help produce a higher quality pharmacy workforce in the future and relieve this disparity. Summary: Pharmacy schools try to accommodate as many students as possible, which can create a job disparity between the number of available jobs and pharmacists seeking work. Suggestions can include stricter entry requirements, certificate of need programs, required fellowships and other means to balance this misalignment.

Daptomycin is a cyclic lipopeptide antibiotic that is indicated for the treatment of complicated skin infections and bacteremia caused by gram positive organisms. Acute eosinophilic pneumonia (AEP) is a rare, but serious adverse effect of daptomycin and caused by accumulation of eosinophils in the lung tissues, and can lead to respiratory failure. Early diagnosis and management of this condition is crucial to avoid severe complications, including death. Herein, we report a case of an elderly man who presented with signs and symptoms of AEP within two weeks of initiation of daptomycin for the treatment of MRSA bacteremia. The patient showed significant clinical improvement and decline in eosinophils upon discontinuation of daptomycin and starting a 5-day steroid course. Acute eosinophilic pneumonia should be kept in mind as a possible, although rare, adverse effect of daptomycin. Early recognition can be established through typical symptoms, eosinophilia, and chest X-ray showing pulmonary infiltrate. Rapid discontinuation of daptomycin with/without steroid therapy and supportive care usually results in significant clinical recover.

Background: Pharmacogenomics (PGx) is a tool to guide optimal medication selection. Increased demand for personalized medicine and the growing occurrence of chronic diseases are drivers for pharmacogenomic medication management services. A review of implementation models identified a paucity of models delivering these services utilizing pharmacists in primary care. Lack of standardization of this process remains a barrier to widespread implementation within health systems. Purpose: Describe the process of developing an institutional guidance document and applying it to implement a pharmacogenomics medication management service at clinic sites within an integrated health system in the United States. Measure the growth in the number of PGx visits completed. Method: A task force of pharmacists reviewed literature, guidelines, and institutional policies to create a comprehensive guidance document. The document included six minimum practice requirements for implementation in the primary care setting, and six additional recommendations. A retrospective chart review of all face to face, phone and eConsult PGx visit types occurring from January 1, 2022 through September 30, 2022 was conducted. Results: A pharmacist-led pharmacogenomics medication management service is now offered at all primary care sites within the health system. During the study timeframe, 1378 patients had a PGx visit, resulting in 1939 PGx visits. Of those visits, 1777 (92%) were referred by a primary care provider and 1675 (86.7%) were conducted by a primary care pharmacist. Twenty-nine primary care pharmacists offered the PGX service and 25 (89%) completed at least one visit. Patients were referred by providers from 56 of the 64 (87.5%) primary care departments. Conclusions: Developing an institutional process and guidance document for the implementation of a new pharmacist-led pharmacogenomics medication management service at clinic sites within an integrated health system was beneficial in developing and standardizing the workflow. Dissemination of workflow expectations to the primary care providers and pharmacists resulted in adoption of the service.

Polypharmacy and somatic symptom disorder (SSD) are common conditions clinicians see every day in practice. Polypharmacy is easy to identify and causation seems to be straightforward. However, SSD may not be so obvious and may be an underlying cause of the polypharmacy that may be more difficult to identify. Identifying SSD as a potential psychiatric cause for polypharmacy and understanding that adding more medications will not adequately resolve the patient's symptoms is important to prevent polypharmacy from being exacerbated.