Journal of the American College of Clinical Pharmacy : JACCP最新文献

英文中文

National Assessment of Reimbursement Models for Clinical Faculty Services in Academic Pharmacy Practice 学术药学实践中临床教师服务报销模式的国家评估

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-22 DOI: 10.1002/jac5.70134

John G. Gums, Craig P. Henchey, Thomas C. Dowling, Donald A. Godwin, Paul O. Gubbins, Thomas G. Wadsworth, Kristin K. Wiisanen, Mark A. Munger

Background

Colleges and Schools of Pharmacy (C/SoP) collect revenue from tuition and indirect cost recovery related to teaching and research. Clinical faculty services are frequently exchanged for experiential opportunities, but this practice undervalues pharmacists and their impact on patient care. Some C/SoP have adopted innovative strategies to secure reimbursement for faculty-delivered patient care services, but they have not been well described. The objective is to describe academic pharmacist payment for clinical services and to provide recommendations on how to increase clinical service revenue based on a national survey of C/SoP.

Methods

The 19-item survey was distributed to 143 (71 public/72 private) C/SoP. The survey covered: faculty billing, insurance sources, state regulation, revenue models, and barriers.

Results

The response rate was 73% (80% public, 65% private). Nearly all C/SoP provided clinical services (97%), but only 54% bill for those services. Many public (58%) and private (49%) C/SoP bill for clinical services. Offset revenue (39%) and flat-fee contracts (19%) were the most common revenue models. The most common billable services included: Chronic Care Management (CCM) (79%), Medication Therapy Management (MTM) (71%), Immunizations (66%), and Annual Wellness Visits (45%). Of those utilizing incident-to billing services, 78% bill at level 1, but only 33% bill at level 3 or higher. Nine C/SoP reported having an employee certified in medical billing. The main barriers to collecting revenue were sites being used only for faculty provision of academic service, legal regulations, lack of pharmacist provider status, cost and difficulty of billing, and lack of interest or knowledge.

Conclusions

Current pharmacist care payment models indicate opportunities for all C/SoP to increase the revenue they collect from clinical services. All C/SoP should have a designated employee credentialed in medical billing and coding. Increased utilization of “incident-to” billing can generate revenue for C/SoP regardless of what happens to pharmacist provider status federally.

药学院（C/SoP）从学费和与教学和研究相关的间接成本回收中收取收入。临床教师服务经常交换经验的机会，但这种做法低估了药剂师和他们对病人护理的影响。一些C/SoP采用了创新的策略来确保报销教师提供的病人护理服务，但他们没有很好地描述。目的是描述学术药剂师支付临床服务，并提供建议，如何增加临床服务收入基于C/SoP的全国调查。方法对143名（公立71名/私立72名）C/SoP进行问卷调查。调查内容包括：教师账单、保险来源、州法规、收入模式和障碍。结果回复率为73%，其中公、私分别占80%和65%。几乎所有的C/SoP都提供临床服务（97%），但只有54%为这些服务付费。许多公立（58%）和私立（49%）为临床服务支付C/SoP账单。抵消收入（39%）和固定费用合同（19%）是最常见的收入模式。最常见的收费服务包括：慢性护理管理（CCM）（79%）、药物治疗管理（MTM）（71%）、免疫接种（66%）和年度健康检查（45%）。在那些使用从事件到计费服务的用户中，78%的用户使用级别1的计费服务，而只有33%的用户使用级别3或更高的计费服务。9个C/SoP报告有一名员工获得了医疗账单认证。收取收入的主要障碍是网站仅用于教师提供学术服务、法律法规、缺乏药剂师提供者身份、费用和计费困难以及缺乏兴趣或知识。结论当前的药剂师护理支付模式表明，所有C/SoP都有机会增加他们从临床服务中获得的收入。所有C/SoP应指定一名具有医疗计费和编码资格的员工。提高“事件到”计费的利用率可以为C/SoP产生收入，而不管联邦药剂师提供者的地位发生了什么。

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引用次数: 0

Evaluation of Medication Regimen Complexity (MRC) and Pharmacist Interventions Utilizing the MRC-ICU Scoring Tool in Hematology/Oncology Patients: A Cohort Study 利用MRC- icu评分工具评估血液/肿瘤患者用药方案复杂性（MRC）和药师干预：一项队列研究

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-15 DOI: 10.1002/jac5.70129

Allison Holdsworth, Michael LaPorte, Jeffrey Baron, Alyssa Loecher, Han Yu, Jessica Hockler, Hang Lin, Jilian Erazo, Eugene Przespolewski

Background

The medication regimen complexity-intensive care unit (MRC-ICU) score is a validated scoring tool to assess the complexity of medication regimens and can be used as a surrogate marker for pharmacist interventions. Hospitalized oncology patients often require extensive pharmacotherapy regimens like those requiring intensive care. Validation of the MRC-ICU scoring tool in this population would allow for proactive assessment of patient complexity and optimal allocation of pharmacy resources. The objective of this investigation was to validate the MRC-ICU scoring tool in hematology/oncology patients as a surrogate for pharmacist interventions.

Methods

Patients admitted to an inpatient hematology service or the ICU for over 24 h were identified for inclusion. Patient demographics and pharmacist interventions were collected, and MRC-ICU scores were calculated for every day of admission. Four items specific to oncology care were added to the original scoring tool to produce a modified score (oMRC-ICU). The primary end point was the correlation between oMRC-ICU scores and pharmacist interventions. Secondary end points were correlations between oMRC-ICU scores and patient outcomes, service, and intervention type. Descriptive statistics were used to report patient demographics and outcomes data. Spearman's rank correlation and Lasso regression were used to define end points of interest.

Results

A total of 138 admissions were included, corresponding to 129 unique patients. Most admissions (65.2%) were to a hematology service. The median length of stay was 5 days (range 2–9) and the median time to maximum score was 1.5 days (interquartile range [IQR] 1–6). Chemotherapy, opioids/sedatives, and antimicrobials provided the highest average point contributions to MRC-ICU scores (additional data can be found in the Supporting Information). There was a strong, positive correlation between total pharmacist interventions and maximum MRC-ICU score (R _s = 0.55, p < 0.0001) and oMRC-ICU score (R _s = 0.57, p < 0.0001).

Conclusion

MRC-ICU scores are a validated surrogate marker for pharmacist interventions in hematology/oncology patients and can be utilized as a measure of pharmacist productivity without the need for daily documentation.

用药方案复杂性-重症监护病房（MRC-ICU）评分是一种经过验证的评估用药方案复杂性的评分工具，可作为药剂师干预措施的替代指标。住院肿瘤患者通常需要广泛的药物治疗方案，如需要重症监护的患者。在该人群中验证MRC-ICU评分工具将允许对患者复杂性进行主动评估和药房资源的最佳分配。本研究的目的是验证MRC-ICU评分工具在血液学/肿瘤学患者中的替代作用。方法选取在血液科或ICU住院时间超过24 h的患者。收集患者人口统计数据和药剂师干预措施，并计算入院每天的MRC-ICU评分。在原始评分工具中增加了肿瘤护理的四个项目，以产生修改评分（oMRC-ICU）。主要终点是oMRC-ICU评分与药师干预之间的相关性。次要终点是oMRC-ICU评分与患者结局、服务和干预类型之间的相关性。描述性统计用于报告患者人口统计学和结局数据。使用Spearman等级相关和Lasso回归来定义兴趣终点。结果共纳入入院138例，对应独特患者129例。大多数（65.2%）就诊于血液科。中位住院时间为5天（范围2-9），至最高评分的中位时间为1.5天（四分位数间距[IQR] 1-6）。化疗、阿片类药物/镇静剂和抗菌剂对MRC-ICU评分的平均贡献最高（其他数据可在支持信息中找到）。总药师干预与最高MRC-ICU评分（R s = 0.55, p < 0.0001）和oMRC-ICU评分（R s = 0.57, p < 0.0001）呈正相关。结论MRC-ICU评分是药师干预血液学/肿瘤学患者的有效替代指标，可作为药师工作效率的衡量指标，无需每日记录。

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引用次数: 0

Comment on “Teaching Interprofessional Collaboration in Diabetes Management: An Elective Course” 《糖尿病管理跨专业合作教学：选修课》述评

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-15 DOI: 10.1002/jac5.70130

Elizabeth LaNou

引用次数: 0

Current Practices in Estimating Kidney Function: Insights From a Cross-Sectional Survey 当前评估肾功能的实践：来自横断面调查的见解

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-12 DOI: 10.1002/jac5.70123

Branden D. Nemecek, Wendy L. St. Peter, Lisa T. Hong, Erica R. Anderson, Wasim S. El Nekidy

Background

Numerous equations have been developed to estimate kidney function. Recently, Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equations reformulated without race have been recommended by the National Kidney Foundation (NKF)–American Society of Nephrology Taskforce and by the NKF Workgroup for Implementation of Race-Free eGFR-Based Medication-Related Decisions. The objective of this survey was to examine current pharmacy practices on the implementation of these recommendations.

Methods

A survey was distributed primarily to specific American College of Clinical Pharmacy Practice and Research Network listservs between February and March 2024.

Results

There were 275 survey respondents who answered at least one question. Of pharmacists who completed the demographics section, the majority were from the United States and were female, with the most common practice sites being academic health centers and community hospitals. Regarding kidney estimation and dosing, 199 (72.4%) indicated that their institution has a kidney dose adjustment policy, with the majority (162/199, 81.4%) utilizing the Cockcroft-Gault (C-G) estimated creatinine clearance (eCrCL) equation within their policy and C-G being the only equation within some policies. Additionally, 88/275 (32%) reported rounding up serum creatinine values for elderly patients when using the C-G equation, with 47 of those 88 (53.4%) rounding it to 1 mg/dL. There was also notable variability regarding the choice of patient weight for C-G eCrCL calculations: actual body weight was used by 137/275 (49.8%), adjusted body weight by 146/275 (53%), and ideal body weight by 113/275 (41.1%). If utilizing an eGFR equation for medication dosing, 36/275 (13.1%) reported adjusting eGFR for body surface area (BSA) in all patients, and 44/275 (16%) reported adjusting for BSA in those with extreme body weights.

Conclusions

There is considerable variability in kidney function assessment for drug dosing by pharmacists, highlighting the need for education and adoption of non–race-based CKD-EPI equations to standardize care and improve outcomes.

已经开发了许多方程来估计肾功能。最近，慢性肾脏疾病流行病学合作（CKD-EPI）估计的肾小球滤过率（eGFR）方程重新制定无种族被国家肾脏基金会(NKF) -美国肾脏病学会工作组和NKF工作组推荐实施无种族的基于eGFR的药物相关决策。这项调查的目的是检查目前的药房实践对这些建议的实施。方法于2024年2月至3月对美国临床药学实践与研究网络（American College of Clinical Pharmacy Practice and Research Network）的特定网站进行调查。结果共有275人回答了至少一个问题。在完成人口统计部分的药剂师中，大多数来自美国，并且是女性，最常见的执业地点是学术卫生中心和社区医院。关于肾脏估计和剂量，199（72.4%）表示他们的机构有肾脏剂量调整政策，大多数（162/199,81.4%）在他们的政策中使用Cockcroft-Gault （C-G）估计的肌酐清除率（eCrCL）方程，而C-G是某些政策中唯一的方程。此外，88/275（32%）报告了使用C-G方程时老年患者血清肌酐值的四舍五入，其中47（53.4%）将其四舍五入为1mg /dL。C-G eCrCL计算中患者体重的选择也存在显著差异：实际体重为137/275(49.8%)，调整体重为146/275(53%)，理想体重为113/275（41.1%）。如果使用eGFR方程来给药，36/275（13.1%）的报告调整了所有患者体表面积（BSA）的eGFR， 44/275（16%）的报告调整了极端体重患者的BSA。结论：药剂师对药物剂量的肾功能评估存在相当大的差异，这突出了教育和采用非种族CKD-EPI方程来规范护理和改善结果的必要性。

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引用次数: 0

A Survey of Veterans Affairs Pharmacists: Naloxone Prescribing and Perceived Barriers 退伍军人事务药师纳洛酮处方及感知障碍调查

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-11 DOI: 10.1002/jac5.70128

Garrett Garver, Chelsea Huppert, Kelly Houck, Justin Roberts, Jeremy Hooker, Cole Smith

Introduction

All Veterans Health Administration (VHA) sites have implemented the Opioid Overdose Education and Naloxone Distribution (OEND) program, which aims to reduce opioid-involved overdose deaths.

Objectives

Gaining a better understanding of pharmacists' perspectives toward naloxone is essential to developing effective pharmacy-based naloxone services. This study investigated the perspectives of Veterans Affairs pharmacists toward prescribing naloxone and perceived barriers across multiple sites in the Veterans Integrated Service Network (VISN) 10.

Methods

This was a multicenter, voluntary, and anonymous survey sent to pharmacists. Survey items reflecting pharmacists' perspectives were evaluated on a 5-point Likert scale, aggregated according to domain, and adjusted for reverse scoring of select questions. Descriptive statistics were scaled from 1.0 to 5.0, representing least-to-most favorable perspectives.

Results

A total of 124 surveys were completed and included in the data analysis. Domain-aggregated adjusted means (standard deviation [SD]) for attitudes/beliefs, comfort, knowledge, fear of consequences, and time and resources were 4.08 (0.91), 3.77 (0.97), 3.64 (1.04), 3.69 (0.86), and 3.07 (1.09), respectively. Pharmacists who reported having formal training on naloxone prescribing or administration reported more favorable perspectives in the domains of comfort (p = 0.001), knowledge (p = 0.002), and time and resources (p = 0.008). Pharmacists who had postgraduate residency training reported more favorable perspectives in the domains of attitudes/beliefs (p = 0.007) and knowledge (p = 0.01).

Conclusion

Pharmacists' perspectives toward time and resources are a perceived barrier to naloxone prescribing. More favorable perspectives toward naloxone were detected among pharmacists with training on naloxone and pharmacists with postgraduate residency training.

所有退伍军人健康管理局（VHA）网站都实施了阿片类药物过量教育和纳洛酮分发（OEND）计划，旨在减少阿片类药物过量死亡。目的更好地了解药师对纳洛酮的看法，对开展有效的基于药学的纳洛酮服务至关重要。本研究调查了退伍军人事务药剂师在退伍军人综合服务网络（VISN）多个站点对纳洛酮处方和感知障碍的看法。方法采用多中心、自愿、匿名的问卷调查方式对药师进行调查。反映药剂师观点的调查项目以5分李克特量表进行评估，根据领域进行汇总，并根据选择问题的反向评分进行调整。描述性统计从1.0到5.0，代表最不利到最有利的观点。结果共完成问卷调查124份，纳入数据分析。态度/信念、舒适、知识、后果恐惧、时间和资源的领域聚合调整均值（标准差[SD]）分别为4.08（0.91）、3.77（0.97）、3.64（1.04）、3.69（0.86）和3.07（1.09）。报告接受过纳洛酮处方或管理正规培训的药剂师在舒适度（p = 0.001）、知识（p = 0.002）和时间和资源（p = 0.008）方面表现出更有利的观点。接受过研究生住院医师培训的药剂师在态度/信念（p = 0.007）和知识（p = 0.01）方面表现出更有利的观点。结论药师对时间和资源的看法是纳洛酮处方的感知障碍。接受过纳洛酮培训的药师和接受过研究生住院医师培训的药师对纳洛酮持更积极的态度。

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引用次数: 0

Thinking Like Tree Farmers, Not Muffin Makers: Competency-Based Education Requires Different Processes and Structures 像种树农民一样思考，而不是松饼制造商：以能力为基础的教育需要不同的过程和结构

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-11 DOI: 10.1002/jac5.70127

Stuart T. Haines, Denise H. Rhoney, Aleda M. H. Chen

引用次数: 0

The Role of Pharmacists in Mitigating Patient Harms and Drug Misinformation Risks Arising From Synthetic Smoke Shop Products 药剂师在减轻合成烟店产品对患者的危害和药物错误信息风险中的作用

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-10 DOI: 10.1002/jac5.70126

Kirk E. Evoy, Cody J. Wenthur, George Folz, Joseph A. Zorek

引用次数: 0

Using Reciprocal Innovation to Advance Pharmacy Practice in the United States 利用互惠创新推进美国的药学实践

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-07 DOI: 10.1002/jac5.70125

Rachel A. Ogumbo, Alan J. Zillich, Imran Manji, Sonak D. Pastakia

引用次数: 0

Bridging the Gap in Antibiotic Stewardship at Hospital Discharge: Evaluating the Impact of Pharmacist Interventions 弥合医院出院时抗生素管理的差距：评估药剂师干预的影响

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-03 DOI: 10.1002/jac5.70124

Kimberly Ly, Thang Do, Timmy, Nicole Rivera-Torres

Introduction

Transition of care during hospital discharge is a critical period that often leads to medication errors. While antibiotics are among the most prescribed medications, half of these prescription orders are not optimized. The Centers for Disease Control and Prevention provides guidance on stewardship programs and underscores the critical role of pharmacists; however, a gap in stewardship practices at hospital discharge remains. This signals an unmet clinical need for antimicrobial stewardship at discharge to avoid unnecessary antibiotic exposure and identify safe alternatives while maintaining patient safety.

Objective

To evaluate the impact of pharmacist-led intervention on the appropriateness of prescribed antibiotic(s) at discharge.

Methods

This was a quasi-experimental study conducted at a community teaching hospital from March 2018 to March 2022. Participants were divided into standard of care and intervention groups to compare the appropriateness of prescribed antibiotics following the implementation of pharmacist assessment at the time of discharge. The primary outcome was to evaluate the impact of pharmacist interventions on increasing the appropriateness of prescribed antibiotics at the time of hospital discharge. Secondary outcomes included rates of 30-day readmission and Clostridioides difficile infection.

Results

A total of 160 participants were included in the standard of care (n = 80) and intervention (n = 80) cohort. Patients in the intervention group were discharged with more appropriate (85% vs. 25%, p < 0.00001) and less broad-spectrum (26% vs. 49%, p = 0.003) antibiotics when compared with the standard of care group. Pharmacist involvement was associated with a median reduction in antibiotic exposure of 3 days (7 vs. 4, p < 0.00001). No significant differences in secondary outcomes were observed.

Conclusion

Pharmacist stewardship intervention significantly increased the appropriateness of prescribed antibiotics at discharge by 60% without compromising patient care. Because most antibiotics are meant to be completed post-discharge, these findings highlight that inpatient antimicrobial stewardship efforts overlook a significant number of patients on antibiotics.

出院期间的护理过渡是一个经常导致用药错误的关键时期。虽然抗生素是处方最多的药物之一，但这些处方中有一半没有得到优化。疾病控制和预防中心为管理项目提供指导，并强调药剂师的关键作用；然而，在出院管理实践方面仍然存在差距。这表明出院时抗菌药物管理的临床需求未得到满足，以避免不必要的抗生素暴露，并在保持患者安全的同时确定安全的替代品。目的评价药师主导的干预措施对出院时抗菌药物处方适宜性的影响。方法2018年3月~ 2022年3月在某社区教学医院进行准实验研究。将参与者分为标准护理组和干预组，比较在出院时实施药师评估后处方抗生素的适宜性。主要结果是评估药师干预对提高出院时处方抗生素适当性的影响。次要结局包括30天再入院率和艰难梭菌感染率。结果160名受试者被纳入标准护理组（n = 80）和干预组（n = 80）。与标准护理组相比，干预组患者出院时使用的抗生素更合适（85%对25%，p < 0.00001），广谱抗生素更少（26%对49%，p = 0.003）。药师参与与抗生素暴露中位数减少3天相关（7 vs. 4, p < 0.00001）。次要结局无显著差异。结论药师管理干预在不影响患者护理的情况下，可使出院时处方抗生素的适宜性提高60%。由于大多数抗生素是在出院后使用的，因此这些发现突出表明，住院患者抗菌药物管理工作忽视了大量使用抗生素的患者。

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引用次数: 0

Enhancing Care: Caring for Transgender and Gender Diverse Patients in the Emergency Department 加强护理：急诊科对跨性别和性别差异患者的护理

IF 1.5 Q4 PHARMACOLOGY & PHARMACY

Journal of the American College of Clinical Pharmacy : JACCP

Pub Date : 2025-10-02 DOI: 10.1002/jac5.70122

Caitlin S. Brown, Fi Fonseca, Kyle A. Schofield, Kharmene Sunga, Tiffany Olswold, Justine Herndon, Keith Roe, Caroline Davidge-Pitts, Kellyn Engstrom

Transgender and gender diverse (TGD) individuals face minority stress and often avoid the emergency department (ED) due to previous negative experiences. The goal of this review is to prepare the emergency medicine pharmacist to care for TGD patients, with the ultimate goal of improving the care TGD patients receive. This review summarizes interactions with TGD patients, trauma-informed considerations, physical exam and organ inventory sensitivities, and gender-affirming hormone therapy and complications that may arise and be seen in the ED. Additionally, this review discusses common complaints and considerations that may commonly arise when caring for TGD patients.

跨性别和性别多样化（TGD）个体面临少数民族压力，由于之前的负面经历，他们经常避免急诊科（ED）。本综述的目的是使急诊药师具备对TGD患者的护理能力，最终目的是提高TGD患者的护理水平。这篇综述总结了与TGD患者的相互作用，创伤通知的考虑，体格检查和器官清查敏感性，性别确认激素治疗和可能出现的并发症，在急诊科。此外，这篇综述讨论了在照顾TGD患者时可能出现的常见抱怨和注意事项。

引用次数: 0

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