American Journal of Health-System Pharmacy最新文献

Purpose: The initiation of specialty medications is associated with patient access challenges and clinician burden. This evaluation assessed the impact on patient and clinician experience of an intervention to improve medication access by investing resources upstream of the prescribing step.

Methods: The specialty pharmacy intervention was designed to improve medication access within 5 medical specialty clinics by utilizing an embedded medication access team assigned to patients and prescribers of targeted medications. Using a multimethods evaluative approach to quantitatively assess associations between the referral process and patient experience, we analyzed the emotional valence of patient portal messages using a retrospective cohort study within the event study framework of a nonrandomized, stepped wedge implementation design. Semistructured qualitative interviews provided an understanding of clinician experience.

Results: The intervention was associated with an increase in the net positive emotional valence of patient portal messages (average marginal effect, 5.3; 95% CI, 3.8-6.8; P < 0.001). Except for patients seen by gastroenterologists for irritable bowel disease, patients cared for in all other specialties experienced statistically significant increases in net positive valence in the primary analysis. Regarding clinician experience, 4 major interrelated themes emerged from 17 qualitative interviews with prescribers and pharmacists: (1) decreased clinician burden, general praise, (2) improved experience and satisfaction, reduced anxiety and concerns, (3) rewarding praise for other prescribers/colleagues, and (4) excellent coordination, efficiency, and speed.

Conclusion: Investing staff resources before, during, and after the prior authorization process greatly improved clinician experience. The positive valence of patient portal messages also increased, suggesting patient experience improvements.

Purpose: This quality improvement initiative assessed the utilization of clevidipine (Cleviprex) in an institutional setting. The purpose was to identify cost-saving opportunities and implement strategies to promote cost-effective and clinically appropriate use of antihypertensive agents in various clinical scenarios.

Summary: This research was a single-center retrospective chart review of patients who received clevidipine from January 1 to August 31, 2023. Patients who were 18 years of age or older and had at least one documented clevidipine administration were included. In the patient population, 70% received clevidipine for a surgical hypertension indication and 30% received it for a medical hypertension indication. Only 18% of patients on clevidipine received concurrent antihypertensive agents, indicating that 82% of patients received clevidipine as first-line treatment. The results also showed significant medication waste when stocking 100-mL vials of clevidipine: less than 5 mL total was administered for 76.9% of the vials used in the operating room. In a cost comparison of the institution's titratable intravenous antihypertensives on formulary, the clevidipine 100-mL vial was the most expensive agent. A 2-phase approach to reduce medication waste and overall medication use was implemented. During phase 1, the clevidipine inventory was converted from 100-mL to 50-mL vials to reduce the amount of wasted medication. Order set revisions were carried out in phase 2 to create a guideline-directed, tiered approach to optimize antihypertensive medication therapy.

Conclusion: A review of clevidipine utilization at the institution identified multiple strategies to reduce use, medication waste, and overall medication cost through appropriate use of intravenous antihypertensive agents.

Purpose: This publication outlines the development and implementation of a telephone-based adherence call program for pharmacy technicians at Community Health Network (CHNw). This program aims to improve medication adherence rates for contracted Medicare Advantage plans.

Summary: As healthcare systems look for ways to improve patient care, Medicare reimbursement can guide ideas for initiatives. To improve medication adherence rates, the ambulatory care pharmacy team at CHNw developed a telephone-based adherence call system to better improve clinical outcomes and lower overall healthcare utilization and costs. Initially developed as a pharmacy student-driven service, the program has progressed to be run by clinical pharmacy technicians. Once patients are identified as candidates for outreach, the pharmacy technicians contact them to discuss medication adherence and coordinate with their primary care provider and embedded clinic pharmacist to ensure medication accessibility and overcome potential barriers to adherence.

Conclusion: Utilizing pharmacy technicians to complete medication adherence outreach calls has proven to be a success, as evidenced by improvement in star ratings in all 3 CMS medication adherence measures. This has resulted in work off-loaded from the clinical pharmacist, financial gain for the network, and improved medication adherence for patients. With this success, we can financially justify having the technicians on the ambulatory pharmacy team and plan to expand their roles into other pharmacy initiatives soon.  This program helps show that expanding the pharmacy technician role may further benefit the healthcare system.

Purpose: Awareness with paralysis (AWP) is an increasingly recognized complication of neuromuscular blocker use and is associated with adverse patient experiences. This manuscript describes the incidence of AWP and mitigation strategies that can be employed to prevent its occurrence and ensure optimal patient care.

Summary: Preventative strategies are essential to reduce the incidence of AWP. Approaches for prevention include awareness of the duration of action of analgesics, sedatives, and neuromuscular blocking agents (NMBAs), timely administration of postprocedural sedation, use of NMBAs for the shortest duration possible, and monitoring of the depth of sedation and neuromuscular blockade. Pharmacists are integral members of the multidisciplinary team in the emergency department and intensive care unit, where nonoperative neuromuscular blocker use is most common. Pharmacists can play a key role in eliminating AWP through their knowledge of the pharmacokinetics and pharmacodynamics of sedatives and NMBAs and their role in medication selection and monitoring.

Conclusion: By applying key strategies to prevent AWP, pharmacists can help make AWP a never event in both procedural and continuous use of NMBAs.

Purpose: Technology-assisted final product verification (TAFPV) is a process whereby a licensed pharmacy technician validates the work of another using a technology such as barcode scanning. While similar to tech-check-tech (TCT), TAFPV requires that technology is utilized in the final verification process. As of 2024, 28 states allowed this practice. In October 2021, the Michigan Board of Pharmacy passed allowances for TAFPV to be conducted in the state. This report describes the implementation of a TAFPV program and its impact on pharmacy operations.

Summary: Following technology and site readiness assessments, a TAFPV program was implemented at a community teaching hospital. Three months post implementation, 4,193 filled medication orders were verified by validated pharmacy technicians (VPTs) with 100% accuracy. Fifty-seven dispensing errors were identified by VPTs upon verification. The median time from medication procurement to final verification for VPTs was 138 seconds (interquartile range [IQR], 53-465) compared to 218 (IQR, 39-736) for pharmacists (P = 0.01). The mean (SD) amount of time spent verifying medication orders daily was 4.57 (0.12) hours for VPTs and 4.53 (0.14) hours for pharmacists (P = 0.97).

Conclusion: Implementation of a TAFPV program improved inpatient pharmacy operational efficiencies while preserving medication safety. A future area of study includes measuring the impact of clinical services provided by pharmacists utilizing the reallocated time from the TAFPV program.

Purpose: In January 2021, Ohio pharmacists were recognized by Medicaid as providers, became eligible to obtain Medicaid provider identification numbers, and were able to begin billing for services using evaluation and management codes. The objectives of this study were to compare outcomes before (2020) and after (2021 and 2022) pharmacist provider status was implemented in a network of primary care clinics: (1) the percent change in pharmacist-provided services that were billed and reimbursed, 2) the percent change in pharmacist-provided services that were billed as "incident-to" versus with the pharmacist as provider, and (3) the percent change in reimbursement per encounter as a result of pharmacist-provided services.

Methods: A retrospective review of all encounters and administrative claims (all payors) provided by pharmacists (7.9 full-time equivalents) within 7 primary care clinics affiliated with a large academic medical center was conducted. The data were compared year-to-year using descriptive statistics to determine the magnitude of change.

Results: A total of 14,416 encounters were included in the study (1,863 in 2020, 4,963 in 2021, and 7,590 in 2022). In 2020, 37.8% (705/1,863) of pharmacist encounters were billed for reimbursement. In 2021, this percentage increased to 39.1% (1,939/4,963) encounters, with a further increase in 2022 to 49.1% (3,725/7,590). Differences in the percentage of pharmacist encounters billed as incident-to versus pharmacist as provider were also evident, with 37.8% (705/1,863) of pharmacist encounters billed incident-to in 2020, as compared to 36.8% (2,796/7,590) in 2022. In this same time period, mean reimbursement for pharmacist-as-provider encounters increased by 189.5% (from $10.45 to $30.25) per encounter, and the number of pharmacist-as-provider encounters increased year over year (from 0% [0/1863] in 2020 to 1.1% [54/4,963] in 2021 and 12.3% [929/7,590] in 2022; P < 0.001).

Conclusion: This study found an increase in the billing and reimbursement attributable to clinical pharmacists in primary care settings in Ohio after their recognition as providers.

Purpose: The prevalence of Candida infections increases each year in the US. The most common Candida species are Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, and Candida krusei. Because of concerns about emerging resistance and impact on clinical outcomes, selection of appropriate empiric antifungal therapy is crucial. At our institution, an antifungalgram was created to help monitor antifungal susceptibility patterns.

Methods: A retrospective chart review was conducted at UnityPoint Health-Des Moines for the time period from January 2013 to July 2023. Patients were included if they had a sterile site culture positive for C. albicans, C. glabrata, C. parapsilosis, C. krusei, or C. tropicalis. Species were excluded if the sample size was fewer than 10 isolates or if susceptibility data were not available. The objective of this study was to evaluate the quantity and type of sterile site Candida species isolates and antifungal susceptibility to create an antifungalgram.

Results: This study reviewed 251 sterile site Candida isolates, of which 242 were included. Of the 242 sterile site isolates, 218 (90.1%) were from adult patients and 24 (9.9%) were from neonatal/pediatric patients. C. albicans was the most common organism with 132 (54.5%) isolates, followed by C. glabrata (74 isolates, 30.6%), C. parapsilosis (25 isolates, 10.3%), and C. tropicalis (11 isolates, 4.5%). The susceptibility rates for each Candida species were summarized.

Conclusion: The creation of a local antifungalgram helps to detect resistance patterns within healthcare systems and may guide empiric antifungal therapy selection.

Purpose: A customized Epic scoring tool for monitoring medications requiring renal dose adjustment utilizing Epic Bugsy and a custom renal function trend scoring column was developed and implemented in June 2023 at UT Southwestern Medical Center (UTSW) to replace the manual review and intervention (i-Vent) documentation process.

Methods: This retrospective, observational cohort study evaluated pharmacist interventions and antimicrobial dosing before and after implementation of the UTSW renal clinical pharmacist responsibility (CPR) dose adjustment tool. Adult patients (aged 18 years or older) requiring renal dose adjustment were included. The preintervention group included patients admitted between July 1 and August 31, 2022, whereas the postintervention group included patients admitted from July 1 through August 31, 2023. Patients exempt from the institutional automatic adult renal dosing guideline (ie, those with cystic fibrosis, solid organ transplantation, or bone marrow transplantation) or actively receiving renal replacement therapy during the index encounter were excluded.

Results: In a comparable 2-month timespan, implementation of the renal CPR dose adjustment tool resulted in a 68.2% increase in the number of renal dosing interventions completed (P < 0.0001), a 47.2% reduction in the number of unique alerts requiring pharmacist review (P < 0.0001), and an increase in the proportion of actionable interventions per alert requiring review from 11.1% before implementation to 39.4% after implementation (P < 0.0001). Pharmacist satisfaction with the renal monitoring workflow also improved with implementation.

Conclusion: In a comparable 2-month timespan, implementation of the renal CPR dose adjustment tool at UTSW resulted iin improvements in interventions completed, a reduction in alerts requiring review, an increased total duration that selected antimicrobials were dosed appropriately, and improved pharmacist satisfaction.