American Journal of Health-System Pharmacy最新文献

Purpose: This article identifies, summarizes, and prioritizes published literature on the ambulatory care medication-use process (ACMUP) from 2023 that can describe ambulatory pharmacy practice. The medication-use process is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The ACMUP is defined in this article as having the following components: transitions of care, prescribing, access, dispensing, adherence, and evaluating. Articles evaluating at least one step of the ACMUP were assessed for their usefulness toward practice improvement.

Summary: A PubMed search was conducted in January 2024 for the publication year 2023 using targeted Medical Subject Headings (MeSH) keywords and the table of contents of selected pharmacy journals, providing a total of 2,903 articles. A thorough review identified 52 potentially practice-enhancing articles: 6 for transitions of care, 11 for prescribing, 5 for access, 6 for dispensing, 8 for adherence, and 16 articles for evaluating. Trends gleaned from the highest-impact articles are described.

Conclusion: It is important to routinely review the published literature and to incorporate significant findings into daily practice. This article continues a series of articles defining and evaluating the currently published literature around the ACMUP. As healthcare continues to advance and care shifts to ambulatory settings, the ACMUP will continue to be a crucial process to evaluate.

Purpose: Evaluation methods for postgraduate year 1 (PGY1) pharmacy residency positions must objectively rank candidates and assess clinical and nonclinical characteristics. Situational judgment tests (SJTs), many of which have been shown to be both consistent and validated, were used as a structure for a new assessment adapted into our selection process to predict candidates' future success in our residency program. To our knowledge, no PGY1 pharmacy residency program has published its experience adapting an SJT in a live panel environment.

Summary: We formulated a modified SJT with 5 scenarios devised to judge 5 behavioral domains: communication, integrity, assertiveness, time management, and problem solving. These domains align with our organization's core values and the American Society of Health-System Pharmacists (ASHP) required competency areas, goals, and objectives (CAGOs) for PGY1 programs. Similarly, scenarios and responses attempted to reduce risk of bias and ensure measurement of relevant skills. These assessments were intended to expose patterns that suggested fear of authority, lack of awareness, aversion to confrontation, or carelessness. We also noted if candidates struggled to grasp and follow instructions, commit to answers, consider multiple facets of a decision, or defend their choice. This information was not assessed in other components of our current process.

Conclusion: Our modified SJTs and structured rubric assess candidate skills in a standardized manner. By evaluating a candidate's response and verbalized thought process in search of core values, we move away from using subjective "fit" and instead focus on specific characteristics we seek to nurture and develop in our future residents.

Purpose: This publication outlines development of the infrastructure and standard operating procedures (SOPs) for handling of gene therapy drugs within an integrated health-system setting. These guidelines aim to fill the gap in occupational safety standardization, as current materials focus on precautions in a research laboratory setting and do not fully take into account occupational hazards for pharmacists, technicians, and other medical staff.

Summary: Pharmacists in a large integrated healthcare system recognized the gap in knowledge as well as lack of standard procedures in handling gene therapy drugs in the pharmacy setting and sought to establish updated best practices. The objectives were to implement the necessary infrastructure and SOPs for the handling, compounding, and cleanup of gene therapy drugs and to update existing resources such as spill kits to reflect the new SOPs. Critical milestones included establishing a new biohazardous drug risk classification and standardizing medication labeling. These steps were necessary to ensure consistent and safe handling across the enterprise.

Conclusion: With the increasing prevalence of gene therapy drugs, it is of paramount importance to establish best practices to ensure occupational safety. While existing regulations and literature outline basic handling guidelines for laboratory use, there is a limited amount of information in relation to pharmacy departments within healthcare groups. In establishing robust SOPs surrounding the handling, compounding, and management of gene therapy drugs, pharmacy groups can better ensure both patient and staff safety.

Purpose: To evaluate the financial reimbursement of a pharmacist-led chronic care management (CCM) program utilizing student pharmacists and pharmacy residents as pharmacist extenders in a privately owned primary care practice.

Methods: A retrospective study assessing financial reimbursement of a pharmacist-led CCM program utilizing pharmacist extenders was conducted for the 12-month period from January 1 through December 31, 2022, at a privately owned family medicine practice. Return on investment (ROI) was the primary outcome. Secondary outcomes included the number of patients enrolled, number of billable patients, time spent delivering CCM (ie, "time-on-task"), and third-party claim reimbursement.

Results: During the 12-month study period, 203 patients were enrolled in the CCM program. Time-on-task was 463 hours. The number of billable patients for time-based CCM codes per month ranged from 19 to 121. Gross revenue from CCM was $55,104.64, and expenses totaled $9,482.64. Reimbursement for monthly CCM codes resulted in $44,042.31 (80%) of the gross revenue. Overall ROI was 481.1%, and ROI for monthly CCM codes alone was 364.5%. Out of the 1,046 CCM claims, 957 (92%) were paid.

Conclusion: Utilization of pharmacy residents and student pharmacists within the pharmacist-led CCM program resulted in a positive ROI, even in a small private practice. The ROI from monthly CCM codes alone was also positive, demonstrating sustainability of profits from the CCM program. Preceptors and schools of pharmacy should evaluate opportunities to utilize pharmacy learners to enhance sustainability of other pharmacist-led programs.

Purpose: This study sought to characterize current trends in the program structure of postgraduate year 2 (PGY2) pediatric pharmacy residencies and to describe the growth of pediatric ambulatory care as a practice specialty.

Methods: A 99-question survey was designed to collect information regarding the current structure of PGY2 pediatric pharmacy residency programs. The survey was distributed electronically to PGY2 residency program directors (RPDs) and was open for 6 weeks from September to November 2023.

Results: 75 distinct programs were eligible for participation; 43 programs (response rate, 57.3%) were included in the final analysis. Of the 43 respondents, 14 (32.6%) indicated their program was at a stand-alone children's hospital. The majority of programs (22 of 43, 51.2%) require residents to spend 7 to 9 months of their residency year on required rotations. Nineteen of 40 respondents (47.5%) indicated their residents staff in both clinical and operational areas. The most commonly reported frequency was every third weekend. Most respondents indicated requiring up to 15 presentations of varying types. A total of 41 respondents participated in the ambulatory care section of the survey; 75% of respondents (30 of 40) reported there has been growth in the number of pharmacists in pediatric ambulatory care at their institution in the last 5 years.

Conclusion: This study describes the current state of PGY2 pediatric pharmacy residency programs, including educational opportunities and trends in staffing and academic activity requirements. This study also adds to available literature on pediatric ambulatory care and potential opportunities for resident-led expansion.

Purpose: Clostridioides difficile infection (CDI) is a hospital-acquired infection commonly treated with oral vancomycin. An institutional policy aimed at reducing costs by substituting compounded liquid vancomycin for capsules may have the unintended consequence of having the liquid formulation prescribed at discharge, potentially delaying patients' access due to a lack of availability in pharmacies or lack of insurance coverage. This study aimed to evaluate hospital readmission rates of patients prescribed either vancomycin capsules or liquid upon discharge.

Methods: This was a retrospective cohort study conducted at an academic hospital using electronic health records data over a 6-year timeframe. The primary outcomes were all-cause and CDI-specific readmission rates within 30 days of discharge, and secondary outcomes included readmission rates within 60 and 90 days. Baseline characteristics were compared using chi-square or Mann-Whitney U tests. The hazard ratio (HR) for readmission was calculated using a Cox proportional hazards model, and readmission rates were analyzed using a Poisson regression model. All readmissions were confirmed by chart review.

Results: A total of 440 patients (61.3% female; median age, 58 years) were included; of these, 68% (n = 298) were prescribed vancomycin liquid and 32% (n = 142) a capsule form. Baseline characteristics were similar in the 2 groups, with the exception of the presence of inflammatory bowel disease (19.0% vs 6.4%, P < 0.0001) and median length of stay (6 days vs 8 days, P = 0.010). Patients prescribed vancomycin liquid were not more likely to be readmitted within 30 days relative to those prescribed capsule, with an adjusted HR for all-cause readmission of 1.58 (95% CI, 0.92-2.73) and an adjusted HR for CDI-specific readmission of 2.21 (95% CI, 0.72-6.76). However, patients prescribed liquid were more likely to be readmitted within 60 days, with an adjusted HR for all-cause readmission of 1.87 (95% CI, 1.19-2.94) and an adjusted HR for CDI-specific readmission of 2.84 (95% CI, 1.14-7.06).

Conclusion: A hospital pharmacy practice implemented to reduce medication costs may impact vancomycin prescribing at discharge and, in turn, may negatively impact readmission rates for patients with CDI treated with oral vancomycin.

Purpose: Key pharmacotherapeutic modalities and considerations for the patient with ST-elevation myocardial infarction (STEMI) across the later phases of inpatient care are reviewed.

Summary: Published descriptions and validation of clinical pharmacist roles specific to the acute management of STEMI are limited. This high-risk period from presentation through revascularization, stabilization, and hospital discharge involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. A companion article reviewed STEMI pharmacotherapy from emergency department presentation through revascularization. Herein we complete the pharmacotherapy review for the STEMI patient across the inpatient phases of care, including the management of peri-infarction complications with vasoactive and antiarrhythmic agents, considerations for post-revascularization antithrombotics, and assessments of supportive therapies and secondary prevention. Key guideline recommendations and literature developments are summarized from the clinical pharmacist's perspective alongside suggested pharmacist roles and responsibilities. Considerations for successful hospital discharge after STEMI and pharmacist involvement in associated institutional quality improvement efforts are also provided. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population and call for further research delineating pharmacists' impact on patient and institutional STEMI outcomes.