American Journal of Health-System Pharmacy最新文献

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: The centralization of prior authorization services to prevent denials and improve reimbursement measures at 2 community hospital-based infusion clinics is described.

Summary: Current process gaps at 2 hospital-based infusion clinics within the health system were leading to a significant denial burden and high out-of-pocket expenses to patients. As a result, authorization and benefit verification processes were centralized by deploying financial coordinators (FCs) at the beginning of fiscal year 2023. A retrospective cohort data review of participating payer claims from adult patients treated at the infusion clinics compared the pre- and postcentralization financial impact. The primary endpoint was the change in the number and cost of denials related to FC workflow. Secondary endpoints included the change in the number and cost of all initial denials, denial type, and success of local denial recovery efforts. Denials related to FC workflow decreased by 68% in the postcentralization period, with a cost reduction of approximately $1.4 million. Total initial denials decreased by 50%, resulting in a cost savings of $3.8 million. Among the top 10 most common denials, 4 were deemed related to FC workflow and declined dramatically after centralization. Local denial recovery efforts resulted in an organizational savings of $0.2 million and a patient savings of $0.19 million.

Conclusion: Centralization of prior authorization services via utilization of FCs significantly reduced the number and cost of preventable denials and positively impacted denial recovery efforts.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

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.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: Hemophilia B is a rare, hereditary bleeding disorder characterized by a deficiency in clotting factor IX (FIX). Traditional therapeutic strategies involve an economically and physically burdensome combination of prophylactic and episodic (ie, on-demand) administration of clotting factor concentrates (CFCs). The first gene therapy for hemophilia B, etranacogene dezaparvovec (Hemgenix), was approved by the Food and Drug Administration (FDA) in November 2022, with approval for fidanacogene elaparvovec (Beqvez) following in April 2024, produced by CSL Behrig and Pfizer, respectively. This literature review aims to provide an overview of current therapeutic strategies for the treatment of hemophilia B, introducing and focusing on the efficacy and safety of the novel gene therapies etranacogene dezaparvovec and fidanacogene elaparvovec.

Summary: Both FDA-approved hemophilia B gene therapies, etranacogene dezaparvovec and fidanacogene elaparvovec, utilize adeno-associated virus (AAV) vectors for delivery of the gene encoding FIX. Each of these medications has a distinct AAV serotype, but they have the same treatment modality, with the goal of curing the disease and reducing or eliminating prophylactic CFC requirements. Despite their different AAV serotypes, both products deliver a functional copy of the gene encoding the Padua variant (variant R338L) of human FIX. Recent clinical trials have demonstrated efficacy in increasing FIX concentrations leading to reduced frequency of spontaneous bleeding episodes; however, safety and response durability remain concerns.

Conclusion: For the first time in history, individuals with hemophilia B have access to potentially curative therapies through gene therapy. Both etranacogene dezaparvovec and fidanacogene elaparvovec offer significant efficacy, reducing the number of bleeding episodes and raising FIX concentrations with a single lifetime administration. While concerns remain regarding long-term safety and durability, these therapies represent a major advancement in reducing treatment burden and improving quality of life for patients. The future of hemophilia B management now holds the promise of greater independence from frequent prophylactic treatments.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

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.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

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.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: The glucagon-like peptide-1 receptor agonist (GLP-1RA) class of medications are widely prescribed for management of diabetes mellitus as well as obesity or weight management. Although there have been rare reports of skin hypersensitivity associated with GLP-1RA medications, no published reports have documented allodynia or skin pain to the touch.

Summary: We report 4 cases of allodynia associated with dose escalation of the GLP-1RA medication semaglutide. Each patient was prescribed semaglutide for management of obesity and developed symptoms of allodynia with the 2.4-mg subcutaneous once-weekly dose. Therapy was stopped in 2 patients, both of whom had resolution of symptoms. Two patients opted to continue semaglutide despite the adverse effect, with one experiencing resolution after 4 months. No pharmacological mechanism was identified for this unique adverse drug reaction. There was a clear temporal and dose-response relationship in each of the 4 cases.

Conclusion: The 4 cases presented had scores of 5 or 6 (probable) on the Naranjo scale. It is not known whether this is a class effect of the GLP-1RA medications or if the adverse effect will consistently resolve or improve with continuation.

Disclaimer: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

Purpose: The study objective was to analyze the use of health equity (HE)- and social determinants of health (SDOH)-related language within pharmacy residency websites and recruitment materials.

Methods: Using the ASHP residency directory of 2022, a randomly selected sample of postgraduate year 1 (PGY1) and PGY1/PGY2 programs from each state were analyzed. After search terms were selected from HE/SDOH resources, each program's residency-specific webpages (RSWs) and institution-specific webpages (ISWs) were searched and given a score based on the frequency of identified terms. The primary outcome was the number of programs with at least one identified instance of HE/SDOH terms. Additional outcomes included the frequency of HE/SDOH terms on ISWs or RSWs and program score distribution. Outcomes were also evaluated among programs in medically underserved areas (MUAs).

Results: Three hundred eighteen programs were included, of which 205 (64%) included HE/SDOH language within RSWs, ISWs, or both. Of these 205 programs, 126 programs (61%) included language only on ISWs. The number of programs that only had one instance of HE/SDOH terms on either category of webpages, or had a score of 1, was 128 programs (40.2% of the total of 318 programs). Of the 111 programs in MUAs (35%), 66 (59.5%) included HE/SDOH language within the ISWs.

Conclusion: Most evaluated programs, including those in MUAs, lacked language specifically identifying their focus and work around HE/SDOH within their residency promotional materials.

Purpose: Optimization of automated dispensing cabinets (ADCs) has traditionally focused on modifying the inventory within these devices and ignored the replenishment process itself. Rounding replenishment quantities to the nearest package size, termed package size-conscious replenishment (PSCR), was investigated as a way to optimize labor needs for ADC replenishment.

Methods: A simulation of PSCR for a subset of medications stocked in ADCs at the University of North Carolina Medical Center was conducted. The simulation utilized real-world vend data and rounding factors to model the impact of PSCR on key ADC metrics. The final simulation utilized 2 months of ADC transactions across 410 medications in 149 ADCs. Four replenishment methodologies were simulated: standard replenishment and 3 PSCR strategies, including rounding down, rounding any direction, and rounding up.

Results: All 3 PSCR methodologies had significantly lower stockout frequencies than standard replenishment at 0.722% (P = 0.026) for rounding down, 0.698% (P = 0.024) for rounding any direction, and 0.680% (P = 0.024) for rounding up vs 0.773% for standard replenishment. PSCR methods were associated with significant time savings for both technician and pharmacist activities (P < 0.001 for all 3 strategies), with a savings of up to 0.27 technician and 0.52 pharmacist full-time equivalents estimated for the rounding-up methodology. Maximum carrying cost was higher for all 3 PSCR methodologies.

Conclusion: PSCR was modeled to significantly decrease both pharmacist and technician time needed to replenish ADCs while also decreasing stockout frequency. Modest increases in maximum carrying cost were also shown. The simulation created for this evaluation could also be utilized to model other components of the ADC replenishment process.

Purpose: To evaluate the effect of oncology services rendered by clinical pharmacists on reducing chemotherapy-induced nausea and vomiting (CINV) and improving overall treatment experiences.

Methods: A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Research Information Sharing Service (RISS). The incidence and severity of CINV were evaluated as primary outcomes. Secondary outcomes were patient adherence, patient satisfaction, quality of life (QoL), emergency department (ED) visits, hospitalizations, and costs.

Results: A total of 12 studies were selected for systematic review, with 8 studies eligible for meta-analysis. We found that clinical pharmacy services contributed to preventing and alleviating CINV as well as improving patient's medication adherence, treatment satisfaction, and QoL, reducing hospital visits, and achieving cost savings. In the meta-analysis, pharmacists' interventions were notably effective in reducing the incidence of nausea (odds ratio [OR], 1.917; 95% CI, 1.243-2.955; P = 0.003) and vomiting (OR, 2.491; 95% CI, 1.199-5.177; P = 0.014) during overall treatments periods relative to results in control groups. In addition, the impact of clinical pharmacy services on CINV control was greater during the delayed phase compared to the acute phase.

Conclusion: This study demonstrated the important role of clinical pharmacy services in controlling CINV and enhancing the overall treatment experience for patients with cancer. Further studies with standardized pharmacists' services and outcome measures are needed to validate our findings.