American Journal of Health-System Pharmacy最新文献

Purpose: A previous study at Ascension Seton Hospital Network (ASHN) found a 1:1 dose conversion to insulin detemir 100 units/mL (iDet100) from insulin glargine 300 units/mL (iGlar300) increased the incidence of hypoglycemia as compared to a 1:1 conversion from insulin glargine 100 units/mL. No studies have evaluated an automatic 20% dose reduction for this specific therapeutic interchange. The purpose of this study was to compare hypoglycemia rates following implementation of a protocol specifying a minimum 20% dose reduction when converting from iGlar300 to inpatient iDet100.

Methods: This multicenter, retrospective chart review-based study was a before/after study evaluating the impact of an ASHN protocol implemented in April 2021 requiring a minimum 20% reduction when converting from home iGlar300 to inpatient iDet100. Previously, a 1:1 interchange was standard. Patients admitted between May 2019 and December 2022 were included if at least 1 dose of iDet100 was received following interchange from iGlar300. The primary endpoint was hypoglycemia incidence before and after protocol implementation. Secondary endpoints included time to first hypoglycemia and number of doses given before hypoglycemia. Logistic regression was performed to analyze the relationship between percent interchange from home dose and hypoglycemia rate.

Results: A total of 284 patients were included: 128 in the preprotocol arm and 156 in the postprotocol arm. The incidence of hypoglycemia was significantly lower in the postprotocol arm than in the preprotocol arm (11.9% vs 24.7%; P = 0.018). The median time to first hypoglycemia was longer in the postprotocol versus the preprotocol arm, though the difference was not statistically significant (13 vs 18.5 hours, P = 0.082). For each percent reduction from iGlar300 to iDet100, the likelihood of hypoglycemia was reduced by 5.3%.

Conclusion: A protocol requiring a minimum 20% dose reduction from iGlar300 to inpatient iDet100 reduced the incidence of hypoglycemia. Health systems should consider adopting a similar approach to reduce the occurrence of hypoglycemia upon interchange.

Purpose: To report historical patterns of pharmaceutical expenditures, to identify factors that may influence future spending, and to predict growth in drug spending in 2025 in the United States, with a focus on the nonfederal hospital and clinic sectors.

Methods: Historical patterns were assessed by examining data on drug purchases from manufacturers using the IQVIA National Sales Perspectives database. Factors that may influence drug spending in hospitals and clinics in 2025 were reviewed-including new drug approvals, patent expirations, and potential new policies or legislation. Focused analyses were conducted for biosimilars, cancer drugs, endocrine drugs, generics, specialty drugs and vaccines. For nonfederal hospitals, clinics, and overall (all sectors), estimates of growth of pharmaceutical expenditures in 2024 were made based on a combination of quantitative analyses and expert opinion.

Results: In 2024, overall pharmaceutical expenditures in the US grew 10.2% compared to 2023, for a total of $805.9 billion. Utilization (a 7.9% increase) and new drugs (a 2.5% increase) drove this increase, while prices remained flat (a 0.2% decrease). Semaglutide was the top drug in 2024, followed by tirzepatide and adalimumab. Drug expenditures were $39.0 billion (a 4.9% increase) and $158.2 billion (a 14.4% increase) in nonfederal hospitals and clinics, respectively. In clinics, increased utilization drove growth, with a small contribution from new products, while prices remained flat. In nonfederal hospitals, new products, price, and new volume each contributed modestly to growth in spend. Several new drugs that will influence spending are expected to be approved in 2025. Specialty, endocrine, and cancer drugs will continue to drive expenditures.

Conclusion: For 2025, we expect overall prescription drug spending to rise by 9.0 to 11.0%, whereas in clinics and hospitals we anticipate an 11.0% to 13.0% increase and a 2.0% to 4.0% increase, respectively, compared to 2024. These national estimates of future pharmaceutical expenditure growth may not be representative of any health system because of the myriad of local factors that influence actual spending.

Purpose: Pharmacy residency training, endorsed by the American Society of Health-System Pharmacists (ASHP), is designed to enhance clinical pharmacy practice. However, in 2022 and subsequent years, the ASHP Resident Matching Program reported unprecedented numbers of unfilled positions, notably in postgraduate year 2 (PGY2) programs. This review explores motivations, barriers, and well-being indices in pharmacy residency pursuit and training, seeking to explain the rise in unfilled postgraduate training positions.

Methods: Two literature searches were performed using relevant resources and databases: search 1, to determine motivating factors and barriers to pursuit of postgraduate training; and search 2, to gather evidence related to resident well-being, burnout, and resiliency.

Results: Search 1 yielded 11 studies about motivating or deterring factors for pharmacy residency pursuit, whereas search 2 produced 16 articles on resident well-being. Major motivators for pursuing postgraduate training included the desire to gain knowledge and specialized training, recognition of evolving pharmacist roles, and viewing residency as a prerequisite for certain positions. Conversely, major barriers included financial or family obligations and concerns about job availability following graduation. Most articles discussed student pursuit of PGY1 residencies. Resident well-being encompassed burnout assessments, other wellness indicators like depression, and the impact of the coronavirus disease 2019 (COVID-19) pandemic. Developed well-being programs elicited mostly positive perceptions from pharmacy residents.

Conclusion: There is a body of published literature elucidating motivations and barriers to the pursuit of postgraduate training and well-being related to wellness/satisfaction on the job. However, to comprehensively evaluate well-being program impact and address gaps in literature regarding barriers to and motivators for pursuit of specialized PGY2 programs, further research is needed.

Purpose: The primary objective was to assess the clarity, applicability, and evaluability of the criteria included in the ASHP accreditation standard for international hospital and health-system pharmacy services. The secondary objective was to determine the proportion of the ASHP criteria that could be matched with those of Accreditation Canada's medication management standards.

Methods: For this cross-sectional descriptive study, a panel of 5 experts was recruited. Each panelist was invited, by electronic means, to consult the ASHP standard and rate its criteria in terms of clarity, applicability, and evaluability. After a 21-day consultation period, a summary grid was produced for a meeting, during which individual results were presented and, after discussion and by consensus, a rating for each criterion was determined.

Results: Regarding the primary objective, the panel of experts considered the criteria of the ASHP standard to be clear (98.8%, 82/83), applicable to pharmaceutical practice in Quebec healthcare institutions (96.4%, 80/83), and evaluable (95.2%, 79/83). Regarding the secondary objective, almost one-third (28.9%, 24/83) of the criteria within the ASHP standard could be matched completely to criteria within the Accreditation Canada medication management standards; a smaller proportion (26.5%, 22/83) could be partially matched to the Canadian standards, and the remainder (44.6%, 37/83) could not be matched.

Conclusion: This descriptive, cross-sectional study showed that the ASHP criteria for international facilities are clear, applicable to hospital pharmacy practice in Quebec, and can be evaluated. However, only a limited proportion of the ASHP criteria could be matched with the Accreditation Canada medication management standards. The applicability to a larger cross section of hospital sites in Quebec or Canada (general hospitals as well as pediatric and specialty hospitals) could also be undertaken.

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

Summary: Despite established value in the emergency department (ED), cardiac care, and intensive care settings, there is currently little published literature describing or supporting clinical pharmacist roles in the acute management of STEMI. The high-risk period from hospital presentation through revascularization and stabilization involves complex pharmacotherapeutic decision points, many operational medication needs, and multiple layers of quality oversight. While rife with opportunities for pharmacists to optimize care, this timeframe appears inconsistently targeted by clinical pharmacy services, which may halt after ED evaluation and then resume upon postcatheterization cardiac unit admission. Herein we review the key pharmacotherapeutic modalities and considerations for the patient with STEMI across the critical initial phases of care. These include supportive therapies prior to revascularization, the host of antithrombotics involved in revascularization by percutaneous coronary intervention and/or fibrinolysis, and other periprocedural medications. Important practice guidelines and clinical resources are summarized from the clinical pharmacist perspective, and roles and responsibilities of the responding pharmacist are suggested. A companion article will extend the review to periprocedural adverse event management, key early decision-making regarding long-term risk reduction, and pharmacist involvement in institutional quality improvement efforts. We aim to support inpatient pharmacy departments in advancing clinical services for this critical patient population, and we call for further research delineating pharmacist impact on patient and institutional STEMI outcomes.

Conclusion: Patients presenting with STEMI rapidly traverse multiple phases of care and receive a host of antithrombotic and supportive medications during acute management, presenting many important pharmacotherapeutic decision points and roles for pharmacists.

Purpose: The transition from chlorofluorocarbons (CFCs) to hydrofluoroalkanes (HFAs) has significantly reduced the greenhouse gas (GHG) emissions associated with metered-dose inhalers (MDIs). However, HFAs still have a high global warming potential (GWP) compared to other alternatives such as dry powder inhalers (DPIs) and soft mist inhalers (SMIs). This transition has significantly impacted GHG emissions, underscoring a need to evaluate the environmental impact of medication delivery via MDIs.

Objectives: This study quantifies the GHG emissions, expressed as carbon dioxide equivalents (CO2e), from the use of HFAs in MDIs within our health system. The healthcare system includes 13 hospitals with over 2,000 staffed beds and approximately 100,000 annual patient admissions. It also examines the broader environmental impacts of the packaging materials associated with these inhalers.

Methods: A retrospective analysis of the use of albuterol and inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) MDIs over a 1-year period, assessing their CO2e emissions and the environmental impact of their packaging. The total weight of propellant was determined by calculating the difference in canister weight before use and after all contents were expelled.

Results: A total of 17,589 albuterol and 20,563 ICS/LABA MDIs were dispensed during the study. The total propellant weight led to CO2e emissions of 212 metric tons (MT) for albuterol MDIs and 506 MT for ICS/LABA MDIs. Including resource use and emissions from inhaler components led to an environmental impact that totaled 213 MT of CO2e for albuterol MDIs and 512.5 MT for ICS/LABA MDIs.

Conclusion: Our study emphasizes the necessity of integrating environmental stewardship into healthcare practices. By fostering awareness and initiating discussions on sustainable practices, particularly in the context of pharmacy operations, we can contribute to a more environmentally responsible healthcare system while continuing to meet the clinical needs of our patients.

Purpose: Health-system pharmacists play a crucial role in monitoring the pharmaceutical pipeline to manage formularies, allocate resources, and optimize clinical programs for new therapies. This article aims to support pharmacists by providing updates on new and anticipated novel drug approvals.

Summary: Selected drug approvals anticipated in the 12-month period covering each quarter of 2025 are reviewed. The analysis emphasizes drugs expected to have significant clinical and financial impact in hospitals and clinics, as selected from 60 novel drugs awaiting US Food and Drug Administration approval. This year's pipeline features gene and cell therapies for rare diseases, agents for neurological disorders, and several novel treatments for cancers and various disease states.

Conclusion: Novel therapies continue to strengthen the current drug pipeline.