INNOVATIONS in pharmacy (Iip - E-Journal)
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Pharmacy-Based Assessment and Management of Herpes Labialis (Cold Sores) with Antiviral Therapy
Full text linkHerpes labialis, commonly known as cold sores, is an infection of the mouth and surrounding area. Antiviral therapy can be used to block viral replication, which shortens the duration of symptoms, facilitates resolution of lesions, and lessens the risk of spreading the virus. Increasing access to antivirals targeted against herpes labialis by allowing assessment and prescribing by a pharmacist may decrease time to treatment for HSV-1, and improve patient satisfaction. Experience from Canada, Australia, New Zealand and the United States demonstrate that pharmacist management of cold sores has a safe track record and may be considered by other jurisdictions.
Commentar
Prescription Adaptation Services: A Win for Patients and Providers
Full text link“Prescription adaptation services” (PAS) refers to the ability of pharmacists “to adapt an existing prescription when, in their professional judgment, the action is intended to optimize the therapeutic outcome of treatment.” If structured appropriately, PAS can provide a benefit in enhancing the timeliness of patient care, while reducing the administrative burden on both physicians and pharmacists. Moreover, it leverages the strengths of both health professions, specifically the medication expertise of pharmacists. Unfortunately, in most states it will require a change in regulations in order to enable PAS
Developing a Co-Curricular Activity to Introduce Student Pharmacists to the Cultural Proficiency Continuum Framework
Full text linkBackground: As the United States becomes more culturally diverse, health professionals must be able to demonstrate competency in caring for a multitude of diverse patients. The cultural proficiency continuum has proven to be an effective framework to assess where individuals and institutions are on the continuum of cultural sensitivity and competence in educational settings.
Innovation: A co-curricular activity was developed as an exercise in self-awareness to allow first year pharmacy students the opportunity to explore potential biases by evaluating comfort in both social and patient care settings. The 90-minute activity employed a lecture, followed by both small and large group discussions and a debriefing session.
Findings: Student survey responses showed their appreciation of this framework and its application to patient-centered care. Student self-rated knowledge increased by 3 points on a 10-point scale after completion of the activity. Students agreed that their level of cultural awareness would lead them to respond appropriately in cross-cultural situations, and that the provision of care is dependent on approaches that are culturally proficient.
Conclusion: This activity dismantles the misconception of cultural competence as an attainable finite skill, but instead presents it as an ongoing process of self-awareness. The co-curricular activity offers an easy to implement model of education that could potentially fit the needs of pharmacy programs searching for ideas to teach cultural competency and social determinants of health, while circumventing the need to affect curricular structure
Use of Medication Error Simulations in Continuing Professional Education to Effect Change To Practice
Full text linkIntroduction: A novel continuing professional education CPE training program and simulation were used to teach pharmacists and pharmacy technicians about continuous quality improvement and how to identify, report, and communicate information regarding medication related errors using root cause analysis.
Methods: Pharmacists and pharmacy technicians attending a statewide pharmacy association meeting voluntary attended a CPE training program and simulation. During the simulation, learners investigated and identified medication related errors in three different pharmacy settings. A collection of items found at each pharmacy and audio recordings were used by learners to identify the medication related error. After each simulation, facilitators led a debriefing to discuss the learners’ experiences. Data was collected using online surveys. Descriptive statistics and chi-square tests were used to analyze the data.
Results: Fourteen months following the program, 15 of the 67 participants responded to an anonymous survey. Of the 15 responding participants, 73.3% (11/15) were confident or very confident they could establish or maintain a high-quality continuous quality improvement plan at their practice site. Sixty percent (9/15) felt the experience reinforced their current practices, 13.3% (2/15) had implemented changes to their practice, and 13.3% (2/15) felt they needed more information before considering changes to their practice. Reported barriers to establishing a continuous quality improvement program were time constraints, 40.0% (6/15), system constraints, 26.7% (4/15), or lack of staff 20.0% (3/15).
Conclusion: A CPE training program and simulation reinforced practice for pharmacy personnel, resulted in changes to practice, and positively increased participants’ confidence in establishing a continuous quality improvement plan in the workplace
How CEO Deans in Academic Pharmacy Describe and Manage High-performing and Low-performing Faculty
Full text linkObjectives: Gather Chief Executive Officer (CEO) deans’ perspectives on: distinguishing a “star” faculty versus one that is “productive”; faculty who are “deadweight” to the organization; the role of organizational fit in defining stars and deadweight faculty; current efforts to recruit and retain star faculty; and the actions taken in regard to deadweight faculty.
Methods: A focus group panel of CEO deans was convened at the American Association of Colleges of Pharmacy (AACP) 2019 Interim Meeting. A semi-structured interview based on an organizational behavior framework was used to guide discussion in the focus group. Content analysis with axial coding was used to uncover themes from the data.
Results: Panelists indicated productivity to be a given, but that star faculty are the ones who exhibit extraordinary citizenship and leverage their talents and networks to make the program and their peers more effective. They identified nascent activities with the need to strengthen those in regard to recognizing star faculty. The panelists explicitly distinguished between deadweight, or unproductive faculty versus those who are more deleterious, even while the former might actually present a more challenging human resources management situation.
Conclusions: The research corroborated the growing recognition of the importance of faculty comportment with behaviors that extend beyond performance metrics, alone. The findings can serve as a platform for additional studies that guide decision making for organizational effectiveness in academic pharmacy
Influence of Pharmacy Characteristics and Customer Quality of Life on Satisfaction of Community Pharmacy Customers
Full text linkObjectives: The study objectives were to evaluate customer satisfaction with community pharmacy services and measure the relationships between customer satisfaction and pharmacy/pharmacist characteristics and customer quality of life.
Methods: This was a cross-sectional survey of a convenience sample of customers at 20 community pharmacies in 10 different geographical areas in Baghdad city between May and September 2018. We used the satisfaction items which were developed by Paterson and colleagues in 2013. The survey also assessed customer quality of life (QoL) with 12 QoL items.
Results: The study recruited 400 pharmacy customers. Overall, customers reported good satisfaction with community pharmacy services. The most three satisfying aspects were the professional appearance of the pharmacy, the professionalism of pharmacy staff and explanations of possible adverse medication effects. Three customer characteristics were associated with high satisfaction rates including male gender, buying medications without a prescription, and seeking services for themselves. Three pharmacy characteristics increased the customer satisfaction rate including the availability of female pharmacists, having more than one pharmacist, and whether the pharmacy is open full time. For quality of life, patients who had a limitation in their activities and those who accomplished less than they would like were less satisfied with pharmacy services.
Conclusions: To improve pharmacy services, pharmacists need to enhance their professional appearance, allocate more time for patient counselling, help patients to manage their medications and extend their working hours to meet customer needs.
Article Type: Original Researc
Cultivating a Community of Practice through Podcasting
Full text linkWhile innovation in pharmacy education can be sparked through many avenues, the opportunity to learn and engage with others through practice communities is considered by many as a creative outlet for exchange and discovery. This commentary specifically describes a contemporary approach to promote such a dialogue globally through podcasting, which is a free and highly accessible medium for dissemination and exchange of innovative teaching practices. In 2018, two faculty from two colleges of pharmacy created a podcast titled Leadership Development in Pharmacy Education (LDPEcast), which provides a unique modality to stimulate discussion and disseminate ideas within the community of practice. This commentary provides a case illustration for how a podcast can be intentionally designed and implemented with the goal of inspiring engagement across a global practice community. Early results of the podcast have been largely successful with nearly 1000 episode downloads and an additional 445 episode streams from audience members. While this podcast was designed specifically to discuss leadership integration within pharmacy training, opportunities may exist for further exploration of podcasting to spread innovative ideas, practices, and evaluative approaches in pharmacy education, while strengthening connections and elevating communities of practice across institutions.
Article Type: Commentar
More Unnecessary Imaginary Worlds – Part 2: The ICER Evidence Report on Modeling Oral Semaglutide for Type 2 Diabetes
Full text linkOn 9 December 2019, the Institute for Clinical and Economic Review (ICER) released its final evidence report to establish the value of oral semaglutide (Novo Nordisk) for Type 2 diabetes (T2DM). A key element in this report was the development of a lifetime cost effectiveness microsimulation model based on a small sample of NHANES diabetes respondents. The model contrasted oral semaglutide added to current antihyperglycemic treatment for T2DM. The purpose of the model was to estimate outcomes that included life years (LYs) gained, an estimate of equal value life years gained (evLYGs), QALYs gained, clinical events, cost per major adverse cardiovascular events (MACE) avoided and total costs for each intervention over a lifetime time horizon. Previous commentaries in INNOVATTIONS in Pharmacy have provided detailed critiques of the ICER modeling framework. While this model differs from previous ICER models, the result is still a framework that constructs a so-called evidence base that fails the demarcation test. It is best described as pseudoscience. The model creates, by assumption, an imaginary world. The claims made for oral semaglutide by ICER should not be taken seriously by health care decision makers. The purpose of this commentary is to point to the limitations of the model with particular reference to the utility metrics employed, the resulting claims for quality adjusted life years (QALYs) and consequent recommendations for price discounting and affordability.
Article Type: Commentar
Applying the Model for Improvement to a Student-run Quality Improvement Project in a Refugee Center: A Pilot Study
Full text linkDue to insufficient communication strategies between healthcare providers and refugees in the United States, this quality improvement project aimed to improve disparity in refugee healthcare. We chose to focus on community pharmacist counseling sessions with refugees in the city of Rochester, New York. The two refugee populations we focused on were the Burmese and Nepali. Due to illiteracy in their native language, the refugees were not receptive to a pamphlet detailing the beneficial roles a pharmacy can have in improving their health and wellbeing. We created a pictorial survey of pharmacies near a refugee center to identify the pharmacies the refugees were utilizing in the area. Once we identified these pharmacies, we created a counseling aid booklet translating common pharmacy language/terms into English, Burmese, and Nepalese languages supported by pictorial diagrams. The counseling aid booklet was evaluated by pharmacists using a satisfaction scale. Overall, the counseling aid booklet was found to be helpful for the pharmacist’s daily interaction with refugee populations. Further plans for the counseling aid booklet include adding more pharmacy counseling terms for common disease states in refugee populations, making the book more inclusive of other languages, and implementation in more community pharmacies and other diverse healthcare settings.
Article Type: Student Projec
More Unnecessary Imaginary Worlds – Part 4: The ICER Evidence Report for Crizanlizumab, Voxelotor and L-Glutamine for Sickle Cell Disease
Full text linkA number of commentaries have been published over the past 4 years by the present author on the manifest flaws in the reference case value assessment framework of the Institute for Economic and Clinical Review. The recent release of the evidence report on sickle cell disease continues ICER’s commitment to what has been described as the creation of imaginary worlds to support value assessment. The purpose of the present commentary is to continue the critiques that have been presented for earlier evidence reports. This is important because of the apparent willingness to take ICER’s recommendations at face value rather than a critical review of the value assessment framework. The case presented here points to a number of weaknesses in the ICER framework: (i) the fabrication of imaginary constructs with a lifetime cost-per-incremental QALY framework; (ii) the consequent failure to meet the standards of normal science; (iii) the illogical reliance of assumptions drawn from the literature to create future scenarios; (iv) the rejection of hypothesis testing in favor of ‘approximate information’ and (v) a belief that in the construction of QALYS that the EQ-5D-3L utility scale has ratio properties. This last point is demonstrably false which means that the ICER value assessment framework collapses. It is impossible mathematically, a failure to meet the axioms of fundamental measurement, for an ordinal utility scale to be combined with time spent in a disease state. The result is that the pricing and access recommendations for Crizanlizumab, Voxelotor and L-glutamine in sickle cell disease (SCD) are complete nonsense and should be rejected