INNOVATIONS in pharmacy (Iip - E-Journal)
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RETRACTED: Patient Safety: A Deep Concern to Caregivers
Full text linkThis article has been retracted: please see INNOVATIONS in pharmacy retraction policy (https://pubs.lib.umn.edu/index.php/innovations/policies). This article has been retracted by the Editor and Publisher due to the inappropriate use of previously published work.
Patient safety is a global concern and is the most important domains of health-care quality. Medical error is a major patient safety concern, causing increase in health-care cost due to mortality, morbidity, or prolonged hospital stay. A definition for patient safety has emerged from the health care quality movement that is equally abstract, with various approaches to the more concrete essential components. Patient safety was defined by the IOM as “the prevention of harm to patients.” Emphasis is placed on the system of care delivery that prevents errors; learns from the errors that do occur; and is built on a culture of safety that involves health care professionals, organizations, and patients. Patient safety culture is a complex phenomenon. Patient safety culture assessments, required by international accreditation organizations, allow healthcare organizations to obtain a clear view of the patient safety aspects requiring urgent attention, identify the strengths and weaknesses of their safety culture, help care giving units identify their existing patient safety problems, and benchmark their scores with other hospitals.
Article Type: Commentar
Assessment of Patient Education about Statin Therapy on Quality Measures and Knowledge in an Independent Community Pharmacy
Full text linkObjectives: The objectives were to 1) assess the possible impact of face-to-face patient education on Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP) performance scores, 2) determine if face-to-face patient education increased overall knowledge and number of identified patients on statin therapy, and 3) identify barriers to statin therapy in targeted patients with diabetes.
Design: Participants received an anonymous survey tool collecting demographic data and assessing barriers, baseline knowledge, and perceptions about statin therapy. Following the initial survey, participants received education from the pharmacist describing the risks and benefits of statin therapy and were given a supplemental pamphlet. A second post-education survey tool was given to assess post-education knowledge and perceptions. At the end of the study period, investigators assessed the number of participants started on statin therapy and calculated the predicted percentage change in EQuIPP score.
Setting and Participants: This study was conducted at Waterfront Family Pharmacy in Morgantown, West Virginia from December 2017 until April 2018. Participants were included if aged 40 to 75, received at least two fills of a diabetes medication at the pharmacy in the last year, had not taking a statin within a year prior to participating in the study, and could read and write in English.
Outcome Measures: The primary outcome measure was the predicted percentage change in the “Statin Use in Diabetes” EQuIPP Score. Secondary measures included post-educational knowledge and perceptions of statin therapy.
Results: During the study period, 10 participants completed the surveys and educational intervention. The predicted change in “Statin Use in Diabetes” EQuIPP score was an increase from 75% to 76.9% (+ 1.9%). Prior to the educational intervention, none of the participants could identify a benefit of statin therapy aside from lowering cholesterol. After the intervention, 80% of participants could identify at least one additional benefit of statin therapy. Before the intervention, 30% of participants stated they would consider taking a statin, which increased to 80% following the pharmacist-led education. Lastly, no participants felt they needed to be on statin therapy prior to the intervention. Following the intervention, 40% stated they believed they were candidates for statin therapy.
Conclusions: Patients are willing to receive education from pharmacists about their medications and are receptive to general recommendations. A common modifiable barrier to statin therapy is patient knowledge, emphasizing the importance of pharmacist-provided education. Education about statin therapy may also increase EQuIPP scores in an independent community pharmacy, leading to better outcomes for patients and improvement of common performance measures. Overall, it appears patients require more education about statin therapy and the benefit these drugs can provide aside from their cholesterol lowering properties. Pharmacist-provided education regarding statins in patients with diabetes can increase performance measures monitored by third party payers.
Article Type: Original Researc
Hypothyroid Symptoms in Levothyroxine-Treated Patients
Full text linkPurpose: Approximately 15% of patients with hypothyroidism are dissatisfied with their treatment due to persistence of residual symptoms associated with hypothyroidism. The purpose of this study was to compare thyroid symptoms using the hypothyroid symptom scale (HSS) in patients receiving stable thyroid therapy for 6 months to patients without hypothyroidism. The HSS was used to identify the percentage of levothyroxine-treated hypothyroid patients with residual or persistent hypothyroid symptoms.
Methods: Patients included in the study had hypothyroidism and were receiving a stable/maintenance dose of levothyroxine sodium therapy, unchanged for at least 6 months. A control group of patients were included if they did not have an active prescription for thyroid hormone therapy. The HSS was administered via phone or face-to-face interactions. Patients were asked to score 10 symptoms over the past month on a scale of 0 to 4 (e.g., 0, absence of, to 4, severe symptoms). Results were analyzed using descriptive and inferential statistics. T-tests and chi-squared analysis were used to assess differences in continuous and categorical variables.
Results: A total of 68% of the contacted patients responded to the survey. A total of 302 patients were in the intervention group and 273 were in the control group. The mean total HSS scores between groups were significantly higher in the treatment compared to the control group (13.92 ± 10.91 vs.10.07 ± 7.85; P < 0.001).
Conclusion: Significantly more patients receiving thyroid hormone therapy experienced residual thyroid symptoms compared to control patients. Attempts should be made to offer alternatives for hypothyroid patients with persistent symptoms.
Article Type: Original Researc
Evaluate Factors Influencing Depression in Baghdad: Using Deck-Depression Inventory
Full text linkObjective: This study goal was to screen participants from different settings in Baghdad for depression using Beck Depression Inventory (BDI) scale and identify factors influencing the levels of depression.
Methods: This cross-sectional study included a convenience sample of 313 people from four settings (teaching hospital, college of medicine, college of pharmacy, and high school) in Baghdad, Iraq. The participants were screened using paper survey relying on the BDI scale during spring 2018. Using multiple linear regression analysis, we measured the association between depression scores and six participant factors.
Results: The overall prevalence of depression in our sample was 57.2%. Female participants had higher BDI scores (depression symptoms) than male participants. Among those with depression, the majority (73.7%) had mild or moderate degree of depression. In terms of the cut-off scores, 42.8 % scored in the normal range, 20.4 % in the mild range, 7.0 % in the borderline range, 14.7 % in the moderate range, 10.5 % in the severe range and 4.5 % in the very severe range depression. Approximately 63% of the participants had sort of suicidal thoughts. The regression analysis showed significant (P-value < 0.05) association between having higher scores of depression symptoms and the presence of chronic disease(s), recent family loss, young age and female gender.
Conclusions: In our findings, depression was quite prevalent among people in Iraq. The study demonstrates the importance of broad screening and social/psychiatric counseling of young population. Iraqi healthcare professionals should structure specific actions for patients with chronic diseases to minimize their depression symptoms.
Article Type: Orignal Researc
Invaded by Cancer, and the Patient is Me
Full text linkA cancer diagnosis is life-altering. Each patient situation is unique, including response to the news, approach to available treatment options, and insight into every aspect of life. As a pharmacist, the author shares personal insights into living with a cancer diagnosis, her new role as a patient, her perspective as a pharmacist, processing the reactions of those surrounding her, and what she’s learning about herself through all of this.
Article Type: Commentar
The Imaginary Worlds of Cure Proportion Modeling: Survivorship and Reference Case Pricing of Transformative Therapies
Full text linkOn August 6, 2019 the Institute for Clinical and Economic Review (ICER) released a set of proposed adaptations to its value assessment framework methods where the intervention under review was considered a ‘single or short-term transformative therapy’ (SST). These adaptations are intended to ‘complement and build upon the upcoming update to the overall ICER assessment framework…’. The purpose of this commentary is to review the proposed cure proportion modeling reference case framework for assessing the value of SSTs together with ICER’s ‘recommendations for fair value-based pricing …’. Following previous commentaries on the ICER value assessment framework, the question raised is whether the proposed cure proportion modeling standards meet those of normal science: is the modeling proposed capable of generating value claims for the intervention that are credible, evaluable and replicable? The proposed standards for transformative therapies do not change the underlying commitment to reference case modeling. At the same time, the cure proportion modeling proposed adaptations have to be seen in the context of the concerns expressed by ICER that their reference case model can be used to justify substantial one-off SST pricing. This follows from the ICER incremental cost per QALY willingness to pay thresholds where the SST QALY gains are sufficient, at even a $50,000 QALY cut-off, to support SST pricing in the millions of dollars. ICER has two options: (i) abandon the imaginary reference case methodology, which is the ICER core business model and would represent an ironic reversal, or (ii) attempt to bolt-on adaptations, possibly incorporating revised survivorship profiles using cure proportion modeling, that supports a modified imaginary reference case ‘rescue’ model for SSTs designed specifically to generate pricing recommendations that may be considered affordable.
Article Type: Commentar
Anticoagulation with Warfarin: Roles of Adherence, Social Support and Illness Perception
Full text linkObjectives: This study was aimed to determine (1) the associations between adherence to warfarin, social support, perception of illness, and demographic factors on the quality of international normalized ratios (INRs); as well as (2) the relationship between the patients’ scores in the Malaysian medication adherence scale (MALMAS) and their current INRs.
Method: This cross-sectional survey was conducted from November 2017 to January 2018 at the warfarin clinic of Jerantut Hospital, Malaysia.
Results: Some 58 participants were recruited, of whom 70.7% were diagnosed with atrial fibrillation (AF). Overall, 87.9% of the participants claimed adherence to their warfarin regimens. Patients with good-quality INR therapy were significantly older, had a higher median income and longer appointment durations. In terms of illness perception (IP), participants with good-quality INR therapy had significantly lower scores in the identity, personal control, and consequence domains. Overall, the total scores for IP were significantly lower in the good-quality INR therapy. Meanwhile, the MALMAS scores were significantly lower in patients with sub-therapeutic current INR. However, there were no associations between warfarin adherence and perceived social support with current TTR.
Conclusion: Monitoring of demographic factors and IP’s domains is vital since they were associated with quality of INR therapy. Meanwhile, the occurrence of sub-therapeutic current INR should raise suspicion of poor adherence in these patients. Overall, IP and MALMAS are useful tools that should be integrated into the patient care protocols.
Article Type: Original Researc
Potential Benefits of Pre-emptive PGx Testing in Male Breast Cancer Patients
Full text linkThe objective is to report a case of recurrent breast cancer in a poor CYP2D6 metabolizer male patient on tamoxifen, and how pharmacogenomic (PGx) testing can play an important role in selecting appropriate adjuvant endocrine therapy.
The case examined here is a 60-year-old white male diagnosed with recurrence of breast cancer. The patient was prescribed tamoxifen four years prior as adjuvant endocrine therapy after initial treatment with surgery. PGx testing ordered at the time of recurrence revealed patient is a poor metabolizer of CYP2D6, which may decrease the efficacy of tamoxifen. The results prompted a change in therapy to an aromatase inhibitor (AI).
This case illustrates the potential benefits of preemptive PGx testing in a male breast cancer patient to assist in selecting appropriate adjuvant therapy based on how the patient metabolizes medications. In addition, PGx testing encourages patient involvement by emphasizing the association of genetics in determining treatment. The ultimate goal in performing these tests is to individualize treatment to improve safety and efficacy while minimizing adverse drug reactions.
Article Type: Case Stud
Assessing Quality of Pharmacist-Led Education for Patients with COPD Using the Lung Information Needs Questionnaire: A Pilot Study
Full text linkBackground: Transitioning a patient from the hospital to home is an area of vulnerability for patients with Chronic Obstructive Pulmonary Disease (COPD). Patients with COPD frequently readmit as they often do not understand their disease state, medications or when to seek medical attention.
Objectives: The objective of this study is to determine the impact that pharmacist-led education has on a patient’s understanding of their disease state by assessing the results of the Lung Information Needs Questionnaire (LINQ).
Methods: This study uses a quasi-experimental design to formally assess pharmacist-led education provided to patients with COPD using the LINQ. The LINQ was used to assess knowledge of the disease state and medications before and after receiving education on disease state management, smoking cessation and proper medication use.
Results: A total of 17 patients completed the LINQ. The survey results showed a statistically significant improvement in patient understanding in 4 of the 6 targeted areas.
Conclusion: Results from the formal assessment using the LINQ suggest that pharmacist-lead education for COPD patients is beneficial and reliable. This study presents a continued need for patient education and research in this high-risk patient population.
Article Type: Original Researc
An Ambulatory Care Clinic and Community Pharmacy Collaboration to Address Prescription Abandonment
Full text linkPurpose: The purpose of this research is to evaluate a collaborative workflow aimed at decreasing prescription abandonment.
Setting: A federally qualified health center and a 340B contracted grocery store-based community pharmacy.
Practice Workflow: An ambulatory care clinic with an established partnership with a community pharmacy chain identified a need to decrease prescription abandonment rates. A process was developed whereby an ambulatory care pharmacy technician received a report from the pharmacy of prescriptions filled for at least 7 days since the initial fill date and at risk for abandonment at the community pharmacy. The pharmacy technician identified health-system barriers, attempted to remedy any identified barriers, and conducted patient reminder phone calls. Health-system barriers were classified by the following categories: incorrect contact information at the community pharmacy, incorrect 340B copayment, incorrect insurance information at the community pharmacy, and need for prior authorization.
Evaluation: A prospective cohort study was conducted from February 2016 to April 2016 in order to evaluate the effectiveness of this workflow.
Results: 551 prescriptions and 350 patients were included in this cohort. Of the 551 prescriptions, 362 had at least one identified barrier that may have led to prescription abandonment. There were 111 health-system identified barriers, and 96 of these barriers were acted upon. Additionally, there were 459 patient identified barriers, and 179 of these barriers were acted upon. When a pharmacy technician was able to identify and act upon at least one barrier, 106 prescriptions (46.9%) were picked-up from the pharmacy.
Conclusion: From the information gathered in this quality improvement project, operational changes have been implemented at the ambulatory care clinic and community pharmacy as a means to further decrease modifiable health-system barriers that may lead to prescription abandonment.
Article Type: Clinical Experience