INNOVATIONS in pharmacy (Iip - E-Journal)
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Use of a Mindfulness Smartphone App in an Advanced Psychiatry Elective for Pharmacy Students
Full text linkBackground: There is a mental health crisis among US University students. Evidence supporting techniques to help students manage the stress are critically needed. Mindfulness meditation is one such strategy which may be helpful for pharmacy students.
Innovation: Third-year pharmacy students enrolled in an Advanced Psychiatry elective course were invited to participate in the study. Students were given a 10-day assignment to participate in 10 free mindfulness sessions offered by the smart phone app, Headspace®. The Mindful Attention Awareness Scale (MAAS) was completed before and after the assignment. Student qualitative feedback was also obtained after utilization of the app.
Findings: Seventy-six percent of students completed the mindfulness sessions daily. A small, non-statistically significant change in MAAS Total Score was observed in the students after use of the mindfulness app. The majority of students would recommend the mindfulness app to their patients, as well as 1st year pharmacy students. The students also reported that the assignment aided in their education about non-pharmacologic treatment options for depression and anxiety.
Conclusion: This pilot study provides preliminary evidence for the further investigation of mindfulness meditation smartphone apps in pharmacy students both as a tool to aid in managing the stress of pharmacy school and as a teaching tool.
Article Type: Not
Establishing Practice Risk Management and Outcomes Claims for Medical Marijuana Dispensaries: Questions Legislators Should Ask
Full text linkIn a previous commentary in INNOVATIONS in Pharmacy, the case was made that a major oversight in approving the establishment of medical marijuana programs through commercially and not-for-profit operated dispensaries is the failure to put in place standards for the monitoring and reporting of outcomes. It was pointed out that the evidence base is limited for the range of dosing options, administrative routes and conditions treated. The concern is that the ease that patients have in obtaining medical marijuana certification in many states means that a medical marijuana program is, in effect, little different from a recreational program. Dispensaries understandably focus on sales and returns to investors with scant attention given to tracking and reporting outcomes across the range of conditions and symptoms presented. While this no doubt appeals to investors in reducing administration costs, it makes it virtually impossible to deliver the appropriate and coordinated level of care that patients should expect if a medical marijuana dispensary is to meet it responsibilities in its duty of care. This places dispensaries at malpractice risk. Given this, this commentary focuses on the questions that legislators should ask in licensing medical marijuana dispensaries to ensure they meet a defensible duty of care to their patients.
Article Type: Commentar
Sugammadex compared with Neostigmine/Glycopyrrolate: An Analysis of Total PACU Time, Responsiveness, and Potential for Economic Impact
Full text linkStudies have previously shown sugammadex works faster and more effectively than neostigmine/glycopyrrolate at reversal of neuromuscular blockade by rocuronium and vecuronium. The purpose of this quality improvement study was to evaluate for differences in patient time spent in the operating room (OR), post-anesthesia care unit (PACU), and patient responsiveness between the sugammadex and neostigmine/glycopyrrolate groups at a small surgical center. Additionally, a cost analysis was conducted to assess potential savings associated with sugammadex use, taking into account the differences in OR time, PACU time, and medication acquisition cost. We conducted a prospective analysis of OR time, PACU time, and responsiveness for a total of 152 patients, 76 patients receiving neostigmine/glycopyrrolate and 76 patients receiving sugammadex, undergoing planned surgery over an 8-week period. We identified an average decrease in total OR time of 6 minutes in the sugammadex group (neostigmine/glycopyrrolate [Mean: 86 min, Median: 77 min, Range 32-211 min] vs sugammadex [Mean: 80 min, Median: 77 min, Range 40-150 min]). Furthermore, there was an average decrease in total PACU time of 6 minutes in the sugammadex group (neostigmine/glycopyrrolate [Mean: 60 min, Median: 56 min, Range 32-154 min] vs sugammadex [Mean: 54 min, Median: 51 min, Range: 28-94 min]). Additionally, the percent of patients fully awake at the end of PACU stay was higher in the sugammadex group than the neostigmine/glycopyrrolate group (86% vs 79% respectively). Cost was evaluated for generating hypotheses. The additional cost of using sugammadex was estimated at 579 per patient after estimating a soft savings of reduced OR, PACU, and staff time. Overall cost saving per patient with sugammadex, which was calculated after subtracting additional medication acquisition cost, is 495,976 per year. We hope this study provokes future research to determine if Sugammadex is a potentially viable economical option for the routine reversal of neuromuscular blockade.
Article Type: Original Researc
Remediation Model Used in a Pharmacy Calculations Course
Full text linkRemediation is a required component of pharmacy programs. In a pharmacy calculations course, two student-centered models of remediation have been utilized. These models were a shift from an intensive, hands-on infrastructure of faculty and student engagement to a more student self-directed process. The models utilized development of an individualized plan for each student, clearly outlined expectations, faculty availability for consultation, as well as flexibility in remote completion of the assigned activities. Both models resulted in student success.
Article Type: Not
Drug Therapy Problems in NCAA Division I-A Minnesota Gopher Student-Athletes
Full text linkAs with all competitive sports, in NCAA Division I-A athletics it is important to maximize controllable factors in order for each athlete to compete at his or her best. One important and controllable factor that has the potential for improvement is the athlete’s medication experience. When medications are used to treat the correct condition, administered at the right time, and with the correct dose, they have the potential to improve outcomes and enhance athletic performance. As an example, it is essential that a soccer player who has asthma is using the correct inhaler, at the correct time, with proper technique, and with the correct number of puffs in order to support breathing and improve oxygen transportation during a game. Ineffective and unsafe use of medications can lead to serious disease-related events and also prevent an athlete from achieving their performance goals when they are not being used correctly. The goal of this project was to explore the presence and extent of drug therapy problems (DTPs) among a college athlete population. Within the 10 student-athletes who were interviewed, there were a total of 36 drug therapy problems identified, many of which were tied to a lack of understanding for their own medication regimen. This project suggests that medication-related needs may not be appropriately addressed among the college athlete population. The addition of a pharmacist on the athletic healthcare team would ensure appropriate medication use and optimization for health outcomes and overall athletic performance.
Article Type: Original Researc
Yet another Ersatz World: The ICER Final Evidence Report for Additive Cardiovascular Therapies
Full text linkPrevious commentaries in the Formulary Evaluation section of INNOVATIONS in Pharmacy have pointed to the lack of credibility in modeled claims for cost-effectiveness and associated recommendations for pricing by the Institute for Clinical and Economic Review (ICER). The principal objection to ICER reports has been that their modeled claims fail the standards of normal science: they are best seen as pseudoscience. The purpose of this latest commentary is to consider the recently released ICER report for Additive Cardiovascular Disease therapies. This report should not be taken seriously in its claims for cost-effectiveness and pricing in cardiovascular disease (CVD). The analytical framework applied by ICER fails to meet the standards of normal science in demarcating science from pseudoscience. Irrespective of the value judgements and recommendations of an ICER report, these lack credibility. They were never intended to be evaluable and replicable across treatment settings. The claims made are constructed, driven by assumption, and should be put to one side by health system decision makers. In this review the focus is on to the ICER modeled estimates of utility scores in CVD, the insistence on utilizing a generic utility algorithm (the EQ-5D-3L) and the consequent quality adjusted life year (QALY) estimates. Two issues are raised that will be the subject of future commentaries: the lack of appreciation of fundamental measurement and (ii) the importance of the patient voice in benefit claims. Given the importance in the ICER methodology of QALYS, the ad hoc nature of the ordinal utilities introduced to the cardiovascular model must raise concerns over the role the ICER evidence report may play in health care decision-making. These concerns extend to the claim by ICER that, on ICER’s own affordability threshold for individual new molecular entities, the anticipated uptake of these therapies may raise questions of overall affordability. Again, we are dealing with an arbitrary construct that may adversely impact patient access.
Article Type: Commentar
Vial-to-Pen: Community Pharmacists Converting Insulin Regimens
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Objective: To describe a vial-to-pen conversion program driven by community-based pharmacists and determine conversion success rate.
Methods: A report based on prescription claims was generated and identified 200 prescriptions filled for an insulin vial product and syringes. Patients were contacted by community-based pharmacists during a five-month period and were informed of the availability and potential benefits of insulin pen delivery systems (IPDS). If the patient agreed to the switch, the pharmacist contacted the prescriber to obtain a new prescription. Prescription refill records were tracked for six months post-intervention to determine whether patients who were converted remained on the IPDS.
Results: The overall vial-to-pen conversion success rate was 26% out of 121 potential conversions. In addition, 52% of patients reached were willing to switch and prescribers approved 71% of the recommendations to switch from vial-to-pen. Of the prescriptions successfully converted to an IPDS, 84% of prescriptions were still dispensed as pen products six months following the conversion.
Conclusion: Community-based pharmacists can serve as a resource to provide education on insulin delivery options and increase use of IPDS in patients with diabetes.
Treatment of Human Subjects: IRB review/approval required and obtained
Article Type: Original Researc
Pharmacists’ Opinions on the Implementation of HIV and HepC Point-of-Care-Testing in a U.S. Pharmacy Chain
Full text linkBackground: The role of community pharmacists continues to expand with immunizations, medication therapy management, and point-of-care testing (POCT). Current guidelines recommend that Human Immunodeficiency Virus (HIV) and Hepatitis C (HCV) testing become integrated into routine care. Current guidelines recommend all people aged 13-64 be tested for HIV at least once in their lifetime, with those at higher risk for HIV tested at least annually.1 Regarding HCV, current guidelines recommend a one-time HCV test in persons born from 1945 to 1965, as well as other individuals based on exposures, behaviors, and conditions or circumstances that increase HCV infection risk.2 Currently available HIV and HCV treatment regimens are safe and highly effective. With HCV, successful treatment can halt disease progression to cirrhosis, end-stage liver disease, and hepatocellular carcinoma.3 POCT in community pharmacy offers an ideal location due to its accessibility, convenience, and lower cost to patients who might not otherwise be tested. However, HIV and HCV screenings are not routinely conducted by community pharmacists due to many barriers. Though many barriers to HIV and HCV POCT have been identified at the patient, provider, and institutional level, little is known about pharmacist-perceived barriers. It is worth noting that the barrier of state legislation limiting POCT in pharmacies has been resolved – currently 49 states have some form of statute that allows for delegation of prescriptive authority between a prescriber and community pharmacist.4 Though this removed barrier means increased availability of POCT, as the studies above have demonstrated, the mere availability of POCT is not enough for its implementation.
Objective: The main objective of this study is to identify pharmacist-perceived barriers and their level of confidence in performing community pharmacy-based POCT for HIV and HCV.
Methods: A cross-sectional survey was sent to all pharmacists working in a regional grocery store chain to evaluate their opinions and attitudes toward the implementation of POCT for HIV and HCV. The electronic survey questions consisted of Likert scale, select-all-that-apply, yes/no and no open-ended questions.
Results: The perceived barriers to implementation of HIV and HCV POCT in a community setting identified by pharmacists include staffing, time to conduct test, patient out-of-pocket cost, and discussion of positive results. Pharmacists’ perceived level of confidence was greatest with providing basic education and incorporating HIV and HCV POCT into workflow; whereas discussion of a positive result was perceived as less confident.
Conclusions: While this survey determined pharmacist support for the implementation of HIV and HCV POCT, additional studies are needed before effective implementation of HIV and HCV POCT in a community pharmacy chain.
Article Type: Original Researc
Patient Experiences at Enhanced-Service Pharmacies in Iowa
Full text linkObjectives: As payment systems are evolving, the role of community pharmacists has expanded from simply dispensing prescriptions to actively providing care to patients. Little is known about patients’ experiences with enhanced pharmacy services under the pay-for-performance model. In Iowa, Wellmark implemented its Value-Based Pharmacy Program (VBPP) where pharmacists receive capitation for performance on a set of quality measurements. Therefore, the objective of this study was to evaluate the quality of services and pharmacies from patients’ perspective in VBPP. A structured interview guide developed from the service quality model was used for this study.
Methods: We conducted telephone interviews with patients from 6 community pharmacies participating in VBPP between December 2017 and January 2018. Patients who were aged between 21 and 90 years, had Wellmark prescription drug coverage, were currently on at least three medications with one or more of the medications for a chronic condition and had received enhanced pharmacy services were invited for the study. The semi-structured interview transcripts were coded and analyzed using an inductive approach of thematic analysis.
Results: Interviews were completed by 25 patients. Most of them were female and the average age was 59. More than half of the patients were taking at least five medications for chronic conditions. A majority of the patients received medication synchronization and immunization. A total of 13 themes across the service quality dimensions were identified. Patients thought their pharmacists were reliable, responsive, knowledgeable and trustworthy when they provided services. Pharmacy services were accessible and perceived as high quality. Privacy was not a big concern for most patients. Patients had a somewhat limited view regarding how pharmacists helped them maintain health.
Conclusions: Patients’ perceptions of enhanced pharmacy services and pharmacies were generally positive while their understanding of pharmacists’ clinical role was limited.
Article Type: Original Researc
Benefits of Levonorgestrel Intrauterine Device Use vs. Oral or Transdermal Progesterone for Postmenopausal Women Using Estrogen Containing Hormone Therapy
Full text linkBackground: Endometrial hyperplasia is a major concern for women that start estrogen replacement therapy (ERT) to control symptoms experienced during perimenopause and postmenopause. Progesterone provides protection against endometrial hyperplasia, and there are multiple dosage forms of progesterone available. Intrauterine progesterone may offer an appealing option with additional benefits beyond endometrial protection for patients.
Objective: The overarching objective of this systematic review is to characterize the relationship between levonorgestrel containing intrauterine devices (LNG-IUD) and the prevention of endometrial hyperplasia in peri- and postmenopausal women. Specifically, this systematic review addresses whether LNG-IUD has equivalent efficacy of protecting against endometrial hyperplasia, but an improved safety profile when compared to oral progesterone in women using ERT.
Methods: OVID Medline, Scopus, and Cochrane were used to find available studies that have investigated the relationship between endometrial hyperplasia prevention and varying dosage forms of progesterone. Randomized control studies comparing LNG-IUD with no treatment, placebo, or other hormonal therapy in adult females were included. In addition, due to a lack of randomized control studies, four non-comparative studies were included.
Results: There were eleven total studies included that investigated LNG-IUD use in women on ERT. According to the studies, the LNG-IUD was equally effective as other routes (oral, vaginal) of progesterone administration in protecting against endometrial hyperplasia.
Conclusions: The LNG-IUD prevents endometrial proliferation at least as effective as oral or vaginal forms of progesterone. LNG-IUD is a safe option for women starting estrogen replacement therapy and has added benefits due to decreased adverse effects.
Article Type: Student Projec