INNOVATIONS in pharmacy (Iip - E-Journal)
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Changing Patient Perceptions of MTM: Determining an Effective Method of Education
Get PDFBackground: Medication Therapy Management (MTM) is a vital resource in reducing medication nonadherence, yet many individuals who are eligible for MTM services are unaware of what MTM is and how to enroll. Little is known about how to best educate patients on MTM services and its benefits. Objective: To determine the difference between in-person education community education versus brochure community education on MTM services on perceptions of and enrollment in MTM services. Methods: A pre-post quasi experimental study, where patients were allocated to receive information about MTM through an educational brochure or an in-person education session and completed survey assessments pre- and post-intervention, was conducted at a federally-qualified health center. Patients who were ages 18 years or older, MTM-eligible, and had received no prior MTM service were eligible to participate. Changes in patient perceptions of and enrollment in MTM from pre- to post-intervention were assessed by survey instruments developed for this study. Results: A total of 35 patients (brochure=25, in-person=10) were recruited for this study. Most participants (94.2%) either reported having never heard of MTM or not being sure if they had heard of MTM. There were no significant between-group differences on pre-survey questions or pre-post within-group changes (p>0.05). There were significant between-group differences on 11 post-assessment questions and MTM enrollment (p<0.05), with the in-person education group showing improved perceptions and greater enrollment. Conclusion: Patients remain largely unaware of MTM services; there is a need for education to increase awareness. Even though educating patients in a face-to-face context had a more positive impact on perceptions of MTM and enrollment in MTM, more research is needed regarding the best educational methods as it was difficult for patients to find time to attend an educational session.
Type: Student Project 
Pharmacy Practice in the South Dakota Correctional System: Discovery of an Unconventional Experiential Practice Site
Get PDFPharmacists must be prepared to care for populations where health disparities are greatest and their services can best impact public health needs. Such preparation requires that students have access to practice experiences in underserved environments where pharmacy practice, cultural competence and knowledge of population health are experienced simultaneously. The correctional facility is such a place.
The American Society of Health-System Pharmacists recommends that students receive preceptorship opportunities within the correctional system. The occasional collaboration or experiential opportunity, like Kingston’s early model, has occurred between health professional schools and correctional facilities. However, to date, the correctional facility-experiential site remains an untapped opportunity, at least in a complete, coordinated, pharmaceutical care, patient management framework. Consequently, a short research study asked: To what extent is there potential for correctional facilities to serve as experiential practice sites for pharmacy students? The research objective was to identify pharmaceutical practices within South Dakota correctional system and compare those practices to the guidelines established by the Association of American College of Pharmacy’s as optimal for student training. To understand medical and pharmaceutical practices in SDPS, three South Dakota Adult prison facilities were included in the exploratory study. Data was collected through a mixed methods approach designed to obtain perspectives about the SDPS health care system from individuals representing the numerous job levels and roles that exist within the health care continuum. Interviews and a web-based surveys were used to collect data. A review of a 36-page transcript along with 498 freeform survey comments revealed that while exact themes from the Exemplary Practice Framework may not have been evident, related words or synonyms for patient-centered care, informatics, public health, medication therapy management, and quality improvement appeared with great frequency.
Article type: Original Researc
Examining Similarities and Differences among Pharmacy Educational Mobile Applications
Get PDFThe use of educational mobile applications (EMAs) to enhance student learning experience is gaining considerable interest across college campuses in the U.S. Some EMAs are more commendable than others because of their ability to effectively help students study lecture materials, learn new concepts, prepare for exams, and improve their overall academic performance. The aim of this commentary is to highlight the major EMAs currently available to pharmacy students while addressing the similarities and differences between them.
Type: Commentar
Study to Measure the impact of Pharmacists and Pharmacy Services (STOMPP) on Medication Non-Adherence: Medication Adherence and Clinical Outcomes
Get PDFObjective: To compare the impact of various pharmacy-based services on medication adherence and clinical outcomes.
Design: Prospective, randomized control trial
Setting: A local endocrinology group (clinic setting) and community pharmacies belonging to a regional integrated delivery network (IDN) in Toledo, OH
Population: Subjects included within this study had type 2 diabetes, were prescribed a minimum of five medications, at least 18 years of age, having the ability to self-administer medications as prescribed, and be able to speak and understand English. Subjects were required to have Paramount health insurance, must be willing and able to provide informed consent, actively participate in the assigned MTM sessions, and have adequate transportation to attend the sessions at a participating pharmacy.
Methods: Patients were recruited through flyers at practice sites, referrals from physicians and pharmacists, and direct mailers. Members of the research team would screen patients to assess their eligibility to participate in the study. Patients who fit the inclusion criteria were randomized into one of the following four different groups: Pill Bottle (PB), Blister Pack (BP), Pill Bottle + Medication Therapy Management (PB+MTM), and Adherence Pharmacy (BP+MTM). Patients enrolled in the BP groups had their medications synchronized. Patients in the AP group were given the option to have their medications delivered, if needed.
Practice innovation: We partnered with a regional integrated delivery network (IDN) with multiple community pharmacy practice sites and a practice group of endocrinologists. A new practice model called Adherence Pharmacy was conceptualized and implemented within the community setting and was accessible to patients.
Main Outcomes Measures: Medication adherence, measured using proportions of days covered (PDC) and pill count scores at baseline, 3 months, 6 months, 9 months, and 12 months; Hemoglobin A1c (HbA1c), body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressures (DBP) were collected at baseline, 6 months, and 12 months
Results: A mixed-model ANOVA was used to study the impact of these services on medication adherence, using PDC and pill count scores. Results of the 61 patients in the study revealed that there was a statistically significant difference between the PB and BP groups (p=0.008); between the PB and BP+MTM groups (p=0.023); and between the PB+MTM and the BP+MTM groups (p=0.041). Except at baseline, adherence scores at all time points (0, 3, 6, 9, and 12 months) were significant with the patients in the BP and BP+MTM groups having higher adherence compared to those in the PB and PB+MTM groups. Pill count scores had similar results to the PDC measures. Insert data from HBA1c, BMI, SBP and DBP. Clinical outcomes were also analyzed using the mixed between-within ANOVA and were measured at baseline, 6, and 12 months. Patients in the MTM groups reached the American Diabetes Association goal of 7%, whereas the patients in the PB group did not reach a goal at 12 months. All groups, except for the PB only group, indicated a statistically significant change from baseline to 12 months. When comparing body mass index (BMI) scores across groups over time, patients in the BP+MTM group showed the lowest BMI at 12 months. There were not any significant differences across the groups, but patients in the two MTM groups saw greater improvement in their BMI scores than patients in the other two groups. There were no significant differences between groups in SBP and DBP reduction. However, patients in the two BP groups reached a SBP goal sooner (per the Eighth Joint National Committee) than patients in the PB+MTM and PB groups.
Conclusion: Patients had improved clinical outcomes and adherence rates when using blister packaging and medication therapy management services, individually and in combination. Blister packaging seemed to have a greater impact on medication adherence while MTM services helped improve clinical endpoints. However, patients who received the combination of services offered within the AP demonstrated higher improved clinical outcomes and adherence rates when compared to patients who did not. While each of these services was found to be more impactful that dispensing medications in pill bottles, combining them can provide a greater benefit to patients.
Type: Original Researc
Alternative Facts and the ICER Proposed Policy on Access to Imaginary Pharmacoeconomic Worlds
Get PDFThe Institute for Clinical and Economic Review (ICER) announced at the end of March 2018 that it proposed to share executable draft economic models with relevant drug manufacturers during ICER evidence reviews. Taken at face value, ICER is offering manufacturers and other interested parties the possibility of a greater involvement in the assessment of modeled claims for product pricing. The purpose of this commentary is to point to the obvious limitations to this policy and to raise questions as to the extent to which ICER is willing to commit to transparency in the creation of modeled claims. While a commitment to greater transparency is to be welcomed, the fact remains that the ICER methodology does not meet the standards of normal science. ICER modeled claims not only lack credibility but are impossible to evaluate or replicate in treating environments. In proposing greater transparency ICER runs the risk of undermining its own credibility. If manufacturers have the opportunity to generate alternative models which create alternative claims, then ICER runs the risk of its pole position in health technology assessment being questioned. Rather than focused on non-evaluable lifetime modeled claims, there is the opportunity for ICER to reject its current business model, accepting instead a modelling paradigm that is consistent with the standards of normal science.
Type: Commentar
Blockchains, Formulary Evaluations and Health Technology Assessment
Get PDFBlockchains have the potential, if appropriately implemented and managed, of contributing to a fundamental change in the application of techniques of health technology assessment in formulary decision making. Rather than continuing to rely on claims made by manufacturers that are non-evaluable, the introduction of blockchains as adjunct to the electronic medical record, meet an unmet medical need in enabling a platform for the real time assessment of claims. Rather than focusing the case for their product on lifetime cost-per-QALY models, which have no chance of ever being validated, the blockchain platform offers a low cost opportunity for claims evaluation. Manufacturers would be required to abandon the construction of imaginary cost-per-QALY worlds to support claims for pricing and formulary trier position, in favor of claims that can be evaluated and reported back to formulary committees in a short yet meaningful time horizon. Manufacturers would present a claims assessment protocol as part of the formulary submission package. If agreed with the formulary committee, the protocol would be implemented and managed through the patient blockchain membership. Claims would be monitored and evaluated in real time with a final report to the formulary committee in a matter of months. Lifetime imaginary claims for cost-per-QALY, set alongside willingness-to-pay thresholds, would be a thing of the past. Pricing decisions and formulary placement would reflect a robust evidence base and not just extrapolations from pivotal clinical trials.
Article Type: Commentar
Exploring Barriers to Medication Safety in an Ethiopian Hospital Emergency Department: A Human Factors Engineering Approach
Get PDFObjective: To describe challenges associated with the medication use process and potential medication safety hazards in an Ethiopian hospital emergency department using a human factors approach.
Methods: We conducted a qualitative study employing observations and semi-structured interviews guided by the Systems Engineering Initiative for Patient Safety model of work system as an analytical framework. The study was conducted in the emergency department of a teaching hospital in Ethiopia. Study participants included resident doctors, nurses, and pharmacists. We performed content analysis of the qualitative data using accepted procedures.
Results: Organizational barriers included communication failures, limited supervision and support for junior staff contributing to role ambiguity and conflict. Compliance with documentation policy was minimal. Task related barriers included frequent interruptions and work-related stress resulting from job requirements to continuously prioritize the needs of large numbers of patients and family members. Person related barriers included limited training and work experience. Work-related fatigue due to long working hours interfered with staff’s ability to document and review medication orders. Equipment breakdowns were common as were non-calibrated or poorly maintained medical devices contributing to erroneous readings. Key environment related barriers included overcrowding and frequent interruption of staff’s work. Cluttering of the work space compounded the problem by impeding efforts to locate medications, medical supplies or medical charts.
Conclusions: Applying a systems based approach allows a context specific understanding of medication safety hazards in EDs from low-income countries. When developing interventions to improve medication and overall patient safety, health leaders should consider the interactions of the different factors.
Conflict of Interest We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties".
Treatment of Human Subjects: IRB review/approval required and obtained
Type: Original Researc
Descriptive Analysis of Acceptance by Prescribers and Economic Benefit of Pharmacist Recommended Interventions in a Critical Care Unit
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Background: Pharmacist clinical intervention is defined as the action that identifies and prevents medication-related problems and optimizes patient’s medication therapy in cooperation with other healthcare professionals. Types of clinical interventions may vary, but each is patient specific. Few studies have focused on clinical pharmacists interventions in a critical care setting at a rural hospital.
Objectives: The purpose of this study was to assess physician acceptance rate of pharmacist-recommended interventions in the critical care unit (CCU) at a rural hospital over five years and to evaluate the economic benefit of accepted pharmacist-recommended interventions over a one-year time period.
Methods: This study was a retrospective chart review over a five-year time period. Each intervention was categorized and analyzed for acceptance or non-acceptance by the treating physician. Evaluation of economic benefit, cost saving and cost avoidance, for a one-year time period was performed.
Results: A total of 1275 interventions were documented during study period. The average acceptance rate for documented interventions was 56%. The acceptance rate by physicians increased over the study period; with the acceptance rate in 2013 being statistically significantly higher than any other years. The overall cost saving for selected interventions was 453,339.36-$468,327.62.
Conclusion: Clinical pharmacists provide various types of interventions to improve patient care. The analysis of potential cost saving and cost avoidance of selected interventions illustrated a positive economic outcome.
Conflict of Interest "We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties".
Treatment of Human Subjects: IRB exemption granted
Type: Original Researc
Use of a Video Module to Improve Faculty Understanding of the Pharmacists’ Patient Care Process
Get PDFObjective: To evaluate change in faculty’s knowledge and perceptions after an online video module on the Pharmacists’ Patient Care Process (PPCP).
Innovation: An educational video module on the PPCP was developed and disseminated to full-time faculty members at Samford University, McWhorter School of Pharmacy. Voluntary and anonymous pre- and post-test assessments were evaluated and analyzed.
Critical Analysis: Thirty faculty completed the pre-assessment, and 31 completed the post-assessment (73% and 75% response rates, respectively). A significant improvement in faculty perceptions was indicated by an increase in agreement with the majority (80%) of questions on attitudes toward the PPCP on the post-test. Faculty’s knowledge of the introduction and assessment of PPCP within the school’s curriculum was significantly increased after viewing the video module. After viewing the module, more faculty were also able to correctly identify the majority of the PPCP components and their corresponding practice activities.
Next Steps: A short video module was effective at improving faculty knowledge and perceptions of the PPCP. Development of a similar faculty development module is feasible for implementation in other Schools of Pharmacy.
Conflict of Interest
We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties.
Treatment of Human Subjects: IRB exemption granted
Type: Not
Combating Substandard and Counterfeit Medicines by Securing the Pharmaceutical Supply Chain:: The Drug Supply Chain Security Act (DSCSA) of 2013
Get PDFOn November 27, 2013, President Obama signed into law the Drug Quality Security Act (DQSA). Title II of the DQSA, the Drug Supply Chain Security Act (DSCSA), replaces all existing or future state-wide drug track or trace systems with a new federal drug tracing program that uses pedigrees and product identifiers for verification of the drugs being accepted by the buyer. While the full implementation of the DSCSA is projected to take about ten years from its enactment, both the implementation framework and milestones of the new federal tracing program have been carefully laid out. In this essay, we will explore the current state of the U.S. pharmaceutical supply chain and the imperatives behind the DSCSA. At the crux of this essay is an analysis of the DSCSA implementation plan, its challenges according to feedback from stakeholders, and its potential effectiveness against the entrance of substandard and counterfeit drugs into the U.S. pharmaceutical supply chain.
Topic: Student Project