INNOVATIONS in pharmacy (Iip - E-Journal)
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Evaluation of Pharmacists' Knowledge of Centers for Medicare and Medicaid Services Medication Drug Plan Star Ratings
Get PDFObjectives: 1) Evaluate Ohio pharmacists’ awareness about Centers for Medicare and Medicaid Service’s (CMS) Medication Drug Plan (MDP) Star Ratings, 2) identify gaps in knowledge about CMS MDP Star Ratings, and 3) determine interest in continuing education (CE) opportunities with CMS PDP Star Ratings.
Methods: A cross-sectional, online survey was conducted in February 2015. The 16-question, pilot-tested survey targeted licensed pharmacists in Ohio practicing in the ambulatory care or community setting. Respondents were surveyed on their self-assessed and actual knowledge on CMS MDP Star Ratings. Respondent’s interest in and preferred source and delivery of CE were evaluated. Data were collected in aggregate; descriptive statistics, ANOVA and chi-square tests were used to characterize and evaluate data. Responses were summarized for all 16 questions using frequencies and percentages.
Results: Of 13,235 licensed Ohio pharmacists, 913 pharmacists completed the survey (6.9% response rate). 454 (49.7%) respondents were eligible to complete the survey based on practice setting and of those, 390 (85.9%) were aware of CMS’s MDP Star Ratings. Respondents’ self-assessment of their knowledge regarding CMS Star Ratings aligned with their actual knowledge as defined by performance on three multi-statement knowledge-based assessments. Significant differences existed between self-assessed knowledge groups in their ability to answer greater than 50% of questions correctly (p < .001). The majority of respondents (81.2%) indicated interest in receiving further education on CMS Star Ratings.
Conclusions: Survey respondents are aware of CMS MDP Star Ratings, yet few indicated high knowledge levels on the topic. Gaps in knowledge were identified in development and utilization of the rating system, identifying quality measures, and sources utilized to measure achievement of ratings. Respondents indicated interest in opportunities to improve knowledge on the subject and would prefer education provided by their employer with a live presentation.
Type: Student Projec
Denkbeeldige Wereld: The New Dutch Guidelines for Economic Evaluations in Healthcare
Get PDFIn 2016 the Dutch National Health Care Institute (Zorginstituut Nederland) published a new guidance for economic evaluations in healthcare to support reimbursement decisions. These Guidelines update and replace three previously published guidelines covering pharmacoeconomic evaluation, outcomes research and costing. The purpose of this commentary is to consider the merits of these new Guidelines from the perspective of modeled claims which meet the standards of normal science: credibility, evaluation and replication in the treatment of target patient populations. In evaluating the merits of the Guidelines the focus will be on the requirement for submissions to follow reference case standards where lifetime-cost-per-QALY claims are the preferred outcome measure. The assessment points out that in adhering to a reference case standard, the Dutch Guidelines, in common with those in the UK, Ireland and New Zealand, fail to address the fundamental question of claims assessment. Rather, in relying upon the reference case imaginary world (denkbeeldige wereld) to inform decision makers, the possibility of evaluating claims and generating feedback to decision makers on comparative effectiveness is put to one side. We have no idea as to whether the claims are right or even if they are wrong. Hopefully, future versions of the guidelines will address this issue and focus on a rigorous program of claims assessment.
Type: Commentar
Patient Feedback on Pharmacist Prescribing for Minor Ailments in a Canadian Province
Get PDFBackground: Pharmacists have been given authority in many Canadian provinces to go beyond simply recommending over-the-counter medicines to patients with minor ailments. In Saskatchewan, they can prescribe medicines normally under the sole control of physicians for 17 conditions. An evaluation program is underway to assess the value of the program. Methods: Adults were recruited over a one-year period and were eligible for inclusion if prescribed an agent for an applicable condition. Pharmacists from 40 pharmacies participated in identifying people who received the service. Of patients agreeing to participate, a link to an online survey was provided. The survey included items on clinical improvement, care options, and patient confidence in knowing when to seek a physician for a minor ailment. Results: Forty-eight people were involved in prescribing encounters, with the majority seeking help for themselves. All but one saw their symptoms improve subsequent to pharmacist assistance, most often to a significant extent. Satisfaction with the service was high. Convenience and trust in pharmacists were primary reasons for choosing the service over medical care (rather than an issue potentially more worrisome such as not having a family physician). Had this service not been in place, 30.6% of those asking for help would have gone to a medical clinic or emergency room. Seventy-five percent were (at least) very confident in knowing when to seek a physician (rather than a pharmacist) for such conditions. Conclusion: Information on the clinical outcomes of pharmacist-led minor ailment care is starting to accrue in Saskatchewan. While the numbers are extremely low to date, what has become available suggests the service is of value to the citizens of the province, it is chosen for appropriate reasons, and is of an acceptable standard of care.
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. However, the authors are pharmacists licensed within the province and bring this perspective to this evaluation of a pharmacy-based program.
Type: Original Researc
Intelligent Design and Imaginary Worlds in Cost-Effectiveness Claims: An Overview of Commentaries in INNOVATIONS in Pharmacy from July 2016 to February 2017
Get PDFOver the past 30 years, thousands of modeled cost-effectiveness studies have been published. Whether this effort has been worthwhile is debatable. For supporters of modeled cost-effectiveness studies, this effort has been worthwhile because the modeled claims are intended to inform health care decision makes. To opponents, the effort is seen as largely a waste of time because the claims are typically non-evaluable. Rather than subscribing to the standards of normal science in its focus on hypothesis testing through experimentation and replication, opponents have viewed practitioners in health technology assessment as being content to develop imaginary worlds with no thought to their role in practical decision-making. Given this ongoing commitment to constructing imaginary worlds, the purpose of this commentary is bring together the various commentaries, together with supporting publications that have appeared in INNOVATIONS in Pharmacy since mid-2016. This is in response to requests from faculty and graduate students at the College of Pharmacy, University of Minnesota for an overview of the arguments presented to date in support of a new research program that rejects imaginary constructs in favor of credible, evaluable and replicable claims to support formulary decision making.
Type: Commentar
The Correlation of Free Health Screenings at Community Pharmacies on Diabetes
Get PDFObjective: To assess the correlation of free health screenings in community pharmacies on patient perceptions of free health screenings and diabetes knowledge.
Methods: The study design was a pre-post observational study using surveys, blood sugar screenings, and patient education on diabetes. Participants were voluntary patients from four REM Corporation pharmacies in Ohio who were 18 or older, not recently tested for diabetes, non-diabetic, not pregnant, and without disorders that could hinder survey responses and education. Pre- and post-surveys assessed both patient perceptions on free health screenings in community pharmacies and on diabetes knowledge.
Results: Among the 26 participants there was no statistically significant difference between patient perception pre- and post-surveys (all p-values ≥0.05), however there was a statistically significant difference between pre and post diabetes knowledge surveys (p<0.001).
Conclusion: Patients have positive opinions on free health screenings in community pharmacies and these screenings can help patients understand disease states and be more aware of their health.
Type: Original Researc
Collaboration between Hospital and Community Pharmacists to Improve Medication Management from Hospital to Home
Get PDFObjective: The objective of this study is to determine if a model for patient-centered care that integrates medication management between hospital and community pharmacists is feasible and can improve medication adherence. Design: This was a randomized, non-blinded, interventional study of 69 patients discharged from a hospital to home. Process measures include the number and type of medication-related discrepancies or problems identified, patient willingness to participate, the quality and quantity of interactions with community pharmacists, hospital readmissions, and medication adherence. Setting: A 214-bed acute care hospital in Northeastern Pennsylvania and seventeen regional community pharmacies. Patients: Enrolled patients were hospitalized with a primary or secondary diagnosis of heart failure or COPD, had a planned discharge to home, and agreed to speak to one of seventeen community pharmacists within the study network (i.e., a network community pharmacist) following hospital discharge. Intervention: Information about a comprehensive medication review completed by the hospital pharmacist was communicated with the network community pharmacist to assist with providing medication therapy management following hospital discharge. Results: Of 180 patients eligible for the study, 111 declined to participate. Many patients were reluctant to talk to an additional pharmacist, however if the patient’s pharmacist was already within the network of 17 pharmacies, they usually agreed to participate. The study enrolled 35 patients in the intervention group and 34 in the control group. An average of 6 medication-related problems per patient were communicated to the patient’s network community pharmacist after discharge. In the treatment group, 44% of patients had at least one conversation with the network community pharmacist following hospital discharge. There was no difference in post-discharge adherence between the groups (Proportion of Days Covered 0.76 treatment group vs. 0.73 control group, p=0.69), but there was a reduction in hospital readmissions (43% treatment group vs. 62% control group). Conclusion: The feasibility of this model can be improved by integrating medication management with the patient’s existing community pharmacist, rather than an additional network community pharmacist. While there was no difference in medication adherence, collaboration between the hospital and community pharmacists can potentially reduce hospital readmissions, improve medication safety, and facilitate medication therapy management across care transitions.
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".
Type: Original Researc
Pharmacy-Based Tuberculosis Skin Testing (TST): Approaches to Legal Authority
Get PDFThe Mantoux Tuberculin Skin Test (TST) is the standard method for detecting latent tuberculosis and has been provided by pharmacists since at least 2006. In the largest published study of pharmacy-based TST involving 578 patients, the most common reason for obtaining the test were employment or school requirements.Pharmacists have demonstrated high rates of follow-up for the reading of the test, reported to be 92.8% to 94.4%. The biggest barrier to pharmacy-based TST is that a prescription is required for the two tuberculosis (TB) purified protein derivative products available on the market in the United States. States have adopted three strategies to enable pharmacy-based TST prescribing: 1) collaborative practice agreements; 2) statewide protocols; and 3) independent prescribing. These three approaches are reviewed, with a focus on the New Mexico statewide protocol and the recent statutory authority in Idaho that grants pharmacists independent prescriptive authority for TST. States may consider pursuing more autonomous models of TST prescribing given the safety and track record of this service at pharmacies.
Type: Commentar
Incorporation of Video Vignettes into Pharmacy Residency Application Processes
Get PDFThis commentary discusses the introduction of video vignettes (VVs) into the context of pharmacy residency application processes. An extension of the conversation around which items are requested of pharmacy candidates when applying to pharmacy residency programs is provided. In conjunction with other documents that provide insights into candidates’ abilities, video vignettes (VVs) are presented as viable considerations to gain additional perspective. Implications for time-saving and cost conservation by utilizing VVs are also in view. Hiring employees will presumably have the latitude to require the content of VVs to address aspects deemed more relevant to their institutional operating procedures. Foreseeable benefits and challenges to video vignette (VV) adoption are described within this setting. Counterpoints are presented in response to disadvantages to adoption that may surface. An example of a VV has been crafted to actualize sample components that may be feasible for future use. The challenges faced by healthcare facilities to filling pharmacy residency positions from a vast number of applicants remain pronounced. Creativity in the pharmacy residency selection process is often stifled by routinized methods of application review. Innovative models such as VVs could offer a refreshing alternative to candidates for showcasing individualities and perhaps afford evaluating bodies a unique resource for further candidate differentiation.
Type: Commentar
A Qualitative Analysis of Student Pharmacists’ Response after an Auditory Hallucination Simulation
Get PDFObjectives: The goal of this research was to evaluate pharmacy students’ experiences and reactions when exposed to an auditory hallucination simulator.
Methods: A convenient sample of 16 pharmacy students enrolled in the Advanced Psychiatry Elective at a private, faith-based university in the southeastern United States was selected. Students participated in an activity in which they listened to an auditory hallucination simulator from their personal laptop computers and completed a variety of tasks. Following the conclusion of the simulator, students composed a reflection guided by a five-question prompt. Qualitative analysis of the reflections was then completed to identify and categorize overarching themes.
Results: The overarching themes identified included: 1) students mentioned strategies they used to overcome the distraction;
2) students discussed how the voices affected their ability to complete the activities; 3) students discussed the mental/physical toll they experienced; 4) students identified methods to assist patients with schizophrenia; 5) students mentioned an increase in their empathy for patients; 6) students reported their reactions to the voices; 7) students recognized how schizophrenia could affect the lives of these patients; and 8) students expressed how their initial expectations and reactions to the voices changed throughout the course of the simulation. Overall, the use of this simulator as a teaching aid was well received by students.
Summary: In conclusion, pharmacy students were impacted by the hallucination simulator and expressed an increased awareness of the challenges faced by these patients on a daily basis.
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.
Type: Original Researc
Foreign Accent Syndrome Secondary to Medication Withdrawal: A Case Report
Get PDFObjective: The purpose of this case report is to demonstrate a possible alternative etiology related to dopamine may exist for foreign accent syndrome (FAS).
Methods: A 79-year-old, 205 pound, Caucasian woman originally presented to the department of Neurology for treatment and subsequently to the pharmacist pharmacotherapy service for evaluation of bilateral upper extremity tremor of high amplitude but was found to also exhibit FAS.
Discussion: This case report contributes to the limited literature regarding foreign accent syndrome and adds to the few case reports of psychogenic origin, as opposed to the majority, which are of neurogenic origin. This also represents the first case that seems related to withdrawal of medication rather than psychotic exacerbation and ranks a six on the Naranjo algorithm.
Conclusion: FAS is a rare disorder and little is understood about it. This case presentation also suggests that chronic use of high-dose dopamine and/or anticholinergic agents may alter pathways in the brain, which in this case, may have potentially contributed to the development of FAS. There remain many unanswered questions regarding FAS, but hopefully more clarity may be found as more cases are discovered and published.
Conflict of Interest
I 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.
Type: Case Stud