INNOVATIONS in pharmacy (Iip - E-Journal)
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Description of Discordance Between LDL Cholesterol, Non-HDL Cholesterol, and LDL Particle Number Among Patients of a Lipid Clinic
Get PDFBackground: While LDL cholesterol measures the cholesterol content within an LDL particle (LDL-P), it may not reflect LDL-P concentrations. If discordance exists, LDL-P may better predict cardiovascular events compared to LDL-C and non-HDL cholesterol (non-HDL-C). In primary prevention patients, discordance has been associated with diabetes, ethnicity, gender, metabolic syndrome, and smoking history.
Objective: To describe discordance in patients of a lipid clinic by exploring associations between patient characteristics and discordance among LDL-C, non-HDL-C, or LDL-P. Secondarily to compare proportion of patients with baseline concordance versus discordance who have ASCVD events, diagnoses of new onset diabetes or death.
Methods: A retrospective, single-center cohort study at a large academic medical center was conducted. Patients establishing care from January 2009 through December 2012 with complete initial labs were included. Logistic regression models were used to explore associations between discordance and patient characteristics.
Results: Of 603 patients screened, the final cohort included 166 patients with 104 (62.7%) discordant. LDL-P was the most common discordant value. Discordance was associated with gender, smoking status, use of lipid lowering medications, and achieving patient specific LDL-C goals. In terms of any event observed after initial measurements, no significant differences were detected between discordant and concordant groups.
Conclusion: Within a lipid clinic population, discordance was associated with male gender, smoking status, lipid-lowering therapy, and being at patient specific LDL-C goal. While associations were found in our population, clinicians should consider measuring LDL-P to fully assess presence or extent of discordance.
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
Transparency, Imaginary Worlds and ICER Value Assessments
Get PDFThe Institute for Clinical and Economic Review (ICER) is seen as offering a credible platform for evaluating the pricing policies for pharmaceutical products and devices. Over the past few years ICER has presented a stream of reports, many of which have recommended substantial price discounts where the results of a lifetime cost-per-QALY modeling suggests they are out of line with notional willingness to pay thresholds and arbitrary budget constraints. At the same time, there have been growing concerns over the lack of transparency in the ICER value assessment process, focusing in particular on the refusal by ICER to allow access to its value assessment modeling framework. The purpose of this brief commentary is to point out that the position taken by ICER over model access is not defensible; the arguments given are specious. This ongoing refusal undercuts the ICER claim to be independent and the credibility of ICER recommendations for price discounting. The solution is for ICER to commit to a transparent process of value assessment, allowing in particular access to its models and for the ICER model to be subject to an independent assessment. At the same time, manufacturers and other stakeholders should have access to the model with the opportunity to challenge the model through developing model frameworks which they feel better represent product value. This advocacy, it should be noted, does not reflect acceptance of the ICER lifetime cost-per-QALY value assessment framework. Health care decision makers would be better served by a value assessment framework that provided short-term credible, evaluable and replicable claims, facilitating meaningful feedback to decision makers, and not on the construction of simulated imaginary worlds.
Conflict of Interest: None
Type: Commentar
Sustainable Pharmacy: Piloting a Session on Pharmaceuticals, Climate Change, and Sustainability within a U.S. Pharmacy Curriculum
Get PDFObjective: To design and assess an innovative session for pharmacy students that addresses the role of pharmaceuticals with climate change and sustainability.
Innovation: One hundred and sixteen third-year students at the University of California, San Francisco School of Pharmacy participated during their required Health Policy course. This 3-hour session included guided pre-course activities, an interactive lecture, a panel of healthcare professionals discussing complex decision-making and small group case-based learning. Curricular assessment was conducted through pre-/post-test measures of knowledge acquisition, student evaluations, and course projects.
Critical Analysis: One hundred and two students (response rate 88%) completed the pre-test and 115 students (response rate 99%) completed the post-test assessment. We identified a significant increase in the proportion of correct answers on post-test questions addressing drug disposal legislation (75% pre-test vs 91% post-test, p=0.002) and the predicted effects of climate change on health (55% pre-test vs 90% post-test, p < 0.001). The session was also well received; average student evaluation scores were above 4 in all areas of course evaluation (where 5=ideal). In addition, 17% of student groups (relative to 0% in 2015) proposed a sustainability-related policy as their final coursework project.
Next Steps: The development and implementation of this brief session resulted in knowledge gain and favorable student response. This project is feasible for other Schools of Pharmacy to adapt and implement.
Conflict of Interest: None
Type: Not
Using Your VOICE(S): Adding Telephonic Communication to Pharmacy Education
Get PDFPharmacists utilize a myriad of communication methods to deliver patient care. One of the most prevalent communication methods is the telephone. The University of Pittsburgh School of Pharmacy created a novel instructional and assessment technique to enhance student pharmacist training experiences in telephonic communication within the PharmD curriculum.
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: Not
Reflections from the Jury Box: Improving Evidence Based Practice through a Comparison with Our Legal System
Get PDFBackground: An experience serving jury duty prompted reflection on the parallels between evidenced based medicine and our legal system.
Findings: The steps of the legal system can be tied to each step of the practice of evidenced based medicine.
Implications: Patients should be included in evidence based decisions. Pharmacists can act as resources for other providers practicing evidenced based medicine. Educators can use this analogy to teach evidence based medicine.
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: Commentar
Geographic Distribution of Antipsychotic Use in Medicare Part D Patients
Get PDFPurpose: To determine if there is a geographic variation in antipsychotic prescribing in Medicare recipients in 10 US divisions.
Methods: Data was collected in the Microsoft Excel format from the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File for 2013 CMS data. Antipsychotics were sorted and downloaded into separate excel formats. The states were separated into the 10 geographic according to the US Census Bureau to identify prescribing trends. The primary endpoint was to determine the difference in the rates of CMS Medicare Part D utilizers who had antipsychotic prescriptions in each of the 10 geographic divisions.
The rate of antipsychotic prescribing was calculated by determining the number of prescription claims for each antipsychotic for the division and dividing by the number of people utilizing Medicare Part D in each division. Data was converted to SPSS (version19, Armonk, NY) for further analysis. ANOVA was used to compare the differences.
Results: Approximately 35 million claims were included in the data set. Antipsychotics comprised 4.75% of the total spending on medications for Medicare Part D. New England was found to have the highest rate of claims at 0.83. No statistically significant differences in the rate of antipsychotic prescribing across geographic regions was observed; however, a statistically significant difference was observed for total claims (P<0.001) and total antipsychotic costs (P<0.017) across regions.
Conclusion: Additional studies need to be conducted to determine if there is a difference in antipsychotic prescribing in the United States.
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: Student Projec
MyDispense: Lessons from Global Collaboration in Developing a Pharmacy Educational Simulation Tool
Get PDFThe current focus on global workforce development in pharmacy provides a perfect stage for continued and extended collaboration between educators, researchers, and practitioners. One such global educational project is the MyDispense Project, which is a collaborative journey that started with an educational need. MyDispense is an online pharmacy simulation tool that teaches dispensing skills to students. Development of the tool began as a need for Australian pharmacy students, but has been customized for other parts of the world as well. Since the project’s launch in 2010, the ongoing use and development of the tool is a compelling story of success for global collaboration in pharmacy education. Lessons can be learned from this collaborative endeavour.
Type: Commentar
Exploring Strategies to Enhance the Presentation of Information in Print DTCA to Improve Consumers’ Recall of Information
Get PDFThis study examines how best to present information in an antidepressant print DTCA. The objectives of this study are to: (1) modify an antidepressant print advertisement to enhance consumers’ understanding of the presented information, (2) create a questionnaire to measure consumers’ recall of the information presented in an antidepressant print advertisement and (3) pilot test the study instruments by comparing consumers’ recall of the information in the antidepressant print advertisement between those who view the original advertisement and those who view the modified advertisement. Modifications of the advertisement were based on the Explanatory Structure Building Model, findings from previous studies, and literature pertaining to the enhancement of the readability and comprehension of written health information. Data collection was conducted in three stages using mixed methods. This study details potential techniques that can be used to enhance the presentation of information in print DTCA in order to improve consumers’ recall of the information. Furthermore, this study shows that strategies to improve the presentation of information in print DTCA exist and that the strategies are feasible to apply.
Conflict of Interest
This research study was supported by the University of Wisconsin-Madison Population Health Dissertation Grants sponsored by the Robert Wood Johnson Foundation and the Sonderegger Research Center Dissertation Research Grants.
Type: Original Researc
Comparing the Research Contributions of Community Pharmacy Foundation Funding on Practice Innovation Between Non-Academics and Academics
Get PDFObjective: Evaluate and compare the research contributions of Community Pharmacy Foundation (CPF) funding on community pharmacy practice innovation between non-academic and academic principal investigators (PIs) with respect to the following measurements: 1) “Pharmacy Practice Activity Classifications” (PPAC); 2) CPF “Coordinated Use of Medications”; and 3) CPF Investigator Impact.
Methods: Quantitative data for all 124 CPF-funded grants awarded from 2002-2016 were obtained from the CPF website and personnel, while ethnographic qualitative data was generated from queries of PIs. Grant categorization was conducted by researchers serving as judges trained on the rules and procedures for coding. A threshold level of 90% agreement in scores of independent judging was established a priori. Findings were summarized and groups were compared using descriptive statistics for quantitative data and a thematic analysis of PI ethnographic reflections for qualitative data.
Results: There were no differences between non-academic and academic PI groups for Coordinated Use of Medications and PPAC domains, but non-academics contributed more to two dispensing-related PPAC subclasses: ‘Preparing the Product’ (10% vs. 2%) and ‘Delivering the Medication or Device’ (13% vs. 2%). Analysis of investigator reflections revealed similarities between groups regarding impact on practice innovations, expanded collaborations, new practice tools, and patient-care financing models.
Conclusions: CPF funding contributed new knowledge and resources for expanding and enhancing practice innovations as shown by quantitative (PPAC & Coordinated Use of Medications) and qualitative (PI impact) measures. Similarities between PI groups suggest that the CPF has established a funding niche with unique diversity of practice innovation opportunities. This investigation’s findings may be useful to the CPF’s continuous quality improvement efforts, as well as future grant applicants to assess research gaps in the medication use process and develop sustainable, transferable, and replicable patient-care innovations in community pharmacy practice.
Conflict of Interest
This program evaluation analysis was funded by the Community Pharmacy Foundation (CPF). Co-author Anne Marie Kondic is Executive Director and Grants Administrator for the Community Pharmacy Foundation. The ideas articulated in the manuscript are those of the authors to characterize historical CPF grant funding and do not necessarily indicate or impact future funding priorities.
Type: Original Researc
Patients’ Perception of a Community Pharmacist-Managed Multidrug-Resistant Tuberculosis Program in Peru: A Public Health Perspective
Get PDFObjectives: The primary objective is to investigate the public’s perception about the role of the community pharmacist in Peru’s directly observed treatment, short course (DOTS) program. The secondary objective is to assess perceived barriers that would prevent the public from utilizing community pharmacists in order to identify future opportunities for community pharmacists to increase adherence to multidrug-resistant tuberculosis (MDR-TB) therapy. Design: Qualitative study comprised of an 8 close-ended survey questionnaire.
Setting: Healthcare clinics established by a medical mission group in Lima and surrounding communities, Peru, from July 13 to July 27, 2015. Participants: Patients 15 years of age and over who sought healthcare at the clinics. Main outcome measures: Public’s perception about the role of the community pharmacist in Peru and barriers that would prevent the public from seeking a community pharmacist. Results: Out of the 445 patients approached, 438 patients completed the survey, resulting in a 98% response rate. More than half (52%) of the respondents were likely to seek a community pharmacist to assist them in completing a MDR-TB medication regimen. Almost half (48%) of the respondents felt comfortable with assistance of a community pharmacist in completing an MDR-TB regimen. The physician was the first health care professional that was contacted for all medical situations, including drug-related questions (61%). Lack of privacy in the pharmacy (53%) and busyness of the pharmacists (52%) were the top perceived barriers for asking community pharmacists questions. Conclusion: This study highlights the need for pharmacist participation in Peru’s DOTS program. Furthermore, this investigation has identified several issues of concern related to current community pharmacy practice in Peru. Therefore, future efforts may be necessary to address these identified areas of opportunity to promote the community pharmacist’s role in health screening, drug therapy monitoring, and counseling to decrease the public health burden of MDR-TB.
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 or royalties.
Type: Original Researc