INNOVATIONS in pharmacy (Iip - E-Journal)
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The Drug Court Pharmacist: Expanding Pharmacy Practice and Addressing Substance Abuse
Get PDFProblem solving courts, including Drug Court, were established to address substance abuse while providing an alternative to prison sentences and traditional corrections supervision. Drug Courts have been shown to reduce crime in participants and graduates, save the criminal justice and health care systems money, reduce victimization, and restore families. Pharmacists in Tippecanoe County, Indiana, and Carlton County, Minnesota, have established innovative practices as members of Drug Court teams; these practices include the provision of a variety of pharmaceutical and health-related services that other Drug Court team members are not able to provide. The role of the pharmacist on the Drug Court team deserves exploration in light of the increasing needs of problem-solving courts across the United States and the current substance abuse epidemic that unfortunately includes prescription drugs.
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: Idea Pape
Medication Reconciliation Limitations: Observation of the Medication Reconciliation Process in the Emergency Department by Two Immersion Pharmacy Students
Get PDFMultiple medical records may exist for a particular individual based on the various health services he or she receives. Maintaining updated, accurate records remains the responsibility of both practitioners and patients. Medication reconciliation, defined as the process to accurately depict the patient’s current orders and medications, 2 seeks to avoid errors in duplicity, interactions and dosing errors. Medication histories at Moses Cone Hospital are currently recorded by pharmacy technicians who follow specific standards, for instance they cannot remove “house meds”, which are prescribed medications with an active prescription attached. Technicians instead mark these medications for removal, leaving reconciliation to the physician. The physicians in the emergency department are not required to complete a full reconciliation for patient's profiles as this is a task left for the admitting physician. This leads to the question whether the reconciliation process in the emergency department (ED) needs to be re-evaluated. Patients’ “After Visit Summary” reports were used to analyze patient profiles in determining medication reconciliation statuses (whether fully reconciled, partially reconciled, or unreconciled). 280 patients’ profiles were used. 243 records (86.79%) were found unreconciled, 18 (6.43%) were partially reconciled, and 19 (6.79%) were fully reconciled.
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
Medication Use Evaluation of Dronedarone in Comparison to Amiodarone
Get PDFAmiodarone is the most effective rhythm-control for atrial fibrillation, but produces serious potential side effects. Dronedarone was designed to eliminate amiodarone toxicities, but increased the risk of mortality in clinical trials. This medication use evaluation compares one year of dronedarone use with a matched cohort of amiodarone patients at a single hospital in Greensboro, NC. Forty-eight patients were included with an average age of 71.8 years and 37.5% female population. No significant difference was found for the primary composite outcome of death, myocardial infarction, stroke, and systemic embolism (OR = 2.4, p = 0.148). Likewise, no statistical significance was demonstrated between the two groups for QTc prolongation, hypothyroidism, liver dysfunction or maintenance of normal sinus rhythm. In conclusion, the clinical decision process demonstrated no increased risk of death or other adverse events in the use of dronedarone.
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
Great Expectations: Cost-Utility Models as Decision Criteria
Get PDFOne of the more puzzling features of published claims for cost-effectiveness is the popularity of claims presented in terms of quality adjusted life years (QALYs). Despite the popularity of QALYs as the ‘gold standard’ outcome measures among academic audiences, professional groups and a number of single payer health care systems, there is no evidence to suggest that cost-per-QALY based claims have ever been assessed, either through experimentation or observation, to support formulary decisions. In part this stems from the fact that cost-per-QALY claims are typically not expressed in evaluable terms; it also stems from the fact that, despite the plethora of QALY publications, QALYs are not collected on a regular basis by any health care system as part of administrative claims or electronic medical records. In the US QALYs have typically been ignored by health care decision makers. Given this, the continuing popularity of utility-based measures for studies published in the leading pharmacoeconomics journals is difficult to understand. One possible explanation is that those promoting QALY claims are locked into a relativist position that defends the publication of nontestable product claims. A position that is reinforced by recommendations from ‘peer organizations’ such as the Academy of Managed Care Pharmacy (AMCP) in their promotion of their Format for Formulary Submission standards which support the role of lifetime cost-per-QALY modeled imaginary worlds or thought experiments. Another explanation is that QALYs have been taken at face value with little though given to how they might be implemented to support both initial formulary decisions as well as ongoing disease area therapeutic class reviews. The purpose of this review is to put the case that the continued emphasis on cost-per-QALY claims has no practical benefit in formulary decision making.
Type: Commentar
Imaginary Worlds: A Systematic Review of the Status of Modeled Cost-Effectiveness Claims Published in the Journal of Medical Economics from January 2015 to December 2015
Get PDFThe purpose of this review is to evaluate the credibility of modeled claims for cost-effectiveness studies published in the Journal of Medical Economics (JME) in the period January 2015 to December 2015. Credibility is assessed in terms of the standards of normal science. Are the claims made capable of falsification and replication? Following the PRISMA-P recommendations, abstracts of all papers published in the JME were evaluated by both authors independently against a MeSH terms checklist: cost, cost-effectiveness, cost-utility, outcomes, QALY and Markov. A total of 32 studies were identified. A systematic review of each study was then evaluated. The consensus was that all studies be included in the review. Each study was judged against four criteria: (i) Is the model capable of generating evaluable claims? (ii) did the author(s) attempt to generate evaluable claims? (iii) did the author(s) suggested how the claims might be evaluated? and (iv) did the author(s) caution readers as to the implications of generating non-evaluable clams for the credibility of the analysis? None of the studies presented their claims or projections in an evaluable form and none suggested how they might be evaluated. None met the standards of normal science. The claims made for cost-effectiveness were either impossible to verify, or if potentially verifiable, were not presented in an evaluable form. The studies lacked credibility. There was no basis for assessing whether the claims were right or even if they were wrong. The JME is not alone. As part of an ongoing systematic review program, covering the leading journals and focusing on chronic condition areas, it is clear that the majority of cost-effectiveness papers also fail the test of credibility. Of course, it might be that the consensus opinion among practitioners is that non-evaluable projections are acceptable. Evidence is not discovered, but is constructed through models and simulations. This lack of scientific credibility is a major concern. If medical economics is to advance through the formulation and testing of hypotheses, then editors of journals should consider whether or not to set standards for the acceptance of publications to include the requirement for evaluable claims and the results of claims assessment. If this is not acceptable, then it should be made clear that published papers are simply imaginary worlds or thought experiments.
Type: Commentar
Imaginary Worlds: The European Network for Health Technology Assessment (EUnetHTA) Recommendations for Health Economic Evaluations
Get PDFThe European Network for Health Technology Assessment (EUnetHTA) guidelines for health economic evaluations represent a consolidated view of non-binding recommendations for assessments of the relative effectiveness of pharmaceuticals or other health technologies. EUnetHTA views itself as the scientific and technological backbone of the development of health technology assessment in the European Union and among its member states and other partners. Unfortunately, the standards for health technology assessment proposed by EUnetHTA do not meet the standards of normal science. They do not support credible claims for the clinical and comparative cost-effectiveness of pharmaceuticals. In rejecting the standards of normal science the guidelines put to one side the opportunity not only to re-assess and replicate clinical and cost-effectiveness claims but to provide meaningful feedback on claims assessment to health care decision makers. The purpose of this review is to make the case that, in failing to support standards for experimentation, EUnetHTA is advocating its partners support the creation of modeled or simulated imaginary or false worlds. While EUnetHTA is not alone in recommending the construction of imaginary worlds to support formulary decisions, there is still the opportunity to revisit these recommendations and decide whether or not to encourage a scientifically rigorous approach to health technology assessments - to abandon a commitment to intelligent design in favor of natural selection.
Conflict of Interest
None
Type: Commentary
 
Patient Medication Use: Interpreting the Results of a Patient Medication Safety Survey by Phase I Immersion Pharmacy Students
Get PDFA medication safety survey was created during our first year pharmacy rotations in order to assess and gain insight to how safe patients are with their medications at home. The patient population was from the nursing units and emergency department of Moses Cone Hospital in Greensboro, NC. The survey questions covered the topics including how the patients take their medications, medication storage, medication disposal, as well as medication adherence.
Type: Student Projec
Comparison of Reading Levels of Pharmacy Students and Reading Level of Primary Literature
Get PDFObjectives: The project purpose was to evaluate pharmacy students’ reading levels using the Nelson-Denney Reading Test (NDRT) and compare these results with the reading level of primary literature to investigate incongruities between student’s comprehension ability and the readability level of assigned reading in the curriculum.
Methods: The NDRT was administered to first- through third-year student pharmacists to determine grade equivalents (GE) for vocabulary and reading comprehension. Twenty articles previously identified as Patient-Oriented Evidence that Matters (POEMs) were analyzed to determine the Flesch-Kincaid Grade Level and Gunning-Fog Score. Student demographics, information regarding language spoken, and reading habits, were also assessed. Pearson product moment correlations, t-tests, ANOVA, and descriptive statistics were used to assess relationships between demographic data and NDRT scores.
Results: One hundred students participated. The mean NDRT total grade equivalent (±SD) was 16.95 ± 2.1 (median = 17.3). NDRT grade equivalents were statistically different for students with different racial or ethnic backgrounds (t(98)=3.74, p=0.026), English as a second language (ESL) students (t(98)=5.19, p=0.021), and students that read works of fiction for pleasure (t(98)=4.31, p=0.002). The average Gunning-Fog Score for all primary literature articles was 11.48, with the introduction section being the most complex. The average Flesch-Kincaid Grade Level was 17.04, with the results section scoring the lowest average grade level.
Implications: While the overall reading grade level of our pharmacy students suggests that they are capable of comprehending reading assigned in the pharmacy curriculum, minority students and students for whom English is a second language may struggle with comprehending complex text.
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
The Value of a Twitter-based Community of Practice for Pharmacy Professionals in the UK
Get PDFAs a means to work across settings and geography, @WePharmacists is a volunteer-led online social-media group open to anyone, with particular relevance to those operating in or with pharmacy teams in the UK. The goal of WePharmacists is to pursue better patient care and outcomes from medicines through shared learning and a connected pharmacy team. The core offering is facilitated tweet chats, on topics suggested by the community. Resources to aid members in connecting with others, finding information and using technology have been developed, along with materials to help members recognize the learning that occurs with social media use. Community members report the value of feeling part of a wider community, along with the benefit of learning from one another.
Type: Commentar
Creative Destruction: Next Generation Sequencing in Drug Development, Formulary Evaluations and Pricing
Get PDFNext generation sequencing (NGS) has the potential to disrupt not only the accepted process of drug development but also the hurdles a drug manufacturer would be expected to face in securing formulary approval and a possible premium price for the new compound. The purpose of this commentary is to consider the role of NGS in this process, one which is characterized as a process of creative destruction, where adoption of NGS in personalized medicine sets in train a mechanism of incessant product and process review. A mechanism driven by continuing modifications and extensions to NGS platforms as our understanding of the role of mutations and mutation load in therapy choice expands. At the same time this mechanism has significant implications for the continued revision of treatment guidelines and their adoption of NGS as integral parts of the treatment pathway. There are, however, a number of unresolved issues which have to be addressed. These include the choice of NGS platform, barriers to integrating evidence to support NGS-based therapy choices in treatment guidelines, the implications of NGS for drug development and the modification or rejection of current trial structures, the integration of comorbid disease states and the standards that formulary committees should adopt to evaluate NGS claims. The overarching theme, however, is the need to invest in a robust and credible evidence base. While we are a long way from achieving this, the focus must be on putting claims for therapy choice forward that are credible, evaluable and replicable.
Type: Commentar