INNOVATIONS in pharmacy (Iip - E-Journal)
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Cost-Savings and Patient Experience with a Pharmacy-Led Medicare Part D Consultation Service
Full text linkBackground: There are many Medicare Part D plans, making it difficult for patients to choose the optimal plan. The decision to remain on current Medicare plans is reinforced by patient inertia and uncertainty associated with plan-switching decisions. By helping patients identify more cost-effective plans, pharmacists and pharmacy personnel have the ability to inform plan-switching decisions resulting in lower out-of-pocket (OOP) costs.
Objectives: This study evaluates 1) patient experience with a pharmacy Medicare Part D consultation service and 2) potential out-of-pocket savings based on a patient’s best plan for 2019 compared to continuation of a patient’s 2018 Medicare Part D plan.
Methods: This study was a retrospective descriptive analysis and took place at a single, independently owned community pharmacy. Patients received free individual consultations with a pharmacist that included a medication review and information on all available Part D plans. Patients were selected to receive the service using pharmacy software to identify potential inefficiencies in current Part D plans. Data on satisfaction and perceived pharmacist role in providing Medicare Part D information were collected via an in-person survey administered at the pharmacy. Potential out-of-pocket cost savings were determined using cost information provided for patient specific medication regimens entered into Medicare.gov, the online platform for Medicare Part D plan information.
Results: Of the 318 patients identified, 79 used the consultation service. Out of 79 patients who used the service in fall of 2017, 44 completed the survey for a response rate of 56%.
Patients generally reported good experiences with the service. Open-ended responses revealed patients utilize a variety of helpers for plan information and decisions. A subset of 14 patients were identified as having clear plan-switching decisions and were included in the cost-savings analysis.
Conclusions: Patients using a free Medicare Part D plan consultation were satisfied with the service, suggesting that helpers were an important resource n their plan-selection process. Using the pharmacist-led Part D consultation may result in decreases in out-of-pocket cost savings due to identification of optimal Medicare Part D plans.
Article Type: Not
The Great I-QALY Disaster
Full text linkThe QALY is an impossible construct; it defies common sense. It fails completely once we consider the axioms of fundamental measurement. Utilities as ordinal scales cannot be used to create QALYS. The QALY should never have been introduced to support the value assessment of pharmaceutical products and devices. The result is 30 years of QALY based assessments of pharmaceutical products and devices which are conceptually and technically wrong. They are a charade and will have contributed mistakenly to thousands of formulary decisions. In the search for a common metric to evaluate cost-effectiveness the impossibility of a QALY was overlooked. The result is a disaster, unfolding over decades. Our next steps must be to abandon the QALY paradigm and look ahead to a new value assessment framework.
Commentar
Navigating Allyship through Indigenization, Decolonization, and Reconciliation: Perspectives from Non-Indigenous Pharmacy Educators
Full text linkAs pharmacy schools across Canada and North America work towards authentic and meaningful curriculum and learning opportunities in Indigenous health and cultural safety, the conversation of “why” we need to do this has become clearer, but the task of “how” we do this remains challenging. This curricular transformation can be increasingly more complex to navigate as a non-Indigenous ally and pharmacy educator. Defining your role as an ally is deeply personal and critically important, as it can transform based on the collaborative work undertaken with Indigenous partners and communities. The purpose of this article is to share perspectives gained over years of experience and practical applications of allyship through the lens of three key separate, but interconnected concepts – indigenization, decolonization, and reconciliation
Improving Patient-Pharmacist Encounters with Over-The-Counter Medications: A Mixed-Methods Pilot Study
Full text linkBackground and Objectives: Over-the-counter (OTC) medication use has increased safety risks for adults older than 65. Most older adults purchase OTC medications from community pharmacies, where the considerable distance or visual obstructions between the prescription area and OTC aisles undermine pharmacists’ ability to assist patients with OTC medication decisions. An innovative redesign of an abbreviated medication section specifically for older adults (called the Senior SectionTM) can facilitate pharmacy staff/patient interaction, potentially improving safe medication selection and use. This study evaluated the impact of the Senior Section on the frequency and content of OTC encounters between pharmacy staff and patients.
Research Design and Methods: An intervention mixed-methods design generated data from patient OTC encounters, and interviews with two pharmacists and two technicians, throughout the study. NVivo was used to code interview transcripts, and frequencies and chi-square analyses demonstrated pre/post-intervention comparisons for the OTC encounter variables.
Results: After Senior Section implementation, pharmacy staff were more likely to initiate (and be involved in) patient encounters, address more topics or problem/symptoms, provide details about OTC products, discuss appropriateness of OTC use, and discuss medication classes highlighted in the Senior Section. Pharmacy staff were less likely to need to leave the prescription department for extended periods; they also had fewer prolonged encounters or encounters about product location. Importantly, the Senior Section did not impede pharmacy workflow.
Discussion and Implications: The Senior Section prompted more frequent, effective, and efficient engagements between pharmacy staff and patients, which may substantially reduce OTC-related harms among older adults.
Article Type: Original Researc
The Impossible QALY and the Denial of Fundamental Measurement: Rejecting the University of Washington Value Assessment of Targeted Immune Modulators (TIMS) in Ulcerative Colitis for the Institute for Clinical and Economic Review (ICER)
Full text linkAll too often organizations embrace standards for health technology assessment that fail to meet the standards of normal science. A continuing puzzle is why the axioms of fundamental measurement are ignored by researchers such as the University of Washington Model Group in constructing lifetime cost-per-QALY claims. The University of Washington Model Group is not alone; it is an accepted article of faith that multiattribute utility scales can be manipulated as if they had ratio scale properties, which they do not. This commitment to pseudoscientific claims, embracing intelligent design rather than natural selection, is endorsed by professional groups such as ISPOR as well as by self-appointed arbiters of value assessment such as ICER. Perhaps the answer is peer pressure rather than ignorance of the axioms of fundamental measurement. More to the point, if you have been an advocate of imaginary simulations a Damascene epiphany creates both psychological and professional challenges. After all, if cost-per-QALY constructs are rejected, then it is difficult to see what options there are for those attempting to model cost-effectiveness claims. If it is just ignorance of the axioms of fundamental measurement then a reasonable question is why these axioms, readily available on any number of internet sites, are ignored in health technology assessment programs. The purpose of this commentary is to review the ICER September 11th 2020 evidence report in ulcerative colitis, with particular reference to ICER’s responses to questions raised in the public comment period on the measurement properties (or their absence) for utility scales; in this context the EQ-5D instruments. The critique pointed out that the utility scores had ordinal properties. ICER, without proof, disputed this statement asserting that health economists believed (or assumed) they were ratio scales. This is nonsensical. ICER has two options: first, to continue to believe that the EQ-5D instruments had ratio properties or second, to acknowledge that they indeed only had ordinal properties, rejecting their many modeled claims for pricing and access. Not surprisingly, the possibility of a Damascene epiphany was rejected. ICER maintained its assertion that health economists, presumably all of them, believe or possibly just assume for analytical convenience that the EQ-5D-3L and similar measures are in fact on a ratio scale. This introduces a new concept in fundamental measurement: a ratio scale without a true zero but with negative values. ICER is quite prepared to admit that negative I-QALYs are possible and their lifetime cost-per-incremental I-QALY modelling can yield negative I-QALYs.
Article Type: Commentar
Pharmacogenomics (PGx) Patient with Mixed Levels of Actionable Variant Evidence
Full text linkObjective: To demonstrate the types of clinical recommendations a pharmacogenomics pharmacist may make to medical clinicians with regard to medication management to improve therapeutic outcomes based on varied levels of medical literature evidence.
Summary: This case demonstrates how a common type of patient seen in a pharmacist practice may present with a varied pharmacogenomic (PGx) profile, how they may benefit from PGx analysis, and how varying levels of medical literature evidence can be used with clinical decision making.
Conclusion: PGx testing can help avoid adverse drug reactions (ADRs) or medication inefficacy by assisting in the adjustment of current or future medication doses. It can also help predict the best medications to use or those to avoid in advance by eliminating much of the existing dosing or medication selection method of trial and error
Good Literacy to Enhance Response in Diabetes Mellitus (GLITTER-DM)
Full text linkObjective: The purpose of this study is to determine the effectiveness of individualized communication strategies and self-management action plans to improve A1c control at 3 months in patients with low health literacy.
Methods: A prospective, open-labeled, pilot study was conducted on 23 patients with diabetes mellitus in a pharmacist-led ambulatory care clinic. Patients who had a Rapid Estimate of Adult Literacy in Medicine- Revised (REALM-R) score of 6 or less and an A1c greater than 7% upon study entry were included. The first group received the teach-back method, personalized actions, and follow-up phone calls to assess comprehension (N = 12). The second group was assigned to usual care (N = 11).
Results: Patients receiving literacy-appropriate interventions had greater A1c percent reduction (A1c difference of -2.0 ± 1.3 vs -1.0 ± 2.2; P = 0.02) and less hyperglycemic events per week (0.1 vs. 2.1; P = 0.04). There were no differences in the number of hypoglycemic events, testing frequency, medication-adherence rates, or hospitalizations and emergency room visits related to diabetes.
Conclusion: Literacy-appropriate methods such as the teach-back method, personalized action plans, and telephone follow-ups may improve glycemic control in low health literate patients with diabetes.
Practice Implications and Innovations: The findings from this study suggest that pharmacists may improve diabetes outcomes when managing patients who possess low health literacy using simplified teaching methods.
Original Researc
The Community Pharmacy Technician’s Role in the Changing Pharmacy Practice Space
Full text linkPurpose: The practice of pharmacy and role of pharmacists has evolved over the decades but markedly since the introduction of the Affordable Care Act (ACA) in 2010. The ACA allowed patients to have increased access to community pharmacy services, such as medication therapy management, leading to an increase in the clinical services provided by pharmacists. This expansion of pharmacist’s roles has led to pharmacists to feel an increase in workload which negatively impacts the time spent with patients. One way for this shift to occur without continuing to increase the pharmacist’s workload is by using technicians as pharmacist extenders to take on more technical tasks.
Summary: The role of pharmacy technicians has been slow to expand from fear of public safety due to the lack of required education and training. Today, state requirements to practice as a pharmacy technician have become stricter with state requiring licensing, registration or certification. This increase in requirements as led to the expansion of pharmacy technician duties. Studies show that pharmacy technicians are able to perform technician accuracy checking, provide immunization and perform Clinical Laboratory Improvement Amendments (CLIA)-waived screenings. In addition to these duties, pharmacy technicians are being utilized in more novel ways such as collecting medication information in primary care and telepharmacy settings.
Conclusion: In order for pharmacy to continue to grow as a profession, pharmacists need to use pharmacy technicians as extenders. As pharmacy technicians begin to take on more of the technical duties, pharmacists are able to increase the time spent with patients.
Article Type: Commentar
Using Biochemistry to Educate Students on the Causal Link between Social Epigenetics and Health Disparities
Full text linkBackground: While pharmacy education standards require students to recognize social determinants of health (SDOH), there is an opportunity to improve how this is taught in the curriculum. One innovative approach is to educate student pharmacists in a biochemistry course through the integration of topics like epigenetics using SDOH as the framework.
Innovation: A 50-minute educational activity was used to supplement material on the regulation of gene expression, in which epigenetic changes are driven by SDOH. It provided students with a biochemical basis to explain some health disparities, rather than viewing them exclusively as social obstacles to health. The activity employed a mini-lecture, a short video, as well as both small and large group discussion. A reflective paper was used to assess students’ understanding of the topic, and the role of the pharmacist in helping patients prevent diseases caused by epigenetic changes due to social determinants of health.
Findings: A post-activity survey showed that the activity increased students’ perception of knowledge about SDOH, as well as the effect of epigenetic changes on health outcomes. Furthermore, this activity increased students’ awareness about the role that SDOH play in epigenetic changes and challenged students to understand the role that society plays in health outcomes.
Conclusions: The preventable nature of health inequities creates an opportunity to integrate public health into pharmacy education. The integration of epigenetics and SDOH gives the student an opportunity to provide a mechanistic link between social inequities and biochemical processes.
Article Type: Not
Rational Prescription and Cost-Effective Medication: Challenges and Opportunities in Pakistan
Full text linkPakistan is one of the countries with the highest number of medications filled per prescription due to overly prescribed antibiotics and injectable drugs. This is due to a lack of ethical practices in prescribing because doctors are significantly influenced by lucrative financial incentives of pharmaceutical companies rather than clinical findings. This immoral activity has become significantly amplified over the past few years and continues to be a challenge in Pakistan. Currently, there is no code of ethics for marketing and promotional activities of pharmaceutical companies. This year, authorities have step up and are in the process of creating policies to regulate companies and practitioners. Implementation of these new policies needs vigilance from health officials, strong professional commitment and institutional collaboration. If executed correctly, these polices should create an environment of professionalism within the healthcare sector.
Article Type: Lette