INNOVATIONS in pharmacy (Iip - E-Journal)
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Affordable Care Act: A review and discussion of its impact on healthcare today, and a primer for pharmacists
Get PDFIn the midst of countless healthcare debates, the Patient Protection and Affordable Care Act is written into legislation as a possible solution to the United States's rising healthcare costs. Individualized into nine titles, the act sought to provide additional coverage to millions of Americans while cutting down healthcare costs through numerous provisions effective into 2020. While the act has been challenged publicly and privately by the states, many healthcare professionals today, let alone the average American, are unaware and uneducated of what comprises the act, as well as the impact in which it has on the future of healthcare in the United States. With an increasing role of patient care placed upon pharmacists today, an understanding of the PPACA allows us to provide extensive answers to questions in which our patients may have.
Type: Student Projec
Student Self-Ratings of Skill Acquisition from a Clinical Controversy Debate in a Third Year Pharmaceutical Care Lab
Get PDFObjectives: To evaluate student perspectives of a clinical controversy debate activity designed to improve their skills to effectively approach and communicate complex therapeutic dilemmas.
Design: A clinical controversy debate activity was implemented in the fall semester of the third year pharmaceutical care laboratory curriculum. Topics were chosen based on controversies encountered in practice. Students were assigned to groups of 5-6 and subdivided to the pro or con of the topic. Each debate lasted 25 minutes. Students completed a self-assessment asking them to rate eight skills (e.g. selecting appropriate references, analysis of literature, defending and predicting arguments, composing and delivering the presentation, and persuading the audience) before and after the debate as: novice, developing, skilled, facilitating/leading, or educating. Results were analyzed descriptively and the pre-post ratings were compared using a Wilcoxon Signed Rank Test.
Results: 140 (84.8%) students responded to the self-assessment survey. The skill that students rated most highly prior to the debate was selecting appropriate resources and primary literature, with only 7.1% rating themselves as novice. After completing the debate, the skill rated with the greatest improvement was predicting opposing arguments with 47.1% rating as developing and 40% rating as skilled. All eight skills had statistically significant improvements pre- and post- assignment (p < 0.001).
Implications: Preparing arguments for and against treatment options is an important clinical skill, used regularly by pharmacists. A clinical controversy debate activity resulted in reports of improvement on eight measures of evidence based medicine-related skills.
Type: Case Stud
Excluding Orphan Drugs from the 340B Drug Discount Program: the Impact on 18 Critical Access Hospitals
Get PDFPurpose: The 340B Drug Pricing Program is a federal program designed to reduce the amount that safety net providers spend on outpatient drugs. The Patient Protection and Affordable Health Care Act of 2010 extended eligibility for 340B to critical access hospitals (CAHs) for all drugs except those designated as "orphan." Because this policy is unprecedented, this study quantifies the gross financial impact that this exemption has on a group of CAHs.
Methods: Drug spending for 2010 from 18 CAHs in Minnesota and Wisconsin are reviewed to identify the prevalence of orphan drug purchases and to calculate the price differentials between the 340B price and the hospitals' current cost.
Results: The 18 CAHs' purchases of orphan drugs comprise an average of 44% of the total annual drug budgets, but only 5% of units purchased, thus representing a very high proportion of their expenditures. In the aggregate, the 18 hospitals would have saved 171,000 average per hospital) had purchases of drugs with orphan designations been made at the 340B price. Because CAH claims for Medicare are reimbursed on a cost-basis, the Federal government is losing an opportunity for savings.
Conclusion: The high prevalence of orphan drug use and considerable potential for cost reduction through the 340B program demonstrate the loss of benefit to the hospitals, Federal government and the states.
Type: Original Researc
Using Think Aloud Protocols to Assess E-Prescribing in Community Pharmacies
Get PDFIntroduction: Think aloud protocol has rarely been used as a method of data collection in community pharmacies.
Purpose: The aim of the report is to describe how think aloud protocols were used to identify issues that arise when using e-prescribing technology in pharmacies. In this paper, we report on the benefits and challenges of using think aloud protocols in pharmacies to examine the use of e-prescribing systems.
Methods: Sixteen pharmacists and pharmacy technicians were recruited from seven community pharmacies in Wisconsin. Data were collected using direct observation alongside think aloud protocol. Direct observations and think aloud protocols took place between January-February, 2011. Participants were asked to verbalize their thoughts as they process electronic prescriptions.
Results: Participants identified weaknesses in e-prescribing that they had previously not conceived. This created heightened awareness for vigilance when processing e-prescriptions. The main challenge with using think aloud protocols was due to interruptions in the pharmacies. Also, a few participants found it challenging to remember to continue verbalizing their thought process during think aloud sessions.
Conclusion: The use of think aloud protocols as method of data collection is a new way for understanding the issues related to technology use in community pharmacy practice. Think aloud protocol was beneficial in providing objective information on e-prescribing use not solely based on pharmacist's or technician's opinion of the technology. This method provided detailed information on a wide variety of real time challenges with e-prescribing technology use in community pharmacies. Using this data collection method can help identify potential patient safety issues when using e-prescribing and suggestions for redesign.
Type: Not
Medication Adherence Improvements in Employees Participating in a Pharmacist-Run Risk Reduction Program
Get PDFObjective: To evaluate the medication adherence of individuals participating in a pharmacist-run employee health Cardiovascular and Diabetes Risk Reduction Program.
Design: Retrospective analysis of medication adherence using pharmacy refill data.
Setting: A medium sized university located in the Midwest United States and the organization's outpatient pharmacy. Participants: 38 participants ≥ 18 years of age, employed and receiving their health insurance through the organization, and have a diagnosis of hypertension, hyperlipidemia, diabetes mellitus, or a combination thereof.
Intervention: Participation in the risk reduction program that emphasizes medication therapy management (MTM), lifestyle medicine and care coordination.
Main Outcome Measures: The Proportion of Days Covered (PDC) and the Medication Possession Ratio (MPR).
Results: PDC and MPR analysis showed a statistically significant improvement in medication adherence for 180 days and 360 days post enrollment versus the 180 days prior to enrollment (P<0.01). The PDC analysis demonstrated a statistically significant improvement in the number of medications that achieved a PDC ≥ 80% (high adherence) for the 180 days post enrollment versus the 180 days prior to enrollment (+30%, P<0.01). The MPR analysis showed a non-statistically significant improvement in the number of medications that achieved an MPR ≥ 80% (high adherence) pre enrollment versus post enrollment (+10%, P=0.086). The percentage of participants in the program that reached a PDC and MPR adherence rate ≥ 80% at 180 days post enrollment was 78.9% and 94.4%, respectively which exceeds that of a matched cohort that reached a PDC and MPR adherence rate ≥ 80% of 66.4% and 82.8%, respectively.
Conclusion: Pharmacists can improve medication adherence as measured by PDC and MPR when working with employees enrolled in a novel pharmacist-run employee health risk reduction program. Medication adherence was shown to be sustainable for at least one year and was shown to be better when compared to a matched cohort of similar age, condition and region.
Type: Original Researc
Prevalence of drug-related problems in self-medication in Danish community pharmacies
Get PDFBackground: Drug-related problems are known to be a major problem associated with pharmacotherapy. A broad range of studies, mainly in the area of prescription-only medicines, supports this fact. Only a few studies have evaluated drug-related problems with over-the-counter medicine and the role of community pharmacies in this.
Purpose: To quantify drug-related problems in self-medication (use of over-the-counter medicine) identified by community pharmacies in Denmark and to document the interventions by pharmacy staff in relation to the identified drug-related problems.
Method: A descriptive study mapping drug-related problems in self-medication registered at the counter at a selected number of Danish community pharmacies.
Results: Data for 3,868 consecutive customers with requests for over-the-counter (OTC) medicines were registered at 39 community pharmacies. The pharmacies registered a total number of 4,324 OTC medicines requests, illustrating that a customer requested 1.1 OTC medicines on average. Drug-related problems (DRPs) were identified for 813 customers, equivalent to DRPs for 21.0 % of all customers, presenting symptoms or requesting OTC medicines, and for 20 % of all over-the-counter medicines requests. 1,239 DRPs were registered, corresponding to an average of 1.5 DRPs per customer requesting OTC medicines. Community pharmacies estimated that they solved or partly solved 76.2 % of the detected DRPs; 73 % were solved without involving a general practitioner.
Conclusions: DRPs were identified for 21.0 % of the pharmacy customers presenting a symptom or asking for an OTC medicine. The community pharmacy counselled the customers with DRPs more thoroughly than other customers by giving 2.4 pieces of professional advice, compared to an average of 2.1 to customers in general. It is not possible to determine the magnitude of the safety risk involved. Based on the most frequent categories of DRPs, there were risks of insufficient effect, unintended effects and, to a lesser extent, inappropriate self-medication.
Type: Original Researc
Unit-of-Use Versus Traditional Bulk Packaging
Get PDFBackground: The choice between unit-of-use versus traditional bulk packaging in the US has long been a continuous debate for drug manufacturers and pharmacies in order to have the most efficient and safest practices. Understanding the benefits of using unit-of-use packaging over bulk packaging by US drug manufacturers in terms of workflow efficiency, economical costs and medication safety in the pharmacy is sometimes challenging.
Methods: A time-saving study comparing the time saved using unit-of-use packaging versus bulk packaging, was examined. Prices between unit-of-use versus bulk packages were compared by using the Red Book: Pharmacy's Fundamental Reference. Other articles were reviewed on the topics of counterfeiting, safe labeling, and implementation of unit-of-use packaging. Lastly, a cost-saving study was reviewed showing how medication adherence, due to improved packaging, could be cost-effective for patients.
Results: When examining time, costs, medication adherence, and counterfeiting arguments, unit-of-use packaging proved to be beneficial for patients in all these terms.
Type: Student Projec
Market Diffusion of Extended Cycle Hormonal Contraceptives
Get PDFBackground: Extended cycle hormonal contraceptives (e.g. Seasonale, Seasonique) when introduced in 2003 were considered a very novel approach to contraception. The idea of manipulating the menstrual cycle so that women would experience just four menstruations a year was radical and was assumed to be responsible for the slow acceptance rate among the general public.
Objective: This report analyzes two different aspects of the acceptance of this unique idea in the population. The first was the level of usage of extended cycle hormonal contraceptives in the general population, which was measured by a review of sales figures over time in the United States. The second was an examination of market diffusion as it relates to consumer perceptions regarding the characteristics of these products.
Methods: To determine the degree of usage of extended cycle hormonal contraceptives the yearly sales, in terms of units sold, were compared with that of other leading methods of hormonal contraception. Along with the data, survey answers were obtained from 65 women who volunteered to participate in the study. Participants were selected randomly to represent the target population to assess the level of awareness about the benefits, risks, and any other concerns regarding the use of extended cycle hormonal contraceptives.
Results: The yearly sales data of units sold showed a definitive increase in the sales of extended cycle hormonal contraceptives since their release on the market. The survey results showed an overwhelming awareness in the study population about the extended regimen. However, only about half of the women in the survey group were aware of its benefits. The main concern reported was the perceived significant side effect profile.
Conclusion: Though awareness about the extended cycle hormonal contraception regimen was widespread, the survey population was not well informed about the advantages and the disadvantages regarding the degree of severity of side effects. To address these knowledge deficits, these aspects should be the focus when distributing information about extended cycle hormonal contraceptive regimens. This may boost the use of a potentially advantageous contraceptive regimen by a population who would derive benefit from its usage.
Type: Original Researc
A Case Based Learning Model in Therapeutics
Get PDFNowadays, learning a Pharmaceutical Profession is an increasing challenge. Apart from traditional texts, lectures and self-guided individual learning, pharmaceutical educators are encouraged to find and implement ways to promote higher order thinking, collaborative learning and to increase students' motivation. One way of achieving these objectives is to complement traditional learning methods with the development and implementation of Case Based Learning (CBL), supported in real life situations. Methods regarding real problems stand in contrast to a more traditional approach to learning and instruction. They promote learner-centered, small group, interactive learning experiences, instead of large group, didactic, teacher-centered instruction. Developing such a learning approach can be a challenge. In this sense, it becomes relevant to promote and share experiences already underway and by doing so, disseminate knowledge in this field. It is our goal with this text to share our experience in the design and implementation of a Case Based Approach to Therapeutics.
Type: Idea Pape