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Journal of Managed Care & Specialty... Feb 2021In 2019, the Utilization Review Accreditation Commission (URAC) required a new reporting measure for specialty pharmacies related to completion of therapy for hepatitis...
In 2019, the Utilization Review Accreditation Commission (URAC) required a new reporting measure for specialty pharmacies related to completion of therapy for hepatitis C virus (HCV). To calculate HCV completion of therapy according to URAC criteria and compare it with a calculation with additional pharmacy proposed adjustments to assess its applicability. This was an observational study of patients who received HCV treatment with a direct-acting antiviral (DAA) from 1 specialty pharmacy. All patients with prescription claims at a pharmacy who had a first fill for a DAA medication between the 2 measurement periods of January 1, 2018-December 31, 2018, and January 1, 2019-December 31, 2019, were included. Additional information was collected via a retrospective chart review and from the pharmacy's electronic medication system. The cumulative gap according to URAC was calculated from claims data by summing the number of days between the last days supply of 1 claim for the prescribed DAA and the subsequent claims. The pharmacy-proposed cumulative gap was calculated using additional information from patient chart notes in order to account for a true start date. A total of 1,485 patients were identified as having a first fill of a DAA between the 2 measurement periods. The HCV completion of therapy measure calculated per the URAC definition was 83.4% in 2018 and 86.5% in 2019. The only variable significantly associated with a > 15-day gap according to the URAC definition was if the first DAA order was delivered to the prescriber's office instead of the patient's home for 2018 (χ [1, N = 573] = 16.8, < 0.001) and 2019 (χ [1, N = 836] = 12.6, < 0.001). Using the pharmacy-proposed adjustment, the modified HCV completion rates for 2018 and 2019 were 88.9% and 89.9%, respectively. The accrediting body's definition of completion of therapy may report a falsely high rate of gaps in HCV therapy due to not accounting for the actual DAA start date. This information may prove beneficial for the accrediting body, as it reviews its initial definition of the HCV completion of therapy measure. No outside funding supported this study. Levesque reports participation in AbbVie's speaker's bureau with regard to its immunology portfolio. The other authors have no possible financial or personal relationships with commercial entities to disclose that may have a direct or indirect interest in the matter of this study.
Topics: Adult; Aged; Aged, 80 and over; Antiviral Agents; Drug Prescriptions; Feasibility Studies; Female; Hepacivirus; Hepatitis C; Humans; Male; Medication Adherence; Medication Therapy Management; Middle Aged; Pharmacies; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 33506724
DOI: 10.18553/jmcp.2021.27.2.263 -
Research in Social & Administrative... May 2023Non-medical medication switches, a change to another medicine or medication label not motivated by medical reasons, occur frequently. Switches often lead to negative...
BACKGROUND
Non-medical medication switches, a change to another medicine or medication label not motivated by medical reasons, occur frequently. Switches often lead to negative patient emotions, such as confusion and anger. Pharmacy staff's communication, i.e. delivering the message and addressing patients' emotions is crucial, but experienced as difficult.
OBJECTIVE
To develop and test a communication training for the pharmacy team to facilitate medication switch conversations.
METHODS
A communication training was developed based on the 'breaking bad news model' and 'positive message framing' strategies, and incorporating needs and preferences from practice. The training consisted of an e-learning with theory and reflective exercises, a half-day live training session, and an online reflection session. The Kirkpatrick training evaluation model (levels one 'reaction' and two 'learning') was used to evaluate the training. Quantitative data were analyzed using descriptive statistics and interview data was transcribed verbatim and analyzed thematically.
RESULTS
Twelve pharmacists and 27 pharmacy technicians from 15 Dutch pharmacies participated in the training. According to Kirkpatrick's model level one, the major learning outcome was to give space to patients to express their emotions and/or concerns (e.g. more silences in the conversations). For level two, most participants valued practicing the conversations, role-playing, and receiving feedback. The majority of the participants indicated that they had sufficient tools and practice during the live training to apply the strategies in daily practice. A few participants still needed time and practice, or missed examples to apply the strategies.
CONCLUSION
The communication training based on the two strategies was well-received and participants felt well-equipped post-training. The take-away for participants was to give space to patients to express their emotions. Using these strategies and skills, pharmacy teams can tailor their medication counseling to patients' emotions and concerns during non-medical medication switches to better support patients in proper medication use.
Topics: Humans; Pharmacies; Pharmaceutical Services; Communication; Pharmacists; Pharmacy; Community Pharmacy Services
PubMed: 36740526
DOI: 10.1016/j.sapharm.2023.01.014 -
Journal of the American Medical... Jul 2021Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT),...
OBJECTIVE
Medication list discrepancies between outpatient clinics and pharmacies can lead to medication errors. Within the last decade, a new health information technology (IT), CancelRx, emerged to send a medication cancellation message from the clinic's electronic health record (EHR) to the outpatient pharmacy's software. The objective of this study was to measure the impact of CancelRx on reducing medication discrepancies between the EHR and pharmacy dispensing software.
MATERIALS AND METHODS
CancelRx was implemented in October 2017 at an academic health system. For 12 months prior, and 12 months after CancelRx implementation, data were collected on discontinued medications in the health system's EHR and whether those prescriptions were successfully discontinued in the pharmacy's dispensing software. An interrupted time series analysis was conducted to model the occurrence of prescriptions successfully discontinued over time.
RESULTS
There was an immediate (lag = 0), significant (P < 0.001), and sustained (post-implementation slope 0.02) increase in the proportion of successful medication discontinuations after CancelRx implementation (from 34% to 93%). CancelRx had variable impact based on whether the clinic was primary care (71.4% change prepost) or specialty care (53.9% change prepost). CancelRx reduced the time between when a medication was discontinued in the clinic EHR and pharmacy dispensing software.
CONCLUSION
CancelRx automated a manual process and illustrated the role for health IT in communicating medication discontinuations between clinics and pharmacies. Overall, CancelRx had a marked benefit on medication list discrepancies and illustrated how health IT can be used across different settings to improve patient care.
Topics: Biomedical Technology; Electronic Prescribing; Humans; Medical Informatics; Outpatients; Pharmacies
PubMed: 33835183
DOI: 10.1093/jamia/ocab038 -
Health Care Management Science Sep 2023Drug shortages are a global and complex issue having negative impacts on patients, pharmacists, and the broader health care system. Using sales data from 22 Canadian...
Drug shortages are a global and complex issue having negative impacts on patients, pharmacists, and the broader health care system. Using sales data from 22 Canadian pharmacies and historical drug shortage data, we built machine learning models predicting shortages for the majority of the drugs in the most-dispensed interchangeable groups in Canada. When breaking drug shortages into four classes (none, low, medium, high), we were able to correctly predict the shortage class with 69% accuracy and a kappa value of 0.44, one month in advance, without access to any inventory data from drug manufacturers and suppliers. We also predicted 59% of the shortages deemed to be most impactful (given the demand for the drugs and the potential lack of interchangeable options). The models consider many variables, including the average days of a drug supply per patient, the total days of a drug supply, previous shortages, and the hierarchy of drugs within different drug groups and therapeutic classes. Once in production, the models will allow pharmacists to optimize their orders and inventories, and ultimately reduce the impact of drug shortages on their patients and operations.
Topics: Humans; Pharmacies; Canada; Pharmacy Service, Hospital; Pharmacy; Machine Learning
PubMed: 36913071
DOI: 10.1007/s10729-022-09627-y -
BMC Medical Education Jul 2023Educational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England....
BACKGROUND
Educational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England. Proctor's three-function model of clinical supervision (consisting of formative, restorative, and normative functions) is assumed to apply to educational supervision, but this has not been tested empirically. The aim of this study was to establish perceptions of the purpose of educational supervision from the perspective of primary care pharmacy professionals enrolled on a national training pathway in England.
METHODS
Using a mixed methods design, data were collected using a validated 25-item online survey and respondents were invited to add comments explaining their responses. The survey was sent to all 902 learners enrolled on a postgraduate training pathway for pharmacy professionals working in primary care. Principal components analysis (PCA) was used to interpret patterns in the survey data, and framework analysis of qualitative free text comments was used to identify themes and aid interpretation of quantitative findings.
RESULTS
One hundred eighty-seven pharmacy professionals responded (response rate 20.7%). PCA extracted three factors explaining 71.5% of the total variance. Factor 1 corresponded with survey items linked to the formative function of Proctor's model, while factor 2 corresponded with survey items linked to the restorative function. No items corresponded with the normative function. Framework analysis of qualitative free-text comments identified two themes: learning support, which corresponded with factor 1; and personal support, which corresponded with factor 2.
CONCLUSIONS
This study identified that pharmacy professionals perceived educational supervision to perform two functions, formative (educational) and restorative (pastoral), but did not perceive it to perform a normative (surveillance) function. Educational supervision has the potential to support allied health professionals advancing their roles and we suggest the need for more research to develop models of effective educational supervision which can inform practice.
Topics: Humans; Educational Status; Pharmacy; Pharmaceutical Services; Pharmacies; Primary Health Care
PubMed: 37438773
DOI: 10.1186/s12909-023-04398-8 -
Pharmacy-Based Infectious Disease Management Programs Incorporating CLIA-Waived Point-of-Care Tests.Journal of Clinical Microbiology Apr 2020There are roughly 48,000 deaths caused by influenza annually and an estimated 200,000 people who have undiagnosed human immunodeficiency virus (HIV). These are examples... (Review)
Review
There are roughly 48,000 deaths caused by influenza annually and an estimated 200,000 people who have undiagnosed human immunodeficiency virus (HIV). These are examples of acute and chronic illnesses that can be identified by employing a CLIA-waived test. Pharmacies across the country have been incorporating CLIA-waived point-of-care tests (POCT) into disease screening and management programs offered in the pharmacy. The rationale behind these programs is discussed. Additionally, a summary of clinical data for some of these programs in the infectious disease arena is provided. Finally, we discuss the future potential for CLIA-waived POCT-based programs in community pharmacies.
Topics: Community Pharmacy Services; Disease Management; Humans; Pharmacies; Pharmacy; Point-of-Care Systems; Point-of-Care Testing
PubMed: 32075903
DOI: 10.1128/JCM.00726-19 -
Contraception Jul 2023To examine adolescents' decision-making capacity for pharmacsist-prescribed hormonal contraception.
OBJECTIVES
To examine adolescents' decision-making capacity for pharmacsist-prescribed hormonal contraception.
STUDY DESIGN
A subset of 60 females, ages 14-21, were recruited to complete the MacArthur Competence Assessment Tool-Treatment. Overall scores were compared by age and demographic factors and variation examined.
RESULTS
Participants scored high on the MacArthur Competence Assessment Tool-Treatment with little variation in the scores (18.8 [±1.9]/20 total points). Factors such as chronic illness, health literacy, and family affluence were not associated with of overall scores.
CONCLUSIONS
Adolescents and young adults have the capacity to make decisions regarding contraception in the pharmacy access settings.
Topics: Female; Young Adult; Humans; Adolescent; Hormonal Contraception; Contraception; Pharmaceutical Services; Pharmacies; Pharmacy
PubMed: 36914146
DOI: 10.1016/j.contraception.2023.110002 -
BMJ Sexual & Reproductive Health Jan 2022
Topics: Contraception; Female; Humans; Pharmacies; Pharmacists; Prescriptions; Progestins
PubMed: 34127517
DOI: 10.1136/bmjsrh-2021-201206 -
American Journal of Health-system... Nov 2022The college of pharmacy has operated pharmacies on campus for over 26 years. Employees and patients are users of the pharmacies; however, utilization across the campus...
PURPOSE
The college of pharmacy has operated pharmacies on campus for over 26 years. Employees and patients are users of the pharmacies; however, utilization across the campus has been limited. This paper describes a process, as well as results, that was used to gather input from employees on a large university health sciences center campus on pharmacy needs and related behaviors on campus pharmacy utilization.
METHODS
Two focus groups of staff and 4 focus groups of prescribers were conducted over 1 month. Participants were selected through purposive sampling via email within an academic health sciences center campus over a 1-month period. The sessions were moderated by one investigator using a preconstructed discussion guide and lasted 1 hour. Two additional investigators observed sessions for nonverbal communication; all sessions were audio recorded for subsequent transcription. An open-coding process was performed on verbatim transcripts using NVivo12. The investigator team then developed, refined, and grouped themes during subsequent group discussions.
RESULTS
A total of 44 participants took part in 6 focus groups. Participants included prescribers (physicians, nurses, physician assistants) and staff (nonprescribers). Two major themes identified were (1) factors related to on-campus pharmacies and (2) qualities valued in a pharmacy. There was an equal split (8% for each group) on awareness of the on-campus pharmacies. Almost 11% of participants commented on the accessibility of a pharmacy being a quality valued in a pharmacy.
CONCLUSION
Focus groups provided insights for the administration team regarding additional value-added services that would be helpful for the campus community, as well as various approaches to increase utilization of the on-campus pharmacies. Focus group methodology is an effective approach to engage employees of a large university campus to garner new ideas to enhance existing policies or services, as well as to gather thoughts on preliminary strategic plans before implementation.
Topics: Humans; Pharmacies; Pharmacists; Outpatients; Pharmaceutical Services; Pharmacy; Community Pharmacy Services
PubMed: 35980283
DOI: 10.1093/ajhp/zxac232 -
BMJ Open Mar 2022To describe the pharmacists' workflow, including tasks and time spent, to better understand their work capacity.
OBJECTIVE
To describe the pharmacists' workflow, including tasks and time spent, to better understand their work capacity.
DESIGN
Cross-sectional, observational, time and motion study.
SETTING
Community pharmacies in Western Australia and New South Wales, Australia.
PARTICIPANTS
Currently registered and practising pharmacists were approached using snowball sampling and selected using purposive techniques to obtain balance representation of metropolitan and rural pharmacies, as well as high and low script volumes where possible.
RESULTS
Twenty-four pharmacists across 15 pharmacies participated during the 135 sessions totalling over 274 hours of observation. Dispensing (30%), indirect patient services (17%), counselling (15%) and professional management activities (15%) were the top four duties pharmacists performed, while only 2% of time was spent on professional services such as pain clinics and influenza vaccinations. Tasks were frequently interrupted and often performed simultaneously. Breaks and consumer-contact times were limited. More time was spent on professional service activities in non-metropolitan pharmacies, in pharmacies with greater daily prescription volumes and those with one or more support pharmacists.
CONCLUSIONS
This is the first study to quantify the pharmacists' tasks in Australian community pharmacies. Much time is being spent on dispensing, supply and management activities with little time for providing additional professional services. An extra supporting pharmacist is likely necessary to increase professional services. These findings could support future research around barriers and enablers of conducive workflows and of extended professional services.
Topics: Australia; Community Pharmacy Services; Cross-Sectional Studies; Humans; Pharmacies; Pharmacists; Pharmacy; Professional Role; Referral and Consultation; Time and Motion Studies
PubMed: 35236731
DOI: 10.1136/bmjopen-2021-055597